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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, have Matt's second success story. 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. We have a slightly different success story today because we have Matt who has been on, he was on episode 95 back in April, 2023. So we're looking at two years ago, talking about his PhD on the left side and how he managed to overcome that. But in the past year or so has struggled with PhD on the right side, being quite stubborn, hard to get rid of, but has managed to learn some additional insights to overcoming this right PhD. And so not only is there a lot of insights to help you with your rehab, but also helps reflect on the reality that totally eradicating PhD and getting rid of it for good is a really tough endeavor. And we can learn tons of insights and we can learn from every little injury, every little setback, every little flare up to be more resilient moving forward. So you're going to love Matt's episode. If you want to listen to episode 95 before listening to this, would be a nice continuation yet listening to the First episode with Matt is not a prerequisite. So up to you. No doubt you're going to enjoy this interview. So let's take it away. Matt, thank you very much for coming on for the second time onto the podcast. Yeah, my pleasure. Thanks for having me, Bernie. Let's bring people up to speed. Well, first of all, if people haven't listened to the first episode and they want to learn more about you, do you mind introducing yourself and what your fitness background was like? Yeah, with pleasure. I'm a French Canadian runner, 42 years old. I've been doing endurance sports for about 25 years. used to be a road cyclist and cross country skier and now I've been running for about 10 years. I train five, six days a week. Just to give you an idea, like my fastest 10 K is like 37 minutes. So not that great. Still pretty good. I mean, I'm reasonably satisfied with it. And my fastest mile is 541 and that's what I train for. I'm like obsessed with, I'd love to run a five minute mile. I'm not sure that's going to happen in my lifetime, but maybe an age graded five minute mile. Um, and, uh, yeah, so that's, that's pretty much the kind of rudder that I am. time you were on, were talking about your success story and talking about, um, negotiating PhD. Um, and we're on again to talk about a second PhD instance that you had, but, From when we recorded our last episode, which was a couple of years ago, how were things going? How were things leading up or just prior to this new injury? Were you still fit and active, still at what you would consider a good performance? Yeah, still training like normally. Once I had gotten rid of PhD after having it on the left leg for about a year, I thought I was done with this injury. I thought I had it figured out. I came on your podcast like really excited to share my hard gained lessons with the world. basically I got it again, but on the second leg and it took me another full year to get rid of it. So now I'm back and I've got, I have like more assurance than I did when I first came that now I figured it out and I'm excited to share with your listeners what I learned. Excellent. How long ago did this right side start? If we're talking timeframe wise. It was started about March last year. So about a year ago. Okay. Right. And what was happening in the, your training or anything around that time that you think might've contributed? So two months before was January 1st. So January 1st, like a lot of people, I was starting a new training cycle. I had read yet another training book, running book. And I decided, okay, I'm gonna try this one. And this particular book had a big emphasis on strides. And strides like strides every five, 10 minutes. Like so you're running, you're doing your slow run, but you're interspersing strides in there. Strides and uphill sprints. And I also started training in the gym again. And the combination of the two, the strides and the sprints and the weightlifting and all that. I injured my hamstring, the right hamstring, but it was like a strain. know, like I pulled the muscle kind of like near the knee. So nothing to do with PhD, but near the knee. And it took about two months to get over that. Like I, you know, I recovered a little bit in a week and then injured it again. so within two months that was, that was over. Um, but after a couple of weeks after that was healed, then I started to feel like, very mild PhD symptoms on the right leg. So what I assume is that while I had this hamstring strain, my hamstring was weak, and it probably got weaker during that period. And so it became like vulnerable to PhD. Gotcha. I can't like the amount of people that have PhD or recurrence of PhD due to speed work is very, common. It's just such a it's such so closely linked to speed and hamstring load, hamstring demand that it's no wonder with not only runners in general, but runners who have the ambitions of running fast, that the likelihood of these things setting in is quite high. So, interesting kind of correlation there. Talk us through symptoms. what, so was it a very gradual onset around about that time or was it quite sudden? Yeah, very gradual. So like that pain in the butt. And this time sitting was never a problem. before with the left leg, I issue sitting. This one never had any pain while sitting, but it was basically sort of the same thing. It just sort of creeps up on you. This is maybe just like a muscle soreness or it lingers. And that classic test there where you're like, taking off your shoe, pulling your heel towards like your body while standing. That was like more and more sensitive as time went on. So I eventually came to terms with just the horrifying idea that I had now PhD on the other leg. was your initial reactions? Like emotionally, I mean, you're very experienced with managing and dealing with PhD. Where was your mindset at when that? when the onset occurred? When it started, it wasn't too bad because I felt like I had the tools to get through it. Like I felt like, I understand this injury. All I need to do is what I did with the left leg, with the initial leg that was injured. So I just started basically starting to do like hamstring strength work again, like the classic exercises. We can go through them, but basically that's what I did. I applied the same protocol. that I had done with my left leg. it just didn't improve for like almost a year. It didn't improve even if I was doing what I had done with my left leg. Do you think of any potential reasons why? I'm not sure exactly why. So basically, just for your listeners, what I was doing is strength work at home. So I have like minimal equipment, have like two 45 pound plates, not dumbbells, I have like the plates. And my idea was, what I'd worked with the left leg was do whatever's painful. Whatever's the most painful will solicit the muscle and tendon, tendon I should say, in the way that it's like, it needs the most strengthening. So that was like my training principle. So for me what... What hurt the most was a single leg of deadlifts. So I did single leg of deadlifts. I did an exercise. I did like, uh, you're like in a bridge and then you slide one leg out. I don't know if that's hamstring sliders. Yeah. would usually call them hamstring sliders and then maybe hamstring gliders. So you're like standing with like a plate, like something sliding gliding underneath your leg. And then you glide back like a backward lunge and then. hike yourself back with the standing leg. So yeah, that kind of would be like similar to a backwards lunge, but you're just sliding instead of stepping. Yeah, exactly. Yeah, that I did like the equivalent of like a burb dog with like elastic bands, like pushing my leg back while I'm like on all fours. Otherwise, hip extension standing hip extension. So I'm just standing on both feet, I've got a band around both both feet. And I pull the leg backwards. So that's what I was doing and I would do that. So I would do that like, I tried all sorts of intensities, weights, like repetitions. I tried it every day at one point to get that numbing effect. I really liked that. Like when I would do it, I would just, I would feel it less during the day. So that would help me like get, you know, just like go run and be annoyed by it less. So I like alternated like all, you know, different exercises. I also did like Bulgarian squat. split squats, also with relatively light weights. So I did that and whatever hurt the most I would do and I was able to manage it well. So I think maybe this would have worked maybe for me if I was like really injured, like if I had a lot of symptoms, but I was like at a one to two on 10 basically. the entire time. Like I was able to keep running, I was able to keep training relatively normally, but with this constant soreness. So I wasn't able to like, shake it off completely. It was like the last, like the last inch, the last bit that I just couldn't achieve with that program. So when you first got this injury, was the pain higher than a one to two? And that's the one to two is the best it got? No, it basically stayed or it like stayed around there because I think because I like I had experienced it before I knew how to like manage it so for running what helped me for running is running uphill I think for some people running uphill is worse for me is like almost you know symptom-free running uphill so I could do intervals running uphill so whenever it was like I would feel like symptoms creeping up I'd run uphill or I'd I have a really geeky piece of equipment called an elliptical Which is amazing. It's like an elliptical machine, on wheels. Highly recommend it. So I really enjoy it. So I would do that and I would have less symptoms with that, but never like zero. I tried resting like between like training cycles. I took like one or two weeks off and that, that didn't make it better. In fact, that I think made it worse. So it was like the downward spiral there that you often talk about. Um, so I felt like I tried everything and I was desperate and I was like this close to reaching out to you like Brody help. I, I don't know what I can do anymore. Um, and finally I tried something and that worked. Gotcha. And that was after 12 months of just trying different whites, different frequencies, different intensities and all that sort of stuff. Yeah, exactly. So about maybe nine to 10 months of basically, you know, lots of different hamstring exercises at home and targeting. uh, what hurt the exercise that hurt the most. I would do those. Would symptoms fluctuate much with running or fluctuate much with like heavy strength exercises or anything like that? They would fluctuate like, you know, some weeks it would be less like, ah, think it's almost gone and then it would come back and a little bit more. So it fluctuate between zero and two, would say. Okay. if you had like a longer run or a faster run or something like that, it wouldn't be. worse off the next day? It could be Yeah, like depending on what the training that I did. It could be like better or worse the next day. Okay. Yeah. Just not getting completely better. So you sort of managing it enough to exactly completely like very subtle. But yet just not 100%. Yeah, exactly. Yeah. Okay, gotcha. And so what changed? What what adjustments did you make in your rehab plan to start seeing improvements? So again, end of the year, so New Year's resolution, I decided, okay, I'm gonna get back in the gym. I'm get back in the gym, not necessarily for for PhD, but just like in general, I'm gonna reintroduce strength training into my program, and I'm gonna start a new training cycle. So I started going to the gym, and I decided, okay, I gotta shake things up with my approach to managing PhD, so. I'm going to focus less on painful movements and I'm just going to do, I'm going to try like a kitchen sink approach. I'm going to try like a whole bunch of different things, but full body. So, you know, like with emphasis on the lower leg, but basically like your classic full body runners strength program. So, So I'd go to the gym and I would run before. So I'd do my run workout before on a treadmill. And then I would do weights and I would try to get out of there within 30 to 35 minutes. So like 30 to 35 minutes of strength training after my run workout. And I would do that twice a week. And in order to get as much variety as possible, I would only do one set of all the exercises. So like one good set, like one set to like near failure. Some exercise I would do like one warmup, like easy warmup set like the deadlift and other like other like power exercises I would do like one quick sort of warmup set. But the rest just one set, a big variety. I would, I'd be able to squeeze in about 15 exercises and those 15 exercises, I selected them out of a bank of maybe 20 to 25 exercises that I have in my head or a list of exercise that I have. And I would just cycle through them and do about 15 of those 20 to 25 every time I would go to the gym. twice a week. How strong were you prior to starting this new going back into the gym? Because you were doing some strength at home and you said you were doing your single leg deadlifts and that sort of stuff. How heavy were you lifting? At home? At At home, it's like I was doing a lot of like eccentric stuff. So it wasn't like heavy weights, but it felt like there was a lot of resistance, but a lot of it was like, was eccentric. I also did, I bought a sled. So that's something like I have fun with, like I push and pull like the sled. So was doing that as like sort of general strength work. But I was doing mostly like all very targeted hamstring stuff, not with like the heavy weights. it was like the maximum you get with like the home exercises. Say like the hamstring glider, for example, I would do maybe like eight to 10 reps, like really slow down. really like whenever it was painful, I would like really like. just drive it as much as I could, like hold it as much as I could. So even if it wasn't like, like big actual weights, I felt like I was still putting a lot of tension on the, on the muscle and tendon. Yep. Okay. Gotcha. Cause you did mention in our last episode that like for you, the more painful meant more effective. And so you sort of went into that more. Okay. And Would you say it was a similar weight and intensity when you went back into the gym? Cause if you're doing one set and the rep ranges are 15, 20, 25, that sort of stuff seems like the overall intensity and weights would be similar. I, uh, I increased the, uh, the weights. So when I was in the gym, there, I had access to like actual, like, you know, barbells and weights and, know, just general equipment. So I like that increased the weight. Um, the exercises like changed, but. Um, but it definitely increased the weight. So I would do one good set, like maybe six to 10 reps depending on, depending on the exercise. Um, so because I was in the gym, like I had access, I had access to equipment. So I was doing like, should we go through like the exercises that I was doing? Yeah. Uh, this may be clarification cause I thought you said you were going through 15, 20, 25 reps. Oh no, no, I was going, I had a bank, like a pool of exercises. like a selection of like 15 to 20, sorry, like 20 to 25 exercises. And each time I would go to the gym, I would select like 15 out of that pool or bank of 20 to 25 exercises and just cycle through them. Where'd you get those exercises from? I guess just like with time, like just what I felt was like most, I guess, running specific. Uh, like we're like the, you like the, the, the fundamentals, I would say, like the fundamentals. Okay. And where'd you get the idea to do one set of 15 on exercises? Um, that was mostly for, I know that's not like the classic approach. It's generally like, you know, do your two to three sets and, and, um, I wanted to do this. Uh, I wanted to keep it short, like between 30 and 35 minutes and I wanted to do something that gave me the biggest bang for my buck. And I didn't want to like come back to the gym. know, the double today to workouts a day. Those years are over. Like I'm not doing that anymore. I have a son now. Like I'm not doing that anymore. So I wanted to do it like in the same session. And, um, I don't know, really. I wanted to get them. I wanted to, I want to try everything like, I was wondering like, maybe it's not the hamstring. Maybe it's like I need more glute strength or maybe I need more like, you know, glute meat or maybe it's like the adductor. Like I didn't know what could help. So I just figured I want to try as many things as possible. And so if I do like the standard three sets within half an hour, I'll do maybe five exercises, six exercises, something like that. But if I do only one set, I can get I can get more variety and I can also get like some, bit of a cardio workout because I'm like switch. I'm going like good intensity. I'm not really resting that much. I'm going from one exercise to the next. So, so that's why I tried, uh, I decided to try one, one set. Gotcha. I, yeah, let's go through the exercises cause I'm curious to see what you had in your repertoire. So before I do for your listeners, I don't think these are, I don't know. if like what in this combination of exercises actually worked. Like I don't know if it was the deadlift, I don't know if it the split squat, know. I can't say if one exercise in particular changed things. But what I do know is that doing this sort of like general all-around program that basically like covers all the bases, that like got me symptom-free within like two months. So the first exercise that I do and I do most times is a shallow squat for power. just pumping up kind of like a quarter squat. Some people call it quarter squat. So like a very shallow squat and as fast as possible, maybe like 12. So you're going down slowly but fast back up? Yeah, but like both pretty quickly, but a little more emphasis on the speed on going back up. That's a pretty classic running exercise. You see that come up pretty often. At least I do. So quarter squats for power, quarter power squats. Then I would do a full squat. So like a deep squat, like ass to grass or however you call it, with a slant board. So like with a 15 degree slant board so that could get down lower. I would have it like the weight in front. So I guess a deep front squat. Yeah. So the bars in front of you like on your collarbones and the slant board is... Um, downwards so that your heels are higher than your toes. Yeah, exactly. Yeah. I really liked that for me that I really liked that. Actually, I bought the slant board and donated to my gym because I really like, uh, doing like, that's the only way I can get a good feeling doing a deep squat. So, um, full squat with a deep squat with a slant board. Um, then a sumo deadlift. So I, I don't do the regular deadlift. I don't know if it's because my physiology, like I have long femurs or something, but I just feel more comfortable with the sumo deadlift. Can you explain the sumo for those who Sumo is like, you you imagine the classic sumo position, like their legs sort of like a little bit, you know, wider than shoulder width apart, and they're like a little bit pointing towards the outside. I sometimes point them a little bit like straighter than an actual sumo. So, but just a wide stance. You could call it a wide stance deadlift. Yeah. Well, with your knees and toes kind of pointing outwards externally rotated. Yeah, exactly. But just slightly like a 45 degrees. Yeah. Okay. Slightly. think sometimes I, yeah, just slightly pointing outwards. I just feel more comfortable that way. And, uh, and I don't know with the deadlift. Yeah. I just, I just feel more comfortable. I lift more. And I think if my gym had, um, I think it's called a hex bar. I think I would be able to do that, but something about the deadlift, just prefer the sumo stance. Gotcha. Yep. Next Bulgarian split squat. So that's, I'm sure your listeners are familiar with that one. find that- those who are unfamiliar, let's go. So it's like a squat with your rear foot, your rear leg elevated onto like a chair or a bench or a box or something. And then you're just going down into a lunge position coming back up. Yeah. So that one really, there's something about it, like in the end range, when you're almost fully standing, there's something about that one that feels like that really targets the the PHT area like really well, at least for me, like at the top range of the movement once I'm almost standing fully straight. So Boliari, small squat. then the classic hamstring curl machine. Yep. Is that lying on your stomach or seated? Yeah, lying on the stomach. Yeah. Incline back extension. Okay. Can you go through that? So it's like that machine that's like, it's hard to describe, just like basically something that you, that's like diagonal. And then you, your hips or the front of your thighs are like against. like a pad, and then you would like dip your head down to the floor and then raise back up. Yep. If anyone wants to Google like a lower back hyper extension strengthening that usually that would come up. designed for strengthening the lower back, but your high hamstring does get a pretty good pull or load through that as you dip down and come back up. Did you notice any symptoms when you were doing that exercise? Yeah, I noticed I wouldn't really like work my like hamstring and like and glutes as well. Yeah. I think it would depend slightly where that pad how high that pad goes up your leg, hip hip crease. From my experience, because I've done this a bit in the past, the pads are slightly higher. You do work your lower back a little bit more. I mainly did it for lower back strengthening. And so that tended to help me but yeah if the pads are sort of I guess like higher or just like high thigh then yeah your hamstrings would need to be recruited to pull you back up so you can have slight variations based on the purpose. So to that one so incline back extension then I did I don't know why I did this but I like a homemade this is a homemade one it's on a leg press machine So like a horizontal leg press machine, not the one where that's like where your feet are high up. So a horizontal leg press machine, but instead of sitting on it, I would be on like on all fours, like sort of the bird dog position. And I would just kick my leg out, like a bird dog. So a bird dog on a leg press machine. Yeah, gotcha. Some people might, I don't know, they could maybe Google like called a scooter. I think some people can do it. not necessarily in four point kneeling, like, um, standing single leg standing, and then kicking back against the like press machine, depending on the setup. But, um, someone Googles like a scooter, maybe that can pop up, but hopefully most people are familiar with the well can paint a picture of what you're explaining. I think some gyms have a, like specifically like they have glute machines where you sort of like kick back. Yeah. So sort of in that spirit, something like where I could. do like the bird dog movement, uh, rift weight. Gotcha. Okay. What's next? Um, then I would cycle through, uh, one glute meat exercise. So they're like, you know, the whole bunch, like the classic ones, you know, like we have a band and you're like monster walking or side stepping. Yeah. Against resistance. Hip airplane. really like, I find that one like really does something different to me to hit bear playing. Um, you explain that? Do you know what that is? Like it's, where you're basically you've got you're standing on one leg and your your whole body is parallel to the floor and then you open up like towards one side and then close back hip everything. So if you're looking at like if you're standing on the left leg, your right hip is traveling up towards the ceiling. Yeah. Gotcha. They're tough to describe. I mean, you're very good at stuff like describe these exercises. So a glute meat exercise, so lots of hip airplanes, the standard like crabs, crab, crab walks, or clamshells. Yeah, exactly. Clamshells as you know, just cycling through different ones. One, a doctor exercise. the Copenhagen, I don't know why it's called like that. I don't know. I don't know either. What's the relationship with the city? So Copenhagen, I would do a lot or just like pulling a band like towards the inside. I would then do a hip flexor exercise. So different ones, uh, pulling a band or pulling a kettlebell, like while standing, these probably don't have anything to do with the PhD, but I would just throw them in there. And then I would do a calf exercise. So different kinds of caches, caffexercises. don't think also that really helped with the PhD, but I wanted to have something like sort of balanced. Okay. And so you would pick. about 15 of these exercises, you'd go through one set, you would keep to about a set of six to eight for some of those exercises, particularly like the ones that require some heavy, the heaviness. You mentioned earlier that you were symptom free within two months. Do you think that was quite a linear progression? Or do you think it did take some time for you to notice it? Okay, I'm on the right track here. Like how did that progress? Before I answer that question, so one thing I wanted to just specify about the exercises is that I would also throw in like some other things like kettlebell swings, sometimes like some sled work, you know, I throw in like Nordic curls sometimes, you know, I'm just sort of like throwing in a lot of different things. I thought that was like really helpful because it's like varying the joint angles, it's varying like the area in the muscle that's or muscle or tendon that's working. It's like working through different ranges of motion. So really like the key focus was just variety. The one set was a good set. So it's not like a warmup set. It's like I'm getting within like one or two reps of failure. And the 15 exercises that I would do each session would also include some other things that I didn't name because they have nothing to do with the hamstring. So upper body exercises. I would do maybe like... 10 lower body and like five like upper body. So yeah to get back to your question so PhD to me was tricky really tricky about the treatment and maybe you've noticed this with yourself and with your patients is like treating it is like watching paint dry like it just doesn't get better like you know like a classic like like injury like spraining your hamstring your ankle for example like or it's more linear. It's almost like you have to put it on the back burner to maintain your sanity. I felt like if I was just focusing on too much day to day, it was just depressing. So when I started this gym program, I just told myself, I'm not going to think about it, and I'll just reassess in a month or two and see where I am. Because anyways, I could maintain my running. I was reasonably... able to train like I wanted to train. So I just told myself, I'll just not think about it and see what happens in maybe four to six weeks. And what I noticed is after about four weeks, I could see notable improvement. could see like, wow, this is like, some weeks it was basically plateauing at the one on 10. you know, pain level, some weeks it would like dip down. But in general, there was a general tendency in the reduction of symptoms over that month. So one month of it like noticeably getting better, but not in a linear fashion, like just sort of like watching pain dry, like just slowly getting better. And then between month one and month two, that's where it went from like getting better to completely resolved. Gotcha. Yeah, it's, it's, almost slowly creep up on you to begin with and then have to slowly creep away to resolution. And it's, it's a tough thing, but that's why some of these pain rules that we have, it's like, okay, pain, can be in a little bit of pain during, but it needs to return back to baseline within 24 hours, just as the general rule. But the third pain rule that I like to always say is it needs to have this improvement, I like to say week by week, but sometimes it can be month by month, depending on how long you've had it for. But that long term trend needs to be there to know that you're doing something or to know that the tendon is healing. So it's good that you had that effect. And some people can have this injury for 12 months, I think they're always going to have it but to your proof, it's like just take some slight adjustments and then better in a couple of months, which is great to have that turnaround. Yeah, I was really thinking like, oh jeez, I'm stuck. I'm stuck. Like, that's what I thought with the first leg, I'm stuck with this. I got rid of it. And I got the second leg. And after like several months, like, man, maybe I'm stuck with it on this leg. And I also thought, I also thought maybe my gate is off. Like maybe my, something with my biomechanics, I'm like stressing the hamstrings more when I run. than I should be, like they're always overworking. Maybe I don't run properly or maybe there's something about like my, the way that I run that I'm just always gonna have this like vulnerability with PhD. And maybe there is like maybe I overwork my hamstrings, but if I go to the gym, if I do like exercises like I'm doing, I feel like I can run as much as I want to and. and not get PhD. At least that's how it is now. And I'm, I'm, touching wood. It's funny where our mind goes when we're injured, because I see that time and time again, even with myself, it's like, I'll be training for this high rocks race and do a lot of squats and wall balls and that sort of stuff. And they'll get this hip pain. And they'll be like, yeah, I think there's an hip impingement on this side. Maybe I'm just not cut out for high rocks races. Maybe I should just stick to something else and maybe something's off. And then that will like, if the pain continues for a few months is like, you know, reassuring that, I shouldn't be doing this. There's something off, there's something going wrong. But then as soon as that injury goes away, I'm like, I don't even know what I was thinking about. And people think that about running as well. They think biomechanics, they think something like a muscle imbalance or a leg length discrepancy. And unfortunately, a lot of health professionals, like if you go to a health professional, some will say, yeah, your glutes aren't switching on or this left glute isn't activating properly, or you need to a stronger core, or you have one leg longer than the other or all those sorts of things. looking back on a taking a step back and looking globally at your presentation, hey, you're running fast. You're you're you've got this. Yeah, sure, we would have a look at your running mechanics. But generally speaking, you want to run fast and you want to run like do that quite often. And you have these ambitions to run a fast mile to run a fast 5k like all those will work your hamstring very hard. And that's going to be the biggest rock in the whole loading cycle rather than if you are slightly activating your hamstring more than your quad or if your glutes aren't as strong and all those sorts of things. So yes, I do get it. And a lot of people who are injured will start to have those worries, concerns, confusions about, yeah, maybe I do have one leg longer than the other. Doesn't really stack up in the research in terms of correlation to injuries or injury risk. But yeah, to your point, as soon as you adjust, get better, like those fears and worries tend to tend to go away. Yeah, I'm really glad that they did. What's a bit, what I like with the rehab side of things is trying to keep to one variable at a time. And the frustrating thing about this success story is there's a ton of variables, as you've mentioned, like it's, it's important that we talk about these things, but there was a few changes to your rehab that I think is worth highlighting. And like we say, we're never going to know what was the one component or multiple components that led to this, you know, resolving, but yes, things did start getting slightly heavier in the gym. You were pushing very close to like one to two reps away from failure. So that is a stark difference to the load that you were doing at home. So we could say that the heavier load might have something to do with it. The changes of exercises might have something to do with it. But the other thing that you mentioned was you were running before the loading for about, was it 25 to 30 minutes or something like that? Running like a regular workout. like maybe 45, 50 minutes. I recently released a podcast episode with Keith Barr. I'm not sure. Have you listened to that episode? Okay, you might be interested to this one. So like, when it comes to what he was explaining is with the tendon, there's a certain portion of that tendon that's that's undergoing that tendinopathy that has this reaction, this, the collagen fibers are getting a bit screwed up and cut the scar formation starts to develop. And the tendon wants to protect itself. and doesn't want more damage. And so what it does is this component called stress shielding. And if you were to load up the tendon, it all the load goes straight through the healthy portion and totally bypasses the affected portion that has all those like mixed up college and stuff. So that he calls that stress shielding. And if you, if it's a, if it's a strong sort of component, goes straight through it and that scar tissue never heals because it's just being directly bypassed. And in fact, it starts to get worse because tendons like load. And if it keeps getting bypassed, then it just keeps getting worse. However, what he was mentioning is if we can find a way to fatigue certain portions of that strong tendon, it's starting to slack off a little bit and we can start exposing a bit of load through that scar tendon. And it starts getting the right signals. It started like, Oh, this is low. This is load that I haven't experienced for quite some time. And it starts to send the signals of these are the directions of the collagen fibers I need to realign with, because it's in the direction of the load. This is a adaptation stimulus and all those sorts of things. And one thing that he did mention was fatiguing the unit and then doing your strength training. And so the fact that you went for a run for 45 minutes and somewhat maybe leading the healthy portions that tend to fatigue a bit earlier would then expose your scar pathological portions of that tendon to start experiencing some loads. So maybe there's a portion to that as well. I found that little element that you added in quite fascinating after relating to that Keith Barr interview. That's really interesting. Yeah, that's, that's a factor I hadn't thought about, like the sequencing of the, of the strength training, like right after the the running, whereas before I would have done it like as far apart as possible and often like before the running. So it could have been that could have been like the added weight or like the variability exercise more like complete compound movements. So, yeah, I'm not sure exactly what it was that did the scale, but it was like it was so black and white like us like, you know, so black and white that that was it. And the way I feel now, like it just It completely shifted things. Just basically going to the gym 30 minutes after, after a run workout, kitchen sink approach, as many exercises as possible within those 30 minutes, twice a week that did it for me. Excellent. Um, okay. So we've gone through two rounds of PhD now, um, based on this second bout, um, is there anything you would have changed in hindsight? Uh, I just would have gone to the gym sooner. I would have stopped doing the exercises at home. I would have stopped focusing strictly on like the painful movements. I would have started doing heavier weights, more complete exercises, not just the, the painful movements, but like just general compound, general strength exercises. Um, basically what I'm doing now, I just would have done that sooner. Yeah. Uh, like hindsight's 2020. And I think everyone would probably answer it exactly the same, but, what I did like about it was that you did try to change different things. Like even though things weren't working. doing the stuff at home. Like you said, you've managed you tried, oh, let me try resting. Oh, let me try some, like bumping up the intensities. Let me try the different frequencies. Like you were still experimenting. Because one thing I like get frustrated with is someone trying something the same thing for 12 months, not getting any better for the 12 months, and then wondering why things haven't changed. But you know, to your point, you had tried to make some adjustments, just we finally made the right adjustment. just took 12 months to do so. Yeah, I think one of the reasons why I was like sticking with what I was doing for so long is because I had a success story. I talked to you on this podcast. I had, I had proof that something worked. Um, so was sort of sticking with that for too long, I think. um, and otherwise I think I would have switched things up earlier. Yeah. Any final takeaways or any messages for someone who might be struggling with PhD that you think might be helpful? Um, I hope that anyone out there who's got this sort of like mild, manageable, but persistent case of PhD, like one to two on 10 in terms of pain, and that's having trouble shaking it off. I hope that if there's any listeners who are experiencing that right now, just my message would be like, keep hope, like the, to get back to zero, like it's there, it's possible. And it might be just around the corner. What worked for me was a general strength training program at the gym, reasonably heavy weights, twice a week with like the fundamental compound movements, deadlifts, squats, know, like the main, like mainstays of classic running programs. So I'm really, I'm really excited to be able to share it. And I hope like it's, it's helpful for for your listeners. There's one thing maybe I wanted to add as well is about eight months ago, so while I had PhD, I decided to also change up my training. I think I was getting bored in general. Like polarized training, like just the training that everyone does now, from my understanding, like slow running, peppered with like some, you know, twice a week, like intervals or, you know, the classic polarized training that everyone's doing. was starting to eat away at me. The slow runs, just so boring. And then when you do the hard intervals, you're just cooked. And they're no fun, because they're just always really hard. it's like, they're really hard and really slow. I just got really bored of that. I've been doing that for 10 years. And I did that before in other sports as well. So I came across a book called The Easy Interval Method. You ever heard about it? I have, yeah. Yeah, you heard about it? So I'm not here to promote this book, but. I decided to give it a try and basically this book it's like light intervals every day. It's like instead of going like a 9 on 10 in terms of like the difficulty you're more like a 6 or 7 but you're doing it every day. So every time there's no more slow running. Every day you're doing light intervals so from 100, 200, 400 to a thousand meters and you're going slower in those intervals than you would like in the classic polarized approach. But you're going from like 800 meter speed, like 800 meter pace for the 100 meter intervals, all the way up to like half marathon pace for the longer thousand meter intervals. So you're doing basically like slight speed work at every session. So I started that about nine months ago and I'm still doing it now and I have no PhD symptoms. So the reason I'm mentioning it is because I think a lot of people who have PhD like tend to stay away from from speed work and because that's where you get the most symptoms I think, at least from my experience and from what I've heard. So I'm on this program now, doing speed work, light speed work every single day and I'm able to do that symptom free because of the strength training work that I'm doing. So I'm stoked about that and I think my last realization, the last realization I'd like to share It's a personal opinion, but I think running makes you weak. Like I think we think it like makes you strong, but in my opinion, it makes you weak in a way. And if you want to run well and not be injury prone, there's like no substitute for the gym. I'm going to keep going to gym for the rest of my life. Now, if I stop, I know like PhD or some other like tendon injuries like around the corner. So that's like, think. my main takeaway, my main like a lesson from the last 12 months, the gym strength work in compliment to running is a non-negotiable, at least for me. Okay. Well said. Um, I think like going back to the start of this conversation when you, you had PhD on the left side and you're like, yep, I've got this, I've got rid of this for good. And then you've got PhD on the right side and you're just like really frustrated being like, am I going to have this forever? Like, um, I think it's useful to finish with a bit of like expectations about injuries and how like runners themselves should like move forward, like what mentality we should have, because I constantly hear people being like, I just want to get rid of PhD. just want to eradicate it from my life, never to come back. And I just want to be injury free and like those sorts of things. And that's great. It's great goal to have a great thing to implement to sort of focus. towards. However, realistically, if you want to run fast, if you want to run a fast mile, 5k half marathon, full marathon, like you're going to be stressing your body. And sometimes you might just nudge into an overloaded state. And sometimes that those symptoms come back. And if we have these ambitions to better ourselves and continue triggering adaptation and keep going, going, you know, every now and then we're gonna fall across that overloaded line and symptoms might come back. And so what I usually have for as a realistic expectation for some is we want to, if there are some signs that, uh, injuries emerging, we catch it really early and we have a slight adjustment to your training plan and then move forward without a loss of fitness. think where some people go wrong is there's a slight sensational early signs of symptoms. They ignore it, they keep training, it gets worse, and then they have to take a huge reduction in their training volume or like a big start making big sacrifices, big restrictions in order to overcome this injury. What we want to do is have these really subtle adjustments, slight dialing back, slightly dialing up, dialing back, dialing up based on how symptoms emerging and we're catching them really early. So that over, you know, five, 10 years span, we haven't really lost fitness. We continue to build up, we continue to build up capacity and function. listening to our body along the way, rather than people just going through these big boom bust cycles and being really harsh to themselves. And if, if these injuries keep coming back, being like, Oh, am I ever going to get rid of this? I want this gone for the rest of my life. I never want to experience it again. want, what am I doing wrong? think mentally that's, it's quite hard to live that those high expectations. It's hard to live with those, those things. And so maybe it's a bit reassuring for some people who are listening. Hey, if you are pushing yourself, if you are racing, if you're wanting to run far, run fast, like these injuries are just part of life. We want to try to catch them early, make subtle adjustments, get back without losing fitness, get back to another training block symptom free. You know that they are goals to have, but reassurance to know if it does come back, Hey, it's part of life. Let's make adjustments. Let's be resourceful and learn from that past little hiccup that we had. So we're more resilient moving forward. I think that's a good. final message to finish on. Anything else you want to mention before we sign off? Um, I've got one little thing. It's not a little thing. It's a really big thing actually. Um, I just want to, on behalf of the running community, I just want to say a huge thank you to you for everything that you're doing. Um, you know, this, this podcast you have, like what an amazing resource. Like there are tons that you go see at the average physio and they have no clue what you have and like, There's a lot of people who are you know, stuck with this thing and they're desperate and they don't know what to do. And, you know, the fact that you're putting all this information together, like a really specific injury, you've got a podcast dedicated to this, specific injury. Like I think that's amazing. And it's, it's like saved me. It was a huge lifeline for me. And I just want to tell you, like, I'm really grateful. I know you're helping like tons of people. And I just want to say like, thank you and keep doing what you're Appreciate you. Yeah. Uh, I think this story has been great for a number of reasons. One, the fact that you've had it again and then can overcome it and learn a bunch of lessons from that helps people who do have a resurgence or a PhD on the other side and another one, they think themselves as a failure. should have learned by now, but you know, like I say, this is life. And the fact that we now have this success story, I haven't really, I don't think I've had a repeat. success story on here. So it's good that you've managed to reach out. I'm very happy that you're considering me and this podcast and helping this community to reach out and share. Cause it wasn't on my cord. You just reached out to me via email. So appreciate you for doing that and helping others in doing so. And so thanks for coming on. Yeah. Thanks very much. 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 personally connect with me, including a free 20 minute injury chat to discuss your current rehab and any tweaks you might need to make. 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 your PHT.