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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, five solutions for stubborn PHT. Welcome to the podcast that gives you the most up-to-date, evidence-based information on PHT rehab. My name is Brodie. I am an online physio, but I've also managed to overcome my own battle with PHT in the past. And now I've made it my mission to give you all the resources you need to overcome this condition yourself. So with that, let's dive into today's episode. Welcome back everyone. I hope you have been enjoying the last couple of episodes on this podcast. A few updates. So if you aren't familiar, I know a lot of you do listen to the Run Smarter podcast, but some of you with PhD aren't runners, so you don't listen. um Quick update on me. I have made the business decision to move away from the Run Smarter content, so I'll no longer be releasing and recording episodes. of the run smarter podcast, and just going all in on the PhD side of things. So what you'll be seeing is ongoing, unaffected, PhD podcast episodes released every second week, but also going deeper on the PhD YouTube channel. And so this has if you want to learn more about my decision, both from a time energy capacity, family, financial, um weighing up all of those elements of my life. You can listen to the Run Smarter podcast. I did release a goodbye for now episode to go through the rationale of my decision. uh But yeah, amongst all that, now that I have more driven energy capacity to lean into more PhD side of things, you will have noticed if you are on my email list. that the PHT YouTube channel is starting to release some more long form episodes. It has been automatically releasing these podcast episodes onto that channel, uh which has just been an automated process. But now I am deliberately creating and releasing kind of full length episodes on helping you overcome your own PHT, which has been a new, I don't know, uh motivation to... uh reach a new audience because YouTube is a bit more of a audience generation tool as people search pht all the time and they click on useful videos that do pop up and There has been some insights and like content that I want to create that I can't like show you through a podcast Forum and so yeah the YouTube stuff we're going through uh exercises technique um this a ton of content that I want to continue creating over on the YouTube side of things. So if you haven't subscribed yet, just search on YouTube overcoming proximal hamstring tendinopathy. Hopefully my channel pops up straight away, even though it is quite a small channel to start with, but is generating a lot of momentum at the moment. I think I've released maybe um three or four ah videos the last four weeks or so. And so yeah, head on over there. If you're on my email list, you will be getting notifications of when new videos are being released. uh But like I say, it's uh created a new passion, especially on that side of things. I have a lot of experience with YouTube. I had the Run Smarter YouTube channel, which has generated 40,000 subscribers. So um I know the ins and outs of how it works, but now I'm all the way back to like at the moment, 200 subscribers now that I'm at this new channel, but we'll take all the principles and things I've applied. to the old YouTube channel, move it across. Hopefully you're enjoying yourself and enjoying the content that's over there. But does bring me to this content, this episode, because I did do a YouTube video on this as I was racking my brain, being like, hmm, what are some really stubborn patterns that I see that emerge when I chat with, well, up to this point, thousands of people with PhD, I jump on a ton of I'll probably say about 15 injury chats per week. I have about maybe five new clients per week. So if we're talking in the maybe 20 new presentations per week of PhD, and if we put that on repeat for maybe 50 weeks of the year, that's already a thousand people. And I've been doing this and building this momentum for at least the last five years. So obviously it's going to... Differ week to week, but that's 5,000 people already. And so I think based on that volume, you could suspect that I see a lot of patterns, jump on a lot of calls and see a lot of common things, especially when PhD is stubborn. They're the people that come to me. Most of the people that gravitate towards me have had PhD for more than a year. This isn't like a two week thing where they're like, oh, let's jump on a chat with Brody. No, it is. people who are like, I've tried everything, I am desperate. Brody seems to be ah talking about this a lot. He seems to know his stuff, let me have a chat. And so purely based on how I've positioned myself, I see a lot of key presentations, lot of stubborn, stubborn chronic tendinopathies. And therefore with the volume of people that I have, have uncovered five main roadblocks and decided to do a YouTube video on it. But because of such great content, and I think this would benefit a lot of people who aren't on the YouTube side of things. I decided to create this episode, expanding upon that video. So I will go through the five roadblocks that I have already created, but like I say, probably elaborate a little bit more because YouTube needs to be short, sharp, to the point, and then move on. um So yeah, can really expand on my thoughts in this particular episode. um So like I say, I've seen a lot of people. And the five roadblocks that I want to talk about roadblock number one, that keeps people with PhD stuck in pain, are having doctors and therapists only offering manual therapies and procedures. I guess like chief among them, like most popular PRP shockwave, I would say massage, dry needling, they're all a part of what I would deem manual therapies. The procedures are more on the PRPs and the shockwaves. I did a little bit of digging, did a little bit of research like I have been like the last several years, but ah displayed on the YouTube video a couple of papers that I thought you might be uh familiar with or, you know, at least you'll find useful. There was one in support of Shockwave when it comes to PHT. If you're not familiar with Shockwave kind of handheld device, put it on locally on the skin. It provides an amplitude of sound that ripples through your tissues and the mechanism behind it of why it actually or helps heal tendons is up for debate. You might have listened to my interview with Aidan Rich. It was the last one that I released. And after we recorded, we sort of talked about Shockwave a bit more. Aidan did mention that he's a bit agnostic to the shockwave process, neither for or against, does suggest it for some people. um But he, while he did talk about like, you know, the debate still continues between researchers and between practitioners of what's actually happening. Like we're not entirely sure what's actually happening at the cellular level to help these tendons. And anyone who proposes something, it's more just theoretical. As surprising as it is, as shock, as popular. as shockwave is. We're still debating how effective it is, but also what's the mechanism behind it. uh Yeah, puzzling when people, it's shocking for some people. But this paper that I found was in support of shockwave. It was titled shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes. So there's a few things in that title that you know, you might find useful. One, it's chronic. Two, it is PHT. There's very, very rarely where you come across a paper that is PHT specific. And three, it is in the professional athlete realm. These are the population uh size or the population demographic that they're going for. Let me just pull up the paper. They had 40 professional athletes with chronic proximal hamstring tendinopathy. They underwent uh shockwave. They had shockwave weekly for four weeks and... Then they did some follow-up at one week, three, six and 12 months. They had a conservative treatment group that they were comparing to, which consisted of anti-inflamm drugs, physiotherapy and an exercise program for hamstring muscles. I mean, unsure exactly what the exercises were, but looking at all of those things, they saw that at three months after treatment, 17 of the 20 patients, in the shockwave group had a reduction in at least 50 % of their pain. Whereas there was only 10 % of the group in the control group that had that 50 % reduction in pain. uh The shockwave group considered had no serious complications. And so in conclusion, they said the shockwave therapy is a safe and effective treatment for patients with chronic proximal hamstring tendinopathy. uh Yeah, very promising. when it comes to looking at this demographic. However, as with most research, there is conflicting studies that come up with different conclusions. uh There was a paper by Aidan Rich that found no difference in effectiveness when compared to a tailored exercise program for PhD. um But like I said, there's not a lot of PhD specific papers. So if we look at shockwave therapy on a tendon, that is very, very heavily researched, i.e. the Achilles, one of the biggest researched tendons out there. ah There was a paper titled Shockwave Therapy for Mid-Portion and Insertional Achilles Tendonopathy, a systematic review and meta-analysis. They looked at all the shockwave, compared it to exercise, compared it to control, compared to a lot, like any paper that they could find. They compiled it and they found no clinical meaningful benefit for shockwave. for one of the most popular and research-based tendons out there. Pretty crazy. When it comes to PRP, the PRP's a little bit more damning and concerning based on how popular it is and how expensive it is. The paper that I found was titled, Effectiveness of Platelet-Rich Plasma Injections for Chronic Achilles Tendonopathy, An Umbrella Systematic Review. This was, I think it was 2025, so recent, and... was a systematic review, so trying to compile all of the relevant papers they could find on PRP and Achilles. And they found that it fails to demonstrate, well, this paper finds it fails to demonstrate PRP superiority over placebo or standard conservative treatments. I find that shocking that, yeah, like I say, despite its popularity, despite how, I guess, much reassurance a lot of clients get from health professionals that it just doesn't show to be that great. uh Like when compared to placebo, when compared to conservative treatments, especially in the long term, it just fails to reign superior, which is very, very unfortunate. It may reduce pain. Like these things can help for you. I have seen people that have PRP and do get better, but I have seen a lot of people that don't get better. And I've seen some people that actually get worse from PRP. And so it is risky and I don't have a lot of confidence in those things. uh Why do I think there's nothing like there's no robust research here? Well, these interventions don't do anything to increase the capacity of your tendon. This is the cornerstone of tendon rehab. is, find where your capacity is, train your tendon to adapt within those training limits. And then when you're tolerating that amount, slowly bump it up and allow your body to adapt, give your tendon the right signal. to say, want me to get stronger, you want me to realign my fibres, you want me to convert back to this normal healthy tissue, that comes with loading and that comes with slow progressive heavy strength training. PRP injections, shock waves, they might settle pain, they might settle pain in the short term. They don't do anything for the function of the tendon. ah And so, yeah, in the long term, we don't see any confidence. uh sure we could try to combine these things like shockwave with exercise therapy and progressive strength training. By all means, I'll be more on board with that. uh But yeah, this is why alone on its own, these things aren't very, promising. uh So roadblock number one that keeps people with PHT stuck in pain is they're just going from therapist to therapist being prescribed or suggested to shockwave, massage, dry needling, PRP, they're doing nothing to increase the capacity and function of their tendon. Tendons need function. That's how we can get back to doing the things we love. Even sitting, we need to increase the function of the capacity to increase your capacity to sit. Which is why I think that previous people are talking about, about the shockwave and it being effective. ah why it was so effective is because it was, remember, in professional athletes. So my guess is that these athletes already had a very, very high capacity and therefore their, I guess, priority is to settle down pain. And once the pain settled down, they haven't deconditioned themselves enough. um Similar to like what we find ourselves in, where we have to rebuild and rebuild and rebuild, they're already very very highly functioning it's just a very sore yet very highly functional tendon because you can have a very strong yet painful tendon I've seen people with a 2 out of 10 pain lifting 20 pound deadlifts and a 2 out of 10 pain with 300 pound deadlifts so you can have a painful strong tendon and a painful weak tendon so I'm guessing with these painful strong tendons the shockwave worked really really well That's why we see it in the professional athletes, but that's not very common for a lot of us. A lot of us have had this for many, many years, have slowly peeled back more and more exercise, slowly doing less and less weights. We've been doing body weight exercise for a very, very long time. So we have, in terms of our capacity, strength, function, it's quite low. And so that's why my guess is that shockwave and PRP are less effective because... like I say, we're not doing anything to restore that capacity. So it's roadblock number one. Roadblock number two, are people persisting with low level loading exercises? This is by far the biggest roadblock that I see, the most common roadblock that I see. A gentleman calls all the time, yes Brody, I'm doing my exercises, my PT prescribed these exercises, I'm doing my glute bridges, I'm doing my body weight RDLs, I'm doing my... banded hamstring curls. ah And my therapist said that because it's a bit sore, I'm not yet ready to progress beyond. Or I've been doing these exercises for two months and I still have pain with doing them. And so I haven't progressed yet. That is if that's you, my like, well, odds are if you're listening to this, this is probably you because I it's by far the most common pattern that I see. ah This is the crux that I try to get to with people. If you're just poking at a bruise, and you're just poking, poking, it's just painful, painful, painful, but you're doing nothing to really heal the bruise, you're not giving the body the signal, hey, we need to get rid of this bruise, that's just gonna keep being sore. Your low level exercises are very rarely tapping into a strong enough signal for your body to react and say, Oh, this is what you want me to do. Now I get it. ah And that comes with heavier exercises. By all means, start with lower exercises. But if it's been two, three weeks and you haven't progressed yet because of pain, I sometimes like to say, you know what, let's just poke into a little bit. Just entertain the possibility of just doing something slightly heavier. with a reduced range of movement, reduced reps, reduced sets if we wanna be on the safe side. But let's just see how the tendon reacts if we go a little bit heavier. That might be enough of a signal for your body to be like, ah, that's what you want me to do. I get it now. And it stretches out the tendon, realigns its fibers, and all of a sudden you start feeling better and your capacity starts restoring. Let's just give it a go. Like let's just say you're doing your glute bridges and it's a two out of 10 pain every time. What about if we do deadlifts and it's two out of 10 pain every time, but then we progress from 10 pounds to 20 pounds to 40 pounds to 60 pounds over the course of, you know, three, four months. Who knows, maybe you are back to doing 60, 80 pound deadlifts, still with a two out of 10 pain. Side by side, which one's going to be a stronger tendon? Which one's going to eventually have a higher capacity? And typically I don't see pain persist, usually the pain when we start lifting heavier, the pain actually subsides. It gives people more confidence to lift even heavier. They're like, oh, I see this breakthrough now. Not only am I lifting heavier, but I'm getting less pain while lifting heavier. And obviously we need to be sensible and careful when progressing load. I want to make sure the pain doesn't get worse and leads to a flare up, because that is another big pattern that I see. But when meeting the right conditions, meaning the right stimulus, that's when we see tendon improvements. Okay, roadblock number three is kind of what I was alluding to with the big jump in or not being sensible with our progressions. And that's doing the right exercises, but you're going through a boom bust cycle. And so unfortunately, when it comes to being injured, it's a very emotionally taxing process. A lot of frustration initially, especially if we're peeling back. the exercise that we love doing, uh that is a lot of runners and a lot of that means forgoing a lot of races and all your friends are doing races or your run club you can't get back to and these goals that you had and you want to tick off or these PBs that you want to continue striving for and they can't quite do all of that just builds up a lot of frustration and that build up can last months. And so at that first sign of improvement, what happens? We get overly ambitious, overly excited. We release that frustration, be like, finally, I'm seeing light at end of the tunnel. We return back too quickly. We do too much. We run too far, too fast. We lift too heavy. And it leads to a big flare up. And we're back to square one and that frustration builds up. So it's this emotionally driven highs and lows and it's this boom bust can happen for a very, very long time and not really appear on someone's conscious level because they just keep repeating it. They keep repeating the same process over and over and over again. So instead we need to break that cycle. If you do identify this is you, we need to reevaluate things. Instead we need to say, okay, what can we learn from every flare up? Every time you have that boom, bust, what went wrong? Was it was it emotionally driven? Was it just that build up a frustration? What went wrong? Was it hills, speed, volume, the weights, something in the gym? Let's identify it and flag it so we don't repeat it for next time. Because like I say, these boom bust cycles, while it happens once or twice, okay, no harm done, we just need a reality check every now and then. But we definitely don't want to keep repeating it. So let's learn from these mistakes. What was the actual factor and how can I mitigate this moving forward? I do this with my injuries as well. If it is a jump in speed work and I get a flare up, okay, that jump was too much. Let me sell things back down. Let me create smaller progressions next time so that I am, yeah, still balancing that in between, still challenging yet doesn't overdo things. uh Another thing that I do is I write down my workouts ahead of time. And that is running distance, it is the weights that I do, I compare it to what I did previously, uh my previous week, and I just make sure that it makes sense on paper first. And then when I go and do my exercise, I make sure that I stick to what I've written down. I don't run further, I don't run faster, because you know, I've had a lot of injuries in the past. And I I'm okay with getting injured, because injuries are part of life if I'm training for high rocks and I'm doing hard heavy workouts, I know I'm opening myself up to a risk for any injury. But there have been some injuries I've been okay with being like, you know what, I was training sensibly. I was doing what's written down on paper. I have been sleeping well and everything's been good. But for whatever reason, this injury has decided to pop up. I can live with that. I can't live with. Oh, I knew I shouldn't have done that. I knew looking back on it, it was too far and it was too fast and I did too many things and I blew up and now I'm facing with this injury that I can't mentally process and I don't want to do that again. I had a huge calf issue at the start of the year because I went from slowly progressing my speed workouts to progressing one of them, but switching my shoes from, you know, ah my standard or I'd say my bulkier high heel drop type of shoes to more minimalist shoes. So I went from a huge shift to minimalist shoes and then progressed the running on top of that, even though that progression was safe. I didn't allow for the transition in shoes and I slowly developed this calf issue that just got worse and worse and worse over several months. And once I picked up on it, It was too late, I already had the injury for too long. And that was one that if I'd down on paper, I wouldn't have done that workout. um And since I have been writing down these workouts, even if I just make it up the day before, like, all right, I got a big heavy gym workout preparing for my high rocks tomorrow when I wake up early. Okay, let me just write down what I'm gonna do. It doesn't have to be a lot of thought with my level of planning, be like, okay, I did 80 wall balls, let me just do 85. and I did this with my sleds, I did this with my sled push, I did this with my running. Let me just do a little bit more. I'm okay with it, I've written it down. Okay, that makes sense on paper, let me go and do it. That's what I encourage you to do as well if you find you are the one to go through these boom bust cycles and it needs to make sense on paper beforehand. And if you can't do that yourself, enlist the help of a running coach or a professional. This is what I do day in and day out with my clients, write things down for them, stick to this plan. um And then just keep reminding yourself like, when you do get better, when things start feeling better, keep telling yourself, this diligent plan got me feeling good in the first place. Don't deviate. This is what got me good. Let me continue with what's been working, but continue to do what's working. It's when things start working, things start feeling good that we all of a sudden get rid of the plan that was working in the first place. And then we blow up. And so be very, very cognizant of that very conscious and layer in interventions, might layer in different interventions that I'm doing. um But whatever keeps you emotionally in check, and rationally in check, uh it's going to mitigate the risks of these this boom bust cycle. roadblock number four. very, very similar to the boom bust, but it's just at a very more subtle level. And it is that you are running your easy pace too fast. Most people under appreciate how much hamstring load is required when you start increasing your speed, even so slightly. I say it a lot on this podcast because I wanna get this message across. Progressing your speed on a linear fashion leads to an exponential load on the hamstring. So it's not just okay increase from a five minutes per kilometer pace to a 5 of to a 440 per pace is a small easy progression. If you do that across your whole thing, if you do that across your whole week, that is a big overload because it is an exponential load on the hamstring. And so this is what I see people run really slowly because of pain and irritability and they just want to be extremely safe, then they start getting better and they revert back to their, what they perceive as their easy slow pace, but it's too fast, it's too fast for the tendon. And so pain creeps back in. And I have this conversation, I'd say about twice a week with my clients. It is the conversation around, okay, Most people can live with running and doing the exercise that they love with like a one or two out of 10 pain. Most people can live with that. I don't want to live with that for you because my goal is to get you symptom free. But if it's doing what you love, you're like, yep, I can do it. I can't run any further. I'm very, very limited because I can't run any faster. I can't run any further. I can't really prepare for races because of this one out of two out of 10 pain, but I am willing to just continue jogging around because it's I do what I love. Often, when things start feeling better, they start running a bit faster and then they float back into that one to two out of 10 because that's what they can tolerate currently. ah You wouldn't believe how many people get better when I just tell them to run really slow for a couple of weeks and then we just sprinkle back in the speed work in a bit more of a systematic fashion. But people say, you know, they might run at a six minute per kilometer. pace or like a 930 per mile pace, and they feel great. And they're like, all right, let me run a bit faster. Still a slow run in their eyes, but let me just run a bit faster because I'm feeling better. That one to two out of 10 pain just creeps back up creeps back in and just permeates into their week. And you know, it's I want better standards for you. um And so yeah, that's when we back off the pace. And then we introduce our speed sessions a lot safer. I like to do strides um once a week and to see how that's tolerated. Keep everything at your 930 per mile pace. And then when the time is right, we may pick one section of one day, maybe go back at your eight minute pace or whatever it might be, and then see how that's tolerated and then build that out just in that one section of that one run per week. everything else stays slow, it's a lot better process. Your tendon can adapt a lot better and a lot easier with that process. If you're unsure how to do that, like I say, you can enlist someone like me for assistance, but I constantly see it. People are stuck in pain with stubborn PHT because they're running too fast and they think their easy pace is easy, but it's too much for the tendon. The fifth and final roadblock. Other people that doesn't come across me too often, but they're doing all the things right. They're doing all the exercises. They've listened to my episodes. listened to the podcast. They've now subscribed to the YouTube channel, wink, wink, and they're still in pain. And it's because we expect when we treat a tendinopathy, well, when we treat a tendinopathy, we expect it to behave like a tendon. Sometimes it doesn't behave like a tendon. That's sometimes because it's not the tendon. In other words, there are there are other pathologies that fit a lot of the characteristics of PHT, not exactly, but a lot of the key characteristics and is something else entirely. So you go trying to treat it like PHT, it just doesn't respond like we would expect. That's because we're barking up the wrong tree. Is that the expression? You get what I mean. And so what might be helpful is me sort of talking through what is what we typically expect with PHT to see if that fits your characteristics. It's not 100 % gonna totally rule in or rule out PHT, but what we would typically expect to see is like the initial onset of your PHT is due to some sort of mechanical overload. That might be running mileage, running speed, very classic, just doing too much of that too soon, preparing for a marathon or a race or. just doing too many speed sessions or hill sessions. If your onset of symptoms was occurring around about that time, then that would be quite typical. We sometimes see it due to intense stretching and a really short period of time, like all of a sudden you've taken up yoga or Pilates and you're doing a lot of deep hamstring stretches for a long time beyond like what your uh body has the capacity to adapt to. Sometimes see it with sitting, it's often like a combination of doing a lot of stretches plus a lot of sitting or increasing your running mileage plus a lot of sitting. And so these are typically what we'd see in terms of the onset of your symptoms. In terms of the location of your symptoms, it is more of a localized condition, does stay around and hovers around that sit bone area, very rarely moves. uh can sometimes radiate into the upper hamstring, muscle belly, but not further down. It doesn't radiate further up. If it does radiate around, across to the side, to the front, down, it still could be PHT, but we're probably dealing with PHT on top of something else. Or it could just be something else entirely. That's why this is a bit of a puzzle. We also do provocation tests. We do like stretches and movements to see if it can reproduce your symptoms. often bending forward, stretching forward, sitting on hard surfaces, hinging movements like deadlifts, um these sort of things we would expect to aggravate symptoms, running just beyond your capacity. So running too far, too fast, doing speed sessions. Some people say, you know, I have this nagging sit bone area that just gets worse the day after my speed sessions. That would be a typical characteristic. um Yeah, aggravated with things like sitting, on hard surfaces. um If we tell you to pick something up off the floor and you sort of do a hinge pattern to pick something up and you say, oh yeah, that reproduces my sit bone pain. It can be very classic PHT. Some other diagnostic tests, we can do a shoe off test, which I've explained before, standing, legs stay straight and you try to push your heel, dig your heel on the affected side into the front of your other shoe to try to slide that shoe off. um That could reproduce your symptoms. We do the heel press test where you lie on your back, your knees and hips are bent at 90 and 90 and you just dig your heel or you rest your ankle onto a chair or a box or something and you dig your heel, push your heel down vertically down into that box that reproduces your symptoms. A long lever bridge can sometimes produce symptoms. So we just do a combination of whole bunch of these. um What we do clinically is say, all right, does the onset of symptoms match? Does the... location, does the pain match? What aggravates or reproduces symptoms? Does that match? And if all of this is sort of fitting what we typically see with PHT, then that's when a diagnostic, that's when we make a diagnosis and we say we're fairly confident with this. We'll go ahead with treatment and see if it still behaves like a tendon. But often we can see, you know, I have this but I also have a lot of lower back pain. When I move my lower back, that's when it reproduces my symptoms. It's maybe like walking reproduces my symptoms where my um foot or my hip extends back. That's when I can reproduce my symptoms or it sort of radiates down into my calf sometimes. Like these things are like, okay, maybe there's something else going on entirely or maybe it's PHT mixed with some psych nerve irritation or like I say, could be something else. I've done other podcast episodes on ischiofemoral impingement, which has a lot of. overlapping symptoms with PhD, but it's treated completely differently. um bursitis could be like a hip bursitis could be something that um can mimic symptoms but not but is treated differently. And so this is where a diagnosis can be nice scans can tell us 80 % of the picture, but people in the healthy population also have been shown to have PhD on scans. And so could be incidental findings if it does come back as saying you do have PhD, but you also have all these other characteristics that don't quite match PhD. I'd still be scratching my head a little bit instead of going all in on that diagnosis. And so this is where it's more of like, wouldn't expect you to come up with this. This is where a medical professional needs to lay out all these puzzle pieces and lay out how accurate we feel like this diagnosis is. But like I said, if we are still puzzled, we then move forward with a treatment plan anyway, we say, all right, even if we are 60 % confident this is PhD, let's treat it like PhD for several weeks and see if you start responding in the way we would hope and the way we'd expect if it is PhD. And if not, we widen our scope, what are we missing? Are we needing to do some nerve tension tests? Are we needing to do a thorough lower back assessment? um you know, just contemplating other structures that might be involved. And then maybe we do some nerve flossing. Maybe we do some lower back mobility exercises. Does that influence your pain either positively or negatively? If it does, then maybe we're onto something. Maybe we are gathering more data and learning more about this presentation. So to recap, roadblock number one, therapists overly prescribing or heavily relying on manual therapies and procedures. Roadblock number two, persisting with low level loading exercises. Roblox number three, constantly going through this boom bust cycle. Roblox number four, your running easy pace is too fast. And then Roblox number five, it not being PHT, either another condition entirely, or other structures going on on top of PHT. Persisting with any of these or presenting with any of these leads to PHT continuing or symptoms continuing and just not getting better. And so that's why we need to change it. Hopefully this these five roadblocks has, um you know, either allows you to consider something different, or least reinforcing what you're currently doing is the right thing that you're doing. So hopefully you found this insightful, valuable. Hopefully you can uh now subscribe to the YouTube channel if you haven't already, go search, overcoming proximal hamstring tendinopathy, find my face on the logo and then click subscribe. I look forward to bring you a ton more videos. Like I say, I have a lot of ideas that I wanna release after the recording of this one. I'm gonna be working on the script for my next one, um which is going to be on sitting, helping people uh overcome their struggles with sitting with PHT. So I look forward to releasing you that. I'll keep you updated in the meantime. And thanks for listening to this episode. If you are looking for more PhD resources, then check out my website link in the show notes. There you will find my free PhD five day course, other online content and ways you can personally connect with me. Well done for taking an active role in your rehab by listening to content like this. And together we can start ticking off all of your rehab goals and finally overcome P.H.T.