Jennifer's PHT Success Story

: On today's episode, Jennifer's PHT success story. 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. Okay, Jen is on the podcast today. I put Jennifer in the title because we've had a lot of Jen's already. We've had, I think maybe two Jen success stories. And so try not to confuse everyone. But yes, Jennifer is on the podcast today and talks about her long battle with PhD with a lot of insights into eventually overcoming it. We've got a lot of kind of setbacks or things that weren't so helpful, things that, you know, slowly start to turn the needle and then, you know, some very, very good takeaways that, uh, Jen has learned throughout this process. I think all in all, I think it was about, um, seven years ago that her symptoms or maybe six years that her symptoms very first start developing. And so, yeah, it has been a long journey, but, um, really seeing good strides and wants to share everything that she's learned. today. So glad to get another success story out here. I know they're very popular, so let's get it underway. Jen, thank you very much for joining me on the podcast. Awesome. Thanks, Brody. Happy to be here. Excellent. Well, let's bring people up to speed on who you are. And let's start off with a bit of an introduction and a bit of an insight into your athletic background. So what sort of exercise you involved in? Okay. Yeah, I'm Jen, everyone. I live in Fort Collins, Colorado, and I work for a bird nonprofit, so I'm a wildlife biologist. And I've always been active. My brother and I were always running around as a kid, riding bikes, playing baseball and basketball. But I would say my main sport when I was younger, between middle school and high school, was soccer. I played year round, either indoor or outdoors, and my dad coached us for a little bit, which was fun. And so we didn't start out as a runner, although obviously there's a lot of running in soccer. But after high school, I was planning to play soccer at a smaller private college. And I think one of the tests was in order to try out for the team, you had to run, I think, a mile in a certain amount of time. I don't remember what it was. It wasn't that fast, but I was like, oh crap, I need to start just running and not just like kicking a ball around. So it was right after high school, I started actually just running to run and just running around the neighborhood where I grew up on the back roads, maybe doing like three miles at most. And then when I got to college, I chickened out on soccer because firstly, I was a nerd and I was like, there's no way I'm going to be able to do, you know, chemistry and calculus and play soccer. So I chickened out and playing soccer. Um, but my roommate was friends with a couple of people on the track team. And so they said, Oh, come join the track team. It's really easy going. The coach is really nice. You can still study and be a nerd and all that good stuff. So I ended up running track and I was terrible at it. Um, I did shorter distances like the 200 and 400 meters and I'm not built for short distance and I think I started in the slow heat every, every meet and I usually finish last, but I had a blast and it got me into the weight room, lifting weights for the first time and just running every day with, with the track team and doing like three to five miles. So at that point, I think I had kind of transitioned from a soccer player to a runner and then I went to a different college that was bigger and cheaper after that. And so I wasn't participating on a track team, but by then I was running regularly. You know, three, maybe to seven miles, I think for my long run and still lifting weights periodically at the gym. So, um, yeah, that was a long time ago now though. What about bringing us up to speed until now? Like if we can have a snapshot as to any races that you might have done or distances that you now, uh, kind of stick to. Yeah. So now I'm, I'm more of a trail runner. That's really what I like to do. Um, Usually during the week, I still tend to run around my neighborhood on the, um, on the pavement and on the sidewalks just cause it's, it's convenient, but on the weekends, that's when I like to get out on the trails. We have so many trails around here in Northern Colorado. It's, it's going to be hard to leave if ever I move cause we're kind of spoiled. Um, and as far as distances, um, I really like, well, I haven't done anything greater than a 50 K, um, trail run. So I feel like for all two runners, the. longest distance you've done always seems to be the favorite distance. At least that's been my experience. So right now I'd say the 50k is my favorite distance because that's the longest I've done. I think I've done three of those and maybe four trail marathons and a few other like half marathons and things like that. My plan was always to do like a 50 miler and then you know 100k and all that fun stuff. So I'm still hoping and holding out hope that maybe next year maybe I can do a 50 miler. Yeah, that sounds good. I love having those sort of goals. Um, let's talk about your PhD. So when did you very first start encountering symptoms? How long ago was that? Oh man, I, I do remember this part pretty clearly. Um, it was probably April, 2017. And so it's crazy to think that that's been almost seven years ago now, but, um, I was training for a very hilly 25 mile race just outside Fort Collins on the trails. And I was working with a running coach at the time. And so I had a nice plan as far as speed work, hills or hill work, um, doing my long runs on the weekend, all that good stuff. And I think I was just overdoing it. Um, and I wasn't really listening to my body on like, maybe you need to scale back this week because you have a lot going on at work and, um, and take it easy. And so it was April, 2017 on one of my hilly runs, I noticed a pain in the back of my hamstrings, right in the belly. Um, and it kind of stopped me in my tracks. It wasn't like I pulled it or anything, but it was just, you know, just a strain and kind of caught me off guard because I don't think at that point I'd had a few other injuries, but never anything with the hamstring. Um, and so my running coach was also my PT, which was very convenient. And so I let him know what happened. And he said, you know, take, take a week or two off, just take it easy. Keep maybe don't run for a few days and see how it goes. And then if it feels okay, slowly, you know, try and add in a little bit more hills on the weekend runs. But at that point it was maybe a month out from the race. So I took a few days off and I kind of eased back into running and did some hilly runs. And I didn't have any pain after that. I didn't actually do anything to rehab the hamstring other than a few days rest, which didn't really do anything. And then I think because I took some time off before the race, I went into the race and I ended up doing really well because I was rested. Although it was during that race. maybe like mile 15 or mile 17, I noticed what I thought was a pain in my glute on the same side where I had strained the hamstring. And I thought it was just glute pain, like, oh, I'm running, I'm doing a lot of hills, my glutes are tight. And then I also had a lot of nerve pain shooting down that leg, which kind of caught me off guard. It's almost like my leg would go numb for like a second every so often, especially on the downhill. It's a little scary, but I finished out the run and didn't really notice any pain other than tightness. after that race. And then I didn't really take any time off and I jumped into my first 50K maybe a month later. And so I didn't do any big runs in between those two races, but the same thing on that 50K, maybe halfway through I noticed almost like a knot, again, but I thought it was in my glute, like piriformis or somewhere in there. And then I would have a little bit of nerve pain shooting down that leg towards the end of the race. And... I don't recall having pain while sitting at the time. I kind of took it easy after that 50K and the pain kind of went away, but it would always come back when I would do my long hilly runs on the weekend. I would just get this like, almost like a knot in my glute that I didn't know what it was. And yeah, so I was still, I wasn't doing the run coaching anymore because I knew I needed at least to try and figure out what the issue was. So I stopped doing that. I was working with my PT and I just kept telling him something is wrong with my glute. I don't know if it's, if it's like if I tore my piriformis. I didn't even think hamstring at all at the time, but, um, so we dry needled my hips and my glutes quite a bit. I did a lot of weights, um, squats and things like that to try and strengthen the glutes and the hips, but the pain was still there. It was never bad. It was never really on short runs. It was mainly just on those long hilly runs, which I really enjoyed doing. Um, and It wasn't until fast forward, I think a year, um, I kind of would take time off. The pain would go away and then I'd get back into running and inevitably with the long hilly run, it would come back. And then in fall of 2020, I ran a trail marathon and then another 50 K and on both of those races, I had the exact same thing where it was this, I like this. Sometimes sharp, sometimes dull pain in my left, like lower glute. And then I have the nerve twitches down the leg. And it wasn't until after that 50 K that I finally realized that I had pain while sitting, or maybe it was finally when like that symptom manifested. And so I finally Google pain while sitting after running. And of course, the first thing that pops up is proximal hamstring tendinopathy. Um, and I was like, Oh crap, that's exactly what the sounds like. And then the light bulb went off. And I remembered that when I was training for that hilly race a year before I had strained the hamstring and I hadn't done anything to rehab the hamstring. I just ignored it. Um, So I kind of thinking this is probably what it is. I think I discovered your podcast, but I was not into podcasts at the time. So I read some of your blogs. And then maybe a couple months after that, I texted my PT and said, hey, I think this is PhD. I forgot that I had strained my hamstring a year before. You know, what should I do if it is PhD? And he's really into weightlifting and runners being strong. And so he suggested doing Romanian deadlifts and just progressively adding weight to add the load to the tendon. And so I started doing that and within about four weeks, the pain was excruciating. I, oh man, I've never, I hope I never get back to that place again, cause that was awful. I couldn't sit at all. Even sleeping at night was hard because I'm a back sleeper and I couldn't sleep on my left side. I couldn't sleep on my back. So I was pretty miserable. And so I stopped doing the deadlifts because I figured out those, or I figured those were probably aggravating it. I stopped running, got pretty discouraged. And about that time, I had to drive around a lot for work to do bird surveys, which was very uncomfortable, but it gave me time to listen to podcasts. And so that's when I was like, oh, there's this podcast that's on PhD. I should take a listen to that. And I remember there was one episode that I think you interviewed Marikee Lou. I don't know if that's how you pronounce it. Yeah. Marika. Yes. And I remember, I think it was why your tendon rehab isn't getting better. And she said in that podcast that, you know, you've got to meet your tendon where it is basically. And so if it's really irritated, you don't start doing heavy deadlifts because you're going to irritate the crap out of it. And so that gave me reassurance because I wasn't kind of worried that when the deadlifts weren't working, that maybe this wasn't my hamstring. Because I thought, well, if it's my hamstring, tendons respond well to load. I'd heard that quite a bit. And so I figured that maybe it was something else. And my PT had thought, you know, it could be hip impingement. It could be a hip labral tear. Those could have similar symptoms. And so I got my hip sex raid, no impingement. And then I also had that MD do an ultrasound imaging of the hamstring where it attaches. And he noticed some feedback and some imaging around there that he said was consistent with PhD, but I didn't really get too many more details from him. It was a kind of a hurry visit. Um, so that, and then that, that podcast episode, I think gave me at least the confidence that, okay, this isn't some unknown thing that I have no idea what it was. It probably is PhD. I just wasn't treating it very well. Um, and so. Yeah. There's a few things, there's a few things I want to dive in and clarify. or at least revisit. One of them was that before these initial symptoms, you said that you were following, you know, you've got a run coach, you've got a training plan, you've got this race that you're preparing for. A lot of people think that, you know, if give me a plan that I can follow so that I can avoid injuries, because they know like building up slowly, building up gradually is a way to sort of mitigate those risks. But as I always remind people, You can't get the risks of injury down to zero. If you're pushing for a race, if you want to race with a decent time, if it's challenging in terms of distance or hills, there's always going to be a risk, no matter how careful you are around those things. And so it can be just a part of the game. Really. A lot of people can be discouraged when they get injured, but it's what we kind of sign ourselves up for. Yes, we can do. all the sensible right things to reduce our risk of injury. That's definitely a possibility, but you could do all the right things and still develop some symptoms if you're just sticking to a sensible training plan. Because there's a lot of other things to go on outside of your training plan. Like you said, you might have had a bit of stress or something going on outside of the training plan that might've led to under recovering or overloading and those sorts of things. So I think that's an important message to remind people, but the The other one I want to address is you said something really interesting. You said that the, the dead lifts, uh, weren't working. So you thought maybe it was something else. Maybe it wasn't the hamstring. Um, my, I, my, my mind goes somewhere completely opposite because I think, okay, if you did the dead lifts and symptoms are worse, my thing is it's most likely going to be the hamstring because if you do a dead lift and, or at least increases my likelihood of it being that structure. because what makes the deadlift so good is also what makes the deadlift so bad. It targets the upper hamstring and it sort of focuses a lot of the load in that upper hamstring and so you could overdo and do too many deadlifts or too heavy deadlifts or through too range of movement, like you said, not meeting the tendon where it's at and if symptoms get worse, um, it's probably the hamstring. It's, uh, whereas if you meet the right conditions, with the deadlifts and gets better at the same thing, we could say, okay, it's most likely going to be the hamstring. It's not going to be definitive, but at least increases the likelihood that might be the case. That was a very good point. And I had maybe now after listening to enough podcasts, I would get that like something's weak, you need to, you need to build up the tolerance and you need to strengthen it, which means it's probably going to be really hard doing that exercise that targets that, that tendon and that muscle. But yeah. And I, I'm glad that it, it was the hamstring still because I was It's just the frustration. I know some of your other guests have said that they've had, you know, lots of misdiagnoses and it's just so frustrating when you think you have this mystery injury that no one knows anything about, because if you don't know what it is, you don't know how to treat it. And so I think part of the issue too, is I just, I then started to go down a little bit of a dark hole because I've been struggling with it at that point only for maybe a little over a year. Um. But running it for me, it was, I was just, it was wrapped up in my identity. And it was really hard to not have that release and to not know why I couldn't keep doing this thing that I, that I liked to do and that I would, I thought I was good at, um, so yeah, then think, you don't know, it's not the hamstring, but, um, but that's why that one episode, I think. I remember I had such a high after that, like listening to that, like, oh, it, maybe it's still is PhD. It's not this mystery thing that I have no idea what it is. I just irritated the crap out of the hamstring by doing that exercise. Um, so that was encouraging. When, when symptoms were really elevated, um, how bad did it get? Like how, when I say day to day stuff, like sitting, um, what was your sitting tolerance like and what were symptoms like at that time? Oh man. I mean, I would say like on a scale of one to 10, just sitting, it was at least a seven out of 10, um, straight away or for how long, if I was sitting for at least like 15 minutes, it didn't happen like immediately, but If I had gone for a longer hilly run, and then at that point I wasn't even running when it was just the deadlifts that were aggravating it. I mean, it felt like almost instantly I couldn't get comfortable sitting. Yeah, I guess that was maybe the frustrating thing was that I wasn't even doing anything. It was just like sitting, I'm trying to work or having dinner or whatnot and not being able to do that. I had to drive around a lot for my job at that point. I said, I should have said, no, I'm not doing surveys if I have to drive for eight hours at a time, because it was, that was really difficult on it. Did you make any modifications to try and help? Did you like try and sit with a pillow or do some standing or do some walking or make any allowances for that? Yes. Yeah. And I'm actually still sitting on, on a pillow because I don't need it anymore, but it's just, it's been there for the last three years. So I just leave it on my chair, but yeah, I was sitting on a pillow. Um, I was using ICE when I had to drive. It's like sitting on a bag of peas was about the only thing that I could tolerate in order to actually sit and drive. I think my partner bought me a standing desk for Christmas that year, which was also a little ways into COVID. And so I was pretty much working from home at that time anyway. So it was good to have the standing desk option. Going out, any time there are high top tables, it's like that's what we're using because I'm not sitting on those hard, uncomfortable chairs. Um, and even like, I can't remember if this was on one of your episodes or someone else, but sitting with, you know, your, your heels closer to the, I don't know, towards your butt underneath the chair. Underneath the chair. Yeah. Um, just sitting like that. Um, and then always like, you know, cause it's on my left side, so we're shifting onto the right, which is probably not great for my back, but, um, just anything to offload pressure on that side. And, um, and then, yeah, I think. Around that time in the spring, I started seeing a different PT. Um, I should have hindsight, I wish I had just reached out to you and set up an appointment because that would have saved me another year and a half of frustration. But I started seeing a different local PT and, um, he agreed that he, he thought it was PhD, that my symptoms fit that. And it made sense. He thought as well with the dead lifts that it was aggravating it because the tendon was already irritated. And I just did something that compressed it even more, but, um, He thought that it had more to do with possibly overtraining, but more of a pelvic tilt issue. Because of the way my pelvis is or was tilted, it was always putting tension on that hamstring, but then my hips were also a little crooked and I think that was normal for me. So it was a little bit more exaggerated on the left side. So then the hamstring was under a little bit more tension than the right hamstring. So he thought that was the issue more than... overtraining or running hills and speed work. And so his suggestion was, obviously stop doing the deadlifts, hold off on running at least for a week or so till symptoms calm down. And then give me like postural exercises to do and breathing exercises. I don't know if I could describe them that well, but like having a band around my knees and then I have my feet against the wall laying on the floor and then it's basically like. moving my left knee back so that my hips were more not crooked and then just doing like a series of breathing exercises to try and train the muscles to stay in that position. And then doing similar things like leaning against the wall. So leaning and sitting. And I mean, I was driving around doing surveys. So I was doing this in the middle of nowhere, New Mexico, laying on the ground, trying to do these crazy exercises that I was really hoping they would work. The hamstring did get a little bit better. Like I was able to tolerate sitting a little bit more, but I don't think it really had anything to do with the exercises. I think it's because I wasn't running much. I had stopped doing the dead lifts. I was icing the hamstring a lot, which just basically numbed it all the time. So it felt better and I was able to tolerate sitting a bit more, but I still wasn't actually doing anything to address the hamstring. I still wasn't doing anything to try and increase its tolerance to what I wanted to do was get back out on the trails and do the long runs. Um, so I think I, I saw that PT from maybe about April that year to October. And, you know, I was like, I was kind of skeptical in my head that the issue was the pelvic tilt, because I've heard from a lot of other folks, my original PT. And I think on some of your, your stuff that like, that could contribute, but that's probably not the ultimate cause of this condition. Um, but I was slowly able to. to do a little bit longer runs and do some hillier runs. And I think at that time, I wasn't really having the pain much, if at all. And so I thought, oh, maybe this did work. Maybe I'm better. But then I ended up running another trail 50K that October. And as soon as I got like maybe 15 miles in, the exact same pain came back and, you know, where it had been before, kind of lower down in my glute where the hamstring attaches, had occasional nerve pain. I felt like I was dragging my left leg. It was really frustrating. Like I was getting absolutely no propulsion from the left leg at all. And then when I started seeing this PT, I just stopped doing all the weight exercises that I had been doing because I had been doing calf raises and some other things for my glutes. And so I stopped doing that and I was just doing these breathing exercises and this postural work. And so during that race, my Achilles flared or my Achilles kind of freaked out on me. And so I developed Achilles tendonitis on top of the hamstring that was still there because I hadn't actually rehabbed it. And so driving back from that race was awful. Between, I couldn't sit and then just my Achilles were so tight when I got out of the car, I could barely move. It was awful. And then I think maybe three weeks after that, we had to put our older dog down because he had a pretty aggressive form of cancer. And so between like the running, feeling like I was a failure at that and then losing the dog, I was like... I think I just went to a black hole again and gave up on running, gave up on things for a couple months and it didn't do anything. So the Achilles kind of got a little bit better only because I wasn't running. And I think the hamstring, I just, I didn't even want to think about it. It was just frustrating to me that I had wasted five months with that other PT and I had not only gotten, didn't rehab the hamstring, but now I also developed this Achilles tendonitis on. in both heels, so I was pretty frustrated. Um, and yeah, and then January of the following year, um, January 2022. So going into year three of, of this injury, um, I reached back up to my original PT. And, um, just cause I know he's really big on, on lifting weights for runners and he's also an alter runner. And so I trusted his experience. And. And I told him that I was like, Hey, I do think this is still a PhD. I'm really frustrated with it. Can you give me exercises that don't compress the tendon doing more like eccentric loading? And so he gave me some good things to try that, um, that helped. I know I can only remember two of them right now, but one was like the long, long lever, long lever, glute bridge, um, where you have one leg at the air and in the air at a time. So single leg, single leg, long lever. Bridges. Mm-hmm. Yep. And holding that like 20 or 30 seconds. So I was doing that every day. And then, um, something similar to a Swiss ball curl, but with the foam roller where I would roll out the foam roller away from the body when I was laying on my back and then roll it back up to me. Um, I'm sure I think he had me doing a three, a few exercises. Those are the main two that I can remember. And I think within like two or three weeks, like maybe the first couple days that I was doing those exercises. I was still having some hamstring pain, but within two weeks things felt really good. And I started doing at that point single leg deadlifts with like a kettlebell, you know, starting like 10 pounds up to 20 pounds, which, and that was pretty scary because I knew that exercise would compress the tendon and I thought it was going to flare up. But my, the weights that I was using were pretty low at the time. So the hamstring tolerated that really well. And then he also gave me some exercises for the, for the Achilles. So I was doing I think standing and seated calf raises with weights. And so thankfully the Achilles cleared up pretty quickly once I started doing the weighted calf raises. I would say within like three weeks, the pain had gone away. I didn't have any issues when I was running. And then that spring I was back out doing bird surveys. They always seem to stress things out because you're sleeping in your car, you're waking up really early, you're driving a lot. And then the... particular surveys that I did in Wyoming, I had a lot of hiking to do. It was really ended up being pretty steep and it's all off trail. But I didn't want to lose my running momentum because I had started, you know, running three to five miles at a time and building back up my long run. So when I was out there hiking around chasing after birds, I was still running in the afternoons. I think between those two things and sitting while I was driving, it just it flared things up. So that was a summer that I finally said mean I think I was at the point where I was convinced it was PhD, that at least wasn't an issue. And then it was like, what do I do to take this to the next level? Cause I'm really tired of this. It just felt like it defined me, um, going from being a runner to being like a crippled runner, and I was just kind of sick of that. So I think it was August of 2022 that I had my first chat with you. Yeah. Back to the pelvic tilt side of things. Um, you know, there's I guess it's good in theory to have to say that someone who has a anteriorly tilted pelvis, so like, um, people want to Google anterior pelvic tilt, but essentially tilting forwards, um, might put more strain and stretch on the hamstring tendons and therefore when you run the hamstrings and tendons under a little bit more strain, leaving you more prone to developing hamstring issues. Um, a few things that I like to remind people of there's always going to be slight imperfections. Like there's always going to be a slight pelvic tilt. There's always going to be one leg slightly longer than the other. It's in 90% of the population. There's always going to be something if you go looking for it. And yes, if you were to overload yourself or do something that's a bit too much too soon, maybe you are a little bit more susceptible to straining the hamstring. I'm not too sure that's like the theory in general, but the same way that someone who has, um, I don't know, maybe maybe someone who's like, energy deficient or malnourished in their teens might be more susceptible to stress fractures if they over train themselves or someone who might be more susceptible to knee pain if they have a low cadence or someone who's more susceptible to Achilles issues if they have a zero drop shoe, there's always going to be something that leads you more likely to develop a certain type of injury once you over train yourself. And so we can say it's pretty clear that around about the time of onset of symptoms, you're pushing yourself pretty hard. And so if you weren't pushing yourself that hard, maybe you'd never develop this in the first place. And so we want to make sure that for most for the vast majority of cases, the overtraining is the underlying cause it's not these mild imperfections or mild imbalances, because we can't really do a lot for them anyway. I I'm yet to find compelling evidence to show that if you do certain exercises and try to strengthen you up. Once you start running again, your posture changes. I'm yet to find stuff on that. So it might be trying to chase a carrot that you can never get to in those instances. And so what we hear from your presentation at the moment, it seems to always be loaded dependent. It seems to be always like, if you do deadlifts too much, if you sit for too long, if you do your long hilly runs, like all of the correlation with symptoms seems to be load the solution out of it would have to be load focused. And a lot of the approaches that you're trying as you're coming up with or suggesting what's been tried in the past, I'm thinking, okay, how is this raising capacity? How is this increasing your strength? And so you mentioned like some dry needling, you mentioned the breathing postural exercises, which you also backed off the deadlifts and backed off the running of that stage, periods of rest and all those sorts of things like that. What are we doing to... build strength, what are we doing to raise capacity? And it's not until you see a sort of slight glimmer of hope when you actually start loading it, you start with some long lever bridges and some foam roller rollouts, and again, isn't until we start loading it a bit more with running, sitting, and all that sort of stuff that symptoms start to elevate. So just looking back at the characteristics, it seems like everything is very much load focused. And so I guess leading up to this point, when we started having chats and started building out plans and those sorts of things, was there any revolutions? Was there, was there anything that sort of, any highlights that you can remember that sort of helped the whole process and helped your recovery? Yeah. I mean, I think there are a few things. One was, I think it was that visit or maybe it was in an email afterwards. when I was asking about a race or, you know, training for a race, and you're like, no, like, don't think about racing right now. Like your goal is recovery. Like, don't even get that far ahead. Cause that was always my issue in the past when I had never really figured out what the issue was with this. I would always get really excited about running a race because that's what I enjoy doing. And then I would inevitably start incorporating speed work and doing longer runs and aggravating things. And so I think, I think you gave me like the, you know, the wake up call, like, no, like. don't think about races right now. It's maybe next year, but not right now. So I think realizing that recovery was my sport, not like training for a race at the time and making that the priority was pretty big. And related to that was also just like slow the heck down in the past, like with running, even maybe even while I had the running coach who was, good about like, you know, 80% roughly, you know, easy runs and 20% you're going to have these, these workouts that you're doing. I still always wanted to push it just a little bit. I'm like the easy runs felt like I was cheating. Um, like they were just like, this is too easy. I just want to do some strides at the end, or I just want to like, just go a little bit faster. Um, and I heard on a different podcast recently, like running is not workout. It can be if you're doing a workout, but in general most of your runs aren't a workout. You're not trying to burn as many calories as you can. You're not trying to increase your heart rate as much as you can. It should be really easy. It should be like you should feel like you can go forever if you keep going at that pace. And so I think realizing that probably my easy runs or my slow runs were not as slow or easy as they needed to be. I think one of your guests that you interviewed a while back, she said something She was running a lot of marathons and doing Boston and just based on her, her race times, she was a fast runner, but she's like, you know, I used to think that my easy pace was like 830, maybe a nine minute per mile. She's like, no, it's like 10, 1030 per, you know, minutes per mile, maybe even 11 if I'm really stressed or tired. And I was like, I don't think I'm faster than her. So I should probably be running, you know, about a 10 minute pace on my easy runs or maybe even slower if I'm just, if I'm tired that day. So, so slowing down is a big thing. Um, and I think just having the, the weight plan was, was really helpful, but because I'm not naturally a weight lifter, I feel like it's easier for me to take it slow with the weights, like the dead lifts, I'm not going to just go from, you know, lifting 50 pounds to a hundred pounds the next week. Whereas with running, because that's more what I feel comfortable doing. Um, and I like doing, I'm more likely to run, you know, 10 miles for a long round and then try and jump up to like. 16 miles the next week for my long run. So I think having that running plan that you gave me, where it's like, no, you need to build up a bit slower than that, like don't overdo it because then you're gonna have a flare up. So those things were really helpful. And I think for the most part, I was running every other day at that point, which that was pretty huge as well because running back to back days did tend to flare things up. So we're looking at. Let's not think about races right now. Cause I think as soon as there's a race in someone's mind, as soon as they start feeling better, they're going to start running faster, they're going to start running further, they're going to start being like, Oh, okay, now let's, let's focus on the race and they'll end up overdoing things and seeing themselves back. And so recognizing you've had years of these fluctuations in symptoms and seems like running too much is what's continuing to set you back, um, seems reasonable to let's reprioritize things here. Let's slow things down. Let's just get back to some consistent running. I sort of think to myself, let's have like a good month of running without any or like with things very stable. Let's try to accumulate those good weeks, turn one good week into two good weeks into one good month and get you on the process to long term healing because the fluctuations in symptoms doesn't help tendon. healing long term at all. But the idea with slowing things down really frustrates some people because it's not cardiovascular, not cardiovascularly challenging enough. But that might still be a adaptation sweet spot for the hamstring, just not for the rest of the body. And so it might feel like it's useless, it might feel like it's a waste of time. But people really underestimate just running at a slow speed. how much strain and load and pressure goes through the hamstring. It is a pretty violent tug of the hamstring when you swing that leg. And if you do that 2000 times, that's pretty decent. Um, and you know, you probably won't feel it hitting your adaptation sweet spot, but your tendons getting stronger and your hamstrings getting stronger, even in that slow short run. And so that's how we. sort of build, that's how we sort of lay that foundation and set that, um, that sort of, yeah, that foundation strength to then eventually start building upon it. So a few good key takeaways there. Um, all right. So we're progressing, we're sort of slowing down the running kind of high frequency for most runners every second day. Um, slowly building upon distance and slowly building upon strength. Was there anything that we might've changed to, to your strength training that you might not have tried before? Um, I think when I started seeing you, I was just doing the single leg deadlifts and I think that was a big thing that you wanted me to start doing just the regular, you know, two legged Romanian deadlifts that way I could increase the weight quite a bit more. So that was a big one and starting out like. half range of motion or three quarter range of motion. So I wasn't going all the way down with the bar when I first started that. Cause I know like I remember being very nervous when I did that for the first time, like, oh man, I'm gonna flare up my hamstring. It's gonna get angry with me because it was the deadlifts, the regular double legged deadlifts that had initially really flared up the hamstring a year or so prior. So that made me nervous, but because I didn't do full range of motion and I did start out with fairly low weight, I don't think I've ever had any flare ups from doing the deadlifts. Can you remember what that starting point was? Can you remember how heavy we might have started with? It was probably like 40 pounds or something. It was more than I thought it was going to be because I think at that point I was doing 35 pounds with the single leg deadlifts. I want to say it was like around 60 pounds, which doesn't seem like a lot, but... Oh, it's definitely a lot more. It's a, it's a bigger starting point than what I'd start most people with. But if you're already pretty sufficient and tolerating single leg stuff, uh, I guess that's what gave us a bit more confidence. Just to at least try it out and see. Um, I'm I've had, you know, guests success stories on the podcast before where all they've done is swap from single leg deadlift to double leg deadlifts. And they've made a, a massive improvement in their recovery. And it's something that I adopt quite a lot because. Well, first we can control the range of movement quite well, the control and time under tension and just quality of the movement, like tendons like the slow, heavy stuff, and you can go really slow with a, when you have two feet on the ground, there's better balance there. You can slowly lower yourself down, slowly come back up a lot of times with a single leg, there's a little bit of a wobble, there's a little bit of a, um, I'll move as fast or as slow as like I can, but I can't really control it. that much. Yeah. So, um, and this, you could just go heavier. You could just go so much heavier. Um, it's not just as simple as single leg. We just have it because some people are doing 200 pound deadlifts. They can't do a hundred pound single leg deadlifts. It just, it doesn't compute that way. And so, uh, yeah, just offering and fostering that slow heavy stuff is, um, just a lot more achievable with the double leg deadlifts. I do think that was part of it too, because you did have me. Initially when I started out, I was counting as far as like going down slowly and coming up a tiny bit faster. But I do remember I was able to control the speed so that I could do it slower, which yeah, like you're saying, I don't have that good of balance. I can't do that with a single like that. I'm going down quickly and come back up quickly. Yeah, not a lot of people do. Yeah. Um, yeah, so that, that was all really helpful. And I want to say for a few months, maybe two, three months, um, I made pretty good progress. I was able to stick for the most part with the. the weight plan and the running plan. But I think maybe at that point I was probably getting a little antsy and wanting to do a little bit longer runs and maybe some hillier trails. Cause we do, most of the trails around Fort Collins are pretty hilly. It is, you have to be really intentional to get flatter trails. So, you know, it could have been that and a combination of work stress or something. But I did have a flare up maybe a couple months after that first call with you. And I didn't realize, I had completely blanked that you had. given me a little tab with, you know, the said flare up plan on the spreadsheet that you made for me. And I somehow didn't even see that. And so I think I tried to manage the flare up myself, which probably meant no running for a day or two, and then just jumping right back in to exactly what I was doing before. And then of course the flare up, the hamstring didn't, didn't appreciate that. So do you know what led to the flare up? Was it getting back into the running too much? I think, yeah, I'm Knowing me, I can pretty much guarantee that I just tried to push it a little bit more. Because I think at that point, you had given me a good start on the how to progress with the running. And I think at that point, I had probably gotten past what you had suggested. And then I was going into like, fly solo. I can like, you know, I can tell myself what I want to do. And it was probably too much. But also, you know, I don't know at that time. I think my in-laws, they always stay the week after Christmas and that's always a little stressful work. That time of year can be stressful as well. So I'm sure it was a combination of multiple things, not just over running. So I had another chat with you, which really was my only, I think I only had two chats with you for the hamstring, which is crazy when I think about how long I struggled with this issue and all it took was two visits. But on that second, visit we went over that flare plan or that flare plan that you had written for me. And all it was, I think, was just reducing the split squat weight and the deadlift weight by like maybe 50%, cutting my running volume by 75%. I might have those backwards, but, you know, obviously taking out strides or any type of speed, not doing any hills and doing that for a week. And then if, you know, if the hamstring goes back to baseline and it's not irritated anymore, then you can, you know. bump back up to 75% on the weights and bump up a little bit more on the running but still don't do any speed. And so I think within like a week, the hamstring was already better. I just hadn't cut back enough on the weights and the running volume, but as soon as I did that, it cleared up pretty quickly. And then a month later, I know I had another flare up. I think I had COVID for the first time. And I think it knocked me out a little bit more than I expected. And I just tried to jump back into running and I had a flare up. But then I implemented the plan and I think within three days, the hamstring was already back to baseline. I was like, oh, okay. That was way easier than like trying it for a week or two and just, you know, ignoring it and hoping it would go away on its own. Um, so yeah, I usually like to have that for flare up plans. I, um, It's kind of like how much do we need to take out? Because we don't want to just stop running. We know that complete rest isn't really the answer maybe for a day or two, but we don't want to do that for too long. But our first thinking as a physio is like, okay, what can we take out so you can still do as much as you can just without irritating symptoms. And usually the first point of call is removing speed, especially if you've got some top end speed like strides, or hill sprints, or some sort of really, really fast stuff would take that out to start with and see how symptoms behave. I guess that was a while ago. Now I'm more likely to say keep the weight in but maybe reduce the range of movement as another first I guess point of call. And if that's still no good, I guess our tier two removal of exercises will be okay, now let's start reducing the weights if we're still not tolerating let's back off the mileage a little bit and see how symptoms behave. So it's just trying to And let's not make it a big overhaul. Let's just make some slight changes, but obviously it would depend on the degree of flare up. So trying to say, okay, how severe is symptoms now? Uh, how irritated are symptoms now compared to what they were before making those decisions, if it's just a very small flare up, then we'll probably start off with very slight adjustments, but if it's really major, really irritated, then we might have to quickly jump to that tier two removal of things. But I'm glad that. You had that template, not only worked the first time, but even just the second flare up that you had without my guidance, just with the template still there, that managed to be successful as well. Yep. Yeah. And yeah, so that, like I said, it cleared up within, I think a few days and went back to baseline, I still stayed within the recovery plan for that week, as far as reduced running volume and reduced weights. And then by the second week, I was able to pretty much go back to what I had been doing before, minus the speed work. So yeah, that was probably like, I think March, March or so. And pretty much since March that the past year, so March, 2023, I was able to just slowly keep increasing things. I was just consistently adding weight every so often to the deadlifts as far as what I was doing. And every time I add weight to the deadlifts, I still always do like three quarter range of motion and then build up to that full range of motion and do that for a few times before I add more weight. And then I think with Hills, I was also a lot smarter about adding back in Hills on my long runs. Before I would just kind of go all in and just, you know, do a full, like a full route that I had used to run. And now just being more intentional about running the exact same trail week to week and just slowly adding in the next hill and the next hill and making sure that, you know, the hamstring could handle what I had done that previous weekend. Um, so that all went, went really well. I don't think I had anything, no other flare ups all last summer. Um, I did very flat bird surveys. I was very specific about that with my office. Like I will do bird surveys, but I am not doing really steep stuff. I'm not wasting my hamstring just yet. Um, so I just did grassland surveys and then I don't know how I missed this, but I finally realized that the workout bench that my partner had that I had been using for other things in the garage. I had the ability to do prone hamstring curls. So laying on my stomach, add some weight, and do hamstring curls. I don't know how I missed that when I started this journey, but this past summer I started adding on the hamstring curls in addition to the deadlifts. I also think that made a huge difference because I was adding this extra exercise that was weighting the tendon, but it wasn't compressing the tendon. So I feel like it was only just making things better and stronger without aggravating them. Um, so I started out with pretty easy weight until I realized, you know, what I could handle. Um, and so I think that really helped help the tendon. Um, and at that point I hadn't, I wasn't having any issues with sitting. I think I'd kind of forgotten about pain while sitting, um, by the summer, which was awesome. Um, was that just like a very gradual sort of improvement that you hadn't really noticed until you think about it? I'm sure it was. Yeah. Like looking back, like, oh, it just happened overnight. And I'm sure it wasn't overnight, but it was, yeah, it probably was gradual to where I was just able to sit, you know, for a half hour at the office and then an hour. And then suddenly I remember I had one day at work where I sat the whole time because I was in meetings pretty much the whole day. And at the end of the day, I'm like, holy crap, I just sat on my butt for like seven and a half hours. That blew my mind. And so I put a... race on the calendar. It was kind of a sort of an impromptu decision but um there was a trail race really close to where we live and it's where we always take the dogs to go hiking. It's not super steep so I was like okay this is a good like get my feet wet jump back into it without going overboard and so that race was September last year and I was going to do a half marathon and maybe about a month and a half before I was going to do it I did have a flare up of both the and the Achilles on both sides. And the Achilles kind of surprised me, but I was able to get the hamstring under control within a couple of weeks as far as the flare up, but the Achilles was a little bit more stubborn. But at that point I was like, I need to test the waters and see how the hamstring is gonna do. So I went ahead and I did the trail marathon or half marathon. And in terms of the hamstring, it was a success. And I remember while I was running, I was like, I need to reach out to Brody and be like, I'm ready to be a success story for a week. Because the hamstring I had absolutely no issues while I was running. I mean, it wasn't a flat course. There was definitely some hills and terrain. I didn't compete as well as I maybe would have liked to have or as well as I did five years ago, but I still did well overall. Just having the hamstring not give me any issues during or even after, I don't think I had any symptoms. That for me was like the biggest success and I just had fun out there. Yeah. Excellent. Well done. Congratulations on that. I'm curious to know how currently what's your deadlift or like strength routine? What exercise are you doing? How many, how heavy, those sorts of things? Yes. Well, as of right now, the last few weeks, I've been doing weights twice a week. Because I've had been working with you as far as getting the Achilles under control, which that's going well now. So Um, at least as far as like the hamstring and my general routine, it's, it's twice a week, usually Monday and Friday, sometimes Monday and Thursday. Um, and I'm still doing the dead lifts. I'm still slowly adding weight. Um, I'm not quite up to two thirds of my body weight, but I'm very excited to get there. Um, I do that. I do split squats. How many, how many sets and reps and range of movement for your dead lifts? Um, for the dead lifts, it's, it's full range of motion. And I usually do, um, three sets of eight. Um, I think I'm at 96 pounds right now. I was really hoping to get up to a hundred before we had this call. Like I thought a hundred pounds would sound better, but I'm tomorrow when I do weights, I am going to bump up to a hundred pounds, which I'm very excited about. Um, and then the split squats, I think I have maybe 45 pounds, um, that I'm doing with that just to kind of work more the hips as well, and then I'm doing the calf raises, which that's a little bit. different because I'm still working through the Achilles issue. So I'm doing those every day. Um, and then what else am I doing? Oh, then the prone hamstring curls. Um, I think I was doing like four, maybe 50 pounds with those, but I started doing, um, single leg curls just cause I, I kind of felt like my right leg was dominating when I was doing those. I felt like it was easier to cheat. And so I'm doing the single leg of those. So I think 28 pounds right now for each leg. Um, How many sets of reps? Uh, three sets of eight for, for everything for the squats and the curls. Okay. Very good. Um, it was funny that, you know, I built out this spreadsheet for you and you follow that template away, you go, I don't hear from you for several months. Then we come back, open up the spreadsheet and you've progressed your dead lifts. And, um, if anyone's been a client of mine, they know that I like writing the phases. We'll have like phase one, then progress to phase two, phase three, phase four. And it's like, you know, adding five pounds each time. And you've gone out on your own and you're down to phase like 55. So slowly progressing yourself and working your way down the spreadsheet and adding in your own progressions. And I've never seen a tale of my progression chart so long in my life, but I'm glad it's paying off for you. I'm glad it's working out. Yeah. I feel like I'm finally getting down to where it's like, the nitty gritty, like what do I need to do to be healthy as far as running? Because I think before I was doing a whole lot of things like Swiss ball curls and the single leg glute bridge with like a 20 pound weight on my gut. So I'm not doing those really anymore. They were good at the time, but now it's like just doing the deadlifts and the curls for the hamstring, hoping to start doing the bent knee calf raises and then I'll do the split squats. Cause I'm like, I don't have time to do like, you know, 10 different exercises twice a week. So I feel... good about what I am doing, um, but the time that I have, yeah, feels efficient. Well, I think it took a bit of fumbling through your rehab to find out what's working, what the causes are, I guess, what the underlying sort of characteristics are, and then having the patience and sensibility. That was another thing that I sort of highlighted that you mentioned, um, talking about slowing things down and maybe progressing a bit slowly. And like you say, when that with the hills, maybe just being a little bit more gradual with and systematic about how I introduce these, I just say it's just a bit more patience and just being a bit more sensible. And I think a lot of people can learn that whether they're introducing distance, speed, hills, all those sorts of things. And so it seems to be some of the main takeaways. And it is a long game, like it is, it does take a long time. And what we want to do is not look for quick fixes that then flares you up or we want time for the tendons to sort of build that foundation, lay it, raise that capacity up to where you need it to be. And I think this is a clear demonstration of that. It's not a success story overnight, it's finding the right ingredients, being sensible, being patient, and then just letting the month roll by of just making progress, progress to where you find yourself now. And so as we are finishing up, Are there any final takeaways that you might have for someone who does have PhD might be struggling or just looking for extra advice, anything we haven't covered yet? Um, yeah, I guess a few things that I was thinking about in preparation for this that were coming to my mind, but you know, one is trust the process. Um, like there was a reason that it generally works for most people most of the time, even though it seems like it is a really slow game, um, it is kind of crazy when you think about how quickly it actually it goes by. If you actually follow the steps and you follow the process, it seems like it takes forever, but then within like a month, like, Oh, wow, I'm already now running like double what I was running, you know, three weeks ago. And I have, you know, the hamstring is tolerating it. So trust the process and be patient. There's a reason that it works for most people. And then I think related to that is even though you need to trust the process, you also need to be an advocate for yourself. And if something isn't working, like if you are working with someone, and you've been working with them for several months and you're not really seeing gains or if there's maybe something in the back of your mind, like, I've heard from so many people that you need to load the tendon, I should be loading my tendon by now. Like, definitely trust yourself, trust your gut and maybe get a second opinion or just maybe back up and try and go back to the basics. So I think that would have saved me a lot of time in the end if I hadn't spent five months doing something that didn't quite seem right. And then at least for me and maybe for others, a big thing that I was missing was protein, and I think that's part of where this issue came from at the beginning was definitely overloading and overdoing it on training, but I also was not properly fueling before, during and after my runs. Um, and so I've been taking protein powder, usually in the morning with breakfast and then always before I go to bed and I've been sleeping a lot better, which sleep is good for so many things. And, um, I think that's, that's also helped a fair bit with the hamstring. Um, and I know it's just as I age, I need more protein and it's hard for me to eat enough meat because I don't like meat that much. So, um, yeah, I think that's been a big thing that I, I've been lacking. So I'm taking usually 25 to 50 grams extra a day than I used to, and I'm feeling a lot better for that. Excellent. Thanks for sharing those. And something I just wanted to piggyback on is. your advice about, okay, if you're going through the wringer for a couple of months and things aren't working, you have this intuition that maybe you should try something different. Um, I would say the same for following this advice. Like if you listen to this podcast and say, okay, Brody says I should start doing slow, heavy deadlifts and, um, find out your own plan along those. Even if that isn't working for several months, we would expect if you're doing the right things and meeting the right conditions that things should improve. We would hope week by week, but definitely month by month. And if you're still not seeing an improvement in six weeks, you need to change it. We can't go through the same thing for another six weeks and expect a different result. And so that might be outside of strength training. That might be within your running or within your day to day activities or your work or stress or something, but something needs to change. And it might be the deadlifts. It might be the slow heavy lifting. Um, maybe it isn't PhD. Maybe it's something else. We always need to see some. And then if you do start seeing some improvement like Jen had seen, then double down on that and, you know, keep to that plan and follow that process, trust that process that's slowly and gradually working. But we can't trust a process that isn't working. So something just to, I guess, piggyback on with that advice. But I really appreciate this story, Jen. You've gone from, you know, doing races, identifying yourself as a runner to then having this setback for several years and really questioning and struggling with that shift in identity and getting back to finding a nice sensible patient game, seeing gains, and then sticking to it, getting back to races and, um, lifting heavy and learning a lot of things along the way, a lot of flare up plans, a lot about strength and those sorts of things. That's just going to be everlasting for the rest of your running career. So I want to thank you for coming on and sharing the story. There's been a lot of key insights here. And yeah, thanks for taking the time. Thanks, Brady. I'm just very excited to be on this end of the podcast instead of always listening to the success stories. So yeah, this was, this was definitely a highlight for the week. So I'm glad to have you. You're welcome. 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.