Amy's PHT success story

: On today's episode, Amy's PHT success story. 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. success story. I will continue releasing these on the regular because I find them super valuable, particularly for all these PhD listeners. It's good to know that even the most chronic conditions can be overcome. Amy's had or had it for a good two years, very debilitating for about two years and has seen the other side. So we dive into some very key concepts. when it comes to rehab and we, I guess, summarize them at the end, but hopefully you can pick up on them during hearing Amy's story, but yeah, I'm excited to bring it to you. Amy was great to have on and I'll continue to put my feelers out there to find more success stories. So let's dive in. Amy, first of all, welcome to the podcast. Thank you. Thanks for having me, Brody. I always love finding people who have these success stories and I know that we kind of reached out, you know, might've been about six months ago now, but I eventually got back around to you to say, hey, let's jump on and let's hear your story. So I guess before we go into the injury and all that sort of stuff, do you want to just introduce yourself and where you're from? Sure. So my name is Amy. I am from the United States, from New York. I live in a suburb outside of New York City on Long Island. about 10 minutes away from the Atlantic Ocean. Cool. And you did go through the liberties of emailing me like your injury history, but what I found very interesting at the start of the email was you're one of these weird runners who just likes to run on a treadmill. How did that come about? So, I have always run just for myself, for meditation. I can honestly tell you I've never run a race until two years ago when I met... my best friend who is the mother of my son's best friend. And she said, well, first of all, I always ran the same speed, same amount of mileage every day, years and years and years and years on the treadmill. I'd run three and a half, eight and a half minute miles and that was my thing. And then I did other stuff and it was my meditation. And I know it's weird. I didn't know how many people had the hatred of the treadmill until I met. you know, these, uh, these runners that real runners, I guess, I always talk about like real runners, because I never perceived myself as that. And so, um, my friend, you know, we started running, you know, she hates the gym, but we were at the gym together one day and she was running on the treadmill next to me and she was like, Oh my God, you're so running so fast, you know, whatever, you should run a race. So I was like, okay, you know, I, I didn't really want to, but then I was in the midst of all this horribleness with the injuries that I was having. And, um, my sports chiro was like, you know, maybe you should, maybe you should sign up for a race and it will give us both, um, you know, a deadline to sort of get you well. Okay. And so I did. And, uh, I ran my first 5k and won my age group and, and I've been doing that since, but I still am a diehard treadmill runner. I think the hardest part of COVID was, um, running outside. after never having run outside. It was a big transition. What's your dislikes with running outside? My dislikes, when I've had to do it before, I zone out when I run. So traffic, dogs, people, just I don't, when I run, it's almost like when you drive to the store and you arrive there, but you don't remember going. You don't remember driving. Do you know what And so I lose that's when I'm on the treadmill, it's like two miles, three miles for it. You know, I'm training for a half marathon now, my first one, you know, and I ran 10 miles on Sunday and it's like, it's just like, it's just, I zone out. It's meditative for me. And so I feel like when I'm outside, somehow I don't get that same feeling because I'm so distracted by having to pay attention. And I think it's that sort of. Um, not being able to go into that meditative state because I have to be so aware of the other things. So it's not enjoyable for me, but I get that most people love the nature aspect and I get it. Well, I can see your point of view as well. It's good to actually know that it's, um, rational why you love the treadmill so much. Yeah. So let's go back to 2018, cause this is when your injuries started arising. Um, Talk us through if there was much change in your training and sort of what were your initial symptoms. I think it was, you know, like I said, I never ran on a cross country team. So I never had like a running coach or a track coach or anyone. So the things that I did, I just did, you know, myself, not really knowing anything. And so, you know, I'd been running, you know, probably four times a week, maybe four miles or whatever. And I just decided that I just wanted to start running faster. and I just did start running faster and just didn't really think anything of it. And at first, the injury that brought me to the sports Cairo was I was starting to have heel pain on my right side. And I didn't, again, didn't think anything of it. You know what I'm saying? And then, you know, I had it like off and on maybe after I'd run for about six months and I had a coworker who was like, oh, you have plantar fasciitis or whatever. I was like, yeah, whatever, you know, and I was just continued stupidly to run through it. And then I would say, so this was probably May of that year of 2018. And then by September, I started having like, just kind of like a weird achy pain in the top of my hamstring. But again, didn't really think anything of it. It wasn't major. It was usually like the last mile of my run. And it wasn't, it wasn't that big a deal, you know? And when I, so I finally did go to a sports Cairo. And I kind of mentioned the hamstring, like just honestly, as like an afterthought. Do you know what I'm saying? You know, you get the thing where you have to mark off the X's where your pain is and whatever. And I was like, you know, I don't really think it's that big a deal. He thought it was my piriformis. You know what I'm saying? And so I continued running through it, you know, and the pain started getting worse, started getting sharper, it started happening earlier. And I just didn't stop. because I just don't. I don't know if I know a lot of, I have running friends who also have similar things, just, you know, the kind of inability to stop running because you just can't fathom the world without it. And, um, yeah, so, so he, um, I think I, I started having problems sitting down then, you know, And that's when I mentioned it. You know, I'd see him like once a week or whatever. So, you know, you see somebody for 15 minutes and they ask you the questions, but it's like, you know, when I started saying I can't, I don't think he even really got it when I said I can't sit down, you know? And then I think, weirdly enough, I just Googled runner can't sit. And this whole article about proximal hamstring tendinopathy came up. Yes, that's all I did. I just Google and I was like, and I started reading it and I was like, Oh, This is, it's like literally, you know, reading your biography. You know what I'm saying? And, um, and I started reading it and reading it. And then I, and then the next time I, you know, and, you know, my sports Cairo may have had an inkling. He's, he like, doesn't really say, you know, people were like, you have plantar fasciitis, he doesn't do that. You know what I'm saying? He's just like treats it or whatever, but doesn't really like definitively ever say you have this, which is, you know. When I look back on it, it's like, you know, and it's hard sometimes to figure out what certain things are. It's a very common, I guess, story that I hear often because similar to plantar fasciitis, often with people with PHT, it can just creep up on you all of a sudden, it's kind of like, yeah, I've noticed it, but I've noticed it for a couple of weeks, but it's not too bad, and then it just hangs around for several weeks and your level of functioning or aspects outside of running, all of a sudden started to become a little bit more debilitating, like you say, with your sitting. And it starts to almost paint the picture of PHT like later on down the track. And I can assume that a lot of listeners who do have PHT would be like, nodding their heads when you say that originally it was diagnosed as piriformis, because it does seem to be somewhere in the glute region. And can be very... easily misdiagnosed. But how long did you have symptoms before you came across that article and realized, hey, maybe I do have proximal hamstring tendinopathy? I think probably like, you know, two or three months maybe. Yeah. Before that happened, when you did, well, when you're essentially treating the Benefits with the treatment that you had approached and what sort of treatments were, did the sports car give you? He was using, like doing like grassed in, um, active release, you know, um, he didn't really send me for an MRI. Um, I didn't think it was like that bad at first. And, and he also said he doesn't usually send someone for an MRI unless he feels like the course of treatment's going to change and, um, He did send me for x-rays to rule out, I guess it's called like an avul- something fracture? Avulsion, yeah, an avulsion fracture. Like at one point when I said I was having like sharp pain, he was concerned about that. And then I happened upon this other YouTube, I sent you this rehab exercise with this- woman, Carolyn Jordan, who has like a YouTube channel for, you know, sort of like rehab exercises and strength training for runners. And that was another thing my sports chiro said. I will tell you, the first thing he said to me is, you have to do something else besides run. Like you have to strength train. You need to do something else. So in my head, I was like, oh, like something else cardio. And he's like, no, you have to strength train. Like, you know, so, so I did start. doing like squats, but I think that was made it worse to be perfectly honest. You know, it was like, I was too deep into it at that point. Um, so I do have to say that I did start doing elliptical starting like alternating in that, but I really hated it. I didn't love it, you know? And it wasn't until it got really bad that, um, that I started, you know, I did start doing the rehab exercises. And then I think the thing that really put the breaks on, like maybe got through my head finally, and this is a long time I'm telling you. So this was September. I w it was April Fool's Day because I remember the week before or the weeks before having conversation with my sports cover and he was like, I think you need to take a break from running. And I was like, I'm sorry, what? Like it was just like, it's not, I'm not understanding what you're saying. Do you know what I'm saying? Because I think you need to take a break. You can do other things that don't bother it. You could do elliptical if it doesn't bother it. You could do strength training if it doesn't bother it. But you need to take like a month. And I just was like... So I just... I didn't know what to say. I was just... I just couldn't deal. I know it sounds crazy, but I just couldn't deal with it. I just have too much of an addiction problem to running. Most people can relate. most people can get into trouble when like running is their outlet. It's like the only form of exercise that they love that actually helps satisfy them mentally, it's for mental health as well as physical health. And so if they take that away and you don't have that adequate substitute, like you may have a substitute, but if it doesn't really scratch that itch, um, it can be. A real, and that's what I told him too. I told him it didn't, you know, I did the elliptical and like, you don't understand, it doesn't give me the same high, like it doesn't, I don't get meditative on the elliptical. I don't get, you know, especially if I'm running fast, there's just like a superhuman feeling that you don't get from anything else. So he was like, I really want you to think about it. He's like, take one more run and think about it. So April fool's day. 2019, I started feeling it on the other side. And that was, you know, I was like, okay. I texted him, I said, you win, I'll take a month. You know, that for me, everybody has their, whatever you wanna call it, the aha moment, you know? And that was it for me, you know? I mean, I was running through too much admittedly when I looked back on it. Um, you know, obviously totally had a laugh at lack of self control working on that. I'm working on myself, learned a lot about myself through this whole journey to be perfectly honest. Um, and, um, so I did, I took a month off. I took the month of April off from running and it was one of the longest months of my life and I, um, did the rehab exercise, started doing those rehab exercises that I sent to you every single day. And I remember. watching the video and her saying, you know, they had to do them every day, have to be religious, and that it took her two years to get over this injury. And I was like, ugh, you know? Like right away, you're doing rehab exercises that you're being told you're gonna have to do every day. And the video's telling me it's gonna take me two years. And I'm thinking two years, like two years, you know? So, so slowly, things did start to get better, you know, very slowly. And my chiro was definitely, he's not a runner, but he does have a lot of runner patients. And he just did say to me, you know, he was started, it took a while before he started asking me detailed questions about how I run. You know what I'm saying? So he would say things like, do you warm up and you cool down? I'm like, yes, of course. You know what I'm saying? I walk for a half a mile and then when I'm done. But I guess he never asked me the detailed questions, which were like, basically, you know, I get on the treadmill, I walk, and then I go right to my top speed and run my miles at my top speed. And he was just like, yeah, you can't, you can't do that. That's just, you really need to like start out slowly and just, you know, and so when I started training differently, I did start seeing results for sure. Um, I will say, um, I also stretched. Um, after running, because it was one of those things that like people do, you know? And, um, I remember reading a book on exercise recovery and about, uh, Dr. Gabe Merkin, who was like the, you know, the sports injury guy saying, coming back and saying like, no stretching, like there's no benefit of stretching. You're just harming, you know, other than like gymnasts who do it for that or maybe some yoga or whatever. And so I stopped stretching. And that. was kind of a game changer for me as well. Right. Okay. Um, good to know, good to see, good to have that, um, your experience and share those experiences, but when I'm hearing your story, uh, let me know if I'm wrong, but I do talk about this downward spiral of, um, levels of tolerance. So like originally you could tolerate high levels of running, but just get a bit of soreness at the end and then all of a sudden it slowly gets worse. So the. Capacity of your running starts to slowly diminish or you keep up the same level, the same capacity, but the symptoms just get worse and worse. And then all of a sudden you try these like squats and that makes it worse. And the squats might irritate the running and then you're limited to certain amount of things that you can do. And then all of a sudden you can't run. So you have to take time off that. And then you have to really pull back the brakes because you're just working your way down that downward spiral. Because. every time you're just pushing slightly above what you can tolerate and it's making it worse. And so that the capacity continues to diminish. Is that kind of what that experience felt like? Absolutely. And like a vicious cycle, you know, and like I'd make small gains and then just feel disastrous afterwards. And I have to say for me, like the worst part about it is like the mental game of it all. And another part about it is... people who aren't runners, you know, just don't get it. You know, I'd have people at work that would see me because I just couldn't sit anymore. And I mean, I could sit, it was just so painful to sit. And so I just stood all day long. And then after a while, you know, you, when I look back on it, it seems crazy, but you know, like you're saying this, these things, you just kind of adapt, you know, and you adapt to the pain. You just like, you know, like, you know, like you're, you're lying in the sand, keeps getting pushed a little further. So. I would stand up all day and then people at work would say things to me and I'm like, well, you know, I have this like injury and whatever. And then people would just say, well, you know, you just need to stop running, you know, like as if it's as simple as that. Do you know what I'm saying? Like then all your problems will go away. And you know, and my sports chiro is really good. I mean, he has always said that his active patients do better when they're active. You know, like modify what you're doing, but stay active because the mental part of just stopping is so hard for so many people who are active, you know? Um, so I will say that when I just stopped stretching, like cancer, and when I say I stopped, I never stretch anymore. Ever. At all. Um, at all. I mean, maybe if I do like. back exercises were more like yoga or things like meditative things. And I will even say that there were some yoga that I was doing that I didn't realize were so bad until I started watching that rehab video and doing that. Those like downward dogs, horrible. Like for me at least, you know, I don't know about other people, but I think it's little weird things like that, that like the running fast. plus the stretching and the downward dogs, there were like things than squats, things that I were doing that I just didn't realize. So by that summer, I started seeing real gains on the right side. And it may just be total coincidence, but there was one time where my sports Cairo like just really attacked it with the... active release and the next day it was super pain, like crazy, crazy. I went for a run and then like two days later it was just gone. And I know that that's not, you know, whatever I've read things that, you know, should do this treatment, you shouldn't do that treatment. It could be for on the right side. You know, it was gone. It was still on the left side and the left side was where I had it. second, do you know what I'm saying? And that ended up sticking around longer. Do you know what I'm saying? You know, my chiro said that's possible like just running with it for so long just messed up my gait or you know, just the over the compensation He's like, you know, you realize when you're running with this much pain That your body is compensating for it whether you think you are or not, you know and so You know I don't know who knows. Do you know what I'm saying? Can I maybe ask you've mentioned this exercise video that you did while you did some time off and I had a quick look through the video when you sent it over to me and it's probably like 20 minutes long and it's a lot of bodyweight exercises. There's a lot of like bridges, clamshells, like a lot of hip strengthening exercises for people who don't know that for that video. Can you maybe just explain like what the routine was just briefly just so we get an idea? Yeah. So like Glute bridges for sure. And she was saying during the video, like that she did them every single day. And so, and then I think they call them, is it like a standing glute bridge? And then there's a star plank and there's like clam shells. And, you know, for me, I found it easy to have that video just because like I did the exercises faithfully. It was easier to do them more faithfully for me. with that video and then I got myself into the mentality that I just had to do it every single day, like she said, because when I did it every single day, I really started noticing gains. So I basically fit it into my life like I did brushing my teeth, you know? Like I really, honestly never skipped a day. And when I never skipped a day, I really noticed the difference. And so the right side went away and it has not come back at all. I mean, I, when I say that I can't feel it, I can't feel it. And it was so bad. It would wake me up in the middle of the night, multiple times a night, stabbing pain. You know, horrible. Like, you know, I'd roll over in my sleep, stabbing pain. When it was really bad, I would sleep in compression leggings. I would live in compression leggings. It was one of the few things that, and honestly, I don't think I could have run without compression leggings. For me, that was a big, I would suggest to anyone who has this and they're at the beginning, even just walking, I would feel it walking, you know? Even a slightly sloped sidewalk, just even just the slightest slope of a sidewalk and I would feel it, you know? And hills, forget it. Hills, just forget it. When you, when you took that month off running, um, a couple of questions. So one, did you find it of benefit to have that one month off running? And two, what was the process like returning to running? Did you just go back to what you, your usual routine, your usual like mileage or dip, was there a slow ease into it? Uh, no, of course I went right back into it. I mean, I'm not going to lie to you. No, I went right back into it. And then actually like a month later, when I started getting better, I just decided that I should run more. Um, I will tell you also something that was a big game changer for me was, um, my sports Kyra really got on my case about, um, sleeping diet. Um, I never did things like put electrolyte, you know, I have these electrolyte tablets that I put in my water. I didn't do any of that stuff. I was not like what I want to say, like a gym person. I just did my stuff and I went home. And so I started, I did change my diet to more of a high protein diet. I was kind of almost a vegetarian. I considered myself to be someone who ate healthy, but he was just like, you weigh absolutely need more protein in your diet. And also he told me to be more conscious about when I was eating. being conscious about like after running all those miles and then not eating for hours and hours and hours and just being more conscious of those sorts of things, which is something I just didn't think about, you know? And then that part though I find difficult because there's just so many variables with this. And I think that's what makes this such a difficult thing, like many injuries, is that it isn't just the one thing maybe, you know? It is like the lack of sleep and then... you know, diet and running on hills or running too fast or doing too much stretching or, you know, whatever it is, it's so hard then to dissect it and figure out what is the thing. It's not just the one thing. And so then, you know, it's so hard, you're conducting this science experiment, which is such a poor science experiment because you're just changing, you know, that's what I felt like I had to do. So my chiro suggested like, when I would... change something, just change like one thing, and then wait like a month, you know? Cause I was so impatient. He's like, you really have to give something like at least a month, you know? Don't just say like, okay, I'm gonna do this exercise, whatever. So I think that trying lots of different things, you know? Like heat, obviously heat helped me tremendously. So once I got like a heating pad and that kind of thing. slowing my pace down was really, really hard, really hard. But I do have to say that I feel like I had an advantage as a treadmill runner because I could very easily control my speed, like slowly ramping up and then slowly, you know what I'm saying? So as a treadmill runner, I think I had an advantage in healing myself. So one thing I would say to people who want to, you know, maybe get back into running or they've given up on it or whatever. And my Cairo was very much like, you have got to be, you know, I would make games and he would be like, do you think I could just like speed it? He's like, no, no. He's like, just keep on the slow path. Very slow path. You know? It does require a lot of discipline, like, and especially people can find themselves in the trap where as soon as they feel better, if they feel, if they have a good week or if they have a good two weeks, they, they're so eager to like push themselves. They're so eager to increase their running mileage, finally get back to the mileage they want to do. And then all of a sudden that's too much. And then they find themselves back a couple of weeks. And I like what you're talking about with the, the variables and treating things as an experiment, because I constantly do that with the, the runners I work with. It's. If I give them some exercises, instead of giving them five exercises, I give them two to three and say, let's see how that goes. Because if you give them six exercises and they feel worse, well, which one was it? Was it a combination of all of them? It's really hard to know, but you've kind of realized that yourself outside of like rehab, but into recovery as well. So the sleep and the diets and the heat and strength and the running variables, just slowly. implementing one thing at a time. I always say as well that you kind of need to put your scientist's hat on. And it's kind of like conducting experiments. And another thing to highlight would be that because you've had this pain for so long, that means you kind of need to be more patient with analyzing and assessing the effectiveness of it. If someone's had a two week injury, maybe they can be, maybe they can test things out for like a week or two. But for something so long standing, um, it really does have to be patient. Like you say, maybe. take it three, four, five weeks sometimes just to see if that routine, that change in routine is effective. And then if it is, you can keep that in and then try and find another thing to pile on top of that to like help the effectiveness. And that's the hard thing. It's really hard because you know, I didn't have a lot of patience and then you start to feel better and you're like, it's gone, it's gone. And then all it for me. I had a lot of setbacks and I sure a lot of people feel the same way. And it's the mental, the mental part of having that setback is so horrible. When you think I'm done, I'm finished with this. And then, you know, for me, it was like, there was a race I ran that had hills and in that just, do you know what I'm saying? And then I feel like, but I think for me, it was just kind of like, okay, well, you got to just calm yourself down, rewire your brain, and just kind of get back to the basic, just go back. For me, that's why that video, you know, and it may not work for other people, but for me, I just went back to that. It was just like, just that you know that works if you just keep with it and do that consistently. And I really feel like you have to be consistent with it, at least for me. I feel like if I hadn't done it every single day and that slow strengthening. I don't think I'd be where I am today. Yeah. And I took a long time. You mentioned in the email as well that you got, well, it was suggested to you that you get referred to a pain management doctor or a pain management specialist. Um, what was that experience like? So, so, I mean, this is obviously a, you know, a 40 minute podcast, so I can't give you the total details and this is like a shortened version but I will say that 2019 personally for me was one of the most horrible years of my life and I had a lot of personal things that happened to me in various facets of my life a good friend passed away suddenly a lot of things happened to me and my sports chiro really started thinking that I might have fibromyalgia that that he, I also, in addition to this plantar fasciitis, I tore my AC joint, I had rotator cuff tears, I had to go to physical therapy for that. And he said to me, I'm concerned for your overall health that you have been in so much pain for so long. So he sent me to, he's like, I really think you need to see this pain management doctor that I know. And as an aside, I will tell you that I'm also in addition to being, you know, one of these weird people that loves the treadmill, I'm also one of these weird people that doesn't take ibuprofen. So I'm not anti-medicine by any stretch of the imagination. I guess I just, I have running friends that like pop ibuprofen and then go for a run, you know, and I just, to me, I feel like the pain is what stops me from really going completely off the rails, you know? And I also feel like I'm responsible for this pain. Do you know what I'm saying? Like to try to, you know, so with the pain management person, I said to my chiro, is he gonna make me, you know, am I gonna get shots, injections, whatever? And he's like, no, no. He's like, he's a like a world renowned acupuncturist, I guess himself. And he does do injections or whatever. And he saw me, you know? And he himself told me that I have enthesiopathy, which, you know, Honestly, I don't know. He was, you know, fibromyalgia. I read about that. It seems to be sort of, I don't know. I don't, I don't know enough about everything, but they seem similar. Do you know what I'm saying? For me, it was like potato, potato. I don't really care what you call it, whatever it is, it's not great. You know? So, um, he, I started doing acupuncture there and, um, I will tell you that I was not. I was not thinking that this was going to work. I'm going to be really honest with you. Cause I was just like, you know, you have to be kidding me really. Do you know what I'm saying? And he said that he was open to other things, but that he wanted me to try this first. So he also did tell me that he felt that it might make it a lot worse before it made it better. And I was like, okay. So I went to acupuncture about twice a week. It was electro acupuncture. And with the needles, I would say on the entire belly of my hamstring, close up to where the insertion point is. I'd been having problems with my hip, you know, and so all over, you know. And I would say it was pretty intense the first like few weeks. It did make it a lot worse. It really did. And then I... I probably went for about four months and... drastic improvements, incredible improvements. And then by the end of... the year that I was doing that, it was just going away. I mean, I felt like I was at the point where I would go to acupuncture and she would ask me like where to put the needles and I couldn't even like feel the pain, you know? And again, I did not think that would do anything, do you know? And again, maybe it was coincidence, you know? I will tell you that when I went to the pain management first and I really was... recommitting to the exercises, you know, because I would do them every day and then I would do them like five days a week, you know what I mean? So again, all I can say is that it went away after I did electroacupuncture. I don't know what to say and it hasn't come back. Can you, can you share that like during that four months, uh, was it steadily getting better from day one, like from treatment? It was, no, it got worse. And like he said, it got much worse, much worse. And when did you start noticing a gradual improvement? How far into those four months? After a month, after a month, I started noticing it slowly getting better. Yeah. Um, but I will tell you the first month. I will, after the first treatment, I was like feeling okay. And then on the drive home, I was like, wow, I feel a little bit weird, you know? And then I felt like I got hit by a train. I mean, it was really pretty crazy. And yeah, after about a month, it started getting slowly better, you know? And steadily better and steadily better and steadily better. And then literally it was just gone. And then, but again, certain things were gradual, like, I will have to say that like, while I say it was gone, it was gone when I was running. But then like sitting was still kind of a problem for me. And then I remember, I think you posted something about training, sit training. Did you post something about sit training that I listened to? Um, not, I wouldn't use the term sit training, so it might've been somewhere else. It might've been somewhere else, or maybe somebody posted it on one of the Facebook groups, the PhD Facebook groups. Maybe somebody posted that. And yes, it was somewhere, it was a YouTube thing that somebody posted. And, um, and I did realize that part of the, the sitting that I had to kind of just get over my fear of sitting, like I had realized that I had actually had like a fear of sitting. which is crazy, you know, I mean, and so that was, even after it kind of went away, I still felt like, so I could run and not have pain, but if I sat for more than like 15, 20 minutes, 30 minutes, it would, I would feel it again and then I would stand. So that was probably like another month or two of just getting to the point. I also was weird. I just, would tell myself I'm going to sit at work, because by this time I was back at work after COVID, and I would sit at work, and then all of a sudden I would find myself standing, like, because I was just so used to standing. So I had to remind myself to sit, like that I could sit. So that was a hard mental thing, you know? It probably took me a couple of months that I realized I sat at work, and I was like, wow, I think I've been sitting for, you know, 45 minutes. It was, you know. And so at this point, I think I'm probably, it's been about six months and it hasn't come back. Wow. I've, I've had here and there, you know, I'm training for a half marathon. So I'm running more miles than I have. Sometimes I run faster than I should. Um, I will every once in a while I will like feel it, do you know? And then, and then mentally it kind of hits me. And then, um, I will say that. that my sports car road will say to me things like, just because you're having a bad day doesn't mean it's like quote unquote, coming back. Because I did him, it's coming back. It's coming back. You know, I'm like this, you know, he's like, you can have a bad day and it's just a bad day. He's like, or you can run too far. And maybe your body is just not bouncing back as quickly. So just, you know, so I've had to really retrain myself to like listen to myself, I'm so rigid and disciplined that it's like, if I'm going to run on this day and this day and this day, I'm going to run on this day. I've had to like stop doing that. You know, I've had to start listening to my body. And that's a really hard thing, I think, for a lot of runners when you're just like, it's my day, I'm running. I think the big thing that helped me too, and that I'm going to do consistently that I have been the last couple of years, is I swapped out. every other run with elliptical. So I will just do that forever. I've acknowledged that I just don't think that I can run every day ever again. This podcast episode is sponsored by the Run Smarter Physiotherapy Clinic, which is my own physio clinic where I help treat a wide range of PhD sufferers, both locally in person. and all over the world with online physiotherapy packages. In the years I've been self-employed as a physio, close to 70% of my entire caseload has been helping people with proximal hamstring tendinopathy, 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, I think that's sensible because what we know about tendons, especially, is that when you subject the tendons to load. They take about 24 hours to go through this repair cycle to like absorb the load, kind of adapt, kind of, um, rebuild, and then it's ready to be loaded again. And sometimes if someone's had a long history of soreness and a long history of that, like loading and just getting irritated, they probably need that, that cycle. And so that, though, the elliptical, like subbing out the run through the elliptical is probably just that kind of rest day, kind of a bit more of a. less harsh load to that tendon. So I can just, yeah, repeat that cycle. Can I go back to the sitting as well? Because it's a very, very important topic, especially with people with PhD, because I often hear people say, yeah, I've recovered from PhD. And then I say, oh, so how's your sitting? And they say, oh no, I don't sit anymore. That I, that I just don't do that anymore because if I do, it will come back or I fear it will come back or just get sore if I sit. So. I asked the question, well, have you really recovered? Have you just been avoiding all the things that might bring on pain? And it's like, if someone wants to sprint or like run fast and they say, oh yeah, I've fully recovered. Oh no, I don't sprint anymore. I want, I probably would want to, but I just can't do any speed work anymore. So have they really recovered? Uh, I really like that. Not only when it comes to that sit, the, the sit training, when you're slowly rebuilding yourself up. You're increasing the tissue tolerance to tolerate sitting, but it's also changing your relationship with sitting. Like you said, you were very fearful of sitting and so it changes the, what the brain thinks about sitting as well as being like, you know what, I could probably tolerate 60 seconds of sitting. And then all of a sudden you're like, yep, 60 seconds was fine. Maybe next day or maybe the next week, maybe I'll try two minutes. And then slowly, but surely you just not only building up the tissue tolerance, but you're calming down the mind. And. Allaying that fear around sitting. Um, so it's, it's very important that not only people just do the things that reduce the pain, but then they also need to start reintroducing everyday activities because, you know, sitting's a part of life. It's sitting's like sitting down with your family to eat, sitting down at the movies with some friends. It's like a very, very crucial part of your social interaction. Yeah, it really did. It really did. It was kind of like if my husband and I would go for like a date night, it would be at a bar because I could stand at a bar. Do you know what I'm saying? And then you're thinking like, this is crazy. I can't sit in a restaurant because a lot of the restaurant chairs will be like, you know, solid wood, which is just not cushioned. So, you know, and so that, but even still, I wouldn't say that when you talk about it that way, I wouldn't say that I'm a hundred percent where I need to be because like, I want to run faster and physically I can, cardio wise I can for sure, but speed still will flare it up. So right now, you know, I've committed to myself that I'm not going to do any speed training because I'm doing lots of miles to train for this half marathon. And so that's my goal sort of like for next year. You know, for next year, um, I feel like I want to be away from this injury for like a really consistently long period of time. And then when I do speed train, it just has to be really, really slow. And just like, if I get it and then it flares up and you know, I have to, you know, the hard thing too is like not freaking out, you know, when it, when it happens again, like just saying that you're just, it's maybe you're just having a bad day or a bad couple of days. And don't. Um, cause like I said, the mental game of it is so difficult. It's so, so difficult. Well, let's just translate this. What we were just talking about with the sitting around the building up tissue tolerance, but also addressing that fear and addressing the, the worry of sitting. Now we can talk about the speed work and say, okay, currently, um, there's a bit of fear attached to speed currently. You wouldn't be able to tolerate speed. Uh, that would. bring on symptoms, but speed's very subjective. It's just running slightly faster than what you're currently doing. So if you were to allay that fear and say, after your, um, your race, um, after your training, say, how about if I run slightly faster for 20 seconds? How about if I just do that just in my, in one session? How about if I just run faster for 20 seconds? Then I see how I go. That's just that stepping stone into that. And then Maybe next time, maybe I do two rounds of running faster for 20 seconds, maybe somewhere close to the start, somewhere close to the end, see how I go. And then you do that for a couple of weeks. And then we're building up the tissue tolerance for speed, very gradually and very slowly, but we're allaying the same fear around building up speed. And it doesn't have to be sprint. It doesn't have to be like 70% of your sprint. It could just be slightly faster than what you're currently running. And so it's, um, again, patience again, it's like methodical. It's that science experiments, putting on that scientist hat, like we were talking about before. Um, but again, um, you did mention that you don't stretch anymore. Um, I wanted to, I wanted to ask, how do you feel like if you had to pick something up off the floor or if you have to bend forward to pick up a box? I squat. I'm terrified still of that. So again, you're saying like, oh, I'm there, but you're right. I'm not there because I will not, no, I will not, I will not bend over and pick up something heavy. So my, I will squat down and pick up something. Yep. Which you probably should do anyway, but I have people who are constantly, well, you might be in the same situation, just apprehensive to do, to stretch that hamstring, which It's more than capable of actually doing because in the past, too much stretching while the tendon is irritated will then irritate the tendon, but people associate just even small amounts of stretching as being detrimental for the tendon, which it isn't. And so when people are, um, when people are building up their level of tolerance, they're running, they're strong. Um, they then similar to the sitting, then just have a fear of just bending forward and just putting stretch on the tendon, which It's not going to do any sort of damage, but the apprehension and the fear is still there that might need to be encouraged. So some people are even cautious or apprehensive to squat to pick something up because that kind of stretches the hamstring slightly as well. But yeah, I just thought I'd ask because there's a few patterns in your language and a few things, a few little inklings that you're giving away to make me think that there's still a little bit of recovery that needs to happen. Yeah, yeah, I'm not a hundred percent there. It's always like, you know, the work in progress. And another thing that I've, that I've done is I, uh, I also did, um, I get custom insoles. I think that made a big difference. Um, my feet are pretty flat and I think, I mean, who knows, but that has made a big difference, but it was also a big adjustment, you know, running, um, with those I had to run through, you know, I started having back pain and other things and been working through that. And I've also been, um, I had read something about, you know, like long strides. I think I was probably over striding. So I've been working really hard on my cadence. Um, and I really do feel like that actually made a big difference as well. You know, so this is the thing I could give you a laundry list of the things that I tried. And so I think that that's what makes this so difficult is I can't pinpoint. I could never, you know, it's like, like I've said all along to my sports Cairo, I'm conducting like the worst science experiment in the history of science experiments, because there's so many different variables, you know what I'm saying? When you change your diet and you focus on your sleep habits. And I also started, um, I also started, um, trying to, uh, meditate, you know? Um, cause my sports Cairo is really like really trying to get into my head about how much the anxiety and mental stress causes physical pain. And so I have seen that to be true, for sure. I started doing some meditation, listening, or videos, and I actually do, I started reading a book that's coming out soon about chronic pain. It talks about... neuroplastic pain and this whole thing. There's an app out now, I think it's called Curable App, and it's about this whole, the fear of pain and about sort of noticing the pain, but not being fearful of it, being curious of the pain. And so I've really tried to do this when I'm running and it has been helpful to... I feel like I'm having, you know, a particular pain or whatever to slow down my breathing, to, to calm myself down instead of I think before, especially with the PhD, the stabbing, I'd be freaking out, you know, as I'm running and I, that's obviously not helpful. So, um, so yeah, I'm still like a work in progress. Of course. I could talk about the meditation stuff all day and the relationship with pain. And I think I posted maybe about three weeks ago, a study where they took runners with knee pain and they had them go through the general rehab, but half of the group actually did meditation or like this, um, awareness and like training around, uh, like paying attention to the pain, but not attributing like anxiety to it and they recovered significantly quicker. I'm just based on adding in meditation. And if anyone's listened to the pain podcast episodes that I have, it makes a whole ton of sense why they would accelerate that healing because you're changing the relationship of pain. You're not attributing anxiety to it. You're not attributing fear to it. It's just appreciating it as, as it being there. And then the brain doesn't consider it as high of a priority in terms of, oh my God, this is the worst thing in the world. It's just more of a, oh, there it is. And it's just more calming and it's more relaxing for the brain that doesn't like hyper wire things up and doesn't create this hyper vigilance around the pain signals. And so that's great. It's great that you have it. And I actually did get the laundry list of all the things that you think that did help you. And I've got a list, maybe I'll read them out. So we've got your, your strength. video, you've got the ART, the active release therapy, the gradstones, hypervolting, heat, the high protein diet, the drink, electrolyte water, the lying down after running, the compression leggings while running, the acupuncture, the sports massage and the increasing in your cadence. So I did get that laundry list. Yes, because I am going to sports massage now. I don't go to acupuncture anymore, but I have a friend at work who turned me onto a great sports massage person and I do go once a week. And I do feel like, especially with the logging more miles, that definitely helps. Yeah. Awesome. I know we're probably gone a bit over time, but I just think this is fascinating. Like this, the conversation is really good. I think as a last question I want to ask, so what advice do you have for those who do have a longstanding injury, a longstanding PhD and they're not seeing results? What, what sort of advice would you have for them? Um, I would say like, just don't give up on yourself. I. When I was in this, I really thought, and I'd read these things about people who had it for eight years or seven years or they had it for two years and then it went away and it came back. Not to give up on yourself, because I was in that position where I thought there is no way this is ever going away. Like you can't have something this long and not have it go away. So like just believe in yourself and like give yourself a break. I think I really like beat myself up, that I caused this problem because I'm a runner. So don't beat yourself up. I think also, I kind of wish that I had found the online community earlier. I think to have an outlet, um, you know, my husband really doesn't want to talk about this, you know what I'm saying? And people who aren't runners don't want to talk about this. So I think like what my advice would be is find someone who you can talk to. I can tell you that I wouldn't have gotten through this without my sports Cairo. I mean, he's become a good friend and his, his mental guidance was as helpful. as what he did for my physical body. So that's what I would suggest. Find someone who you can talk to that gets it. Either reach out to someone else on one of these things that has it maybe, and I don't know, talk online, because I know a lot of people are all over the world. Find someone who you can have an outlet to talk about this with that isn't gonna think you're a crazy person. I think I would have done a lot better if I found someone else. When I found this group online, I was like, oh my God, there's others, you know, out there because I, I don't know another runner that has it to be honest. You know, I know people who have other injuries. Um, and then my other advice would be just keep trying different things. Like if this one thing isn't working, I mean, do like we were talking about before, give it a month or whatever, but if it isn't working, you know, maybe try something else. You know, um, I. When, when the pain management guy said acupuncture, I was like, you gotta be kidding me. You know what I'm saying? Like I've had this horrible thing for like two years and you're telling me that like acupuncture is going to fix this problem. I guess just be open, like keep an open mind to the different things that might work. There's plenty of different options out there. And I think, um, you took the words right in my mouth when you said that last bit of advice, cause we've been talking about it for the last, you know, half hour. It's. trying something different if what you're currently doing isn't working, but also have the patience to know that, well, at least have the sensible decision to give it some time to see if it is working because people do a couple of things. There's this one type of person that tries a new thing every week to see what's working and they're swapping the treatment too much. Then there's the other side where people try one thing for way too long, way too long. Um, sometimes there's maybe body weight exercises without progressing. They said, I've tried strengthening, it's not working. And then they've just been doing double leg bridges for the last six months without seeing any progress. Um, it could be like a massage or it could be like a, it might be an acupuncture or dry kneeling for someone. They've tried it. They've been continuing at it for six months and they just haven't seen results, but they still continue doing it. So there's somewhere in the middle. Make sure you're sensible with testing something out to see if it's effective. But then there's also the try something different if what you're doing isn't working, because like you said, you've got this laundry list, you've tried so many different things until you finally come across something that works. Uh, and now you build on those lessons and you continue what you know is working through, um, while you start to build up your tolerance, you're training for a half marathon, you like slowly just building things up, um, but you're still applying a lot of those things that you've learned along the way. And it does take patience. It does take time. but pays off in the long run. Well done. Um, so I think there's a lot of takeaways here, not only for PhD, but for people with other injuries as well, uh, just, just universal principles. It's like, Oh, sort of building up tissue tolerances. It's all laying a lot of fears. It's about being patient. It's about like different treatment, um, modalities. And so it's going to help a lot of people, even people without PhD is going to listen to this. Even people who want to, um, who want to overcome like these sort of injuries or want to prevent injuries as well. Because I think there's another little lesson, a little nugget in there when you're talking about this may come back as like a fleeting kind of maybe for a day, maybe for half a day. And it's not something to freak out at. It's something that you just appreciate because I do try and communicate to people who have had a certain injury for several months, several years. And I say, will I ever get over this and we say, yeah, well, you will have, you will be able to return back to what your, what your goals are. But there may be a time where you may be over-trained, maybe you have a high stressful week, maybe you have a poor sleeping week. It might just come back. It might just come back with very fleeting and you can overcome it very quickly and you can return back to your levels of activity very quickly. And so have you overcome it? Even though it comes back every now and then, I know every, almost every injury that I've had in the past. has come back in some form, whether it's a couple of days or just a day or so. But it's not something to be fearful of that you're going to have it for the rest of your life because you build lessons along the way, you build experiences along the way and you know how to overcome it very quickly. And there's a ton of lessons in here. So I really want to thank you for coming on, for sharing this story. Thank you. Thank you for asking me. I mean, honestly, you know, when I was in the thick of it, like all the things that I saw online that helped me were so in. helpful. So if it helps anybody, you know. Yeah, it'll help a lot of people, help a lot of people. I'm thrilled to do it. And I really appreciate you asking me. Thanks once again for listening and taking control of your rehab. If you are a runner and love learning through the podcast format, then go ahead and check out the Run Smarter podcast hosted by me. I'll include the link along with all the other links mentioned today in the show notes. So open up your device, click on the show description, and all the links will be there waiting for you. Congratulations on paving your way forward towards an empowering, pain-free future. And remember, knowledge is power.