“How do I know if I actually need surgery — or if rehab is still the right path?”
Drawing on decades of surgical experience and extensive research into hamstring avulsions and proximal hamstring tendinopathy (PHT), Dr. Lempainen walks through how he actually makes decisions in real clinical practice — not just what MRI scans show, but how symptoms, function, timelines, and rehab quality all fit together.
Together, Brodie and Lasse unpack the gray area that most runners live in: partial tears, chronic pain, mixed scan results, failed rehab attempts, and fear-based decision-making. The result is a balanced, evidence-informed discussion that helps runners understand where surgery fits — and where it doesn’t.
What You’ll Learn in This Episode:
How Surgeons Decide Who Actually Needs Surgery
- Why MRI findings alone are never enough
- The importance of correlating scans with clinical function and symptoms
- Why some complete avulsions heal well conservatively — and others don’t
Hamstring Avulsion vs Proximal Hamstring Tendinopathy (PHT)
- Key differences between acute avulsions, chronic avulsions, and tendinopathy
- Why not all “avulsions” are the same (1-tendon vs 3-tendon injuries)
- When retraction distance matters — and when it doesn’t
Critical Timing Windows
- Why acute avulsions should ideally be operated on within 2–3 weeks
- What happens when diagnosis is delayed
- When chronic injuries become harder (or impossible) to fully restore surgically
“Failed Rehab” — What That Really Means
- Why many runners are told they’ve “failed rehab” when they actually haven’t
- Common mistakes in conservative treatment (under-loading, poor progression)
- When even excellent rehab is unlikely to succeed due to tendon biology
What Surgery for PHT Actually Involves
- What surgeons look for during surgery beyond “tendon thickening”
- The role of semi-membranosus release, scar tissue, and sciatic nerve involvement
- Why surgeons often find structural issues not obvious on standard MRI
Common Pre- and Post-Op Mistakes
- Why under-diagnosis is one of the biggest pre-op risks
- Why returning to running too early post-op leads to setbacks
- The importance of fixing why the injury happened — not just repairing tissue
Key Takeaway
Most hamstring injuries — including many cases of PHT — can and should be treated conservatively.
But there is a subset of runners where surgery is not only appropriate — it’s the missing piece.
This episode helps you understand which group you fall into, without fear-based decisions or false hope.
What is Overcoming Proximal Hamstring Tendinopathy?
Proximal Hamstring Tendinopathy is a horrible condition affecting athletes and non-athletes alike. If you fall victim to the misguided information that is circulating the internet, symptoms can persist for months, sometimes years and start impacting your everyday life.
This podcast is for those looking for clear, evidence-based guidance to overcome Proximal Hamstring Tendinopathy. Hosted by Brodie Sharpe, an experienced physiotherapist and content creator, this podcast aims to provide you with the clarity & control you desperately need.
Each episode brings you one step closer to finally overcoming your proximal hamstring tendinopathy. With solo episodes by Brodie, success stories from past sufferers and professional interviews from physiotherapists, coaches, researchers and other health professionals so you get world class content.
Tune in from episode #1 to reap the full benefits and let's get your rehabilitation back on track!