Arthi's PHT success story

: On today's episode, Arthes' PHT success story. Welcome to the podcast helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments and bust the widespread misconceptions. My name is Brody Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. Very happy with today's episode and bringing it to everyone. I just got off my interview with Arthi to discuss her PhD experience, which started a year or so ago and talking through her journey and race preparations, her discoveries, what worked, what didn't work, what insights she's gathered has, um, Well, well worthy of an episode to be on this podcast. You'll take a lot of wife from this and a lot of positivity. And so don't want to give away too much. Let's just dive straight into the interview. Arthi, welcome to the podcast. Thanks for joining me today. Thank you Brody. It's good to be here. Yeah, I'm excited to share your story because you've already sent me an email. I know a fair bit about it, but I guess where we can start, how about you just introduce yourself and where you're from to start with. Yeah. Um, again, my name is Arthi. I am 33 years old and I live in Colorado right outside of Denver. Excellent. And we know this is a PhD success story. And we might just take you back to the moments when symptoms first start arising. So what sort of running were you doing at that stage? And yeah, a potential cause for symptoms to start arising? Yeah, so I have been I was training for my 15th or 14th marathon rather, in September of 2021. So I've obviously run a I'm familiar with the training pattern, but I started to notice towards the end of my last 20 milers. So for this training season in September of 2021, I did like two, three 20 milers. And in my last 20 miler, I started to notice this like... pulling at the top of my hamstring. Um, and it was something that I haven't felt before. Um, I have had my fair share of running injuries and this felt a little bit different. So that's when it first started to kind of come on set. It was right when I was training for that fall marathon. Hmm. And I guess you say you've had the experience with training for marathons and you've, you've done a couple of these 20 milers. Um, Looking back now, do you think there might have been any other particular causes, maybe intensity or terrain or shoes or anything that you can maybe pinpoint of why the hamstrings started getting tight? Yeah, so I was I was trying to kind of go back to this a little bit and I, this was my first marathon post COVID training post COVID. So I was getting back into those longer distances, I think many of us took a very extended period of time away from training long distances. And I eased into my training and I built mileage well, but I think for me. I was doing too much for what my body could handle at that time. And I wasn't giving myself enough recovery. So the mileage I was building consistency consistently, but I didn't give myself those days of rest in those weeks of rest that I think I did in my previous training cycles that were really helpful for me. Yeah, for sure. Because we know that it's, you don't get stronger during those hard sessions. You get stronger with the adequate recovery after those hard sessions. doesn't match, if it doesn't, if you don't give yourself the recovery you need, then the potential for overload is quite, yeah, overload can be quite common, especially if you're trying to the high mileage that you were preparing for the marathon. Yeah, and I remember in that last 20 miler that I started to feel the symptoms, I didn't even need to do it. I had already done a couple of 20 milers and I was like, we'll see, I don't need to do, I'll just run for as long as I feel like running. And then I ended up started so right damn pushed me over the edge. Okay, yeah, going astray of the plan. So would you have a classic kind of marathon training plan to prepare for? Like, did you have it down on paper or was it just based on your experiences of the sort of figures that I should aim for? A little bit of both. I've run with training plans for years and so I kind of had that as my base and I tweaked it a little bit just based on where I was in my own training. And so it was a little bit of like using a formal plan but then my own little spin on it, which I've done with other races and it's been fine. This one, however, was not fine. Okay. So let's move forward. You've had this 20 miler. You started noticing some upper hamstring tightness and what was the reaction? What sort of treatments or what sort of information did you find to sort of overcome it? Yeah. So initially when it first came on, um, my immediate reaction was like, it's probably just tight. I need to stretch. I need to foam roll. I'll take a couple days off. I swim laps for my cross training. So I was like, I'll just get to the pool a little bit more. I also teach yoga on the side. So I would just go to the studio more and take more classes and did all the classic things that were wrong, like kept overstretching it and just kept trying to get deep tissue massages to fix it. And it wasn't getting better. I realized that pretty quickly just because I have had some other running injuries that responded really well to rest and this one wasn't. And so with my marathon just a few weeks away, I didn't want to like make it worse. And so I went into a physical therapist office pretty soon after that and did like a full assessment with him. And he actually said it was some probably some kind of tendonitis, but he said I'd be OK for the marathon. going to do any more damage to it. Um, you'll probably feel it, but he kind of like cleared me to run the marathon in a way. Um, but I knew after that visit that there was going to be, there was something wrong with it that I would need to like address a little bit more, but I just wanted to like get to the marathon and be able to run it. Okay. And did that therapist give you a diagnosis or just as the, you know, the tendons of it saw, um, you should be okay to run. Yeah. He was more like. It could just be some upper hamstring tendonitis. And he was sort of like, yeah, I think it will go away after you rest for a little bit. Um, he did some dry needling around the area, which, which helped initially, actually it helped, I would say. And I got through the marathon fine. Um, but obviously it didn't, didn't fix the problem. Sure. Yeah. Nor would we really expect it to, but, uh, okay. So it seems like the initial treatments were quite passive in nature, you know, stretching foam roller, yoga, bit of cross training here and there. And then like the hands on stuff, the massage, the dry needling. And so, um, talk to us about the marathon. You said that you, you managed to negotiate the marathon, um, how, how to go during the race and how are things feeling afterwards? Yeah. So during the race, um, surprisingly well, and even before the marathon, I would say like maybe 10 days, two weeks before that marathon, I ran a 15 K race, um, I went awesome. Like I placed in my age division. I had a really strong race. That probably made it worse, I would say, just because I was like flying through that race and I wasn't training speed at all the entire season. Yeah. And so I ran the marathon and I surprisingly felt good throughout it. I maybe felt it a little bit here and there, just kind of that pulling, some soreness, but... It didn't bother me as much as I thought it would. And I finished in three hours and 28 minutes. So I was really happy. I qualified again for Boston and was really happy with my time. And then I was in a lot of pain after the marathon. And I was definitely, I think the adrenaline kind of wore off. And I was limping around. And everything was locked up and hurt. So I knew that I was going to have to really pay attention to that. You do say that quite often. with big races that symptoms subside and people can get through a big race, you know, to their surprise, considering like how past training runs might go, they might be a little bit sore and be like, Oh, I'm not sure how I'm going to go. And then they just feel great. You know, most running related injuries have this warm up effect where when you warmed up, it's like, it feels okay. But the added adrenaline rush of race day sort of just, you know, makes a lot of those worries go away and then the ramifications come soon after. Yeah, exactly. So Some people with PhD notice that, okay, speed work, um, particularly flares things off, which you said was a bit aggravating with the, the 15 K. Um, but they also say things like sitting can be an issue. Was that ever an issue for you at that stage? It was, I would say it was an issue, um, later on. So not right in the beginning. I didn't feel like sitting bothered me as much. It was more when I started running and I would feel that like pulling sensation. a little bit, it would kind of dissipate. But that was just in the beginning. And then post-marathon, I would say a lot more of those classic symptoms arose. Like, just sitting on a flight or sitting just for work, whatever, I would be really uncomfortable. And then even after I'd start running, like, it wouldn't go away even after I was warmed up. So it turned into a lot more of those classic symptoms. OK. That would be. Yeah. Usually as the pathology progresses that warmup effect tends to, well, it takes longer for that warmup effect to happen, or just doesn't happen at all. Sometimes it gets worse throughout the run. Um, as that pathology just tends to develop and get worse. How long. Because you mentioned in your email, like after that marathon, things just slowly started to spiral and things started to get more severe like symptoms started to become more irritable and I guess the capacity started to reduce how long was that process because we're eventually going to get to the point where you sort of started unraveling some useful information and started applying something a bit more effective but in that particular time as symptoms were getting worse, what was that experience like and how long did that take? Yeah, so the marathon was mid-October, yeah right around mid-October and after all of my marathons I usually take at least a week off running which I did for this one and I again and I realized pretty quickly that the week of rest did absolutely nothing for my recovery. I was actually even in probably more pain when I started running because the warming up didn't do anything and I just felt it the entire time. I also as I shared I live in Colorado so I hike a lot and hiking started to bother me because it was that incline and like putting a lot of that like load on the tendon when it was just like weak and not happy with me. So hiking didn't feel great anymore and that was another thing that I'm like, I can't do another thing I love. So I realized within that month after the marathon, like my normal go-to strategies of rest and swimming a lot and getting deep tissue massages, like none of those things were working. And so that's when I started to like spiral and try to research everything I could about what was happening to my hamstring. And that's when I found you. Fantastic. Well, I'm glad you did eventually. Because like, when people do start developing these symptoms, you try and grasp the story and say, okay, how long was it kind of mismanaged for? How long was either the runner? none the wiser and just like being like it should be fine, symptoms go away or maybe they do realize it's a bit of a serious injury, but they're a bit stubborn and just, you know, have a race to prepare for and just do it anyway. Or if it's just like misinformation, like you think that the massages and the stretches and the foam rolling should make things better and you're actually doing the right thing. But in the eyes of, you know, effective treatments, I think. resting and then doing a 15k race and then like just doing the marathon and then resting again and then trying to start running again. It's all just a bit of a convoluted mismanagement kind of style which seems like that's what's followed the pattern. Not only are symptoms not getting better but actually getting worse and like you say sitting becomes more irritated. That warm-up effect when you're running just no longer exists and yeah that whole cycle seems to be very very common with what I see. And so once you've like discovered this particular information, you discovered the podcast and probably done some more research on PhD. Were there any obvious I guess things that were missing in your treatment. Were there any things that you hadn't really started yet that you think you might need to start immediately? Yeah, I mean, for one, I wasn't doing any strength training. And I think I got away with it for years and years of running just because I was younger and I think you can kind of bounce back from things. And then I think now with the amount of mileage that I've continued to put on my legs and like just the amount of marathons I've done, I think strength training is something that is so critical and I just didn't even consider it for years. So hearing about just your experience with that and just kind of an understanding of the tendon and like how it responds to load and just everything you shared about the knowledge there was new to me. And I think it kind of, I had that like aha moment where I'm like, I was just, I was kind of stupid with my training and I could get away with it for a lot of years, but now I need to be smart about it. was a big piece for me. And then I think, too, just. The rest and recovery piece, I know that's important. And I think a lot of us as runners get really stubborn with wanting to just do more all the time and constantly put more mileage on our legs. Just sometimes we think that leads to better training. But for me, I know now that I need more days off in my training plan, and that makes my legs stronger. It makes me a better runner. So I had to kind of re-learn. learn my plan in a way. And those were two big takeaways I realized after this injury wasn't going away. And I started to listen to your podcast and just research it a bit more. What's? What were the first strength training exercises you started with and how'd they go? Yeah. So the first things I did were just like standard glute bridges and I would just lay on my floor and I would do them forever. It felt like every single day. And then I eventually progressed into the single legged glute bridges. I'd started using those like big medicine balls, um, like the hamstring curls, where you like put your heels on them. extend out and in. So I basically just listened to your podcast. And every time I'd hear a new exercise, I would add it into my own little routine. And I did notice, though, that it was making my legs stronger, which was good. And I was able to build up on the intensity. I was able to build up on the time that I was holding those exercises. So I've been to physical therapy a lot of times before for other injuries. And I know that it's good. kind of the results pretty quickly from it. So I was happy to see that, but I still knew that, you know, I was six weeks post-marathon or whatever it was, I was still having a really hard time running and I had qualified for Boston and I knew I wanted to run Boston and that was like the thing in my mind of like, I need to do something about this. And so I had to... I kind of had to take myself, I took myself off the road for a month. So took myself off the road from running and that kind of kickstarted my like rehab journey. Nice. And You started, okay, double leg glute bridges, eventually progressed to single leg glute bridges. And you also said like your feet up on the big kind of Swiss ball and doing like rollouts and back. Was there any discomfort during those exercises? Did you notice an improvement as they went on? Yeah, there was discomfort, I would say, especially with the single legged. It's my right hamstring that was bothering me. So when I would have when I would be when I would have my right foot on the ground and my left leg lifted. hamstring. That, you know, of course bothered me in the beginning, but also going back to some of the things you shared about understanding pain. Typically, I would want to just back away from that if something was sharp or it didn't feel good. I would probably think like this is I'm not ready for this. But hearing kind of how it's important to understand like where you are with your levels. That was something that really helped me to like stick with it and slowly increase. So there was discomfort during those particular exercises initially. Was there any irritation afterwards after doing this exercise? Or was it only just in the moment? No, just in the moment. So this all kind of started. I took myself off the road for a month at the start, or I think in December. So it was December of 2021. And I decided I was like, I'm going to take a full month off running. I need to just like give myself the time to focus on strength training. and really get a good base here. And so during that time, I was really focused on all these exercises, just like a lot of isometric stuff. And I was swimming on the side too, and walking a lot. And then in January, I went in to officially start working with a physical therapist. And so I started adding in more exercises and also incorporating some dry needling and just some more of the manual stuff, which... I think it can help to some extent. Obviously, I don't think it's a fixer by any means, but I think it can add a nice, you know. nice little thing to whatever you're doing. Yeah, for sure. I sort of counted as like, um, an adjunct to what is like a core foundation. So like, if you've got the strength and you've got the, the load modifications, even if someone is running at that stage, they can still be running, but. manual therapy that works well for them, like massage might work well for someone, but not for others. Drain healing might work well for some, not for others. There's a few, there's a fair few manual therapies that you just need to trial and error. And if you notice that it reduces your symptoms, just recognize that it's mainly designed to reduce symptoms in the short term. But if those symptoms are reduced in the short term, that's an excellent adjunct to then do all your rehab, Do your running at particular... dosages that you can tolerate. And so it actually becomes advantageous to have those things in if you notice that there's benefits. So it's good that you found the nice balance. And when you started the PT, was there, did those exercises progress? Did you have any other particular favorites that helped your rehab? Yeah. So I started PT in January and that's when I, you know, after a month off of running, I kind of wanted to try to keep that time on my feet. I didn't want to lose that like base in a way. So when I started PT, he actually cleared me right away just based on the assessments that he did. to start running again. So I was happy to hear that. And we kind of together created like an ease back into running plan. And so I met with him once a week, and we would do a little bit of dry needling. And then we would add like new exercises. The Nordic hamstring curls, which you've talked about as well, those were probably a game changer for me. Those are the hardest exercises I've ever done. They don't seem to get easier. within the first couple of weeks, I would say, of even doing those, just how much stronger my hamstring got. So that's something that I've continued to do. And then there's some other exercises that he gave me with bands and things like that. One of the things that he had me do, he calls them tantrums. I don't know if you've heard of these before. You attach a band to two long poles, and you kind of like. kick your heels down on them. So it's sort of just, I don't know if I'm explaining this right. I would call tantrums, like sometimes without the band, it's kind of like a bridge with your feet elevated on like a bench or like a long lever bridge you can call and the same thing you sort of alternating the striking down at the heels. And so it's kind of like you're kicking and you're trying to keep one heel on the ground at all times. Very good for hamstring activation. of activation because that quick rapid from one side to the other just is a sure fire like of the hamstrings, which is kind of what you need for running. Running is a very fast contraction of the hamstrings. So introducing that speed could be quite helpful. Yeah, that was that was really helpful. And then we also did a lot of activation for like your like low back, your low back muscles and then hip flexors as well too, because that was something for me specifically. that my hip flexors were kind of tight, pretty weak. So those areas we focused a lot on in addition to the hamstrings. So all of those together, I think helped a lot each week. I know. The listeners would probably want to know like the dosages, sets, reps, and that sort of stuff. But you said that the Nordics were very helpful for you and got your hamstrings very strong. Can you remember what sort of sets and reps you might have started with? Yeah, so we started, he told me to do them like every other day is usually the kind of the, what he would have me do my exercises with. and I would do like eight to 10 in each set. And by the second set, I was like basically falling on the ground, but it was really helpful. And then on top of that, I was also doing just like a lot of deadlifts and then single leg lunges, like that kind of thing, squats. I was adding those into my little workout routine as well, which was helpful. A lot of the single leg stuff, really big for me. Yep. So lunges and did you do single leg deadlifts or anything else? Yeah, a lot of the single leg deadlifts is something that I'd focus on. During that time too, I also started going to kind of like a boot camp hit plyometric type class. My hamstring tolerated jumping totally fine. Like it tolerated plyometrics all of that fine. So I did a lot of that. which helped a ton because I think with, especially with running, like you need to have that jump training involved when your tendon can handle it. And fortunately that was fine for me. So I maintained a lot of that fitness too. So a lot of like squats, lunges, like jumping type exercises. So I continued with that too, in addition to all the kind of physical therapy exercises. Well done. And well done for tolerating the bootcamp plyometric stuff as well. It's a good sign. and the PT gave you the... mission or like to start running. And you said that you've worked with them to come up with a bit of a strategy. So how was that introduction back into running? And what were symptoms like in those early stages? Yeah, I think, I mean, coming back after a month of not running, it was hard physically, and it was hard mentally, too, because I think from a mental perspective, I was so used to just being able to run miles and miles, like, didn't have to think about it. And now it was no more than three miles, walk, run it, run a half a mile, and then walk for a little bit. And so it felt really restraining in a way. But I told myself when I started at the beginning of January, I was like, I'm going to increase a little by little every single week. My goal is to get to 10 miles by the end of January. And my PT felt like that was totally doable just based on where I was. January, it was not normally where I would have been for like a normal training season for a marathon, especially for Boston. But I knew I had to also adjust my goals a little bit and adjust my training plan to, to kind of work around and with my PhD. That's really sensible because it's often tough for runners to find a to sort of return back to running sensibly when they also have a race that's, you know, on the back of their mind, that's ahead of them, because they have a certain reference point of where they want to be at, depending how far away the race is. And so as soon as you start introducing running, or you start introduced, like feeling better symptoms, start, um, settling, you know, people usually just take off the handbrake and just try and accelerate their rehab and often leads to a flare up, then they set themselves back and there's like this boom bus cycle trying to prepare for this race. And so you've done really well recognizing to you, it's probably sensible to adjust your goals, adjust your expectations and make sure that, you know, the recovery is the number one focus. So very sensible of you. Well done. is there, I know that when people start running again, especially like I've noticed this when I'm returning back from PhD. you know, every single leg swing, you're like, how's my hamstring doing? How's my hamstring doing? Is it okay? Did you encounter that particular, um, experience? Yeah, I absolutely encountered that. And I, it kind of took away the joy a little bit of running. Cause I was so, I was just so worried about it. And I didn't want to, I didn't want to make it worse. I didn't want to feel like I was going to all of a sudden have to go backwards in the progress that I made. And I think that's why it's really important to work with somebody. professional, whether that's a physical therapist or sports chiro or somebody that's just knowledgeable about whether it's PhD running something because there were times that I went in and I felt pretty concerned about whether or not I would even be able to run Boston because I maybe I had a flare up or I had a bad run or whatever it was. And it was helpful to have somebody else tell me like you're going to bounce back, you'll be fine. Because I just didn't have the confidence in myself that I once had with my running. And so I think it's important to have somebody to kind of like bring you back when you're kind of spiraling into that place of I'm never going to be able to run again. Or I'm going backwards in my progress. Cause there's going to be flare ups. Like you said. Yeah. You mentioned that, you know, starting the strength exercises, there was pain during the exercises, but didn't irritate afterwards was running very similar. mild levels of discomfort. Yeah, so one of my takeaways from a lot of the things that you shared was really think about like. Don't focus as much on how you feel during the run. The pain level should be at a certain place, but be really mindful of the next day or the next few hours later in the day. And that's what I focused on. So during the run, as long as my pain was kind of in that four below level, I felt good. And by the next morning, if it was gone, I tracked everything. I wrote down my mileage every day, my symptoms, everything. And as long as it was gone the next morning, then I felt good about what I was doing, and I continued on with my plan. If the next morning I woke up, and if my hamstring was flared up, if it was more sore than normal or whatever it might be, then I adjusted my plan a little bit. Maybe that meant taking another day off, going to the pool instead of running. So having to just kind of course correct in the moment a lot with this instead of just really trying to drill your plan. is what I noticed about kind of what I had to do. Good work. And was there a stage when your running was building up where the Boston marathon looked more likely? Did you start to see progress and start to become a bit more optimistic and confident? Yeah, I think throughout the entire, you know, January to April of training, I was able to build up my mileage. Like I hit 21 miles in my, my longest run, which I didn't even think that I was going to be able to get to like 18. In my mind when I initially started off my plan I was like if I can get to 16 miles by March or whatever then I'll feel good about running it. So I didn't even think about being able to go past that. I would say towards the end of February I started to feel like a little bit better about okay I'm actually getting the mileage that I need. I definitely had flare-ups throughout the entire training season so there was a point in March where I even considered was just bothering me. But again, having that support of a PT that I trusted and that was knowledgeable who I went to, and he said, you're going to be fine. You're going to be able to run Boston. Just give yourself a couple of days to let this chill out, and you'll be able to train again. And so I think having that was a really good resource for me. Yeah. The topic around flare ups is really interesting. I'd like to hear kind of what your experiences have been like. Did you find a common pattern of why you had flare ups or did, and did you have a particular plan when a flare up did occur? Yeah. You know, it's, it's interesting. I've noticed, and maybe this is just in my head, but I feel like my flare ups happened after a night of really bad sleep. Like if I didn't sleep all the night before. and I went on a run, I felt like my hamstring was a little bit more aggravated. If I was like really stressed at work or something else going on, I just felt like it aggravated it. Like I, and maybe this is also me just yoga instructor on the side, like there's this mind-body connection and I think that leads to some of it sometimes. That was one piece of it. And then if I, if I tried to play around with speed a little bit too much, it would, it would flare up. And so for me, I realized like I need to throw speed out the window this training cycle. It's just, it's not in the cards. Um, and so once I did that helped with it a little bit. 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 PHT 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 caselo 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. Yeah, they're pretty good insights. And if you suspected that the PhD started initially from, you know. of recovery or not enough rest days. The same thing can be said with poor sleep and stress, in those particular moments, your body struggles to enter like a certain recovery state or recovery mode. And so the loads can kind of compile upon each other. But also we know that lack of sleep and increased levels of stress make you more sensitive to pain signals. And so it might not be necessarily the injury has flared up, but the same injuries just causing a more of a a tised state and so yeah a flare up would occur but like you say with the speed it's that's very classic you know faster speeds increase hamstring demand which if it exceeds the capacity would lead to a flare up and so I The advice I would have for those who are listening and are finding a pattern with poor sleep and stress to flare ups, which I don't know how many people would be that sensible to do, but if... in particular weeks or days or moments when they are stressed, you know, modify the training. I, you know, it's a very, it's very hard to forecast that. And, um, you know, before the flare up occurs to say, you know, I've had a couple of days or today's been quite stressed. Let me dial back the intensity of my training or let me swap my run day for, for a cross training day, or let me, um, just mitigate this particular moment. And when I'm that for more days of longer low intensity running or something like that. So having that foresight to try and adjust the plan in those moments I think is pretty key and won't really necessarily be picked up unless you're doing that documentation like you say if you're documenting your symptoms and you're also documenting like your training loads and your sleep or your stress. Those particular patterns might just go unidentified without this is just a very random flare up but it's really interesting that you've picked up those particular traits. That's very well done. Then we're getting close to marathon and you're becoming more optimistic as you know the date approaches. How did things go? How did things go on marathon day? Things went very well on marathon day. I was struggling because one, I didn't know how my hamstring was going to respond that day. I obviously hadn't run a marathon in a while on it. I think two, I didn't know from a speed perspective. I've had some really fast marathons and I knew that this wasn't going to be my fastest marathon. So I think like ego, all of that was taking a little bit of a hit of I just, you know, this might not be a great race. ended up having a really, really good day in Boston. We had perfect weather for race day, which is very unusual for Boston. And I ended up running a three hour and 32 minute marathon. And I was really happy. Yeah, I was really happy about that for a few reasons. One, again, I didn't train speed at all because I just, I couldn't. I didn't train hills at all because I couldn't. And that's obviously important. for Boston. So I was kind of going in just with whatever training I had and just kind of like the heart that I wanted to be there and I wanted to run this race. I ended up having just a strong race day. I felt my hamstring probably a little bit throughout the race but it wasn't too bad. And then after the race actually my recovery was really good and I think that all of the strength training that I had been doing the last four months And I remember finishing the race feeling like, I can't wait to train for another marathon and do all of the right things that I haven't done in so long and see what I can do because I think my hamstring and my legs are just stronger than they've ever been right now. So that felt really good. Another pattern that I usually see is like the stronger your legs and the tendons are, the more like the less recovery time you need, or after like a heavy session or after a race, you know, some people say they overdo things and obvious over training and then their symptoms flare up and they're like, oh damn, like I'm back in another flare up and then one or two days later, they're totally fine. They're like, oh, that actually wasn't as bad as I thought. And what I like to explain to them is that's a good sign of a strong tendon, like all of your hard work of doing your lunges, you know, deadlifts, hamstring quite weak and you had the same error with the same flare up, that's likely to extend four or five days a week more in some circumstances. And so credit to you and that pattern makes a lot of sense why you went through quite a challenging marathon, which is obviously a challenge for the hamstring, expected symptoms to increase a little bit. But fact that you're surprised at how quickly return just shows all the strength and all the hard work that you've put in is really come through and delivered that outcome. Excellent. And so where do you find yourself now after this marathon? Like what are symptoms like? What's sitting like? What's your strength training like? Where do you find yourself? Yeah, so the marathon actually was, it was just about a month ago at this point. I took about 10 days off of running. And I swam a lot, walked a lot. My recovery was good. And I got back into running and I felt, I felt pretty good. I definitely still have that the hamstring pain. It hasn't totally gone away, I'm not healed by any means. But I was really happy with just kind of comparing Boston to my last marathon and how I felt after that. previous marathon, I mean, I was in a lot of pain afterwards. And for Boston, I was normal sore, but my hamstring wasn't aggravated from it. It recovered very well. I am still kind of easing back into running. I shared with you, I just got back from Peru, a very long hiking trip, and my hamstring held up great there. I'm going to get back into training for my next marathon, probably more seriously in July, but I'll start running again in the next couple of weeks. I need to ensure that I'm doing is just keep up with my strength training and make sure that I have a really good plan with that. Even right now, I know that it's so easy with all of those exercises that are so good for us like the glute bridges, the deadlifts, everything. I think we should be doing those like year round all the time. I think it's important for runners and it's so easy once you start feeling better, you kind of just throw all your exercises out the window and you just start running and training. person so many times and I think I realized like no I need to do that year round if I want to continue to run strong and feel good so that's what I want to incorporate into my training. Yep well done. Things like sitting is what is there much discomfort like that at the moment? Yes sometimes so I noticed after the day that we left for our trip I went on an eight mile run and then we went straight to the airport on a plane for like 17 hours. That did not feel good. But I also was not smart about I didn't warm up. I was in a hurry, you know, day of travel, you're just trying to do everything at once and try to just get in a run and then sit on a plane for too long. So that didn't feel great. But it it recovered very quickly and the next day I was fine and sitting felt fine from there on out. So it kind of it flares up every now and then. But I think I don't panic about it as much because I'm like I know what to do. I know it'll be fine probably tomorrow. Let me just like walk around a little bit or whatever exercises I need to do and it usually bounces back. Yeah a lot of people when will I be symptom free? And I like to explain the circumstances and what how realistic the recovery is. And it fits exactly what you're saying. I say like, you know, you might be dealing with this for a little bit for quite a long time in some circumstances, but you know, your capacity increases your ability and your level of function increases, you can get back to running can get back to races, you can get back to cycling and all these sorts of things, but you know, still have symptoms. So you're not completely it's not completely gone, but you're still happy, you're successful, you're fulfilled because you're completing these races. Yes, symptoms might return for a couple of days here and there if you really push the limits, but it's less panic, it's less stress because you know that you've challenged yourself, you know that symptoms are only gonna be there for a day or two, you're gonna do the right things and then you're gonna overcome it. And then, you know, maybe if you challenge yourself for an ultra marathon, maybe a couple of months later, the pain returns for a day or two. really like left you but yeah, there's less worry whenever there's a flare up you're like, you know what, I know how to deal with this. I've done this in the past. I'm strong and I know that the tendons really stable and so we know what to do to negotiate it. And so that's like a really realistic expectation of what to expect for, you know, the recovery process. I'm glad that you're in that moment. You're kind of in there now and training for happy, happy with how things are progressing and still performing at quite high levels. Yeah, I think what I had to kind of come to terms with, because again, all of us, we want to heal quickly. We want a timeline of when is this going to go away. When a bone breaks, it's kind of a set amount of time where a doctor can tell you when it's going to heal. And even some acute tendonitis, you kind of know. And what I realized with this is this didn't happen overnight. in the last month of training. It's like years and years of consecutive training all compounding onto my hamstring that's finally showing up that it's not going to go away in a month. It's not going to go away probably in two months. Like it's going to be something that takes a bit of time to work through. And that mindset helped because I think, you know, obviously we all want to heal quickly, but we need to be realistic with this didn't just happen overnight. chronic thing and it's gonna take some time to like work through it. Well said. As we wrap up, are there any other final takeaways or insights or things that you might want to share with those who do have PhD and you know want to get to the same scenario that you're in now? Yeah, I would say three things. One, like do your strength exercises all the time even when you're feeling okay just like don't guide. Two, kind of coming back to what I just shared, like be patient with yourself. Patience doesn't necessarily mean just sitting around waiting for it to heal. It's being really consistent and disciplined with your strength exercises and your training plan. And it's making sure that you're giving yourself the time for this to heal and not putting a timeline on when it should be better by, because you're just going to drive yourself crazy. which I think is the most important part is, is like have hope that it's gonna heal. Something that I noticed, and if you kind of go down this rabbit hole of reading all the Facebook comments and everyone's story, like there's a lot of negative stuff out there that can, people are struggling and I get that. And that can sometimes bring your mindset down of, this person's been dealing with it for nine, 10, 11 years, like they haven't gotten better yet. to get better. But you got to trust that your body wants to heal. And if you do the right things, if you are consistent with your strength exercises, if you believe that your body wants to heal and have hope that it will like, I think it will. So I think that would be my third takeaway. Well done. It's kind of like a catch 22 at times when, you know, people don't have hope, they're stressed, fearful, like those we've already discussed in this episode already that those things amplify pain signals but also inhibit recovery because your body can't really enter recovery mode if your stress hormones are constantly circulating through your body. It's really tough and I've done episodes on that in the past but you know that's sort of if you don't have hope you're stressed, fearful, delays healing, hinders progress and then kind of feeds forward into the loop that you know it is hopeless and then you know seeing recovery because you are stressed and fearful and you need to try and break that cycle, have hope, have confidence, build up your confidence with your strength training and that loop can kind of be broken and yeah, it's a very good message. I'm glad that you've shared that and this is just story in general. I know that a lot of people with PhD, they have flare ups here and there and they're kind of like still making a lot of progress but then still struggling in moments and when their stories, they're like, yeah, but I'm not completely better yet. I don't really want to I want to have like 12 months pain free of doing these marathons and like having all the success before I can share my success story. But I think you're a perfect example of someone who is an out of the woods and still, you know, mitigating and strength training and doing all these sorts of things. But seeing a lot of success and focusing on a lot of the positives rather than just still having pain when I sit on a 17 hour flight. I think this story like in the moment where you're in right now is a perfect example of a good success story so I want to thank you for coming on and sharing because it's contained a lot of insights. Yeah absolutely thank you for having me on it I hope it helped. I know how frustrating it can be and I know there's a ton of people that are that are kind of battling with this but I think what you're doing is really helpful and just being able to share like your insights so thank you for everything you're doing. Thanks for coming on and Yeah, I think if this might help someone else who is going through this, like this story will definitely help a lot of people, but maybe might convince other people to come on and share their stories as well, because it's a great story that a lot of people are finding themselves in at the moment. So thanks, Arthi, thanks for joining me. Thank you. Good work. 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. you