Interpreting your PHT symptoms over 24 hours

: today's episode interpreting your symptoms over 24 hours. 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. into a very important topic today, how do we accurately interpret the symptoms that you're currently having with your proximal hamstring tendinopathy. Today we are covering another chapter that was in my ebook and we follow Pete's journey and we go with a bit of a recap before diving into today's episode. If you want the whole ebook or if you want to learn all the chapters, particularly if you're a runner as well, It is available on the Run Smarter app. So if you go to the more section, it will have get the ebook or ebook or something. It does require you to sign up to my email list, which if you are on the list, you just enter your email, then you can read the book straight away. If you are on the email list, you will get emails on my weekly blogs and my weekly, say podcast episodes that come out, bit of information about that. So you can always unsubscribe, but it is a bit of a lead generator. So, um, feel free to jump onto the, the app, go to the more section, download that ebook if you want to learn more, if you want to read about it. Um, but we're going to dive in today, um, into this specific chapter that I've picked out for you guys on how to interpret symptoms. This principle today will apply particularly, uh, if you are injured, it is directed towards injury and symptoms. and observing those symptoms and making sense of them. I'll go into detail in a moment, but let's go back to see how injury prone Pete is doing. From last episode, he was getting a few symptoms here and there. It was starting to be a bit bothersome. And yeah, so let's tune in. Just a little recap before I go into the chapter. Pete started running a little bit longer than usual. and accidentally combined increasing his distance and speed with a few more hills as he found a longer loop around his house and so started getting a little bit of Achilles tightness and some mild pain. So here we go, so the mild pain was ignored for several weeks, that should sound familiar to some runners, particularly because the pain wasn't too bad during the run. In fact... It was a bit tight at the start of the run, but was starting to feel a lot better once he warmed up. As the weeks progressed, he definitely started to notice pain and increasing stiffness during his first steps in the morning, especially when the previous day consisted of running. However, since symptoms during running were very well managed, Pete interpreted this as a green light to continue running. He did make the sensible decision to run at a distance and pace he was comfortable with previously. and didn't increase any running variables while the stiffness was occurring. After all, his 10k race was coming up, a few more weeks had passed to no avail and symptoms persisted. So let's break this down throughout the chapter in the ebook. So a physio will often ask you what your symptoms are before, during, immediately after running, how far you can run before symptoms arise, does it get better or worse throughout the run? and equally important, what is it like when you first get out of bed the following day? Most tendon pain and some muscle pain can improve throughout your run as the tissues warm up and load is gently applied to those structures. This is often followed by mild pain after a run, but definitely worsening pain the following morning, so don't be fooled. This is different from your expected muscle soreness that you would get the next day. after having like a heavy gym workout. Morning stiffness and morning pain can be very useful in determining whether you have overloaded the structures the day before. So in the book I've put, so how does this scenario affect the stress graph? If you can visualize last time the increase in speed, distance and also Hills has exceeded Pete's maximal capacity to tolerate load and his Achilles has flared up. I also mentioned that last time, once those structures have become irritated, the maximal capacity line has diminished. It's actually got weaker. So if we go back to Pete's running, once he's had some symptoms, some morning stiffness and he's decided not to push and not to increase his speed, he's gone back to a conservative running pace and running speed that he's used to in the past. But since that maximal capacity line has now dropped, even that conservative run that was okay in the past is still now very mildly exceeding that maximal capacity line. So symptoms do persist and they slowly get worse and worse. It's a better visual in the graph, but you can notice that if he's slowly exceeding that line again, there's a little bit more irritation. And that max line. will start to slowly creep down because the structures, the ability for those structures to tolerate load are still dropping as you slowly exceeding that capacity line. So we see this quite often. The symptoms aren't that bad, but if you continue to push that maximal capacity line to continue to just exceed it, symptoms, the gap between the load that you've applied, and that maximal capacity line starts to become greater and greater very gradually and so you're getting more stiffness in the morning, it's becoming slightly more painful and it gets to this point a few weeks down the track where people start to become bothered and then they see a physio. That one's a bit tough to visualize but the lesson is very simple. So you can reflect this on your past running and your current running if you are symptomatic. Depending on your injury, it will depend on If symptoms are increased during your run, if symptoms are increased immediately after, or if symptoms have increased the following day. So really pay attention to when you notice it and how severe it is throughout the 24 hour period. 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 hand ring 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. This also applies not only to your running, but also if you are undergoing like some gym workout or rehab exercises with your injury. If you're say having to do squats or lunges for an injured site and the next day your symptoms are particularly worse, you've probably overdone either the weight or the amount of reps or the speed of those exercises. It just determines the level of irritation and if everything's all clear, if you do your rehab exercises or if you do your run and you're no worse, during, immediately after the next day, it gives you the all clear to proceed. How does this apply to the real world? Last episode I talked to you guys about this knee pain that was, it was kind of like a mild knee pain that I got after I was running 10k and going at a pace that I thought was a bit too fast. I was just feeling really good and got to about k5 or 6, looked at my watch and looked at my splits and saw I was going a bit too fast. So backed off. The next day symptoms were there, like the knee was sore. but not as bad as if I was to push like I was in the previous 5-6Ks. So I wasn't feeling pain at the time, I wasn't feeling pain afterwards, I felt increased pain the next day. So I wanted to make sure, oh well, I was grateful that I did back off the pace because my pain the next day would have been so much worse if I hadn't. How about if we were to look at some specific conditions? So conditions that would flare up during a run. would be things like patellofemoral pain, which is pain like around the knee cap and also maybe ITB injuries, um, that's sort of to the outside of the knee and some acute muscle strains like these type of conditions are repetitive based. The more you go through that running action, the more it irritates either the knee or the ITB and starts to stir up symptoms. if someone were to have this condition, they will say things like, Oh, I feel great. Like during the start of the run, um, symptoms will usually come on at about 4k, 5k, everyone's different, but it'll come on at a certain period of time. And then they report once that one symptoms do come on, it will just get worse and worse as the K's go on. And then afterwards it will be quite irritated. So that's a classic presentation of those sorts of conditions. Um, And once that structure becomes more irritated, they will say, oh, it used to come on at K5. Now it comes on at the two kilometer mark. Um, just as symptoms become more irritated, but it's still a repetitive pattern. Um, conditions that might flare up straight afterwards could be like more acute, uh, tendinopathies, say you're, if you've got a sore Achilles or just a low level muscle strain or muscle. or ligament strain. These sort of conditions, particularly tendinopathies, they're fine once they've warmed up, once they've had load applied and someone will come into the clinic and say something like, oh, I noticed a bit of stiffness, no pain when I first start jogging. But once I'm warmed up, I feel fine. Like there's absolutely no pain and I can run 10 Ks, no worries. But then once I cool down, maybe half hour, hour later, the pain will start rising. And that can be as the structures cool down, that's when the irritation becomes more apparent. So pay attention if you're experiencing those sort of symptoms. And then you have conditions that flare up the next day. So plantar fasciitis is probably the most common that I see. And it's a very classic presentation of. Symptom soreness with your first few steps in the morning, which is, which is tricky because you won't truly know if you've overloaded that tissue until the next day. And this can be from standing. If you have a job like a chef who has to stand still all day, or if you're a runner who is doing a little bit more distance work, or if you have transitioned to like a minimalist or a barefoot type of shoe. These can all be fine during the day, but you won't know if you've overloaded it until the next day when you first wake up and start walking around and limping and that's when you're most likely to experience it. So it can be a bit of trial and error sometimes documenting what you did the day before, knowing that that's too much. And then next time not being as aggressive or not running as far as fast or walking around in bare feet, that sort of thing. So they're just a couple of classic. running conditions that sometimes can flare up the next day. Pay attention to all those things because I see a lot of runners continuously irritating the structures. So really pay attention, don't be fooled. A chronic tendinopathy, like if you've had Achilles or patellar tendinopathy for a long time, say 12 plus months, you will be sore, but we wanna make sure that the next day's symptoms are no worse. two out of 10 pain when you first wake up and then you go about your day, you go for a run, you do your gym workout and then the next day it's still a one or two out of 10. That means you haven't overloaded it because symptoms are no worse. This can be particularly helpful for someone who is in competition or doing athletics races or in a team sport and they're towards the end of the season. and they have their trainings multiple times a week, and then they have their competition on weekends. If you are going through a game and the next morning you're sore, if it's a chronic tendinopathy and symptoms are no worse, then you can still continue. And then you wanna focus on once the season's completed or once you get into your pre-season, you wanna really make sure that you're focused on your rehab and symptoms are down to either zero. or hovering around that pain level. So summarizing this chapter from the ebook and applying it to proximal hamstring tendinopathy, I guess the key takeaway is just don't be fooled by symptoms. Make sure you accurately interpret them over 24 hours. Also, the rehab, as I mentioned last episode, pain during exercises can be okay. It's encouraging to load up that hamstring. Tendons love load. if you give it the right environment to thrive. The other thing that I will mention is there are some key tests that you can test, retest following certain exercises or following a bout of say running or cycling or a gym class to see if your tendon is appropriately, I guess, tolerating the load that you're putting it through. So one could be the shoe off test where you're just in standing. and you dig your heel into the front of the other foot, just as in you're mimicking to slide that shoe off the foot. And if you notice there's pain in that hamstring, well, notice how severe the pain can be, and then do that same shoe off test after a bout of exercise in that moment, just to get a bit of a snapshot, just to see if pain is increased, if pain is exactly the same, or if pain has decreased. And what I like to do is, an exercise say during a bridge. You can do a bridge on the ground, sometimes long lever if it's producing a bit of pain. What I would do is do that bridge when I first wake up in the morning, say there's a 3 out of 10 pain, go for a run, come back, do that same bridge again and say, okay, where's the pain level now? Is it a 2? Is it a 3? Then I will do that same bridge again later on in the day. If it's a 5 or 6, I know that the run that I did may have... caused a bit of soreness, I'll do it the next morning. If that bridge is a two out of 10, I know that over 24 hours, it has managed to handle that load. However, if I woke up the next morning and it was a six or a seven, I know that what I did the 24 hours before was a bit too much. Some other tests that you can do, if you can try and visualize lying on your back with your calves resting up on a bench or on say your bed. So you're your hips are bent at 90 degrees, your knees are bent at 90 degrees, and you're kind of just resting with your back on the floor, and your legs are resting up on the chair or bench or table. And you dig your heel into the bed or dig your heel into the bench and see if that triggers any pain. So that can be something you can test and retest several times throughout the day to see how the tendon is going. You don't necessarily need to pay attention to symptoms. as you're just standing still or as you're sitting still, that can be another way to hone in on the accuracy. So keep that in mind. Also, while we're interpreting symptoms, keep in mind that fears, thoughts, emotional states, anxieties, all these things can have a particular influence on pain signals. So I have some of my clients track their daily. symptoms and what they've done throughout that day to try and find a pattern in their symptoms. And sometimes particularly if the pain is chronic, they notice days where they're feeling a bit depressed and anxious or fearful, dwelling on the past and really getting down on themselves. They are the days where symptoms are particularly worse compared to days where a bit more optimistic, a bit more happy, a bit more occupied by happier things that are going on. that's when symptoms are less. So keep an eye on that while we're trying to interpret thoughts, while we're trying to interpret pain, that thoughts, fears, anxieties, emotional states can influence the severity of pain signals. And I will do some pain science episodes later, which will kind of summarize or give you a better understanding of that particular process. But that's all I have to say today. Next time, we're gonna look at the hidden dangers that hinder your tendon. to recover and so I look forward to bringing you that. Stay tuned, 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.