Rob’s PHT Success Story

: On today's episode, we have Rob's PHT success story. helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments and... 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 once again. We have another success story episode. I know these are very popular and highly requested. And if you have your own success from either listening to the podcast or just on your own, having your own insights, reach out. Um, we can see if this format and jumping off for a podcast episode is a nice story. Nice compelling. Um. Insights that would help a whole bunch of other people because even just in particular this week, I've come across a lot of injury chats where people have been very discouraged and in a very, I guess, negative mindset because websites, forums, Facebook groups, um, just all of those tends to generate, manifest a bit of negativity. usually the ones who have had it for the longest and it's been the worst and they've tried everything in their mind and they can't find the answers. They're the ones that are likely gonna post and publish and ask. Understandably, if you're in a lot of pain and you're confused, posting those sorts of things is what you wanna do, but someone else can, you know. join that forum or join that group and then scroll down the feed and be like, oh my God, am I ever going to get rid of this? It looks like this is a condition that is never going to get better. It doesn't seem to get better for anyone. And that could negatively impact your own rehab. And so because the way that these pages and forums and groups naturally compel the worst to publish that sort of stuff. It just looks a lot more skewed. There's a lot more of a skewed population sample size and it can look all doom and gloom. But this podcast here is here to spread a bit of positivity, encourage you that you can overcome this and there are ways to do it. And so these success stories are to show you that, yes, they have been there. Yes, they have had these mindsets of, is this ever gonna get better? And they've started doing the right things, investing in the right knowledge, implementing the right strategies, pretty much what this podcast entails. And you know what? They get better and let's sing it from the rooftops. Let's, you know, publish it to everyone who feels like they need it, everyone who feels like they need that positivity. So that's what, one of the main things that I love about this podcast, having that forum. So if you have some positivity to spread, reach out to me, let me know. Um, And we can dive into Rob's success story, who he is a urologist. He's a surgeon. He's a scientist as he will explain and has a pretty compelling rehab success story. A lot of lessons, a lot of insights and you're going to love it. So let's hear from Rob. Thanks for joining me on the podcast, Rob. Thanks for having me. It's a pleasure to be here. Yeah, exactly. I'm very happy to get you on to tell your story. Cause, um, It seems like it's been quite a long yet, well now rewarding journey. Um, for those who, uh, would like a bit of a backstory before we get into the PhD stuff, could you just maybe introduce yourself and sort of a bit of insight into your, your background? Yeah, thanks. I, uh, my name is Rob and I'm in Texas, San Antonio, Texas, and, uh, I am a urologist, I'm a surgeon and a scientist. And I've been running for a few decades now. I started out with triathlons and then I quickly went into, uh, trail running. So my favorite type of runs were long distance, ultra runs. I did a lot of marathons and a long, a lot of, you know, long distance trail running. Excellent. And so what, what are some of the races that you have completed? Do you have any of your favorites? Yeah, so I mean, I started out doing, you know, just trail runs that were available in the community. And as I worked my way up, you know, 50 milers were kind of, you know, 50K and then 50 milers. I've done 200 milers. One was Leadville and I finished under 25 hours for Leadville, which was really a great race. I did another 100-miler in Southern Oregon. It was called Pine to Palm. And I've done a bunch of sub-100-miler ultras, 50-milers, 50Ks, things like that. And then I also kind of routinely did a marathon each year, the San Antonio Marathon. But I'm not a super fast runner. Like I haven't qualified for Boston yet, but... I did okay on the ultra runs. I would, I guess I'm, I like that terrain better. Hmm. Prior to the PhD, um, did you have any other significant running related injuries doing this long distance stuff? Oh, you bet. I mean, I, you, you name it. I've, I've injured it. Um, so, and that was part of the problem because you get so used to managing your own injuries. Um, I've had Achilles. Uh, I had. plantar fasciitis, I had IT band. So yeah, I've had plenty. And the next question would be, well, how did you manage those? And you know, that it was for me, it was always just stop running rest and they got better. And I mean, I had a serious Achilles tendonopathy and I remember just taking, you know, two weeks or maybe four weeks at most off and, and I was able to come back. But not with the, not with the hamstring as we'll talk about, I'm sure. Let's get into it. So, um, was it during a particular part of your training or any particular factors that led to the onset of PhD? Yeah. As I was kind of thinking back on, you know, what led up to it, it was a, and this has been several years now. I mean, my injury occurred in 2017. And It was the fall of 2017 and that was a busy year. I had run a lot of ultras and I was just running, like I had no limit. I would just sign up and do the next race. And I ran a downhill marathon in Utah in September of 2017. It was a big cottonwood and my wife was trying to qualify for Boston. So I said, I'll run with you. And that... evening before that race was when I first felt the hamstring. So leading up to that, and I ran it anyway, I ran it the next day despite that pain, but leading up to that I had run an ultra maybe a month before, like a 50 miler or something, maybe a 50K before, a month before. That whole summer I was running long distances. So I think a combination of ultra running. And then speed work on top of that to try to run for marathon. You know, if I had, and plus my age, I mean, I'm, uh, you know, 46 now. So as I was getting older, I think that combination may have led to, to this and you know, absence of any other. Shrink training. It's very hard to identify like a training. Like an increase in your training load or an abrupt changing your training load when you're just going from race to race and you're already at such high mileage, like when you operate at such a high mileage and just really nearly picking races to go to it's fun. But I guess that lacks a bit of structure or lacks, it's not like that gentle build up and prepare for one race and then you have an off season and then gently build up again. It's that lack in structure can catch you off guard at times. Absolutely. And you know, I felt invincible. I mean, I felt that, you know, I knew I could get through injuries before and I felt that I could, I could run anything. I mean, I knew my, I knew I had to watch my speed, but, um, I didn't watch, I didn't carefully watch my mileage as I should have. And so you said that prior to that race symptoms started, that's when you first felt it in the hamstring. Um, what did, what were the sensations like? Yeah, I was, it was, you know, it's so funny because I remember that whole evening so clearly. I was using my wife's, this, what is it? It was just a ball that I was just rolling my leg out and I felt pain in my left, what we call the sitz bone or the ischial tuberosity, very high part of my hamstring. And I thought, oh, that's interesting. I hadn't felt it when I was running, but that's really tender. And, um, and I, you know, I thought about it for a few seconds or maybe, you know, less than a minute and didn't think anything more about it. Said, oh, it's just a little minor pain, but it was clear that was, um, you know, a sign of things to come. Uh, so it was just a pain with pressure from that, um, that lacrosse ball. that elicited it. But it was not, there was other than that when I, other than using the ball, I had no pain at rest and I didn't remember any pain before when I was running. And the next day, you know, the marathon started high at a high altitude and it was all downhill. I don't remember any pain during that race. And I finished that race with a, with a, you know, an okay time for me. I didn't, I wasn't limited by pain. It was, it was a couple of races later, like a short distance eight-miler that maybe was two or three weeks later where I had to stop and I couldn't finish it. I had to walk, uh, walk back to the finish line and that, that's, so that's like October 2017 and that's when I really set in that I have something that's not trivial. Okay. So would you have said over that course of two to three weeks after the marathon that symptoms to start to linger and just become more annoying up until the point where you had to quit that race? It was subtle. I didn't really appreciate the symptoms at that time when I wasn't running. I don't remember having symptoms in the very beginning, but after I ran that eight mile or where I had to walk, then I really noticed that I had symptoms at rest or symptoms without Okay. And so I guess the level of urgency started to rise and what did you seek answers? Like, did you have a diagnosis pretty early? Yeah. I mean, you know, so I, I read and I tried to distinguish, um, a hamstring injury versus sciatica versus a, um, So I kind of used a differential and I think I figured out that it was hamstring. And then I did the usual approach which is rest and stop running. And I remember that year I was signed up for a marathon in December and couldn't run it. And I thought two weeks. At first I thought one week and started running again. That didn't work. And then I tried two weeks. Um, then I tried a month and it was that kind of thing. And you know, um, because usually a month that's the most I've ever had to take off to heal a tendinopathy. I guess it's very much like human nature when there is an injury to say, okay, my body would just do a good job if I rest, but it does a good job of healing. So let me just take time off. Um, and that's usually. like a pain rest weakness downward spiral that I like to talk about on the podcast. And it just fosters a bit of weakness. But did you notice that like in those rest periods, was there still, was there pain like day to day stuff, or was it only once you just resumed running that you're like, yep, still there. Let me take more time off. It was pain even during those rest periods. So the pain never went away. And I didn't feel. that I was that the, you know, maybe in the very, like when it was super intense, maybe it got a little better with rest, but honestly, it, the pain was there during the rest period. Um, and that, and it just wouldn't go away. Okay. And so at what time did you shift your focus away from restism working and start looking for other alternatives? Yeah. So I think it must've been, you know, moving into the new year 2018. So that's six weeks. I've been out for about six weeks now, not healing on my own, not healing with my usual approaches. And so I sought physical therapy and did that for a while. And at that time, The physical therapy and I can go into that detail too Brody if you want but that the physical therapy that I did at that time was a lot of stretching and some very basic isometric a lot of bridges and kind of very basic things which are good or fine but I didn't get better quickly enough and I kind of got discouraged. Okay. Did you notice or can you remember if the stretching was more effective than the isometrics? I never felt that stretching helped. I mean, I, and I stay that now, like I, I don't stretch now. I mean, other than, you know, a little bit, uh, but I never felt that stretching helped me if anything, it hurt me. Okay. And the isometric bridges. So holding those glute bridges, did you notice any improvement? If it, if there was improvement, it was very minor. I will say that for me at least, a single leg bent where my knee is bent and then I'm raising up my…that was a good assessment for me. That could really elicit the pain if I were to do that maneuver. It would just cause the pain immediately. As I did the isometric, the single leg bridges… Um, I got a little stronger. And so that, that assessment that, that raising wouldn't hurt as bad. Um, so I think that was, you know, that was some area of improvement, but it didn't help me to have, you know, with regards to running, I didn't get better with running at that point. Which makes sense because oftentimes people are prescribed glue bridges and they see some noticeable improvement as mild as it might be. Um, but. is less functional. So if you're wanting your capacity to raise, you know, 50 times to at least get to the demands of running a glute bridge is like, you know, raising it up to five or raising it up to 10. So there's like a little hiccup of improvement, but the attendance craving like a progression, let's get heavier, let's get into more meaningful functional sort of movements. But a lot of people surprisingly just stick to the glute bridge, whether it's Um, because they have that initial success or because any other progression causes mild discomfort. They just stick to that, that home base and then, um, don't it just plateaus and just stays there. But, um, interesting to hear your experience as well. So, and I think, you know, your point. So, and there's a lot of misinformation, uh, out there. Um, and you know, I was even told, uh, I saw two orthopedic surgeons. And, um, at one point I was told, you know, don't do exercises that, you know, cause pain. And so I was fearful really of doing things that would elicit the pain. And so I think that really, and that was early on in this process. And so I think that had it, you know, an impact on what I was, you know, willing to try or do, because I was worried that would make things worse. Especially when it comes from like an orthopedic surgeon, like you'd hold their advice to a very high regard and like you say, become fearful of, of producing symptoms. And, and, you know, I don't know, maybe I misinterpreted it. It's hard to know because you're getting so many different pieces of advice and, you know, so I don't, I don't exactly remember that conversation, how it played out, but I do know I had a fear of delayed my recovery. Yeah. And it's a, it's very common. Like I talk to people with PhD all the time and they're worried to do a weighted exercise because they're worried about if it does cause pain, will it further damage my tendon? Will it get worse? Will these tears that are in them, will it retear or will it cause more tears or will it rupture and all this fear and, um, threatening language that they use that have probably been used by health professionals. That's why they're getting it. Um, But key point on this, that's a very honest answer to, you know, how, what was said might be different from what you interpreted or how you walked away from that session. Because I know a lot of times when I'm talking with clients, I'll try as much re assuring language as possible and say, it's okay to load. And then sometimes if I get them to repeat, you know, what, what's been said throughout the conversation, they'll say, okay, so you're saying that it's bad to load the tendon or whatever. So. What I'm saying and what they're interpreting is two completely different scenarios. And so people can walk away from a consult, um, with a, not what was intended, but to have, you know, maybe they have preconceived ideas and they stick to those preconceived ideas before, um, contrary advice is, is laid upon them. Who knows? Yeah. I think that's a good point. The, well, I guess so moving away after these bridges and stretches, you saw this PT, you got discouraged because there was no real carryover benefit into your running. Um, what was the next step of your rehab journey? Yeah. I mean, you name it. I did it. I, um, I tried a masseuse. I tried dry needling. I tried, um, different physio therapy. Um, I did this 10 X procedure, which is an ultrasound guided percutaneous needle, tenotomy. Um, Where they just... Can you explain exactly what that is? Yeah. So they use an x-ray to guide placement of this metal sheath. And it's a small diameter. I mean the size, I mean smaller than a, you know, like it's like a large bore needle that is placed near your ischial tuberosity. And they use this high frequency ultrasound, which the idea is that it targets the unhealthy tendon tissue, but doesn't hurt the healthy tissue. And it does have some, like most of these things, it has some data that supports it. And we can talk about that, but it didn't work for me. It's a brief procedure, didn't hurt me, I don't think, but it didn't work. I also had PRP, platelet-rich plasma injections, two of those. And so all of these different things, I would say, I altered my diet. I did a lot of different things. Each time, and I have to say, I was at one point, I'm an ultra runner, it's a part of my identity, and I got really bummed out and maybe not clinically depressed, but I was very down. I say that because I know a lot of people out there are feeling this. It can really... affect your kind of day-to-day living. So I was willing to try anything. And every time I signed up for something or I had an appointment, it gave me a little hope and I was kind of looking forward to the visit. And this was just a cycle. I'd look forward to this next visit, maybe this is going to do it, and then I'd crash. And then I'd go again. This is how it went for two years. So those are the things that I tried. seems to be like all the procedure type of things or manual therapy. So the dry needling and the massage and all of that, I guess, blanket sort of treatments. I did do, and I did do in terms of physical therapy. I mean, I, and I think my physical therapy was probably on the right track, but I gave up on it too soon. You know, it wasn't progressing as fast as I wanted and I thought, Oh, it's not working. You know, I was doing some prone leg curls, some supine leg curls with the Swiss ball, which I think are helpful. But none of the stuff that I did had weights involved and that was the one thing missing. So I did a lot of physical therapy, but I didn't use any weights. And so it wasn't that I wasn't doing physical therapy. And I mean, I was really trying. Yeah. identity crisis as well and having it affect your mood because it is a spec like for runners, for athletes, triathletes, um, we hold a particular identity when it comes to our athletic endeavors, especially when it's such a part of your life, like, like it is and what, like it was, and when that's taken away, you sort of question a lot and, you know, people get moody, people get frustrated, people like their relationships become strained, their sleep becomes poor, their diet becomes poor, just because there's that missing piece of what was, you know, complete in their life. It's now taken away. And it's sort of mixed with, yes, that's taken away, but also you're in pain because pain's very closely linked to despair. And so you've got this worry, this fear, this, um, the, the one thing that, you know, gives you a sense of wellbeing is now taken away and you're in pain. Like that whole combination of things is just really, really does negatively affect your mood and wellbeing. Absolutely. And if, you know, running is your outlet for stress and now, you know, you don't have that outlet it's, you know, it's, um, it is hard and, and it's hard to replace it. You know, I tried cycling and swimming, um, and I felt pain with doing all of that. And I Got scared. Like I can't do this because I'm having pain. And so, um, you know, you're absolutely right. And the things that you're saying are resonating because it really, uh, did affect my, my entire, you know, wellbeing, uh, not being able to train and, um, and run. When did things sort of turn? When did, when did things start making improvements and you start seeing a bit of hope in a bit of, um, know, a lot at the end of the tunnel. Yeah. So, um, it was really when I started listening to your podcast, honestly, this was 2021. So I think, and it was the end of 2021 and I had just started listening to your podcast and what struck me and I have to say, you know, I'm a, like I said, I was a scientist. So I had read all the literature or a lot of the literature on this and So I knew that most of the papers out there, they're not randomized controlled clinical trials. I mean, they utilize some new approach and then some patients got better, some didn't. And so there's evidence that it works, but without a control population, you don't really know. And so there's just a paucity of evidence, real good evidence for managing a PhD. Fortunately, there is some data in other tendinopathies, When I heard you speak, I immediately realized that you had a lot of experience in PhD and you had experience working with runners. It may have been that timing that I was receptive to it at this time because it could have been that one of my other physical therapists told me the same thing, but I just didn't hear it. know, specific exercises, especially deadlifts. Um, and I was like, wow, I don't do deadlifts because I'm afraid to do deadlifts that is something that really elicits the pain. Um, and so, you know, I was just immediately captivated by your podcast. And so I reached out to you and, and that's when, that's when the real healing began. It's funny that, you know, you say the deadlifts are the things I shy away from cause that's the one that almost hurts the most. And it kind of hurts the most because it targets that area more specifically than any other exercise. And it's designed in a way to target the upper hamstring in the, um, the most localized way possible. And so that's what makes that exercise the worst thing, but also the best thing. And it's just about finding the right condition because people can, I see it all the time, people really quickly jump into deadlifts. either with too much range of movement or too heavy or too many reps and flares them up and kind of confirms their belief. Okay. Yep. I should just remove that. Don't even think about deadlifts. I'm not ready. It's, it's too painful, but they're not giving themselves the right condition because maybe their starting point's a little bit too low. And yeah, they've just jumped the gun a little bit too much. And there's always some particular modification that you can start with. And I'm glad that sort of that resonated with you or caught you at the right moment of your rehab to start resonating with you. And so I guess what was, we obviously started working together. We jumped on a call and then got to work with an action plan. Yeah, no, I remember the first visit with you. And I, you know, I remember that you had clued into, you know, the paint. I started with the low weight and I said, I have this pain that comes on with deadlifts, but yet when I'm done with the deadlift, it actually feels better in some cases. I don't know, but what I remember was that you immediately recognized this as the PhD that you've seen before in other athletes and you gave me some reassurance. You said, Rob, I've done this before. And what you're experiencing is normal and that's a good sign. And it was like such a relief, such a great feeling to think that, you know, there's hope, like I may be able to run. And at that time I was not even, you know, it's just like, maybe I'll be able to do a 5k, maybe I can do the Turkey Trot again. Um, I mean, I did a Turkey Trot on crutches once. I, that's, I was like, I, we'd always done a Turkey Trot for Thanksgiving and I'm going to go out there and if I can't run it, I'm going to f***. do it with crutches. It was just so silly. But, you know, I, when I met you and I had that initial visit, it really gave me a lot of hope. And I, uh, I think it was a great feeling. Can you recall what, uh, how long it took for you to recognize that the path that we set forward was starting to work? Yeah, probably a month. So before I started meeting with you regularly, I kind of through listening to your podcast, kind of started my own a rehab program based on what you had recommended. And so when I had actually met with you, I was already into it a little bit, but I didn't really progress on the running. And so even though I was getting stronger, I didn't test it on the track because I was still scared. So once we had met and then you started looking at my exercise plan and, and you know, you had a running plan for me. Um, I would say it took about maybe three to four weeks to, you know, that I really realized that, you know, I'm, I'm able to get, my running is getting, I'm able to improve. So I'd say about a month. Okay. And what was your usual symptoms during a run? Like was there any pain during, was it, um, increasing symptoms afterwards? Would there be a particular characteristic or trait that was consistent? Yeah, so it would be pain in the ischial tuberosity right at the high insertion point of the hamstring. It would sometimes radiate down to the belly of the hamstring. And sometimes I'd only feel it in the belly like in the middle part, but usually it's at the sits bone and it would you know, it would be worse with as I ran longer or I ran faster. And, um, you know, before, before I started working with you, that pain would stay, it would be worse after the running and it would just stay there for, you know, days, uh, until I just had to let it heal. But after when I was working with you and I was, you know, training, the, the pain would, you know, might come on during running, but then would immediately stop when I was running. or it wouldn't last very long. Yesterday, I ran seven miles. I had a little bit of pain toward the end, but immediately it was gone after I was done. This podcast is sponsored by the Run Smarter series. If you want to take your knowledge building to the next level, I have built out a proximal hantring tendinopathy video course, which complements the podcast perfectly. Sometimes it's tough delivering concepts and exercises through 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. Yeah. I tend to see a particular pattern around how strong the tendon is and how quickly you revert back to baseline. Once you've challenged the tendon a bit. And you know, if people just keep to body weight exercises and then they do a run. and that aggravates their symptoms. They could be sore for several days, similar to what you were experiencing. But what I see often in clients is the stronger you get the tendon, so that's with slow, heavy deadlifts and building up and ramping up that tolerance, they can have a similar amount of pain during the run. And like you say, just that particular irritation just totally backs off sometimes within 60 minutes. So what was once? five days of irritations now less than an hour. And that's what I would kind of interpret or contribute to. Okay. The tendon is now robust and yes, it might be sore cause you're challenging it and you're pushing its capabilities, but is robust and strong enough just to quickly settle. Yeah. Makes sense. How about any other particular challenges? So, um, our management plan slowly building up the dead lifts, slowly increasing your running. Um, Was there anything else that you may have found effective in terms of moving, moving the needle and accelerating that healing process? Effective. Yeah. Effective. Yeah. I mean, I think the. So if I could kind of summarize it, I mean, I think the progression is key and not just with the exercises, but also with running. So you had me progressing on the weights, how much weight I did, but you also had me at the same time progressing on my running, whether it was we were progressing with speed or distance or elevation, whatever it was we were progressing. So that was, I think, critical and it has to be controlled. It has to be, you know, careful progression. But I think progression for me was key. And I remember I keep asking you, do I ever stop like adding weight? I mean, I'm like one of the, you know, I'm doing too many, too much on squats. Am I ever gonna get to a point where you're gonna be like, that's enough? And you said, no, just keep going. So it was, it was kind of funny. So I think that the progression with the right exercises and the right, you know, timing of progressions, like, you know, I didn't rush it and I was patient. I think being patient is critical. If you try to move through this really quickly in four weeks, you could risk, um, you know, taking a major setback. So I was at that point, you know, I had been injured for over two years. So I was, my hope was not to get back to racing. I would just want it to get to running again. Um, and so I, I think my attitude was different. I was no longer like, you know, I'm going to run this race next month and I need to figure out how to do it. I was like, I just want to be able to run. And so I entered our program with a really good attitude. So being patient. And I think it's critical that the types of exercises and the weight bearing was also important. Hmm. Well, what I usually say, particularly for runners. So I don't always work with runs with PHD. I work with anyone with PHD, but the runners that I like to work with, I sort of talk about, you want to work on two pillars at the same time. So you've got your strength training, which is, you know, your squats, deadlifts, lunges, calf raises. You want to slowly build that up and build up that slow heavy load. But concurrently, you kind of want to build up your running tolerance at the same time. And both of those pillars. You want to be systematic about it. You want to be progressive and slowly build in the next layer, the next slide, the next layer, and provided that those two pillars don't progress. Like on the one day you might progress, you know, on alternate days or, you know, different times throughout the week. But, you know, the goal should always be to, you can tolerate more running loads once you can tolerate more weight in the gym and vice versa. So both of those components. stimulating the tendon in two completely different ways, but you're just restoring the capacity in those two, those two stimuli at the same time. And so I guess that's where you found that benefit and it's sort of, you're sort of concurrently seeing two, two victories in two different domains. Yeah. And I think the, the running, it's just healthy, you know, for me to see that I'm improving and it can be. You know, in the very beginning it was a small amount, but just to have that as, um, it was kind of like positive reinforcement, you know, Oh, okay. I see the benefit of this, of going to the gym and doing the weights. Um, cause I'm seeing that I'm able to run a little bit more next, you know, neck the next day or whatever. So that was important for me. Yeah. Okay. And so were there any hiccups, were there any setbacks, any flare ups, anything like that? You know, I never had a serious flare up. I had times when I was concerned that maybe I pushed myself a little bit too hard. You know, I, and I, and I told you, I was very honest with you. I said, Hey, you know, we started racing again. Um, you know, I had some pain during racing. Um, but it was never where I had to stop, you know, since I've met you, Brody, I never had to just, you know, stop and rest. Um, and so I think that whatever course we set on, it's been working. And when we first started, you had me walk running. And so I would run and then, and I ran a half marathon, I think probably six to eight weeks after I met you and I walk ran it. And I did get like to a six out of 10 pain toward the end, but it immediately went away the next day. And so, like you said earlier, the... the duration of pain after the event was short. And that suggests that there's a strong, a pretty strong tendon. But also showing like in the moment with those high levels of pain, um, probably that, you know, the tendon might not have been ready for it. And, you know, being with a race saying, okay, well, let me just see how I go. But On the backend, you have that luxury of it returning back to baseline really quickly and saying, yeah, I know I overdone it. Maybe ran a little bit too far, a little bit too fast, or maybe the elevation was a bit too much, but I know that I know that now. And now I'm one, two days later back to baseline. I'll learn from that and move forward. Yeah. But I never had a serious setback where I had to stop, um, and restart the clock. So I'm, I'm very grateful for that. Excellent. And. I guess, moving on from there, um, fast forward to today, what have you managed to return to? So, um, you know, after I met, you know, we worked, I did that half marathon the next month. Um, after that half marathon, I did a 25 K you, you walked me through that and that's, that's 15 miles roughly. Um, and that was Hilly. Um, and you were a little concerned about me going in for a Hilly race, but you let me do it and, and we did okay. I mean, I. I didn't have any long-term pain after that and I was able to continue. So then I just kind of kept working at it and working at it. And I worked my way up over a year, you know, over a year of time building such that this year I ran a marathon in December, sorry, December of 2022. So last month I ran a marathon. My pace, it was 333. So, and my fastest marathon right now is around 312. So it's not too far off my fastest time. And, you know, and I felt great. I mean, I did have some pain during the race. Toward the end, I would say it even got to a seven. It's at one point, you know, but the next day I felt fine. I was sore more in other areas than I was in my hamstring and I was able to kind of continue to run. I'm still running now. So I'm currently, you know, my wife has gone to Boston multiple times and I just go and watch her. So I'd really love to be able to run with her. So my goal right now is to qualify, which for me is like 315 or actually 320 maybe. But anyway, I really want to beat my old record, which is a 312 marathon. And then I like to get back to doing trail running, eventually do another a hundred miler, uh, but, but right now I'm just taking one step at a time. You know, I, I just want to qualify for Boston first and then, and then we'll go from there. Yeah. And also a good sign that when you do that marathon, yeah, you're sore, but you're sore in every other joint and muscle and that sort of thing as well. So it's almost like your tendon has caught up to the capacity of the rest of the body. So understandably it's going to. be very strenuous and it is going to be sore, but, um, no different from any other muscle. Out of curiosity, um, how heavy are you deadlifting at the moment? So, uh, I just deadlifted, um, uh, you know, two, three hours ago and I'm, so what did I put on there? Like the bar plus 85 or 90. So 135. Yeah. I mean, it's, you know, I'm, I'm a pretty, I mean, I'm, you know, I'm not a big guy. So for me, that's a lot. And, and it's taken a long time to work up to that point. What's your, if you don't mind me asking, what's your weight? 130, 132. So lifting, lifting almost your body weight. Oh, well a little bit over your body weight. Yeah. Yeah. Nice. And that's, that's usually like a benchmark. I like to give people as like, how heavy should I be lifting? I usually just throw that benchmark out there because sometimes they're lifting 40 kilos or 40 pounds and they're saying, Oh, you know, when, when do I stop? Like when's enough enough? And I sort of throw that out there. You want to be lifting over your body weight and they sort of say, Oh, okay. Wow. That's, that's a lot. And, um, sort of. respects, it gives them a bit of a benchmark or a bit of a, at least a reality check of how heavy you should and could be lifting. So yeah, good that you've worked your way up to that because that's quite impressive. Yeah. And I like, I remember asking you, like, when can I stop increasing my weight? And one thing that you said was, well, you want to run an ultra, you want to run, you know, a 50 mile or a hundred mile or you're not there yet. So You're going to need to get stronger to get to that distance. And I kind of like that. So I kind of feel like, okay, this weight is good enough for me to run a marathon distance at this, at this pace. But if I want to go faster, I may need to get stronger. So that's kind of my mindset right now. Yeah. And I almost like sometimes answering that question myself with the opposite. It's like, okay, when should I stop doing, when should I stop progressing the weights? And that makes me think of a scenario where someone's, let's say a runner, they're running 5k three times a week. They're getting no symptoms whatsoever. And they're satisfied with that. They don't want to get faster. They don't want to run further. They've sort of capped out what they want to do. And they're satisfied with that with no athletic endeavors beyond that. And they're doing, you know, their deadlifts that are pretty heavy. I'd say, okay, let's tap it out. Let's, you know, maybe maintain that and keep running. keep doing that, but if you ever so choose to run further, run faster, prepare for a race, that's when the deadlifts need to ramp up. And it's just trying to match the demands that you set upon it. Excellent, mate. Well, um, as we wrap up, are there any other sort of tip bits, bits of advice, uh, someone who might be struggling with PHT, um, and. Want that little bit of advice, anything that we haven't necessarily talked about? Yeah. I mean, I really empathize with the listener out there that is suffering from this and who has almost given up because I've been there and I was searching social media sites and. You know, I mean, you know, I had been there and I want to say to you that there is hope. I mean, you may have to change your expectations. You may have to not be able to run that sub three that you wanted to do, but you can get better and I was, like I say, I really struggled. And my first piece of advice is there is hope. You may not regain all that you have but you can you may have to make some concessions to the way you're running But you can get back to running it's possible the other thing is I think the correct exercises the You know for your particular injury state is important the correct amount of weight and the correct amount of progression like we talked about And then and then to be patient That's are the things that I would know say Yeah, I just wrote down patients because I wanted to reinforce that, but you've gone ahead and said it anyway. Um, it's good to see that. Um, I was just chatting to someone today and they were like, Oh, um, how about collagen supplements? Is that effective? And I'm like, well, I don't know. Um, I can't really find research that proves or disproves it. But I said to them, what I do know is that the vast majority of people get better with slow heavy load, without collagen, uh, without PRPs, without and all that sort of stuff that you've listed. It's back to basics and it's patience and it's progress. And it's, you know, most, the vast, vast majority of people will get better with that particular routine. And if that's not working, then go back to the drawing board, maybe with some slight alterations, you know, making slight tweaks here and there. Like say you almost hit the mark early with some loading and seeing some initial success, but then just... not progressing, not having that guidance to say, okay, let's progress from here. And let's be patient with it. Um, it's, it's something that, you know, a lot of sufferers do need to have, cause it's a, it's a whirlwind of a condition. You can be pulled in so many different directions and you can start with stretching, you can start with, um, PRP, and then you can talk about surgery down the track, like it's, you just pulled in so many different directions and there's so much confusion, but. Back to basics and. You're a good story to show that yes, it does take time. Yes, you may need to readjust your expectations, but with enough time and enough structure, it can work. Yeah, I agree. A hundred percent. Thanks for coming on, Rob. This was an incredible story. Um, best of luck with your ultra endeavors, returning back there and getting, um, a marathon PB. Uh, it's good that you've found yourself in a situation where you so much better that you're actually looking in the sites of PBs and return to altars. So always a good sign. So thanks for coming on and sharing. Thank you, Brody. Thank you. I appreciate it. 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.