Charlie's PHT success story

: On today's episode, we have Charlie sharing his PHT success story. 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. Thanks for joining me and I did originally have planned to do an episode on stretching. I was going to just make the title, when is it okay to stretch? But a lot of people have been requesting success stories and Charlie has agreed to come on and share his success story. He was a previous client of mine and messaged me a couple of weeks ago. a static saying like, you know, this PhD thing, I can't believe it's finally gone. Or he said it's 99% better. I can't believe it. And decided to jump on for recording. So the episode about stretching, when is it okay to stretch? I will leave to next episode and we'll dive straight into Charlie's story. Charlie, thanks for joining me on the podcast today. I mean, it's good to be here. It's good to be. We finally found a time, a time that works considering I'm about 12 hours time difference from you in the UK. So yeah, crazy times, no differences, but glad we can make it work. To start off, can you just maybe introduce yourself and, um, you know, for how you first got into running. Okay. So my name is Charlie Butcher. Um, I'm 39 and I live in the UK. Um, so I've been running. I've been probably been running actually for nearly 20 years. However, I've only really been running with structure and conviction, I'd say, for about 10 of those and probably really only seriously for the last, I'd say six or seven. I've always had quite an active, I guess, lifestyle. And, but, you know, I played a lot of sports when I was at university and I sort of ran casually through my twenties, but I only really got into it. Probably seriously my early 30s. And then I came at it from the wrong angle really. I started ultra running first, which was a bit weird. I was with a friend in London and he suggested that we do some crazy ultra marathon in the Alps, a 50 mile race I think at the time. And I trained for that. And then I kinda got hooked on ultras for a few years. Um, and built sort of a huge endurance base with absolutely zero speed. And then came at the road running scenes at the wrong way around and started doing a bit of road running and shorter distances, uh, pretty over the last few years. So yeah, that's, that's a very, very brief history. Yeah. You are working backwards, like I say, cause most people start with a five K 10 K then half marathon, then full marathon and. You know, they worked their way through the ranks, but you've gone the totally opposite direction. Yeah, I mean, that's distances I competed at though, right? So it's not, you know, obviously, when I started running, I just went running for 5k, and then you know, maybe 10k and that's how I ran for a very, very long time. I used to go to the gym quite a lot when I was younger. And, you know, just doing sort of strength work, really, but it wasn't very structured. I mean, you know, sort of, I guess, I guess, as a young 20 year old guy does, you know, I'd go to the gym and lift some weights and then I'd I'd run a bit, you know, in my spare time. Um, and yeah, it was only really when I started training the ultras that I started to really think about things like, you know, mileage and then, and then increasing to a bit of, a bit of structure into my, um, running. So yeah, it's, it's been a good journey, nearly, nearly a journey that nearly came from an abrupt end, but yeah, it's, uh, it's, it's been good. Yeah. Talk to us about that because, you know, the PhD symptoms started, uh, around like the end of 2020. So, um, what, I guess what was the, the change in your structure, uh, change in your training that might've like arose, um, might've been the cause of that. Oh man. So yeah, I mean, there's loads of stuff at play really. So I, I ran a race, um, a big, a big ultra marathon called UTMB in the Alps, um, in the August of 2019. Um, and I trained really hard for that over the summer of 2019. But all of that training, as you're probably aware, with mountain ultra-marathons, it's trail running. There's a lot of vertical gain in that race. There's a lot of hiking involved. So whilst I was running 18, 19 mile weeks in my peak weeks, a lot of that was quite low impact stuff. A lot of just long days out in the mountains. So my body was used to the mileage, but then I basically finished that race, I thought, all right, I want to run a quick road marathon. So I started running with the guys from my local running club and sort of threw into the spring of 2020, I was due to run the London marathon in March, 2020. Um, and sort of trained very, very hard for that. And we all know what happened then that race got canceled due to COVID. Um, and I just really just carried on running. I mean, you know, big mileage for me, you know, for a normal guy who, you know, who had a family and a job, et cetera. I was running 80, 90 miles a week the whole of that summer, training really, really hard and just desperate to run the road maratholing. So I thought, you know, I think quite good condition, I was in good shape and I was like, you know, I really want to do this, I really want to get the opportunity to do this. And I had this like laser like focus and I look back at it now. I mean, man, I was pretty, a little bit mental in a way, you know, like completely obsessed with this goal. I was doing some hill sprints in July of 2020 just outside my house here in Rygate in Surrey and I tweaked something. I tweaked, I didn't know what it was at the time, I got a very sharp pull on the inside of my left, sorry, my right knee and at the time I thought it was the top of my calf. Anyway, I took a few days off and I jogged on it after a few days and actually it was fine. It wasn't like a normal calf strain or what I thought was a calf strain. It sort of seemed to recover quite quickly and I started jogging again and within about 10 days, you know, I was running again, you know, I was running up to decent mileage and I think I did my first sort of hard workout about two weeks after that. So it didn't really set me back, but unbeknownst to me at the time, actually what I'd done is I'd tweaked the bottom of my. semi tendinosis muscle, one of my hamstrings. And anyway, I carried on training, but as I was training at this point, I should add actually I had a race booked in October. So this was pretty late, I was into August now and I started sort of doing that final 12 week build up to this race. And every time, you know, I had a coach at the time, every time he set me a harder session. and things like sort of Mongeti Farplex, you know, these kind of like shorter speed works or just things like one minute on one minute off. Every time I had those short reps, I really got a bit nervous and I started to feel like it wasn't pain, but it was just a real awareness that there was something not right in that leg. I just couldn't, I was scared to generate speed basically. It just felt like kind of restriction. Anyway, I carried on training, I did all the wrong things really, but I was just so obsessed with doing this break. did the marathon and thank the running gods that I was able to do that in a weird way because that was the last time I ran without any pain up until very recently. So I ran the marathon and then took a bit of time out and ever since then I've been battling this hamstring issue. It was interesting because I had it diagnosed quite early on by a very good physio here in the UK who did some ultrasound. And he said, yeah, you've got tendon, an opportunity of your semi tendon, the notice muscle. Um, so one of the, uh, kind of internally rotating hamstring muscles, but initially it was down at the bottom. So it was down by my knee. Um, and. You know, as I guess people are, you know, as the advice is nowadays, you know, it's okay to keep running. I'd never clarified what that meant. So I did keep running. So I was running, I was running too much. Um, and started loading the area. But once again, in hindsight, and I'm sure we'll talk about this, but it was just, I was just overloading the structures so much. And eventually this issue moved its way up the muscle and came up onto the issue of tuberosity and became like a classic PhD. And that's how it all started. And that took me through to sort of December 2020. Yeah. And that's kind of, and that was, that was the beginning of a very long story. Um, so yeah, kind of reminds me of like a plantar fasciitis thing that's just like creeps up on you. And like this throughout your training and it's just like, you're slightly, um, during those speed sessions, just slightly overdoing it, slightly overdoing it. And then it would like just carries over into something that just becomes more annoying and more obvious and then more localized and. Um, I've actually heard a couple of times people strain their hamstring muscle belly and you know, they manage that and then back at training, they like, and just like your experience slowly molds into something higher up and more proximal and more around that sitting bone after that, something further down. And like the actual cause that not too sure, but it's a pattern that I see sometimes, um, so it's not an anomaly for you to, to you know, report that. Um, but I do think it is quite common for, like you say, you just have more awareness around that particular area, feeling like the leg isn't right. And just like being really fearful or shy to do speed work and not too sure why. And then just like, as the weeks go on. And I guess the, um, weeks of mismanagement just slowly tends to reveal itself more and more become more localized and like, Oh, that's where it is. It's high up in my sitting bone. And, um, Yeah, just like the awareness just becomes a bit more localized. Would you agree with that experience? Like as you go over those weeks? Yeah, totally. I mean, I mean, we, I mean, there's the initial, originally he, he only scanned that part of my leg, right? Cause that's where the original injury was. So, so I don't know if, if there was kind of a developed tendon issue up on the sit bone and actually then it just manifested itself down, down by the knee. You know, I don't know, you know, cause you can have these things without pain symptoms, right? So it could have very easily been that. I don't know, but it was definitely an insidious, slow, yeah, kind of buildup. I mean, we've all had injuries where you're running along and pop and you limp home or you get a taxi or something and that's it, right? And that was my experience of injury. And this is why I made all the mistakes I did initially is because my experience of injury was, right, you get injured, you take a bit of time out. And as soon as you can run again, really, then I'd always sort of run and I'd kind of, I'd kind of try to strengthen my way and bully my way out of these injuries. Um, and, and it worked, you know, because with soft tissue muscle, well, I say soft tissue, but the belly of the muscle stuff, which I'd always seen to done before, you know, there's loads of blood flow into that area and I could, you know, I could heal up pretty quick. And, and this is why this got so chronic is because I was trying to do this and I had no understanding of, of how to heal a tendon. You know, I just had no, I mean, I had Google, but you know, there's a lot of, you can go down rabbit holes with Google and get yourself into a hole there. So it, yeah, I got myself into a real sticky situation with it. Um, and actually looking back now, if I had managed that correctly, you know, over those first few months, I think I'd have pretty saved myself a year of, a year of time, well, I would say a lot of time. Um, because yeah, it's, it, it just, it grew and grew and there was never a time when I suddenly thought. bang, that's gone. You know, and some runs were better than others. And this is the classic thing. One day it would be a one out of 10, and it's getting better. And then, you know, the next time around, it would be a five out of 10. And there was no, I couldn't put together a pattern. Like in hindsight now, I can see the pattern, but then I couldn't, you know, I didn't associate the heavy strength work I was doing, you know, with, I was like, ah, is that making it worse? Is that making it better? I wasn't giving anything time to develop. And, you know, and yeah, and obviously that's something you have to do with this condition. Yeah. So over time, like as you're talking, like over, you know, the period of years, um, how were the symptoms behaving? Like you say that it wasn't necessarily following a pattern, but with symptoms changing at all were your effects on training. Was that, um, changing at all? Yeah. I mean, so, yeah, so symptom wise, um, it went from being very localized initially, um, and then purely kind of in that. that single muscle, sort of the semi tendinitis, so the inside of the leg. And symptoms were brought on by all the classic things, you know, hill running. And actually, it's always been a problem is downhill running. And I guess, because that muscle, I am quite tall and I've got quite a long stride and that muscle, you know, I think, from what I understand is very heavily involved in, you know, when you're in your full extension. So it, yeah. but it was always in that area. But over time, those symptoms just started to move around and I'd start to get pain on the right side of my knee, on the outside of the right side of my knee and in the belly of the muscle. And yeah, it was always, I could always trace it back to the original injury and the symptoms were just so random. and they were moving around the whole time. And it got really, really frustrating to the point that I was convinced that I had like five or six different injuries. I was convinced my whole right leg was falling apart at times. And I was trying so many different things. And I didn't realize that obviously I didn't understand about the sciatic nerve getting irritated. And looking back now, that was definitely, there was definitely a neural aspect to all of this as well, which we discussed when we spoke. But yeah, it's, yeah. the symptoms just got worse and worse, if I'm totally honest. I never really got any pain with sitting initially. That's something that developed a little bit later on in the story. After I started riding the bike more actually, in a bits one offload the hamstring, I kind of made it worse in that way. But yeah, the symptoms were all over the place and my training just, it was just so you know, the mental aspect of dealing with injury came in and I was really bad at it. And you know, this is where I've had the biggest learning through this whole process. I was just constantly trying to get back into training. I was, you know, I was, anytime I got a good, like maybe a week of training where the pain was down at one out of 10, for instance, for a few runs, I was like, right, okay, I'm in. And I'd email my coach, right, I'm in, I'm in, I'm in, right, set me some stuff. And I'd go and do like... a week of like sort of little workouts. Okay. Yeah. I'm getting through this. And then I just have a massive flare up, you know, like an absolute biblical flare up and, and then just have this crashing load. I'm sure lots of people can appreciate it and understand, you know, and just feel really rubbish and then go back to square one and I was just in this absolute cycle of a boom and bust really. It's the best way to describe it. Yeah. And earlier you said that, um, You couldn't really find a pattern with your training, what would flare up or wouldn't flare up. But then you over time, you ended up, you know, maybe isolating those aggravating factors. Were those the downhill running and the speed sessions that you described before? Yeah. So I mean, to be honest with you, so I, this, I mean, I should probably just, yeah, the story, what actually happened is I, I ended up getting to the point where I bought a bike in May or April last year, and then was combining training with the bike and with running. I'd run one day and I'd bike the other day. That was working, obviously, because I was taking the impact away. It seems stupid in hindsight that I didn't pull this together. I got to the point where I was cycling loads and the cycling was making me actually really tight. I didn't really pick up on this either. And so whilst the hamstring was actually kind of responding quite well at that point, I started getting some other symptoms of tightness and actually got to the point in May last year where I just completely stopped running and I stopped running for four months. And it's only been in this sort of comeback to running that I've made since sort of October last year that I've managed to put all these pieces together and work out. how to sort of manage this condition and actually, dare I say I'm touching a big bit of wood in front of me right now, but yeah, get over it and be running without pain right now, which is unbelievable. But yeah, I would say that the key factors in hindsight for me was strength work, which is just the absolutely, the most important thing I did. but then just slowly working out over time what worked for me and more importantly what didn't work for me in terms of training and load. Because it's this tendon, it's one of those things, I mean, I say I'm over it, I'm going to have to manage this tendon probably for the rest of my running career, it's a grumbly tendon, it can, it will react badly. if I overload it in the wrong way. However, I've now worked out how to train to a pretty decent level for me, um, and, and not overload that structure and put the strength training in the right place. And it's amazing how just little things like putting the strength training on this day, and then giving myself just enough break, even, even just an extra five or six hours in that, in the rest of that tendon before I use it again, however I'm going to use it will make such a difference between getting a little flare up or not, you know, so, and that stuff. Just, yeah, it just took a lot of working out. Um, a lot of trial and error. Yeah, for sure. So I guess quite early on you were doing that strength training. Um, were there any other initial, um, modes of treatment that you attempted like during that particular trial and error phase? Yeah, loads. Um, so I, so, so I started strength training probably in January or January last year and that was during lockdown. So I had to order a load of weights to home, which my wife was pretty pleased about as they arrived in the kitchen. But I started doing some very good strength work, heavy strength work, and I immediately felt a huge benefit to that. But the error I made was I then started running the day after because I still wanted to train. I still had this kind of mindset. I wanted to stay fit and I wanted to give myself my body time to recover really. the level of weights I was doing and these heavy deadlifts and stuff, my body needed probably two days really before I ran in hindsight. But in answer to your question, yeah, I had shockwave therapy in February, March last year. I've also had a steroid injection. I had that actually more recently. That was in October 2021. And I've seen a lot of videos, I've spoken to a lot of people, I've spent a lot of money, I've tried everything. I mean, I literally, you know, anything that I felt would improve the condition I've tried. And I soon realized that, yeah, there's no magic bullet to all of this. I mean, there are things certainly that help, but there's no magic bullet. But yeah, I mean, Shockwave was good. Shockwave did help me. And it didn't cure the condition, but definitely helped me. And the cortisol injection made it a lot worse. Okay. It's a pretty common pattern that I hear. Well, I guess with the shockwave, what the shockwave can make things feel better, but also needs to be accompanied with, you know, the right load management, the right strength training, rehab, you know, all those other variables, because a lot of people think. Um, that the shockwave is actually meant to heal the tendon or has a role in healing the tendon, but in fact, it just, um, helps with the symptoms. It doesn't actually change the structure. So that's why the strengthening and everything else that goes alongside it needs to be alongside it so that, uh, you know, we want longterm success. Um, so I guess with the idea of shockwave, and you said that there was a benefit. Did you like in hindsight, looking back, um, was it the other stuff, like all the other stuff that running the training, which, you know, kept the injury, um, like symptomatic. Yeah. I think my problem was I was trying to advance and this is sort of the biggest takeaway and, you know, the biggest bit of advice I'd ever give someone has it, is I was trying to advance through the steps too quickly. Um, I was always keen to jump onto the next stage, you know, because if I had a good couple of days, I'd feel like, oh, we're getting progress here. And. And so I think that the strength work was absolutely key. And I got that right pretty early. I've done a lot of strength work in the past. So I had a really good routine for that. What was causing the issue to continue, that the continual flaring was just too much running and just not accepting. And this is another big takeaway is that I was trying to maintain like a level of aerobic fitness that I didn't need to maintain. I, you know, fundamentally the aerobic fitness was never going to be my limit to the training. It was always going to be this injury. And I, you know, and also I was there like going for long bike rides. And obviously there's enjoyment factors to all this, right? So you want to get outside and you want to enjoy stuff. And I get that. But I was instead of giving my body just time to heal and absorb the strength work and let the changes in the tendon take place, etc. All the good stuff that strength work does. I was then running on it to maintain this aerobic fitness, which was completely pointless because whilst a bit of running is okay, I was running 10 mile hard tempos on the road on rolling hills and it was just flaring up. It was just utterly ridiculous in hindsight. This time around, when I came back to running in the autumn, I just said to myself, right, you're going to run 5, 10k three times a week and you're going to jog and you're just going to take it really easy until you're doing those runs pain free. And you know, I even started off doing a jog walk pattern, you know, which for me felt utterly crazy, but it didn't matter because I wasn't trying to get aerobically fit. All I was trying to do at that moment was just heal the tendon and get the body used to running again. And that shift in mindset was the key for me. It was never gonna be, you know, even now, it's not aerobic fitness that holds me back in my training. It's making sure my muscular system is strong enough to do it. And that for me has been the absolute key. Um, sorry, I don't have to answer your question. I'm just, I'm just waffling home. No, it's good. It's useful. It's useful to know, um, like you started doing your strength training well before we started working together. Um, so I'm just out of curiosity. What were the strength exercises, uh, that you've, you found that was like really beneficial for the tendon. Um, did you have any particular favorites? You, I know you said it was heavy lifting, um, but any particular favorites that you think might've been beneficial. Yeah. So. It was heavy lifting, so deadlifts were absolutely key, but I had to be quite specific with the deadlifts because my hamstring muscles were quite strong. You know, there wasn't really an issue with the strength in the muscle. It was trying to therefore make sure that I did the deadlift, you know, in such a way that I managed to actually get the load into the right part of the hamstring, if that makes sense. So I was doing a lot of single leg work. So the single leg deadlift. I actually found split squats really useful. Quite heavy Bulgarian split squats going quite deep, so really getting down to put some good pressure onto the tendon. I also found hip thrusters and then I do a single leg hip thrust with a light, I mean not too heavy bar. I mean this sounds... difficult setup but then I'd have a leg slider underneath my heel and I'd gently just slide the leg away to get some eccentric movement. So it's really, I mean, good exercises. And then I got the, my latest purchase has been the Nordic, the Nordic curl machine that you, or the Nordic curl bar that you recommended. And you know, that's been great actually because that's something I could do very easily. So I'm sort of in a maintenance phase now at Rehow. I'm still doing it but I'm... I'm just kind of doing enough now to keep symptoms settled, if you know what I mean. I'm not sort of manically sort of obsessing with the strength work. I'm trying to like bring the running forward and do enough to keep the tendons stable. And that's a brilliant piece of kit. Yeah, anything that I could really get some compression on that tendon with and put the load into the tendon. So yeah, I messed around with loads of stuff. I found for me though, I needed heavyweight. I needed to really, you know, bodyweight bridges and stuff. They were good. But only really in that initial phase, I really needed some really, really heavy weight on the bar and to really sort of just work the tendon. Yeah. Quite hard. Yeah. And I was quite impressed when, you know, we started working together and you were talking about these ongoing issues and like the mental aspects, you know, really taking effect and just really frustrated, but I was actually quite impressed with all the, the productivity that you had been doing, you know, the, the strength side of things and how. You'd developed that, I guess. Was there a, well, we know there is a turning point in your rehab somewhere, but I guess at the rate was it's like a, um, a slow turning point that slowly started to tilt things in the right direction. Or was there one moment, one pivotal moment that sort of shifted the course of your rehab to make things like significantly better, um, maybe just talk us through where that turning point was and exactly what might've been the cause. Yeah. So I. It's interesting because I think I'd got close before. I think I got close last spring to turning the corner because I think the strength was working. I was just overloading the muscle with too much running. And then ironically, I turned my back on it and just started cycling. And I didn't do a single squat or deadlift or something. You know, I didn't do any strength work as I went on my bike. And actually, it was fine. I had a good time, but I didn't. The hamstring just, I forgot about it, basically. So I got back into running in the autumn and immediately the hamstring hurt. It actually hurt more than it had done before because I hadn't done any of the stuff, you know, somebody trying to run on it again. And I had this cortisone injection and, you know, and I don't know, it was completely my decision. I sort of pushed the guy to do it, but it was completely the wrong decision in my opinion. Because it... by me because it just made symptoms a lot worse because my body kind of, I don't know, I then just started running more thinking I can run more again because it didn't hurt obviously because I just had this shot of basically a giant painkiller into my tendon and then made it even worse then because instead of just going away and doing the rehab, which everyone says you should do, but I didn't, I just ran on it and it just got worse. So I think then I immediately that that's when I had this sort of moment of, right, I'm just going to get this better and that was that mindset shift, you know, it's like, right, so this, I'm just going to get this thing better. And I'm just going to do whatever it takes to get this thing better. And if I get really, if I lose all my aerobic fitness, I don't care, I'm just going to get this better. So that was, that was the first kind of prominent shift in my mindset. It was like just, just focus and getting this thing better. I then, yeah, I think I spoke to you around this time. and just came up with some sort of way of putting everything together. That's what I was struggling with, getting everything into a working week, making sure I was hitting the right spots. And I didn't do anything fundamentally different with the strength work. I did less of it. I wasn't doing it every other day. I was doing it twice a week, maybe three times a week max. Having a really easy day after the strength work, maybe even just doing nothing. God forbid, you know, having a rest day. And, and then, you know, just doing very, very easy running, and just jogging, really, just to sort of get the body used to moving in that respect. But you know what the biggest, and I did that for about three or four months, through Christmas. And you know what the biggest turning point was, actually, and this sounds really weird, and this probably wouldn't be the same for everyone. But it was actually, I think with the strength work and the running. I was, you know, the body was getting itself into position where the tendon was, well, the tendon was certainly getting much better function, but the rest, I hadn't really thought about how my body was moving as well. And I actually just spent some time, you know, just really working on my release work and just thinking, you know, I got onto a foam roller a lot, you know, I was putting hours on this thing and really just trying to loosen everything up. I stopped cycling as well, completely. I'm not saying that's the right thing to do, but for me it was actually really irritating, the tendon on the sit bone. So I stopped doing that. And I just, yeah, and over time that was sort of, I just started to run a bit more and it just started to feel like my body was just functioning the correct way. Because obviously this injury had come on because. uh... of an issue somewhere my kinetic change somewhere so yes there's some of the things that the word moving properly that the cause this hamstring to get overworked and tend to not be developed so and that was actually the big change that was kind of in conjunction with the strength work and everything else it was just really focusing on getting my body moving the right way and that sounds very vague but i was yeah it really did work for me and i've spent a lot of time sitting on on the roller and i had a lot of massage work just to sort of really loosen everything up because i kind of just locked myself up with all the strength work. I then started introducing some slightly quicker running so i started just doing the odd sort of set of strides here and there but being really careful with not you know because my big problem was always doing too much you know i was always doing too much and i've never i've I'd never give the dose of exercise, whatever that dose was that day, I'd never give my body a chance to show me if that had hurt, if you know what I mean. I'd never, so if I ran, I'd then do strength work in the evening. This was the old me. And then I never quite knew what had caused a little flare up, whatever. Whereas this time I was just like, right, I went for a run, right, I'm gonna do four strides. You know, I'm gonna do four hundred meters of the 80% effort runs, and I'm gonna see. I'm gonna leave it for 24 hours and I see how that and you know, and then okay, that was okay That was okay. Okay, so and just building through that and writing everything down. It sounds really kind of like Almost over the top, but it worked for me. It really did work for me And yeah now I'm running having 50 miles a week In case I don't know what that in case about 80 K's a week of I don't know But yeah, and you know, I'm doing you know up to sort of 10 mile quite hard sort of tempo runs And you know, it's unbelievable how it's turned a corner. Absolutely unbelievable. I never ever thought this would happen. I mean, I texted you a few weeks ago and I just like cannot believe this happened. I'm still, I actually think that the biggest issue I've got to overcome now is my brain is still fixated on that thought in my body. Like my brain, the connection between your brain and a sort of chronic injury, I mean, I guess everyone knows this, but it's unbelievable how focused I am. you know, there'd be nothing wrong and I would just, I'd be like, what was that? What was that? You know, running along, what was that? You know, and even in the middle of the night, I'll sometimes like, I'll kick my leg out and sort of like put a bit of pressure on the, you know, like sort of almost doing a bridge in bed, it sounds weird, but you know, like just sort of doing that sort of, that movement. And it, oh, that, it's sore and it's not sore. It's not sore, but my mind is, that's been the challenge now, is actually just getting over that kind of. that complete hardwiring I've got between the tendon and my brain. But yeah, and it's still taking some management, right? It's not, I said to you before we started recording, you know, it's not like it's been some things, it'll probably always be a grumpy tendon, right? It's always, I'm going to have to manage it. And you know, I did a hard run this morning and this afternoon. You know, it wasn't sore, but it was like, you know, I was aware that... I've done a harder run than usual, but you know, I know now I'm confident that by tomorrow afternoon or, you know, I've just got a rest day tomorrow, by the next time I run it'll be fine. And that's just, it's unbelievable. Yeah. It's a lot of things at play. This podcast is sponsored by the Run Smarter series. If you want to take your knowledge building to the next level, I have built out a proximal hamstring tendinopathy video course, which complements the podcast perfectly. Sometimes it's tough delivering concepts and exercises through an audio format, so the course brings a visual component full of rehab exercise examples, graphs and visual displays to enhance your understanding. Even if you sign up now, you'll have access to all current and future modules that I create. Sign up through my link in the show notes, then download the Run Smarter app, and you'll instantly have unlimited access to all the course resources on any device. And to say thanks for being a podcast listener, I want to give you a VIP offer. There will be a link in the show notes in every episode that will provide you 50% off the course price. Just click on the link and it will automatically apply your 50% discount. Definitely a lot of things, a lot of things need to be a play for you to overcome it. Because like you say, in the past, there's been one or two things that have helped, but the rest has just made things worse or just, you know, fallen back to the same. Like you say, the strength training was beneficial, but then, you know, maybe the cycling or maybe the running, jumping in too quickly, might've just hindered things and makes it very hard to interpret a lot of that stuff, which unpacking a lot of your turning point, I guess that moment, it was one having a plan, like just having things written down on paper and making sure you're doing all the right things day by day. And then just alongside doing all what I would call the short term pain relieving stuff like the massages and the foam rollers and those sorts of things and getting yourself like moving correctly, but then just the patience. So it's just like the combination of all those things. You need to have everything in place, particularly with chronic tendons. You need to have all that play in place, but then you need the patience to back up and not just get into that same repeated cycle of as soon as you have a couple of good days or a good week. It's like, all right, we're back into training. Let's go. And yeah, like repeat that boom bust cycle is. as soon as you catch that particular behaviour, as soon as you catch that particular pattern that goes on, is when you can start addressing it. And it does take patience, which a lot of us don't have, because this injury is really frustrating and because as athletes, you know, you want to get back, you want to start training, you want to have an event to train for. And you know, sometimes impatience just gets the better of us. But the other thing I think is worth mentioning, like you say, if you introducing something new or like a variable, if you introducing speed or if you introducing a new strengthening exercise, making sure you isolate that and don't change everything else like close to that moment because then you can accurately interpret what's happening and you can accurately interpret a change in symptoms and sort of pointed to that one thing because you have isolated it away from all other change in variables. Um, even if you want to introduce strides and then you wanted to increase the weight of your deadlifts, just make sure that, you know, there's a day separating the two. And so we know that, um, if there is an increase in symptoms, we know exactly what it was based on when symptoms arose. And so I think that's a particularly nice insight. And then the hypervigilance like that just slowly fades over time. It does take a while for that, that brain rewiring to happen, but As soon as you start having a lot more successes, then, you know, the brain to starts the relevance and the priority of pain or that particular area to start to creep down and, you know, just eventually sort of drifts off. I know I had a, um, a tendon flare up on the inside of my knee for, uh, was years that it lasted and I was at a very mild form, but I remember driving. And in my right leg, I'd always like rub my thumb over it just to see if it was still sore. And that was just a habit of mine. And even when it was a lot better and I had months of it being pain free when I was driving, I'd still like as habit, just like, you know, get rubbed the inside of my knee to see if pain was there. And it's been, I catch myself like maybe once every six months doing it, just purely out of habit, but I haven't felt pain there for the last three years. But, you know, just the brain, you know, rewires habits and Hypervigilance is a very real thing because when you do have chronic pain, it is such a high, it's so high on the priority scale of the brain, that it's just really tough to calm down once symptoms improve. The brain takes a lot longer to, you know, re-prioritize things than symptoms take to settle. So yeah, that's more of a patient's side of things. Yeah, and that's it, right? It's just, it's amazing. Yeah. do start, once you just, once I calmed down, I mean, it literally was that once I literally just, you know, I let myself calm down, I sort of got off this, you know, as you say, that sort of boom bust cycle where you just, you know, I've got, I've got a train for a race and just, I'm just, I always fell back into the armchair a bit and just like, okay, just let yourself heal here and let the body, let the body do need, and it sounds like cliche because then you read it everywhere, but it's very, it's easy to say. that it's very, very hard to do. But that's when it started to click into place. And it is interesting as well, the point you make, because I, you know, there's been days where I've done a run and then I've done my, I still do single leg deadlifts and some Nordic work as well. I try and do that a few times a week, maybe three times a week. And because I'd run that day and I knew I had a long day at work the next day, I was like, I better switch that into tonight. I was gonna do it the next day. And I did it 12 hours earlier, and this was recently, and the next day I was really, I saw it, I was like, what's going on? And it was amazing, just that little subtle change, even though the tendon that's super stable now, that little change, you know, it didn't create a flare up, but it created a mini flare up that lasted a day or so. And so it's like, yeah, you've still got it. It's amazing how sensitive these structures are. And I never, I just, as I said, I just tried to. blast my way through everything with hundreds of dead lifts and 10 mile tempo runs. It doesn't work. It doesn't work. Yeah. But the point is, you know, there's so much negative stuff about this injury online and you hear so many horror stories. And, you know, and I genuinely believed, especially after I've had this for, you know, 12, 13 months, I was like, this is going to be, this is it. This is game over. And actually, I I cannot believe how it's turned this whole corner. And it just goes to show that something like, it was really, it was sore, I couldn't sit. I was thinking about it all day long. It was, I don't wanna sound dramatic with what's going on in the world at the moment, but it really was kind of really affecting my life. It was kind of ruining my life. I remember sitting there, my son was being born in the hospital and just feeling my. sitting on this chair with a sore bum, you know, because there's blooming tender and like, and that's what I was thinking about, like your son's being brought and like, you know, sounds crazy, but it was, you know, it took away like this massive part of my life and running, you know, running was, I mean, my wife completely, it's everything, but, you know, I love it. And then suddenly when that's gone, I can see, you know, I'm sure lots of people who listen to this can probably understand it's huge. And it's a it really is a nasty injury. So the fact I've got over it, you know, I thought I was never going to get over it. I'm pretty good and get something else now. But yeah, I've learned so much about I've just learned so much about dealing with injury from this. And I think actually having an injury like this, it makes you Yeah, yeah, I just feel like I can I feel like I can tackle anything now. You know, I really can learn so much about how the body works. And yeah, I mean, the other the other bit of advice I'd sort of say as well is speak Yeah, don't I tried to Google my way through this at the start and was jumping between different theories and how to do it. The best thing I could do is speak to someone who could actually put it all together for me and try and look at it objectively from the outside. When you're in it and you're trying to come up with theories and if you're obsessed with it and you want to get back, you do find yourself going through these internet sites and reading this, reading that, I'm going to try this, I'm going to try that, I'm going to buy this supplement, I'm going to do this, I'm going to stick. 18 needles in my other leg, you know, you end up sort of just like losing the plot a little bit. So it's quite good just to get some, get some guidance and advice from someone on the outside, I think. Yeah. And just you just talking about that is that there's like a ton of takeaways and you've already shared so much already. Any other final takeaways or bits of advice for people with PhD that might be in the same scenario you were, you know, a year ago? Yeah, I mean, I mean, obviously, I've just said don't give up because that is the biggest one. Yeah, I mean, the biggest thing for me is... You know, when you do something, when you do your deadlifts, or when you go for your easy run, you know, just give your body, just trust me, just give your body time to, and, you know, everybody is different, right? And you need to work out how long, you know, it's going to take for that tendon to... to be ready to do something on it again, basically. Just give the body time to do the work you're trying to induce by doing the strength work, basically. Yeah, allow the strength work time to work. And that was the big one for me. Yeah, and I mean, I just, I think as soon as I accepted, I wasn't gonna be racing until it was better. And that just took a huge weight off my shoulders as well. But you know, I was meant to do loads of races in 2021. I signed up to another marathon this spring. I signed up to loads of races and all this was kind of like playing on my mind. And as soon as that kind of got white, I was like, okay, it's fine. It doesn't matter. Just take as long as you need to take. Yeah, it's very, very easy to say in hindsight, man. If you'd just spoken to me at the time, I was going mental. Yeah. And it seems like you have very realistic expectations about moving forward with this. And like I say, understand that it's just management. And I guess the encouraging thing, um, for me to say is that all the hard work that you do put in with the strength work and with the building up mileage, then slowly introducing like strides and tempo stuff, like all these, the planning and also the progression. Means that the tendons developing becoming more resilient so that. You know, if you were to elevate your training and your overall dosage, then it does become more resilient. And if there does, if there is a flare up that does happen, it is like a bit more of a mini flare up. It only just happens over 24, 48 hours and then you're good to go. That's a good sign of a strong, robust kind of, um, resilient tendon. That's been, uh, adapted to several different elements of training, several different. intensities because you are doing the slow stuff, but you are also doing some quicker stuff and you're also doing the slow heavy stuff and when the tendon adapts to all of those varieties, all of those intensities that just makes it more robust and so if it were to become irritated because of some abrupt change or some fluctuation or you pushing the envelope just that little bit too much then it's only just a minor hiccup and then you're back. to your normal routine back to your normal training. So I do like that you have that realistic expectation that you're not out of the woods. You're not like a hundred percent free to do whatever you want. It's still like a conscious effort to manage the loads, but find yourself in a very, very good situation. Yeah. And then, you know, I'm not, I'm not training anywhere near the way I was in the summer of 2020. You know, yeah. I mean, I don't know if I have any massive desire to do that anyway, because it's probably, you know, it's why I got injured, right? I did too much. Um, you know, and another little thing I've done, I mean, this is, this is just a very sort of, um, yeah, I mean, I don't know if runners around the world do this, but I always trained on a seven day cycle, right? And in that seven day cycle, I'd do one speed session, one sort of tempo threshold session. I mean, this is, this is very generic and then I do a long run, right? So that's four, three sort of quite hard sessions in seven days. with a rest day in there. And I've gone on to 10 days now. So immediately now I do a harder session. I always have a minimum of two days recovery. And for me, I'm 40 next year, so that pretty applies certainly to people like myself who are getting older and can get beaten up a bit more. But just little changes like that, just always erring on the side of caution. And the biggest thing running is consistency. showing up every day and getting, not every day, okay, okay. It's showing up and just getting consistent blocks of training in. And it's no good training really well for two months and then getting an injury. What you need to be able to do is train consistently over time and whatever you can do to keep yourself injury free is the most important thing, right? And then I just find herring on the side of caution now. If I wake up in the morning and I've got any doubt on. I'm just like, no, I'll go easy today and I'll do the harder session tomorrow. And that's been a huge mental change for me. Yeah. Well, I want to congratulate you. I think it's a, it's, um, quite a journey with a lot of lessons along the way. And I'm kind of glad that we organized this success story, like so far down the track. Um, because I just have a feeling that you've spent the last couple of months feeling really good, but also kind of working things out and sort of making sense of everything that happened in the past. Because like you say, in the heat of the moment, um, it's really hard to grasp. What's. what's working, what's not working, doing so many things at once and along with the pain and then the frustration, all these sort of things can kind of jumble things up. But I think at this particular phase of your journey, you've got like a clear head, or you're getting, you're sort of fitting the pieces of the puzzle together. And I think you've, you know, mentioned a couple times already, like hindsight, hindsight's 2020. And It seems like, you know, things are now just all falling into place. All the pieces have come together, all the errors that you've made in the past, like the successes within those particular errors. And then just eventually, you know, finding those pieces of puzzle and putting it all together and then being able to share it on this episode at this particular moment of your journey, I think is really good timing and really good for the listeners to kind of disseminate and kind of work out this particular condition. And some tips and tip bits to help them with their recovery as well. So thanks a lot for your, for being patient, for doing all the right things, for sharing this story and helping a lot of people. And thanks for coming onto the podcast. I'm April Matu. I wish everyone the best of luck with it. It can get better, definitely. Thank you, Brody. Absolutely. You're welcome, Charlie. 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.