PHT Q&A Celebrating 100 Episodes!

: On today's episode, we are celebrating 100 episodes with a Q&A. Welcome to the podcast helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments, and of course, bust the widespread misconceptions. My name is Brodie Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series, and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. you the right knowledge along with practical takeaways in today's lesson. Can you believe it? 100 episodes. Um, I started this podcast with a bit of a hunch because I was, uh, you know, appealing to a broad range of runners. And so many of those runners came asking questions because they had PhD. And I was like, what is going on with this condition? Look deeper. Found out a lot of you, uh, managing it. for a long period of time, getting a lot of misinformation. So on a hunch, started the podcast and now we're 100 episodes in and I'm loving like just talking with friends and family who don't really know about this podcast, they're fairly familiar with the run smarter one. And I mentioned, Oh, by the way, I have a second podcast and explain the premise and they say Wow. How niche is that? Just talking about one specific condition. And I say, yeah, we're up to 90 odd episodes. And they're like, what? You have talked about this condition for 90 episodes. And now I'm pleased to say that we are up to 100 and very, very happy with the things that we have achieved. I love sharing the PHT podcast with those who need it. those who reach out and say, yeah, have this really high hamstring, glute issue. It's hard sitting. Um, don't know what to do. And I've said, have you heard about PhD? And then I send them to the podcast and they're like, wow, um, just their reactions and people who have been listening and have loved it, even just this week. Um, when's this coming out? This episode is coming out next week. And just this morning had, um, someone, let me give you a shout out because I love when people shout out the podcast, Kelly. Kelly Hall. Thank you very much saying, um, in the PhD support group on Facebook, that she's been binging the podcast and she's, um, just promoting the podcast. Then I had Trina, I had Jamie, James, Jan, look at all these J's, um, in that thread saying, yes, this is a good episode. This is a good podcast. Absolutely love it. So thank you everyone for sharing the podcast cause it's very hard to, um, reach out to people or it's hard to get discovered naturally when it comes to podcasts and people like you who are listening, seeing the benefits and then promoting it to others. That's what helps grow the podcast. And so first and foremost, I love that it's helping you so that you feel compelled to share it. But it also helps others. So thanks everyone for doing that. If you ever come across someone with PhD, if someone's posting on Facebook and they're looking for answers. Uh, please let, please like just share. Oh, also I just expanded those comments. Michelle, Andy, Gabrielle, Jackie, expand again. Oh, that's just me. Um, yeah, thanks very much for everyone sharing their thoughts. Um, really, really appreciate it. And this podcast is a lot smaller than the run smarter podcast in terms of overall downloads and views and that sort of thing, but We're very close. Um, it's very much a, it's a niche down little community compared to the other podcast and I really appreciate it. It's, it's got a spot in my heart. And I've even had people reach out saying Brody, do you have another success story lined up? I could really use one now. So just, you know, trying to help out those who aren't just getting better, but those who have like flare ups and setbacks and need a bit of positivity as well. For the podcast, moving forward, I want I do have the idea to give you more content. I want to do more Q&A episodes. I want to do these new injury chat insights, which I'm starting to roll out on the Run Smarter podcast, more online content interactions with me. I'm sort of testing things out on the Run Smarter podcast with some patron tiers doing like a patron support tier where sign up for a certain tier, you get a certain amount of more content and more like online content interactions with me, like injury chats that we can jump on more frequently. So there's some ideas I'm rolling it out with the Run Smarter podcast and see how that goes and then apply what does work, what doesn't work onto this podcast. So keep an eye out for that. Um, and yeah, let's get into this Q and A. So I've had some people on Facebook and those submit some questions and They've been really good questions I've gone through, typed out some responses to them, and then I'll just riff from there. But we have Joni who has asked, how do you recommend exercises and the number of sets and reps based on different age groups? So very good question. In terms of the clients that I do see, they can range, I have clients in their 60s, I do have clients in their 70s. probably as old as I think I've got. Across a wide span of age groups. So many people develop PhD, whether it's in their 20s or up to their 70s, so it does happen. But it might surprise you, Joni, but my exercise prescription, so the type of exercises that I assign, doesn't really change too much. The odd occasion that I don't prescribe a deadlift would be if someone's just way too weak or their starting points not equipped for the very foundation basics of a deadlift, but almost always I'll have some sort of modification or variation of a deadlift in their prescription. I would probably have some variation of a hamstring curl. If they have access to a gym, that would be a prone hamstring curl with a machine. would get someone to do some step ups, plus or minus a few others like a hip extension or a Nordic curl or a Nordic hip dip like I've talked about this on the podcast at Nausium, but yeah, so my exercise prescription doesn't really change too much when it comes to the weights, the sets, the reps, those sort of things I do consider a little bit more, and I consider them what I assign based on a whole bunch of factors. So let me go through those factors now. One would be the injury severity and the pain irritability. So let me break that down. The injury severity would be like, you know, how long you've had it for, how elevated your pain levels are. Is it constant? Is it intermittent? Is it overnight? Is it purely just based on? sitting and something mechanical or is it just constant throughout the whole entire day. Those sort of pain characteristics would definitely, I would need to consider how much weight they start with, how many sets and reps, but that's the injury severity side of things. But the irritability is something slightly different. So the irritability would be how are flare up lasts for. And there's no, there's no hard and fast kind of rules about, you know, objectifying irritability. But if someone said that they walked for 20 minutes, and they're used to walking about 10 minutes, and all of a sudden they did 20. And since then, their pain's gone from a two out of 10 to a five out of 10. And it stayed so for three or four days. That's quite a high irritability. How long do your flare ups last for? Do they last for two weeks or do they last for two hours? These are the pain characteristics can fluctuate wildly, but shows how different that irritability is. Someone who is very highly irritable, I'd be very cautious about assigning too aggressive, like in terms of the weight, in terms of the sets and the reps. So their sets and reps, might be three sets of five on each side. If we're using the example of a step up, it might be starting with body weight or starting with holding onto a couple of pounds or a couple of kilos and then doing that, seeing how they respond and if there's no reaction, then we progress from there. But you can't usually go wrong with starting too conservative. If you start too conservative, it just builds up someone's confidence. We know that they can tolerate that amount. And then next time we try a little bit heavier, that's a better approach, a more sensible approach than trying to guess in a more aggressive fashion where their sweet spot is and getting it wrong and overloading them and then they be flared up for five days. That's a scenario we don't want. So that's why we factored these in. Uh, other things that I would consider when it comes to a prescription of exercises, weights, sets, reps, those sorts of things would be your previous history. So we're not talking about age, but we're talking about like, what else have you done in the past? What has what injuries have you had in the past? Do we need to consider knee pain or hip pain? Do we need to consider shin splints or, you know, commonly with say proximal hamstring tendinopathy, we might have like I don't know, hip flexor issues or low back stiffness. That would definitely factor into exercise prescription. Some people can't do step ups because they have a history of knee injuries. So we might try something else. We might try just doing double leg stuff for a long time, but also their current capacity. This one's huge. So your current capacity is like, what's your fitness history like? Rather than injury history, do I have someone in their forties who is a gym goer, you know, played team sports for the last 10 years and now has PhD or is someone in their twenties who's just not done any strength work, not done any sort of gym or fitness classes or strength training and now has PhD because they sat for too long. So all of those would definitely factor in. Um, I definitely want to consider those things, but another, another thing. So injury severity, irritability, like they're just overall history with injuries and just getting a general sense of how fit they are. We're starting to hone in on what exercises might be appropriate sets, reps, weights, even if it's starting more on the conservative side of things, if they're highly irritable, we then definitely sway towards the conservative side of things. But lastly, it would be their goals. Like what are they doing? What do they want to return back to? I could have a 40 year old who wants to return to tennis and cycling, just recreational, just wants to be social with tennis and just wants to get out on a weekend with friends and tolerate sitting on a bike seat for a couple of hours. That will approach that and the... what we prescribe sets reps will start looking differently compared to a 30 year old who wants to return to CrossFit or a 20 year old who just wants to sit for more than two hours. And so yes, we would approach those differently. They would all probably start off with deadlifts. They probably would all would probably trying to foster slow heavy load for most of those people. But eventually, once we establish a bit of a baseline or a bit of a foundation, that's when the exercise prescription might start looking a lot similar to what their goals are. So if they want to play tennis, they want to change direction and do the one change direction do like short sprints of like five meters here and there to try and get to a lob shot or what's a drop shot? Not much with tennis. you know, those sorts of things are different. So we might do strides or we might do running or we might do drills where they're changing direction side to side compared to someone who's doing CrossFit who needs to do kettlebell swings and wall balls and box jumps and sprints and that alongside the heavy lifting that they have to do. So that's where the exercise prescription would look a bit different. They would do some plyometrics, they would do speed work. But for the 20 year old, who just, their goal is just to sit for longer than two hours, their goals, we wouldn't do plyometrics, we wouldn't do speed work, we'd probably just do the slow heavy stuff and just let the tendon adapt, adapt to compression and maybe more emphasise similar to what an athlete might do who wants to return to running where we do walk run strategy where we... slowly build up their tolerance. We might do the same for sitting for this 20 year old who just wants to sit for longer. So we might say five times a day, what I want you to do is sit for 15 minutes, sit for 15 minutes in your chair. It might be a comfortable padded chair, but no cushions, no pillows, nothing like that. And time 15 minutes and just spread that out five times a day. Whenever within the day you want to do that, see if we can tolerate that. If we can, next week, we're going to change it to 18 minutes. Then we're going to change it to 20 minutes, then 25 minutes, then, you know, we're eventually building upon that. So we're using their goals to build out their plan. Um, but probably their exercises, the exercise prescription would probably stay the same. And then the rate of progression will vary. Like, um, we know that going back to Joni's question. So, um, how do we recommend exercises, sets, reps, and those sort of things for different age groups. It would all factor in things other than age. But what I do factor in when it comes to age is the rate of progression. Because we know that the older you are, the longer it takes for you to recover from a workout, the longer it takes for you to adapt to a stimulus. So the rate of progression will be a bit slower than someone who is in their 20s. and doing their deadlifts. So how you progress the weight might be a little bit slower, but that's fine. Age, gender, like someone who's perimenopausal. I've done some episodes on that in the past in terms of genders and age and how the tendon adapts, but the rate of progression will mainly depend on your symptoms and how you're responding rather than me just saying, lady is in her seventies, let me take this slower. No, I'll assign the exercises and see how they respond. Then based on how they respond, I will then progress based on that response, based on the symptoms. But though, but it's more likely that it's going to be progressing slower than someone who's in their thirties. So hopefully that makes sense. Thanks for your question, Joni. Let's move on to Arthi. I spent a year of rehabbing PhD on the right hamstring. and it finally feels really good and strong, no pain, and I'm able to sustain a very high mileage and speed. But now my left hamstring flared up. How common is this? And what else would you advise aside from the typical strength training which I've been doing? Thanks, Arthi. Sorry to hear about the other side sort of cause of being symptomatic. Start off, how common is it? I guess it's not uncommon. You'd probably see on the Facebook groups, no sorts of things. Um, I think I saw a question or a post about it popping up on the other side. And there was a ton of comments saying, Oh yeah, this happened to me. Um, so it's not uncommon why it happened. I am not too sure, but I have wrote down some potential reasons. I've got three, um, which we can then dissect and then get into the second part of your question, which is about advice, um, other than strength training. So. Potential causes I would say from a mechanical standpoint, probably compensation. So like if you have a long-term injury on one side, your body's gonna essentially favor the other side when it comes to dynamic sort of exercises like running or strength training, or you can even appreciate sitting. Like those who have annoying PhD with sitting, they get that ache and they sort of need to sit on their side, sort of lean towards one side. Sure, you're taking pressure off the symptomatic side, but you're also increasing the pressure on the other side. And so if you go and do your strength training, so you do your deadlifts, and you're returning to high mileage, and you're returning to some speed work and you're getting heavier and heavier with your deadlifts, and then you sit and it's a bit achy, and then you go and sit on the other side, your asymptomatic side has essentially been subjected to heavy deadlifts, running, speed work, and then more and more compression when sitting because you're favoring that other side, you're leaning into that other side. So just even without the sitting in that equation, just so you know, like the body tends to favor a side that feels more confident with more competent with when you run, probably producing a little bit more power on that unaffected side. If you're deadlifting, you're probably lifting, you know, 52% on one side, 48% on the other side. Sometimes it can be a little bit more than that, but compensations are a thing. So that is one potential reason. The other reason is just purely overload. Your subjecting your body to deadlifts. Like you say, you're doing the typical strength training, so congrats. I'm happy to hear that you're doing that. And you've also mentioned that your return to activity being that very high mileage and speed. I'm not sure exactly what that looks like, but you know, your body is going through a fair bit of load if that's what you're introducing. And sometimes that overload can wobble if you're under recovering, so you might be progressing safely with your mileage and your speed, but all of a sudden your sleep is a bit disrupted or some stress, you know, sort of comes in and starts to affect your recovery. So maybe that's a potential factor. The third one that I wrote down was just the complexities of pain, because there are so many complexities and what is a bit different now is that you've had, um, you said that you spent a year rehabbing your PhD. That's a significant amount of time. And that's time that you are, um, kind of, I guess it's hard to be not psychologically, not scarred, um, psychologically influenced by, I guess. Um, so your brain and your body has been, has been learning over the past year or probably more that, you know, this is a very serious, significant injury and we need to be really worried about it. If it pops up, um, quite hypervigilant and just increasing the amount of relevance. That's what the brain does. And so if you have just a minor, minor sensation from the PhD on the other side, your brain is going to go into alert mode. All these alarm bells are going to go off and say, this is a serious injury. We really need to take care of this because we need to take care of it. And because it's so serious, I'm going to send all this pain to make this person stop and adjust and think and do all those sorts of things. But it's, um, oversensitive sensitization purely based on your previous injury habits and your thought. process and everything that's happened with your past experience that The brain then evaluates and then judges how much pain should we cause and in someone who hasn't had PhD Maybe it's a couple of days of like oh my upper hamstrings feels a bit tight and then it just goes away a few days later But in an oversensitized State your body's just sending off all these alarm bells and pain can be quite severe pain can be can last for a long period of time. And so that's another influence that we need to factor in. Advice. So you asked what advice I do have other than the typical strength training which you're already doing. I would essentially just treat it like any other PhD. You will have a certain adaptation zone. You will have a certain starting point is this finding where that starting point is. My guess is that you are quite strong. So the tendon is quite capable of doing a lot of these things, but it might just be sensitive. I have had a previous podcast episode in the early days, the difference between a strong and painful tendon and a weak and painful tendon. My guess is it's probably a strong and painful tendon. So maybe just making some fine adjustments and then things will settle down. So maybe backing off the speed work because you mentioned that you've returned to very high mileage and speed. So making some adjustments there, maybe modifying your sitting for a few days, probably still keep the slow heavy stuff in, but just trying to see what dials you can tweak. Like I say, speed is probably the first adjustment that I would make. Overall, mileage would probably be the second one that I would adjust. And then once things start settling down, like we do with phg, like we always do, we just slowly reintroduce and dial those things back up to a pre flare up stage, slowly introduce the mileage back in slowly introduce the speed at a rate that you can tolerate. So hopefully that helps advise when I'm not entirely sure of your particular circumstances, but hopefully this advice relates to your circumstances, you can start applying those things. Okay, we have three questions left. One comes from Marco and Marco asks, what is the best way to treat PhD if it's going on for years and doctors have misdiagnosed it for something else? How often have we seen that? How often have we had a success story where it has taken so long, too long for there to actually be a PHT diagnosis. And even a misdiagnosis. So someone can go by seeing therapists after therapists where they say, Oh, we're not too sure what's going on, but let's try this XYZ stretching massage, dry needling, all that sort of stuff. But someone can actually be misdiagnosed and say, you know what? I think it is piriformis. So I think it is referred from your back, or I think it is. and they go off on a different tangent, only to be found out that was misdiagnosed and it's actually a PHT. So, Mako, sounds frustrating, but unfortunately it's all too common. I've seen it way too often. And your question, so what's the best way to treat it? I guess your history doesn't, like the misdiagnosis doesn't really matter too much. Like we'd still treat it just the same as if you know, we've just discovered it for the first time, we need to find what your starting point is, everyone has a starting a different starting level, we need to find out what that is and what you can tolerate. We need to I don't know much about you, but we need to find out what your strength is like, what your sitting capacity, walking capacity, running capacity. All those sorts of things are that symptoms don't get aggravated and return back to your baseline. the next day, once we find that, then we just build up from there. Everyone has a different starting point based on their pain sensitivity, pretty much while I discussed before, but their previous history of strength. And so we sort of need to work around that and try and find what to do. But I do have some other information for you and you probably didn't ask for this. But I think it might be helpful to discuss because based on your history and how you've sort of phrased the question. Um, I get that it's very frustrating. Um, but I think most people that are listening to this have had a very similar experience and a message just for everyone else listening as well. Um, I get that it's frustrating that you've done the right thing. You've gone to a medical professional. You've been around the ring, seeing doctor after doctor or scans or, um, different health professionals and they hadn't quite pinpointed what it was until too late. I would say don't give your past experiences too much attention because it's not that helpful when it comes to your recovery. It can be frustrating, it can be disempowering, it's out of your control, it's happened in the past. This might be a little bit controversial, might hit a few buttons here but It's very hard to recover on your own if we are playing the victim and blaming others. Like if a lot of our attention and our focus is blaming people of what's happened in the past, it's going to be very hard to pave a way forward that's empowering and productive and seeing momentum and Like Marco, I'm not putting words in your mouth. I don't know if this is the path that you have been going down or your frustrations in the past, I'm not saying that I am saying that if someone else is resonating with this, if you have been frustrated with health professionals or friends and family and doctors and surgeons and all those sorts of things that in your eyes have done you disservice and misled information and all those sorts of things, constantly thinking about it is not going to get you better. If anything. And this is 100% true. If you continue to focus on that, it is going to actually be unhelpful for your recovery is going to foster a lot of stress, a lot of frustration, a lot of anger, and that isn't a place for your body to recover. As well as it being very disempowering, like what we want to do as paving your way forward to something that's very effective would be putting you in control of your own rehab. I say, I've mentioned it in the past, like a therapist has the role of showing you a roadmap if you need it, but you're in the driver's seat, you're driving the car. this is your recovery, you're recovering from this injury. No one should be dictating where you drive or how you drive. No one should be taking the wheel and pushing you into the backseat and saying, this is how it's done. You should be hands on wheel, trusting the therapist in the backseat saying, here's the map, turn left here, turn right here. Maybe slow down, maybe hit the accelerator, take your foot off the accelerator. and just guiding you through, but you have that control. You, ultimately, what you say goes, you can ask as many questions to that therapist in the backseat as you want to try and gain an idea of what their thinking is and what the right direction might be, but don't let anyone push you into the backseat. So, yeah, I thought I just like, it's probably not worth, well, probably not what you're expecting Marco, but... when it comes to having control, move forward in controlling your own destiny. That's why you're listening to this podcast. And that's why I love that you're listening to this podcast because you're not bypassing, but you're finding another resource away from what medical staff might tell you or away from those consults and the scans and the discussions about surgery and PRP and all those sort of things. And you're sort of gaining more research. you're gaining more resources, more understanding, more information, and, um, that's always going to be a good thing. So that's what I'd say. Um, so thanks for your question, Marco. Next we have Jennifer, the lovely Jennifer who participates in a lot of these Q and A's and is a big, um, fan of the podcast and has heavily promoted the podcast in the past, so thanks very much, Jen, um, asks. Do you ever recommend conventional deadlifts as a rehab exercise for PhD or are Romanian deadlifts always going to be the best variation? Let me start off with the difference between the two. And this is even confusing for me because I once learnt about a conventional deadlift versus a Romanian deadlift and even now I see differences in terms of the blogs I read or you know what turns up in search. Because what I once thought was a Romanian deadlift would be the exact same as a conventional deadlift, except you just start your repetition at the very top. So you're standing up when you start. So a conventional deadlift is more from like weightlifting and that sort of era where you have the bar, it's on the floor, you squat down or you hinge down, you grab onto the bar. and then you pick it up in a deadlift action all the way to upright, and then you go back down you place it on the floor. That is one repetition. So that's conventional you're picking it up off the floor and you're finishing it with on the floor. The Romanian deadlift you would have some like if you can, you have the hooks that sort of put the bar at about your mid thigh range or you know about knee height and so you can or pick it up off the hooks and now you're starting from upright. And from there you go further down if it's a full range of movement, Romanian deadlift, the weights just touch the floor, you don't place all that weights down, but it just touches the floor and then you come back up to complete the rep. So you start at the top, you finish at the top and then you can rack it and once you finish your set and that would be the difference between the two. But this is where it gets tricky because when I read certain other blogs and I read other things, it seems like an RDL would be with more straight knees. So you're approaching the actual movement is slightly different, the quality of the movement slightly different with the Romanian deadlift or RDL being with straight her knees. That's where I got confused because I still want people to do their RDLs with bent knees the exact same way you would for a conventional deadlift the only difference being you're starting at the top and you're finishing at the top and so Let's move forward with Mutual understanding that the conventional deadlift and the Romanian deadlift have the same Mechanics, they've got the same knee bend the same tendon compression the same hinge backwards All this different is the start and finish. So my preference is the Romanian Deadlift based on a few things. I managed to come up with four things. One is you have better control of the tempo of the exercise. So when you pick it up off the floor, it kind of needs to be this, kind of need to push with a lot more force, kind of need to push, sort of get it up quite quickly. then you can slow control the tempo a little bit. But I find that if you're starting from the top, you can control a little bit better how you go down and up in terms of timing your amount of seconds, pacing the amount of seconds, I think it's a little bit easier when starting at the top, unless you've got a lot of experience from a conventional deadlift, but that's probably one of the minor benefits or why I preferenced that. These other ones are probably the big winners. So the Romanian deadlift, you have better control of the range of movement. So a lot of people when they're rehabbing PHT, they can't tolerate a full range of movement. And so if you do a conventional deadlift, you have to pick it up off the floor. And so you have to do a full range, you have to start with a full range of movement. And that can be very tricky for some people just starting out. But if we start from the top. we can slide down to the bar or the dumbbells or whatever weight just touches your knees and then you come back up. That would be similar to like a half range of movement deadlift. And so that can be very, very helpful with your rehab. My third point, which is similar to the second point, is you can go heavy with reduced range that is better for the tendons. So If you're doing conventional and you can tolerate a conventional, but you can only do 10 kilos, otherwise it flares things up, but you can do 30 kilos, but only do half range of movement and you do three seconds down, two seconds up, so five seconds per rep, that is arguably better for the tendon than trying to just do conventional with lighter weights. And you can do a mixture of both. But if you're trying to aim, if you're aiming for the slow heavy stuff and you can't really tolerate larger ranges of movement, I would very much preference really heavy but just reduced range of movement and like I say making sure the tempo is you're still getting that time under tension So three seconds down two seconds up even though the range of movement has reduced tends to foster better when it comes to tendons and the last point is Like a lot of people that are just starting their deadlifts and rehabbing PHJ, they don't have much experience with deadlifts. They're inexperienced rehabbers with holding onto a barbell and those sorts of things. And they simply can't do full range of movement. Like I think a full range of movement deadlift is months of practice. So if you're really experienced, for Jen, I know you are quite experienced with your. deadlifts been doing for a very, very long time and getting super heavy and your technique is flawless. I don't see much of a difference in terms of you and your circumstances doing a conventional versus a Romanian deadlift. But for those who are rehabbing, and they're not familiar with what they can tolerate, they can't really tolerate a lot of weight with full range. That's why I always start with the Romanian deadlifts. Like I say, if you're a seasoned person, experienced in the gym, um, you can tolerate some really heavy stuff with full range, then maybe conventional is up your alley. So thanks Jen. Another great listener of the podcast, loyal, faithful, uh, Alicia. She asks, how do you know when it's time to enter the maintenance phase of your rehab? And so thanks for your question. Um. What is maintenance phase? So that's sort of what I've talked about in the podcast and in the past, uh, pretty much discussing when you rehab, um, you want to progress. You kind of want to do start off with, if you can only tolerate really light stuff, then you probably want to do it several times a week, maybe five or six days per week. But as you start getting heavier and heavier stuff, we need to allow for reduced frequency to eventually we simmer down to twice a week, two or three times a week of rehab, which is hopefully going to be heavy stuff. But then a maintenance, if we still with that twice a week, we still want to progress. We want to get heavier with our deadlifts. We want to get heavier with our step ups. Maybe we want to introduce plyometrics depending on your goals. Like we're still progressing from there. A maintenance phase would be okay, time to put a pause on the progressions and just stay where we're at just being very content with where we're at, maybe once or twice a week, stagnant, that would be like, you know, a good maintenance phase. We're not progressing anything, but we're still preserving all the strength and capacity that we've spent so long building. We're into that maintenance phase. So when is the time to enter the maintenance phase back to Alicia's question? It would be based on a few things. It'd be based on two things mainly. Um, one is your goals. So I've mentioned a few different people that do have PhD in the past. Someone might be just wanting to get back to sitting. Someone might be wanting to return to slow long distance running. Someone might want to return to sprinting or team sports or hill sprints or, um, those sorts of things. So how close are you to your goals and are you achieving your goals? If you're achieving your goals and you don't have any ambition to push beyond, then maybe we discuss maintenance and maintenance phase. If you can, if you have an office job and all you want to do is to sit throughout the day and we've got you to a point where you can sit throughout your week. No issues with sitting, no issues with the surface that you're sitting on. You can enjoy a movie. You can sit out. with your family for dinner and you have no issues whatsoever, and you have no ambitions to sort of push beyond that, then maybe we can enter a maintenance phase. If your goal is to run a marathon but not fast or happy just to walk jog it and you're sort of up to that capacity, no issues, then we're entering a maintenance phase. But if your goals ever change, if that marathon then wants to turn into a fast 10k or that sitting you then have. travel plans where you've got a long haul flight or a road trip where it's going to be you know 12 hours of sitting every day then we might need to restart reengage and start building back up to meet that goal So that would factor in the other thing is symptoms. So goals and symptoms The symptoms need to be essentially symptom-free in my eyes or maybe a 1 out of 10 max like really mild stuff So it's not a worry. It's not an issue. You don't really have to change anything. Those, those things would then correlate to say, okay, time to enter a maintenance phase. So if you have achieved your goals and if you've achieved your goals and symptom free, then you can hit the maintenance phase. If you've achieved your goals. So you have run the marathon, but symptoms elevated throughout the run, bits all the next day. that we wouldn't hit a maintenance phase because we haven't necessarily achieved the goal. We've got through the goal, but if our goal was to get through it symptom free, then hasn't been achieved. So we're working out those two things. And then you can decide what you wanna do from there. And if you decide to do a maintenance phase and drop to say once a week and not progress your exercises and symptoms return, then maybe we need to restart it. Maybe we need to start things back up and start progressing from there. So thank you everyone, Alicia, Jen, Marco, Arthi, Joni. Thank you everyone for submitting these questions. Thanks for tuning in to help us all celebrate 100 episodes. Um, this podcast is not going anywhere. Like I said, I have some ideas for, um, the next year, the next hundred episodes to come. Thanks once again for sharing the podcast. It really, really does make a huge difference. So once again, thank you and we'll catch you in the next episode. Thanks once again for listening and taking control of your rehab. If you are a runner and love learning through the podcast format, then go ahead and check out the run smarter podcast hosted by me. I'll include the link along with all the other links mentioned today in the show notes, so open up your device, click on the show description and all the links will be there waiting for you. Congratulations. paving your way forward towards an empowering, pain-free future. And remember, knowledge is power.