PHT Success Story: Michelle

: on today's episode, our first success story with Michelle. 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. So let's give you the right knowledge along with practical takeaways in today's lesson. One of the main things I wanted to do was start sharing some success stories. I know we've seen a lot of stories of people not getting better or things they've done that's made things considerably worse. So let's start generating some positivity and knowing that this can be a condition. Even if you had it for many, many years, it can be overcome successfully. And so. This is my first interview. Uh, this was from the run smarter podcast and it was from several months ago. I think it was November, 2020 and Michelle is actually a client of mine. Um, I don't want to go into, I don't want to repeat myself because once I throw you into that snippet, um, I'll explain a bit more about Michelle's, uh, condition, but she has had proximal hamstring tendinopathy for the last 12 months. and there's a lot of key takeaways which I'll chime in at the end and sort of talk through my notes what I've got written down but I already have quite a list of people that I want to interview with proximal hamstring tendon that have had a bunch of different experiences potentially with surgery without surgery just different treatment methods that might have worked for them and we can all just learn together. Before we dive in if you are listening on Apple podcasts, you can subscribe to the podcast. That way you get a notification every time a new episode gets released. I do recognize that in these early days, I haven't quite found my feet and I'm just releasing episodes willy nilly, sometimes two episodes a day. Um, so getting notifications will be a good thing. Um, so if you can subscribe, also, if you can leave a rating review that helps people who discover the podcast know that it's actually legit and it's actually helping your condition and helping your rehab. And I'm going to say this, I'm going to prompt people quite a lot throughout this podcast, but just to share it, share it to people who you think might need it, share it to those who have proximal hamstring tendonopathy. If you've found a lot of benefit, um, cause it can go a long way. So it can go a long way to, um, building up the podcast, which then organically reaches more people. Um, but then it's just helping out the community, helping out the, the PhD groups. So that would be unreal. If you could just reach out, maybe make a post or maybe just tag someone who might benefit that'd be great. All right. Let's dive into the snippet from the run smarter podcast. Michelle started talking to me after having 12 months of proximal hamstring tendinopathy. She was getting really frustrated with her rehab because. it not only was not getting better, but over the three to four months prior was getting worse and things were starting to become more restrictive. She was starting to do less and less in regards to her level of function, the exercises she was doing. I'll let her explain that as the episode gets started or the interview gets started. We're not going to use Michelle's last name for confidentiality reasons because I have seen her through online physio in the past. Um, but she shares a great story, which I think you guys will take a lot out of. Like I did mention, it does say success story, but Michelle isn't out of the woods yet, but seeing some really nice progressions and, um, yeah, you're going to learn a lot from it. So without further ado, here is Michelle. I think we'll, um, we'll work chronologically through your whole journey and your. Story around the hamstring tendinopathy. I think what. would be a nice beginning is for you just to talk about how it all started. You did say before we started recording, the recollection is a little bit fuzzy because it was so long ago, but in your, the best way possible, can you just talk about how it first happened and what the symptoms were like? Well, I think it was probably brewing for a while. So I had a previous injuries beforehand, but probably not the same injury that I had now with the tendinopathy. But it probably came up when I was training for Melbourne Marathon last year. And it tends to kick in when I was doing the longer runs, you know, I'd be running, you know, 20, 25 plus Ks. And my glutes would get really tight, my hamstrings would get really tight. And then even when the speed sessions during the week, I couldn't get the paces that I normally could have gotten. And I think it was just load over time. And I just couldn't get as fast as I used to get, even for shorter distances. And I just thought, oh, I'm getting older, I'm getting slower. And maybe it was just the load that I couldn't cope with. And then before Melbourne Marathon last year, I did have an injury. I was... I was on one of my long runs, it was probably three weeks out, and I had like a groin injury or sort of like a strain. And I was seeing physio and doing like pilates and rehab exercises. And then I just, I decided at the last minute to do the half marathon, not the full marathon, just being that the load and the longer runs were just not gonna be good for it. So I was quite happy I could do that without any pain. And then at least post marathon, I could still run because I think if I would have done the marathon, I probably wouldn't have been able to run for maybe two or two months afterwards because I probably would have got another injury. So I think this injury, the tendinopathy has probably been brewing since September last year, maybe if not before. So, and I was just running with it, so running with pain and just running through it and doing the same loads with my, and the same. you know, number of runs each week. So I was sort of trying to ignore it and just run through the pain. And then it got to a point where I just, I couldn't run anymore. It was just getting really painful. And that's when I had to start seeing, you know, physio and work out exactly what it was. Okay. You did mention that you've, you did some half marathons with the marathon as the goal. Can we just get a general glimpse of like your... your background and maybe the races you've done in the past and what your endurance career was looking like? Yeah, sure. So most years I would do, I normally did like run for the kids. I do puff and belly race. I do quite the large events, Mother's Day classic. So I normally liked the shorter distances being, you know, the 14K city to surf type runs, eight Ks. you know, Mother's Day classic, I run Melbourne half, and then I do the Melbourne marathon as my marathon for the year. So, but I did prefer the shorter runs before the Melbourne marathon. So I've been doing that probably for the last 10 years or so. So I've probably been running probably for 10 years and slowly increased my distance. So I'd start with the 10K, then I work myself up to the half and then to the marathon. So, yeah. marathons have you completed? Okay, yeah. So I'd say that's quite experienced and experienced with the training that goes along with it. And one thing that I found really interesting was you noticed almost as one of the initial symptoms that you were losing speed, even in the shorter distances, was that accompanied with symptoms like pain? Or was the drop in speed something that you just weren't associating with us or tendon? I probably came with pain and I probably noticed that in the Burnley half, which was September last year, which is like six weeks before the Melbourne Marathon, and I noticed I couldn't get my speed and it was also associated with pain. So that was probably the first race I realised that normally I'm okay at a half marathon, but I really struggled to get the pace. It was my slowest time that I'd ever gotten. And I think it was from then on that the pain was really starting to kick in, in all rounds, pretty much, whether it be speed runs or longer rounds. Okay. And you did mention at that stage where it got particularly irritable, you did go to a physio did, was there a diagnosis straight away? Did you have the answers of what was producing these symptoms? Not necessarily tendinopathy. It was more myopic hamstring related. I thought it was to do with my groin strain, which I had on a longer run before the Melbourne Marathon. But it was probably only early this year that it was really diagnosed as a tendinopathy and also had a scan to see whether there was something else happening and it was just showing an inflamed tendon basically. Okay. So the scans didn't show any other pathology. No, no, just normal, probably wear and tear for my age, but, um, pretty much just like inflamed tendons. Yep. And was initial physiotherapy effective? Um, it, look, it was, everything was, it was very slow with the tendon, with tendinopathy. So, um, you know, at the beginning I was just really given, um, bridging exercises to do. So at first I was to take off the load off my runs and not to stop straight away, but to slowly decrease. And then where it got to a point where sitting was even painful, it was pretty much stop running. Let's try and strengthen that area with bridges, double bridges, which slowly went to single bridges. So I went through a period where I wasn't running for four months, probably about four months. And I was just walking, because that was the only exercise I could really do. And just doing bridging exercises. So just trying to strengthen that area. Also going to Pilates until lockdown happened. And just to try and strengthen that hamstring and glute area. Okay. I'd like if you could. perhaps just describe the timeline over a period of a couple of months, because when we first started chatting, you did describe a time when you, as symptoms just got more and more aggravated or irritated, you started doing less and less that was going to irritate it. So you started doing less activities or less day to day sort of things that might produce symptoms. Can you maybe just talk us through that? Yeah. So, yeah. As it got more and more irritable, like sitting in the car for any period of time, whether it be five minutes or 10 minutes was becoming painful. I'd have to sort of sit on my hands because sitting on that sitting bone was quite painful. Any sitting at all was really painful. So I'd spend the whole day standing, eating all my meals and working on a kitchen bench on my laptop. for working and standing all day. So I'd just get tired standing because I couldn't sit at all. So that was quite debilitating and I couldn't really do anything other than just walk. Walking was the only relief I had. So some movement was better than nothing. But I guess initially I was told not to do anything and to not put any load on. So I did that and probably until I... probably started speaking with you about introducing load after a period of time, whether it be with exercises and then obviously a slow return to dog run program. But yeah, it was impacting, you know, I guess my life. Normally I just wouldn't be able to see it. Yeah. And you were still quite active with exercise sessions and doing some like group classes and things. And you mentioned that like all of a sudden or gradually over time, things like step-ups or lunges or certain types of squats were becoming irritated. So you would just start modifying those exercises as time went on, as it became more aggravated. Yeah. So I guess with Pilates, uh, and you know, wouldn't be able to do lunges. I was working with a PT as well. Um, had to back off the lunges, the high step ups, which I still don't really do at the moment, just because it's sort of strengths at stretches that hamstring. So I just modify that, but yeah, I had to really back off those sort of exercises until I was pretty much doing nothing. Yeah. I talk about this concept a lot on the podcast and it being like this downward spiral of once something becomes aggravating, you take that out or modify it in a particular way, but don't replace it with anything that maintains that level of strength. And so if you were running at a considerable high amount. If you were doing some strength exercises, it might be irritating, but the, the exercises themselves, at least maintain some level of fitness or maintain some level of strength in that tendon. And it's all about modifying at the right dosages. You might need to back off for a week or you might need to modify something for a particular week, but making sure that we're still loading that tendon so it can adapt and get stronger. It seems like it almost a little bit too conservative. Like you said, you went. months without running and you started subtracting like more sitting or subtracting out lunges, which might help the load up the tendon like almost maintain some level of strength. But it just seems like the limitations and the restrictions just became more and more severe as the months went on. Would that be accurate? Yeah, definitely. Yeah, I was pretty much doing nothing, just walking. I'd be walking for hours when I could. So yeah, it's true that if I had something to keep, continue that strength, it's better than nothing. So when I did return to jogging and running, my fitness was just gone because I hadn't been doing anything else. I might've been doing upper body, but it's just not the same. So I wasn't really loading the tendon in any way. I wasn't strengthening the area really much in terms of the only thing I was really doing was bridges. Yeah. And I think it goes to show as well. When you very first started running, you said you felt a little bit like awkward or uncoordinated or just hadn't ran for a while, so it felt a little bit unusual. But after doing those very low levels of running that was prescribed, you're, you just were getting general muscle soreness, just like around the hips and around the thighs to go to show how unconditioned you actually were even just with low levels of loading. Yeah, definitely. I had to teach myself how to run again. So I felt awkward at the beginning and it took a while to get back into it. And even when I started doing, you know, 30 seconds on 30 seconds off, I couldn't wait for the 30 seconds off to come around because firstly, my cardiovascular, everything was gone in terms of fitness. And, um, you know, it was, it was hard. Definitely. I had the question written down. Um, have you, Did you create any beliefs around what was causing your pain or what was preventing you from getting better? I already identified one that you talked about a couple of minutes ago, which was not putting any load through that tendon. You were just told by either health professionals or whoever just not to significantly load that tendon. Was there any other beliefs or anything else that was manifested throughout your rehab? Probably, I guess... it was the fear of putting load on and stretching it. I thought I would be going backwards. So even the fear of starting to jog again, I was, my confidence had completely gone. You know, I didn't think I'd be able to run again, even now that I've been running probably for the last four weeks or so. I still don't have that confidence to run with my running group because I didn't think I'll get the speeds that they run at. And firstly, I don't want to get caught up with it again. until I'm completely recovered. But I think it was just that fear of going backwards and maybe overstretching it if I did something or if I did an exercise that I shouldn't have been, shouldn't have believed to have been loading where in fact loading was probably a good thing if it was tolerable. So, you know, they always say a pain of two or three is okay. I think when it hits a five, maybe that's where you've got to sort of be a bit cautious. So, you know, I was always conscious of that. And even now, like when I run, I've got that awareness and it's probably a one to two, but it just fits with me. So I just run with that, just being that, that's obviously the load that I can tolerate at this stage and I'm not going backwards. So I don't feel it after the run or 24 hours afterwards. So I think it was just that fear of going backwards and then overloading and maybe stretching it and then thinking, oh, I'm gonna have to start again. I think it goes to show as well that your, your path, your journey to getting better had to start with addressing that belief as well. Because if we were to start giving you like hard exercises to do or strong exercises to do, or give you running without addressing that belief, you'd be, you'd just be thinking to yourself, why am I doing this? I'm just further damaging the tendon. I'm just going to take a couple of steps back. If I try and do this. If you do have low levels of pain during the run, you might interpret that as I'm doing more damage, which it's not, it's not going to help recovery. So you're a great student remembering those, um, those pain levels and knowing that it's okay to go through those low levels of pain, provided that there's no increase or marked flare up afterwards or the next day. And so you're paying attention and interpreting those signals correctly. But yeah, it definitely goes to show that addressing the underlying beliefs before. we start your journey to recovery is paramount. This podcast is sponsored by the Run Smarter series. If you wanna take your knowledge building to the next level, I have built out a proximal handshaking tendinopathy video course, which compliments the podcast perfectly. Sometimes it's tough delivering concepts and exercises through an audio format. So the course brings a visual component, full of rehab exercise examples, graphs, and visual displays to enhance your understanding. Even if you sign up 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. Moving forward from that, I wanted just to discuss the, or like at least highlight to the listeners, just the level of frustration that you did have, because we're talking for, you know, 20 minutes now, and it might just go to show, okay, this is just a path to recovery, but it was a very long period of time where. Like the lifestyle start to change. Like I said, your sitting was starting to become quite limited and you had to stand for most parts of the day. And you did mention on one of our calls that you're extremely frustrated with people not really understanding around what you're going through. Can you maybe just talk about that a little bit? Yeah, sure. Look, it was really frustrating. I think running is my outlet. So that's my way of escape. And especially now, when things had shut down and we were in lockdown, running was the only thing I would have been able to do and I really couldn't. especially, you know, we had three kids homeschooling. I just wanted to run away from the house and I couldn't do that. So I'd just be walking. So, and running, I guess, is my passion anyway. And it is my release. So to have that taken away was really hard and it was really frustrating. And, you know, not being able to do something is always makes you even more frustrated. So I think that with everything else going on around in the household and everything happening outside, it just made it even more depressing and more debilitating. So it was really difficult. It was really hard. So I would just run, not run, I would walk for hours. I'd see my running group, I'd wave to them and it'd be really hard not being able to run with them. But I guess the dog got a good workout this year. So she's had the best year of her life. Yeah, that's all I could do. So it was really frustrating. And... It was really hard and it was quite depressing and you know, I'd be eating more because I wasn't running. So everything sort of starts to slow down. Your metabolism starts to slow down. Your body's so used to being so active and running and burning off the calories. And now all of a sudden that had just stopped. It was really hard. So of course it put on weight over the COVID and it was quite depressing. Yeah. And that can almost like. self-propelled into more frustration if you are putting away and you're starting to eat more like an unhealthy lifestyle and you know you're slowly moving away from the identity that you hold like that you want to be you want to be this fit healthy runner and you're slowly like getting pulled away from that it can just create a lot of frustration and I think that would resonate with a lot of runners especially those who have been injured for a considerable amount of time it's that runners are the best at times get very jittery when they can't run. They want to run every day. And even if they're like sick, or if they've got like a, a little niggle here and there and they have to take some days off, they just get jittery even after like a week of not running. Can't imagine like four months. And so I think that identity shift as well can really start to hinder people's recovery. Definitely. Yeah, no, it was, it was not fun. So I'm sort of happy to be out of the worst part of it now, but yeah, it's even like when I would normally run and I'd miss a day, I'd be in the worst mood ever. So to not be able to run for four months nearly killed me. Yeah. Feel free to repeat yourself once I ask this question, but what component within the rehab when things started getting back together and you did start running a little bit, you started loading up the tendon a little bit. What do you think was the component of the rehab that had the most positive impact? Probably when I started to introduce more loading exercises other than the bridges I was already doing, it started to just bring back some of the confidence, well, I can actually do this without a lot of pain. There might've been some pain, but it was tolerable. So once I started introducing some exercises, then obviously when I started to do the walk, slash run return to run program, it started to give that confidence back. And it just was, even though it was really slow, just being able to do more was giving me a little bit more confidence because I felt like just doing bridges, I just felt like I wasn't getting anywhere. You know, it wasn't painful. And I'm thinking, how long am I gonna do this for until I can actually introduce more exercises? you know, you couldn't go to the gym, everything was shut down. So it was really whatever I could do at home. So I think once more exercises were introduced and I could provide more loading to the tendon, it was giving me that little bit more confidence than what I had previously. Okay. Can you maybe just describe the, what exercises do you think would be, would have the most benefit and were they pain-free while you're doing them? What sort of symptoms were you going through? I think when I was using more weights, you know, when I was loading on the legs, it wasn't painful, but I could feel my hamstrings working. And so where I could feel more, I guess, exerting more, you know, exerting more energy and load is when I felt like it was actually, I was actually doing more than doing nothing. So just introducing whether it be, you know, kettlebells, you know, where you're doing like one leg lifts, not deadlifts, oh, well, some deadlifts, but where it wasn't stretching the hamstring too much, squats were, you know, it wasn't painful. You know, I could introduce weights with the squats with my PT as well. So anything that wasn't stretching the hamstring too much, I could do. And so I just continued to do that. And... Again, with the bridges, single leg bridges each week, holding for more seconds than previous weeks until I was able to do the, you know, return to run program. Yeah. I think we, cause you were still continuing the PT sessions during your rehab. And I think just the instructions that you can load, as long as it's like slow and controlled, they can be low levels of pain. I think just the fact that. Sometimes body weight exercises might be a, a two out of 10 pain, but if you load them up and you go slow on control, that stuff still might be a tour or three out of 10 pain and you're still loading them up considerably, which helps load the tendon and help the tendon adapt. And I think it was a, a nice experiment just to start trialing some heavier stuff with a little bit more liberation with, you know, you have a better repertoire of exercises that you can now do with. the physio permission. So yeah, and then just the return to running as you very first started, even in those low loads when you started getting into a jog, was there pain? Were you mindful of that area? Was it irritated afterwards? Yeah, I would record after each jog, you know, what the level of pain was, you know, and whether there was pain afterwards, the day after. So initially there was always the, there was that tightness in the hamstrings. you know, when I first started, there was more than say a week later. And that was probably just from not moving for so long and not working my hamstrings. So, you know, sometimes I'd be, you know, be waiting for the pain when I'm jogging, thinking, oh, is that pain or is that just, you know, putting pressure on the tendons or on the hamstrings? So it was never a pain where I had to sort of stop and then not continue, you know, two days later for the next run. It was just more of tightness using the hamstrings, awareness in the glutes. And then as I continued to run further down the track, that pain or awareness would slowly go as well. It wouldn't be at a four or a five, it'd be more at a two or a three. Yeah, perfect timing for the garbage truck just to start emptying my bins. That's very good, thanks for that. I often talk about runners who do get injured to have, they, they tend to create like hypervigilance around a certain area. So if they have a particular injury for a long period of time, once they get back to running, like it's almost like every step, it's like, how's my foot doing? How's my foot doing? And like every single exercise, like how's my foot, how's my foot, wherever the, wherever the injury may be. And I've experienced that so many times with all the injuries that I have. And goes to show that we really need some work on. like calming down what our brain activity, what our brain activity is doing. Because if you do have this for such a long period of time, it's only natural that you're going to constantly think about that area. But once you get into the stage of, um, confidence level of strength and just having, uh, you, you kind of self ability self-efficacy to do certain exercises that generally starts to calm down. I think you, you mentioned the state where you're at right now, you're still a little bit vigilant around the hamstring, like how long you're sitting for and being mindful when you are running. Okay. What's that hamstring doing? Can you maybe paint a picture where you've progressed to in terms of the running capacity that you currently have or the exercise capacity currently have? And yeah, what, what currently where you're at in your rehab? Yeah. Um, so I guess now after maybe four weeks, of continuous running. So the program initially started, you know, with it'd be like a 30 second, like a minute walk, 30 second jog, and then slowly increasing that, increasing the reps over a four week period. So you might do six reps of two minute run, one minute walk, and then the next one would be seven reps and so forth. So that return to run program was over like four weeks until I got to some continuous running. without walking. So I probably would start with 20 minutes, continuous running, increase that to 30 minutes. And then I have just built on that. So now where I'm at is I'm doing four runs a week, I'm trying to space those runs every second day. Except for one. So I do and only last week, I started doing some speed sessions. So just slow speed, but just getting, you know, I did, I think it was like, eight times 300 meters of fast in a run. So I'm now up to say two 50 minute runs during the week, 30 minute run, and then my longer run is about 14 Ks, around 70 minutes. So that's where I'm at now. And on my off days, I've actually started doing a bit more cross training as well, so a bit more upper body strength and also still with my PT doing strength work where I can. And Pilates has just come back. So I'm trying to get back into that. Fantastic. I think a lot of people would love to be in the situation right now. You're not out of the woods just yet. Like you say, you're slowly still building up and slowly still increasing speed and you still have a little bit of awareness around like sitting for long periods of time or loading it up too much. But to, based on what you just said, the amount of running that you're currently doing that, that weekly mileage is starting to really ramp up, which is extremely positive. Do you notice any particular increase in soreness the next day after doing these heavy sessions? No, no, luckily there hasn't been soreness. There's always that awareness during the run and I guess the longer the run goes for the more that's when it probably starts to kick in but it's tolerable so it's you know it'd be a pain of maybe two out of ten. Um, but it doesn't impact me afterwards or the next day. So then that's where I know, you know, I can sort of keep going with the program. I think if I did feel that the next day's thornness or, you know, that night, then I probably would need to push back a bit. Yeah. Very wise. If someone is in the same position you were like, say, uh, four or five months ago, when symptoms started, started affecting your day to day and it's sort of like, the sitting became really limited and the exercises started to become really restrictive. What would your advice be to them to like how they can kind of kickstart their rehab? I would definitely say, listen to your body. It's something I tend not to do or didn't previously. I would just push through it and just think, maybe it was the pilates I did the day before and maybe that's why I'm tight. So I always made excuses for it. Maybe it was the load I was doing at the time, because it was repetitive pain in the same area, I probably should have got it looked at earlier than I did and not pushed through races, not pushed through speed sessions where it probably flared up more when you increase the pace. So yeah, I would definitely get it attended to earlier than later, because you don't want to get to a point where you just can't sit for more than five, 10 minutes at a time and you just can't run. So... Yeah, I would definitely get it looked at earlier. And even now, like if something comes up, I'll, you know, always mentioned it to a physio or in Pilates, if there's pain in a certain area and then to get it addressed then and there. Yeah. I think the, the body awareness and like knowing that niggles do happen. Niggles are perfectly fine, but just knowing to where to differentiate. And if you've had it for longer than a couple of weeks, it's definitely something needs to be addressed. And you, you know, hindsight's 2020 in these sort of cases, but if you're continuously pushing through races and it can, and one area is continuously flaring up because of that, try not to convince yourself otherwise try and, uh, yeah, get it checked out and make sure you have the answers and a good plan in place to, um, still keep healthy, still keep maintaining your levels of fitness, but just do the right thing, start making the right decisions to recovery. very well said. Any other lessons that you'd like to share, anything throughout your journey, the listener might want to take on board? Yeah, look, it's definitely always good to get a second opinion. Even if advice that you've been given is good advice, it's always good to hear other professionals opinions. I also looked into, I'm sorry, a sports physician and she was suggesting a PRP injection, which I'd heard about. And I'd spoken to different physios about it. And there was some people that had it and it worked really well for them. And I was advised, maybe wait until you turn the corner because they obviously had the confidence that I was about to turn the corner, but I just couldn't see it. So they were saying, look, hold off on doing it because then you'll have to wait six weeks afterwards. you won't be able to run straight after, maybe two or three weeks after you've had it. So it's gonna put you back anyway for another three weeks. So I was very close to getting it, but in the end I didn't, which is probably a good thing just being that, it's probably not good to have things injected into your tendon, it may go the other way, you just never know. So I did investigate that. And also I think it's just, it's good to be able to increase some load, even if you're quite hesitant to do so, it's better than not doing anything because then it'll just take longer, your recovery, if you don't introduce some load into exercises and just something that you can tolerate rather than just resting completely because then it's just gonna take twice as long to get back into it, which I felt for me even now, I feel really unfit, but at least I'm starting to move a bit more. This podcast episode is sponsored by the Run Smarter Physiotherapy Clinic, which is my own physio clinic where I help treat a wide range of PhD sufferers, both locally in person and all over the world with online physiotherapy packages. In the years I've been self-employed as a physio, close to 70% of my entire caseload has been helping people with proximal hamstring tendinopathy, which is why I decided to launch this podcast. So if you're building upon your own rehab knowledge through the podcast, but still require tailored assistance, I'd love to be on your rehab team. Whether you are a runner or not, head to runsmarter.online to see your available options for working together. If you're still unsure if physiotherapy is right for you, or if you need a rehab second opinion, you can always schedule a free 20 minute injury chat with me. Find the free injury chat button on my website or in the podcast show notes to be taken to my online calendar to book in a time. Going back to the advice around the second opinion, I'd say definitely if you're not progressing, if you're noticing week by week, month by month that things aren't happening, definitely get a second opinion or at least ask your health professional that you're currently seeing if there's ways we can change things up because I've seen cases of people trying things like shockwave for months and just not getting anywhere or trying the same type of exercises for months and months and just like not seeing any progress, but they still continue with those same exercises over and over again. And so perhaps, um, getting that second opinion, or at least trying to change things up, you should, no matter how chronic an injury is, you probably should start seeing some level of progression might not be day by day. Might be a little bit week by week, but definitely month by month. You should start know some sort of improvement. Uh, and in cases like yours with having a hamstring tendinopathy for 12 months or more, it's expect a week by week kind of progression. And if you looked at your, your state from a couple of months ago to now, there's definitely a lot of progression with the amount of low that you're doing and what you're tolerating. So that's a good sign to continue the sort of journey that you're on. And then if things do manage to plateau. or if you're just not seeing that same level of gains, then maybe it is time to change things up or change the approach. And so, yeah, very well said, very good advice. Anything else we need to, you think the audience would like to get before we wrap up? Probably don't get too caught up in, you know, I did join lots of Facebook groups and yes, there's always some good advice, but then sometimes... you know, hear about people that have had the same condition for years and years, and sometimes that can also impact your confidence, and you think, oh no, am I gonna have this also for five years, I couldn't bear it. So I think you've got to look at it and think, oh, you know, maybe that might work, I could try it. But then also just not get too attached to how other people have reacted to certain things, because everyone's obviously very different, everyone reacts to... to rehab differently and I was going through a period where I just thought I wasn't getting anywhere and now I look back and I think, oh, I've obviously got somewhere because I can now run. But I was going through a period where I really felt like I was never gonna get better even now when I'm running and have that awareness. I think how long am I gonna have that awareness for? But as long as it doesn't get worse, then it's probably a good thing. But yeah, I'll just continue the way I am and hopefully you'll just. slowly disappear and I might be able to race again, maybe next year if I'm lucky, if there's races. Yeah, but back to what you're saying about going onto Facebook groups and perhaps it might, you might find some doom and gloom of someone who's had that condition for a lot longer. It's almost similar to, I often talk about low back pain and when I was practicing in clinics and someone's come in with low back pain, you can tell that they're not going to recover as well. because they've had say a parent who's had low back pain for years and years and years, or their grandma who's had that same type of back pain, they've had it for 10 years and now they've, they're really limited with their mobility. They've ended up in a wheelchair because of back pain. It's those stories that you tell yourself when you have this particular condition that really triggers a lot of worry, a lot of anxiety, a lot of fear and that's... really hinders recovery and so potentially Facebook groups and you might actually find that story that's going to really hinder you so it can be a little bit doom and gloom you might find some really good advice but if you do come across stories where someone's had your particular condition for several years take it with a grain of salt and don't get too caught up in the emotions if you believe that might be you very important so very well done. Michelle, thank you for coming on and sharing the story. Like sometimes a bit uncomfortable to talk about these sorts of stories. I like relive the rehab experience, but because you're, you're seeing this level of progression, I think you're quite, um, in terms of the emotion, you're feeling a little bit happier and you're feeling a little bit more excited about what's, what's going to happen and a little bit more excited for the future. And the fact that you're sharing this story has helped or will help a lot of runners and a lot of people that are going through the same thing. So thank you very much for sharing. me again, charming back in. I have had a listen or re-listen to this interview and I've wrote down a few notes for us. Proximal hantrum tendipathy sufferers to see what takeaways we could learn. Number one, I guess the initial symptoms how Michelle first started describing symptoms was when she started doing speed work. So a key takeaway to know that intensity, speed that being whatever. activity you're involved in cycling, running, team sports has a tremendous amount of load and if you do increase your amount of speed it does increase the tolerance and we don't want to do too much too soon. Some mistakes or like some like why it developed into such a chronic issue what I wrote down it seemed to be really mismanaged in the early days Like Michelle described, she ignored it for quite a long time. She was just running through pain for a lot of the time. And even just when she did get it looked at and get it assessed, she was met with some misguided education around resting the tendon and avoid loading the tendon. So I guess that just created a bit of a perfect storm for developing to such a chronic issue. She did. follow the same pattern of that retreat to safety, that pain rest weakness downward spiral that we describe and avoiding the load and just contributing to more of a deconditioned tendon, which is a common pattern that we do see and I've highlighted in earlier episodes. The emotional impact of the pain, like it was extremely frustrating for her. She didn't really necessarily go into too much detail and I think she'll be... okay with me describing it here, but when I did have our one-on-one session, our first one-on-one session online, and I did ask about how frustrating it was, she actually got very emotional talking about how she just didn't feel understood and how her family just hasn't really recognised the impact that does have on her and yeah, did take quite a toll emotionally. And so just slowly... gravitating towards a bit more of an unhealthy lifestyle as well which has further contributes to an emotional impact. So that's something that I recognized and thought I'd jot down. The positives though, we can know that loading seemed to be really helpful for her throughout her entire stage. Once she decided to start loading up the tendon then from then on upwards she just noticed it just responded really well. when she was returning to run, it was a very gradual, but the walk run program seemed to work really well for her. So that's a really nice positive. And just the power of implementing a plan, the power of having this management plan, the small progression that you can make and sort of seeing the goals that you're setting can have real power and have really impact a nice positive recovery. Another thing that I... highlight which I did in the interview anyway but just around the pain awareness being hyper vigilant and once she started running noticing there she's still aware of it like almost every step or every time she goes for a run she still notices it there which in my experience it will eventually settle once she builds the confidence once she really increases her loading and starts to slowly um yeah just build up more confidence around running that it won't produce a flare up, that's how we settle down the brain, that's how we settle down the mind and see real benefits. And I've had it before, I've had injuries where I'm just thinking about the pain or thinking about that area every step, it's just this hyper vigilance every time you sit, every time you move, bend forward, are you thinking about that tendon? It just connects the nerves and has this strong connective pathway between the nerves whenever you think about it while you're bending forward or you think about it while you're sitting. So bear that in mind. She still has awareness but recognizes that it's fine and it doesn't create a flare up so that's great. Hopefully you are like hearing her story and paying attention to these principles, these earlier episodes and you're starting to see a connection, you're starting to see that there is success in the real world. It's not just... delving into science or delving into what should be done. It's actually people implementing these strategies and it's actually helping them. So hopefully you enjoyed, hopefully you enjoyed Michelle's story. It is the first one and it'll be the first of many that we'll produce on this podcast. And I hope you enjoy, so we'll catch you next 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.