Rebecca’s PHT Success Story

: On today's episode, Rebecca's PHT success story. small 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. I am loving the success stories that have been coming out in the recent episodes. We've sort of lined up a fair few because you listeners request them and I searched for them and, um, a lot of people are getting better from listening to the podcast and, um, if they ever so decide to work together, um, this is. Creating a lot of momentum of positivity. And so, uh, yeah, Rebecca's story started off like horrible. Really? She'll share it. Um, a lot of frustrating years of pain and unable to find answers, especially from health professionals had to, you know, source a lot herself and do a lot of the research herself and has found a lot of success, um, not out of the woods, not 100% back, but you know, Back to doing what she loves, feeling great. And towards the end, we get really specific in terms of the exercises she's doing, how much weight sets reps, all those sorts of things. Uh, and so a lot of practical takeaways that you'll love. So let's dive into it. Rebecca, thanks for joining me on the podcast. Thank you for having me Brody. We appreciate it. Let's dive into people learning a bit more about you. So, um, what I guess, where are you from and like your athletic background and those sort of things before we dive into the injury side of things? Sure. Well, I'm currently live outside of Chicago in the central US and, you know, I've been here about 15 years and, you know, I've always been a recreational runner. When I was growing up, I did cross country and things like that throughout middle school and some in high school. I did some other athletic things growing up, some short stints of gymnastics and some ice skating and different things like that throughout childhood. But running was always my go-to activity and I loved being outside and just experiencing the out-of-doors. I was always very outside as a child. And I spent all my time outside and usually barefoot. But running was always my go-to. It was never a lot of running. I typically did probably one to three miles at a time, maybe a couple of times a week. And it really wasn't until I was in my twenties and thirties that I started looking for other things to do also. And after having children, they started doing martial arts and things like that started getting my attention. And I started doing more of a training regimen. But But strength training and running were always in there. And even throughout that time, strength training was always part of my routine and usually going to a gym. So I always had access to the weights. And I just think that gave me a nice base for my running foundation and the other activities I was doing. And it really wasn't until I kind of switched gears and switched from the gym. to like full on training at something specific that the injuries started flaring up and giving me a hard time. Okay. Do you think there was a certain element of those particular sports that you think might've contributed to the PhD? So I had like a traumatic injury about 15 years ago with both high hamstring where I was stretching and one day and they both kind of went. pop snap and it was like a burning sensation and really painful and I couldn't walk for a couple days. And I'm not sure what that was. I was on vacation, so I didn't go to a doctor. I had a baby. I just kind of, you know, I used the stroller and got through it and got back home. And I talked to my chiropractor about it after that. And you know, we did some regular adjustments and things like that and he kind of kept an eye on it, but it kind of went away on its own. And I think the, my background in the strength training and always doing some heavy lifting with, with lunges and deadlifts and squats really kept it in check. And it wasn't until I switched from the gym to martial arts training that the PhD really flared up and I was no longer going to the gym and doing those other loaded exercises that I really started noticing it and I could no longer. tamper it down. The martial arts we were doing had a lot of kicking, a lot of stretching of the hamstrings. It was very jump based, a lot of plyometrics. And I would wake up in the morning and just trying to get out of bed, my hamstrings would just be screaming at me. Right. Yeah. And, uh, so I went to, you know, went to the physical therapy first, and that was my, my first step and that was. I don't know, like six years ago. So with the kicking and that sort of stuff, it wasn't one incident where you sort of notice a spike in symptoms. It was like an overload of the hamstrings that sort of just, uh, slowly or like the next day. developed into that time. It wasn't one kick or one movement or one stretch. When I was doing the actions, it felt fine. But the next day, it would hurt so bad. And I would use a heating pad or I would try ice. The first round of physical therapy mostly addressed hip imbalances. There was a lot of... crab walking and Swiss ball rollout type exercises, but all body weight. And, um, and I'm sure they were very helpful. And there was probably an issue there of some kind. And, but it did not address the PhD and I had never heard the term proximal hamstring tendinopathy at that point. Um, and I did it for many years. And, uh, yeah. So that was just the first round of therapy. Okay, yeah, that's round one. So they sort of assigned you some strengthening exercises, but seems like their focus was in a different area. It seems like they were more looking at the glutes and the hips and sort of having the imbalance from right to left. And so, you know, maybe addressing the secondary signs and symptoms, but not... Like you say, not really addressing the main cause and that therefore didn't see much of an improvement. No, it didn't. And, um, you know, at the time I was still running because the training was just a couple of days a week and I would still run on the weekends or on the off days. And running didn't hurt. Um, but you know, what I really wanted to do was, was the training and it was really painful. But again, not during, so I wasn't really attributing anything in particular. to the pain. And at the time I was seeing a different chiropractor and I talked to him and he would do more like a TENS unit and stem therapy on the areas. And there was a massage therapist there also and I would talk to her. And of course that area is so high and it's so hard to like to get to. If you're trying to roll it out, even with like a racquetball, it's... It's such a difficult area if you're trying to reach it that, massage therapy, everything else felt great, but you can't get to that area and they don't even know if it would have been helpful. Having listened to the podcast, I know that massaging it isn't probably, it might feel good in the moment, but it isn't actually helping the healing process. But with repeated efforts of talking to different therapists, and telling them where exactly the pain was, that injury never came up. No one ever said, you know, proximal hamstring tendinopathy. You know, and internet research, I started looking at anatomy because that's not my background. And I said, what are the parts of the leg? I want to know what this is so that when I go to the doctor, I can be more specific because no one seems to understand what I'm talking about, you know, and where this pain is. And You know, eventually I went to an osteopathic doctor and her conclusion was that there was fascial distortion. So there was this painful process with her thumbs where she was trying to release and push and flatten out the fascia around the sits bones. And oh God, I'd had these huge bruises, you know, all over my boots. And it was painful. And it was painful for her because she was like, oh, my thumbs are so sore. This is such hard work for me, too. And I was like, is this really helpful? And I wouldn't say that it ever felt better. I was very hopeful because every time somebody had a new idea, I was very optimistic that something might work. And, you know, again, I was still running and the running wasn't having problems. My main problem was sitting. Sitting was terrible. And. Every year I take my two boys and we would drive to my parents' house for a vacation in the summer. It was 12 hours and I knew it had to be split in two days. First of all, they were, when we started doing this, they were young, but so it was good for them, but there was no way I could drive, you know, for more than five or six hours at a time. And we would make many, many stops so that we could get to a rest area and I would run a couple laps. And I do some squats and I had to work out the pain because it was excruciating to continue driving. And I think that was always my biggest concern. And it became a real fear where it was like, oh my gosh, our drive is next month. How am I going to get through it this year? And I would take extra ice packs, you know, like the popping ones so I could sit on them in the car while I'm driving. And you know, and or I would take a heating pad and try to use that in the car, anything to alleviate. some of the pain from the compression of sitting, because that was always my biggest downfall was the sitting. Were you still doing the martial arts as well? Was that maintained? I was, yeah, I was still doing that. And then I had switched to mixed martial arts by this point. So we're talking now probably about 2019. And I'd been working on it for about three years, the PhD and trying to figure out what it was. And so I was doing more striking along with everything else. So there was a little bit less going into just my hamstrings and still running, but not as much because I was now training more like four or five days a week and at the training facility. And... But I still had the pain and I was doing more, more like cycling and different things like that were available, you know, at that facility to offset when I felt like I needed more cardio, I just needed more exercise. But yeah, I was doing that throughout. And it was in, I had a really bad relapse last year. in the winter. And normally my worst leg was the right and this time it was my left and my hip was really locked up and I couldn't do that anymore either. Then I couldn't run, I couldn't kick or do any training, I couldn't pivot and I couldn't stretch and that's when I got really, first I was fearful and then I started thinking gosh maybe I'm just getting old. And I'm not going to be able to do these things that I love anymore. You know, I'm 47. And I said, maybe it's just, it's just age. And, and that was really scary because it was, I've worked really hard all my life to stay fit so that I can do this forever, you know, or as long as possible. And, and I said, you know, it's been about a year since I've really looked to see. Let me try again. So I started searching again and. At first I looked at anatomy again, and I'm like, I know this is what it's called. I know this is my proximal hamstring. I know it's right around the sits bones. And I just started Googling different terms and proximal hamstring tendinopathy came up and I clicked on it and there was, Bertie Sharp. And your podcast, the PhD podcast, the specific came up. I didn't even know you had the. the other podcasts, the run smarter one, I was just like, Oh my God, that's, you know, I've never heard that term. And it was so exciting. And, um, and I started reading through the information first. And I think the thing that really caught me was you had the shoe off test and, um, I didn't even have to do it. I just said, yes, that's, that's it. That's, that's the thing. That's the thing that it is. That's what I have. Um, and I've seen so many doctors. and four different therapists and chiropractors and massage therapists. And no one has ever said this to me before. And I was like, here's somebody across the world who knows exactly what I'm talking about. And that was so exciting. It gave me so much hope to be able to find someone that could just put a word to it and name it for me. I'm glad the podcast is high up there in the SEO of typing in proximal hashrington and opthia and the podcast turns up. That's, it's good to know. Yeah. I also wonder if it's just not. Not a thing or not something that's as commonly talked about in the US yet. I mean, I think, you know, Australia and Europe just seemed to be in a different place with therapy, whereas here it's still You go to the doctor and the doctor might give you a referral to therapy, but your first stop is the medical doctor. And, and they don't know what it is. They're just like, Oh, you need to go to therapy. And, um, and those are at least in where I am is they're big clinics that are big chain clinics, you know, that are just like plopped everywhere in the shopping centers, um, you know, and you don't get very detailed information. and they're not really very interested in listening, you know, to your systems. I'm not entirely sure. I think the whole world's taken a long time to catch on to PhD. I think that's a global issue that's, you know, a lot of people in the UK and I get people in Australia, they've had a similar experience. So the understanding of PhD is probably really, really struggled, you know. worldwide, but I do think the process that go like your process of going to a doctor and the process of getting the right answers is maybe a little bit behind in the US. I've seen, well, just my connections as I've like been talking to people on injury chats and those sorts of things. But I guess from the time that we started talking together and the time that you first got those, martial arts. How long all up would that have been? Um, it was about six years. Wow. Yeah. Even just talking about your annual drive and with your kids and saying, Oh, well, you know, that time of year is coming up again and starting to get that worry and starting to get the, um, that anxiety, you can tell there's been going on for a very long time if every year that rolls around and, um, you start to become more apprehensive about it. So, uh, sounds extremely frustrating. Sounds like a, um, really been put through a lot of discomfort and a lot of worry and anxiety for a very, very long time. But I guess, um, how long from listening to the podcast, did you then sign up for an injury chat and jump on a call with me? Oh my goodness. About two days. I start, I found it and again, I was reading through it first and just reading the information. I immediately started the PhD podcast and listened to the first 10 episodes. Um, and binged them in like two days and said, I have to do this. Because I was, and I was doing some exercises, but it was so painful. And I felt so locked up that I was very apprehensive about hurting myself further. But I did start adding some step ups and doing starting deadlifts again, but I start really, really lightweight. And I remember we jumped on the injury chat within a week. And I was like, I have that drive coming. And I talked to you about the drive. And the drive went okay, because with the left leg, the sitting wasn't so bad. The right leg has always been really bad with the sitting. So the drive last year wasn't bad with the sitting. It was hard to move around because my leg was so locked up. But... the driving itself was okay. And the right leg at the time was not in a flare up. It was actually oddly calm. Maybe it's because I was so focused on the left. I just didn't feel it in the right as much. But, and it was shortly after I got there, that is when I was like, I wanna start working with you. I was on break for the summer, cause I'm a teacher and I was at my parents' house and I was like, okay. now we're gonna start working on this. And I took like everything I could take in the car as far as like hand weights and stretchy bands because I wanted everything that I could possibly have, you know, that I would need to start with you, you know, at the ready. And yeah, and you know, I think one of the first things you did was kind of take some of those exercises off because I was so excited about finding the right exercises. I was trying to do them all. And- It was like, you know, let's not do A, B, and C. Let's just really focus on the basics until you're really calmed down and back to running. Because at the time, this flare-up was so bad with the pain in the hamstring and the hip being locked up that I couldn't run at all. My leg wouldn't tick over at all. So we started very slow. There's probably about 10% of the time, I'll start working with someone and know straight away that they're doing too much. And it might not necessarily be in your case, but I've seen people do five, six exercises and they're kind of either body weight or like, you know, some light curls or deadlifts and they're doing it twice a day. And you know, their symptoms are constantly hovering around a two or a three. all day, every day throughout the day. And I'm like, you just get that in that sense that, you know, they're doing too much, that the body's never going to have that recovery time and never have that downtime. It's sort of one thing that people get stuck in. Like I said, it's probably about 10% of the time, most of the time people aren't really privy to loading it up and actually doing more, or they need the encouragement to start doing something that's a little bit heavier than what they're used to. But Is there anything from memory when we started working together, anything that might've surprised you or anything that might've, um, you know, been counterintuitive to what you thought we might've, the process we might've gone through any lessons there? Um, you know, the way you laid it out was so helpful. Um, you know, a spreadsheet and being able to see the, the exercises, but also that the progressions, um, I thought. That was really helpful because it helped maintain optimism because I could see that, you know, I was gonna be doing, you know, a certain weight or a certain load for a couple of weeks, but I could see where it was going. So even if it felt like it wasn't very much exercise and I wanted to do more, that if I was patient, I was gonna get there. So I found that super helpful and Um, I was surprised at some of the very specific exercises that made it hurt. That, that just targeted that area. So specifically, um, I think the one I hated the most for the longest time was the, um, the standing hip extension with the TheraBand, man, I just thought that would never ease up. No. you know, no matter how that went every day, the pain was always the same. And, you know, that was surprising. I just, you know, I expected things to just start kind of get better all at the same time, but the different exercises, I progressed at different rates and at different speeds and the amount of weight that you could stack on was varied so much from exercise to exercise. And I could feel which exercises were helping the most. And not just in targeting it, but that the more weight I added, the better it felt the next day. What sort of exercises with diaphan? Yeah. So with the left leg, deadlifts was a huge, huge thing for me. And the Nordic hip extension. And You had me doing the ones, the dips, right? Not all, not, not all the way down to the ground, but, but dipping at the hip. And those really helped. And deadlifts, which I was really hesitant about deadlifts, which I've always done, but I've always kept them very light because I have a history of low back, um, injury where it gets locked up and I can't move for a couple of days and deadlifts just kind of scare me. And I'm still working on that and getting over it. Um, but we started really light and I could feel it though in my leg. And I knew I was like, I'm doing them right. And I I'm doing it safely and slowly. So, you know, I'm going to be okay. And the more weight I could add, um, it helped it so much, so much better. Um, so much more quickly, um, what the dead lifts. Can you remember, I could probably pull up the asperger now if we don't. But can you remember what the starting point was for the deadlifts? Like how much weight you were lifting and the range of movement and that sort of stuff? Yeah, at the time, because I had hand weights, we were doing, I think I was starting with a 20, 20 pound total weight with the deadlifts and. And it would be increased about like five to 10 pounds a week, um, you know, for the first couple of weeks, just to get my body used to doing it again. And, um, once I hit about 40 pounds, I really felt a big difference. That's when things started progressing much quicker, um, with the step ups as well, that we started body weight step ups and And then it went to 10 pounds, and then it went to 20 pounds. And one time I got to 30 pounds, things started really picking up quickly. And the pain was really diminishing. Yeah. I was just looking at the program now and don't think we really have the starting point, I might've removed the starting point, but the, for those who are listening, the Nordic hip dips would be like the same setup as what people would. Now is like a Nordic drop where you sort of pin your heels or feet down. You know, most people tuck them under furniture or you could get like a Nordic tea bar or something, but instead of lowering your whole body down, you're actually dipping at the hips. So your femurs or your thigh bones stay vertical as you sort of dip forward, like a drinking bird and come back up. And I think I had you, like we really reduced the range of movement. We started like maybe half range of movement. three sets of eight or something along those lines. And like you say, the step ups were body weight and the dead lifts as well. The hip extensions are something that I find people, some people are totally fine with and others really struggle. And why that is, I'm not entirely sure. I guess it's just the way the hamstring works. It might be a particular vulnerability for some people and particularly why your shoe off test. was quite aggravating because that's a very similar movement or a similar requirement for the hamstring. But for those who aren't familiar with that exercise, so you have a band sort of attached to something on the floor in front of you, and then you wrap that band behind one of your ankles and then while you're standing, you sort of just swing that leg back behind you and apply tension that way. And sometimes if that becomes too irritating, I have people pull back just to neutral. So they sort of start with that band in front of them with the leg in front of them with the band around their ankle. And then you sort of pull back just to meet the distance of the stance leg. And that can be okay sometimes, but how long do you reckon it took before you started to actually notice an improvement or some sort of change with that particular exercise? With that exercise, oh, at least two months. Okay. And was there any, what were the symptoms during and after? Like, was there a sense that symptoms were falling with unacceptable and just not getting better? Yes, with that particular exercise, it wasn't any more painful. It wasn't more painful during the exercise. Like every day it was always the same. And before or after it was fine, but just performing the exercise was just, it was, it was, um, and not really painful. It's just this kind of pain that just really grated on me because it's such a stingy sharp pain. Um, and when that finally started going away, I noticed it immediately. I was like, doesn't hurt as bad today. And it was very exciting. And now it doesn't hurt at all. I still do that. It doesn't hurt. And it's, it's so, I'm like, I can't believe this doesn't hurt. And I can extend behind me, um, you know, and I stand further back and I'm using a heavier band. Um, but I really thought that would never, never alleviate. And good to know for some people who are doing their deadlifts or stepups or hip extensions or some particular. exercise where they're not seeing too much, but they're doing it consistently and symptoms are falling within acceptable limits. But, you know, it took you two months to see that carry over and then see that momentum from there. I kind of think of it like, you know, if you're planting a plant and, you know, it sort of grows its roots underneath and you can't really see what's happening on the surface, but it's actually doing something, it's doing something good and then as soon as it sprouts and you can see the momentum and the growth from there, then, you know, it's all happy days and it's good when you can visually see some improvements, but might take a lot of time for those roots to grow underneath. And you did mention as well the deadlifts, progressing the deadlifts to about 30 pounds was when you started to notice some momentum. Yeah. And it took, you know, it took probably about a month to even get to that, just because we were being very cautious. And, you know, we had started with the run walk. I think we started with a one minute running, two minute walk. And I was actually surprised that I was even allowed to run that much at the time, because it was still, you know, painful and locked up. And But it was really exciting when I could do that 10 times. And then we went to two minutes running and one minute walking. And I did that 10 times. And I started actually realizing, wow, I'm actually like, I'm covering some distance. It takes a long time, but this is really great. And it gives you hope. And along with the strength exercises, You know, we went slow with those also, but, um, as the weight went on, you know, the running started feeling better. Also, you know, they, they really do work together. And I, I'm so thankful that you include the running, you know, and there's not like you can't run or we shouldn't be running until you can do certain amount of strength training, because when you can do them both and you're feeling like I'm have a running day and then I have a strength day and you're, you are covering distance. Um, as you're healing, it really does give you hope for, for healing and, and something that you've had for so long. Um, you start to see that it might, it may not go away completely, but you'll be able to get back to activities that you enjoy. And, um, and I just, I think that's one of the things that I find the most beneficial that I've had working with you is, um, not just that I have improved so much, but that along the whole journey, it's been so uplifting, and there's so much information and everything about the exercises and the program has worked together so well and really just, really helped me get things back. I feel like I can run again and I can do things. And... I've come so far and you know it's been almost a year and you know I'm not training in martial arts but I can do what I want to do and it doesn't hurt and there are flare-ups along the way and I know what to do with them. You know I know better how to handle it and it can still be frustrating and get you down but but having a plan and going back and seeing the exercises and how they've helped because keeping the comments on things from day to day really gives you a timeline to see how you've progressed and where something might have gone awry and back off on certain things. Going back to your insights about doing a little bit, doing a little bit of running. at the start sort of really helped you. I think it does help most people just with their headspace when it comes to rehab, because some people might say, you know, when can I get back to running? How strong do I need to be? Or when can I get pain free in order for me to start running? And like you said, there's two pillars that you can work concurrently. One's the strength side of things. And the other is running or whatever exercise you love that you want to return to. It's not just as simple as, okay, I am now ready to run and I am going to go back to what I used to do. It's all about level of tolerance and we can substitute the running for cycling, for swimming, for sitting, for those who aren't that athletic or don't have those goals. If someone has pain sitting, let's just find out what you can tolerate and let's keep doing that thing. and then keep building it up once you can tolerate more. And it can be a mind shift for people. And it's, like I say, it puts people in a better headspace because if they're doing the things they love, maybe not sitting, but if they're cycling, then that's, you know, it might just be a little bit, but that's a little bit of time that you're in a positive mindset and can actually see the goals. All I need to do is just do this a little bit more next time, a little bit more next time, then I'm back to Um, or I'm on a really good roadmap for getting back to what I really want to do. Um, so yeah, good for people to think about back to the, the sitting side of things. Was there a moment when you started to notice some improvement in that domain? Cause it seemed to be in the early days, that was really one of the most debilitating and painful aspects. Um, well, since it wasn't, I didn't have as much problem sitting with the left leg. It was mostly the right leg. The sitting with the left when we first started working was okay. That was really just the movement that was so bad. With the right leg, so the right leg, the PHT comes and goes much more frequently, which, you know, now obviously the exercises that we do, we do on both sides. You know, I know the right leg is strong, and I did have, you know, flare up after the holidays. And I know I reached out to you and you know, we had a brief, you know, discussion or reminders about, you know, just holiday stress and dietary changes that might cause a flare up and things of that nature. And, and the right leg it did, it was back to the sitting again. And it's not just sitting, it seems to be more of driving, which was always my concern doing the long drive. It's like the pushing the pedals and things like that. Um, because even with the current flare up that I had on the right, the sitting wasn't a problem unless I was driving and with the right leg, the thing that helps the most, um, are the step ups. So the heavier I can get with the step ups, the better the sitting gets with the right leg. And, um, and I found that interesting too, because it's a different exercise, depending on which side of my body it is. And the step-ups, so now I'm up to 40 to 45 pounds when I do the step-ups, and the heavier I can go with that, the better the right leg gets every day, and as far as sitting also. So again, I just keep going back to the same exercises. I never stopped them, but picking them up and sometimes even doing them every day. I find really helpful, you know, and paying attention to see how I feel the next morning or right after, but, um, sometimes getting an extra session in a couple of times a week does make a big difference too. Yeah. Cause you can have that analgesic effect where, you know, loading up that tendon actually makes you feel better during and, you know, several hours afterwards, and if that's sprinkled in more often throughout the week, then that's just more time. with less symptoms. And so understandable that people can have that reaction. What people need to be cautious about is going back to that scenario I was talking about before where people are just overloading themselves way too much and they're hovering around a constant two or three out of 10 pain because they're constantly loading it or constantly overloading it in like a chronic kind of state of overload. And so that's where that balance needs to really come in. And what I would say on that front, Sometimes to have an analgesic effect, you only need to do like maybe one or two sets of a particular exercise. It doesn't need to be three or four sets to really strain and stress and build strength like you would if you wanted to accumulate or build capacity, but that analgesics can be considerably less, which means you can do it quite frequently throughout the week. It's just a different stimulus. So maybe that's where people can find the balance. Yes, and I agree because what I would do and what I've been doing is if there's a lot of pain, I come down, because I come down to the basement and I'll get the bar and if there's no weights on it and I don't have a lot of time, just even using a barbell and doing like two sets of 10 makes it feel so much better and doesn't cause any pain and everything feels the same when I'm finished and the next morning. And it hasn't been the day to do that. So I didn't do the full set at the right weight, but just adding some of those exercises back in with some load is very helpful. Yeah. And sometimes if, like you, if you do notice that analgesic effect and you sort of want to try and find the balance between, okay, I want to build strength, but I also want to load it frequently throughout the week to maintain a good analgesic effect, what people can do is kind of. fluctuate where they have one day where what we call a heavy day or a high day where there's a lot of Load that's your goal to build strength. So you're testing your limits You're doing your three sets of eight really heavy or like a challenging sort of heaviness but then after that heavy day you have you can still load it but a light day and that's where the Doing the bar with no weights two sets of ten and just have that analgesic effect But throughout the remainder of day not that challenging And then you can have a moderate day and then put that on like a, a cycle. So it goes high, low, moderate, high, low, moderate. And you can sort of, um, get those or maybe a rest day in there as well. But the, that can be a nice balance for people where they can still see progression with their strength. Cause they've got two or three high days. Per week, but then several low and medium days to, yeah, to grasp that analgesic effect can be quite helpful. You mentioned before, flare ups, setbacks, hasn't been smooth sailings the whole time. With this entire journey, how do you think differently and how do you behave or act differently when it comes to dealing with fluctuation symptoms and flare ups and those sorts of things? The first thing I do is remind myself that pain doesn't equal damage. Because when something starts flaring up, my initial reaction is still to back off. And sometimes backing off for a day or two is helpful, but mostly during that time, I am reflecting and thinking about what it might've been that caused the flare up. so that I can get back to it as quickly as possible, but take off whatever that extra load might have been and test it out one little thing at a time. And that while reducing the fitness for a couple of days might give it extra time to recover, I can continue to load it and... and strengthen it and bringing everything back to baseline. I feel like I have an understanding enough, especially of my own body, of where that baseline is, understanding the pain scale and my tolerance that I can bring it back down and keep going without producing fear that I'm hurting myself, that I've done something wrong, that I'm never gonna be able to do it again. You know, that, oh no, I've lost everything. You know, I think it's just been really helpful to build the confidence that I can help take care of myself. I have the techniques and, you know, I've gained some of the skills and, you know, an understanding of my own body and how it works and that I can handle it and everything's gonna be okay and we're gonna get back to it and we're gonna keep going. you know, and I can keep progressing. And I think you get more confidence the more flare ups you have. Like flare ups are part of life, but you know, the more you can negotiate it yourself and sort of do the testing, it's confidence building in a way. And it's reassuring to know that, okay, I've been through this before we can get through this again. I think I've said it way too many times on the podcast, but you can learn from every flare up. days off to help calm things down. And one of the first adjustments I make is if they are a runner or if they are a cyclist, you know, dialing back those areas first before dialing back the gym stuff, because we know that the slow heavy stuff can be quite safe. Maybe backing off the range of movement. So the deadlifts may be not full range, the step ups may be reduced in the height of the step. but still fostering that time under tension and that load and trying to still create that analgesic effect like we're talking about before then when things head in the right direction, dialing back up the running, dialing back up the cycling and those sorts of elements that might be a little bit more threatening. I've usually found for most flare ups is a good, that's where I would prioritize things, the running first, running and the cycling, but then trying to preserve the strength that in the gym as much as possible. That's the last thing that can be dialed back. Um, but yeah, some good, good things to learn from there. What's your current strength routine? So how often in the week, what sort of exercise are you doing? I think you mentioned the step ups now are about 30 pounds. Um, can we go through those numbers? Sure. Um, so, um, I have currently, so we're just. You know, it's finally warming up. It takes a long time here to get warm. It's cooling down here. So, yeah, I'm jealous. I tried, I've tried really hard to embrace winter running and, um, and I think I did pretty well. I was a little concerned about slipping on ice. Um, as long as there was snow, I was okay with it. Uh, you know, most winter days here are like 15 or colder, but, um, you know, I, I geared up and I did it. as often as I could, which was maybe once or twice a week. But things are getting better now. And so currently I'm running three days a week. I do a long run on the weekends, which is about 10K in my long run. I do two, five to six K runs during the week. I strength train three days and I have one dedicated rest day. As we... As I wrap up the school year, um, I might switch a strength day for a running day, just because I really want to get outside and run more. And, um, it's beautiful now. So I want to get outside as much as possible before it gets cold again, which happens quicker than we would like. And, um, so with strength training, I do, I do upper body stuff as well, but my lower body, um, I do deadlifts. I'm up to 65 pounds on the deadlifts, which is I'm almost at two-thirds my body weight. So I'm feeling good. I'm taking it really slow. But again, I, you know, it's I still have the I have some tennis elbow issues. So sometimes I have to back off on some of the weights. So that's the deadlifts. The step ups are at 45 pounds. Um, I'm doing, so is that, um, two, so you've got 45 pounds in total. You know, yes. And until on a barbell. Okay. Yep. And how high would the step be? Uh, it's knee height. Okay. Yep. Great. So, um, and, uh, the prone hamstring curls, uh, we started with a band and now I'm up to 40 pounds. Um, with a cable or with like the, one of the machines that you can attach to with a bench at home. Yeah. Yep. Um, so that's two legs at the same time. And, um, what else am I doing? Lower body. I'm still doing the, the hip extensions with the band. I'm just using a heavier band and I'm going behind me now. And, uh, I do too quick and too slow. Oh, well done. And, um, What else was on our list? I think I prepared, I might have it here. You mentioned the Nordic hip dips earlier. Yes. Oh, full range of movement now, full range of movement with the five, I'm up to a five pound weight holding a five pound weight. Well done. With the full range of movement. Very tough to do. Um, so that's exciting. And, um, I have started squats. That was one of the things we took off and I'm. I'm keeping that light because sometimes I'm, sometimes I feel like that flares it up, um, a little bit more. Um, it kind of depends on if I've been running more Hills or not where I've been running, if I, if I take the squats in or take them out for a day, but, um, I'm keeping a pretty light, I'm at about 50 pounds. I'm depending on the amount of Hills that are in my runs. Um, but, um, And the single leg bridge on a step. Um, I'm still doing those and those are, you know, there's still, uh, the step has gotten higher. Um, sometimes I hold weight. Um, you know, it's, um, it's kind of just one of those, it's an analgesic one for me. It feels good. And, um, it just fits into the routine nicely when I'm doing it. It's just like, oh yeah, let me do that too. Um, So yeah, I think, I think that's, that's the, oh, and calf raises. Cause, cause I know those are great for running. And as I'm doing, I'm doing those at 70 pounds, my calf raises. Okay. Full marks. And I guess in the last couple of weeks or like, you know, um, during some of your good weeks, what would symptoms be like for the running, for the exercises, those sorts of things? My left leg is zero. Wow. Zero. It's amazing. I, I'm. It's just, I run and I just, I'm like, my left leg doesn't hurt at all. It'll just dawn on me like, oh my gosh, like it really doesn't hurt. And I just, a year ago, I couldn't walk. I could hardly walk. And it's just amazing. I did my mother's day 5K a couple of days ago. And I was just hoping, I just, I was like, I can't go crazy. I know there's a lot of hills in this run. And... I don't want to hurt myself, but I would really like, I'd really like to have a good run and do it in like 31 would be like great for me. And, um, and I woke up, my throat was really sore and I was like, I don't even feel good today, but I went and it's so exciting and I haven't. This is my first race. I hadn't done, I mean, I did a Turkey truck, but that was in our neighborhood. And this was like the first time I signed up for something in many, many years, probably 15, 20 years. And, um, So it was really exciting. And I ended up coming in at like 29, 46, I think was my time. I was so excited. I was like, oh my God, my normal running pace is like 11 and a half minutes a mile. And I was like, that's so great. Yeah. And so it was very exciting. And, but my right leg is probably at about one to two pain when I'm running. Again, it's like when I'm sitting, it doesn't hurt. It's when I drive. And it can be a short drive to work is 25 minutes and man, I just can't wait to get out of the car. But then it goes away. And I'm reminding myself that that's not damaging myself. It's not hurting the tendon. It's just that that's what produces the pain for me, that it's okay. And I just remain calm. I think remaining calm is a good... ruminating negative thoughts, the perpetuating, catastrophization, all that sort of stuff. It's very, very common, especially as soon as you have a flare up, everyone's like, oh, I'm back to square one. Is this ever going to get better? Like all those sorts of common thoughts do manifest, but it's a good reminder, you know, not doing any damage. Yes, it's sore, but hurt doesn't equal harm. Pain doesn't equal damage. You're strong, you're capable, you're doing so many like strong, like, you know, in the gym, you're doing, you're very impressive with the amount of weights and things that you're currently doing and the progressions that you've made. So, you know, that's more encouragement than anything. And what's next? Like, what are you working on? What sort of goals do you have? And what do you look forward? What will you be working on over the next couple of months? Well, I'm excited. I'm signing up for a 10K. It's not until September. So I have you know, lots of time. I already run that distance, but I want to finish strong. I don't just want to finish. You know, I really want to feel good about it. And I'm adding in speed work. That's something I've been hesitant about whenever I would try strides. It would, I wouldn't get a flare up, but I would feel more pain than I would hope to the next day. So what's been working for me is adding in more like intervals. you know, throughout like doing 10 seconds, um, the first 10 seconds of every minute, you know, for five rounds in the middle of a run. And that seems to be really helpful. And I'm not having any, there's no ill effects from that. Um, so I'm just trying to do that more. Um, and I actually, after listening to the last podcast, um, got the app for the, my motive and, um, he has, there's some workouts on there that are like that too. So. I just started that a couple of days ago. So I'm looking at that to see how those fit in too, because speed work is in there as well. But yeah, I want to finish this 10K. I want to finish strong. I'd love to have a great pace. I'm just looking forward to more running and continuing the strength training. And I'm running more now than I ever have, like ever. And I love it. And I feel like I was getting through that first like 2 miles on a long run and then I just like run and I – I don't wanna stop. And I run because I – I stop because I have to because like, oh gosh, I gotta get back home. I gotta make dinner, you know. But it's so exciting and it feels so good and I'm just – I'm so pleased and I'm so – I'm so happy that – that I can just continue getting stronger and doing the things that I love. Dr. Justin Marchegiani... Yeah. Well said. Is there any, you're very welcome. Are there any final tips or any final takeaways that we might not have covered that you think someone recovering from injury or having PhD might benefit from? It's not permanent, right? Any state that we're in is always fluctuating and this injury in particular is stubborn and irritating and painful as it can be. It can go away. And even if it comes back, you're stronger and it can go away again. And, you know, it's, you have the tools and once you have those tools, it's so much easier to handle it, you know, as it comes up. And I find, you know, of course, those tools are helpful for any injury, tendon injuries. And I remind myself of that also. And I think just. reminding yourself that our bodies are meant to yield themselves, you know, if we know how to do it properly, and really looking for the right help. There are people out there that know how to help you. And sometimes you just have to be really persistent in digging for that information to find it. Yeah. I think that encapsulates your journey pretty well. I think they have, you know, you're talking about much time it takes you. Like one of the big factors here is patience. It took you a couple months to start seeing improvements in your hip extension, but you persisted. And there was getting back into the running. Yes, it was slow. Yes, it was short, but you have patience and diligence and you get into it. But not only that, but addressing the emotional side and the psychological side of recovery, I think you do really well. It seems You're seeing the positive side of a lot of this, rather than focusing on the symptoms you currently have. Like you say, you still get symptoms in the right leg with driving. People can fixate on that, but you have been focusing a lot of your attention on all the things you're getting back to, doing more miles than you ever have, doing your first race, how good you feel when you start running, focusing on all those things that you can do and have regained rather than what remains or... you still need to work on. I think focusing on all those positives is tough to do when people are in pain, but needs to be a good reminder because the overall experience is better and you recover a lot quicker when your mindset's focused on those sort of things. So yeah, anything else before we wrap up? Um, no, just thank you. Thank you so much for putting all this information out there and making it available. It's so helpful. And I think you're helping so many people. 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.