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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 episode, we have a special Q&A from the new membership platform. 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 Brodie Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series, and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. you the right knowledge along with practical takeaways in today's lesson. Feeling pumped. I am feeling excited. I have, as you heard at the top of the show, I have released a membership group. If you are interested, I did a soft launch over the past month or so doing some social media posts and just reaching out individually to some people to see who would be interested dis-gaging the level of interest and whether this is a viable sort of product that people want and people want to sign up for and I thought I would launch the product if I had five or six members that were interested. I'm like, yep, that's enough interest in this soft launch to go ahead and do it. And quickly I had 15 people who are like, yep, need this, um, excited to get started and have signed up. And so now my, uh, viable or just my testing, my initial testing has then launched into this thing, which is, which is now a product. Um, so you'll be hearing in the Um, pre-roll and mid-roll there's now ads, um, promoting this stuff to, to reach more people with PhD. Cause overall idea of the podcast is to spread the right information, get it to as many people suffering PhD as possible. Um, and just my attempt to make this product affordable, sort of like a semi private rehab, you might call it, but with a great community feel sense about it. Um. Currently have members. Like I said, it launched a couple of weeks ago and you get exclusive podcast episodes and what you're about to hear is one of those exclusive episodes. It's actually the second one that I have done. Um, the first one I introduced the into the members, answer some questions, sort of familiarizing people with the platform, but now you'll hear the second. Exclusive episode that I did for the people of this community. just to kind of share it, so you get a sense of what happens in these exclusive episodes. This is a one-off kind of a special occasion where I will share this type of content. And yeah, as I'll explain as I hit record, there is a certain channel in that community called Learnings, Wins and Insights, and members then go in and share their experiences, what they've learned, what wins they've had, how they're... you know, kicking their rehab up a notch or seeing benefits, what, what changes they've made to see such benefits. And so I share a few of those in this episode, and then I get into answering their questions, answering their podcast questions. So it's about, you'll hear questions about, um, rehab as you age, about. Sitting with a cushion, um, about plyometrics and also recovery expectations. So The links are in the show notes and you will be hearing these ads in other episodes coming up in the pipeline. I do have some injury chats that I want to talk about, some book reviews I want to talk about, and also some other podcast interviews that I have done. So look forward to bringing you all of those in the coming weeks and yeah, hope you enjoy. I am so pleased to now be talking to people because last episode I actually recorded. when there was no members and just wanting to have some content released before members stop joining this community. But now we have a bunch of members contributing and posting their insights, their wins, their questions, all those sorts of things. So I'm absolutely loving it. I thought might actually we'll go to the questions in a second, but I thought just as a good start off, I might just take some key posts away. and share it on this episode. So going into the channel, let me find out what it's exactly called the learnings, winnings and insights, where all of you are doing a very good job of contributing to some of these insights. I just thought I'd nitpick a little bit just to you know, get the ball rolling get sort of this positivity flowing. So one I picked was from Massey who in though in that particular channel said one of the insights and learnings was avoid heels as much as possible and limiting them to once or twice a week. So I thought I'd take that away because it's quite useful. Yes, heels are an aggravating factor for a lot of PhD sufferers. But while Massey you do say avoid heels as much as possible, you're still only limiting them to once or twice a week. So you're still doing them a little bit, which is why I thought I would talk about it because You don't need to get rid of them altogether, but just trying to limit whatever the aggravating factor might be for you. Try not to look in absolutes. Try not to just cut it out altogether. Just trying to, trying to minimize it, reduce it until symptoms get back under control. Sabina in terms of her insights said, track your exercises and running, increase one thing at a time and track over 24 hours. With this method, you know exactly where you stand in your rehab and what caused your pain 12 hours afterwards. And also mentioned, accept that not being able to run is a really hard thing. It can feel like a depression and affects everything in your life. Speak to others that will understand in brackets like this group. I thought that would be interesting to share or like worthwhile sharing because you're not in this alone. And yes, it is tough. I know that a lot of runners love running. They do it for mental health. They do it for a lot of other reasons and when that's taken away, it can affect you and you can voice out and share that. And when you do share it and know that you're in a community that has those same feelings, then it makes you feel a bit better about your rehab. You're not in this alone. Melissa said that checking my mindset and really practicing not becoming hypervigilant when having a flare up. So that is a real key issue. She also mentioned checking my stress level and making sure I get enough sleep, which all kind of ties in. Very, very important. Like the hypervigilance is not that helpful when it comes to managing any injury. And for those who aren't familiar, like hypervigilance is a, you're just hyperfixated on. the area on the pain on the symptoms on, you know, the location, every time you step, it's like, how is my pain every time you go for a run, how is my pain? You do your dead lifts and it's like, okay, what's my pain like beforehand after I know from the podcast, we talk about monitoring your pain levels. Even Sabina just mentioned, um, increase one thing at a time and track your symptoms over time over 24 hours, but this, there needs to be a balance. You can't hyper fix on it. Um, you can't focus on it every minute or even every hour. You shouldn't really be paying too much attention to it. Just needs to be occasional and a ballpark figure and doesn't have to have many heated like attachment, emotional attachments towards it. So what does that look like? So hypervigilance would be checking in on your pain every 30 minutes to be like, what's it like out of 10. And then as soon as it's a four out of 10, be like, Oh, my pain is increased. Maybe I've done too much, maybe I've done something wrong, maybe this isn't gonna get any better. What will I, how will I ever get this under control? And you can see that there's like an emotional attachment to that, whereas on the other side, once a day you could be like, how did my pain go? Okay, it was a four out of 10. Let's not overthink it. Maybe it was something that I overdid, but let me just reassess tomorrow. Not giving too much attachment to it or too much emotional attachment and just. checking on it a bit less often. So thanks Melissa for sharing that. And also we had Alicia who's done a very good job of submitting via video, which I usually recommend like in this group setting, when people are posting questions and those sorts of things, I'm replying with a video because I know, I think it's a bit more engaging and it's a bit more fun. And Alicia did that with her insights. And just thought she'd share a product that she uses that was really helpful. So I thought I'd play that now. Good morning. Good afternoon. Good evening, depending on where you are in the world. I wanted to share this with you all because it worked for me and gave me a much needed mental break from my pain, if only temporary, but still, um, I currently am doing maintenance exercises and I'm not in pain. But when I was, I found this to be very helpful. My husband picked it up at one of our local, I guess you would call them CBD shops. It doesn't contain THC. This is the CBD Living Freeze. It's a roll-on, so it can be tricky to apply, wink, wink. But the nice thing is that you can target the area and it kind of just gives it a cooling, not numbing effect, but just a cooling effect. I used it. daily for quite some time. I found myself using it less and less as I progressed with my exercises. So again, you know, just gave me a mental break from the pain, which I found to be much needed. So I hope something like that works for you all. Thanks Alicia. Thanks for again, submitting that video. Um, as we dive into the Q and a section of this, I would like to answer your question, Alicia. So Alicia asks, hypothetically. Wink. What happens when it when and if I age out of being able to perform my current weekly PhD exercises? Are there alternative exercises that will keep my hammy happy? Okay, so my initial thoughts on this would be okay, you need to still continue doing the slow heavy stuff. There's not going to be a time when hopefully there's not a time when you say you know what these are way too heavy. maybe I should start backing off the weight. I've got some other options here for you because we want to, it should be your goal to build as much strength as possible and then preserve as much strength as possible. Or strength, capacity, power, all that sort of stuff. We wanna try and build and then preserve. And so if you get to a stage, if there's like a hypothetical out there where you are doing really heavy deadlifts, let's just say you're doing 150 pound deadlifts, in your 40s, then you get into your 50s and 60s and it's starting to become really, really heavy, your body will start telling you. Your body will tell you that you're doing too much. But we want to respond to that by still keeping it slow and heavy, but we can do things like reducing the reps. So if you're doing three sets of 10, we can try reducing it down to three sets of eight or even three sets of six. As long as it still stays heavy. and we can do things like increasing your rest periods in between your sets. So, I don't know, people pretty classically spend like less than a minute in between their sets and they go into the second one, go into the third one. I like to spend four or five minutes in between sets. If it's really, really heavy stuff, I like to really feel just as fresh on my third set as I did on my first set and that comes with enough rest. You're still getting good quality. strength reps in there but if you are going from set to set to set and feeling more and more fatigued each time you're probably just trying to train your endurance and not getting that good quality in there so if you're noticing that things are slowing down things are starting to feel quite heavy you might want to do that as a consideration might want to increase the amount of time in between your sets the next i guess intervention or level of escalation would be to reduce the frequency of your strength sessions, particularly if you're finding that you're doing a strength session, you're doing the slow heavy stuff. But as you get older, there's more delayed onset muscle soreness and that muscle soreness is carrying over longer than what it used to. So sometimes doms classically one to two days, but in my last three days or four days, that's signed to back off. But again, we're not reducing the weights. What we can do is reduce the frequency of those strength sessions. And hopefully when you are doing the heavy stuff, you're doing about two strength sessions per week, but we don't wanna back off to one session per week. That's just too much of a cut. So what you can do is spread it over two weeks. So there might be a scenario where you're doing one, well, let's just spread. three strength sessions over two weeks. So we're only dropping one session, but that should be enough of a reduction in order to see an improvement. The weight should be the last thing to go. If there is a scenario where you've done all those things and it's still quite tough, okay, maybe we can back off the weights, but we want that to be the last case scenario. And not just for tendon rehab. We... You can also consider how beneficial slow and heavy strength training is just for older people in general. So like I listened to a podcast, Peter Atiyah, he has a podcast called The Drive and he is such a heavy proponent of strength training into old age and just lists all the benefits when it comes to maintaining muscle mass. maintaining bone density, maintaining stiff and strong tendons. All of these come with heavy strength training and just doesn't cut it if you start reducing the weights. Because as we get older, as we start to lose proprioception, some people start to, you know, struggle with their balance, their bones become brittle, they don't have as much meat on them. And then if something happens, like they have a fall, if they fall down the stairs or, you know, fall off their chair and land on their hip. muscle around those hips, you can break that hip. It's, it's quite common for a deconditioned elderly person. And that can have really serious consequences. And so maintaining the heavy stuff, not just for your rehab, not just for the tendons, but for you in general, you're going to love it. And, you know, strength training improves your metabolism, reduces your fat, reduces likelihood of developing diabetes like all those sorts of things really important to keep in mind. The second part of your question Alicia are there alternative exercises that will keep my hammy happy? I'd still just keep to deadlifts, keep to curls, keep to step ups, don't really need to change that. Like I say there's other modifications you can make like the sets, the reps, the frequency and all those sorts of things maybe range of movement as well but Um, yeah, we still want to keep those core exercises. Okay. Next up we have Jen who says, real using a cushion long-term make the tendon weaker in sitting or is it better to wean off using a cushion at some point? Okay. Um, first of all, I'd probably change the term. I probably wouldn't say the tendons getting weaker. I would say the tendon is getting deconditioned. Um, Slight difference there, because what comes with weakening a tendon is just weeks and months of inactivity, but you're still being active. It's just becoming more and more foreign to that stimulus. So I think deconditioned is probably a better word. But ideally similar to the strength exercises, similar to what I was mentioning with Alicia's question about You want to, um, you know, preserve, build and preserve as much as possible. The same thing can be said with sitting tolerance. We want to find out what you can tolerate. Then we want to preserve it. And if anything builds upon it. And that comes with using the cushion and without using the cushion. So you might say, okay, when sitting with a cushion, I can sit for the most part on a typical day, I can sit for about. 60 minutes. Without a cushion, I could probably tolerate 20 to 30 minutes. So you need to make sure once you've found that tolerance, you need to make sure you still do that thing. You want to make sure you're still doing, sitting for that period of time, sitting for 20 minutes without a cushion, maybe twice a day, and then sitting with a cushion for the remainder and standing for the rest. You're preserving what your current tolerance is. And then as you get stronger and as you can tolerate more and more, those sessions start to fill out. So 20 minutes without the cushion can turn to 25, can turn to 30 as you build it in. And this should, this should be done alongside your rehab. So you want to do if sitting is a vulnerability of yours. Progress the strength, make sure you're doing your curls and your step ups and your deadlifts and those sorts of things. But alongside that, having some sort of structure throughout the day of saying, okay, when I'm at work, let me sit for 20 minutes with a cushion, 10 minutes without the cushion, and then I'll stand for 20 minutes. And let me just do that on repeat until lunchtime and then change it up from there. And if you write it down, You can say, all right, let me stick to two weeks of just doing this structure. Then after that, let me just massage these numbers around. Let me turn the 10 minutes into 15 and et cetera, et cetera. We should be exactly like your rehab. Rehab is all about just finding a tolerance, finding small progressions and just monitoring from there. Just do the same with the sitting. The ideally, to go back to your question, Jen, ideally I would say, You'd want to wean off the cushion eventually, uh, essentially because like it's fine to sit with a cushion, but you don't want to carry it around all the time, you don't want to be too, I don't know, vigilant about how you're going to sit, where you're going to sit. If you go out to the movies or go out for dinner or go out to a bar or watch your kids sporting event, you don't want to constantly be thinking about, oh, what's the, what's the sick going to be like? Hopefully it's not too firm. Do I have to bring my cushion? Should I leave it in the car? Like we want to eventually move away from paying too much attention to this injury and giving it less and less of your time and energy and emotion. And we want to get back to a normal life. We don't have to, we don't, we want to get to a point where we don't have to carry around a cushion all the time. Not only for a tolerance point of view, but just for a lifestyle point of view. And so that's probably the reason why I would suggest it'd be better to wean off a cushion at some point. Not only are you building up the tolerance to sit on firm services, but you should be sitting on firm services anyway, um, for everyday life without thinking too much about it. So hopefully that helps practically build some sort of structure and hopefully we can move things along in that sense. Um, it might be slow. Might need a lot of patience, but structure. and progressing through, yeah, we'll do the trick. Jen also asks another question. Once the tendon is near the end stage of recovery, is it recommended to do any plyometric exercises to make it extra resilient? If so, what would be some recommended exercises? I would say yes, plyometric exercises are recommended only for the people who want to return to doing very high end explosive stuff. Cause that's what plyometrics are. They're a very quick explosive movement that requires a lot of the tendon and a lot of the rest of the body. And so we want to build up those conditions, we wanna build up that tolerance and have your body recognize and handle that force when returning to those goals that you have. So if you wanna do sprinting, if you wanna do jumping, bounding, if you want to do kettlebell swings, if you want to do team sports like basketball, where there's a lot of changing directions, jump, land, takeoff, all those sorts of things. You'd want to incorporate some sort of power-based stuff into your rehab, but you probably don't need to do some specific plyometric exercises. You can just do a structure that looks like the thing that you need to do. So if we're using running as an example, and you want to get back to your goal was to always do just slow marathons. Don't really care about speed. Don't enjoy speed. Don't really want to do anything like that. Um, I just want to keep it slow and not really push my capabilities. Plyometrics doesn't necessarily need to be for you, but if you're a sprinter or if you want to get back to heel sprints or fitness classes that involve like, you know, sharp, short, sharp efforts. Um, when I used to do CrossFit, that used to be the case, you'd run 50 meters and then do something, run 50 meters, do another thing, you know, incorporating some sort of power-based stuff, but it would look like the thing that you want to do. So if I want to go back to CrossFit classes, and they did have 50 meter sprints, I would start by doing 50 meter efforts, but at 60% of my maximum sprint, if I can tolerate that, I'd go to 70%. If I do that, go to 80. So we're not just, saying, okay, do these plyometric exercises, and you should be fine to do these classes, we're actually doing the thing in the class and building up towards that. So team sports, I sometimes have people returning back to team sports and does require some explosive movement. And we might assign some plyometric exercises, but I might also say, hey, how about instead of attending a game, how about you attend training. and only attend 30 minutes of your training. And if you can only do that at 70% of your capacity, do you have the availability? Do you have the control? Do you have the time to do that? And if they do in, they go, they're getting used to that movement by doing the, by doing the thing. And then. The half hour might turn to the full session, that 70% might turn to 100%, and then they're going into games where, you know, all restrictions are lifted and away they go. That's better, more functional, more enjoyable for some people, and more specific than saying, okay, do these plyometric exercises, and then you can play basketball. And there's a fair bit of a disconnect and a bit more risky to do it that way as well. However, if I have someone wanting to return to sprinting, and they went from 60% to 70% and flared up. We had to bring that under control. Then we introduced it again, we went from 70% to 75%, they flared up. Okay, back to the drawing board. If that kept happening and there was a vulnerability there, I would say, all right, let's not continue trying to pursue this. Let's try and do, obviously make sure the slow heavy stuff is under control, but let's try and meet the conditions in the gym. Let's pull you away from sprinting and let's sit down in the gym and trying to come up with some sort of thing that bridges the gap because right now it's a vulnerability for you. We don't want to risk another flare up. Let's try and change the conditions a little bit. And so some plyometric exercises might look like kettlebell swings. They're not really plyometric. They're more power-based. Plyometric is very sharp like pergo jumps. you're looking at like a very short contact time, very explosive where kettlebell swings, it's a bit slower, but it's still power based. Um, plyo lunges where you're doing a lunge, then you're launching yourself in the air, swapping the legs over and landing, um, with the opposite foot, uh, heel strides can be classified as like a power based exercise. Um, those are some of the ones I recommend. Usually kettlebell swings and plyo lunges in the gym would be something, but box jumps. someone dropping from a height and then quickly jumping into the air is a plyometric, those sorts of things. So if you get really strong with your plyometrics in the gym and then go back to sprinting 60, 70%, hopefully we've bridged the gap enough so that risk of flare up diminishes. I will say though, just to finish off this question, we wanna be very, very careful with assigning, prescribing, progressing power-based stuff. The, the slow heavy things are actually a lot less riskier because it's slow time under tension, the tendons like thrive on that a bit more, but the power based stuff, yeah, it's I've had people do, you know, they can deadlift a hundred pounds and then they do a 20 pound kettlebell swing and it flares them up just because the sheer act of heavy mixed with power flares them up. It's just a, it's It's an incredibly tough thing for the tendon to try and endure. So just make sure that you start off very conservatively and you progress very carefully and sensibly. Okay. Um, lastly, we have Joseph who asks, is this a condition that could be cured? Or is it a chronic condition that has to be managed for the rest of my life? Um, I saw, I have a specific answer for this, but it will apply, it will change from person to person. Um, in a general sense, if you have a chronic tendinopathy, um, on the, um, structural level, you can't heal a chronic tendon. It undergoes some sort of derangement and some sort of degenerative process that is irreversible once it gets to like a six. 10, 12 month mark, it starts to have those sort of changes. But I usually don't like saying that because that sparks a lot of fear in people and think and people think that, you know, they're destined to have pain and dysfunction for the rest of their lives. But, you know, I've had tendinopathies, I've had a shoulder tendinopathy, I've had well proximal hamstring tendinopathy, I've had a pes anserine tendinopathy, what else have I had? And some of those have lasted years and there would clearly be some sort of permanent degenerative thing through that tendon, but here to say that I've managed to overcome those and have no pain whatsoever for years and years. And all we're doing in those circumstances is even though it's a really painful, really chronic tendon, The degenerative portion of that tendon is probably like 15%, 20% of that tendon is like a really severe degenerative tendon. All we do is strengthen up the whole healthy tissue of that tendon and that can easily restore all the capacity that you need, all the strength that you need. And once you restore that strength and capacity in the healthy portions of that tendon, pain subsides. And... Yes, if you do the wrong thing. Yes, if you over train and sprint and do things you probably shouldn't overload the body. Symptoms are likely to come back. If I do a lot of sprinting, increase my deadlifts and then have to sit on a long haul flight, my PHT symptoms would probably come back. You know, something that I'll accept. Even these days, if I do like a pretty hard workout then I have to sit. to drive somewhere for a long period of time. I'll start to get a bit antsy, I'll start to wriggle in my seat a little bit, but this is where I like to reassure people that maybe these things pop up throughout your life here and there, but you can get to a stage where it does not become a concern. If you keep a lot of strength, if you progress a lot of that strength, you return all of your function. If it does flare up and you're really strong, it lasts 24 hours max. And that flare up is probably like a two out of 10, goes back to zero the next day, and you just get back into your training. Not much of a concern. That's realistic. That's where I find myself. Every now and then, some of my old injuries will pop up, but I know that I'm strong. It doesn't worry me at all. I know that I can, if I'm sensible, I can train for a marathon tomorrow. I can train for a fast 5K. I can do sprints. I can do... Heel sprints and I'll be fine. Just only because I've put in the effort and you can do exactly the same. Just keep in mind that you do have the potential no matter how long you've had this injury to return back to symptom free, pain free, return to the things that you love and continue doing those things for years and years and years without any fear of this injury. Yes, there may be hiccups path, but if you do the right things, if you keep nice and strong, that's a very healthy and happy life that the people go through. So that's sort of where I position myself. I sort of sit on the fence. I can't say, yes, you can completely cure yourself of this, but you also don't want to go away thinking that it can't be cured or you can't have the life that you want to live at the same time. So That's it. They're the four questions. I hope helps instill a lot of reassurance or maybe make some tweaks in your rehab based on these questions that we've had. I think in future episodes, I might chime in on everyone else's posts and like introducing yourself and the tips and learnings and insights. And obviously these questions as well will be a nice recap of what has been in the Slack community. So thanks for all your contributions. Good luck with your rehab this week and we'll catch you in the next episode. 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.