Introducing speed & hills into your PHT rehab

: today's episode introducing speed and heels into your pht rehab. 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. This idea for the topic actually came in from a listener during one of the Q&A's when I asked for questions on social media and it comes from Kylie Walker and I decided to dedicate an entire episode to it because I thought it was such a good question. There's a lot of detail I can go into a lot of tangents that I could talk about with this particular question. So I thought I'd turn it into a small solo episode. So Kylie said, when you're returning to running after PHT and you've built up some bass, so getting back to normal weekly running volumes, is it better to introduce Hills or Speedwork next? So what should you do first? And I love this question and it's something I've seen a lot, a lot of questions get asked around this particular topic when I'm working with my runners who do have PhD, a lot of them wonder about this particular topic. So yeah, thought it'd be perfect to talk about. So the first thing I wrote down is, or the first thing I thought I'd discuss is why. Is there a caution to introducing these things? Some people may know that if you, some people may have even like had an increase in Hill work or increase in speed and that's what gave you the PhD in the first place. So we do need to be very careful when we introduce them, but why, and let's break it down with say speed to start with. When you, if you're a runner and you increase your running speed, the extremely hard. I think I've said this on the podcast before, but during the action of running, when your leg goes through its swing phase, when the foot isn't making contact with the ground and it goes through, say the mid swing. So the foot, I guess is directly under your body. But if that's the start of the phase and the end phase is just before it touches the ground, your leg actually goes from a bent action to a bit more of a straight action. And this is all happening very quickly, but what happens is the hamstrings contract as they, as it lengthens, we call that eccentric control. And so the hamstrings work really hard to slow down the momentum of your swinging leg while it's lengthening out before it makes contact, before your foot makes contact with the ground. And so that eccentric control requires an enormous amount of force and enormous amount of strength for the hamstrings and able to do that. If you run slower, then the hamstrings still go through that same phase, but because it is a slower contraction or a slower momentum, they don't necessarily work as hard. And there was a nice study done that actually looked at the force requirements of several different muscle muscles throughout the body. in a runner who changes their speed and you can just see when a runner increases their speed, their hamstrings, the requirements of the hamstrings just go through the roof when speed is introduced just because of that eccentric control just becoming the demand becoming so much higher and if we know anything from rehab and capacity limits and adaptation zones we know that if you are recovering from PhD even if you're back to pain-free running in your rehab you could easily overdo it, easily exceed your adaptation zone if you return to that speed work too quickly. And that's particularly why people develop PhD if they do introduce speed work a little bit too quickly. And then there's running uphill. So when you run uphill, your foot gets placed obviously in a more elevated position. What that does is cause the hips to flex a little bit more and your push off. So when you sort of make first contact with the ground, hips a little bit more bent. So the tendon and the hamstring itself is in a little bit more compression. And similar to say squats and deadlifts and lunges. We need to be careful with introducing these things and introducing those rehab exercises. When the tendon isn't necessarily used to compression. If you haven't been sitting for long periods of time, if you've avoided doing squats and deadlifts, then the tendon itself wouldn't really tolerate high levels of compression. So if you're back to running and you feel quite good, you haven't really worked on those compression qualities. Then you do uphill work where there's. a small amount but significant enough to warrant compression through the tendon, then again there'll be another flare up. And so that's why we need to be too ca- be cautious with these two variables. And so, um, yeah, I guess that's to start with exactly why we need to be careful. So if you've built up a pain-free bass, which one should you introduce first? Back to Kylie's question. I want to start with saying there's no right or wrong here. You can choose one or you can choose the other. Um, as long as you introduce them both, um, separately, like you can introduce both of them at the same time, like within the same week, but not within the same session, because we need to really dissociate the two to see if the tendon can tolerate one or the other, not recommended that you would introduce. Hill work and also speed work if you haven't introduced one of the two in the past. So we'll talk about how to actually divide the two or the variables you can do with dividing the two in a second. But so there's no right or wrong Kylie, you can try slowly introducing speed, see how that goes. You can totally back off the speed and see how hills go to be very gradual. And yeah, see how they go. You don't have to start with speed and be very successful with running fast and then say, okay, now it's time to introduce Hills. You could do phase one of speed, see how that goes back that off to phase one of Hills, see how that goes and then concurrently work in the two without combining them together within the same session. But there's the One thing I want to talk about is there's so many different variables within Hill work and speed work that might lead you to overdo things, underdo things or find that right sweet spot. And that's the next topic I kind of wanted to dive into now, because if we just focus on one of those components, yeah, we could focus on, okay, how long, what's the duration like? within that. So if you say, Oh, let me do speed work. Yeah. Well, how long are you doing speed work for? Is it two minutes or is it 20 minutes? Yes, I'm doing hill work, but how long are you there? So duration is very important. Also, how confident are you with introducing these? Because that can be a real factor as well. Are you very fearful or apprehensive to do any hill work? Are you fearful to introduce some speed work? Because that might have flared you up in the past. going to the symptoms themselves, does your PHT, is it quite highly irritable? So with irritability, it's like a, if you were to overdo things, is it flared up for 12 hours? Is it flared up for a couple of days or is it flared up for a week? That's obviously the week would be higher irritability. And so these are these factors, these duration, the confidence levels, the irritability or characteristics of your symptoms. These are all things that we need to consider and factor in before making a guess as to okay how cautious should we be? How gradual do we need to be with implementing these components? So let's break it up. Let's look at hills and look at the different variables of hills. Hills will require, well, the knowledge of what the incline is, the duration and the distance of that hill, and what speed you're going to be operating at when you do these hills. Because all of those things, the incline, the distance or duration and speed, are all going to need to be documented in order to work out, okay, is my tendon tolerating this set dosage? You can't say, okay, I can now tolerate hills because I have been successful with the hill that is in the loop around my house. Well, how long did it take you to climb up that hill? How fast were you going? What is the incline? Because you could easily say, all right, hills are good now, now let me go out on the trails and try something more challenging. And then all of a sudden, that's a greater incline and that flares up your symptoms because we're trying to work out where that capacity line is. So there's no starting point. If you haven't introduced Hills like safer Kylie and you're back to pain free running, there's no starting point to say, all right, let's introduce Hills. It's kind of like the same with return to running. If someone says, oh, is my PhD ready for running? Well, it might be, but it only might be tolerating a very small dosage. You might be running for one minute, walking for five minutes and doing repeats of that five times. Does that mean that you're back to tolerating running? It is, but only very small dosages. And so when you say, okay, let me try heels, let me reintroduce heels. There's no starting point. There might be a really conservative starting point. There may be some middle ground, or you might wanna try and risk a little bit more running, say like 10 minutes continuous, or a challenging hill just once, and to see how things go. But I've got some examples here on how, or just one example of how you might want to start really conservative and then build up from there. And it's just a pure example, but hopefully it, um, the principles do apply and then you can apply it to say a hill near your house. So, uh, let's just say at the front, I have a hill that's 5% incline. roundabouts and it's about a hundred meters in length. It's about a hundred meters long. I can kind of work that out with some sort of tracker, Strava per se or any other fitness device tracker that you have. Okay, so I know that it's a hundred meters. I know that it's five percent gradient. I know that my running pace, my running speed, I'll start like quite conservative. As a starting point, as a very conservative starting point, let me start with a slow 50 meter jog. So I'm jogging halfway up that hill and then I'm walking for the second half of that hill, walking the second 50 meters. And then I could either continue with my normal run that I know that I can tolerate because Kylie said she's back to her normal weekly running. So that might be one attempt or you might want to do repeats of that. So you might want to do. let's just say your normal four or five K run, then you get to the hill. Maybe you wanna do that jog for 50 meters or for the first half, walk the second half, jog back down and do say four repeats of that. So all in all, you've done four repeats up and down that hill, you've ran for the first half and you've walked for the second half. Then you can just go home. As always, we pay attention to symptoms. We pay attention to symptoms over 24 hours to see if that is, um, if that was tolerated, if the tendon was strong enough to tolerate that dosage and if it did, if there's no significant symptoms beyond your baseline, then we can have the confidence to say, great, let me, um, let me increase that. Or let me, um, try something more challenging next time. And so next time you might want to do eight repeats of jogging for the first half, walking for the second half and jogging back down. So last time you did four repeats, today you do eight repeats and see how the tendon feels. Then you might want to go from those eight repeats and go to four repeats except your jogging the entire length of that hill. So instead of jogging 50 meters like before, you're now jogging 100 meters. So covering the entire distance of that hill, jogging up and maybe walking down or jogging down, that's up to you. So we're still covering the same distance as before, but it's more continuous. So therefore more challenging. See how that feels. So four repeats. Next time you might want to do eight repeats and then Once you're confidently tolerating eight repeats, then you might wanna start going up the hill a bit faster, again, making it a bit more challenging for you. And as you're going through these steps, the tendon itself is getting stronger along the way. We're adapting to these, this stimulus along the way. And so, okay, we're tolerating eight repeats of this hill, and you wanna start introducing speed. Let me try to do two repeats of this. little bit faster and then the remaining six my normal slower speed and then you slowly build up until all eight repeats are faster and then once you can once your tendon is strong enough to tolerate that then you might wanna say, all right, I can tolerate that. Let me increase the incline. Let me find a more challenging hill. And you might wanna find somewhere around your area that instead of 5% incline, it's 8%, 8% incline and repeat the process over and over again. And so this is just an example. There's no right or wrong. All we do is start with something that's quite conservative. We see how symptoms feel. If they feel okay, then we just change one variable at a time with a slightly more challenging. scenario next time and then again paying attention to symptoms. And so this does a couple of things. One, it's making the tendon adapt to your scenario. So as these, as the process goes on, your tend to get stronger. But two, because we've started conservatively and our steps are very gradual. It means that if you do, if you do surpass your adaptation zone and into a scenario that increases symptoms or sparks a flare up. It's not going to be a major flare up. It's only going to be sore for maybe 24 hours because we've only just made that minute incremental step in above that adaptation zone. And so then we can learn where your ceiling is. You might want to back off, let symptoms settle for a few days. And then when you repeat, you know that this is your current limit. You might want to spend more time just below that. So if something did flare you up, let's drop one step below what that was and do that for a week, maybe do that for two weeks before repeating. It's just that methodical process that can be really empowering and give you real control with your symptoms. And that's the Hill component. Now let's flip into the next variable and let's talk about speed. 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 handshaking 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. Okay. So there are different, a few different variables when it comes to speed. It's kind of obvious to say out loud, but a few runners, uh, a bit confused about it when they say, okay, am I ready for speed? Now speed is on a spectrum. Speed can be a flat out sprint, or it could be something that's slightly faster than your normal conservative jogging. And it also depends on the repeats as well, like how how long you are spending at that certain speed. And so it's very loosely defined when it said, I'm back to speed work, or let me try speed work. Because, like I said, it's just, it's so hard to define it's yes, this is speed work. Yes, I'm successful with speed work. No, I'm not successful with speed work, because the variables are just on a spectrum. And so the first thing I could think of when someone says, how should I introduce speed work? What's the best method? Um, think of it like a walk, run program. Most people are familiar with say a couch to 5k. Um, if you're not familiar, you download say an app on your phone or your follower program on your computer. And you start off with a lot of walking and just a small amount of running. And these are usually designed for someone who hasn't run in several years or hasn't run in. and just wants to give it a try and wants to start slowly and let the body just build up and adapt along the way. So the first session might be you're out for 15 minutes, but for, you know, 12, 13 of those 15 minutes, it's all spent walking and you're just running or jogging for a couple of those minutes. And you do so every day. So maybe you do this five or six times a week where the next day is just a little bit more running, a little bit less walking. And then as you go through the process, it's only takes about two to three weeks before you're doing a significant amount of running and continuous amount of running, sometimes 50, sometimes like 60%. running 40% walking. And I found tremendous success with this particular structure, because it just allows you to one, follow a method, follow some sort of strategy, and to just introduce something really conservatively, and slowly adapt it similar to what we're talking about with Hills, we're just making incremental steps. So patience might be the key. However, back to the speed very, very similar. So if say Kylie's back to continuous running back to a normal weekly mileage, you could follow a couch to 5k app or a very similar process. But every time it says to walk, you're just doing your normal jogging. And then every time it says the running component, you can just increase the speed of running. And again, there's a conversation to be had around how fast you actually run. But as long as it's conservative and it's just another tick up in intensity, the, this particular strategy, you're only running at that intensity for, um, you know, 10 second intervals or 30 second intervals, whatever that, um, whatever stage you're up to in this return to run, or I'll call it return to speed kind of workout. And it's, it's a game containing something that's quite methodical. It's containing something that's incremental in its steps. And if symptoms do flare you up, then it's not a significant flare up because you've only made that minute amount. And so, um, that's can be a really nice tip of how to introduce speed. Um, it can, like when you do make that, I guess, um, introduction, we want to pay attention to symptoms, like always, pay attention to symptoms over 24 hours to see if you were successful. And if it isn't working, there might there may be some troubleshooting that we might need to do within your rehab, say if you're trying the most conservative step. to introduce hills and that just flares you up straight away. Then you might need to work more on compression, particularly within your rehab, particularly within your strength training. A lot of people do say bridges, isometric bridges, hamstring curls, and then maybe some and they're never really challenging the tendon into compression. And so they can get to, you know, decent amounts of running, slow running and feel fine. But then as soon as they introduce a hill, even if it's a minute amount and they flare up, it might be just because that tendon just has no tolerance for compression. And so you might need to troubleshoot this scenario with introducing compression into your rehab. It's recommended anyway, we've got tons of episodes on this, but compression like deadlifts, single leg deadlifts, rocket jumps, Nordic dips where we're just bending at the hips. All of these are very good for compression and firing under load under compression. The rocket jumps especially are very high end type of exercises. Um, if those of you who aren't familiar, if you were to, um, have a box in front of you, say the box is about your knee height and you put one foot up on that box, a rocket jump is when you push through that leg that's on the box so that you kind of almost in the step up motion, so you step up. so that you're completely standing on top of that box, but you launch yourself in the air at the same time and it's a good like triple extension drive that just launches you up in the air, so it's very it mimics that elevation sort of gain very nicely and So that's what I thought I'd add in here. If there's any troubleshooting, if you're really flaring up with heels, make sure, should make sure anyway, but compression is a component in your strength rehab. If it is, and you're still flaring up with heels, maybe introducing speed into those compressive exercises. So you might want to do a deadlift. You might want to go down slowly, but then increase the speed of your return back up from that deadlift action. those sort of components. If any increment in speed is flaring you up, there are some troubleshooting kind of things you could do. Again, back to your strength training rehab. You might want to introduce speed into the gym, you might want to do like faster hamstring curls or faster eccentric work or just more eccentric work, I guess you could say. that could be the key, I think, maybe say, if you do a bridge with your feet on a Swiss ball, you bridge up and then you roll that ball out. If you do that, say, with single leg, or if you do hamstring curls with your foot on a ball, so you start in that bridge action, and then your one foot is on that Swiss ball and you roll it out and you curl it back, that's a lot of concentric, eccentric work through the hamstrings. And so that, if you... get quite good at that and then you start doing it quite quickly. This can adapt the hamstring and the tendon to transition to more speed work. So just making a little fine adjustments in your rehab to suit what your running goals might be. And so as we kind of wrap this up, I've got a couple of tips. But before I do, let me do a little bit of a recap. So you can introduce speed first, you can introduce hills first or running uphill first, there's no right or wrong, but don't combine the two together at the same time as a first introduction. We can break these down into their individual components like the duration, the incline, how fast you run, how fast you go up a hill, break it all into those separate components and then just try and find a very nice methodical plan of introducing increments. Like I said with the hills or a cash to 5k type of scenario. Yeah, so the tips that I have down here are control the variables, make sure you control them and document them. You can use a Garmin, you can use any activity tracker, you can use Strava, make sure that your those components are quite drilled in and written down so that we know what components you can handle and what you can't handle. I think treadmills are quite a good tool to keep things quite consistent, especially when it comes to hills, you can just press a button and all of a sudden you have a 4% incline or a 6% incline and you can... you can keep speed very consistent as well. So if you wanted to really control those variables to a minute degree, treadmills could be nice for that. Start conservatively, especially. You can start like underdoing yourself. It's similar to when you return to run. Nothing wrong with underdoing yourself and being overly cautious, but just that being a stepping stone and then build up from there because... you'll eventually catch up to the point where it does hit your adaptation zone and then you just adapt along the way. There's no right or wrong, there's no process that's, I would say is incorrect unless it's really, as long as you're sensible, there's no right or wrong, as long as you're writing down the process, as long as you slowly implement these increments. sensibly and as long as you're paying attention to symptoms and interpreting those symptoms correctly, then you're doing yourself a big favor and you're giving yourself a big advantage with recovery from that rehab. So thank you very much for your question, Kylie. Hope that answered your question, probably in a bit more detail than you're expecting and we'll catch you in the next episode. 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.