Michelle's PHT success story

: On today's episode, Michelle'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. you who have listened to a lot of the episodes out there. I have had a Michelle success story in the past. This is a different Michelle. She was diagnosed with PhD in 2016 and talks about her journey. One of the most frustrating things about her story and what's different to some of the other success stories I've had in the past was her... drawn out process of actually reaching a diagnosis or an accurate diagnosis, I should say, because she saw 13 doctors before actually getting the PHT diagnosis. And we'll delve into that in a second, but this particular story shows a lot of resilience and a lot of lessons that we can learn around strength training, around sit standing, around just optimism and constantly striving for a management plan that's effective without giving up and just trying to reiterate and modify and just try new things. And yeah, like I say, a lot of lessons that PhD sufferers and any running related injury or overuse related injury can learn from. And so I was pumped to have Michelle on this is actually take two of our recordings because last month we recorded and lost the recording audio. So weeks later, five, five weeks later or so we came back on for round two and let's take it away. Michelle, thanks for joining me on the podcast. Thank you so much for having me. And I'm looking forward to being able to talk with you. Yeah. I'm looking forward to it as well, because success stories are high on everyone's priority list and whenever I ask for feedback, people are just like more success stories. And so I thought reaching out that I think your story is, has a ton of lessons in there. And so, um, would you mind maybe just starting off with how the PhD came about, how long ago it was and, um, what, what transpired to bring on those Sure. Um, I remember it started in 2016 in November when I was at a football game, sitting on those nice metal stadium seats. And I just developed this pain in my, in my butt and, um, thought, well, this is kind of weird, I don't know what this has to anything to do with, but, and it wouldn't go away. Um, so that was kind of disconcerting. Previous to that, I had been a special ed teacher or an inclusion specialist teacher, or referred to a lot of different ways, intervention specialist in schools for about 20 years. And so I was constantly moving and not sitting a whole lot. But then previously in 2014, I had left that position and started a desk job. So this is about two years after that, but I continued to run and bike and do all of the things that I was normally doing with my teaching. But I wasn't doing a whole lot of strength training. But I was getting some strength training through my teaching career. But like I said, when I went to the desk job, that kind of went put. So sitting at this football game, I never would think that to connect anything to do with strength training or not strength training or... running or cycling or anything like that. I would just think this is weird that this happened. So I didn't really do a whole lot about it, continued on my running, continued on my cycling. I think I did three half marathons that year. Wanted to train for a long bike ride. And then in 2017 I think I started picking up my cycling. miles and was getting a lot more on the in the saddle time and that's when I really started having a lot more pain on just one side on just my left side and um That was when it really picked up and so I thought oh gosh it has to it has to be cycling now Okay, it has to be that's the that's the evil thing. So I stopped doing that And meanwhile, you know had visited a few doctors and One was like, you know primary care doctor and they didn't really know. Well, we thought maybe this could be issue from issue or not issue for my piriformis syndrome, which seems to be very common diagnosis that we all hear about. And went through some therapy for that. That didn't really do anything. Went back to another doctor and worked on that and had many different doctors to work with throughout the process, which I'm sure we'll get into a little bit more. And so you develop symptoms, um, initially sitting on a hard surface or the hard chairs of the football game and still continued to exercise, still continued to run and symptoms were just, I guess, mild enough not to, um, not to stop you. And while symptoms continued, you were going to a doctor to try and get answers, but we're still exercising. Is that right? Yeah. Because it wouldn't like it would. hurt a little when I would start running, but then it would go away after you know, after you run for a little bit, then it would go away. So that just reinforces you to, of course, to run more. Gives you the green light. Yep. I've seen that way too often. And then symptoms increased the following year once cycling picked up. And then that was more cause for concern. Yeah. And it was one of those things of like, you know, like we all seem to learn after the fact of that. the pain comes around 24 to 48 hours after. So it's one of those that, again, it's hard to make the connections immediately to that it's what you did a day or so ago. So that was always another thing too that was like, so along the way I finally did start to keep a journal of what I was doing so I could kind of backtrack and be a detective. and find out, you know, what is it that's going on? What am I doing consistently here that's messing things up? But like you said, pain was definitely increasing throughout this time and I was having the sit job and I got to where, when I was at the job, I couldn't sit anymore. So I got a stand up desk, which was great. But then after a while I got to where I was like, this is just uncomfortable just to stand. So I told my My boss said, I'm like, if I could, I guess I could just walk forever. I said, it was just the standing or the sitting. That's not good. He was like, well, let's just get you a desk treadmill. And I said, I've never heard of this. What is this? Yeah. So, so he, uh, he, he showed one to me and I was like, that's, I'm good. I'm let's get that. So that helped a lot, but that was of course, Oh, that was probably two or. Two or three years into it. You know, before we got that. One thing that fascinated me about your story was, um, seeking, trying to seek a diagnosis, trying to seek medical professionals to, to help with this condition. And you said that you saw 13 doctors before you actually received the PhD diagnosis and that was in, um, I think you said 2019. So what three years later from symptoms initially starting, um, Do you mind talking through that, that experience and, um, like what sort of diagnoses were, were arising and how treatment was, um, suggested? Sure. Um, like I said, right away, I thought, Oh, this, this can't be anything big. So I won't really worry about it too much. So I mentioned something that, uh, to my physical or to my primary care doctor. And she was like, well, it sounds like, you know, piriformis syndrome. She's like, let's, let's go with that. I said, okay. So started on that one, went through some physical therapy for that and some things worked, some things didn't because you know, they would have a mixture of strengthening and stretching exercises and when I would do the strengthening, it'd be good, but when I would do the stretching ones, it would hurt again. So did that for a while and then was like, okay, this isn't it. And went back to a doctor and I'm trying to think which doctor. that it went to the second one. I think the second one was a referral from my primary to a bone, you know, to the bone doctor. And his, that second diagnosis was ischial bursitis. And so that one was the second one, yes. And so I went through and did some things that he thought, you know, well, maybe we can do some. steroid injections or you know this kind of thing or whatever and like I really like to try and keep out of injecting anything let's just try you know at least it's restrictive you know kind of thing first so I did some did some oral steroids and that seemed to take some of the tension and pain away because at this point I was having issues with my nerves and having issues with the sciatic nerve and I was really not being able to sit with that. So anyway that was the second one then the third one oh I don't know if I can remember what that one was. Then I know the fourth one was a Tarlov cyst diagnosis and that one kind of has it's kind of like a garbage disposal of symptoms. It kind of covers everything. And so I thought, okay, this has got to be it. This has got to be it. And then I start looking into stuff and I'm like, oh, I don't think I want this to be it because there's really no recovery from it, you know, besides having surgery on your spine and didn't really want to do that. So I did go see a couple of the specialists in that in that area and One of them actually said, well, I think some of the things that you're experiencing are from the tarlofsis, but I think I'm not sure what this pain in your, in your butt is. He said that that's not really a tarlofsis. So that was really what triggered me to continue on to another doctor. And he actually said, maybe you have some genetic issues. And so I came back and went to genetic route and found that, no, that's OK. I'm fine with it. And then saw another. No, sorry. So after that one, I came back and nothing was wrong with genetically. I'm like, you know what? I'm just going to go back through all of the diagnosis that I've had and see if they've missed something. And so I went to YouTube of all places and ended up finding a video on is it ischial bursitis or is it high hamstring tendinopathy? And from the Bob and, not Bob and Tom, Bob and... Bob and Brad. You remember the other one? I'm familiar. Bob and Brad, thank you. And watched that video and I think, you know, it's about six minutes in or so that they were talking about if you rub back and forth really hard on your area where you're having issues with your pain and sitting and it doesn't increase your pain the next day, then they said you probably have high hamstring tinninopathy. And I thought, well. I've been in a lot of pain, let's try it. You know, so I did and I didn't have increased pain the next day and I thought, ooh, let's check out this high hamstring tendinopathy. So I went on that route and started checking things. Well, so I gave it some time before I went to another doctor after that just to kind of see like, do you really think that this could be it? You know, because like I said, this has been I think almost two years. probably that have gone through these things. So I thought, no need to rush into another diagnosis. And so I gave it about, I think it was probably a few weeks before I ended up making an appointment with a doctor that was referred to me by one of our friends who is a doctor. He said, you know, Oh, she's, you know, she's a cyclist as well. And, you know, so she, she should probably know, you know, about these things. I'm like, okay, well, let's try that. And I also got on Facebook and there's a, um, high hamstring tinninopathy, you know, Facebook page that we all know about pretty much that I just went and searched for Cincinnati and looked for doctors in the Cincinnati area and ended up the recommendation was for, um, of our local doctors, Dr. Kremchek, who is the Cincinnati Reds team doctor. And I thought, okay, let's make an appointment with him and let's make an appointment with the other doctor that was recommended. Because at this point, I'm, you know, pretty much making two appointments just to have backup and get a second opinion right away. So the first doctor that I saw that was recommended thought it was Ischial tuberosity, Ischial femoral. Sorry, ischial femoral impingement syndrome, I think is what it was called. And I'm like, okay, well that one sounds kind of. um interesting but I don't know if that's it and I happened to bring up the PHT and she didn't think that was it at all. I thought okay well I'm going to get a second opinion as well let's just go with it and see. So then I went to Dr. Krimchik and he did the you know he did the exam and he felt that it was PHT as well. And so I was kind of excited with the diagnosis because I thought, okay, I think we've finally gotten them to something. And then I wasn't so excited when I started doing the therapy because, you know, it takes so long to see any change. But so yeah, I ended up seeing 13 doctors that had six different diagnosis through the way and that I ended up not having any surgeries or anything like that done, which I'm very relieved. I think there's a few lessons to unpack there. Um, it sounds extremely frustrating just hearing your story and hearing like it's all in all, like if you know what PhD is and you know how to assess it, it's very easy to assess and diagnose, um, if symptoms, um, fit that of like a classic PhD. And so it could have just been so much easier for you if you just like went to the right health professional at the start. And so that's, that's why I like my blood boils is it's just so frustrating just to hear that. But there are a few takeaways in here. I think one, the story or like the lesson around like an incidental finding when scanning the body, like I'm assuming with the, the Talov cyst, they would have scanned the back or scanned the hips and seeing that there may have been some abnormalities there, but The thing around incidental findings is you can have a particular, you could show up something on a scan that doesn't have anything to do with your symptoms. And in fact, that finding may be totally asymptomatic and not be producing anything, especially when it comes to the back. We have disc degeneration, disc bulges, we have arthritic changes, and all of these are very, very common. in a healthy population. And so if they then point to, oh, there's a talof cyst here. That's the diagnosis when in fact, that's probably most likely going to be a total incidental finding. Uh, did they do an MRI of the back or some sort of scans to diagnose that cyst? That I did have some MRIs. I think I probably had six MRIs along the way. I had a couple of x-rays and the x-ray actually was how they found the Tarlov cyst. So yeah, it's just, I agree completely with you because they've found so many things, you know, within your body that, or within my body, I guess I should say, that are not correct and not good. But my body is still functioning as good as it can. with even with those imperfections. The other thing I wanted to delve into is the fact that treatment wasn't working. And, you know, you'd find a diagnosis like piriformis syndrome and you'd say, yeah, well, the strengthening might make things a little bit better, but the stretching doesn't make things feel better. I don't think this is it. Let me sort out a second opinion. And I think that's very wise to not only, you're not trying to. Um, like the diagnosis itself doesn't matter. What matters is if symptoms are improving or not. And then if they're not improving, that's when you need to start questioning either the diagnosis or the management of that diagnosis. And so you've done a very good job of paying attention, dissecting things and making sure that what you're currently doing, what is working, what isn't working, what are those individual factors to help you understand what, how your symptoms are behaving? I think that's a very important lesson to learn. Yeah. And. The same thing too, if you know what works for me might not necessarily work for someone else. It won't work for someone else, might not necessarily work for me. It's completely your body and you have to do what works for you. Um, for sure. So once you had that diagnosis, once you said, oh, this, like this PhD sounds like my symptoms. It sounds like what I'm describing or what I've been going through the past two, three years. How did you then approach it? What was the initial management like? And were you starting to see results after the correct diagnosis was made? Yeah. So when I saw Dr. Kramcheck, he, it happened to be on a Saturday, I remember, and he, in July of 2019. So it had been almost three years that I'd been dealing with it, which listening to some other people, that's not very long at all, um, to have. to have to deal with it, but he actually started me that same day with a PT, physical therapist, that was in his program there. And so, and he didn't, I mean, he knew about PHT, but he had not had a lot of experience with it. So, I worked with him, and I had already met my deductible for my insurance at this point, so I was like... You know, kind of thinking in my head, you're probably gonna see me till the end of the year, whether you want to or not, because I've already met everything on this and I'm gonna get as much out of this as I can. So he took me really as far as he could, but even after I had been doing PT for six months, I still had, you know, some slight pain with sitting and still, you know, couldn't do everything that I was. felt like I should have been able to do at the end of that time. And so I kind of was a little disgruntled and I thought, and they just kind of were like, well, you know, just keep doing what you're doing and keep in touch with us and let us know if things get worse, you know, we can start things up again or we can do some other things, you know, injections or things like that. And then once again, I'm like, I just don't really want to inject anything if I don't need to. Um, and So anyway, they had me go through and do some things and do some bridges and that kind of stuff. And I noticed improvement right away, but it did level off a few months after. And that was kind of, like I said, disheartening. So I went ahead and continued on. And then to the end of the year, I was dismissed. And then in 2020, January of 2020, I started my own program. It's kind of like, you know, get kicked off the school bus and, you know, okay, here you go. You're on your own. Bye bye. So I started some doing some running and fast forward, just fast forward really quickly. And, you know, I thought, well, maybe I'm doing too much physical therapy here after a while and kind of started pulling back on it. And then ended up having to flare up about six months later. and then found a second physical therapist that this was during COVID time that I worked with and had a lot more success with him. And now I'm able to run again. I just did a Thanksgiving day race here in the States just a few days ago and ended up winning my age group. But so it's one of those things, like things are a lot better now and I can sit and do, it's just, it's exciting. I can ride my bike. So things are much better now. you'll have access to all current and future modules that I create. Sign up through my link in the show notes, then download the Run Smarter app, and you'll instantly have unlimited access to all the course resources on any device. And to say thanks for being a podcast listener, I want to give you a VIP offer. There will be a link in the show notes in every episode that will provide you 50% off the course price. Just click on the link and it will automatically apply your 50% discount. Can I maybe unpack that a little bit? So after the first PT, when you started doing some strengthening, it seemed like you noticed initial benefits, but then the benefits started to plateau out. And you did mention some bridges. And I query whether those exercises, those strengthening exercises just weren't progressive enough, or you weren't progressing frequently enough to continue with those gains? Um, would you looking back on it now, would you say that those strengthening exercises while they initially had the benefits, um, it then plateaued out because you weren't progressing the weight or progressing like the, how challenging the exercise was or those sorts of parameters? No, I agree with what you're saying completely. I do feel like it. They weren't challenging enough or they weren't situated exactly how they should be. Like the bridges that I'm doing or that I had a lot more success with the second physical therapist, I do elevated bridges and do some things with that and have a lot more success with the bridge than just doing bridges that are level on the floor. So it's a lot of little things that the second physical therapist, which you know him, Dwayne Scottie, He has a lot more knowledge about the physical therapy or about the PhD because he had it himself. He's also a runner. So he has a lot more knowledge about it and is really, was really good with guiding me through things. The first physical therapist that I had, he had, he's not a runner. He didn't have it. He didn't have, you know, his personal experience with PhD. So, Like I said, he took, he did as best as he could, but I just don't feel like it was completely guided towards exactly what somebody needs with that physical therapy, with the PhD, because like you said, if you're not loading enough, then it's really, I guess. I'm speaking out of, I don't know. I'm not from physical therapy land, but, uh, I'm guessing if you aren't loading it enough, then you're, it's really not like you're doing anything to it. I guess. Yeah. I think it's a trap that some people might have because initially when you notice that bridges or assert, you can just name any top of exercise. If any strengthening exercise is showing. a lot of benefit initially, like, yes, this is the answer. This is what I should be doing. And then you just become too strong for that exercise. Um, it becomes a trap where people are like, I've been doing my bridges for, you know, six months straight. And while I saw initial benefits, it's just not doing it for me anymore. And strengthening isn't working. And a lot of people can interpret that as like, I've been trying all my strength rehab, like you suggest, but it just hasn't. It just hasn't done it for me. But then you go back and have a look at their history. And yes, it did work initially, but you just haven't followed it up with that progressive quality, because we all know that with strength and conditioning and with rehab, it needs to be progressive. Otherwise you're just going to build yourself up. You're just capping your own ceiling and reaching a point where that exercise, um, can't, can no longer do anything for you. It's now redundant. And the next step is to. make it harder or progress the weight or like you say, you can make it more challenging by bridging with your feet up on a step. And that particular focus and that timeline is crucial when it comes to these sort of exercises. Because like I said, you're just putting a cap on yourself and your ability to heal. It can be quite restrictive. I'm glad that you found Dwayne Scotty and Dwayne Scotty is a, um, friend of the podcaster. I love the work that he does and the information that he provides. And I think it is another crucial step to have, like you say, to try and find a PT that is a runner as well. Or his experience with seeing runners. So you need to have someone who knows what it feels like to not be running or to start running and the certain parameters around Hills or speedwork or warmups and all those individual components. Uh, can be extremely helpful because a PT that is also a runner knows the ins and outs of running and knows what it feels like and the demands on the body and so many different aspects. And I'm glad that you've found your current success and like I say, you're, you're back running and do you mind just maybe just giving a bit more of a, an insight into your current capacity and your current like cycling capacity as well? Yeah. Um, Like I said, I left, I stopped working with Dwayne. Let's see, this is 20, the end of 2021. Stopped working with Dwayne at the beginning. Sorry, about a year ago this time. Um, and so, you know, I was running just a little bit then. I can't remember how much, you know, I think it was, I think when we finished our sessions together, I think I was running maybe three miles, two and a half or three miles, um, and I started out, you know, he started, he guided me through and he wanted me running through. through the physical therapy process, which I was amazed with because, you know, with the previous physical therapists, they were like, no, I'm gonna tell you to stop running. You know, that was, you know, so complete, two completely different approaches with the PT. But Dwayne, yes, definitely took me through the running, through the physical therapy process. And then, so about this time, about this time a year ago, I was doing about two and a half or three miles at one running session. And now I'm up to, I think the longest run is nine or 10 miles. I've just kind of been focusing on the shorter, the longest run I've done has been a 7K, so you know, 4.3 something miles. But. I've been able to do well in these races a lot better than I had before the physical therapy and before the PHT diagnosis but throughout the process too of getting this PHT diagnosis I also had some digestive issues and ended up finding out that I needed to eat more fiber and ended up because of eating more fiber I ended up losing like 20 or 25 pounds. That has helped increase the running ability as well. Of course. Yes, like I said, it's one of those that just came along as well. That's a good thing. Yes, like I said, the longest that I run for long miles is nine or 10 miles. I do speed work once a week, speed work or a tempo run once a week, and then two other days of just easy running. a couple of days of cycling and I'm just I'm on the trainer here because it's cold outside first of all and secondly I don't want to I'm not going super far so it's easier just to climb on the bike in the basement rather than load it up and go somewhere yeah um but yeah so you know do those things and but I'm just I'm very thankful to be able to do all of those things and not be in pain afterwards Absolutely. Well, congratulations on your success. Congratulations on your rehab. It seems like you're really hitting your stride with your fitness routine. And as we wrap up, are there any final takeaways? Maybe someone is struggling with PhD and they're listening to this. Any other final tip bits or lessons for them? Yeah, as we wrap up? Um, I think the biggest thing that was very helpful to me while I was going through the physical thing, or while I was going through PhD issues and actually post-PhD has been to take a diary. It's not a lot of fun, but to do a diary or a journal of your activities that you do every day, even what you eat, and just to be able to see, do I have any triggers here? Do I have any commonalities that I have? that are maybe setting off things, you know, or doing something that way. That helped me, I think, probably the most. And then now looking back is when I was trying to figure out how to get through the PhD and how to get over it. You know, you want to do it as quickly as possible, but also just to realize that, like I said earlier, what works for one person may not work for you, but to find yourself a good... physical therapist who can identify with this and is willing to work with you and listen to, listen to you when you say this hurts or this doesn't hurt or this doesn't feel right or whatever. Yeah. I love what you're saying when you talk about what works for you might not work for someone else. And I think while most of it, the management principles are still the same. I think, you know, the the strength and conditioning portion, the slow return to running portion, the paying attention to symptoms along the way, all of these are kind of universal managements, but if you try out something that's worked for someone else that doesn't work for you, it's all about being resourceful enough or creative enough to try something different, try something different, keep finding something that works. And I think those, that initial... strengthening plan that you had as a prime example, like the bridges were working and then sort of plateaued out and it's up to the next step to be like, okay, this currently isn't working. What should we do? What should we try? And as long as you're paying attention to your individual symptoms, then that's the real goal for a tailored management plan. As soon as it's not working, change something up and see what trying to find something that does start working. And so plenty of lessons to unpack here, plenty of value, um, throughout your whole lesson, I'm sorry, this, the whole experience has, um, happened and especially around that misdiagnosed for so many years and getting second opinions, third opinions, more scans, more diagnosis so many times. I'm sorry that's happened to you, but I think it's an extremely valuable, um, story that a lot of people can learn from. So thanks for coming on and sharing. Thank you so much. I like to think of it as character building. Fantastic. All right. You have a nice day, Michelle. Thank you. Thank you for your time. Thanks once again for listening and taking control of your rehab. If you are a runner and love learning through the podcast format, then go ahead and check out the Run Smarter podcast hosted by me. I'll include the link along with all the other links mentioned today in the show notes. So open up your device, click on the show description and all the links will be there waiting for you. Congratulations on paving your way forward towards an empowering, pain-free future. And remember, knowledge is power.