How to Cross-train your way to recovery

: today's episode, how to cross train your way to recovery. 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. everyone who has replied or commented, asked some questions for today's episode throughout the Facebook groups that you're involved in. I'll continue doing that. I think it's a nice idea to get you involved and allow me to get a bit of insight of the questions you guys want. helps me give the episode a bit more structure rather than just me building something and assuming that's what you wanna hear. But today we have, we're just talking about how to cross train your way to recovery. And cross training should be a part of your rehab no matter what stage you're at. And just treat it like any other strength in the exercise that you need within your rehab. Is there anything I need to talk about before we get started? Thanks for downloading all these episodes. I... Highly recommend if you haven't listened to all of them, please go back and start listening from episode one You do need to understand all of these episodes. Not just the ones with the catchy titles of the ones that you feel You might be more interested in it's designed in a way that you will to get full advantage of your recovery and make sure there's no missing pieces or gaps within your rehab. You kind of need to listen to all of them. I know it's a bit of work, but overcoming this is going to be tough work. So right. Also, yes, I'm going to remind you if you know someone who has proximal hairspring tendinopathy and you are finding a lot of benefit from these episodes, please. Give a shout out, recommend to the podcast. That's how people get, how this gets discovered in the first place. Um, so thank you for that. Okay. Everything we will discuss today will just depend on your level of tolerance. We're going to dive into several different types of cross-training. We're going to do swimming, elliptical, cycling, strength training. And, uh, let's just say like cycling, it's going to depend on your current level of tolerance because. Let's just say cycling might be fine for others, but not for you at this current point in time. And it will depend on two things. One, the sensitivity of the hamstring in the moment. You might be having a sensitive like couple of days that it can't tolerate certain levels of cost training. And it just depends on your level of tolerance, like how far into your rehab stage are you? Have you done much work into compression? Have you done much work with heavy weights? Have you done much work with power? And the best way I can describe it is, you need to think of all these activities, just like you're running, just like you're sitting, just like your strength exercises. They're all on this spectrum, they're all on this scale. And depending on your level of, your current level of tolerance, some things would be good for your hamstring, whereas if someone else has a proximal hamstring tenopathy, at that point in time, it might not be a great option for them. And so let's just say if we're using running as an example, there are certain modifications, certain variations, certain tempos, certain speeds that we can modify and adjust that might fall into a you can currently tolerate or might fall out of you can't tolerate. So that's the best way I can kind of start off this program because I don't want you to say cycling is bad, let's not do it. Or Um, elliptical is good. Let's add that in. It will all just depend on your current level of tolerance because there might be a hamstring out there where currently cycling is quite bad for it. It will cause a significant flare up. However, if you do the right baseline strength, if you do the baseline like building into compression and you can actually start tolerating levels of cycling, then adding in cycling actually might be an advantage for you for your rehab. And so. There could be a no, there could be a yes, there could be a bad, there could be a good, it just really, really depends. Keep that in mind. So, we're gonna start our first one with talking about cycling. And Tori asked her question, there was a couple of questions around cycling, but Tori asks, is cycling like spin classes okay? If so, should I focus on staying out of the saddle to avoid aggravating the area? compressive forces or creating compressive forces, not cleating, creating compressive forces, this will all just depend. So I've got a couple of dot points here that I want to talk about cycling. Cycling the action of cycling will combine a couple of components. One it will combine compression because you are sitting and depending on the type of seat, it can like all other sitting can compress the tendon underneath the sitting bones. but it can do that in combination with stretching the tendon as you bring your knee up towards your chest in that cycling action that actually stretches the hamstring and stretches the glutes and brings you into hip flexion. So you're compressing the tendon and you're stretching the tendon and then you're creating some power as you push down on the pedal and generate some force over that pedal stroke. So just thinking about that, we know that the tendon might not be able certain levels of compression, especially under stretch, especially during high levels of hip flexion. But also the difference in power that you might produce every single pedal stroke. So if you're pushing down on that pedal a lot harder with a lot more force than someone who's in a lighter gear just ticking them over, that's obviously greater compression and greater demand for the hamstring tendon. And then there's obviously duration. We know a 20 minute bike ride won't be as strenuous on the hamstring tendon as a 60 minute bike ride. There's a couple of factors. Anything else, I guess the effect of compression similar to sitting will just depend on the individual. If I recommend, oh, if I say that cycling contains high levels of compression, I don't want you to instantly disregard cycling as an avenue. because like sitting, we wanna encourage levels of compression, we wanna build you up instead of just avoiding it altogether. Similar to cycling, maybe cycling something you wanna do, we just find what level you can tolerate and slowly build up. The seat type will depend, sometimes a really narrow seat width can avoid that direct compression and you're just tolerating like that stretch and producing that power. Also, keep in mind the position that you're in, because cycling can come in a bunch of different varieties. We're talking about spin classes, we're talking about just a casual bike ride, we're talking about mountain bike, and we're also talking about sort of like an aero tucked position. And the more aero you go into, so if you go into a really tucked position where you're leaning forward quite a lot, that's gonna be more and more compression, and some of you might discover. that a spin class where you are in a very casual seated position or sitting up and not putting your hands down on the bars, that could be fine. However, if you then go out on the road where you're leaning a bit more forward, sometimes a little bit tucked into that aero position, that can generate high compressive forces and you might not be able to tolerate it. So a lot of things to keep in mind, a lot of different variations that you can do. Spin classes are quite nice because you can get out of the saddle and you can ride without the hands on the bars quite for long periods of time so it can be nice as an introductory into cycling to see what level you can currently tolerate and then you can just go into a lighter gear so that you're not producing large amounts of force or power that would be a good start and then you just slowly build your way up maybe just slowly coming out of the saddle and avoiding that compression every now and then, maybe just mix it up. I like alternating coming out of the saddle, going back into the saddle, out of the saddle, into the saddle, similar to like a sit-stand desk throughout the day. And that could be really helpful. But then once you can tolerate good levels of sitting, then you might want to slowly go into more of a hip flexion. So you might want to have your hands on the handlebars and then just slowly adapt to that. then you might want to introduce a little bit of power and do that for small amounts of time and see if the tendon adapts to that. Then if you want to become quite competitive or quite fast on the bike you might get out on your road bike and slowly integrate a bit more aero tucked positions. And similar to how a runner might start a running program and do a walk run program, you can do exactly the same. You can go from every now and then sitting up on the bike seat to then putting the hands on the handlebars to then doing an aero position and then a non aero position or Doing power sessions for 60 seconds and then come off for five minutes and repeat that It's very structured. It can be very structured but there's a lot of variables for you to work around with when it comes to cycling all it is just testing something out making sure you're not overdoing it making sure you're not changing too many variables or once and Once you know the tender can tolerate that, then you're slowly easing your way in. If you're not tolerating it, if you're not tolerating any levels of seated position on a bike, then I recommend start doing some strength exercises, some rehab exercise that involve some levels of compression. Okay, let's move on to the second point, which is swimming. And Karen asks, she just puts the question, oh, how about swimming Brody? Does this aggravate it any way? Is there... Does it aggravate this in any way? Is there a way we can get cardio through this? Does the stroke matter, whether the breaststroke or front crawl, which is like pretty generic freestyle? Anything else we can do in the pool that won't aggravate? It's a good question and it'll depend. When we're doing swimming, particularly freestyle, we're looking at open chain hip extension. So open chain means that your foot isn't fixated to something like the ground. if you're doing hip extension with the foot floating in the air, that's what we call open chain. And if you were to lie down on your stomach and you were to keep your leg straight and lift a straight leg up in the air, and you do like a little flutter, like you're sort of practicing some kicking, sometimes that might grab the hamstring and sometimes that might be quite painful. And if it is, it probably means you're not ready for swimming or you're not ready to do any kicking in the water. And so that's what, cause that's what happens when you do freestyle. and it's a test that you can do. I know sometimes when my hamstring is quite flared up, doing that activity can spark a little bit of pain, like a bit of a grab up in the sitting bone. But I still swim regularly. I just make sure that my tendon is quite settled before I do my swimming, or I focus on not kicking as hard, which triathletes tend to do anyway, because it's the only leg where you just have to use a lot of arms. But... You can test this out at home. You can test like lying on your stomach and do those straight leg flutters lying on your stomach. Or you can in standing have a band around your ankle and attached to the front in front of you. And then you can try standing, keeping the leg straight and then just moving your leg back behind you. If that's painful, then probably you're not gonna tolerate a high level of kicking in the water. I think breaststroke. is less demand on the hamstring. You're sort of incorporating more glutes with that external rotation of the hips. So that could be a good option if you enjoy breaststroke. I'm never good at breaststrokes, I never do it. I only just do freestyle when I swim. But some alternatives, if you can't tolerate high levels of kicking, you can just not kick as hard and just give your legs a bit of a break and just use most of your arms. It's similar to what I do. Or you can get fancy and use like a floater, floating buoy. or a kick board or put that in between your legs and not kick at all and just use your arms. That can be quite nice. And you can still get a good cardio workout. Swimming is great for your cardiovascular system. So probably something to keep in mind. But if you cannot tolerate high levels of this open chain sort of stuff, then you might wanna do some rehab exercises for it. So like I described with that TheraBand in standing, that might be part of your rehab exercises and incorporating a little bit more speed, trying to flick back with the TheraBand quite quickly. And once you build up and tolerate and adapt to that exercise, then swimming shouldn't be an issue. But like I said, some people might tolerate good levels of swimming because that open chain hip extension is fine. It's only compression which tends to trigger pain. And so that brings me to my third alternative for cross training. which is the rowing machine. And I think Michelle and Mandy both wrote very similar questions just around tips and how to use the rowing machine. The rower is a tricky one because similar to cycling, it's you're producing power, but under a high compression load. So your knees are very close to your chest and then you're pushing with your feet. And so your glutes and your hamstring being compressed as you push that, yeah, in that sort of row action. And it's very similar to like an aero tuck on a bike. But this might be very good for you, let's just say if you're at the end stage of rehab and you're tolerating high levels of compression and you want to continue testing out that hamstring, you want to continue adapting that hamstring to more and more compression, then at the end stage of rehab, a rowing machine might be very good for you or very... beneficial for your recovery. So something to keep in mind, but you need to be able to tolerate it first. Tips around rowing. So if you can't, if you're struggling to, if you enjoy the rowing machine and you're not tolerating it right now, then you need to start tolerating higher levels of compression. So I'm talking deadlifts. So doing some, say half deadlifts with weight and seeing what weight you can tolerate. And then as you want to progress and as you want the tendon to get stronger, you want to progress to doing full range deadlifts. So going more and more into compression. And then you might want to, once you're doing quite heavy deadlifts through full range, you might want to elevate that or challenge you more to do something with a bit more speed or a bit more power, which would be like kettlebell swings, which is kind of like that deadlift action as the kettlebells passed underneath you. and then you're producing a lot of force under compression as you swing that kettlebell into the air. So doing a lot of that could be fine. And once you're able to tolerate and adapt to that, then go onto the rowing machine and see what you can do for the hamstring and if it can tolerate those levels of compression. And the rower you can't really do change the range of movement. I guess you can get only like say 80% range with the rower. Might feel a bit weird if you... sort of do like a half row on a rowing machine, but 80% can be fine. And then you might wanna move into 90% and then 100% range of movement. Those are big differences. So, cause you're under just more and more compressive load. And yeah, also consider the speed and the watts that you generate when you're on the rowing machine, because you might have the same level of compression, but how fast you push off those foot platforms. and produce force could be like if you were to go slow, even if it's the full range, if you were to go slow, your tender might be able to tolerate it. If it's a very fast, very powerful row, you might not be able to tolerate it. So we are testing and tweaking and paying attention, listening to your body along those lines. 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 recommend 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. Okay, the fourth one is the elliptical machine and Amy and Kimberly say very similar things. Amy said, I would love some forms of cross training that could get my cardio as high as running. The running elliptical is the only one that I found. Kimberly is the elliptical machine. Okay. I have, is it safe to run on flat ground? I'll, we'll talk about running in a different episode, Kim. So we'll just talk about the elliptical for now. running variations is on my list of episodes to cover. So keep that in mind. The elliptical machine, so, or the cross trainer, what some people like to call it. I haven't had much experience with the elliptical. I've only just been on it for a couple of seconds. I remember once at uni, I just tried it out, but haven't been on it since. But I recommend it based on what I know of the elliptical and based on like the, I guess the biomechanics of it. it doesn't require a lot of demand. It's almost similar to walking, but you're pumping your arms a bit more, you're using your core and your body a little bit more, but this doesn't, it seems to be quite gentle on the legs, definitely compared to say swimming, rowing, and cycling, all the other ones that I've gone with so far. It does seem to be minor compression, sometimes just looking at the action. I think some cross trainers are designed a little bit differently, so the foot. placement can be a little bit higher than on some models than others but if it is minor compression and you can't tolerate that minor level of compression so let's just say you can't it's sore to go upstairs or if it's sore to go uphill you can always just use your arms on the elliptical training you're not working the legs as hard so that's a really nice option something I would recommend to test out as a cardio option if walking hiking isn't really tolerating those sort of activities very well. So yeah, I think it's a really good starting point. And we do want some cardio options because we want to feel good. We want to feel like we've had a bit of a workout. We don't want to feel like we're getting lazy and putting on weight and not having a cardio alternative once we have a very irritable hamstring. So yeah, gets my approval, but like anything. We want to see that we can tolerate certain levels of power, certain levels of resistance under a certain level of time. Once we know we can tolerate that, then we slowly build up from there. My last one is gym exercises. So we're looking squats, lunges, jumps, those sort of things. And Kate asked a very nice question. So squats, lunges and jumps, including squat jumps and lunge jumps are amazing for getting the heart rate up and as good lower body workout. but I know I should avoid them. Can you suggest other proximal hamstring tendinopathy friendly exercises that are a bit more bouncy than bridges? I'd actually kind of disagree with you, Kate, when you say that I know I should avoid them because I see this belief a lot and it's the belief of... you've done something in the past and it's flared up the hamstring and therefore you just disregard and say, no, I can't tolerate that, I can't do it. Let's just avoid that and let's do something else. But let's try and switch our attitudes to, okay, I can't tolerate it right now, it has flared me up in the past, but let's build up the tolerance so that I can build that up in the future. And so when you say you should avoid squats, lunges, jumps, I'd say just build up the tendon enough so that you can tolerate squats, lunges, jumps. and even just squat jumps or lunge jumps, those sort of things. So this is where we need to be quite creative and you might need a little bit of guidance because there's no one straightforward answer of whether it's good or bad because we need to find out your level of tolerance. So squats, lunges, deadlifts, they're all good. They're all good exercises for building up levels of compression so you can tolerate more levels of compression. for just building up speed, building up strength I mean. But it all just depends, depends what weight you need to start with, depends what reps you need to start with, depends how fast you do that exercise. These will all just depend on the demand of the hamstring that we want to generate. And so you need to tolerate high levels of compression before doing some speed work. So if we're looking at jumps, if we're looking at squat jumps, if we're looking at lunge jumps, you should be having a good level of baseline strength and a good level baseline of tolerating compression before we even talk about power. And so squat jumps generate a lot of power, generates a lot of demand through that tendon, therefore we need to have a good baseline. And yeah, we just wanna make sure we have a good foundation. You can even, if you've returned to say squat jumps, we can do half speed. So just try not to jump as high or maybe get a shorter box to jump onto. but we can also do half range. So the squat down before you jump up can be half range or then we can progress to full range. So all just depends. That's why I said at the start, you kind of need to be creative. You need to kind of find your baseline. We need to kind of change one variable at a time. That'd be the weight that you hold, the range of movement that you go through, the speed that you generate. Yeah, a lot of factors, but hopefully that provides some sort of clarity. If anything, like all these, we just test it out, test out one dosage, see how you feel, and then just move on from there. And I'll probably be repeating myself because I've discussed this several times on different episodes. It can be a little bit sore during the exercise. It could be like a maximum four out of 10 pain, but we wanna make sure that there's no significant flare up afterwards or the next day. It should be settled down by the end of the day. Otherwise, we know that we've done too much. So that's it. My key takeaways, oh, I'll do a bit of a recap. So one, cycling does generate high levels of compression and force, but we can monitor those with say sitting up on the seat, with getting out of the saddle and start cycling out of the saddle, and then just slowly tolerating more compression, more power as we lean more forward and generate more force through the pedals. Swimming, if you can tolerate open chain, hip extension, so sort of that kicking back kind of action. Swimming can be good for you. If not, then you can just not use your legs as much and incorporate open chain hip extension into your rehab exercises with some TheraBands, those sort of things. The rowing machine, it's high levels of compression. So make sure that you have a good baseline. Make sure that you're doing your deadlifts. Make sure you're doing some like, even some kettlebell swings. So introducing some power before going onto the rowing machine. but we can always reduce the range of movement slightly and reduce the power that you generate with the rowing machine. The elliptical can be quite nice, can be quite safe compared to all these other options, so a good start. And then we have those gym exercises with all those variations I just discussed. So I have how many here? Five dot points to finish up, so sort of like key takeaways. Number one, there's no right or wrong answer with these. There's no yes, no. good, bad, there's none of that. It'll all just depend on how much you can tolerate because what might be bad for you right now might actually be very good and very beneficial later in your rehab because we don't wanna avoid things. We wanna just build up to tolerate those things, which takes me to point two actually. So the mindset of if it hurt in the past, I'll never do it again, I should avoid it. That's a mindset that we need to overcome and we need to... have more, we need to be liberated, we need to have more freedom, we need to have more control that we can build up and start tolerating what has flared you up in the past. I know it's scary, I know it's scary to stretch a tendon under load. This is where some reassurance might be needed, be the coaching or your health professional to let you know it's okay. But the fear of doing it can actually hinder your recovery as well. So let's start overcoming those little boundaries with a step by step progression. So instead, which is point three, instead we need to switch our mindset to the cycling flared me up in the past. Let's build up the strength I need. Let's build up the power that I need. Let's build up the compression I need in order to return back to cycling. A more positive frame of mind. The fourth key takeaway at the end, like everything we test and we assess and we tweak just based on how your tendon responds to a certain load. It's very simple, similar to all these other rehab exercises. And like I said, the fifth key takeaway, which I've repeated several times but it's worth repeating again, if it flared you up once before, it can actually be helpful in your rehab down the track. So if deadlifts once flared you up, we just need to prepare you for low-level deadlifts and then build on those deadlifts later down the track. because that can build up so much strength, so much compression. It's very hard to get a full rehab and return to all the things you want to do if you can't do a deadlift, if you can't do a heavy deadlift. Keep that in mind. That's our episode today talking about all things cross training. Sometimes you do need a bit of insight around the biomechanics or the intensities, which is why a coach or some sort of PT personal trainer guidance can be really helpful. But keep that in mind if you're really struggling with some routine, if you're really struggling with trying to be consistent, if you're really struggling with understanding these variables, then find someone who can help you. All right, that's all for today guys. Next up, I'm gonna be adding some shockwave episodes, whether I combine into one or split into two, I still haven't decided yet, but that's in the pipeline very soon. So look forward to that. We'll catch you next time. 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.