Client insight: Rehabilitation tips & being kind to yourself

: today's client insight episode, rehabilitation tips and being kind to yourself. 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. you the right knowledge along with practical takeaways in today's lesson. You are enjoying these client insight episodes. I think this is the third one that we've done. I hope you enjoyed Michelle's success story last episode. Uh, the, uh, before Michelle's episodes, the previous two episodes, I had been going off some client insights and feedback, some revelations that they've had during their. rehab, they've worked with me in the past. Um, like I've said so many times on this podcast, the bulk of my caseload are PHT clients. And so thought I wanted to spread some wisdom cause everyone has their own individual experience, have their own individual revelations or insights. Um, no matter what they all have the same condition, but it all presents slightly differently and everyone has different lifestyles. And this particular condition affects people in so many different ways. And so it's nice to go through a management with someone and then they have a completely different revelation to someone else and always nice to share a bit of positivity, a bit of just their experiences, their positive experiences that have happened throughout just to help you with your rehab. And the first insight that we had was learning about patients. I think three episodes ago now, two episodes ago, we had talking about just exercise running and rehab from a few different clients. This one is another one that's just one person, but contained their revelations, their feedback contain so many different dot points that I want to go through most of them today. And so I have it written down. talk you through its entirety and then we'll break it up into different clients, different sections and sort of, yeah, take a deeper dive. So this client says, I've pretty much just reached out to all of them and said, what insights revelations do you have that I could share on the podcast? And so this one has said, my main learning points from my 2.5 years would be, so 2.5 years, so two and a half years of PhD would be. Don't think the PHT will go away by completely resting. Pain will decrease with rest, but once you attempt to return to activity, then you'll have more than PHT to worry about. Seek input from someone who has experience in treating this condition. Keep notes on what activity you do and reactions to this, both rehab and the other daily activities that might impact. Do not accept corticosteroid injections if suggested. Seek MRI or ultrasound to help with diagnosis if unclear. Talk about the condition and its impact on you with those close to you. It's a nasty injury that impacts many aspects of life. Be kind to yourself, make sure you get enough sleep. Eat well, including regular protein in your diet. Realize that in order to make progress, you need to really commit to your rehab. There will be progress, but also dips and flare ups, which can mess with your head. Get a sit stand desk for work, but don't become fearful of sitting. You can't stand all the time. So, so many things to unpack there. I've chose some of my favorites. Oh, most of the, the dot points that this person has talked about. And the first one being, PhD won't go away with complete rest and symptoms might get better, but that's not the idea. The idea isn't to completely avoid everything. for a long period of time until symptoms settle. And I think people do get carried away with the initial successes of, I guess, resting. So if someone reduces their running from 20 kilometres per week to 10 kilometres per week, and they notice a benefit, then it's more encouragement or incentivised to go, oh, and it's still here. Well, my PhD isn't better yet, so let me go to five kilometres per week. and it does get better. And then you think, oh, but it's still there. Maybe if I have complete rest, maybe that will, that will finally allow me to completely heal and then I can get back to what I want. And so then you're completely back off running. And then all of a sudden long sitting starts to produce pain. And so you say, oh, let me just limit my sitting throughout the day. And then symptoms get a little bit better, but still haven't gone away yet. And you continuously take things away. And in the hope that complete rest will alleviate these symptoms for good. And it's encouraged like those initial successes are encouraging people just to continue on that trajectory, but just fosters that pain, rest, weakness, downward spiral that we talk about so many times on this podcast, you have pain. So then you go to complete rest and then that just fosters weakness and the atrophy, the inability to tolerate loads. If you don't use it, you lose it and even though symptoms might get a little bit better, it's definitely not a solution for the long term. If you do have a flare-up, okay to rest for a couple of days to let symptoms settle. But then after that we're back to trying to manage this with load management, trying to see where our adaptation zone is, train within that as much as we can. and build that capacity back up. That's as proactive as you can be. It's better long-term solutions and helps the body, helps the mind as well if you're a bit more active, a bit more proactive. So yes, people get swept away with the initial successes but it's also driven by fear, especially sitting, especially like bending forward, stretching, those sort of things can spark a lot of fear. So it's not necessarily. Sometimes it's the initial successes of symptom settling, but then it's also, or can be driven by fear. So people are just scared of sitting and then they don't. And then that can foster that pain, rest, weakness, downward spiral at the same time. And so just be aware of that. Be very cognizant of this pain, rest, weakness, downward spiral. Recognize, self-reflect on the past couple of months to see if you are pulling back more and more and more. And what trajectory you're on. So good point to start with. The other one was to keep notes. So documentation, again, I've talked about this on the podcast and you might hear success stories and clients that I have had in the past, talk about documenting their symptoms can be extremely helpful. And we sort of need to work in the balance. I recognise that for those who are extremely chronic, and their flare ups aren't really making sense. They're very hypervigilant. It seems that the primary driver is the more you think about it, the worse it gets, usually with those very highly irritable chronic sort of sensations. We're sort of tipping between the balance of not paying too much attention to it, but also needing to pay attention to it to know if what we're doing is working or what the balance is. So I'd say for 95% of people, and 95% of the PHT rehab, it's documenting symptoms. So we can learn what your tendon is tolerating. We can learn what capacity you have and whether the tendons agreeing with the current management plan. But I do believe that there are 5% of people who are extremely chronic, extremely irritable. We're thinking about it too much and saying, oh, is this a five out of 10? What's my pain right now? I just did some sitting, what's my pain and constantly think about it might not. be as helpful. So I am conscious of that. But like I said, it's probably about 5% of cases out there and is more likely to be in that 5% if you've had it for a very, very long period of time. If it's very highly irritable, if symptoms mechanically aren't making sense and just random flare ups that just don't make sense, those particular things. This person also talks about injections and scans. Let me scroll back up. Do not accept corticosteroid injections if suggested. Do seek MRI or ultrasound to help with a diagnosis, if unclear. So it might be apparent that this person had a corticosteroid injection, didn't do anything. I've rarely seen corticosteroid injections make a significant difference. But what I would say to, first of all, to the injections and to the MRIs and ultrasounds. is make sure you have good management first. Rarely do I see someone say, um, or have been suggested a corticosteroid injection because of a failed management, like very good management. And if someone says, Oh, look, I've tried strengthening, it doesn't work. And all they've done is some body weight bridges. That's not, that's not being proactive enough. to really test it out. And when I say good management, there are tons of episodes, past episodes, talk about what good management is. It is training the tendon into compression. It's training it for speed, training it for endurance, and just general strength into compression, outside of compression, all those things, building up the strength nice and progressively. So not just keeping to body weight for two months, it's- progressing with the weights, progressing with the compression and seeing how it feels. If you try that for four to six months and you're not seeing progress, then maybe we can start talking about a corticosteroid injection if the symptoms themselves are not improving. And so someone might not be that patient, but the corticosteroid injection is... not there to heal the tendon, it's there to settle pain and it's there to settle inflammation. That's what a steroid does, it settles inflammation. But often in cases, and this is why it doesn't work most of the time, it's not an inflammatory disease, it's a tendinopathy. And tendinopathies aren't presented. Inflammation isn't the primary driver when it comes to this particular pathology. And so that's why it's not the case. So that's why good management. try it for several months. If you're still not seeing benefit, then maybe you can start looking at other alternatives. But rarely do I see someone's given it a good go with their management, followed the principles of the podcast, and then said at the end, oh, maybe I need plan B. I rarely see that. Okay, this was a good one. I like this, talk with someone close to you. It's a nasty injury effect. affects many aspects of life. We kind of need to think about it as all aspects of life, especially when it comes to sitting, especially when it comes to exercise, you're no longer socializing in the groups that you did when it comes to exercise. I've seen a lot of people avoid going to movies, going out to dinner, or having to try and find a place where they can stand to eat their dinner. It's, it does, it impacts your life. It negatively impacts social, um, social situations. And sometimes that could be quite emotional, fearful, frustrating, all those sorts of things. So it's very important, especially because if you feel like you're being understood, uh, it does help the rehab process. If you are frustrated, but keeping it to yourself, if you're really not talking about it externally to people. people that care about you or people that could understand, then it hinders your recovery. So especially with this condition affecting so many aspects of life, really important to talk to someone, uh, talk to family members, talk to, um, people who will have a kind ear and have a listen. If that's not working and you're still, it's emotionally affecting you. You can definitely seek help. I have had a recent podcast on the run smarter podcast. about the mental health benefits of running and the mental health impacts if someone is unable to run and they running is their only outlet for exercise and the detrimental impacts that can have. And my guest Glenn Robbins was talking about the need to seek help if you're really struggling emotionally because it does help rehab. People think that it's not a... components. They think of strength and conditioning, they think of load management, they think of PT, Cairo, osteo, all the health professionals, but they don't necessarily think about the emotional, psychological side of things. And there's definitely help out there if you need it. Which goes along with the next point of just be kind to yourself. And there's, I see so many people beat themselves up when they're injured, when they are going through a flare up, when they've done something, they've made a mistake in their rehab and they've flared up and they're blaming themselves. And so try and avoid like self pity, blaming others or blaming yourself, um, victimizing, having that victimized mentality. A lot of people are blaming, say a therapist or a health professional or someone for not diagnosing them earlier and going around the ringer of maybe scans that weren't necessary or injections that weren't necessary and being mismanaged or misled during their rehab. And that still might be true, but playing the victim isn't going to be proactive with moving forward. So try and take control of your own rehab, try and take control of yourself, which you're already doing a fantastic job of like listening to this podcast and trying brilliant step for any athlete or any people with PHT to take is to start educating themselves and having control of their own rehab. So that's a great start. If you do feel like you're slipping into these tendencies of blaming others or just being really frustrated, self-pity, you know, just not being kind to yourself, just recognise that and know that if you have a bit more acceptance, if you have be a bit more kind to yourself, it's actually going to help the rehab process. 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. The next point we have here is get enough sleep, which I haven't heard a lot on the revelations and advice and insights that past clients have had, but definitely get enough sleep. I've had sleep, I've talked to sleep scientists and I've had some recovery episodes and hands down the number one best recovery tool you have is a good night's sleep. If you're struggling to sleep, And it just means that the body isn't entering recovery mode often enough. And that's comes for athletic performance, whether that be cycling, running, um, strength training, but also when it comes to injuries, cause we also want to hit recovery mode when we do our rehab. So we go into the gym, we do our strength and conditioning, but we also do our rehab exercises and we want to adapt and. get better after doing those exercises by entering recovery mode. And so if you don't get enough sleep, you're not optimizing your recovery. Eight hours is just the general recommended, um, average that adults should get of sleep. And it's if, for children and adolescents, I think it's higher than that, but eight hours is of good quality sleep, I should say, is what's recommended. If you are an endurance athlete, if you push yourself quite a lot, if you're working out multiple hours, then that probably should bump up close to nine, 10 hours of sleep. You can use a sleep tracker, how accurate they are is debatable, but at least you're documenting something and having a reference point somewhere pretty similar to how people measure, say, pain good of interpreting what's a three out of 10 compared to a five out of 10. Well, you got to start somewhere and at least your individual reference point is something to go off. You know, it's, it's better off trying something, even if it's a little inaccurate, then try nothing at all. And so, um, you can use sleep trackers. They can be quite helpful. I have an aura ring that, um, I wear every night you wake up and it gives you your sleep stats. I use it quite superficially. I don't really heavily rely on the stages of sleep I get because I think it's quite inaccurate for that, but it's actually quite accurate in terms of the amount of sleep that you get, the total amount of sleep that you get, and also accurate for heart rate variability, which is a good indicator of recovery. So you can try a whole bunch of different things out there. And also PHT specific. Some people with PHT struggle to sleep because of PHT pain. If they lie on their backs, sometimes it sparks some pain because of the pressure on the sitting bones. If they're lying on their side, sometimes that's painful because of the pull of the tendon in certain directions. I've found if sleeping on your side with a thick pillow between your knees, which then continues down the shin bone and to the feet so that the feet are also on the pillow, that could be quite nice to help reduce pull of the tendon and then you lie on your comfortable side, you have a pillow between your knees and your ankles. Sometimes I've found that's the most comfortable spot. How long you stay in that for, not too sure because a lot of people toss and turn in bed but sometimes that can make a difference. The other point that this person mentioned was to eat well and have a lot of protein Well, let me scroll back up. So eat well, continue regular protein in your diet. Um, the, the thing I would say about recovery and, um, eating well is I spoke to Shona Halston, who is an expert on recovery and she has her recovery pyramid and pretty much like the base of the pyramid is the, the good, well researched, most effective recovery tools you have. And then the further up the pyramid you go is less, less of a priority, maybe less research heavy, sometimes like fads as you go to the very top of the pyramid, we're looking at like little gimmicky sort of stuff. But the base of the pyramid, number one was sleep. And the second layer of that pyramid was nutrition and hydration for recovery. So you wanna make sure you have good nutrition if you're eating junk food, which is a kind of like a cycle. When people are in pain, they're miserable. No one likes being in pain. They're more likely to reach for takeaway foods, junk foods, and continue down that trend, but recognize that get a well-balanced diet. Everyone knows what healthy eating is actually helps with your recovery. So I'm glad we've, we've touched on that point on this episode. And as we approach the end, realize that in order to make progress, you need to really commit to your rehab. There will be progress, but also dips and flare ups, which can mess with your head. Absolutely, I've seen this so many times before. People makes progress for two or three weeks, then they have one setback and they feel like they're back at square one and they let themselves down. They don't feel like they're making any progress. They feel like they're out of options and yeah, it's a real mess with the head. So my two points that I have here, going back to writing things down. If you write things down, you can easily say, actually, let me go back the last three weeks. I actually had two really good weeks in a row and then just had this little setback. And sometimes it's hard to see that, it's hard to see that progress during a flare up if you haven't written things down or if you don't refer back to what you have written down. I've seen it like myself all the time. Well, say three or four years ago when I'd be injured, I'd say, this isn't getting better. I'm back at square one. Nothing I'm doing is working. But even when I work with athletes, they fall into that same pattern, that same mindset, and you can look back and say, Hey, let's look at all these comments. Let's look, you said that you were having great week, the best you've ever felt, the best you've ever felt, woke up only a two out of 10 pain, three mornings in a row, that was only two weeks ago. And now we've had a flare up, which we can know why you had that flare up because you ran two days in a row and now you have an uptick in pain. That's all it was. And so you can refer back and rationalize and identify those trends to help with the mindset side of things. But the second point I want to say, which I've said on the podcast before is celebrate the two steps forward. Don't dwell on the one step back because that's usually how rehab works. It's two steps forward, one step back. two steps forward, one step back. And that's understandable if we're pushing the limits of your adaptation zone. We're trying to find where that adaptation zone is and how it's progressing. So once a few runs, if you run for 10 minutes, if you walk and run for 10 minutes and that's successful, then we wanna do that for a few days and then we wanna push to 12 minutes and then we wanna push to 15 minutes and we're constantly. trying to chase where that adaptation zone is. But sometimes we can go a little bit over that adaptation zone. And then we learn where our limits are. And we say, that's fine. We're pushing boundaries a little bit. This is how rehab is meant to go. There will be a slight uptick in pain. However, that pain won't persist. Because we've only done a slight climb in progression, that means that the flare-ups only maybe 24 hours, maybe 48 hours. We'll learn from this and we'll be a little bit gradual next time. We'll identify any missing links for next time. And then we'll continue striving forward. Let's celebrate those two steps forward because people expect the two steps forward. They want it and they, once they achieve it, they're like, yeah, this is meant to happen. And they don't celebrate it. They don't recognise it as a positive step forward. But then when there's the one step back, it's, um, it's all doom and gloom. It's all fixating on. Oh my God, I'm not getting better. Oh my God, this is, we're starting from scratch. And I think that's just human nature a lot of the times, particularly if you're in pain, people dwell on the pessimistic side of things. So, make it a conscious effort. Make it part of your routine to celebrate those two steps forward. As soon as you wake up with less pain than you did the day before, celebrate that, recognize and celebrate it and be more. consciously make a shift towards the optimistic side of things. The last point in here was get a sit stand desk for work, but don't become fearful of sitting. That's a really nice balance. You can't sit, you can't stand at all times. Exactly what I say when people say that they've overcome their PhD, they no longer have PhD and I ask, oh, how's your sitting going? And they say, oh no, I don't sit anymore. Sitting is just not a part of my life. I feel it should be a part of your life. You should be able to train your tendons, train your hamstrings, train your body to sit at a functional period of time. So people have to sit down for dinner, people have to sit down to watch the movies, people have to sit down to drive somewhere. It's a part of life and we should train your body to be integrated into everyday life. And sit-stand desks I've seen have worked really well for people. Um, whether that's standing until symptoms settle or standing, having the majority of standing, but then slowly waning into more and more sitting, um, trying to overcome that fear avoidance. That's what we call that fear avoidance for people that are just scared of sitting. So now we're just standing all the time, feel a lot better, but are just standing all the time and they're fearful to introduce some sitting because they've made such good gains. But this is another form of that. pain, rest, weakness, downward spiral that I've mentioned earlier, because we're avoiding pain, but we're completely resting that tendon from sitting, that capacity to sit. And because you've stopped sitting, that tendon gets weaker to sitting. So then all of a sudden, only five minutes of sitting becomes painful because you haven't trained your body to tolerate sitting and therefore gets weaker. So there's that pain, rest, weakness, downward spiral representing itself again. So in much the same way that if low levels of running produce pain, then we start a really gradual walk run program. So we might start 10 minutes of walking with 30 seconds of running and then slowly build up. You can do the exact same thing with a stand sit program. So throughout the day, every hour, maybe sit down for two minutes and then you stand up again. maybe the next day or after a couple of days, you sit for five minutes every hour and then continue repeating the process until somewhere along the line, you're at about 50-50, you're at about sitting for half hour, standing for half hour, and maybe you wanna just continue that for a few weeks. But that's just how we can build that into our plan. That's how we can build that into our management plan. And... see reap the rewards because not only is the tendon tolerating high levels of compression, but we're also integrating back into everyday life and doing those everyday things like driving, sitting, eating, all those sort of things. We covered a lot today so let me do a little bit of a recap. Number one, we talked about PhD won't go away with complete rest, make sure that we're being proactive with our rehab and not just... Reinforcing the behaviors that are reducing pain because of rest. So make sure we're being proactive, making sure that we're integrating sitting, integrating stretching slowly, building up some strength, building up some cardio, all those sorts of things. Document notes, keep pain levels, 24 hour responses, any changes in loading, changes in running, changes in the sitting position. identify those trends. Talk with someone close to you. Talk with someone who will lend an ear to so that you can communicate your frustrations. Talk about the impacts that this has had and start be like start talking to someone, but then also being kind to yourself. Don't play the victim game. Don't blame others. Just continue moving forward with a bit more of a proactive optimistic outlook. Get enough sleep. Get enough nutrition, realise that there may be some steps back, some flare-ups, some dips in your progress, just recognise that as part of the process and celebrate the two steps forward. And then we talk about the sit-stand desks can be very effective, but we need to slowly integrate sitting. So yeah, we've covered so many aspects of PHT on this episode. I do have a couple more that I want to introduce, a few more client insights, their submissions And we'll do so over the next couple of weeks, mixed in with a few success stories. Once I stumble upon them in the future. So hope you enjoyed best of luck with your rehab this week and we'll catch you next week. 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.