Q&A: Preserving Strength/Rehab vs Strength/Anterior Pelvic Tilts/Stride Implementation

: On today's episode, we're doing round two of our Q&A session. 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 bust the widespread misconceptions. My name is Brody Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. Thanks for joining me for another episode. We have the rest of the questions to get through. Last episode, we covered the Q&A answering four questions. And now we have questions coming in from Brent, from Rob, Jennifer, and Rebecca. So let's. Dive in, we have, let me scroll up to the top. Rob Jones asked a question who is actually appearing on as a success story next episode. But nonetheless, Rob, I suppose I should mention that when people submitted these questions based on the time of recording now, it would have been about. two or three, probably three weeks ago. So sorry, it took so long to get to your questions, but, um, as it, as is the nature of the podcast, um, these things do take a bit of time, but Rob says, uh, my rehab has recently been going amazingly well, thanks to the various, thanks to various things, including your podcast. I can now run 16 miles and sit for longish periods of time without an issue. However, I'm currently on a two week holiday and do have access to a gym, but the equipment isn't as good as my own gym at home. Is easing back on the exercise likely to set me back at all? There may be times in the future when I don't have access to a gym. How much of a rest period is okay before I start to see symptoms worsen? Um, in terms of like symptoms worsening, it's, it would be really hard to point on that because it depends what else you do throughout. It's like you could travel and, you know, be on a long haul flight and then that might increase symptoms. So it's hard to put a timeframe on that. But what I will say is, um, when it comes to easing back into the exercises, um, will, will symptoms worse or will you start to notice, um, things weakening? No, if it is only two weeks. So if you go away traveling and it's. You're staying relatively active while you are traveling, you're walking around, you may be doing some hikes, just sightseeing, those sorts of things. If you're relatively active and it's for two weeks, no, you won't lose fitness. You won't lose strength. Also, no, if it extends beyond two weeks and you do a really minimalist rehab. So I'm talking like lunges, talking squats, or maybe just doing some running here and there, whatever you can tolerate. Um, I always say it's. Hard to gain, but easy to maintain. So if you are doing your rehab, you're doing your deadlifts, squats, lunges, and you're looking to build upon your strength, that's quite hard to do. It does take a bit of time to slowly build up, increase the weights, increase the reps sometimes, increase the time under tension, just make it more difficult. That's a really slow progression that does take several weeks. But once you have made those gains, once you've gone through like a six to eight week training period to maintain that strength is really easy. You only need to do some strength training maybe once a week, and you're no longer contributing to building upon that strength, but you are maintaining it. When it comes to travel and when it comes to only two weeks, trying to just maintain your level of activity is might just be enough to maintain your strength. So in the future, If you are forecasting that you are planning a trip, if you are going away for a couple of weeks and you don't have a gym, you can just plan, well, it depends on how long you're traveling for, but forecast this and then plan. If rehab should be implemented or not. Let's just say if I, if I'm going away, if I'm going to Italy for four weeks and I know I won't have access to a gym. And I know it's four weeks. So four weeks is quite considerable. If I did nothing in four weeks, I'd probably start losing strength. But what am I doing when I am traveling? If I'm hiking, if I've got a heavy backpack and I'm hiking for a week out of those four weeks, well, that's something, that's a lot of strength that's required that will help maintain my strength. What else am I doing? Will I be walking most days or am I just relaxing by the pool? If I know I'm traveling for three weeks and I'm just going to be relaxing, staying at a resort and not really doing much, then I'd probably want to be a little bit more proactive with preserving the strength and it doesn't have to be a lot. It doesn't have to, you don't have to go find a gym somewhere and start lifting heavy. You can do lunges or step ups and just have a weighted backpack on, on yourself. Usually when people travel, they have a backpack or they have a suitcase. They can just hold that while they do their step ups or their lunges. You can do some Nordic hip dips, which don't require weights at all. You just tuck your heels underneath a piece of furniture or have someone hold them in place and then you just dip forward, hinging at the hips, like a drinking bird, um, uh, bridges, bridges on a chair, single leg bridges. You can bring some resistance bands and do crab walks, side to side shuffles or some, um, resisted band, hamstring curls. All of this isn't anything like the slow heavy stuff at the gym. but at least some stuff just to preserve your strength. Like I said, that's only if in that scenario where I forecast and said, okay, I'm traveling for three weeks, I'm not gonna be doing much. Or let's just say it's on a cruise that doesn't have a gym and you're just gonna be relaxing the entire three weeks. Maybe just have a few proactive measures just to maintain some strength. But like I said, hard to gain, but easy to maintain. You just need to be a little bit more, a little bit proactive and forecasting what you should do. But I should say as well, if you do go on a cruise, or let's just say you're unwell for three weeks, and you're mainly bedridden, you know, just doing very light movement around the house when you are unwell, yes, you will lose strength, but it's easy to rebuild that strength. It's a lot easier than the initial steps, the initial six to eight weeks to build up that strength. It might only take two to three weeks this time, just because your body's recognized it, Um, it just rebuilds a lot quicker. So just keep that in mind. Hope that helped Rob. Um, we'll chat to you next episode on with your success story. Next one I have is coming from Brent who said on one of the podcasts, you said you cycled rehab doing run, bike, run, strength, rest. Um, I can't remember saying that. Maybe I did, um, maybe on the earlier episodes, which is probably why I can't remember it, but apparently, um, so I was doing a run. The next day bike, then run, then strength, then rest. And just putting that on repeat and Brent continues. I'm currently trying to implement that cycle, but I'm also alternating stage two and stage three rehab of the Maliara study in the mornings of those days. All those days that aren't rest. So on the run, bike, run strength days. alternating doing stage two rehab exercises and stage three rehab exercises, which I'll talk about in a second. Brent continues, are the rehab stages considered strength training? And if so, is it too much strength taking away from my run and bike days? So for those who aren't familiar, the Goom and Miliara study mentions progressing your rehab through certain phases. Let me scroll up so I can try and find what episode it was. Episode four, which was titled three stages of PHT rehab, which covers that particular article. But essentially like stage one is quite easy exercises, stage two, progressing stage three, progressing even further. The ones, the exercise they're in stage two that paper studies was things like a prone leg curl. So a resisted leg curl lying on your stomach. supine leg curl, so you're lying on your back and you're doing a bridge, but you're curling your foot back and forth with something like a skateboard or a hamstring slider. Nordic hamstring exercises are in stage two and also some bridging progressions like adding weight, those sorts of things. So not a lot of hip flexion, not a lot of tendon compression, but stage three does introduce tendon compression. So that has Romanian deadlifts, step-ups, lunges, hip thrusts. and single leg deadlifts as some of the exercises examples given in that study. So starting to introduce more of the hinging bending type of activities. So Brent is alternating stage two and stage three exercises almost every single day, um, and is wondering if that is considered as strength training or if it's, you know, all just being too much. I would consider strength when someone says I'm doing strength training. the aim to build upon force, the ability to produce force, the ability to push, pull heavier amounts like a structure, a design that is having the aim for you to lift heavier and produce more force with your muscles. And so sometimes rehab might count as strength, but it depends on where you are in the progression chart. And once you have progressed to something that is pure strength, You simply can't do it every day. You need the right balance. So people might think that they're doing strength, but let's just say they're doing body weight, double leg bridges, very common for PhD. Would I say someone who's doing bridges, they're doing them daily, they do them every single day and they haven't progressed them in four weeks? I would say that's nowhere near strength. Yes, you're activating your muscles to do that exercise. And yes, it might actually help the tendon, but it's not strength. that would be more rehab because you have no intention to build upon. You're probably not pushing the capabilities in terms of what the tendon and the muscles can produce. And they're just not going to adapt to become stronger because it's just been maintained for so long. And so if you do get to say stage three exercises where you are doing deadlifts, step-ups, lunges, hip thrusts, single leg deadlifts, and you're progressing those particular weights every other week. Progression is always in mind and all of those exercises are kind of just pushing those capabilities. You're really like pushing the envelope of how much you can lift and, you know, exceeding that week by week as the body adapts, that's definitely strength. Um, but like I said, if you do eventually get towards strength, like if you are purely strengthening your body with these exercises, you can't do it every day. You won't be able to do what Brent's doing of stage two and three. alternating days, doing it six days a week, I guess, based on this schedule, because the body needs to recover, you need to really challenge your body with really heavy strength, but then the body needs some recovery time. That way the tendon and the rest of the body sort of adapts, gets stronger in that recovery mode, and then it can repeat that same thing again or a bit stronger a couple of days later. So you do need to really find the balance between strength and recovery. And sometimes the tendon might be too irritable to get to this particular stage where it does need that recovery afterwards or lifting that heavy. But that's always the goal of rehab should eventually like progress to that point where you are getting quite heavy. Um, so yes, you do need to start doing it less often. So the body does have time to recover, but we also know, and a lot of you listeners may be. in this camp as well. That sometimes loading on most days helps the tendon has that analgesic effect, reduces the amount of pain that you have, reduces symptoms. And so sometimes it's nice to load it most days, but that's where we need to have that real fine balance. Sometimes you need to have some heavier days to sort of push your capabilities. Sometimes you need to have some lighter days if you feel like you need to, if you're compelled to do it most days for that analgesic effect. So this is where it says in that Goom-Maliara study that when it comes to like the end stage of your rehab, if you're sort of getting to stage three, getting to some plyometrics and you know, you're doing quite well in terms of tolerating that, you can have a cycle of high, low, medium rest days. So you have a high or a heavy day. The next day after that, you're still loading it, but it's an easy day. then it's fairly recovered after that easy day. So then you go to a medium day, then you go to rest and then on repeat, high, low, medium, rest, high, low, medium rest. And the paper suggests this because this seems like a pretty good balance between strength, between recovery and that also sprinkling in that analgesic loading for tendons. Cause you're loading three out of the four days, but it has that cycle of heavy, but also low. So might not work for everyone, but it does work really well for most, especially if you are at that stage where you are doing quite heavy deadlift, step-ups, lunges, those sorts of things. Um, but then we need to add in some complexity, especially for Brent and runners and triathletes that are out there. Cause we need to find ways to sprinkle in some cardio. When do we do our runs? When do we do our bike rides? Um, so this will just change depending on for everyone. Um, so your routine. might change from the high-low medium rest, depending on your unique circumstances. It'll all depend on the duration and intensity of your cardio. Like if you have a run day, but it's a 4k or like a 20 minute really easy low intensity run, that could be done on any day. But if you have a certain dedicated sprint session or high interval session or hill sprints or a heavy interval session on the bike, that needs to be very carefully placed in the week. And unfortunately I don't have the answers or depend on someone's unique circumstances and what they can tolerate, but it does need to be quite careful. If you don't need those analgesic days, um, and you are really far along in your rehab that you're doing really well and returning back to competitive running or triathlons or those sorts of things. The day can then, or the weekly routine can then shift towards two heavy days. So you still want two heavy strength days. Um, maybe one of those two days is combined with a cardio day. So maybe on a Monday you do your heavy stuff and that's all you do. But then on a Thursday you do your heavy stuff again, but it's also with a 4k light run. So you're doing your two heavy strength days per week. Then you can maybe sprinkle two or three other cardio days and then two or three rest days, if you are an athlete that's looking to do the majority of cardio. And you're also doing really well in your rehab and you know, symptoms are really settled and you can start tolerating a lot. 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. Jennifer has a question and says, I had been dealing with PhD for almost two years and saw a new PT who recommended postural restoration to treat my hamstring. He said my hamstring was constantly under tension because of a pelvic tilt, which was more pronounced on the affected side. He recommended exercises that incorporated deep breathing with back bends and shifting my hips to work on the pelvic tilt. It didn't fix my PHT. I've since seen another PT and have been doing isometric exercises, progressing into single leg deadlifts, well done. But I'm so paranoid about this injury that I can't stop doing the silly breathing exercises in case they help. Do you know if anterior pelvic tilts can be a cause of PHT or if there's any benefit to correcting the tilt? What a fantastic question. Thank you, Jennifer, for asking this. Um, so for those who aren't familiar with a pelvic tilt, um, a pelvic tilt, if you were to sit in a chair and, um, just be in a neutral sort of posture and then go to extend your back. So you're increasing the curve that is in your lower back. You'll notice the pelvis kind of rolls forward, what we call anterior tilt. And you sort of go from sitting, you sit more onto your sitting bones. That's anterior pelvic tilt, which Um, is what Jennifer was saying on her affected side, that one side of her pelvis is anteriorly tilted more. And I hear this a lot. I hear questions or, um, suggestions from therapists like a pelvic tilt or a leg length discrepancy or a spine malalignment, or, you know, any sort of repositioning, um, or imperfect alignment that may be a cause for their injury, no matter what the, no matter what the injury is. Um, and I was taught this at uni too, a little bit. Um, and I was always very skeptical. Um, for example, when it comes to leg length discrepancy, I'm not sure if I've talked about this on the podcast before or not, but leg length discrepancy is been like prescribed or diagnosed or, um, suggested as a cause for a pathology for a very long time, still, still to this day, very popular. saying, oh, you have a five mil difference from your right to left, which is causing a tilt in your pelvis, which is causing your spine to be malaligned. And it is the one of the causes for your injury, no matter what the injury is. You know, people fail to, or maybe the therapist doesn't know or fail to tell you that leg length discrepancy is extremely normal. 95% of the population have some sort of leg length discrepancy. granted, it is quite low or the average leg length discrepancy is only about five mil, so five millimeters, but you know, sometimes that's what people are diagnosed with. They say, Oh, you have a three millimeter difference on your right side to your left. It's causing your all kinds of disruption in your body. And it has been shown that having about a perform biomechanically different, that might start to maybe have an effect on your body. But we know that people with more than a 20 mil difference is less than 1% of the population. So it's quite rare. And well, I wouldn't say quite rare, one in 100. But you know, so many people are coming back saying, Oh my god, I have a five mil difference, right to left, can you fix me? Can you realign me? But it's essentially a normal finding and hasn't really been shown to create a significant difference in your muscle activation or strain on any particular type of your body part. And so what Jennifer's saying here is they found an anterior pelvic tilt on one side of the body, which is probably only a couple of mil. And I haven't seen your pelvis, Jennifer, but I'm assuming I'm skeptical and I'm probably teetering on the same line as this leg length discrepancy. It's probably very minor. It's probably quite normal. And yes, theoretically, if you have an anterior pelvic tilt, purely based on the anatomy, the hamstring might have a little bit more tension on that side than the other side, but it is probably negligible. It's probably so small that wouldn't make a difference, especially because you've had that same tilt your entire life. This comes back to say, um, leg length discrepancy. If someone has a three mil leg length discrepancy. They've had that three mil leg length discrepancy throughout their whole adult life. And nothing's happened to them beforehand. They've been, people run cycle, swim, bend, do all these things with this three mil difference, it's only until they're injured that someone eventually identifies this leg length discrepancy and say, this is the cause, um, that just increases my skeptical nature. Um, if it was really acute and acute change, that's completely different. So If someone didn't have a leg length discrepancy and then someone said, Oh, wear this three mil heel lift in your shoe and go for a run. That might make a difference because your body isn't used to that three mil difference. It's not used to that and might, um, start moving differently and move in ways that's not adapted to, and that could increase your likelihood of injury for sure. Um, if you, I don't know what sort of accident or something might cause a acute change in pelvic tilt. But yeah, completely different story. But if you've had that same tilt your entire life, it's negligible. And there's not really much you can do about it. Theoretically, I was told this at uni, or I think my boss at my private clinic that was working at told me someone has an anterior tilt. You can strengthen their abdominals, release their back muscles, pretty much. release what's on the loose end, no, strengthen what's on the loose end and loosen what's on the tight end. And then maybe that pelvis rule realign itself or correct itself. I'm even more skeptical about that than everything else. People just move in the way that they move their anatomy. We know that everyone's posture alignment anatomy is different and they're used to moving in that way. And if it's so minute and it's so negligible in terms of millimeters here and there. I say, just leave it. And I'd say, just let them move the way they want to move and just strengthen what's weak, um, build up the capacity of what is sore and people get better. It's really simple. And one thing I don't like people can probably tell there's an undertone of, um, a little bit of outrage and a little bit of, I guess, anger in my tone. When I talk about these sorts of things, it's because this particular approach is very common, but is detrimental to the patients. detrimental to the clients because I'm not sure about Jennifer, but I've seen people being told this and they're alarmed. It's very threatening language to say your body is letting you down. Your body is collapsing. Your body is tilted. Your pelvis is out of place. All these sorts of things. Um, I've had people go to their health professional, come back, really worried, really concerned and. scared, anxious, it's, it's a, it's very threatening language. And so, um, to, for someone to be so alarmed for something that's not evidence-based and not that, not shown to be that effective or that level of contribution to the injury, it just like gets me angry. So I guess that's probably why. Um, so I hope this has maybe helped. alleviate, allay some of those fears, Jennifer, hopefully it's helped me calm down those things. But one thing I will say is you mentioned that you're persisting with doing these breathing exercises because you're paranoid that like maybe it might help. You're not sure. I would say that with treatment, you should see a noticeable improvement. If you're not seeing a noticeable improvement, it's time to change something. It's time to change how you do. I would say that there's some cases out there. they do these breathing exercises and they feel significantly better. Why it's actually feeling better. I have no idea. Maybe they're calming down the nervous system. Maybe it's changing them, making them move in a different way that makes them feel better. I don't know, but you've mentioned in your question that you've tried doing them and they're not that effective. You didn't notice an improvement and you've since moved on to do other things. Um, but I would say if you haven't noticed improvement, there's no point doing them. Same with someone who, um, might start doing dead lifts or let's say might start doing bridges and see initial success, but then continue doing the bridges and not seeing any more improvement, but they continue doing those bridges for six months. Do something different if you're not seeing a noticeable improvement. And when it comes to say people that have been told that they have a, a tilted pelvis. And they do all these like correction exercises and it might help in the short-term they might have something released here, something adjusted here, maybe something manipulated here to realign them. And they feel really a lot better, but next week they're back to where they started. I would question, I would hope that something long-term, a long-term, um, management plan or long-term strategies are in place and not just relying on that short-term fix every time. because this is where we do see improvements week by week when you do the, the strength and conditioning that is evidence-based and does work for most. And I suppose, Jennifer, if you were to do all these deep breathing exercises and not see a difference, but then you start doing heavy deadlifts and things do start getting better. I would not worry one bit about continuing to do those breathing exercises because Um, like I said, I, I'm very skeptical. I don't really believe, don't really prescribe to that narrative. And, you know, I see people with PhD all the time. In most cases, you strengthen them up in most cases, they get significantly better. So keep that in mind. Hope that helps. Our last question comes in from Rebecca who says, when the PhD is responding well to a solid rehab plan. At what point can strides be reincorporated into a return to run routine? Or does the PhD need to be remedied first? Thanks, Rebecca. Firstly, for those who aren't familiar, what strides are. So if you are a runner, strides are essentially finding a hundred yards or a hundred meters of flat straight running. And what you do is you do repeats of faster efforts. So you start. at, um, you actually start quite slow, but you accelerate for about 10 to 15 seconds, hold a top speed for five to 10 seconds and then start decelerating. And so what someone would do it's, it's a good opportunity to introduce speed, introduce quite fast speed, particularly if you can tolerate it. If someone isn't injured and they want to do strides, they're getting close to their max sprint and they're doing it for very short periods and they stop, they recover. They turn around and they repeat that sometimes four to eight times would be like a particular session, mostly or commonly done after a run. So like after a 30 minutes slow run, that's when you do these repeats and then finish that overall workout. So thanks Rebecca to answer your question. Um, no, the PhD doesn't have to be cured before you start doing strides. I would say, um, it's a similar concept to. when to introduce running. Running should be a part of the rehab, not the end results. And we want to be very clear on that because if you have a goal to return to something pain free, it's very important that is included within the rehab. You can't just simply wait, wait to get better and then expect to return back to it or return it easy dosages and do it successfully. Um, the most effective way to do it is to slowly integrate it, even if you are still managing the condition and even if you're still a little bit symptomatic, it's good to just poke into it, see how the body responds and try and find the right amount that doesn't spark symptoms. Similar to with everything that we're doing in, in your rehab with the strength and, um, Cardio, everything else, we just do a little bit, see how things respond. Do a little bit more and Everyone with PhD will have different goals. Some might be running, some might be triathlons, some might be just wanting to do some gardening. Some might just be sitting at a desk for six hours might be their goal. But we're just trying to help the body respond to these certain stimulus by just getting them to do it. You can't ascend, you can't try and strengthen the PhD, wait for symptoms to go and then expect to sit for six hours and be totally fine with it. Um, you might start by. sitting for 30 minutes and being okay with that and sitting for 60 minutes. And then, you know, being a little bit sore afterwards, but back it off with some recovery, do it again for 60 minutes. And then once you're tolerating 60 minutes, do it for 80 minutes. It's all about just poking into it, fluctuating into the, the challenging, push the envelope sort of stuff. And it's essentially just trying to find where that adaptation zone is, where that sweet spot is and trying to. foster the right environment for adaptation. And so strides are no different. Well, they are a little bit different, but the concept is exactly the same. And why I sort of pushed this concept is because you could be completely, or you could be waiting. You should, maybe it's within your rehab, or maybe you've got the belief that let me just wait till I'm pain free and then I'll return back to it. You might be underserving yourself. you might be treating that a little bit too conservatively actually creating more risks for yourself. So let's just say strides were a part or something you wanted to reintroduce. And you said, okay, maybe once I'm back to pain-free running, that might be a good opportunity to start doing strides and let's just say that opportunity takes three to four months to do when you're eventually running, let's just say 40 minutes and then you say, yep, now strides seem to be okay. Let me see if I, how I go. And then you try strides and it flares you up because you haven't done them for so long. It's a lot more risky and it takes a lot of time on that time scale, three to four months to introduce it and then introducing it has its risks. You're better off saying, okay, yes, it's okay to do some, have some benchmarks. It's okay to have some benchmarks in place before reintroducing something. I would never introduce strides for someone who can't run slow for certain amounts. That's not in the same. We work up that rehab ladder that I mentioned on the podcast. So often you don't want to skip steps in the rehab ladder. You want to slowly progress through that. But if you are running small amounts and doing it successfully, well, let's try strides. Let's try one repeat and see how you go. If that's okay. Maybe next time we try to, but that concept is always there. And it's what I've found to be, I guess, the most efficient, the most effective, because we're, we're kind of time efficient because we're introducing this. We're sprinkling it into your rehab, um, before you have to get to quote unquote cured, um, of PhD before we're reintroducing these things. Um, I would say the benchmark would possibly be continuous slow running for 30 to 40 minutes for most. before reintroducing speed would be my just general vague kind of understanding. Um, or I guess like a safe option. If someone can only run 10 minutes, they run 15 minutes, they flare themselves up. I wouldn't introduce speed if they're handling 40 minutes and might be a little bit sore, but settles down really quickly. And they're returned to baseline symptoms in less than 24 hours. I would say, all right, let's give some strides ago. And for those who have worked with me, for those runners who have worked with me and strides are on their plan, you would know that I have a pretty methodical way of progressing through strides. Um, let me bring it up now because, um, I can easily pull up the generic table that I have for some. So phase one for a stride that I have for most of my clients is four repeats. And the max sprint that they're approaching. in that session is 75% of their max sprint. For some people I might change that to 60, but it's also quite hard to, I guess, comprehend when you are running it quite fast, what percentage that is of your max sprint. You can use power if you've got a foot pod, you can use speed if you wanna quickly look at your watch while you're looking at it, but... For the most part, I usually just use a general feel, just try your best, 75% of your max sprint and repeat that four times. But that's not a hundred meters of sprinting at 75% of your max sprint. That is slowly accelerating from meter one for accelerating up to that point. And it takes you about 15 seconds to slowly accelerate up to that point. Then you're running at 75% of your max sprint for about eight to 10 seconds. After that is when you start slowing down, completing that overall stride workout. So four repeats of that at 75% of your max sprint is phase one, what I would call phase one for most people. Phase two, you're doing exactly the same thing, but instead of four repeats, you're doing six. I have it up to about phase four, which is when we're doing about five repeats, but then we're increasing the max sprint. So instead of 75%, you're then going to 80 to 85 of your max sprint. And all the while we're knowing that you tolerate phase one. If you can tolerate that, we observe symptoms afterwards. If you return back to baseline less than 24 hours, we know that was tolerated. Next time we might want to try either repeating phase one or have a go at phase two. But similar to Rebecca's question, if you have any other questions about I guess, introducing things. When is it time to do this? When is it time to do more sitting or sit on a firmer surface or introduce, um, interval sessions on a bike. It's not too hard just to introduce a little bit at a time. See if it makes sense. Like you should be peddling on a bike for 30 minutes before you can even think about doing any sort of short interval sessions, but give it a go, give it a go just a little bit and see how you feel. You're relatively safe if you just do a little bit, because if it does flare you up, it's not for very long and you'll learn from it, but if it was successful, then you can just do a little bit more next time. And so I guess that's my approach for most things. Don't wait until it's totally feeling better because who knows when that is, who knows when that that's going to happen. And you could be running pain free for two weeks and think it's better, but then you overdo yourself and it returns. So There's never really like a moment. There's never really one moment to say, finally, my PhD is gone. You can just slowly tolerate more and more and more until you eventually reach your goal. Hope that helps. Thanks for everyone submitting those questions. I know this was over two episodes, but eight questions and a lot of value coming out of these questions. So I look forward to the next Q&A. I'll post on Facebook groups and across my social media. And if you see one, feel free to submit. And if you find me on social media and you do have a question for a future Q and A, don't wait for a post, just submit it and say, Hey, on the next Q and A, can you ask this? I'll be more than happy to do so. Good luck with your rehab this weekend for the next week as well. I look forward to bring you my next episode, which is going to be another success story that everyone always asks for. So I look forward to bringing you that. What else do I have on the pipelines? I have another interesting success story coming up, which isn't necessarily about PhD. But I'm really excited to bring you this one. And I also have another episode on, um, the difference between tendon rehab between males and females. So I've got a fair few in the pipeline, looking forward to releasing that onto the feed and getting you to have a listen. But until then, like I said, good luck with your rehab and take care. 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.