Avoiding the Pain, Rest, Weakness Downward Spiral

: today's episode, avoiding the pain rest weakness downward spiral. 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 of course, bust the widespread misconceptions. My name is Brodie 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. chapter of my ebook and I think this will be the last episode where I actually pull out a chapter specifically or a chapter that I've chose for you guys and I've handpicked these chapters for a particular reason. We want to make sure that you understand these concepts before you have the confidence to... manage and successfully build a rehab plan. And this topic is a key one. It is one that I explain to every patient that I have. I talk about it multiple times a day. This concept of the pain, rest, weakness, downward spiral. And I won't delve into it too much right now because I'll let the chapter speak for itself. But like I said, this will be our last episode. We'll have a listen to like I said last episode or was it the episode before that, it is in the Run Smarter app. If you want to get that, sign up and then you can read that e-book and have a look at the visuals, the graphs, which obviously enhances your ability to process it because these can be a bit- tough to explain just purely via audio. That's why the ebook has some nice graphics and graphs in there to explain it all. So yeah, let's dive in and then I'll tune in at the end of the snippet to bring this little segment to a close. I really like this concept, avoiding the pain, rest, weakness, downward spiral. It's a lesson and a concept that I share almost every day with my clients whenever I see a runner or... someone with shoulder pain, low back pain, it applies to everything. And it's a concept we all need to know. But before we do, let's quickly just jump into the ebook and see what Pete is up to. And let's see if this experience that Pete has rings a bell with anyone. If we were to just recap, Pete last episode went through a new promotion and less sleep, more stress and started developing knee pain. If you're unaware why he started developing knee pain, go back to lesson 7 and let's see what happens with Pete now. So injury-prone Pete was worried. He didn't want to have another injury like his last, so he decided to have a week of complete rest. Day-to-day symptoms had settled and I should probably mention that this is his knee pain, not sure if I mentioned it before. Day-to-day symptoms had settled, which was a relief. But during the next long run... symptoms came on at the 12k mark. So previously he was running about 24-25ks and then after the promotion he started developing pain at the 20k mark. Rested for a week, came back. Knee pain came back at 12ks. Pete stopped straight away and walked home. Maybe he just needed a few more days to recover. Another week went by and Pete tried another shorter run. On his third attempt symptoms Pete became alarmed and booked in with his physio. Not sure if that rings a bell with anyone, but let's dive into the physio part of the chapter. As you have already learned, when a structure becomes irritated, the capacity for that structure to tolerate load drops. In other words, it becomes weaker in the short term. A weak structure in combination with complete rest continues to weaken that structure. Very rarely is complete rest the answer, however some exceptions such as stress fractures need to be considered. From Pete's experience, there's a clear timeline that shows structure irritation followed by further weakening which leads to further irritation. I call this the pain-rest-weakness downward spiral, and can even spiral down to the point where there's irritation with daily activities. because it becomes increasingly difficult to climb your way back up the further down the spiral you are. I see this very commonly with plantar fasciitis or Achilles tendinopathy and someone might be running 50k's a week, develop plantar fasciitis for whatever the circumstances might be. It gets to the point where they can't run 5k but it continues to stir up with daily walking, standing as a job like a chef or... a security guard, they try to get back into running, and then just everything, any part of running just flares them up. It continues to weaken, continues to irritate, now they've completely stopped running, but daily activities are now starting to flare them up. So if they go to work, if they have a long day at work, then that starts to flare them up. And you can just listen to their story and recap their history and just notice this downward spiral. And if we can catch it early enough, say when they were at the 5K running mark, we can do great things and it can bounce back quite quickly. But if now, if they're standing for half an hour and getting irritated, that is a totally different scenario and we really need to work quite hard at settling down their symptoms with building up strength and slowly working their way up that spiral. So it's a simple concept to understand once you know what's going on. Hopefully this rings a bell for you because it's hard to know the cycle that you're in and get a bird's eye view over the last couple of months. People really struggle to grasp and visualize what's happened in the last couple of months and it's not until I hear their story and relay it back to them that this concept starts to become apparent and become obvious. Another cycle and concept that you might be familiar with is the boom. bust cycle, which is very, very similar. The continuous cycle of running too hard until you're injured, followed by months of frustratingly slow and short runs while you're managing that injury. And then as soon as that injury comes good again and you feel like you have the freedom to go again, you go back to your desired pace and distance, which is usually too much and you're left with another injury. And it's just that boom bust cycle. And it's very similar to this pain, rest, weakness as their patterns that runners struggle to grasp or identify. And it's usually associated with someone who overvalues high intensity training and has the go hard or go home mentality. And they don't really, they undervalue low intensity and they have sayings like rest is rust and they have that kind of attitude, which is a personality type as well. And we'll talk about personalities later in. these principles, but what are you telling yourself about your injury? What common reasons are you giving yourself? Why do you think you are getting injured? I hear people say I need to stretch more, I don't warm up, I have flat feet. These are reasons that don't serve you and we know that 80% of injuries are due to training errors and load management errors. might create counterproductive illusions, but you're probably thinking if you are in pain, well what should you do? The short answer is to trial and error your duration and intensity really conservatively and then build yourself back up. And it all depends on your level of irritation and you might need a health professional who does see runners a lot to more accurately predict what level of intensity you can return back to or trial in your trial and error phase and then to see how things go. It's funny because I can use an example that's happened. I went for a run on Thursday. I did 8Ks and I did a little bit of an interval session towards the last 2K. I wore my minimalist shoes which I have been running in. Felt great during the run, felt great after the run and then just standing up and walking around at work later on that day. my right calf started tightening up, which was really strange, I don't usually get those sort of symptoms. Became more apparent and walking I was starting to feel it. So I've obviously overdone my calf a little bit. Trying to be smart and trying to follow these principles, I did have two days off. So I had the Friday and the Saturday off and just mixed it up with some swimming and I did some gym. So not doing anything to the calf really, but still staying active. By day three, walking was no longer an issue. I did a quite a hard bike ride yesterday. The calf was fine, so still keeping fit. So my mentality is still positive. And then today, I just put on my non-minimalist shoes. So a little bit more support takes a little bit of pressure off the calves and just went really conservative, went for a jog. After about 500 meters no pain, but I'd say no tightness, but just symptoms. I can just feel it's not Right to my left calf. So started walking walked for a couple of minutes did another 400 meter jog Could feel it again. So I was at my house at that stage walked back in and I've done a K of walking so far no further irritation and Tomorrow, I'll go again. So Hopefully tomorrow I can do maybe 2k, the week after that, the day after that maybe 3, 4k, and then just in a week, hopefully, I'm back to 4 or 5k without any issues. I haven't rested. You could tell that the calf has not become weaker, it hasn't become more irritated, and it's just making sensible steps throughout the last couple of days in order to... Get back as soon as possible. This podcast is also sponsored by the Breakthrough Running Clinic, which is my own online physiotherapy business where I treat clients all over the world. I always recommended that my clients build on their own knowledge and try to manage their symptoms on their own to build self-confidence. However, if you still require a tailored approach and one-on-one guidance, whether you are a runner or not, I'm more than happy to be on your team. You can sign up for one week or one month packages and have me by your side every step of the way through the duration of your package. So head to the Breakthrough Running Clinic link in the show notes to learn more. Now this is just me following these principles, but if someone weren't to follow these or be unaware of these, what's a very common pattern is for someone to run 4K. Oh, let's say someone ran 8K like I did. Felt pain, got worried. rested completely for four days, then they start feeling good again. Started running, felt a little bit of tightness within a K, but just kept going to see how it went. Let's just say they did 4 Ks and then they're limping again by the end of the day. Worried, rest again, go for another run. You can just see this cycle repeat itself. Go for another run. Then after two Ks it's completely irritated. uh... then they have a week off this is what i hear my clinic all the time and it's not until they become extremely worried like they're running maybe five hundred meters and then they're limping again is when they go see the physio so make sensible decisions i know you are probably thinking about i just want to return as quickly as i can and as effectively as i can so i'll take the week off and then i'll try another four k run something like that really doesn't serve you. You really need to put on your sensible hat, think in the long term, learn from past experiences and then make sensible decisions. Don't be triggered by emotion. And I know the thought of when you return back to running, sometimes the running plan I get people to do is cringe-worthy for them. If I tell them to run, if I say when you're injured, okay, your first run back is going to be a five minute walk. followed by a jog for one minute, walk for one minute five times, and then another walk for five minutes. People roll their eyes at me and think I'm joking, but I'm not joking. Depending on their level of irritation, that's what they need. But then the next day, we pay attention to symptoms. If symptoms have not increased and you're still feeling good, you can go again the next day. And this time, instead of doing five lots of running for one minute, walking for one minute, you're doing it eight times or ten times. It will all depend on your individual circumstances. And then if that's fine, maybe have a day off. Day three, you're doing two minutes of running followed by one minute of walking and doing those intervals. And before you know it, after a week, you've done five sessions and... you're not irritated, that's a lot better than taking a whole entire week off and then trying to run again and then being irritated. So going on really easy runs, really slow, interval, jogging, walking, serves a lot of purpose. So don't roll your eyes. I can also talk the benefits of loading a tendon, and if someone is undergoing like a chronic tendonitis, either being the Achilles or the patella, You can benefit a lot from doing either isometric holds, so like putting that tendon under load and holding that. So like for an Achilles issue, it might be bringing your heels off the edge of a step, standing on that one foot and just loading through that Achilles and holding that for 15-20 seconds. For a Patella tendon, it might be doing a wall squat, so sitting against the wall with your back to the wall and feeling that load through the knee. And this can help the properties of the tendon get used to triggering load or get used to having load applied through that structure. And you can do this before a run and it can limit or eradicate the symptoms you feel during the run and after the run. So these are little strategies you can do to counteract this pain, rest, weakness, downward spiral. It can even apply these isometric loading exercises throughout your day to slowly build that up so you're not completely resting. If you are going a couple of days without running because you are irritated, you can apply these sort of loading tests throughout the day so that you're not completely resting that structure and it's not becoming weaker day after day after day while you are resting. There we have it, the concept of the pain rest weakness downward spiral and the last chapter of the ebook that I'm extracting and educating to you guys. The, when it comes to proximal hamstring tendinopathy, it's all about just trying to maintain as much capacity as you can while you are injured. If you experience a flare up, it's all about trying to maintain as much capacity as possible and if you have to take extended time off your main activity, let's just say you're a cyclist and your hamstrings flared up, if every little bout of Cycling is flaring it up, means we have to take some time off, but we need to maintain the capacity of that tendon through other means. It might be walking, strengthening exercises, cross training, as much as we can while we're waiting for it to rehab enough to go back onto the bike. So we're not retreating away to safety, or we're not just avoiding things as soon as they become irritated. I see a pattern quite often where someone will have a bunch of exercise and a bunch of fitness routines that they go through. And then as soon as something flares up the hamstring, they immediately pull it away and say, okay, my hamstring can't tolerate this. I'm never doing this again. I have to find some sort of alternative. It shouldn't be that way because as the tendon gets weaker and weaker, you're constantly retreating and removing more and more exercises and therefore it becomes weaker and weaker. So we need to really make sure that we're on the front foot. We're being proactive. and if we have to take something out in the short term, we're putting something in to work towards and bridge the gap to get back to that activity that you just removed. Sitting can be another one of these. A lot of people will say, oh, I can't tolerate one hour of sitting. So then they constantly up and down and spend less time sitting. But then as the weeks go on, because you're not spending a lot of time sitting, the hamstring tendon isn't used to sitting. And so all of a sudden, you can only tolerate 10 minutes of sitting. Then you avoid sitting altogether. And then when you have to make a five minute drive to work or to run some errands, it flares up. It's constantly, you're constantly like retreating away from sitting and the tendon is becoming less and less able to tolerate sitting. Hope that makes sense. So make sure that we're being on the front foot, we're aware of this concept being extremely mindful of it when we're applying this to our rehab program. Just one more thing I'd like to add before we wrap up. If you're finding this beneficial, if you're finding that you've got through these first eight episodes and you're seeing a lot of benefit, maybe some revelations in the rehab, maybe gaps that you're missing and you're starting to put all these pieces together and you really can see the impact it can have for you and other people, I highly recommend that you just recommend this podcast to people. I don't do, it's... It's a tough job getting a podcast in front of someone, especially one that really needs it. The best way that we can do it is, I'll try my best to advertise it, but it makes it super, super effective if you start recommending it to people who you think this is tailored for. So like I said, if you've had a listen and you think you're noticing a benefit and you think it'll benefit other people, I highly, highly recommend, and I'll be extremely grateful if you start sharing it around. That's it for today, guys. I have a ton of new concepts to introduce to you in the next coming episodes. So I look forward to bringing it to you then. 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.