Amy's PHT Success Story

: On today's episode, Amy's PHT success story. 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. bust the widespread misconceptions. My name is Brody Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series and a chronic proximal hamstring tendinopathy 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. So let's give you the right knowledge along with practical takeaways in today's lesson. special shout out to Alicia, who's a keen avid listener of the podcast who messaged me was several weeks ago now saying I could really use a PhD success story right about now to a couple of weeks. Sorry, Alicia, but we eventually got there. Hopefully this is enlightening and inspirational and strikes a lot of positivity for you. Um, I have done an Amy success story in the past. I'm doing too many success stories. People having to double up with the same names, but this is a different Amy. from what we've already listened to. Um, and here's her story. Amy, thanks for joining me on the podcast today. Thanks for having me. Let's dive into your story. Um, I think it might be good to start off with just an introduction of who you are, where you're from and what sort of like athletic backgrounds you come from. Sure. Um, so, uh, my name is Amy Beck. I live in San Francisco, California. Um, I'm a pediatrician. I am a runner. I started running probably in medical school for really for stress reduction. And I didn't really run that far or that often at the time, but during my medical training. And then really actually after having children and then trying to kind of get back in shape after. pregnancies and all of that, I started to run more often. And then, I don't know, something like in, really like in 2017 when, actually, no. 2018. Yeah. And something clicked and I just started running a lot and got really, got much more into it and started doing, uh, road races and trail races, and then some half marathons and one, one marathon in 2019. So, okay. Do you have like a favorite distance or a favorite, um, terrain that you prefer? Well, I mean, I really love trails, but it's, it's a little hard for me to run on trails on a regular basis, but I do like signing up for trail races. And, um, and we do, I mean, as a family, we do a lot of hiking. Um, that's the nice thing about Northern California. We have like a lot of beautiful trails and places to hike. Um, and then for a road, I mean, I, I've always, I've enjoyed the half marathons a lot that I've done. So. Nice. We're going to get into your PhD injury, but I thought I'd ask prior to that, had you had any significant running related injuries that, um, halted your running progress? No, I didn't. And it's sort of interesting in thinking back, you know, cause I trained for a marathon in 2019 and I didn't get injured. And then, you know, why, you know, after all of that, um, but you know, I, in retrospect, I do think that. in training for certain things, I was following a training plan. And I think that may have been protective because I was following something that was sort of set out by someone who, you know, had a good idea of like, what would be a good, you know, type of a good, you know, progression and a good advance in terms of mileage. And so, but yeah, no, before PhD, I really, well, I guess I did have a little bout of piriformis syndrome. maybe a few months before I got the PhD, but it was, it was pretty mild. And I just, I think I rested for two weeks and did some stretching and it got better. Right. Okay. Well, your onset of PhD, how long ago was that? So I think, I think it actually very early first started, um, back in February of 2020. I mean, I mean, actually distinctly remember we had, well, we had gone skiing and I, and I, then I was. you know, running and feeling this pain. And I was thinking, could I have done something skiing? But it just didn't really make sense to me because I, I don't know, I hadn't fallen, et cetera. But I did feel, you know, some, just like some deep, you know, buttock pain. And then it was sort of be there at the start of the run and then actually get better as the run, you know, as I was running. And so I read, was doing some reading and I thought, oh, you know, just based on the location of the pain, like this is probably PhD. And I just started doing some bridges and it got better. But then, you know, that was February, 2020 and then the pandemic started. And, you know, and there was a long period of time when, you know, we have young kids and they were not, you know, in school or childcare. And so I basically just stopped really having any time to exercise. And then in just kind of like November 2020, things, we had like a better childcare situation. And I started to run again. And then I think I started to use running as a, like a kind of to just help with like stress and anxiety, maybe more so than I had done in the past. And I think I've kind of gotten the mindset of like, well, running makes me feel good. The more I run, the better I'll feel and kind of ramped up. And then the symptoms came back. And then You know, they just got much worse at that point. So I tried the bridges and, you know, I didn't really see any improvement. So, right. Well, I guess it kind of makes sense why the PhD would appear from skiing in the first place. Like you're looking at like a slightly bent over crouch type of exercise where you're utilizing, well, your glutes a lot, but I think that constant bending over is putting compression on that upper hamstring quite a lot. And You know, maybe in combination with some running, maybe it was enough to, you know, trigger some sort of stimulus to, to create pain, but seems like based on life circumstances, there wasn't enough, um, challenging running or regular running to notice if it was sticking around or whether those initial bridges were effective enough to really sort of get rid of it for good. It kind of like went dormant because my running went dormant. Exactly. And so. returning to running, um, once everything back opened up, back up again, you mentioned that you might've done a little bit too much. Are you, are you talking about like progressing the distance or maybe the frequency per week? I think both. I mean, I think, I mean, I went from not running much at all and I went up to five times a week pretty quickly. Um, and then yeah, definitely distance. Um, you know, I mean, I was I was running maybe like four to five miles on weekdays, like three times a week, and then like one longer run on the weekends. And I think I, you know, just increasing the distance of that longer run pretty fast. And I wasn't, I mean, there were no races or anything. It was just kind of, I felt like I wanted to have that feeling of like challenging myself and, you know, increasing distance and so. I think I just was pushing it too far. Do you think it was a gradual onset or was there like one moment, one run when like afterwards it increased symptoms? Um, what was that onset like? It was definitely gradual. You know, it was like, Oh, there's that feeling again. Oh, but then, you know, you would run and I would feel it for like miles one and two, and then it would get better. Um, and then, you know, so I feel like December, 2020. I was having symptoms with running, but it was more the sort of nagging, like low grade pain. And then like January, February, it sort of really ramped up. And then I would have pain after the run. And then I like developed the pain with sitting and with driving in particular, being in the car. So And then it just, I feel like it just like took a life, took on a life of its own. Like I cut back on the running and the pain got worse and, you know, the, the sitting pain, like it felt like each week, my tolerance for sitting went down. So. Yeah. It sounds like very similar for say tendinopathies in general, but, uh, plantar fasciitis, especially it seems to really gradually come on and. the point where it doesn't really bother you, but then it just hangs around for a couple of weeks, you're like, oh yeah, there's that symptom again. And not until it starts to disrupt things that it becomes a bit more like that urgency starts to creep up. Whereas before like the level of urgency is quite low. It's like, oh yeah, I can still run running is actually pain free. Once I've warmed up and you know, let's just see how it goes. And then like you say, it carries over into daily activities, sitting driving. Um, sometimes with PhD people are like bending, stretching, picking things up off the floor. Like that's sorta against us to irritate and carry over into those particular tasks. Did you notice that for you? Oh yeah, absolutely. Yeah. I mean, like just, you know, my kids, like their beds are kind of low. And so just like bending over at night to like, you know, I would be like, oh, mommy doesn't want to do this, you know? So, yeah, no, absolutely. Um. Yeah. And any stretching, you know, of the hamstring was, was super painful. So, yeah, quite tough as well when your initial running, like you say, is for mental health and sort of relieving of stress and anxiety. Did you have to take much of a reduction in terms of, or was your running restricted or affected in any way? Yeah. I mean, I, I can't remember exactly when, but I think at some point in February of 2020, I just stopped running entirely. I mean, I was even having pain with like long walks. And so, yeah, I think that probably the total, my total like not running at all was, I don't know, eight or nine weeks, I wanna say. And then I like started to see a physical therapist. And then after that, I found your podcast and video course. Yay. Right. Yeah. And there was, and that was all very, that was very positive, but yeah, I think it was at least eight or 10 weeks that I didn't run at all. Was the decision to take the running time off, was that based on, oh, let me just give it some rest and see if it gets any better, or did you think that, you know, maybe let me try another thing. So you. You substitute running for something else to see if it improves. No, I just, I thought if I keep running, this is going to get worse, you know? And I just was worried that I was making it worse by running. Um, and yeah, and it was just too uncomfortable, honestly, because, you know, it was, it would flare up so much after a run that I would be taking ibuprofen. And I didn't want to be taking like so much, like, you know, I don't know. Yeah. Um, to be taking NSAIDs on a regular basis like that. And so it felt like I just needed to, you know, needed to stop. And I mean, there was so much, there's so much information out there. So there were people who were like, you will not heal your PhD if you do not stop running. Other people were, you must continue running. You know, so yeah, but so yeah, so for about eight or nine weeks, I was, I stopped, I mean, at least I stopped running entirely. I was still doing some walking, but. Okay. Well, what was your experience when you stopped running? Did you notice an improvement in your symptoms, say like with sitting and those daily tasks? No, I will say not particularly. Um, and I think that was, that was very frustrating because I, I wouldn't say it got worse, but I definitely felt like I stopped running. And I, I kind of thought that the like worst of the symptoms that were, you know, like, as you said, sort of impacting your day to day that they would. that those would resolve because this was quote unquote caused by running. Um, but that, you know, that just, it didn't happen. It, it felt like the pain was sitting almost sort of accelerated. Um, yeah. And everything just kind of either certain symptoms were like stagnant, but, um, you know, I also had pain kind of down the back of my leg as a little bit as well. And yeah, that didn't, it did not get better with stopping running. Yeah. Well, it's a principle I talk about a lot. It's. Usually with running related injuries, you know, it'd make intuitive sense that I just need to take time off and wait for symptoms to settle because the body does an amazing job of healing itself and I'll just get back to running and happy days, but you know, most often that's not the case if anything, if symptoms do get better from complete rest, you know, the return back to running almost causes symptoms again, because you haven't actively addressed the capacity of that particular structure because If you continue to run with it, it gets weaker or it gets more sensitive. A sensitive structure like reduces its adaptation zone. And so you're sort of resting and, um, deconditioning that whole tendon or that whole, um, muscle unit. And yeah, it makes sense. And especially if it gets to the point where that particular level of irritation and that particular strength is so low that sitting irritates it or bending forward, irritates it, then we're removing the running. further contributing to weakness, but you know, those daily tasks that continue to irritate it, there's no long term strategy for recovery. And you did mention taking an extended time off and then you mentioned starting some PT was where was that when you started doing that? Where in the rest period did you? It was pretty early on, I think it was like about a week or two in, you know, I was like, okay, I got to do something. And I did, I mean, I had started the, you know, the bridges again, because that had been helpful, you know, with the very, very initial symptoms that I'd had, although that was, at that point, that was, you know, practically a year, you know, prior, but I didn't really see improvement. And so, I went to see a physical therapist. And I mean, I think there were certain things, that she definitely got right. I mean, she said, you need hamstrings. I think she said, to use the word dynamic recovery, she said, you don't want to stop all activity. You need to kind of find the right zone. And she did start me with hamstrings strengthening pretty early on, but she also really, I think what she didn't know is that you shouldn't be stretching. So she was encouraging me to stretch and even doing having me stretch during the sessions. Um, and my sense was it was making things worse, but. You know, it's hard. I feel like when you're getting advice from someone, you feel like, well, let me give this a try, you know, and, and see what's going to happen. And so I think the first couple of weeks, I think that the stretching, any benefit I was getting from the, you know, starting some strengthening, um, was just sort of offset by, um, really, it was just getting really worse, um, with the stretching. And so. Um, yeah. So that's why I was so like when I found your podcast and then the video course, and, you know, I already felt like the stretchy was making it worse. And there's just like hearing like, you know, don't stretch, um, that's not going to work well for this injury. And, you know, and then you need to take this sort of progressive strengthening approach, um, you know, and adding, adding weight and adding load, um, that was all, you know, just so, so helpful. Um, And the physical therapist, I mean, I, I mean, I, I kind of just shared a lot of the information with her and she, um, was really open to it and also very, very good about helping me to like make a program, you know, based on that information, it's like, okay, excellent. You think you're at this stage, like let's, you know, let's try these, um, specific exercises. And so. Yeah. So that's great. Uh, pay day. Yeah. So once I stopped stretching and kind of convinced her that was not a good idea. I think she also like had this, and I feel like you've mentioned this before, maybe other guests of yours have mentioned this, that she thought that part of the problem was like related to like pelvic positioning and like anti, like kind of like, I guess, the introversion of the pelvis. And I mean, yeah, I don't know. So I was doing certain exercises for that, but I wasn't really seeing specific benefit from them, but I think around like week three of seeing her, I started doing like some of the Nordic dips. And then I started doing bridges also like with, you know, my legs elevated. And I think even just that one week of a little bit more, you know, load and a little bit more compression, I noticed improvements. And then Yeah. And then the deadlifts. Good. Yes. We'll talk about the deadlifts in a second. Um, one thing that I want to bring up with the stretching is, um, you know, there's, it sort of swings in a couple of directions. Like if I, 10 years ago, people were like, Oh yeah, stretch PhD, stretch your hamstring injury, cause that's, um, going to help alleviate symptoms. Found out that's not really the case. It's not really helpful to recovery, but then people with PhD read that. Stretching is no good and they sort of swing in the other direction and say, okay, all stretching is bad and they sort of develop a fear and anxiety around stretching. And so then they do their strengthening and even when they get a lot better, they just persist for months and years of just really scared about stretching because they feel that it's going to come back or exacerbate or it's bad. And so that's kind of like the protective, um, sort of overreaction to, to that advice. And so where I tend to sit on it, now that I've seen the swing in both directions is like, like anything, your hamstring can tolerate a certain amount of stretch. And we want to try and make sure that when it is irritated, yeah, it probably can't tolerate a lot of stretch. So it's probably best that we don't do static stretches or overstretch. But then when it settles down, you sort of want to develop the tolerance to stretch because you need to stretch it for everyday life to pick something up off the floor to you know, if you want to do some cycling or if you want to sit like all of that's like a low level of stretching that needs to be tolerated. And so, um, and if your goal is to return to stretching or yoga classes or Pilates or those sorts of things, then like you do with strength, you just build up that tolerance with a progressive strengthening, not a progressive strengthening, but a stretching sort of regime, um, so that you don't sort of. you're not left with those anxieties of, oh my God, I can't stretch this, this injury because it's going to make things worse. And so, um, would you feel any grants with that? Yeah. I mean, now, now I, now I, now I do stretch, not a ton, but, um, yeah. I mean, I mean, prior to this, I used to do this like bar workout. Um, not, you know, super religiously, but you know, do it a couple of times of week here and there, um, just using. I mean, before I had kids, I used to go in person and then it was a little too much, you know, so I would do some of their video and streaming. And there was a lot of stretching. So I kind of missed it, you know, when I stopped because it actually, you know, it feels good, et cetera. And so, yeah, more recently, I have I have resumed stretching both my hamstring and my quads. But yeah, and like you said, being able to bend over and pick something up. Exactly. Yeah. I think it was just in that very acute phase of, yeah, that the stretching and also sort of having someone else do the stretching for you, it just, I noticed almost immediately that it kind of flared the pain up and so. But yeah, I do stretch now. Good, I'm glad. Well. I'm glad that you actually found the podcast in the online course because someone can really easily be assigned stretches and strengthening exercises and then it not get better. And then you scrap both of them and say, no, this isn't working. Um, they, you can immediately sort of dismiss the strengthening exercises because you're not getting better. Um, so I'm glad that you sort of came to the realization, okay, let me remove just the stretching. Let me keep the strengthening and then move forward from there. So when did things that actually sort of. When did the needle start to move towards recovery? When did you start seeing some sort of progress being made? I think it was probably about six weeks in, um, when I don't remember the like exact sequence, but, um, you know, I was, I was doing the, the Nordic, um, dips and, and doing the, um, you know, the bridges and with my legs up. And I started doing the Swiss ball rollouts. And I mean, they were really hard and they like, it was, it was painful when I did them, but. Um, you know, it just started light. And then I think, then I started, um, with the single leg, uh, I don't know. My PT would call them Romanian deadlifts, like the single leg. Yeah, we can do single leg deadlifts. Yeah. Like with a kettlebell. Um, and that, and then, yeah, then I moved on to, um, like, you know, actual, I mean, I just, I just got a barbell on plates cause our gym was still, you know, there, there was not really a lot of opportunities for, um, you know, going to the gym and equipment. And so I just was doing everything with home equipment. But I think about six weeks into sort of progressive strengthening, I started to feel quite a bit better. And I mean, I was still having pain and I was still having pain with sitting. And then I think basically in May, so it was probably be like eight or nine weeks of not running, I started to run, but very, very. You know, small amounts initially. Um, we also got a dog at the end of April who's a very active dog. And so I think even just, I mean, even this, like the walking I was doing with him, you know, started to just dog a little bit because he is just a very hyper and, you know, just one of these dogs who needs a lot of exercise. And so then kind of slowly built up from there. Um, so you mentioned the Bridges, you increase to putting your feet up on an elevated surface. You mentioned the Nordic hip dips would be like, you know, strapping your foot underneath something and then dipping forward at the hips. So kind of bending at the hips rather than doing your traditional Nordic drop, which is like, you keep your whole body straight and sort of drop towards the ground. You mentioned single leg deadlifts. You mentioned getting a bar and sort of starting to do heavier stuff with that. Did you have any particular guidelines in terms of how to progress, when to progress, what pain to follow? Um, how would you know when it's time to progress? What sort of parameters did you have? Um, well, I mean, you had a lot of great information in the course. So I, I tried to, um, you know, I tried to sort of assess basically like, how did it feel during the exercise? And then how did it feel after the exercise in, you know, tried to go with if there's some discomfort during the exercise, that's okay. As long as I wasn't, you know, worse the next day that I, you know, than I had been previously. And I felt like at least for, you know, for the all of the strengthening exercises that I was doing that worked pretty well. You know, I kind of, I mean, I think it was, I think I had a lot of apprehension and you could have talked about this and people have a lot of apprehension initially and they're worried that anything that is going to kind of put any strain on the tendon, you know, it's gonna make the pain worse. And so I think, you know, the first few weeks I wasn't using any actual weight, but yeah. Then once I started, you know, just tried to just, you know, be very gradual about it and yeah, just slowly increase. And I mean, at that point I actually was going to the, seeing the physical therapist twice a week. And so She, and then I went to once a week and then every other week. Um, so she was really good about saying, okay, you know, you've, you've done. You know, this many sets are this weight and like, I think it seems like you're ready for the next thing and, and helping me with the form, um, and making sure that, you know, that was, um, good so that I, you know, I mean, I was worried. I was like, Oh my, I'm gonna do deadlifts. I'm gonna hurt my back. So, um, yeah. So she was really helpful with all of that. And then eventually adding in some of the plyometric exercises, which I feel like maybe it was probably about eight weeks before I started doing any of that. Okay. What were the plyometric exercises? Just like a lot of jumping, like the back and forth. I forget what they're all called, but... Um, was that like a lunge? So you go into a lunge, jump up, swap sides and yeah, I did that. And then, um, and yeah, and just like hopping back and forth over a line and you know, forward and back side to side. Um, these other ones, I, I forget what they're called, but where you're, you sort of jump and then put one leg kind of behind the other and then, you know, back in the other direction. Um, But, and I mean, again, similarly, like at the start of each one, I was like, Oh, you know, this is like, is this going to clear things up, et cetera. Um, but you know, just starting gradually increasing, paying attention, seeing how I felt the next day. Um, and I think when I first started to run, there was this challenge of could I run and then, you know, even though the running was a lot of mostly walking, but Could I do any running and then do the strength training on the same day? And initially I couldn't, it was too much. So if I did some deadlifts and like a sort of a full, what I kind of considered like my PT session and then tried to run on the same day, I felt like that would, it was not good and I would have a lot more pain the next day. And so then I realized I just needed to alternate because for a while when I wasn't running, I was actually doing the PT exercises, something every single day. which is why I decided to launch this podcast. So if you're building upon your own rehab knowledge through the podcast, but still require tailored assistance, I'd love to be on your rehab team. Whether you are a runner or not, head to runsmarter.online to see your available options for working together. If you're still unsure if physiotherapy is right for you, or if you need a rehab second opinion, you can always schedule a free 20 minute injury chat with me. Find the free injury chat button on my website. or in the podcast show notes to be taken to my online calendar to book in a time. Well, it's just about running a test, right? It's like, okay, can I handle my strength and run on the same day? Well, how about we don't do all of your strength, we just do some of it. And then we just do a little run, do that in the same day and see how you feel the next day and if symptoms are increased, you're probably like, okay, might not be ready for that. Yeah. I did, but you did mention when it started, you started doing the heavier sort of stuff, the apprehension or, you know, nervous to say, okay, is this going to flare up my tendon? And I guess the more you do it and the more you progress, the more you increase your confidence as well. Yeah. The, I've seen a lot of, um, PhD clients like try a deadlift or try an exercise and they're like, oh yeah, I just go down until the point where I feel pain. And then I come back up. And often I think when that's the case, um, you sort of want to go through that. slight stretchy, uncomfortable, um, symptom for a bit. Like if you're doing, say a deadlift, go beyond the point where you feel that stretch, because like you say, people start being fearful and they say, okay, let me just do it all pain free. But I actually encourage people to do a range of movement that does provoke some of that discomfort because otherwise you're not providing that stimulus for the tendon and actually it's what they enjoy provided that it's not irritated afterwards. And so someone does a deadlift through a bit of discomfort. And it's maybe a two or three out of 10 during and quickly settles afterwards. You're probably into the right sweet spot. Did you find that particularly for you? Yeah, no, absolutely. Absolutely. Yeah. No, there was, I definitely realized that I had to be okay with, you know, with some pain during, and that some pain during the PT exercises did not necessarily. Was not a bad thing. And oftentimes, oftentimes I felt like when I was in the sweet spot, like I would like, even by the next day I would feel like, Oh, I feel better. You know, I feel stronger. I have more tolerance for sitting, you know, et cetera. Um, so yeah, no, I definitely, um, I had to, I had to kind of play around with that, um, and like you said, just, just feel comfortable. Um, and I mean, I made mistakes too. Uh, I'm not so much with the strength training, but I mean, with, you know, the returning to running, like just. You know, having after a while I got to the point where kind of where I had been initially where I would only have pain at the beginning of a run. Um, and it would start to go away. And so that was sort of dangerous because then I would tell myself like, Oh, I can keep going because I feel good. Um, and then I, you know, at least two or three times, you know, really overdid it, ran too far. you know, and then, you know, the next, even within a few hours, like, you know, had a much, much more of a flare up. Um, so. Did you have a written down structure of like, you know, returning to running and how much do you increase and that sort of stuff? I did not, you know, I, I just, well, I mean, how dare you. Yeah. I was very structured, like with the strength, because I had the physical therapist, you know, with this, and she would, um, kind of. verbally tell me things and also write them down for me. So that part, I felt like there was a lot of structure. And then returning to running, I mean, I kind of just started with like, let me walk and then I'll run a few blocks and then I'll walk the rest. And then I, you know, just, then eventually I progressed to, for one mile I would walk a block, run a block, walk a block, run a block, you know. But then, you know, eventually I was like, oh, I... I, you know, I can run a couple of miles. Um, and then yeah, they're like crazy runner mind. You're like, oh, if I can run two, I can run four. Or there was one day where I had, you know, in the prior week had been able to run four twice and I was like, oh, I can run seven. No, seven is like a really big step up and not a good idea, but so. I think we're identifying a bit of a, a missing link here in not only your recovery, but what happened to the injury in the first place? Like you said, in the past, you've trained for a marathon following a plan and everything went well. And then all of a sudden, you know, once you started increasing your running without a plan, developed the PhD and then upon your rehab sort of phase, you had a plan for your strength and conditioning all went well. And then didn't have a plan for the running that caused a couple of flare-ups and setbacks, and you could probably. Um, accurately assume that if you did have a running plan, you'd probably return a lot quicker because you know, every little flare up has a little setback and a, um, you know, delays that recovery. I was going to ask about flare ups if you did have, if you encountered any flare ups throughout your rehab, but it sounded like from those, um, from you sharing that it did sound like you did have a couple, how did you deal with that sort of mentally? I know a lot of people, they see initial success. And then they have a setback and they're thinking, Oh, am I always going to have this is like, is this ever going to go away? What if I keep doing the wrong thing? Um, were you able to, was your mentality okay, whenever those symptoms increased? I think by the time I was at the point where, I mean, literally it was like one week running four miles, and then I decided to, you know, do a long run and ran seven, I think at that point, I, I had, I had learned enough to realize like. oh, that was just a foolish mistake, you know, and that was really not a smart thing to do. But, you know, probably it's going to be okay if I, you know, step back and it just was sort of able to take it in stride. I think there were a couple of times earlier when it was a much smaller step that caused a flare up, you know, like, oh, just running up for just a slightly more distance that I think I was more worried and frustrated and more concerned about that sense of chronicity, is this ever going to go away. But again, some of your podcasts were really helpful and just thinking about, I mean, I think there was just realizing that sort of catastrophic thinking. in and of itself is very harmful and is not, it's just once you get into that mindset, you're not thinking critically and you're not sort of recognizing what are the patterns and what are the steps that you can take. And so trying to just kind of pull myself back from that abyss of like, I'm never gonna run again, I'm never gonna do a race again, et cetera. And I was able to. sort of, you know, reframe, but, and then I think also just the accepting, which took me a little while, but accepting that it was going to be a long process, you know, that it wasn't, this wasn't going to be a two month injury or a one month injury, you know, it was going to be a multi month injury and, um, you know, but still healable and curable, um, something that could get better, but was not going to get better quickly. So, yeah. I think a nice lesson to have, and it's quite reassuring when you say that the flare ups that got you down the most was making the most gradual increase in that exacerbating symptoms. Reassuring for people who are injured to know that, yes, you do need to be patient and you do need to take those steps really gradually. But when you're starting from baseline, like you hadn't ran for 10 weeks and you're just getting started, you're pretty much starting from the ground up. And when you start from the ground up... It's, it's almost harder to get from zero Ks to five Ks or like from zero minutes of running to 30 minutes of running, it's harder to do that than to go from 30 minutes to 60 minutes. It's almost like you, you develop a bit of stability and foundation along the way. And then going from a successful 10 K to 20 K is even easier. And it's just because you're sort of laying that foundation, that foundation takes a lot of time. But once you have a bit more of a robust, um, resilient. tendon and structure, you can just follow those principles, as long as you follow those principles that those leaps and bounds become easier and easier and easier. And you sort of gather that momentum. And so I know there'd be a ton of people listening to this already that's frustrated with their little flare ups, just making those little increments. And so that reminder can be very, very reassuring. Yeah, yeah. No, definitely in the beginning, it was, you know, very... It was very discouraging. But yeah, I think after, I don't know, maybe, I mean, I was trying to think back, like, how long did it take me to, you know, get to a 10K, which is kind of what I would have considered like a nice good run, like not a super long run, but a run that, you know, I would, and I think it, I don't, I think it really took like May, June, July, August, it really took me like four to five months from. starting running again to, you know, comfortably running a 10 K. So, um, which, and from there, I guess, what's your, what sort of momentum have you managed to build like, you know, progressing your strength, progressing your running. What, what have you progressed towards? Yeah. So I did, um, I did two half marathons in the spring. Um, and then I started to train for a marathon, but then I, well, then I got I had COVID and had kind of a miserable, you know, several weeks with that. And then other life stressors, some family illness and things like that. So the summer has not been great. And then the piriformis syndrome kind of kicked in, but which I'm, my most recent injury, but I'm coming back from. But yeah, but it was nice to those two half marathons. I, you know, absolutely were, were pain free. So. Excellent. Did you do any particular speed workouts or is it all just slow running with that buildup? Um, you know, I'm trying to think I, if I, did I do speed workouts before the half marathon a little bit, but again, not super structured. Um, I mean, I do a lot, a lot, a lot of Hills, not. it's just because of the neighborhood that I live in. I mean San Francisco is like incredibly hilly terrain. So we're kind of just always running hills and which is nice. Cause then if you do a race, which is flatter then you realize how much fitness you've gained from running all the hills. But no, I didn't do any structured speed workout. I sometimes will do like some strides or some, you know. intervals if I'm doing a shorter run. Um, but nothing, nothing very concrete or structured. Hmm. If like looking back on your whole journey, um, is there like a couple of key revelations or principles that you think really did help move the needle? Like, I know, you know, some might have a bigger impact than others in your eyes. Um, despite like several things actually having benefit. Can you think of anything on top of mind? So I think, you know, just the, just sort of recognizing the whole concept of, you know, load versus capacity and that, and just realizing how sort of dynamic, you know, that was going to be over time. And that in order to get over this injury, I was going to have to do specific exercises, you know, to load the tendon and to, you know, put stress on the tendon. to make it stronger and healthier. And then also take that same approach in starting running and just sort of that interplay, I think was really just understanding that conceptually. And I think probably it has a lot of parallels with other overuse injuries, but just sort of understanding the nature of. overuse injuries and tendinopathies in general, I think was really, really helpful. And, you know, just even though, okay, yeah, maybe we don't understand the exact pathophysiology like at a molecular level for some of these things, but those principles for me were very helpful. And yeah, I think just recognizing that it was going to be a long path, but that people do get better. from these injuries that, you know, it's not, this is not a life sentence of a PhD necessarily. You can improve. Yeah. Well said. Is there any other, I guess, final advice that you might have for someone who does have a running related injury or a PhD that might be really struggling? Is there any particular words of wisdom or anything that we haven't covered yet that you think you might want to share? So I do think that I did benefit from some of the episodes about stress reduction, mindfulness, and thinking about the impact of stress and stress hormones on recovery and sleep, all of those things. I think in the beginning, I was thinking about things very purely mechanistically. I have this tendon, this tendon has this problem, I have to load the tendon in a certain way, I have to start loading it into compression. It was sort of like, I was like a car mechanic, you know, trying to fix my tendon. And I have this physical therapist is going to help me figure out the right exercises, et cetera. Um, but I think, you know, that the more holistic approach and, you know, considering those other aspects, um, I do feel like made a difference. I mean, again, my, you know, my N of one, um, and just, you know, the sort of speed of recovery, taking those other things into consideration, um, And then it's also the sort of the relationship that one has with running. Like you said, you know, if you're it is challenging if you're using running for stress relief and then need to cut back or stop running entirely. I think that, you know, that is difficult. And so trying to have a bigger arsenal of possible approaches to deal with stress. recognizing that running is a great one, but it's probably not, shouldn't be your only approach so that you have some other tools in the toolbox if you need to cut back on running and also to sort of squelch a little bit of that desire to, well, if this feels good, if running makes me, X amount of distance makes me feel good, then even more is gonna be better, because sometimes I think that can lead to overdoing it. So that balance, I mean, I still think running is great for stress relief. And so I don't, I think that's like scientifically proven really at this point. Um, but you know, probably not. I think people, you know, you need to have something, you need to have other, other avenues and other approaches, um, at the same time. I'm constantly struggling with clients who only run and need to run because it's their stress relief and they're injured. Like that combination is just really tough to negotiate for. Um, cause you're taking away a love and a stress relief, but you're also in pain. Like all of those things are just, um, it's, it's a really poor experience. And if you don't have any other alternatives, and then on top of that, once you are making those small gains, try and celebrate those, try and focus on those positives of making those, those gains. Because I know a lot of people that do make those gains like, yeah, well, I'm not running pain free yet. And then they're running pain free and they say, no, while I'm running pain free, but it's not 10 K like I used to. And then they'll probably get to 10 K. It's like, yeah, but I'm doing it really slow. I need to be faster. And like, it's never enough. Like, yeah, we can strive to the next step, but celebrate the winds along the way. The more, like you mentioned with the catastrophizing that sort of stuff. If your mindset is a little bit more positive, it actually helps your recovery and helps the overall experience. You know, pain is very, very close linked to misery. And if we can sort of break that cycle and the overall rehab is a little bit more positive in the whole experience, then the enjoyment for appreciating what she can do rather than what you can't do is like, it's just a better journey. Absolutely. Yeah. I mean, one of the things that I tried to do was to think, okay, what are all the things that I like about running? And can I, you know, is it possible? to get some of that in other ways. And it's like, well, I like being outside. Well, if I'm outside and I'm walking, you know, or outside and really, you know, I like having a little time to myself in the morning. You know, it's, you know, like, I mean, my run takes me out to the beach and back. So, you know, I like being able to see the ocean every day, if ever, so briefly, et cetera. And so, you know, trying to mentally realize that Yes, there was the actual running and the, you know, endorphins and elevated heart rate and feeling of accomplishment, but you know, there were other aspects of, of going for a run that, um, you know, had these benefits and, and could be obtained other ways. And again, that's looking at the holistic approach is looking at, you know, stress, um, mindset as well as just the physical mechanical side of it as well, so I'm very glad now, I guess it all started with you. wanting to have a better understanding and sort of investing in the knowledge of the injury itself, rather than just having someone tell you what to do and have someone go through, just write down the instructions you wanted to actively seek out your own knowledge and understanding of this condition. So credit to you for doing that and seemed like it was a crucial part into your overall recovery and sort of empowering you a little bit more. And yeah, it just... carries over, leads to some good successes, better understanding, not only for this injury, but if another injury was to happen, I'm sure with this Piriformis stuff, you're applying the same principles and if there's another injury down the track, those same principles would apply. And so investing in those knowledge is the ethos of the Run Smarter podcast and we can do great things if we invest in a little bit of knowledge. And so... Thanks for sharing all those principles and thanks for coming on and sharing your story. My pleasure. 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. your way forward towards an empowering pain-free future and remember knowledge is power.