Matt’s PHT Success Story

: On today's episode, Matt's PHT success story. Welcome to the podcast helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments and of course, bust the widespread misconceptions. My name is Brodie Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series and a chronic proximal hamstring tendinopathy battler. How are 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. love bringing success stories and today is no exception. Matt is on the show to talk about his journey, first of all developing PhD and struggling with it for a bit, overcome it and I think listening to his story there's about six or seven key lessons. to overcoming PhD and it's all just blended into one good story. So we cover all those lessons. We sort of break them all down and you're just going to love this one. Matt was great to have on the podcast and you're going to love his journey. So let's take it away. Matt, thanks for joining me on the podcast. Yeah, my pleasure. Thanks. Uh, thanks for having me. I'm honored. Any success story, uh, more than willing to jump on and have a chat about your particular story and, um, I'm happy to dive in. So. I guess we can set the scene by just introducing yourself and I guess your athletic backgrounds, which resulted in the injury. Yeah. So, my name is Matt. I'm from Montreal, Canada. So I'm French Canadian. That's where the French accent is from. I'm 40 years old. In my 20s, I cycled and cross country skied competitively. And then when I was about 32, I switched to running. Uh, I trained about, uh, seven hours a week, more or less. Um, and I'm currently training for a 10 K and a half marathon in the spring. Okay. Why the change from cycling and skiing into running? Um, I, when I was cycling and cross country skiing, I, I think I wanted to, to just see how far I could go. Um, and then when I reached sort of my early thirties, I was like, I'm packing it in. I think I did what I could in those sports and I just decided to focus more on work. So I run a translation company. So I just sort of built up the company. And I think like for a lot of people who switch from those sports, cycling especially, or triathlon to more just running is sort of lack of time. It's like the three hour training sessions. are no longer an option. So, so I've always enjoyed running. Um, and we ran the mile when I was in high school, that was a, that was a big thing every year and I really enjoyed that. So, so I was happy to, uh, yeah, just to, to switch to running at that point. Well, we're going to dive into the, the PhD stuff in a second, but just out of curiosity, was there any other running related injuries that you had any significant running related injuries prior to getting the PhD? Yeah. So I've had, I think I've had like most, most injuries. I'd never had any like knee problems or plantar fasciitis problems, but I think, I think all the others I've had as someone of those runners. Okay. So, you know, shin splits, basically just the whole list. I've, I think I've gone through them. But PhD was the one that stuck with me the longest. So I had it for like about a year, but we'll. sure we'll have it. We'll dive into that a little bit later. Yeah, let's dive into that now. Like, I guess, at the moment of the symptoms first arising, can you pinpoint exactly what it was within your training? Or surrounding those circumstances that might have sort of been a cause or been a link to the PhD developing? Yeah, so it was like really crystal clear. I signed up for a retreat in a in a sort of mountain village near Montreal. It was a month long and one of the reasons I went there was for the trail so I could run more in a different environment. And so I was just really excited. It was like just a whole new playground for me. So I increased my training volume significantly, probably 30 to 50 percent. A lot more hill running, so uphill downhill. more frequent ones, frequent runs. So when you're at these things, they have nothing to do, so you run in the morning and then you run in the afternoon again. And as soon as you feel okay, you're running again. So I did all that while maintaining my regular sort of two times a week, higher intensity sessions. And as of like the third week of the retreat, I could feel like, oh, I could feel like I could start to feel my hamstring more and more. But I just figured I'd just push through till the end of it. And then hope to recover when I was, you know, when I was back at home. Yeah. Few things there. Like the, the elements when it comes to, okay, training volume, uh, we know that mostly PhD, like most running related injuries is, uh, load dependent. It's, it's an overload of that joint or that structure. And not only were you picking up, it seems like if you were doing say two speed sessions per week, you could. maybe negotiate that or successfully overcome that when there was recovery sessions outside of that throughout the rest of the week. But it almost seems like you sort of maintained your intensity twice a week. Like that was unchanged, but what did change was all those sort of lower intensity of recovery rest sessions around those sessions, which means that there's less time to recover. And therefore when it comes to the speed work and the harder work that You just weren't getting the recovery that you needed. Would that make sense? Yeah, that sounds exactly right. And then one little thing I wanted to add, because I think this may be relevant for some of your listeners. I'm one of those sort of running geeks that likes to read a lot about running and experiment different things. And I'm constantly tweaking stuff and trying stuff out. And I think at this point, I was reading a book that encouraged making adjustments to running form. And And this one involved like a little bit more kickback. So like sort of kicking back a little bit more. And, um, I think that really significantly increased the load, uh, on the hamstrings. So I think that was like another factor. Were you increasing your running speed as you were trying this kickback routine? Or do you think it was staying probably the same intensity and speed? It was, it was staying sort of constant. I was just sort of focusing on this, sort of this different, a little, this sort of different form. Um, And I think I just wasn't, you know, wasn't used to bearing that load. And I think just micro adjustments to the way you're moving. And I think any kind of conscious, like form modification, uh, can really alter the load that your muscles and, and tendons carry. So, uh, so I, I learned that the hard way. Yeah. Um, most of these things comes down to overall training volume. Like you said, there was. There's moments in there where running more frequently, sometimes running multiple times a day, um, running hills, just the overall volume pickup by 30 to 50%, how much relevance is there with the change in technique, you know, there might be some, there might, it might be like a 10% influence, but I'd say like the 80% influence would be that overall training volume. So yeah, definitely the, the main factor. Yeah. Well, it's also hard to say. It's also hard to know when you've combined or added in or changed so many variables and then you end up with an injury, it's hard to know what the relevance is, but just speaking from, I guess, my understanding of the pathology, um, I would probably place those percentages to those factors. Um, okay. So you said the hamstring started getting tight. You started noticing a little bit of soreness there, but you decide, okay, well, while I'm at this retreat might as well just. push through, um, see how I go. And then after the retreat, Spend some time on recovery and finally sorting this out. So how did that pan out? So not well. Uh, so, so I came back and I was like, I, you know, reduced the training volume significantly. Um, and, uh, it just, it just lingered. Um, it lingered, um, and it was compounded by sitting. Uh, so it was one of those injuries where caused by running, but then everyday life activities, like makes it worse. Uh, so sitting made it worse. Um, and I reduced the training volume, but I was maintaining the intensity. And I think at this point, like my hamstrings weren't, weren't tolerating that. And so, um, yeah, so it just, it just hung around for, uh, for over a year. Were you noticing it? during the running as well or was it only just after and sitting for the remainder of the day? It varied. I think for a lot of people it varies. Like some days you don't feel at all, other days you really feel it. It's a really annoying injury in that sense. It's like really a soul-sucking injury. It's like it's always, you know, it's either there you feel it or it's lurking in the background like, you know, going to flare up. So basically I felt it when running less when I was running slow. I could really feel it any kind of, anytime I'd increase the speed. I really felt it more. Um, I felt it resitting. I felt it anytime I'd be like reaching down, you know, time, my shoelaces. Um, I'd feel it there as well. Um, it was basically, I mean, you've had it. It's really, uh, it's really an annoying injury. And I think the worst thing is. Um, is the sort of feeling of helplessness like, uh, you know, I've tried this, I've tried this, I've tried this, and it's just keeps coming back. You feel like I'm going to be stuck with this for my whole life. Um, so, um, yeah, so I feel a lot of, uh, compassion for anyone, anyone who's had this, anyone who's listening and hope that, you know, maybe something during this podcast can, can give you hope and help to, to resolve the issue. Yeah. And like you said, you're saying to yourself, I've tried this, I've tried this, I've tried this, um, you. briefly mentioned that one of your attempts was to reduce your overall volume and maintain the intensity. Was there anything else that you might've tried within that year to, you know, kick this injury? Yeah. So I went, I went to physio, um, and it was, uh, it was, it was correctly diagnosed. So I think that's something, I mean, like from, from what I hear is that a lot of people have trouble with. So they go see a physio and then they get diagnosed for something like piriformis syndrome or something sort of not at all related. So I was lucky, I went to a physio who specializes in running injuries. And I think that was really key to getting a proper diagnosis. So I was properly diagnosed. And I was given to start off light strengthening exercises. And I did those. And I'm. I saw a lot of improvements with those exercises. But what I did, and which I now know is wrong, is as soon as it sort of started to recede, I stopped the exercises. And then it would flare up again. And in my mind, it was, to me, like I equated that with the strength is not the issue, it's something else. If I'm strengthening and then it keeps coming back. It must be something else. Yeah. How far, how long have you had this injury for before you eventually went to the physio and started these light exercises? I, I went, I went to quite early and then, and then I went to another one and then I went to another one and then I eventually went back to the first one. Okay. And so, yeah, so, so. Because I tried the strengthening, I was like, oh, it must be something else. And eventually I think I went sort of full circle and I listened to your podcast. So the success stories, and then it was one episode with where one or two at least, where you're talking just more directly about PhD. And that really changed everything for me. Okay. Well, let's get a little bit more, I guess, practical and dive into the exact exercises, because I'm curious to know you said you start some light strengthening exercises and you found initial success. What were those that you included? Yeah, super happy to share about that. So the light, what I was given first was an isometric hamstring hold, I guess you could describe it's like you're lying on your back, your feet on a chair. and you just raise your bum slightly and then that works the hamstrings. And it was like hold that for 30 seconds and then do that maybe like five times. So super light. And then I did those and then running was going a lot better. And then I just stopped. And that was my mistake. It's interesting how people interpret these things. Like Ava just doing something as simple as that. And feeling a lot better. And then once you feel a lot better, you stop doing them. And then because symptoms return, you sort of interpret that as, okay, the exercises were no good. But exactly, exactly. You can easily flip the script and interpret a different way and saying, all I'm doing is this one exercise and I'm feeling better. You know, maybe it is something to do with strengthening, or maybe this might help move the needle once you sort of move. I guess into that same direction, just with progressions and maybe different exercises, newer exercises, make it more challenging and then see what that is like. But that's a really nice lesson because there'd be a lot of people listening now that would interpret that situation the same way. Yeah. And another thing I wanted to add is that the strength training tended to make the running more uncomfortable because you get a bit of soreness. And so... So the strength is like a little bit annoying because you know your run might be like a little bit, you know, less enjoyable because your hamstrings a little bit more sore. So I was happy to ditch the exercises, you know, when I could. It's only when I understood that I had to really increase my capacity or my strength by doing different kinds of exercises, by doing more and by leaning more into the pain. It's only then that I was able to increased like my capacity and, and finally recover completely. Yeah. Did the physio give you any advice when it came to the running or were you following any particular guidelines when it came to your running to sort of manage the injury? Yeah. So the physio was fantastic. So, uh, she, she told me, uh, for the running that I should self manage. So she didn't tell me like stop running or run less self manage. And that thing. that I think really worked really well for me. So it was self-managed in the sense if the next day you're still sore from what you did then you did too much. So 24 hours later after for example your speed session your hamstrings are still like you know hurting then you went overboard and so scale back. And then during the running never go above like a three on ten pain level. I think you mentioned that as well during the podcast and during the strength exercises, maximum of five on 10 in terms of pain. So those limits that she gave me, they worked extremely well. And they seem to follow or fall in alignment with the podcast and sort of what we've talked about in past episodes as well. So good to know that there's a bit of concurrency in the advice that's given there. And so you mentioned that you've gone from physio to physio physio, then back to the first physio. Was there any other nuggets or any other insights, whether that be helpful or unhelpful as you tried out different physios? I think the most really the most helpful thing was Was from your podcast and if I can't all maybe Dive into a little bit. It'll be more detail So the first thing was and I think this seems to be a common pattern with a lot of people who have PhD Or other tendon issues is that they shy away from the pain So as soon as it starts to hurt or be uncomfortable they stop And that's what I was doing. And so when I started, when I listened to your podcast, I decided to sort of lean into the pain and I wasn't shying away from, I wasn't avoiding it anymore. So I started to do some work at the gym. Before I was just doing sort of like Swiss ball stuff and the hamstring isometric exercise I mentioned, sort of the standard physio kind of, usually kind of exercise. exercise that we associate with rehab and physiotherapy. So I went to the gym, signed up for the gym, hadn't been to the gym in a few years, and I started doing some heavy lifting. So squats, deadlifts, single-legged deadlifts, stiff leg and bent leg or regular, split squats, step-ups. and eccentric Swiss ball hamstring curls. Okay. Swiss ball eccentric hamstring curls. Okay, so we have squats, had deadlifts, single leg deadlifts, you mentioned some straight legged deadlifts. So there's a lot of those kind of variations, split squats, and then the exercise where you sort of do a bridge onto a Swiss ball and then you roll out eccentricly and sort of Okay. Yeah, exactly. Yeah. And I might add step ups, which were really, they're sort of similar to a split squat, uh, but step ups. Um, what I did with the, uh, eccentric, uh, curls was that I was lying down and then with two legs, I would roll my feet away from my body. And then, no, with, with one leg, sort of on the eccentric portion, I would roll away and then with two legs, bring it back. So I'm working just. E-centrically, the concentric part is easy. Yeah. That's a good gambit of exercises. And would you perform all of these exercises within one gym session, or did you spread it out more throughout the week? I spread it out. So I did, um, I did, uh, two sessions a week. Um, so at the beginning, when I was doing the sort of the light strengthening exercises, those I could do every day. Um, and that was helpful. Um, but then as I progressed. Um, then I was lifting heavier and then, then I had to make the workouts more infrequent. So it was twice a week that worked really well for me twice a week, Monday, Thursday. Um, and, uh, I did, um, I did, uh, so heavy weights. So, uh, five to five to six reps was, was standard. So it's like maximum strength. Work. Five to six reps per set. And how many sets? Uh, maybe two or three. Yeah. All right. Great. So you are getting quite heavy with those, um, back to your point as well about, you know, people shy away from pain. Yeah. I think that's an excellent, uh, bit of advice, especially because if it's only saw in the moment, um, you know, you can really challenge yourself and like, there's a, you can get a lot of reassurance to know that's actually fine. Uh, if there's pain. during the exercise, but then it lingers, you know, quite substantially for hours afterwards, maybe that's a little bit too much. So everyone has different levels of irritability, but for the most part, I find that if you are sore, and there is a little bit of pain during that exercise, and there's nothing that lingers afterwards, you can go quite significant. Like, when I have a tendinopathy in the past, like let's just use the PhD that I used to have. I used to push my pain to like a five or a six out of 10, which I don't really recommend for most, but only because I just know myself so well, and I'm happy to sort of take on those risks. I found that I even responded really well to a five or six rather than a three or four during that particular exercise, because I knew that irritability, like the symptoms afterwards would go back to zero straight away. And I'd feel a lot better throughout the day if I really loaded up with something quite heavy. And yeah, people don't like being in pain. People shy away. They think and understandable think if you do a deadlift and you have this pathology in this tendon, that it might cause more tears or more damage or a rupture or something like that. People are have that inclination that might happen, but actually the opposite happens and so yeah, a lot of reassurance about those sorts of things is key. Yeah. That rings really true to me. And I remember listening to say that in one of your episodes that you went to five or six on 10. And when I heard that, I just started like really hammering my hamstring in the gym. And I think that really tipped the scale from sort of lingering and flaring up to like disappearing completely. I've been 100% recovered in complete remission for over six months. And my hamstrings are like stronger than ever. Like I'm done. I'm over this. And I was suffering from it for over a year. So that to me made a big difference as well. And if I'm if I might have which is like a little piece of advice in terms of for your listeners What would really help me at least in terms of exercise selection? Whatever was the most uncomfortable was the most helpful So if it's like, you know if the single leg deadlifts is Is like what really like, you know really brings you to like a higher pain threshold, that's the one you need to do I think as long as it's tolerable and as long as, you know, the next day you're, you know, you're, you're not worse than you were. Um, that to me, that to me, like, is a good guide for, for exercise selection. Yeah. A lot of this can be a lot of the advice that's given is quite like the opposite of what someone would intuitively do. Like we can use pain during exercise as that sort of intuitive sense of, okay, let me stay away from that. Whereas we're steering into it. Um, the same thing can be said for exercises. Like people can find, Oh, my hamstring curls, I do those and they don't cause pain, so I'll stick to that. And, um, all of these other exercise, like a step up or a lunge or something, um, causes pain. So let me just avoid those. But to your point, we need to steer into those because recognizing that the hamstring works in different ways, different directions. under different loads, eccentrically, under compression, out of compression, concentrically, isometrically, all those sorts of things. So if you can find an exercise that really you're vulnerable to, that is a weak link that you need to get as strong as possible for you to have full recovery. And so the same thing could be said for people to say, Oh no, I'm fine running, you know, really slow, but as soon as I increase my speed, the hamstring pain comes back. That again is a. a vulnerability, a weak point that we need to strengthen in order to make this condition as resilient as possible. Um, so yeah, steering into those things. It's might be tricky on your own, trying to come up with a plan to introduce speed or modify an exercise so that we're addressing that vulnerability and eventually progressing to. know, strengthening that weak link, but needs to be done. If you want to be resilient and you don't want all these flare ups popping up every couple of weeks or a couple of months, then they do need to be tackled. Yeah, absolutely. The one talking about the exercise prescription side of things, there's probably one exercise in there that I haven't seen and that I would probably include, which would be some sort of. Hamstring curl. So you did mention that you're doing a bridge. on the ball and you're coming back to legs, which is kind of like a hamstring curl. And then you're eccentrically, um, releasing with one leg, but probably isn't that heavy progressive type of thing that I would, um, like, it doesn't really foster that progressive environment when it comes to the hamstring curl. So a prone hamstring curl with like a, um, on a machine that you can sort of curl would probably be one that I would. Add in there to then give you a gold star for almost every single exercise that you're doing. But, uh, was there any, uh, was there any advice or any inclination to do some, some sort of exercise like that? Um, I think, uh, I'm pretty sure you mentioned it. I, uh, I think I had like sort of that base covered with the Swiss ball one. Um, but in hindsight, I would have added that one and. The one I never did, but which I, you know, you keep hearing about is the Nordic, is it Nordic curls? That was called that one. I never did that one, but I'd be curious to hear your thoughts about it. Yeah, I think I don't really prescribe the Nordic curls a lot for people. They, so for those who aren't familiar, it's sort of the exercise where you're kneeling and you have your ankles secured, locked in place. is that be like a, like you put it under a bit of furniture or under like a weighted bar or, um, those sorts of things. And then you lower yourself. So you're trying to keep everywhere, the whole body between your knees and your shoulders straight, stiff as a board as you lower yourself down. And as you do that, you're eccentrically contracting your hamstrings. And if you try and see how far you can slowly control yourself in that descent, and then once you sort of lose control, then you just put out your hands and sort of catch yourself and repeat that process. That is really working the hamstring muscle belly and working the hamstring muscle belly eccentrically. Which if someone was a sprinter, if you had a runner that mainly wants to get involved in sprinting, I would 100% give them that exercise. Because that eccentric component needs to be super, super strong for runners running it at speed. But doesn't really foster compression like a squat or a deadlift or a step up those sort of exercises which more target the upper hamstring and like sort of isolate the tendon. The Nordic drops, yes, very, very good for the hamstring muscle and the muscle belly doesn't really do much for the tendon, the higher up tendon. So why the deadlift works really, really well is people say, oh, I do the... deadlift and all I do is feel my upper hamstring. Well, that's because the idea of that exercise is to localize to the upper hamstring, almost isolate the tendon to work, which once you foster the right conditions can do wonders for rehab of this condition, which is why I give deadlifts to almost everyone that I see. But yeah, I guess that's where it depends on the type of athlete, depends on what goals that athlete has, depending on what... exercise I prescribe, but yeah, I probably give Nordic drops to maybe 10% of my caseload. Okay, interesting. Yeah. Any follow ups on that particular topic? On the exercises? No, I think I've given you everything I've got. Yeah. Another thing I wanted to address, you mentioned that you're doing these twice a week. You initially started with doing all of these exercises twice a week, but then progressed to the point where it became quite heavy, quite challenging, and you had to separate them out. Um, I think that is another good lesson for people to realize because a lot of people get stuck on daily exercises, sometimes multiple times a day and simply can't progress and they do bridges, they do hamstring curls, they might do like some isometric sort of stuff. Um, And then they do that once or twice a day and never, well, they initially see some progress because they're fostering some sort of strength, but their rate of progression plateaus and they can't progress that progression because if you try to progress those exercises and continue doing them daily, it's going to get too sore. You need that recovery balance. And so you do naturally want to gravitate towards. If you are quiet, weak and need to start at a real foundation level, definitely start with the easy exercises. You can do them daily, but needs to very gradually progress to the point where eventually maybe six to 10 months down the track, you're doing what Matt's doing. So heavy, heavy stuff once or twice a week and really reaping the rewards of the slow heavy stuff. Um, Any thoughts on that? Or would you agree? Yeah, I agree completely. Yeah. I think that was really. key for me, I think a lot of people, including myself, associate physio rehab exercises with the everyday sort of really annoying, soul sucking, 25 minutes of boring exercises that you would rather not do, and not with the heavy lifting in the gym. And that, at least for me, was what really paid off. and you've seen that, I guess, sustainability and strength and those sorts of things. What have you managed to return to or alongside that, do you find that you still have any vulnerabilities or weak links when it comes to your performance? I think the gym work has made me much more resilient in general, so I haven't had any kind of, any injuries that Made me have to stop running or even curtail my running. I've had some like and still have some like little occasional niggles you know little things that You know, maybe one on ten out of you in terms of pain and But nothing that has kept me running in the last six months so I can I can I can I can confirm that for me at doing the gym work, uh, twice a week, strength work, the heavy lifting has, uh, has really benefited, benefited me in terms of my resilience, um, in terms of injury prevention. Yeah. And you're preparing for a 10 K race at the moment. Um, what does your training volumes like days of the week? What does that look like? Um, it's about an hour a day, more or less. Um, I'll have the two strength sessions a week. Uh, two harder days, so like either speed work or like tempo or intervals or some sort of form of intensity. And then one longer run usually, which is not that long, maybe an hour and a half to maybe two hours at the moment. And then the other days are just sort of easy days. So usually about an hour. Before the higher intensity days, I'll do usually some strides. So I'll include strides like at least two or three times a week. And I, where I live, there's snow. So I cross country ski and, and snow shoe a little bit as cross training. So I'll replace the easy days by like a cross training day, sometimes. Excellent. I'm curious to hear Matt, what are some like final takeaways, final bits of advice you might have for someone with PhD who's really struggling? And if you have any advice for them, what would that be? Yeah, for sure. So this is my favorite part of our little chat because I get to, you know, maybe offer some information that hopefully might be valuable for your listeners because I really benefit a lot from the success stories and from your insights. So thank you very much for that. Maybe the first thing I could say is that foam rolling, massage, stretching, all those things can be helpful for certain injuries. PhD is not one of them. So those things did not help at all. For me, and I really tried them extensively, PhD is a strength or capacity problem. And if you increase your capacity, you'll get rid of the PhD. At least that was my experience. That'd be my first takeaway. Okay, foam rolling massage. You've tried them, didn't really work out well for you. What else do you have? To get a proper diagnosis, really important to go see a physio who works with runners. That seems to be really important because that physio is going to know about this injury. He's going to know that runners get it a lot. And I think it's in an area at a PhD where it could be a lot of things. And that is really key. So if there's any listeners who are working with a physio who isn't specialized in running, Um, I would, I would recommend that, uh, as, as something that can really, can really be a game changer. To your point about the foam rolling, stretching massage, like those sorts of things. Um, I do think I want to avoid overstretching. Um, I want to avoid like similar to say running. We want to know how much you can tolerate with your running and stay running. Um, with stretching, we all have a, and sitting, we all have a certain load dependence. We all have a certain amount or a certain duration that you can tolerate. And if you like stretching, you can still stretch. It's just below what you just want to sort of hover around what you can tolerate. Um, otherwise you become deconditioned and some people don't like stretching. So they don't need to stretch, but some people want to return back to yoga classes or pilates and those sorts of things and similar to sitting. Sometimes sitting can be sore if you do it for too long, but you don't want to avoid sitting at the same time because then that really deconditions you to tolerate sitting and then trying to return back to sitting six months later is a real struggle because you just sort of atrophied or you sort of decondition yourself in that particular domain. And the foam roller, yeah, I'm never a fan of foam rolling particularly really high up in the hamstring where it's sore because that tends to irritate things. But I think it can be kind of in the category of foam rolling and massage other areas of the body if you so choose, if you so want. And if you do get some benefit from it, for example, some people might like a massage of the hamstring and of the glutes and they might feel better for a day or two. If that's you, great, continue doing it, but you don't really want to do sort of deep friction massage around the sitting bone area just tends to irritate. So Um, yeah, this sort of like a somewhere in between, but to your point, I think a lot of people find themselves in that wrong direction, either stretch too much and irritate the foam roll or massage that, um, sitting bone area and it further irritates. So, um, my advice as well as Matt's best to stay away, it's not really that effective. Yeah, good stuff. So, uh, another one for me, and you mentioned it is a sitting. So for me, limiting sitting was, was really helpful. Like a lot of times when you're running you tend to like you drive somewhere So you're sitting you run you take your hamstring and then you sit back in the car again Then you go to work you sit so you're like always irritating it Unloading it in that way. So reducing the sitting I almost like other than meal times. I like eliminated I got a standing desk and And that was really helpful because that Allowed that reduced the load on the hamstring and so allowed it to recover more uh, between like the strength sessions and the running. And at a curiosity, like now, when it comes to your sitting habits and your sitting tolerance, where are you at the moment? Absolutely. No problem. Like I, I'm absolutely in a problem. Okay. Good. Cause a lot of people, um, sometimes returning back to sitting or building up the sitting tolerance is like one of the last things to return. And so it's very encouraging for people to know that you can, um, sort of build up that tolerance and get back to a completely normal, like day-to-day life with sitting and, um, social events and those sorts of things. So great. Um, any other final takeaways? Um, we mentioned a little bit at the beginning, uh, about running form, small changes in running form. Um, in my opinion can make a big difference on, on the load that's applied to muscles and tendons. And, um, if they're done, they should be done. Ideally. when the overall training volume is low. Yeah, very good advice. So because there are changes to the body, when you do, um, make adjustments here and there, then it's good to just dial back. So you're sort of taking all of your training dials and seeing what you can manipulate to not subject yourself to an overload, um, very, very wise words. Um, similar to like say speed and those sorts of things, you don't want to increase your volume and your speed at the same time. So if you say, Okay, let me go see how I go with a speed session, maybe dial back your long run, or maybe dial back some of your shorter recovery runs to see how you can sort of manipulate the rest of the week to help suit that to make sure that overload isn't present in there. Yeah, very good advice. Another one would be about speed work. Speed work to me was the last piece of the puzzle. So I couldn't feel a PhD anymore on my easy runs, but I could still feel it when I was running faster. And I feel that, I think it's mentioned in one of your podcasts, the load. increases significantly the load on the hamstrings specifically increases like exponentially speed work was like six or seven times. Yeah, yeah, you can just see it on a graph like slow running and then as you gradually pick up your speed, the demand in the hamstring just skyrockets. And so I think a lot of people would agree with you that yes, hamstring the hamstring originally came on due to Speedwork that that's very, very common for a lot of people. All of a sudden they start doing a lot of speed work and develop PhD. Um, but to your point as well, a lot of people find that I felt a lot better starting to improve, did one speed session back, flared up or. Um, similar to your circumstances, just that last little piece of the puzzle, that last element to your training that seems to be, um, vulnerable to. Yeah. Yeah, absolutely. So I think it just has like, if when it's at least for me, when I reintroduced it, it was very gradual. Like I started with just strides, like maybe just like six strides, and then eventually like some faster intervals. And now, you know, now I'm able to do any kind of speed work and my hamstrings are not a limiter. Yeah, excellent. Anything else? We touched on it a little bit before. If you think you're fully recovered, keep... doing the strength training. So that was my big mistake. To me, I see it now as your capacity is like a horizontal red line. And if your load is below that line, you're gonna be symptom free. So things are gonna be going great. But as soon as you go over that line, that's where you start to feel symptoms. So you can do some strength training, raise the red line. But then as soon as your training load catches up with your capacity, then you start to have symptoms again. So by keeping up the strength training sort of on a continuous basis, then you're consistently increasing or raising that red line to make sure that you stay in remission. So that was really important for me. Yeah, I sort of have this as a, you know, it's easy to say in theory, but one of the approaches to rehab that I like is let's just raise your capacity, endurance. strength, power, plyometrics, let's just continue raising it so that you can't possibly reach it in like your training, like when you do your sprint sessions or when you do your deadlifts and those sorts of things. If we can raise your capacity so that you can never even get close to reaching the capacity, then you know, you're never going to get a flare up. That's overly simplistic. And it's like I say, in theory, it's easy to say, but Should be a goal should be like a mindset for people to okay, I'm feeling great. I'm loving my running. It's pain free symptom free in the gym, but what else do I need to work on? Like how can I progress so that I'm overall like building more and more resilience, I think that's a good mindset to have. Yeah, absolutely. Absolutely agree. Um, maybe another nugget I'd have would be, and this I didn't mention, but it was a key part of recovery and it was like a turning point for me, is I started working with a coach. I've always been a self-coached athlete and six months ago I started working with a coach and I told him I had this persistent hamstring issue and I told him what my training load was. And right away he basically... cut it by 30 to 50% for several weeks. And although it's hard to say exactly what effect that had because there were a lot of variables that I was playing with at the time, I'm confident that had a really big impact. So by deloading, by decreasing my overall trading volume, that allowed my body to allocate resources to... repairing my hamstring. And so even if PhD is like a localized issue in the body, I think like a runner's general state of fatigue, like the general training load or stress load, I think that can have a big effect on an injury like PhD and on the time that it lasts. So I think if an athlete is self-coached and is always kind of training At the limit of what their body can tolerate. Um, I think one of the things that kind of athlete, which I was can do, um, is to start working with the coach. Yeah. Um, it gives that level of accountability as well. And I say this all the time. When, when you start getting better, it's the most dangerous part of your rehab. Because especially if you don't have a coach, you just. say stuff, yep, I'm back, finally, let's, you know, pick up the running, let's increase the speed, let's, you know, introduce heels again, let's find a race that you can prepare for. And like people just jump straight back into that and symptoms return really quickly. And so if you do have a coach and you start feeling better, you know, you've still got that accountability for someone to say, well, okay, let's follow the process. Yes, we can sprinkle in some mileage. Yes, we can sprinkle in some speed, but it needs to be the process. The process is what got you here to the symptom free in the first place. So let's continue with the process so that we can mitigate any flare ups or, um, reduce that risk of a flare up in the future. So yeah, very good point. Yeah, absolutely. And I think another thing that a coach can give you is that they can vary the training load more on a macro level, so that you have sort of longer periods where you're just kind of slowly building up. Rather than I think, I think, at least for me, a self coach athlete will tend to tend to train by feel, okay, I'm feeling good today, I'll go run for two hours, and do that sort of more in a more homogeneous way. So week to week, it's sort of that looks more the same. And I think with a coach, we'll have a more global vision of an athlete's training load and is able to vary it like different cycles. And I think that is really important, especially if you have an injury like PhD to allow it to recover. Yeah, well said. Anything else as we wrap this up? Yeah, maybe the last one. would be if you have PhD, at least for me, that's the number one limiter in your training. Like my running was going nowhere with this thing because you tend to like run slower not do any speed work and so if I had to like do it all over again right from the start I would make it my main focus. to curtail their training, to focus on an injury. And I think that that's what makes it worse or that's why it ends up lingering for months. So if I had to do it over again, I would make that my first priority right from the start. I would say reduce my training load by 50%. I would reduce my running and I would start... focusing more on the gym right from the start. And I would do, I would make that my priority to, to get rid of it because it is, it's basically the number one limiter of your running, if you haven't. Yeah, well said. And I'll touch on a few of those things, but like as we were going through this conversation, I sort of wrote down a few things that I wanted to commend you for. One was actually getting a membership. So, getting a gym membership and starting the heavier sort of stuff. And then number two, just keeping to it. So once you did get better, you still stayed at the gym, still stay doing the heavy stuff, which a lot of people don't do. So well done for doing that. And the other one was just like not shying away from the elements of your running that, you know, you have particular vulnerabilities to, because a lot of people can say, I talked to them and they say, yep, I'm back to symptom free. I'm back to. doing everything I love and I don't see it coming back. And I say, okay, so how's your speed going? And they say, Oh, no, I don't do any speed work anymore. That's not a part of my life. It's just because I'm so scared of PhD coming back. But it seems like you've really faced this head on and returned back to strides and intervals and racing and all those elements to not only do what you love, but also add resilience to that tendon and add in the speed work, once you can successfully do the speed work, then that's another chink in your armor. That's another layer of foundation that you've got in there. And so yeah, very, very key people always ask me like, what can I do to reduce the risk of a flare up? And if you're avoiding speed work, because you know that you have a vulnerability to it, then you're leading yourself susceptible to an element within your training that might bring you undone. So very, very good for doing all those sorts of things. I think there's a ton of takeaways in this, which we haven't really seen in other success stories. So this is going to help a lot of people, Matt, thanks for coming on and sharing your story. Yeah, I'm, uh, I'm, I'm overjoyed. Thank you so much for, for the opportunity. And, um, I hope that, you know, your listeners will have, you know, taking some insights from this and be, I'd be really happy. Um, so yeah, thanks so much for having me. 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 to stay safe. Knowledge is power.