Angela’s PHT Success Story

: On today's episode, Angela's PHT success story. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments, and of course, bust the widespread misconceptions. My name is Brodie Sharp. I'm an expert in the field of 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. Get ready for a few more success stories. I think I've got a fair few lined up at the moment. If all goes well and all the recordings and the scheduling that I have, probably expect another four or five success stories in the next 10 episodes. So you all are requesting them and yeah, more than happy to deliver and spread some positivity. Now we have Angela on this episode. I worked with Angela and had discharged her, she was doing really well towards the end of the gear in 2022. And then I received an email from Angela about her update. And so let me read it out for you now. Dear Brody, I want to thank you and tell you how instrumental you were to me reaching my goals. When I started working with you in the fall, I said that my goal was to PR the Boston Marathon. It seemed like a stretch given that I was totally terrified of speed work at that point. Well, I kept up with my rehab and since then, always asking myself, what would Brody say about this progression? And I went back to listening to all of your old podcast episodes to come up with a plan when my injury flared up a few weeks ago, I am so happy to say that I did it, I got a two minute PR on a tough hilly course in Boston. The PhD was the least of my worries throughout. In brackets, now the calf cramping and shredded quads, on the other hand, dot dot. You helped me realize that recovery was possible when all other PTs were just telling me not to run, not to run. I'm so grateful to you for empowering me to make real progress. I wouldn't say I'm 100% healed, but I no longer feel like it is a limitation. Thank you so much, all the best, Angela. In response to that, I reached out and said, congratulations, Angela. What sort of lessons have you learned? What sort of insights have you found to be beneficial? She's come up with a list of six things. And so she's going to jump onto the podcast. We're going to discuss all of those and dive into a bit more detail for each sort of topic, and it's going to end up being a very inspirational yet practical success story. Angela, thanks for joining me on the podcast. Thank you. I'm very happy to be here. I'm excited to have you. Um, let's dive in. We're doing it slightly different with these success stories, how instead of going through, you know, from start to end of this journey, um, you know, we've sort of talked back and forth about some of your insights throughout your journey. Um, but before we go into that, let's briefly cover, um, an intro, sort of who you are, like your running history. And also on top of that, like what sort of injuries, major injuries you've had. prior to this one. Okay. Yeah. So let's see. I was never really an athlete, like in school and whatnot, but I always kind of liked running. I always kind of gravitated towards it as my kind of like cardio. So I think for a long time, I would do like three miles on the treadmill and 30 minutes. And that was like kind of my max. And I was happy with that. Um, and then about five years ago, I, um, started a PhD program and I suddenly found, uh, myself not only with more like flexibility in my time, but also like new found like anxieties and stresses in life. Um, and I also happened to, uh, move to Chicago and I was just a few blocks from the, uh, Lake Michigan Lakefront. There's this beautiful trail. And so yeah, over time, over the course of a year or so, I just really ramped up. It was running a lot. I used it as a chance to listen to podcasts and audiobooks and like really getting that state of flow, you know, really being able to kind of be in the moment and really, I just developed a love for running. It was all solo. I wasn't doing races. But then, you know, like it starts to creep up like, Oh, maybe I'll just like hop in one of these races. See what it's like. people. So I did a 10k, had a great time, did a half marathon. And that one, it was like, wow, adrenaline, you know, like, it's just, you know, you can get competitive with yourself and with other people and, you know, do something you didn't think possible. So from there, I was really hooked and started running marathons, had a couple of really great races, I wasn't really having any issues with injuries. I think probably because I started so slowly and kind of worked up over time, like not because I knew to do that, but just naturally. And then, you know, I ran a 50 mile race, two falls ago, and that was sort of like the pinnacle. I was like, this is, this is really awesome. Really, really magical finishing that race. It was like part trails, part road, really big. It's one of the biggest ultra marathons in the world, the JFK 50 miler. And, um, so I loved it. Everything was going great. Um, occasionally I would have like runner's knee, you know, kind of like some knee pain when I was driving or things like that. But I kind of had it in my head that I was invincible. Uh, so, um, most people get that before, like, you know, a major injury. Yeah, exactly. So you can see where this is going. Uh, but not quite. So then the last thing I did, I had a. a really big training cycle. My goal was to qualify for the Boston Marathon. So, you know, I went out and I was doing a lot of mileage, which mileage wasn't really a problem for me, but I was doing a ton of like speed work and hills, you know, a bunch of 70 mile weeks with a lot of speed. I went out and I raced the marathon and I qualified, but then in the weeks after, I was realizing that just something wasn't quite right. I gave myself some time to recover, maybe not enough. Um, but there was just this pain and I couldn't even really identify it. It was, you know, it wasn't something that came on really sharply. It was just, it was starting to hurt a lot, you know, basically like in my butt when I was running and I couldn't quite figure out what's going on. And I remember one, uh, trail run with friends was like 19 miles. We got like halfway through and I just really just broke down crying because I was like, there's something's wrong. Like it hurts, um, to do the things that I thought, you know, were so easy before. Um, and then we had to run back. So, uh, it was, it was rough, but that's kind of the moment where I was like, okay, I need to do something. Um, can I ask how long, like, it's probably hard to remember, but how long do you reckon it took you to go from the very first onset of symptoms to that moment where it's like, okay, I really need to do something about it. I think I started. Honestly, it was probably a couple of weeks. And it all happened like after the marathon. Maybe I didn't even notice the pain at first. It probably crept on very, very slowly, but I just remember like, you know, trying to come back from this race and just feeling like something wasn't quite right. I also did some, you know, I... I thought in my head, I was like, oh, hills are better for your body than speed work. So I did like some hill workouts. And like in retrospect, I think all of that kind of exacerbated it. Like probably I was already in like a weakened state from having trained and raced so hard. And then, um, I don't know, I think it was over a couple of weeks when I went from like, something's not quite right to like, just like balling in the middle of the woods and Wisconsin with, you know, like 18 years, sorry, like eight or nine miles to head back to the car. Yeah. Yeah. Okay. Well, um, like I said, we're structuring this slightly differently. So, um, we know you're not entirely out of the woods just yet, but you've had, you've had some significant insights and progress along with this rehab. Um, but we have six areas or things that you'd like to cover six insights. We'll call it, but I guess it would be nice to sort of get people up to date with your rehab and like how things are going currently, what, you know, current sort of running mileage and symptoms are like that. So can we just fast forward through your rehab and just give us a brief summary of like what you've gone through and what you're up to now? Yeah. So if we want to like fast forward to the current day, um, I think I'm like, definitely like on track to, you know, being able to do anything I want. I think I am at a point where I can do whatever I want to. Have to be kind of smart about it and make sure I'm like keeping up with the exercises I still do feel the PhD occasionally, you know, we could talk about it. I kind of went away for a while I thought I was out of the woods had kind of a bad flare-up. I think now I'm not like Certainly, I feel it but I'm not so worried about it being like this huge limitation Yeah, and so I'm just I'm just back at it. I'm I'm training for a hundred mile race. I've signed up for one in September. So, um, so yeah, I, I don't think I'm like fully, you know, healed or, you know, a hundred percent recovered. Um, but I don't feel like it's a limitation. Yeah. Well, the fact that you've got that race to train for, and you feel like you're not too worried about it. I'd say you've made significant end roads, um, from now until, you know, when you first started having rehab or seeking treatment, how long has that been? in its entirety. Yeah, so it was probably, I think it was about May or June of last year when I like really was like, all right, I have to, at the time I was like, I have to stop. I have to like, in my head I was like, okay, first things first, you just take some time off, right? And so yeah, that's when I kind of started really dealing with stuff. And then I would say there were a few months of it being kind of bad and kind of. being out in the woods trying to figure out what to do with my rehab. I'm happy to talk a little bit more about sort of how, you know, how that process went. Um, you know, and what happened in the, in the mentor, uh, in the, in the meantime, if you like, but yeah, well, I think we'll dive into that. Cause, um, so we're looking about 12 months later, a lot of success, a lot of momentum with some hiccups along the way. Um, when I asked you to. write down some of your insights. The first one that you wrote down was flare-ups are normal and can be managed. So talk us through that flare-up itself and how you managed to negotiate it. Yeah. So let's see. After a few months of physical therapy that didn't quite go well and then working with you and then I kind of was back on track. And so I had a... training cycle, I started like around the beginning of this year to train for the Boston Marathon. And when I talked to you initially, I said my goal was that I wanted to like set a PR in the Boston Marathon. At the time that seemed actually like a stretch because at that moment I was afraid to run fast. I was afraid to run up hills. I had gotten to a point where I was like, okay, I can run slowly. And that, you know, doesn't seem to irritate things but like two fast laps around the track. were worse than a 20 mile run. So, you know, working through, doing the lifting exercises, just keeping really consistent, I got to a good place. And so I kind of thought I was out of the woods, honestly. Like January, February, I was feeling great. I was having other little issues along the way, but the PhD itself, I was just like, who would have thought this would be the least of my worries? So I thought I was out of the woods. And then I had a flare up and it was basically the week before my peak week. So in that, in my mind at that moment, I was kind of trying to figure out, okay, well, what would you do? Like, do I do the peak week? Do I do these speed workouts? Do I keep going at what I'm at? Um, and also like the pain, it was, it was really bad, honestly. Like, I think it was brought on by between the training and like doing a lot of sitting. One day I sat for like six hours, you know, working really hard on this hard bench, and then I got up and it was, I was in a lot of pain. And I think at that moment, I got really discouraged. I sort of was thinking, this is it, right? Like I've undone all this progress. And now that goal of running fast in Boston is not gonna happen. I think I really kind of sunk down emotionally when that happened. And I kind of sat there for a little while trying to figure out what to do. And then eventually I was like, Okay, let me just make a plan. Let me just keep moving forward. You know, I went back and I listened to like old episodes of the podcast about like flare ups. And, you know, specifically, I remember you know, the difference between like a like a painful weak tendon and a painful strong tendon. I was like, I know this is a strong tendon, because I lifting way heavier than I was, you know, a few months ago. So I was like, all right, I'm gonna I'm going to cut back. I'm going to rearrange. I'm going to maybe like not do the two big workouts that I had planned during that peak week. I still did one of them. I was probably playing with fire a little bit, but it's hard to, you know, I don't know. I like to do what's in the plan. And then I tapered and, but I was still feeling the pain. And so even like leading up to the race, you know, I was just thinking like this, it just might be it. I just might not be able to do it. And then, you know, I went and I had the race. It was about a month ago and I was like, I was surprised. It was not the limiting factor, you know, and, and I think because I kind of like trusted what I'd been doing and I trusted that I, you know, had grown stronger, I was able to go into that race and a lot of things hurt really bad during the race. Maybe the tendon hurt. I just didn't notice it because like my legs were exploding everywhere else. But it was just in the end. Like I wish I could go back and say like, this isn't the end of your goals, right? Like you can have a flare up and move through it and still be able to achieve what you want to. Yeah. So many times I have had people have like three, four good months and they're like, yes, I'm so happy. I'm so grateful. I'm back to doing all this. This is amazing. And then they have a flare up that lasts three days and it's like the back to square one, like in their mind. They start to question everything. They start to question like, am I always going to have this? Is what I'm doing working? Um, maybe I should give up running all together, like all this sort of stuff. And I completely forget about the three, four months that they've had going from strength to strength, you know, rebuilding. And it can be really like emotionally detrimental to the rehab as well. And I understand it. Like people are miserable when they're in pain. It's. very closely linked and I understand I've had those thoughts when I've been injured as well, but constantly say it. And to your point, there is a big difference between a painful weak tendon and a painful strong tendon because the strong tendons will be just as painful, but will revert back to baseline a lot quicker. And you actually manage it quite easily. compared to someone who's got a flare up with a weak tendon and it fluctuates wildly, flare ups last two weeks, you know, flare ups just come out of nowhere out of like really insignificant sort of moments. And yeah, to your point, you've put in all this strength work, you've put in all this training, you've built up all these successful miles and then had a flare up makes sense as to why you have the same frustrations as any other person who goes through a flare up but then You sort of manage it and get through the big weeks and get through race day and, you know, come across not a hundred percent, but actually well managed the race. But back to the mental side of things, the frustrations, you mentioned trust, trusting that you had, you've done the hard work. But for other people who are really struggling mentally, any other tips and strategies for those to help negotiate that particular phase? Oh, man, I don't know. It's it's really hard. I just I understand like for people like me who just love running or love your sport so much and just feeling like you can't do it. It's it's so hard. I mean, there's all kind of sometimes I try to like, you know, maybe focus on like, finding a silver lining. We can talk about that a little bit later. But I don't know, I just think that Okay, here's what's helpful. I think having a course of action is very helpful in those moments. I think, you know, I literally had to sit down and sort of write out what the week was gonna look like, you know, write out, you know, the isometrics that I was gonna do. I just really, for me, I needed a plan, and once I have a plan, I feel like I can execute it. And that was actually, you know, going back, I mean, to the early stages of this injury, that's what was so frustrating and so hard was not like really having plan because I felt like I hadn't really understood yet what the injury was and what I needed to do. So I think that can be super helpful to managing. Absolutely. I was actually hoping that you'd mentioned that because you did say prior that you wrote down these things you adjusted. Do I do this big workout? Do I not? Do I sort of make these adjustments? And you did mention like, keeping true that plan. I think that's great. I think people can be more proactive than they realize during a flare up. It's not just laying in bed and being in misery. It is you can cross train, you can do some isometrics, you might scale back your strength training a little bit, you might scale back some of your speed sessions, you might modify your sitting, all that sort of stuff, you know, you can be a lot more proactive than you think. And because flare ups are really a big mental hurdle, just having a plan helps that mental side. It might not help too much the pain side or could if you if your brain sort of settles down, then pain can settle down. But you know, people just realize I've had so many people that have this injury. And as soon as we write a plan and put it down, they're like, man, I feel so much better, even my pains calm down and I just mentally I'm in a good place. So yes, it does require some adjustments when you do have a flare up, but go back to the drawing board, be resourceful, make those adjustments and you can feel better. It's definitely it's empowering, right? There's nothing worse than just feeling like you don't have any power over the situation and writing a plan helps with that. Excellent. Yes. And I guess trusting the process as well. The second out of our six insights that you had, you mentioned, don't be afraid of pain, but don't obsess over it. And don't obsess over it. So I want to kind of break those down to two points. So the first one, don't be afraid of pain. So What did you learn or what have you learned about your pain and making sure that, you know, what's acceptable, what's not acceptable, you know, how do you describe that? Yeah. I mean, if we, if we want to, you know, go back to kind of the early stages when, you know, I don't think I really had like a good sense of what the injury was and what the rehab needed to look like. Um, you know, the, the doctor told me, okay, you can't run for a month. And then the PTs were like, don't run. And it was all just like, you know, if you're feeling any pain, you shouldn't be doing, you shouldn't be running. And I think one of the kind of earliest lessons I learned that was helpful was that, you know, this entry doesn't love rest, you know, that like, you can and actually maybe should be, you know, continuing to do whatever level of activity is going to, you know, keep you within the guidelines. The guidelines being three out of 10 or less during the activity, back to baseline in 24 hours, and progression week to week. I've done my homework. Well done. Full marks. Yeah. But no, I mean, just honestly, that was very helpful because learning that and then realizing that like, yeah, it was hurting when I would run initially, but honestly, not that much. And I think like even a little bit of pain, it can be really scary because you're thinking this is a signal that I need to stop. And just knowing, you know, not to let that get blown out of proportion. So, you know, when I was having this flare up, you know, right as I was finishing my marathon training cycle, I would just like, I felt like I was reading tea leaves at every moment. You know, I would be like standing on like one foot, you know, kind of doing the shoe test constantly. I was always just like trying to like, is it there? Is it not there? like climbing the stairs into my apartment after every run, you know, I would, you know, I would feel that pain and I would just think, well, it wasn't actually that bad, but the fact that it was there was really unsettling to me. And, you know, again, like I said, I was just so convinced that meant that I could not run a good race and it really wasn't the case at all. So. So like now, you know, it's actually, it's, it's getting better. I'm not feeling as much pain during runs and things like that, which is great. And that just says to me that, you know, this is okay, right? This is progress. Just because you feel it doesn't mean that like, you know, it's, it's bad or it's gotten worse or something. It's just so hard to read those signals sometimes, but I think with time and with experience, you get a better sense of it. Yeah. You started by saying that. rest doesn't work. Unfortunately, a lot of people go through the same journey of being told like, you can't run or you can't exercise or you should rest. And, you know, a couple months later, they're saying, well, I still have this injury. Well, what's the go? And I'd say, you know, we're talking about PhD, but I'd also mentioned for most overuse injuries, the exception being probably stress fractures or bone stress reactions, but Most of them don't really fare with rest and you can be active as long as these, these guidelines do allow. And one thing I'll mention on top of that is, you know, you mentioned progressing week by week, but I also mentioned that your symptoms should be like, um, trending on the improve, you know, week by week or month by month, you know, A lot of people say, I'm following your pain rules, Brody. I've got a two out of 10 during my running. It returns back to baseline. And, you know, that continues that same pattern continues for six months. And, you know, that's still not a good trend to be in. That's still mismanaging it in a way. So provided say you over the last 12 months have managed to go from race to race feeling better and better. That's a good sign that your management, your load management is on the improve. So that long-term trend is important. Um, very good discussing the pain guidelines, but you also mentioned to not obsess over the pain. You mentioned climbing stairs, doing like the shoe off test to see if the pain's still there and those sorts of things. This is what I struggle with as a physio as well, because I like to know the pain scores. I like to know where my clients are with how they're reacting, how long it takes to revert back to baseline, what's the pain like during the running, but at the same time. I also don't want people to obsess over it. So it's kind of like this conflicting, you know, dissonance that I have where, how do I find the balance between identifying the pain, knowing the pain characteristics and whether we're heading in the right direction, but also not getting people to obsess over the pain. Because when it comes to pain science and those sorts of things, if you become hyper vigilant of that area and really fixate, that doesn't help rehab either because things become more sensitized. the worry, the fears, the emotions, and all that sort of stuff are always there, which actually, you know, you ruminate and have these negative sort of loops and go through like, catastrophization and fear of movement and all those sorts of things. How have you managed to find the balance between the two? Well, I think like, you know, what you just said about that, like sensitization and realizing, you know, It's not that pain is all in your head, but really it is very much a neurological phenomenon. There is a connection there. So noticing I'll be running and I'm wrapped up in my audio book or conversation or whatever. And then I'll think, oh, I wonder if my injury hurts. And then I focus on it. And then I'm like, oh, wow, it hurts. It's not like it started hurting in that exact moment, right? It's just that I was kind of like giving it that attention. And once you give it that attention, it like takes on an outsized importance. So I think like, you know, obviously if you're in a lot of pain, you're going to notice that, but I think like, you know, just, just getting, allowing yourself to be distracted and just not be focusing on it all the time is really helpful. Yeah. When I'm talking with clients, like one of the a big sign that they're actually getting better is when they're like, Oh, I actually went for a 40 minute run. I didn't think about my injury once. Or, you know, I just sat down at a three hour meeting and didn't think about my sitting pain at all. Those, those attitudes are knowing that yes, you're getting better because pain is less, but also your mind isn't that fixation that hypervigilance focused attention isn't there at all like is fading away. So it's sort of addressing the physical and emotional side of things as well. So when that tends to happen, it's always like good that momentum really shifts and carries over. Um, excellent. Well, the third point that you have is that rehab isn't all or nothing. What exactly did you mean by that? Um, I think what I meant by that is that like above all else, you know, you just want to be consistent and show up as much as you can. Um, I mean that you might wanna do all these exercises on Tuesday and these on Thursday, and that's your plan and you're really sticking to it. And I was sticking, it's my plan very well for a long time, but then life comes up, right? And I was using the gym at work and then I was working from home, so I found that I was skipping things. And initially, I would just maybe not do it or maybe just do one a week. And then it got to the point where it was like, do whatever you can at home. Just try to keep the habit alive so that it's still there when you can like go back to like, you know, doing your, you know, A plus, you know, rehab, right? Like, I mean, there are little things I can do at home with like the band and like the jumping lunges and all these things that don't require, you know, a barbell. I probably, if I, you know, wanted to, I probably could have found like alternatives, things that I can do at home. Um, but, but just in general, I think it's, it's really good to just keep the habits alive, even if you're only doing a fraction of it, it's so much better than not doing it at all because it's, it's really easy to kind of just let the habits die out. Yeah. Similar to when we're talking about the flare ups about being resourceful and flexible and adjusting to the plans. Um, cause you know, people have lives, people travel, people have different like work commitments, stress, and all those sorts of things where, you know, plans change. as well as flare up symptoms change, your goals change. And we need to be flexible in those circumstances. Can you recall, or do you have any favorites when it comes to exercises at the gym, when it comes to exercise at home that you think really helped you and helped move the needle with your recovery? Yeah, I mean, definitely the deadlifts, probably the RDLs, the Romanian deadlifts. Those are so much fun. I love those. I loved, you know, it's kind of the first time. What do you love about them? Well, it was kind of the first time I'd like gone to that part of the gym with the barbells and the big weights that you lift up and, you know, and it's a bunch of like. It's a bunch of dudes and I'm like, no, I'm here too. Like I belong in this part of the gym. You know, you got a guy hovering your shoulder, like, are you done? Are you like, no, I'm not done. You know? Yeah, it was really fun. And it's like, it's such a great exercise because you know, you can progress and like you can see yourself lifting heavier and getting better at it. So yeah, and you know, from my understanding, it's just... such a great exercise for, for runners to do. So, um, I, I really enjoyed doing, doing the deadlifts. Um, I hate the step ups. Okay. Yep. Each to their own. I kind of stopped doing them. Thanks for your honesty on the podcast. No, but I think, uh, yeah, well, this is related to probably the next point, honestly. Okay. What about any home exercises? Um, home exercises, um, Let's see. Oh, the kind of the hamstring curls with the band. Um, I don't know if you call it prone or supering when you're laying on. Yeah. Prone just means you're lying on your stomach. So yeah, prone hamstring curl. Yeah. No, I really like those cause you know, you do them kind of fast and, um, I feel like it's really doing something. Um, you know, also the, uh, you call them the heel hammers or tantrums. Yeah. Um, those, um, those are great ones. And like. can do them at home, no problem at all. So I really, I really like those as well. I'll talk people through those. So like, it's almost like a long lever bridge where you have your feet really far away from your body. But then you have your feet elevated on like a bench or a chair or something. So you're looking at a double leg long lever bridge. But then you have this like a baby kicking a tantrum, you have this really fast rapid heel kind of your heels coming down into that bench or into that chair and you're quickly swapping from one leg to another. It is just a burner for the hamstrings and really fires them really well works well for the hamstring itself, the upper hamstring, the tendon. It's just about, I guess, progressing your way to eventually tolerating that it's probably one of the end stage exercises, particularly for those who want to get involved into speed work and faster running and hills and all that sort of stuff that really requires that rapid sort of activation. But yeah, that's a good one. All right, well, we'll move on to number four, which you've had here is don't be afraid to progress, but don't overdo it. So how have you progressed? What have you found a method for progressing through your exercises to make sure that you have the balance between the two? Yeah, so I guess I'm figuring that out right now. I did take a couple of weeks off after my last marathon, so I'm actually kind of coming back. So I'm not even really at the level that I was about a month or so ago. But yeah, I know you've talked on the podcast about, don't be afraid to progress. But I think some of us might have the opposite problem where we get a little bit too excited. So I think that's actually probably part of my love hate, hate relationship with Step-Ups is that I was just trying to do much too heavy weights. Like I thought that I needed to, and I was starting to actually feel some pain in like my IT band. So the hamstring tendon was fine. So I was like, okay, I had to keep progressing. But I think I was kind of starting to ignore signals from other parts of the body. And the same thing happened with the deadlifts. I think I heard, oh, you want to get to your body weight. So I was like, okay, I'm definitely going to get to my body weight. But you can't just make that happen because you want it to happen. You really need to get there. So I think for me, part of the key has been if you're advancing the weight. you need to decrease the number of reps, right? Like you can't go from 12 reps at, you know, a hundred to, you know, 12 reps at 110. It's better to go to, you know, eight or with the step ups like six, you know? So I think for me, like the key with the progressions was really just tuning in to my body and knowing that if it's really hurting, even if it's hurting places that aren't, you know, the hamstring tendon. Um, that's when you need to just be smart and, um, don't be a hero. Um, you know, um, just try to be smart about it. Yeah. Well said. I think there are some, some guidelines for people to follow those who are listening, um, whether it's for deadlifts or any other exercise, I think. Coming up with some sort of progression chart on paper that sort of makes sense step by step. So you have phase one, phase two all the way down and every. increment is only just a very mild jump. So, you know, you would understand that what I do with most of my exercises, and I've explained on the podcast before, if we're doing an exercise and we're hovering around eight to 12 repetitions, sometimes I do six to 10, sometimes eight to 12, but let's just say if you're doing your deadlifts and you're doing three sets of eight at a certain weight, the next progression can just be three sets of 10. next progression can be three sets of 12. So we're only just increasing by two reps every single time, which on paper doesn't seem doesn't look that abrupt. But then when we get to 10, when we get to 12 reps, and want to drop back down to eight reps, we then increase the weight, so increase the weight, drop back down to eight, then with that weight to go eight, 10, 12, and repeat the process. But we can also listen to our body and there's a few instructions I like to give out. regarding when it's time to progress. So I like to say progress one, when symptoms allow. So we're talking about pain less than a three or a four out of 10, returning back to baseline. You know, those things we're talking about before. Two, making sure that your form and technique and the level of challenge is okay. Making sure that you're really completing good quality with all of those sets and reps. I know a lot of people that say, yeah, but my grip strength really struggles by the third set and you know, I'm struggling to get through the end. Well maybe you need to take more of a break between sets or maybe you just, um, you know, maybe that quality just needs to improve before you can progress. And three, you need to make sure that the rest of the body agrees with you as well. So not just talking about symptoms, not just talking about your injury, talking about the rest of the body. So for deadlifts, you know, common for people get strain in their lower back. Um, you know, for your step ups, you said that the ITB was starting to cause issues, even though your symptoms were fine and your injury was fine, your body was giving you signs that, you know, let's not progress. Let's either, you know, drop things back. And so you need to listen to the rest of the body as well. And then when you do execute the next progression, make sure you're only progressing one exercise at a time. So, or two exercises, we don't want to do all of your six exercises and progress all of those in one workout because then that's increasing the risk of overload and that sort of stuff. So. All those sorts of things to bear in mind. Um, would that resonate with you? But all those sort of instructions agree with you? Yeah. Yeah, absolutely. Um, you know, definitely the grip strength point, you know, that, that really came into play. Um, so I was looking at like, do I need to get these like wraps that people have around their wrists or, you know, um, but, you know, maybe I just needed to, maybe I just need to wait, or maybe I was just pushing it like a little bit too hard if, if I was really, really struggling at the end. Did you find things that worked for you? Um, I didn't get quite that far before I had to kind of cut back for, for the race. I think I'm still like working up towards that, I guess, cause now I'm back to kind of like a lower weight cause I feel like I'm building up. Um, so I don't know. I do think that, you know, maybe the wrist wraps helped a little bit. Um, but I haven't quite gotten to the point yet where, um, where that's a limiting factor. When you were lifting heavy with your deadlifts out of curiosity, how much rest were you taking in between sets? Oh, not a ton. Like maybe like I would walk over, fill up my water bottle, have a few drinks and then come back. Um, okay. So maybe about a minute or so. Yeah, probably, probably something like that. How much, how long should you wait? That's a good question. Um, depends how heavy you're lifting and depends. I like to say that your grip strength, if you can comfortably hold onto the bar for your first set, um, It should feel the same second set. It should feel the same third set. And if you're getting this accumulation of grip strength fatigue, um, throughout the second and third set, you're probably not resting enough. And sometimes I rest for five minutes just because the weight is so heavy and your grip strength takes so long to recover that you can, um, superset something. So you do your deadlift. I know in a gym setting, it's not the best because people are waiting to use the bars and that sort of stuff. But. In an ideal world, I would do a deadlift, go away, do like some push ups or do like some core stuff or a plank, you know, just mix it up with something else while your grip strength is resting. Don't do what some of my other clients have done and go away and do another exercise that requires a lot of grip strength, like a chin up or something. Wait for it to recover, go back to your second set. Sometimes that might be two or three minutes, probably on average is what I'd recommend. But if it's really, really heavy, walk away for, you know, four or five minutes and then come back. Um, a few tips there, you're not going to, um, D load. It's not a progression to do like less rest breaks or fewer rest breaks. You're still going to get, you're still going to reap all the benefit of the deadlift if you spend longer away between your sets, so something to bear in mind. Okay. Number five, we have PhD sucks and you are entitled to feel frustrated. but find the silver lining if you can. So when people are injured, you mentioned you alluded to silver linings before. So what are some examples? Can you remember any silver linings that you had? Yeah, I think there are probably a couple of probably good things that came out of this. So first of all, I think sometimes injuries can like just be your body's way of just forcing you to slow down a little bit. You know, like I said, I thought I was invincible. The sky's the limit, you know? And obviously that's not sustainable. And you know, so sometimes it's, you know, kind of naturally just pump the brakes a little bit. And I know I have a lot of friends who've come back from injuries, you know, stronger than before. And you know, maybe it's because of the cross training or strength or whatever they were doing, or maybe it's just because your body kind of needed a bit of a reset, you know? So I do think that that's probably part of it. You know, my- I probably enjoyed having a break from these like really intense training cycles. Um, you know, other parts, things beyond, you know, the hamstring, the tendon. Um, and then, you know, also the, um, I think my legs have just gotten a lot stronger. I think I felt that. Um, I certainly think like the Boston marathon course, it's like tons of downhill, you know, and then you have Hills starting at mile 16. I just felt like there was a lot of like. power in my legs, you know, to the point where at the end I was like, okay, just, I was saying to myself, just let your legs do it. You don't have to do it. You have to run, you know, like I just felt like I could kind of just trust that. And I do feel stronger than before. And then the last thing, which I suspect is related to the break and all of the rehab is that persistent runner's knee that I've had, you know, like kind of low lying pretty much the entire time I've been running and doing big races. was absent this training. Somehow, whatever I've been through in the last year has really helped with that issue. Because I know historically, it really hurts to drive, being in that position, I'd get to a point where I really need to stretch out my leg. And there was a moment about a month or two ago where I was like, where's that pain? It's not there. So maybe that has something to do with all the strengthening as well or the rest. But I do feel like I've... probably built back better, you know, come back stronger in some ways. Just as you were explaining that, like, as I was listening to that, I was writing down a few silver linings that people might have. First of all, like you can learn from every injury, you can learn from every flare up, like there is something in there that you can take away. First and foremost, you might realize if you are a runner, and you do some speed work, and then you get PhD, hey, you might realize, okay, maybe that speed work was too much of a jump. So now you realize, okay, what did I do? What am I doing now compared to what I used to? Okay, if that's too much too abrupt, let me make sure I don't do that again. But also, you identify that training error, but you also work out yourself where your weak links are when you do speed work, you might say, because some people do speed work and get an Achilles tendinopathy or plantar fasciitis or hip flexor strains. And if you're getting a hamstring issue, that's probably a vulnerability that you need to strengthen up. And so that's like you said, it's your body telling you a few things that you maybe are over training or, um, there, there might be some signs there for you individually, but we can learn from injuries. We can learn from every flare up exactly the same. Okay. What was that adjustment? Why did that flare up? Wasn't my sitting, am I under stress? Wasn't my sleep and recovery, or wasn't my, my training load? Um, And then as a silver lining with your rehab, Hey, I'm just building on tools. I'm just uncovering all these management tools to help me in the future. And with my future injuries so that I do come back stronger. I do come back with more knowledge, more wisdom to not only help this injury, but also help every other injury that I have in the future. Because the management's the same, like on the run smarter podcast, like I have universal principles that matter for most running related injuries. It is. You know, Don't mismanage, don't overload, get stronger, you know, build, bridge the gap between what you can currently tolerate and what you need to tolerate in the future. And that's a prime example that you say, you know, I'm treating this PhD and all of a sudden my knees feeling better. Well, that's probably because you've been doing the strength work. You're loading yourself like your training loads are not being mismanaged. So when you build up your mileage or when you build up your speed work, it's sensible, it's progressive. You're listening to your body along the way. And so no doubt that the tools and strategies and lessons that you're learning will not only matter for your current PhD, but it will matter for your current other injuries and then will matter for all your other future injuries. So, uh, plenty of silver linings there for anyone who needs a little bit of a positive outlook with their rehab. So well done. And I do, I do want to say the first part of that was important to you. Like, you know, it's It's okay also to recognize that this is not fun. You know, like I don't wanna come off as being like, oh, you know, always just look on the bright side. Like, especially for someone if running is like a huge part of your identity, your mental health, maybe your social network. Like it's okay to also kind of like mourn the fact that you're not able, you know, you're being like limited for a little while. And I think it's important to kind of not just push those feelings down, you can experience them. But then, you know, for your own sake, if you can kind of shift it to look, you know, maybe try to see a positive, I just do find that it actually, it, it just helps, right? That's not to invalidate the difficulty of going through something like this, but, um, it can be, I think helpful. Yeah. I think that's very wise to say, because a lot of times on the podcast to talk about, Hey, there's positives to focus on, stay positive, stay positive. When people like Brody, what the hell are you talking about? I'm in pain. I'm in misery. I can't think of one positive thing. Um, sometimes that's, you know, that's reassurance that your frustration is justified. I think that's, um, that's very well said. Okay. Number six, we have, don't let anyone define progress for you or make you feel weak. Yes. What do we, what can you say on this topic? Um, I think here, the key point is to just really know what your goals are and what's important to you. And. you know, and stay focused on that. So this kind of stems from, you know, kind of my frustration of not initially really knowing what the injury was and, you know, going to PT. And I guess the doctor had written something about like hip strength, you know, that my hips were weak. And that was part of why I was going to PT, which I never thought of my hips as being weak, but you know, so then I'm going to PT and they're just like so focused on my hip strength and I was really frustrated. It's probably partly my like, failure to like communicate. But um, you know, I just felt like, you know, they were just saying like, okay, don't run, don't run. You got to get your hips stronger. And you know, I think I don't care about my hips. And, you know, probably at that point, I was in some kind of like pain, rest, weakness, downward spiral, and my hips weren't getting stronger. I was doing what they were telling me to do. But I was also just, you know, starting to, it was really actually demoralizing to be honest, to the point where I started to kind of run. They were saying, don't run, don't run. I started to run because I'd been doing all this reading. I thought I can do this, I think, and be smart about it and kind of build it up in a way. But then I'd go to PT and they'd be like, oh, why did you run? That's terrible. Instead of saying, how did it go? How did you feel? Are you moving towards where you want to be? And then I remember like one day I went in and it was like a different PT than the one I'd been going to. And she like read through the notes and she started off, she said, well, it sounds like it's, it's really not going well. And at that moment, I just like lost it. I was like, it's going great. Like I ran 15 miles, you know, without pain this past weekend, right? Like, or I felt it a little bit, but then I was back to normal and I was just like, so frustrated at my inability to kind of like communicate the things that like mattered to me. and sort of have that be validated. So I think like there the lesson is that, if you feel like you're not being heard, maybe try to be heard, like try to just make it very clear to the people who are helping you, like what your priorities are and what matters to you. And that's like an empowering thing to be like, look, I'm in charge and okay, I guess you think my hips are weak and whatever, but. Um, I'm running and I'm happy and that's actually that's success for me. Um, so yeah, um, I think that's, that's where it came. It was, it was really like a low point, you know, just feeling like I wasn't. I wasn't doing the right thing. I wasn't making progress in the ways they wanted me to. And then just to be able to realize like, Hey, no, like I'm actually running. That's what I want to be doing. You know? Yeah. Like, um, yeah, I think that that's just where it was coming from with that. You're following, I guess, your intuition a bit as well, like getting like an intuitive sense of I feel like I should be heading in this direction. And when you start heading in that direction, you're actually like getting better. And so that's obviously a good sign. Like you say, running 15 miles pain free. This is like the progress I'm making with this path. But it's hard to go against like, you know, medical professionals and like, you know, on the contrary to what they might think or might see and like, bit of a tangent, like, my girlfriend and I, we have a baby due in six weeks. And we're doing these baby classes. Thank you. We're doing all these baby classes where these midwives or this midwife we're listening to is saying like, if you don't, if you don't feel like this intervention that they're requesting while you're in labor is right for you. then you just question them and you ask about the risks, benefits, intuition, like what, what about if we do nothing while the alternatives, all these sort of things. And I think to myself, like, you know, how many people would actually push back on a doctor or a professional or a midwife or someone that's suggesting something you'd go ahead and just do it. If they say, Oh, we think we should do this. You say, all right, let's, let's do it. You're the, you're the professional, but you know, listening to these as well. There's a lot of stories of people who have gone down the wrong path. And when on the other side of it, they're like, Hey, I actually probably should have spoken up there and you know, let me know my frustrations or my concerns or ask about alternatives. And I, you know, I was struggling with that in the past couple of weeks, but hearing your story like relates like, I'm a physio, so I kind of know like that side of things. But as a patient who doesn't know. much about an injury and knows, oh, my health professional said, I can't run. Otherwise it's going to make it worse. Who's going to push back on that if you don't have that, that wisdom and that knowledge. So I totally get that. Um, and back to your point about, you know, don't let anyone define your progress as long as you are making progress and as long as, well, if you're not making progress, you should change something, whether that's what your health professional is advising or whether you go against what they're advising, if you try something and. it starts working in a favor then head in that direction. But the pace of recovery, a lot of people listen to the PHT podcast and say, you know, your success stories, they're lifting 70 pounds, a hundred pounds. That's not me. I'm nowhere near that. And, you know, I'm experiencing like this because I can't even do, you know, 10 glute bridges. You know, you define your own starting point, you define your own rate of progression. Everyone has a different starting point, but as long as you're moving in the right direction and you're seeing the benefits very slowly, but don't let anyone define your, your speed of recovery. Cause a lot of times I get, I, they ask the question, how long does PhD take until I'm back? I have no idea. We have to make a start. We have to see how you respond. We have to, you know, go through. a lot of trials to know, to get, gather more data, to know what, how long it might take because everyone's completely different. I really resonate with what you said about, you know, not wanting to push back against professionals, but like, you know, at the end of the day, like, you know, sometimes they don't have like a clear answer, you know, like I've, I've gone through, you know, talk to different people who said I had different things going on. One of them's probably wrong, you know, they can't both be right at the same time, you know, with friends who've gone through different... injury journeys, you know, from person to person. Like, you don't, I mean, obviously we want to have respect for like the expertise of people who've like studied this, but at the end of the day, it's kind of your body and you probably, you know, have some sense of what's going on and if that seems right or not quite right. And, you know, for me, it was like a really empowering moment when I was like, I talked to someone who had said like, oh, I have PhD, it sounds like very similar. And it was a very empowering moment to me to just like go and just like search for like medical journal, like search for articles. And I found like a very helpful, you know, you know, peer reviewed article that talks about PhD. And that's where I was like, really like, I think this is actually what's going on here. I kind of had to like self diagnose to some extent. But yeah, I mean, I think there's definitely like a balance between like trusting people and also knowing that they're human as well. And, you know, like, maybe you need to. meet somewhere in the middle. I like to think of it as, and you sort of mentioned this a little bit as well, taking control and, um, I like to think of it as you're the client, the injured person, the athlete, you are in the driver's seat, you have, you've got your hands on the steering wheel, you've got your hands on the, or your foot on the accelerator and the brake, you have complete control. The other health professionals and doctors and other runners, they're just in the back seat. They can hand you the roadmap. They can give you a bit of guidance here and there, but ultimately you have control of where that car goes, how fast it goes, where, where the turns are made. Don't let health professionals take the wheel, take control of the car and push you into the backseat. That's not how rehab should go because you mentioned empowering before, like we want people to feel empowered in control and, you know, making sure they're heard and they're, they're a part of the rehab process. So, um, If you're listening to this now, you don't feel like you have your hands on the steering wheel, like, you know, start making a few different moves, start asking some questions, um, pushing back a little bit, or just asking questions, making sure that you're asking enough questions. So you feel like you do have control and yeah, sort of shift that, that power of control. Yeah. I wanted to finish off with, um, so we've, we've covered all those six insights, which was fantastic. So thanks for sharing those. Um, I thought it'd be nice to wrap up sort of where to now, like what, what do you have planned in the next couple of weeks, months? I know you said you have this race coming up, um, when it comes to your rehab and those sort of things, what are you focusing on? Yeah. Well, um, I mean, first of all, I just had an incredible race. You know, really it was a high point. Yeah, no, thank you. It was like really a high point of, you know, running so far, especially because, you know, when I started training for this marathon, I didn't, I was afraid to like, I was afraid to run fast. I was really afraid to do hills. I had a lot of fear and I feel like it was just, you know, such a great training cycle, you know, working through the challenges along the way and then like the race itself. was just incredible and I achieved the goal. I got my PR, but I'm kind of bored with running a faster marathon now. So, yeah, the next thing is to spend a lot of time out on trails. I'm super excited to train for this. called the Run Woodstock. It's the Hallucination 100 mile race in September. Big running festival with kind of a looped course. And I'm just excited to, you know, go out and do what I love, which is run long, slow miles and eat a lot of food while I'm out there running. And you know, it's like a very different thing. I think it's strangely probably kind of PhD friendly just because you're so slow and with walking and all that. Um, so I think it's, um, probably going to be a decent, you know, thing to train for, uh, with my injury and I'm just going to keep getting stronger and stronger and, um, and who knows, uh, what comes next, but, um, really I'm just so thrilled to have like the joy of running in my life. Um, yeah. Well said. I think, um, you know, a lot of people ask me how long until I'm back. how long until this goes away forever? Or will this ever go away forever? And I tend to explain to them that, you know, you can get back to all the races, all the goals that you have, but you know, if it ever has a hiccup, if you ever have to sit for a long period of time, if you ever have like, you know, if you wanna try and run a fast marathon, you do a lot of sprint work and those sorts of things, like the odds of it, like resurfacing is gonna be quite high. Like it's... you do all the right things, you can still like really challenge your injury and symptoms can arise, but, and I'll highlight but, it's going to be really insignificant. You're not going to worry about it. And you sort of at the start of your story sort of explain that you're sort of like, you know, I'm signing up for these races and I'm not out of the woods because I still have a bit of a few symptoms. Like it's not gone, but I'm doing what I love and it's not a worry. It's not, You wouldn't have like a major concern that like, oh, this is going to disrupt all my goals or am I ever going to run again? And those sorts of things like you're living with it and improving. And who knows, maybe you go two, three years without any symptoms. That's definitely within the possibility. Like I've had PhD for years and I haven't had symptoms resurface for three or four years or so. And I know if I run a really fast marathon tomorrow and then I have to jump on a long You know, my hamstrings will be pretty sore afterwards and the next day it'll be completely fine because I've done all the strength work and those sorts of things. To your point, it's not gone completely, but I have no worry whatsoever. And happy to, you know, accept all these goals and all these challenges and enjoy all those sorts of things. So really encapsulates where you are right now really encapsulates my answer to that question. And so. I hope that helps a lot of people going through these sort of similar scenarios. And you've done incredible amount of work and dedication to your rehab. And it's good to see that you you've got to the place where you are now. So I think this is going to help a lot of people with all these sort of different topics that we've talked about. So thanks for coming on and sharing. Yeah. No, thank you so much. I found these resources to be super helpful. Um, and you know, like the biggest thing is just. It's just feeling empowered and knowing that, you know, it's not all over, you know, like there are things that I can do and, and if I feel a little bit of pain, it's, it's really not the end of the world. Like it's just, you know. Like you said, you might have to like live with it to some respects, but I was recently reminded that marathons are really, really painful anyway. You know, so like, you know, what's a little like tended like pain in the, in the middle of it. Especially if it doesn't mean that you're, you know, injuring yourself worse, right? Because you've done all the work. So, yeah. And like you said, before we hit record, you love these, hearing these success stories as well. So thanks for contributing to helping out a lot of people. It means a lot. Yeah, good luck everyone. Knowledge is power.