PHT Client insight: exercise/running/rehab

Show Notes

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In today's episode, Brodie unpacks the reflections and revelations from a past client. Here is their response when Brodie asked what really helped their recovery:

"Well definitely the exercises you said to do! And made sure I stuck to doing them. I stopped doing the glute bridges etc and focussed on increasing weight-bearing ones. I had read about it and self-diagnosed at first and thought I knew what exercises to do but didn’t know how many to do or how to progress through the exercises. I didn’t realise that I could have kept running. And if I could start again, exactly how. I avoided long sitting and if I sat, I used a cushion. I found other ways to exercise like swimming which I found I could do without making it a flare-up. Definitely need to find a physio that knows how to diagnose PHT and how to treat it. I definitely needed someone to relate the treatment to my particular condition and what I was able to do or not do. It’s not a quick fix so don’t give up! I still have some runs where I feel it but the next day it’s fine again".

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What is Overcoming Proximal Hamstring Tendinopathy?

Proximal Hamstring Tendinopathy is a horrible condition affecting athletes and non-athletes alike. If you fall victim to the misguided information that is circulating the internet, symptoms can persist for months, sometimes years and start impacting your everyday life.
This podcast is for those looking for clear, evidence-based guidance to overcome Proximal Hamstring Tendinopathy. Hosted by Brodie Sharpe, an experienced physiotherapist and content creator, this podcast aims to provide you with the clarity & control you desperately need.
Each episode brings you one step closer to finally overcoming your proximal hamstring tendinopathy. With solo episodes by Brodie, success stories from past sufferers and professional interviews from physiotherapists, coaches, researchers and other health professionals so you get world class content.
Tune in from episode #1 to reap the full benefits and let's get your rehabilitation back on track!

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On today's PhD Client Insight, exercise, running and rehab. Welcome to the podcast helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments and of course bust the widespread misconceptions. My name is Brody Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series and a chronic proximal hamstring tendinopathy empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. joining me on another episode. If you had listened to last week's episode, I'm starting to get some feedbacks from some of my clients who have been suffering from PHT, whether they are 100% better or just noticed a marked improvement or just still managing the condition but had some real revelations or insights. I thought I'd share on this podcast because it's what it's all about. It's about spreading the right information and also getting some nice positive feedback and some nice success stories. And so I have put the call out to my clients to see what insights have you had, what revelations have you had. key insights that really turned a corner for you and I'm just reading some of those out in the next couple of episodes and so this one in particular I've only got one today and there's a lot of individual components within this person's response and so I thought I'd just break it down into each individual segment I've got like a few dot points to talk about with each segment but I'll read it all out in its entirety now, and then we'll break it all down. And so this client says, when I asked about what their revelations were, well, definitely the exercises you said to do, which was me, and made sure that I stuck to doing them. I stopped doing glute bridges, et cetera, and focused on increasing weight-bearing ones. I had read about it, PhD, and self-diagnosed it first, and thought I knew what exercises to do. but didn't know how many to do or how to progress through the exercises. I didn't realize that I could keep running. And if I could start running again, exactly how, and if I sat, I used a cushion. So that helped. I found other ways to exercise like swimming and found that I could do so without making a flare up. Definitely need a physio that knows how to diagnose PHT and how to treat it. I definitely needed someone to relate to treatment to my particular condition and that it was a, and what I was able to do and not do. It's not a quick fix, so don't give up. I still have some runs where I feel it, but the next day it's fine again. So thank you very much for your feedback and let's go into a whole bunch of dot points I have written down. So the first one that this client mentioned was, well, the exercise that I said to do and make sure that you stick to them. And this is one of the benefits of having a health professional on your team. It's like assigning some accountability, not only providing the right exercises, but how to build it into a plan. And I think building a plan and then following the process can be quite liberating for a lot of people. The amount of times that... A client comes to me with PhD and they've tried everything. They're like, I'm trying my squats. That didn't work. I tried my, I tried sitting that didn't work. I tried doing all these different things. And then we come up with a plan and they say, Oh, it's just so relieving just to wake up and know what I have to do. Just based on the plan that we. assigned to them. I know that I wake up on a Wednesday and I need to do XYZ exercises. And I know that I have to do XYZ cardio exercises and I don't have to think about it. And following that process and that process adjusts based on symptoms, but this is having the plan. making sure that you're paying attention to symptoms along the way and making sure that plan is then progressive, which we'll talk about in a second when it comes to like the strengthening exercises, but making sure that if a plan starts working, you don't just keep to that plan three weeks in a row. If it's a good first week, fantastic. Let's do the second week very, very similar, but let's challenge you a little bit more so that the tendon builds up and your whole body builds up, the capacity builds up and you get stronger. that's something where people do get a little bit stuck because they think what they do is working, let's keep doing it and hopefully symptoms go away forever but it's the progressive side of things that's really going to allow you to overcome the tendinopathy. The next point, I stopped doing glute bridges, et cetera and focused on increasing weight bearing ones. So I have a list of some of my favorite weight bearing exercises. I think what this client meant was more compression because glute bridges is a little bit weight bearing, but, uh, or more standing, standing up doing exercises, um, as defined as maybe weight bearing. Anyway, so some of my favorites, obviously deadlifts. I have an entire episode on how to progress your deadlifts from the very basics all the way through to like end stage advanced stuff. So that wasn't too long ago if you want to scroll back a few episodes and listen to those deadlift progressions. Weighted step ups, I'm a big fan of. So just holding onto some dumbbells, find a step of various height depending on symptoms, sometimes about mid shin height or just below your knee, that kind of height and holding onto dumbbells by your side and just stepping up, stepping back down and repeating that. hip dips which I've put on social media a bunch of times, I've spoken on the podcast a bunch of times but similar to a Nordic drop where you're on your knees and you hook your heels under something instead of keeping a straight line between your knees and your shoulders and dropping all the way down we sort of do a deadlift action and kind of dip at the hips. rather than keeping a straight plank of your body and dropping down. If you want to look that up, if you want to follow me on social media, I have a better description of that. Squats would be one that I'd keep in there once you're able to tolerate it and very similar to the deadlift progressions that I have in that previous episode. You can also apply to your squats as well. You can do some isometrics, you can do a reduced range of movement, reduce speed and then build up from there. Um, arabesque or good mornings are a good exercise as well. And then lunges or split squats would be another exercise that I love doing. Obviously symptom dependent, obviously depending, we start at a very, at a level that's challenging for you, but just not bringing on symptoms and is progressive enough to keep you moving forward. But those are a list of some of my exercises. The next point, so this client said that I've read about it, about this condition and self-diagnosed it first and thought I knew what exercises to do but didn't know how many or how to progress through the exercises. So this could be trial and error if you were sensible enough or if you had enough education about the matter. you could just trial three sets of five for your deadlifts and see how things go. And if it doesn't go well, then next time we do a little bit less or we modify in a certain way. I'd like to think that the most efficient way is to get a health professional or someone who's very experienced to help you with this. Because the dosages of when I assign dosages to people, it's based on what level of fitness or what level of strength they currently have. I had a PhD client who was a strength and conditioning coach, and we could progress very well because the technique was there. The baseline fitness was there and that particular case, we could, you know, have a little bit more leeway or a little bit more freedom with the weights. based on someone who's never done deadlift before, never done strength work in the past, and we still want to assign them some sort of deadlifts, those dosages are gonna be completely different. And when we talk about dosages, it just means sets, reps, maybe the speed, maybe the range of movement, maybe the amount of rest in between the sets, all those sort of things. So trial and error, if trial and error doesn't work for you, if you've tried it several times and it's not working, then I'd say, recruit a health professional to be on your rehab team. And the other thing with health professionals is they can steer you in the right direction. Once you've found someone who's right for you, they can move you in certain directions. And the certain directions be one, either it's time to back off. Some of you who are rehabbing PHT are go-getters and will overdo things very easily. I've had a client who you tell this person to do. 15 lunges and they'll go ahead and do 45 to say, Oh, I just felt good. So I'll see how I just wanted to see how I go. And then they've flared up for the next couple of days. But a health professional can also, it might be a healthy time to say, Oh, now's the time to progress. And sometimes when I'm working with clients, it's maybe, maybe they don't feel ready. Maybe they don't feel psychologically ready. Maybe they've can they like the current routine that they're at? They're like, I'm making good leeway here, let me just keep doing this for a bit longer. And we say, actually, let's try and progress, even if it's just the most minute increment, we need to progress now's the time to progress. And so yeah, health professional can help assign those dosages, but then can help steer the reins in a particular direction based on how things are going. Next up we had, I didn't realise that I could keep running. And if I was to start running again, exactly how. And I always like to do, if someone hasn't ran for a very long time, I like to start with walk, run programs, assign it to someone and then just based on symptoms. I always have them with a few instructions. Yes, slow running to start with. Yes, flat ground to start with. And then it's just symptom dependent. So walk runs, running slow. keep to the flats and then just based on symptoms from there. And it can be that methodical, it can be structured. And if that was successful based on symptoms, then we can progress to the next rung of that walk, run rehab ladder. Next, a bit brief, but, um, this person said that I avoided long sitting. And if I sat, I used a cushion. I'm getting mixed. messages with, not mixed messages, but I'm getting mixed stories from people with PHT. Some people say that soft surfaces really flare them up, whereas hards sitting on a hard surface is actually easier for them. And then the opposite, some people say hard surfaces are just the worst for me, I need a cushion. And so this is just based on trial and error as well. I think, I believe it would depend on the type of tendon in the PHT that's involved. and what portion of that tendon is involved because your tendon is like the size of your finger and certain parts of that component is not the whole entire tendon that has a tendinopathy and is reactive or the portion that is causing pain. It's certain parts. It could be internal. It could be the very center portion of the tendon. It could be an outside portion of the tendon anywhere around that area. So I think it depends on what tendon it is and where it is in the tendon that might explain this variability. But that's just a theory that I have. So yep, trial and error. Cushions do wonders for you, then use cushions. But the key is to don't avoid sitting altogether. People who say sitting is bad for me, I should stop sitting. Just fosters weakness and... giving your body a chance to just become extremely vulnerable to sitting in the future. We want to still maintain whatever tolerance you do have. Maybe that's sitting for five minutes every two hours, but make sure that we do that so that we don't continue this perpetual cycle of weakness and unable to respond to compression, which the tendons do that compress when you sit, which the tendons should be able to tolerate. and we need to be able to maintain that tolerance. Okay, I found other ways to exercise like swimming, which I found I could do without making a flare up. Again, this is another trial and error, trial different cross-training alternatives and see how symptoms feel. And if symptoms are great, then that's going to be involved in your management plan. Because if we're cross-training and symptoms are kept at bay, then we are staying active, we're staying healthy. We're staying both physically and mentally, well for our physical wellbeing and our mental wellbeing, it's so much better for your rehab. And not only that, but you're maintaining the capacity, the strength, the tolerance of all your other joints, ligaments, muscles. If you are swimming, then it's doing very well for your cardiovascular system, doing very well for your upper body, for your core, for your glutes. And it's, yeah, there's... I can obviously, I hope that you understand the benefits that it can have. Um, swimming may or may not increase your symptoms depending, um, how strong your PhD is with doing, um, like that sort of kicking action. You can swim with a buoy or a buoy in between your thighs or between your knees. So you're not doing any kicking and you're just doing arms. That could be an option for you, or you could just do very, very light. kicking or slow kicking in the water and just doing most upper body that can be quite nice as well. But some people tolerate swimming really well. So if you lie on your stomach on the ground on the floor and try and mimic that quick kind of kicking action where you're keeping your legs completely straight but just doing very fluttery sort of kicks and your PHTs and grabbing or pulling or causing symptoms, then you're most likely going to tolerate swimming. Cross-training alternatives, skipping or like jump rope, jumping over the rope. Cycling can or cannot be great for PHT, symptom dependent, depends on the individual. A cross-trainer or like elliptical machine can also be nice and even if your PHT is so irritable, can't really tolerate any of those things, I like to just give someone like an upper body or core Um, doing some sort of physical activity that could be a circuit that is well, jump rope skipping that can, um, that shouldn't be able to, that shouldn't flare up your PhD, so you can do that, but you can also do pushups like ab crunches. You can do bicep curls, shoulder press, tricep dips, and just create a circuit for yourself and then just get involved with that. That could be quite nice. This podcast episode is sponsored by the run smarter physiotherapy clinic. which is my own physio clinic, where I help treat a wide range of PHT sufferers, both locally in person and all over the world with online physiotherapy packages. In the years I've been self-employed as a physio, close to 70% of my entire caseload has been helping people with proximal hamstring tendinopathy, which is why I decided to launch this podcast. So if you're building upon your own rehab knowledge through the podcast, but still require tailored assistance, I'd love to be on your rehab team. Whether you are a runner or not, head to runsmarter.online to see your available options for working together. If you're still unsure if physiotherapy is right for you, or if you need a rehab second opinion, you can always schedule a free 20 minute injury chat with me. Find the free injury chat button on my website or in the podcast show notes to be taken to my online calendar to book in a time. Next, we have... This client says definitely need to find a physio that knows how to diagnose pht and how to treat it. I would agree with that. I would say that so many health professionals don't really know much about this condition mismanage this condition quite often. And that can be quite frustrating because you're there for help. You're there for healing. You're there for advice. And sometimes people just don't understand it. It can always ask. the health professional, have you had much experience with this? And you can ask them about what the rehab path looks like. And if you don't like the sound of it, if it's not really resonating with the research of say this podcast, cause you know, by listening to previous episodes that you need to start tolerating compression, that you need to start, um, symptom dependent, that sometimes zero pain is under loading it. And we need to, you know, low levels of pain and just paying attention to those particular symptoms and we know how we need to progress and if the rehab plan, when you ask this health professional what does the rehab plan look like, if it doesn't really resonate and they say oh you just need massage or you just need shockwave or maybe surgery or some sort of injections and then that should do you. If they say you only should do stretches and nothing to do with strengthening then maybe that's a few like alarm bells to say maybe I need to find someone else. Almost at the end, next one, I definitely needed someone to relate to, to relate the treatment to my particular condition and what I was able to do and not do. This is pretty much around like a tailored rehab, making sure that the rehab that we assign is individualized for the person and we build a weekly routine based on those individual factors. So things that I ask is, okay, what? gym equipment do you have access to? What fitness equipment do you have access to? What could you buy? What could you, could you, is there a gym nearby? If you, are you open to having a gym membership or do you just want to do the stuff at home? And a lot of people these days do have a lot of fitness equipment at home or can get access to fitness equipment to use in the home. And then we say, yep, that's enough stuff, at least for now, let's build upon that. And that's a part of the tailored experience, but it's also the symptom tolerance, the symptom irritability, all those sort of things. So just making sure that we're tailoring a particular management plan for them. And lastly, this person said, it's not a quick fix. So don't give up. I still have some runs where I feel it the next day, but it's fine. But it's fine by the It's not a quick fix, so don't give up. I still have runs where I feel it, but the next day it's fine again. This particular statement is very similar to the last episode I had around patients, but the advice around I still feel it during the run, but it's fine the next day is a good sign around those symptom rules where as long as symptoms are remaining below, say, a 4 out of 10 during a particular run. as long as it returns back to baseline within 24 hours, that's usually what we consider as acceptable levels of discomfort and just following those rules and seeing the benefits along the way, because that's more likely to hit you within that adaptation zone, rather than under loading you if you are striving for absolutely 100% zero pain. So. That was great. So this particular episode, we've covered things like exercises. So your deadlifts, your weighted step ups, your squats, lunges, how to exactly, or the advice around progressing those, making sure if you are running, making sure we're keeping to walk runs to start with, keeping things slow. We're keeping the flat terrain, some advice around sitting hard or soft surfaces to base on your individual, individual symptoms, and then some cross training advice. And so covered a lot. So thank you very much for this person who submitted this advice. And I will have a couple more episodes similar to this based on the successes or the insights, revelations of other PhD clients. So look forward to bringing you that next time. And for this week at least continue doing well with your rehab and best of luck. Thanks once again for listening and taking control of your rehab. If you are a runner and love learning through the podcast format. then go ahead and check out the Run Smarter podcast hosted by me. I'll include the link along with all the other links mentioned today in the show notes. So open up your device, click on the show description and all the links will be there waiting for you. Congratulations on paving your way forward towards an empowering, pain-free future. And remember, knowledge is power.