Liz's PHT Success Story

: On today's episode, Liz's PHT success story. 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 Brody 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. Another success story is coming out of the woodwork. We have Liz on today's episode. I thought it structured slightly differently, rather than just telling the story from start to end as most of these success stories go. Just for a bit of variety, I thought I would kind of chop and change. So we have Liz talking about her symptoms, how she managed them, how I guess severe symptoms did get in terms of function and pain and that sort of stuff. But we then skip ahead to where she's at now, how well she's doing, and then we kind of backpedal and go through some certain domains of her rehab and sort of nitpick, take a deeper dive into those sort of domains. So we have sitting. we have her strength, we have her running, and we have her cross training. So we sort of backpedal and dive into all of those bits and pieces, and I sort of prompt some questions that I know a lot of PhD sufferers do ask about, you know, how long it took for sitting to start noticing an improvement in her sitting, or when it comes to running, what sort of... I guess, pain levels you're following and when to progress, how to progress, and a lot of those elements. And so we break those down and Liz was great with her responses and her story itself. She's doing really, really well. Um, I won't give too much away. I'll let her explain everything. Um, but yeah, for without further ado, let's chime into Liz's success story. Liz, thank you for joining me and welcome to the podcast. Hello. Thank you for having me. It is my pleasure. And this is, I'm glad that you've decided to jump on, glad that you reached back out to say, you know, um, to mention your successes that you've had so far because it's exciting. Um, and I'm looking forward to diving into it, but before we get into the specifics, can you maybe introduce yourself and prior to the PhD, um, what was your like fitness, your health lifestyle revolving around? Yep, that's fine. So yeah, my name's Liz. I live in Huddersfield in West Yorkshire in the UK. And I developed PhD in late 2020, I think. Prior to that, I've run for years. But more seriously, probably the last 10 years or so, I started running as a teenager. always enjoyed the outdoors, but probably, as I say, the last 10 years or so, got into races, just, you know, not majorly seriously, but run a few marathons, lots of halves, 10Ks, run with my local running club, just enjoy it, just, you know, keeps me sane, enjoy the social side. So yeah. And up until... developing PhD, I had started training for the London Marathon and was training quite well actually, really enjoying it. Had to coach, so I was kind of really focused. My fitness was probably the best it had been. And then as we all know in 2020 everything came to a grounding halt. so London was cancelled and I carried on with training at quite a high, not intensity necessarily but continued. We all had a little bit more time on our hands so probably continued, not as though I was training for a marathon but not too far off. It's hard to say what my injury was caused by in the first instance. It wasn't PhD at that point, it was, oh gosh what was it called? perineal tendonitis, I think. So I developed that and managed that over the summer. Thought I was doing the right thing by doing lots of cross training. And I think I probably was, but my personality is that I tend to do everything to the extreme. So I was doing loads of online pilates sessions, probably tons of stretching, got on the... when things reopened a little bit, got back on the, well, the spin bike, so to speak, at the gym. Sometimes doing two sessions on the bike a day. Just really, particularly because I've been so fit, not wanting to lose it all. And then started feeling a little bit of a niggle into my glute in November, December, 2020. So yeah, and at that point, because I had a... I had a little bit of a similar issue when I was training and managed to, or I thought I had, I thought it was a piriformis at the time because it was so high up in my glute. I thought I could kind of manage it and run through it. And the rest is history because obviously I couldn't eventually, it became apparent it wasn't that. Not for a while though. It wasn't until I think the March when I went for a biomechanical assessment. with a different physio over in Manchester and immediately he said it's not piriformis, it's actually, I think he called it high hamstring tendinopathy at that point. So that's when I kind of was able to begin managing it a little bit more, you know, in line with what I needed. I said stop stretching because I've been stretching because I've got hamstring. pain. So the immediate thing was to, oh, I need stretch. She said, your hamstrings are, you said zero, whatever that meant. I think, you know, I had completely flexible hamstrings, which as a, as a runner, I didn't need and was very unusual. So yes, I think I've probably gone off on a complete tangent there talking about the history of it. Well, it is a long history and from the general sense, I guess there's trying maintaining sort of high volume training that being like running and also the spin classes that you're talking about. Just trying to not lose fitness, which I think is a pretty valid concern that a lot of people have when they are injured or like you say you had the ankle issues and wanting to cross train to preserve fitness, because I think that's a lot of fear, especially if you were hovering around marathon fitness, I think that's a pretty strong motivator for most. And I guess like the onset of symptoms, you're talking about, okay, start noticing some tightness and some soreness around the high hamstring or glute sort of area, to which that you may be suspected the piriformis. Was there any other signs? Was there any sitting pain or was there any like pain bending forward or any of those other classic signs of PhD? Um, yes, I think sitting was quite an early symptom, sitting pain. Um, and I remember, um, I remember cause I came back just before Christmas and I remember saying to my, you know, to my running friends, I'm going to get through Christmas. and then have a couple of weeks off because that was niggling and I seemed to remember sitting and sleep as well. At the same time, I've never been a great sleeper. I decided to try and tackle that just after Christmas. So I started doing an online CBT, like sleep, CBT course which involved sleep deprivation. in order to get myself absolutely exhausted, which I probably didn't need to be honest because I felt already exhausted. So I'd sleep. And I remember my husband saying to me, I'd like literally fallen asleep on the living room floor because I couldn't sit. So therefore I was laying on the floor. But then I was so tired. I was just falling asleep because I was laid down. So that was probably, yeah, around Christmas time, January time. but I'd had a little bit of that with the piriformis. You know, I had a bit of glute pain. So again, it felt different. It felt more intense. But at that point, I know when I look back on Strava, I had said at one point I was having an easy week because of hamstring and glute pain. So I was obviously aware that it was in the hamstring area as well at that point. But you know what it's like, you try and... kind of taught yourself, oh, it's just the same as what I had before and I can manage it and if I run off road, I'll be fine. So I don't think I did have that week off after Christmas. And then I remember I have, so in terms of physios, obviously, I ended up having some online physio with you later on in the year. I've had a physio for a long time. here in Hudsfield. So obviously I saw him and then the guy that did the biomechanical assessment. But I'd gone to my physio here at home and he said, well, just at that point, I think I can manage like four miles. He said, well, just don't do a run more than four miles. But then I kind of ran every day at four miles, just trying to manipulate the advice all the time. Well, you know, I can do, you know. And then had to accept it was just not getting any better I needed to rest but the problem was because my usual go-to would be the bike and that wasn't good either and obviously the stretching and things I think I carried on with Pilates but just said to my Pilates instructor I knew which exercise is not to do but it was a pretty miserable time really to be honest. Especially when I wasn't really sure how to treat it. I think the turning point came when I went over to Manchester, had that assessment. And then I think we probably started working together about a month or so afterwards. I've just done lots of research into it. Because I think one of the issues with the condition is it's not very well heard of. I still have lots of people who would say to me now, oh, well, you need to be stretching. And I don't think. It's despite it being such a common injury for endurance run, it's particularly well, and sprinters, I suppose, as well. It's, it's not really well understood still, I don't think. So I felt a lot better then once I started. But yeah, my, my symptoms were sitting probably that was a main one, really uncomfortable. I can imagine like the. with wanting to rehab, but also compelled to run as well. And if you were to, if your therapist was to give you a little bit of leeway or a little bit of a ill-defined parameters, we can call it, you'd probably do the upper end of what was asked of. And if they would have said probably, okay, don't do 4k anymore, go down to 3k. You probably would have done the 3k like fast and hilly and all that sort of stuff. So just like, yeah. Less. Guidelines like, um, if we don't put the restrictions or really set parameters on you, then if any ambiguity or any gray zone, then you're going to find that upper limit, but it's why it's tough. It's why it's tough. You know, you don't want to lose fitness. You want to, you've got races like, you know, set off in the future. I want to stay as fit as possible. And that's, you know, generally what people gravitate towards, particularly with the certain runner personality traits. Um, and how bad did it get? Like if we're spending over, you know, a year or so with having this and the therapists maybe like misdiagnosed or piriformis and a diagnosis, then, um, backing off the running. What did your capacity drop down to or what, how intense did symptoms end up getting? The sitting was very painful and given the time as well, it was, you know, we were having holidays in the UK, so it wasn't ideal that I had two, well it was fantastic I had two holidays, but one was in Scotland and then the other one was in Cornwall, so the two opposite ends of the UK really. So I remember, you know, having to sit on long car journeys and, you know, that was really And, you know, my job is I'm a head teacher. So, you know, a lot of it is desk based, although I am obviously up and down a lot. So, but I had to, I can't afford a sit stand desk at work, although to be honest, I never tried. But I had one of the old overhead projector desks in my room. In fact, it's still there. and you used to stand at that rather than sitting, but then if you stand too long, your back becomes achy, doesn't it? So I had like a timer on my, you can get apps, can't you sit, stand apps to sit down and sit, it was timed. So there was that, and then obviously just the pain, and I could feel it walking, and the frustration of it all. I mean, the worst thing really is, I think most of us do. you exercise for your mental health, don't you? And it was that really. And there's some bleak stories around as well, isn't there? You've just got to be careful as well. I think some people, mine was tendinopathy. I hadn't torn anything off the bone or it's a classic overuse really, but you can read lots of... horror stories out there if you're not careful that people never recover. I mean it was a nasty injury I think from start to finish. I think it took me 15 months to get 95% right. Even when I was training for London this time, so around London Marathon again this time. Even then you know I did have one flare up where I had to sort of rethink what I was doing. I was meant to race a 10 mile race. Um, and I just, I did do it and it did it at quite a good pace still, but, um, I kind of did it more as a training run, um, as opposed to a race. So even, you know, that's what two and a bit years later, um, you know, I can, and I probably will get other flare, flare ropes. I think it is once it's kind of a damaged tend and it has, um, it's a weak spot, but you know, I know how to manage it now. Hmm. Yeah. It's kind of a double whammy when. You run for mental health and then you have that taken away or you have that severely diminished and it starts to affect your mental health, which then starts to inhibit your recovery. And so there's that, it's that really tricky point. And like you said, at the start, when you're talking about your lifestyle, your fitness lifestyle, you're running for, you know, the social side of things as well. And that's also a good part of recovery. But You're not socializing. You feel rubbish because you're not exercising. And it's that, that downward spiral of all those factors, which is really, really tricky. It's hard to, to really navigate. And you're talking about how long it took you to get to 95% better. Um, was that, that timeframe would have been from the onset of symptoms until like then, but there's, it's probably a little bit shorter. If you consider. how long it took you to eventually find the right exercises and the right rehab, because like you said, there was a time in that point where you were sort of mismanaging it with too much running, you're sort of stretching and overstretching possibly. Would that be fair to say? Yeah, absolutely. Um, I think I consider that I was back probably late last summer. Um, suddenly I was back in my running club, so September ish. Um, I think I probably, I did run. Last summer. Yes. I definitely ran last summer. So I'd say probably it was a year, um, maybe slightly longer. Um, I did, I did actually. No, it was actually less than a year. I didn't manage to give us, get myself another injury just as I was coming back. Um, I had, I'm prone to, um, Oh, um, another, I can't even remember what it's called now. There's too many injuries, but I'm prone to another injury, posterior tibia tendonitis. So I managed to get a little bit of that as well, just as I was returning, which is very frustrating. I have like three injuries within that period. Nodding your head, you understand what it's like. We're trying to come back and then something else happens. So yeah, maybe a year, maybe slightly less than a year for that actual injury, but a long time. It's the longest injury I've ever had to like manage. And you've got to remember as well, this was all during sort of lockdown periods as well. So in terms of, you know, social and managing your mental health, you know, there was a time where people could go out and exercise with one other person and I couldn't do that. And, you know, it was really frustrating and upsetting at times, really. I know it's just it's your way of life, isn't it? And you're so... as runners and people who just enjoy being outdoors, you know, you kind of mold your life around that really. Yeah. It's important that you talk about it as well, because sometimes these injuries, you feel alone and you feel like you're not heard or people don't understand when it comes to how severe this injury is, how long, how drawn out, how tough it is to not sit or not go to a movie or out for dinner and socialize and all that sort of stuff can really impact people's mental health. And so people listening to this... I carried a cushion around. Okay, yeah. I carried a cushion around everywhere. Carried a cushion absolutely everywhere with me to all restaurants and things. It was just, yeah, it just became a norm. Yeah, yep. I could imagine that. I hear that very often when talking with people with PhD, but you said that you're 95% better. Can you talk about if we just jump ahead and we're going to... pick up the pieces after that. Currently, what have you managed to achieve? What's your running status? What are your symptoms? Where do you find yourself right now? Yeah, I mean, I think now I'm kind of 98% there. I've not had anything for months, but I think I kind of keep that 2% so I'm not freaked out if it happens again. I think it's just there. So it's not if it niggles or, you know, it's not that I've done it again. It's just there a little bit. Well, since then, I'm really pleased that I managed to run London. I had run it previously, but it was my first marathon. And then as I described, I was meant to do it in 2020. So unfortunately I'd lost my place by then. So I was really lucky in that my running club had, I think they get one place per a hundred members. So I put in an application for that and managed to get a place this year. And loved training for that, really, you know, focused. on it and got a PB. So by quite a bit as well. So it shows that, you know, you can come back stronger. So I really, really enjoyed the race. So everything kind of came together, which is when I got into a trillium and I've done it. So that really pleased. And then also I have done my first triathlon because one of the things that I tried to do whilst, thought I need to learn to do front crawl. Never been a swimmer. Always got quite a negative mindset about swimming. So learned to do front crawl, which I think it was something again, you try and find something positive out of all the negatives. And then did my first sprint triathlon, which I enjoyed. It was hard. I'm still not convinced I'll ever be a good swimmer, but I did it. And then I did a duathlon. I thought, well, I did quite well on that. And I'm not a very good swimmer, so I'm going to do a duathlon. I'll leave out the swim. I love that. Really enjoyed that. So I'm now I'm training again for a half marathon. I thought I'm going to try and PB my half marathon time. So I'm doing Manchester in October, but I'm actually going to I'm training for it properly as opposed to just doing it as part of marathon training or off the back of, you know, my normal. just running training. So I'm in a good place now. I've not had a touch wood. I've not had any niggles at all. I kind of know. And I continue, I'm sure you're going to ask me about what I do to maintain, but I do continue, you know, some element of strength training, probably not as much as I should do, but certainly all through my marathon training I did, you know, and I've invested. in, you know, it has cost money. So, you know, I've had regular massages and things. And just for London, for the London marathon, I put everything into it that I could just to make sure I got there. Yeah. You mentioned the PB of your marathon. What time did you end up running in at? 3.15. So bang on 3.15, which I was pleased with. So that I think it was a seven minute. PB and I was delighted because my running club actually awarded me the marathon trophy this year, which obviously is given to, you know, marathon performance. I wasn't the fastest marathon this year by any stretch of the imagination, but I think they kind of recognized where I'd come from. You know, I don't think just gone back to the club back in the autumn. So that was really nice that was recognized. Yeah. So yeah. I think it's also important to mention that not only are you returning to these races, but you're doing it at a fairly fast pace, which when it comes to PHT, speed is really impacted and it's a very strong correlation between hamstring strain and demand and how fast that you run. So a lot of people think, okay, how long does it take to actually get back to races? But it's another thing to get back to racing fast. for you to do that in this period of time, I think people will be quite reassured that it's quite tough to do and achievable. So thanks for sharing all of those. I had a few elements that I want to break down when it comes to your treatment, sitting strength training, running and cross training insights that you had for each of those and what's helped move the needle, what's been effective and that sort of stuff. So Let's start with the sitting. Uh, was there anything that you, you did mention that sort of maybe manage symptoms with the cushion, carry me on the cushion everywhere. But a lot of people with PhDs, like when is this sitting pain going to resolve? Um, what insights did you have in that, that domain? Yeah, and that's the thing because the pain's there constantly, so it was really hard. You can't just, you know, other injuries, you might, it might settle, but because you're kind of pressure, putting pressure on the tendon every time you sit, it was just constant. And you know, that can really get you down. I think just, I think it's just your mindset more than anything because obviously, you know, you can use cushions. but it's still a bear. I don't know, that was the worst, the longest lasting thing really. I never found a way of completely managing it, moving around, not sitting for too long obviously, but that's hard, isn't it? When you're in meetings or long car journeys, particularly, I think I had a couple of cushions to boost myself up in the car, so. Um, yeah, I'm thinking about the angle of my legs as well. I think rather than putting your legs out, having that kind of angle, um, helped a little bit. Um, Are you still sitting with cushions? No, no. Uh, although I think I've got one in my, I've got one at my dressing table, but I think that's more just the height. It's, it was a better height to be able to see. Um, but no, I don't need it to be honest. Can you think of somewhere in your rehab? Is there, how? I guess strong, did you need to be all like, how much running were you doing when you started to notice there was actually improvements in the sitting? Cause I think you said that the sitting was one of the last domains to actually start seeing improvement. Yeah. Um, I certainly was running again, but still having that sitting pain. And as we know, it can be delayed, count it to the next day, the pain. So then you just feel it creeping, creeping in. But it did reduce, it wasn't like just really about one day and then went the next. And as I say, sometimes, you know, it was very easy to get a flare up and I'm convinced that the flare ups, you know, obviously I've done a lot of research around pain and reading around pain. It did seem to be triggered by, you know, stress and things like that as well, without a doubt. So yeah, it just was a gradual decrease over time, but it probably, certainly still, I think I had a conversation with you around, well, we'll just accept a bit of sitting pain because I wasn't getting it any other time really. You know, I was obviously did a return to running program and that was okay and walking was okay, but it was then the sitting. So I had to kind of separate the two, I think, which is hard because then you feel like you, you know, because when you've had such a long time off, you then do get to the point of you're scared to come back and do too much too soon as well because you've, you know, you don't want to, you get, you get to that point where you've got to accept you're not running, but you don't want to prolong that anymore by, it's all a balance, isn't it? But you've still got to load. load it in that way as well. You've still got to sit. If it's like anything, you've got to return to it and increase it. I think that's probably what I did, you know, um, Blank it out, I think, but it's, it's like with the running, increasing the time that you can tolerate the sitting and just trying to increase that bit by bit. Yeah. Did you have any particular structure about the sit, stand strategy, sitting a little bit more often or weaning off the cushion, or was it just purely based you felt that you were getting a bit better, so you said a bit more and it's a little bit unstructured. Yeah. I think I tried using, as I say, I got an app to time sitting and standing, but then it's hard in everyday life, you know, when you're called off to do something or then you've got to sit down for, you know, most meetings were online again, although I did sit and stand even on Teams meetings. You know, I think everybody, everybody knew about it by the end. It's boring. Everyone's to death with the, my injuries. Uh, so yeah. Um, but I tried to structure it a little bit, but then you've just got to be flexible as well, having you, which may have, um, prolonged things. I don't know. Yeah. And it's interesting that you found a connection between your psychological state. If you were stressed or anxious or worried and fearful and all those sorts of things and link it to. having a bad day with sitting, there's nothing that's was correlating physically, but that's almost means that you can still sit means like you're not doing further damage, you're overloading it, it's just like your physical state, you're being worried and anxious about it, which a lot of people do. There's a lot of people are fearful to go out for dinner or fearful to go to a movie or go on a car ride and go on holidays. I've got PhD clients now who have holidays that they've got a several hour flight booked and they're worried about it because they're worried about the, the plane ride and it can really, um, strain or, you know, be quite stressful. And like you say, that, that does really trigger symptoms. It increases pain sensitivity, um, stress itself inhibits recovery. So it's, it's a tough balance to make. Um, but did you think on the psychological side of the sitting. Did that, did you naturally just increase your confidence as you were getting better or was there any proactive measures to mitigate the stress and worry like mindfulness or positive thinking and those sorts of things? It's to thinking, I think, I mean, as I say, the amount of, um, I became quite knowledgeable about the condition, I think, and as you've just said, it's, um, it's not actually making things worse. Um, It just feels that way. Um, so I think it's just, I mean, I did do mindfulness, but not necessarily, um, at my desk, but just as another way to try and get through, um, you know, the situation really, I've always kind of done that on and off. Um, so yeah, just, just that belief that it will sort of gradually, um, dissipate really, which it did. Yeah. Yep. Self-belief is pretty strong. Okay. Um, Thanks for the breaking down the sitting side of things. Let's go into the strength training. So were there any strength training exercises that you think were really effective in managing overcoming PhD? Yeah, I think, well, I started with the Nordics, amongst other things, but, you know, in terms of what I really think you find you go to, exercises, so did lots of those, think they kind of got me going, and then obviously added some weight, so, oh, I can't remember what they're called now. Like the Arabesque. Yeah, single like deadlift looking thing. Yeah, deadlifts. So did those a lot and I still do those. And reverse plank actually, I think has really helped me just that whole posterior chain, you know, holding on one leg for 30 seconds, which, you know, that's, that's quite a hard exercise, but I think that really. kind of get to that point. So use, use that a lot as well, but, and I think we did lots of different exercises, didn't we? You sent me lots, but those particularly, um, stack ups as well. So, um, yeah, might be good to explain the reverse Nordic. So for those who aren't familiar, if they're familiar with like a normal plank, this is where you turn around. So you're actually, um, chest up or facing the ceiling and you've got your elbows back. onto the floor and so it still looks like a plank position, but you're just facing the other direction. And you said that you were doing single legs, so lifting up one leg and sort of driving your heel in towards the floor and holding that for 30 seconds. Yeah, it was tough. And it's your posture as well, isn't it? So trying to keep as flat like with a normal plank, your core as well. So I think it was quite good for that as well. And my whole body will be quivering. after 30 seconds. So I do those, still do those on both legs actually. And interestingly, I find it harder on my good legs, so to speak, than my other leg. I think the tendon is, although it's damaged, it's stronger now on the leg where I did have PHT, but I do obviously then do it on both. So that's, that's still definitely a go to exercise and one that I would, you know, recommend, highly recommend. I do recommend that to, you know, friends who sort of describe similar niggles. So do they, you know, do the reverse plank? Um, my husband can't do it. He can't do it on one leg. He just does it on both legs. So I think it is quite challenging. Yep. And do you prescribe to a certain, how many times per week or do you have a set structure around those? No, not enough really. I mean, certainly when in my head, now I'm training again, like one strength session a week at least. I know I should be doing more, but it's fitting it all in. When I was training for London, I did actually go to a strength and conditioning class at my physio, paid for a package that involved you got a strength and conditioning, but only I went, so we could tailor it to what I needed. And I remember she was doing The physio was getting me doing, you know, like three or four sets of the reverse plank. And I think actually, to be honest, following that, that's when I had my niggle. So I think it just, it wasn't necessarily, I think I just overworked it really, and then was conscious I didn't want to race on it after that. But ideally, I guess I should be doing it twice a week, really. Yeah, well, like you say, it's trying to find the balance in things and I guess running is taking up a lot of your time and in saying that moving on to the running domain, do you have, my first question would be like, do you follow any particular rules, guidelines when it comes to symptoms during a run or after a run? Do you, yeah, do you do you prescribe to any particular guidelines right now? Not now, because as I say, luckily, I'm pain free. I think I would listen to my body more than I did do previously and not try to, I think I would be quicker to stop. Hence, you know, the decision I made not to do this race through my training actually. Looking at the bigger picture, you know, I wouldn't risk that again. But that's, you know, that's me listening to my body and it's hard, isn't it, to know what is a little niggle and what's an injury. but if it is a little niggle then you have a couple of days off, then it doesn't matter, does it? So, and then throughout the injury, then I probably tried to subscribe to the three or four out of ten. But again, that's so relative. I don't remember thinking, well, that's, I don't feel like I'm being stabbed to death, but then somebody said to me, no, it's like kind of you've got to think of it as in the most pain you'd have for this particular injury, not like the worst pain you could have ever. So even then I was thinking, you know, trying to rationalise it in my head, thinking, well, it's not that bad because I don't feel like I'm being... So I think that's something as well. It's pain, you know, it is so subjective, isn't it? And what you feel is pain might not be what other people... So, yeah, I think I would certainly at the moment be more... conscious, I try to listen to my body more. I know I wouldn't be running through things that probably I might have done before. Yeah, it's a question I get a lot. Like, what is a four out of 10? What is a three out of 10? Because like you say, it can be quite subjective and some of, to your point as well, if you're the type of personality that's going to do more if allowed, if giving that sort of... a little bit of slack on that rope. If you, you know, pull on it, there's, you could almost convince yourself that it's like a three or a four out of 10. And therefore, you know, falls within acceptable limits, but someone else might say, you know what, that's like a six or a seven out of 10. And so that's where it can do, it can get a bit messy, but I think for those listening who want a little bit more guidance, um, you can also go for a run. subjectively tell yourself, okay, I think this is a four out of 10. And then every time you go for a run, you're using that as a reference point. And so your four out of 10 is going to be different to someone else's four out of 10, but you have your four out of 10. And then we pay attention to that staying below that amount. And if, you know, three or four weeks go by and you're, it's still, you're still not making an improvement. We're not moving the needle in terms of. managing greater loads, then perhaps your four is someone else's six and we need to recalibrate what the rules are. So your four is still a four, but our rules might be, okay, you need to be under a two out of 10 rather than a three out of 10. So based on how you're perceiving those, that pain, we can then assign a rule to that. We can calibrate to those rules, if that makes sense. Yeah, definitely. Um, and progression, I guess, in terms of running, running distance, running speed, uh, introducing speed, was there any particular method that you found helpful? Uh, well, it was very, very incremental. It was, uh, I think I started on, gosh, um, one minute. And I know you might be able to remember what we, on the plan, it was like the lowest, um, amount of running really. So yeah, was it one or two minutes out of 12 or something? I'll bring it up. Let's have a look because I haven't looked at it for a long time. Yeah, hardly any running at all and then did that for three or four days, was it? And then progressed and just tried to keep it. I mean, I have, my cadence is kind of not bad usually and I know people say that your cadence is... is your cadence, but actually mine, the cadence is a lot slower if I run slower. Um, or a lot. Yeah. So, um, I tried, I just tried to run relaxed. I didn't want to run too slowly because then I think I maybe, um, the strides were longer, um, obviously I was so unfit by then. Um, so yeah, and then gradually built it up and then sometimes had to pull back. Um. on the amount I was running. It was really, really slow, frustratingly so. And then introduced a bit of speed, hills as well, because you know where I live, it's Pennines and Yorkshire, so if I'm running any kind of run as opposed to just up and down a road, it involves hills. So just very slowly trying to listen to your body. The issue was, hurt that much when I was running. I could maybe feel a bit of a pull. Um, it was the next day. So, you know, I had to listen to my body in the next day and, uh, just, you just get that pain creeping in. You think, oh no, it's back. It doesn't go, um, which was just gutting them. I looked up the first phase of the walk-around program that we assigned and it was four repeats of one minute running, three minutes walking. And then progression every like every third sort of attempt or second or third attempt, but we just added one repeat of one minute every time. But then, you know, that one minute turned into two minutes, the four rounds turned into six, eight, 12. And, um, once we were doing fairly considerable amount, we then started introducing speed and these speed sessions. Started at 30 seconds of. faster running than one minute of jogging and doing that five times and then building up upon that. So yeah, like you say, very gradual, very incremental, but necessary when it comes to seeing what you can tolerate. I think people ramp up way too quickly and have a setback and have a flare up and those sorts of things. So, can't go wrong with making these little slight increments because if you do end up overdoing yourself and you end up doing too much from what the attending can tolerate. We've only just made that little step into the overload territory. So it's, you notice it, you notice symptoms, but symptoms might only increase for 12 hours compared to three or four days if you wanted to take a bigger increment. So yes, the patient diligent, sensible approach takes a lot of time that is often necessary. Yeah. And in the grand scheme of things, you know, it did seem very slow because you're itching to get back, but compared to the amount of time I'd had off in total, you know, it was, um, you know, a drop in the ocean, a big drop in the ocean, but you know, it was, uh, it certainly was worth it. And just that confidence in knowing that you were doing something in a structured way as well, I think helped. Yeah. I often like to have people for like. Step away from the heat of the moment, the week by weeks, the race to race and sort of look at a wider lens, look over the period of 12 months and say, look, it's gonna look painfully slow week by week, but you'd much rather in six months time from now, be running pain-free and maybe running 10K symptom-free compared to being in the same. cycle you find yourself now where it's getting better, worse, better, worse. And you have this boom bust cycle so that in six months time, you're still following that same boom bust cycle. Um, but if you take the sensible approach now, it sort of reaps a reward. And in six months time, you find yourself way better off, which you've sort of found that in a grander scale, like a 12 month scale. Yeah. I think, um, you know, once you accept that you're running fitness is going. You just want to do whatever it takes to get right. And I remember listening to the podcast, can't remember the woman's name, and I have the book actually about injury. Recovery becomes your sport. And I kind of invested everything into that. And I think that gave me the focus. Probably quite obsessive by nature, so it allowed me. be obsessive about something else and how to get better. Um, yeah. So, um, and you know, I understood that that's what I needed to do to get better. Yeah. Carrie Cheadle was the, the author of that book and talking about, okay, you can't, those who identify themselves as a runner and purely a runner, and all they want to do is run, they find themselves like in a bit of a, um, identity crisis and they get back way too quickly, way too fast and it flares them up. But you tend to shift your focus and say, you know what? You aren't purely a runner. You are an athlete. And this is, we are now entering the rehab phase. Uh, we need to focus on rehab as your sport, as much as you would, as you would running when you are pain-free. So. dedicate that time, focus, energy, identity into rehab and helps shift that, that focus, which I find really important. I want to talk about cross-training. So what elements did you find effective or, um, not effective at any stages when it came to your recovery, uh, outside of running. The main thing I did really was I walked and walked and walked and walked. I probably walked more miles than I used to run actually previously. And just enjoyed that. I think because it gave me the outdoors. I need to be outside. You know, having lost that through running, I needed to find another way. Couldn't be the bike. So, walked for miles, we have a dog, but sometimes I walk to my own, but we walk with the dog loads. And then, I think at the gym, I think the elliptical trainer was probably the piece of equipment that was most like, you know, that I could actually get my heart rate. I remember thinking, feeling like, brilliant, because I've actually got my heart rate up, because obviously walking doesn't do that. And I hated it to begin with, to be honest, and kind of, you know, sulked that I was having to do it. Because obviously that's inside and I found it harder than running. But then I made it a challenge and would go and sort of almost do like a speed session on it and tried to make it a bit more interesting and got some music on. And so I think, and that didn't flare. the injury up at all. It was quite late when I discovered that actually, or when I kind of resigned myself to having to go on it because like I said, I was walking that, I really didn't want to. So yeah, cross-training on the elliptical. But other than that, it was the walk. And as I say, to begin with, well, I think all throughout actually, I did carry on with my pilates but just avoided those. stretches my instructor continued to do some sessions online so you know I could just sit out and do she was aware that I wouldn't be doing those but nobody else would have noticed anyway. What else did I say I did learn did my swimming but that was later on again but the main thing probably was the walking the strength exercises and then in terms of getting the heart was the elliptical and anything else would have flared it up and it was particularly bad. Did you ever, do you ever have issues with walking? Cause I know some people walking fast might elevate their symptoms. Did you ever get any of that? I remember going on quite a hilly walk and then I remember once actually walking a mountain with my husband and brother in law. They told me it was going to be four miles and not too hilly. And then actually the route was, I think they mapped it out in one direction. So actually it was like, well, more like nine miles up a mountain, which is going to be hilly. So yeah, I think that bled it up a little bit, but not as much as running. Like you say, I think it's that quick, you know, that burst explosive. So the hills did a little bit. but not as much, you know, as soon as I tried to run that, that's what did flare it up more. So, but walking, not so bad, as I say, I think I felt a bit of a toke sometimes. Um, and, um, yeah, it wasn't too bad. Yeah. As we're wrapping this up, I wanted to ask if someone had just been diagnosed with PhD, uh, yesterday, what would be your advice on what they should do or, um, any advice you can give? Stop stretching. Your automatic go to is to stretch if your hamstring hurts. Try to stay positive. It's really hard because you want to research it but then it is a nasty injury but that belief that you can get through it and you can. Bodies recover don't they? Be patient. Probably not running on the head straight away really or really reducing. Um, and then try to maintain, you know, for me, like, if like for me, it is a lot of your social life and, um, I, I continue to try to be involved in the running club, um, through, you know, marshalling and things like that races. So just trying to, to keep as positive as you can, but you have to, you know, it's acceptance. You probably are going to lose your running fitness. but we've all been there where to begin with, you try and fight it and then you try and manipulate the situation, think, well, if I just do this, that doesn't count. But you can't trick your body, can you? So you've just got to accept it and be patient. So yeah, and it's finding somebody who understands. I mean, I think if you can have that support through a physio. therapist or somebody such as yourself who can just be that person to, to ask whether, well, what do you think? Do you think I can risk this run or it's just, like I say, I think there's that limited understanding sometimes from, from people. So, but I think mainly is, you know, try to, try to remain positive. It's really, really hard, but. belief, you mentioned also those stories and posts and things you can find on Facebook that does the opposite, they can actually be quite detrimental in terms of your mindset, if you find that people are really struggling and have had it for years and years and seeing no improvements and requiring surgery and all those sort of things that will gravel gradually will gravitate towards those sort of posts and those sort of groups because they're the people that wanting to post the most. You don't see a lot of people posting success. You see a lot of people posting questions because they are themselves quite fearful and looking for answers. And so when things, when that naturally happens, it can provide a lot of fear. But you coming on and sharing your story, you know, bucks that trend. It's sort of getting people to think more positively, people to start confirming to themselves that they do have belief and people can negotiate this and having it. for quite a long time and having your struggles and then seeing the other side of it and like you say, 98% better, which a lot of people will take that doing, um, really fast marathons and trying to go for half marathon PBs. I think, you know, a lot of people would strive, um, to, to aim for that. So thanks for coming on and sharing a story. Best of luck with the half marathon PB. I'm sure it's going to go resoundingly well. And, um, yeah, thanks for coming on. Oh, you're welcome. Thank you. I've enjoyed it. Thanks. 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.