Sneak Peek Membership Q&A: Rest Days / Training Rescheduling / Pelvic Tilts / Progressions Post Flare-up

: On today's episode, we have a sneak peek membership Q&A. 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 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. Welcome back everyone. I am heading away next week, heading to our beach house and won't have much time for recording. So I thought it'd be a good opportunity to release this membership episode that I've done. If you aren't familiar, I have created a PhD community who are all rehabbing their PhD with additional resources, chats with me and These episodes, these episodes get released only to members and alternate weeks to the release of the main feed podcast. This episode itself was recorded months and months ago, probably about six months ago. And we have the members ask questions throughout the week or two. And then I just answer them on the podcast. And like I say, it's just exclusive for members. And at the time of recording, we have done about 18. membership Q&A is just releasing one today, just to see if you would that interest you. If jumping on calls with me interests you if jumping into a community with like minded rehabbers who want to learn more share their insights and just enhance your PhD recovery. That interests you there's always going to be a link in the show notes to participate in that membership. It's just like a subscription just like any other sort of group community. And yeah. If you do sign up and become a member, you can binge all 18 of those episodes. They all become available, even the ones that are archived. So if that interests you, you can check that out. But today we're going to release this sneak peek and answer the membership questions. I hope you enjoy. I hope you're all gearing up for the festive season. It's probably only about four weeks away or so. And yeah, hopefully getting your shopping done and getting ready to eat a lot of food and spend. time with family. I know we're starting to slowly turn down the pace with my work and everything we're doing at home now. Hope you're doing the same. Okay, thanks for submitting your questions in the Slack community. Janine, I saw that just the other day you posted a few rehab questions and I thought I'd answer those in today's podcast. And also we have a answer Melissa's two questions. So I think we might start with Janine. So a two-parter, so I'll cover them individually. Janine says, rest days. I've been religious about rest days for months, but have just been out for a short, slow mile to start the day and reminded me how good daily run streaks can feel with a short, slow trot on the days you don't have anything else planned. How important are full rest days and what should our balance be between run, rest, strength, days, and what would that look like for good recovery? Thanks, Jane. Let's start off with why rest days are so important just to run everyone up to speed. So the importance of rest days. First of all, if you have a challenging day and you're backed up by a rest day, it gives a good opportunity to interpret your symptoms for those who are interpreting their symptoms, documenting and seeing how long the symptoms or elevation symptoms last for. So if you went from run back to back run days, sometimes it sort of gets masqueraded in there because it's warmed up and you're not too sure and then it's by the end of the second day or even the start of the third day that symptoms have really elevated and you say, oh, I might have done too much the last two days. Maybe the combination of the last two days has been too much and you had been unaware because of you hadn't had that opportunity to rest and fully evaluate those symptoms. So that might be the case for some people. The other is having some rest days spread into the week has the added benefit of being, of providing the opportunity to be flexible in case there are some things that happened. So for example, I work with a lot of clients, I build out their weekly programs and I think it's nice to have one or two rest days, even if they're not injured. just so they say, oh, something's come up on Saturday, I can't do my long run. Or I've got this work meeting, work meeting, can't get out of it. So I can't do my run at the end of work. When you have these rest days, it's like, okay, let's shuffle things around. Let's just move that, let's just move this rest day, let's make today your rest day. And let's move everything and shuffle. It makes it a lot easier. Mileage stays the same, intensity stays the same, still working. towards your goals as if you would have. But when there's fewer rest days, it's very hard to jumble those around. So if someone does have these opportunities or life circumstances where we don't, can't really foresee a lot of things, maybe you're a shift worker, maybe you're a casual worker, maybe you've got these unpredictable family commitments, unpredictable work commitments, you know, these things happen, everyday life. It's a bit easier, you can be a bit more flexible. But most importantly, the importance of rest days is to enhance the adaptation response. Adaptation to make you a better athlete, make you fitter, make you stronger, improve the strength of your tendons, improve the strength of the rest of your body. The adaptation response needs recovery. It needs a recovery phase in order to adapt. You don't get stronger during your deadlifts. You don't get stronger during your sprint sessions. You don't get stronger during your long runs. You get stronger once you have entered adequate recovery after doing those tasks. That's how you adapt and that's why it's so important. So again, highlighting the importance of why rest and recovery is so important. However, rest days don't need to be complete rest. So this is just partially answering your question, Jeanine. A run can still be a rest day. It all depends on how you respond to that bout of exercise and how you dictate or how you execute that day. Because you could do a yoga session and be nice and calm, nice and zen, low level of activity, low strain. And that could definitely be a recovery session, but it could also be a really intense yoga session where you're sweating, you're shaking, your muscles are tensing and all those sorts of things. That definitely is not a rest day. You haven't given your body adequate enough time to recover or adequate space to foster that adaptation response. So complete rest days aren't that necessary. Do can have a purpose, but in Janine's case, if you do like to run And you do like to at least get out and do something. I do get that a lot. A lot of clients like, I just like doing something every day. I say, well, you can walk or you could do like a hike or a low intensity hill walk or something along those lines, you know, something cardiovascular, cross training, swimming, all those sorts of things. But if it is our dedicated rest day, it needs to be low intensity. It needs to be short duration. For most that might be a 20 minute session, but everyone's got their own individual baseline. 20 minute session might be a lot for someone, might be very challenging for someone. So it all depends on your fitness level, your level of experience, um, and what your body would consider as a rest today. Otherwise, it just inhibits that adaptation response. It inhibits your ability to enter recovery mode and then reap the rewards. People might think doing more is better. You need to find the balance. If you don't trust yourself, don't do it. I think most people will know whether they can trust themselves or not. If you say, OK, today's a rest day, let me go out for a 20 minute easy run. And then all of a sudden, you're like, oh, such a nice day today. Let me just turn it into 30 minutes. And then it gets to 20 minutes, and you've got 10 minutes to go with that run. You're like, I'm feeling great. Let me pick up the pace. And then you just. Just do that a little bit more. You go 30 seconds quicker per mile or per kilometer. And then you're breathing pretty heavily. By the end of it, you're sweating pretty hard. And it's like, okay, maybe I've done a bit too much. If you don't trust yourself, don't do it. Keep to a complete rest day. I think you would be, or learn to trust yourself or set yourself some markers, set yourself alarms on your watch if you get too fast or your heart rate gets too high or your intensity. If your perceived effort gets too high, back it off, do some run walks or something. Really, it's really, really important. So, um, keep that in mind. Effort levels on a normal day. I know if it's like summer or it's entering summer here, but, um, for most of you it will be winter. Most recovery runs should feel like it's, it's hardly an effort. comfortable conversation, low slash no sweat rate, if anything, everything composed, everything in control. Once you finish the run, you feel like you could do it all over again. That's the feeling that we want. When it comes to recovery sessions, that's for your cross training, that's for swimming, that's for your running, all those sorts of things, even like yoga. That's how you should feel with yoga. You should feel calm the whole time. You should feel like it's not a strain on your body. Um, and if that's achieved, then yes, you can do that on your rest days. And then you're doing something most days. Um, however, there's another, however, um, we do need to follow symptoms. If in Janine's case, um, she's noticing that symptoms are improving. Sitting is improving, uh, overall pain levels during running is improving. And. week by week, noticing that long-term trend, noticing that trend of improvements. And then all of a sudden starts doing some running on the rest days and executes a perfectly low intensity, uh, short duration and, you know, does a textbook recovery run and then starts noticing symptoms plateau out and starts to notice that she's not seeing. symptoms improve week by week over that long term trend, then we need to dictate, okay, for you, what you're currently doing isn't working. Maybe it's too much load, maybe it's too much pull on the hamstring on those recovery runs. You just, your cardiovascular wise, that level of intensity is fine to be a recovery day, but for whatever reason, your muscles and tendons and hamstring and proximal hamstring tendon, they're just not tolerating it. So we have to back off again. So we always fall back to symptoms, your baseline the next day, your improvement week by week. Yeah, that's how I would structure it out. The other thing that you mentioned was, what should our balance be between runs, strength, rest? Very, very hard. That needs to be extremely tailored for everyone because some people can only withstand two runs per week. Some people can withstand four to five, even more runs per week. I would say, you know, we need to find if the balance is right for you. Strength sessions, I would say for most, two to three times per week. If it's really, really heavy stuff, twice per week. If it's quite light stuff and you're just finding your feet, three times per week. And... whatever that balance is, it needs to be a little bit too tailored to come up with a full answer. But Janine, thank you for your question. You also ask that you have some Christmas do's. They're starting up. Christmas do's, like a British thing. Christmas events are starting to intervene with my training schedule. If I am having to cut sessions, my sense is I should prioritize a white session over a run. but just looking for some advice on balancing. Okay, excellent question because, you know, festive season coming up for everyone and it does throw people's training schedules off, people are traveling, more work or less work or more kids or less kids, family stuff. I should start off by saying, everyone, it's natural for everyone to have a fear of losing fitness. I've even just, it's like this. end of November here. Well, I guess it was Thanksgiving for you, US people. But a lot of people like, Oh, I'm traveling, I'm going to miss a run day. How can I move it around? How can I not impede my weekly mileage? I've made so much gains. I don't want to lose it. People have a fear of losing fitness. It is common. It's natural. But I would say that that fear is completely irrational for missing run days for missing like weeks, as in like one week. I always say the fitness is hard to gain, but easy to maintain, very easy to maintain. It's hard to gain in the sense of, you know, building up your volume, building up your strength, building up your deadlift weights, building up your speed sessions that takes a long time to slowly adapt. months. But once you've built up that fitness level, all you need to do is the bare minimum and you've preserved that fitness. Hard to gain, easy to maintain. So missing one or two run days, missing like only doing one run over the Christmas period, you're going to be maintaining your fitness. All depends on what you do within that week. Like if you're moving around, if you're moving around, housework, all that sort of stuff. If you're mobile, then that fitness is more easily maintained. If you're doing hikes and cardio stuff that you wouldn't naturally do, so you're not running, but you're still cycling or cross training or swimming, you're probably gonna come back fitter. But if you're bedridden because of an illness, if you're in hospital, like post-operative sort of stuff, yes, fitness is lost really quickly. But very rarely are people bedridden for days and days and days. Um, even just being up and walking around the house is enough to preserve that type of strength and muscle mass and fitness and that sort of thing. But, um, yeah, so it all depends what you do, but most of us aren't bedridden. Uh, most of us are just spending time at parties and with family and, um, just moving, being mobile. So, you know, fitness is still preserved. Yes, Janine, you are correct. I probably would prioritize the weights over a run session. Um, just because we know that yes, fitness is easy to maintain, but weights have a really nice analgesic effect. A lot of people report after I do my gym session, I feel great for that day. And even into the next day, I feel fantastic. Um, we can reap that reward and especially with travel and, um, you know, festive season, you know, sitting down, eating, spending time with family, I think there's a lot of sitting involved and just doing your weights can help preserve a lot of that. Whereas if you go for a long run or a fast run, then you have to sit. It's tends to be quite annoying. Uh, but we can always do short, easy runs on our strength day. I think that will suffice as well. If we wanted to try and get the best of both worlds, um, let's just say you. Uh, traveling. or you've got parties on and you can commit one day over the next four days, I would if I was you do definitely do my strength do my full strength session. But if you had the time, maybe do a short 1520 minute, low intensity something type of exercise, just to, you know, trigger some sort of cardiovascular response and then get into your strength training. I do the cardiovascular stuff first. So you can cut into halves even if you want to cut out some of the weights so maybe do two sets instead of three or three sets instead of four or maybe do three exercises instead of four exercises and have some time for a 15 minute cardio session combine the two if you wanted to that's just an option if not if you can't like i say don't worry about missing days natural here at all time people worry about losing their fitness because they've worked so hard to build upon it. But I feel like it's not that rational. So just a bit of a reminder. Thanks Janine for those two questions. They're very insightful and I think a lot of people have those same questions and so hopefully that helps a lot of people. Okay, Melissa, let me get to your questions. So you ask, I've been told over the years several times by PTs, doctors. and have read online that tight hips and tight hip flexors will create a pelvic tilt that pulls on the hamstring and will aggravate the PHT or may or even cause PHT. Is this accurate information? Great question Melissa. So for those who aren't aware, let me try and paint a picture here. So your hip flexors attach onto the front of your hips, but more the top front of your hips. So if you had a feel around the top of your hip, you have your iliac crest, which is the crest that sort of runs along the outside of each side of your pelvis. But then as you get toward, if you follow that around to your front, you sort of get to this bony kind of pointy ridge. That's where your hip flexors attach onto. So yes, it's the front of your pelvis, but it's also the top front of your pelvis. And so when your hip flexors pull, you may think that they pull down on the pelvis which tilts it. We call that an anterior pelvic tilt. And just like a seesaw, if you tilt that forward, the back of the pelvis moves up, moves up towards your head or superior. And that could cause more tension, back part of the pelvis, just like a seesaw. You pull on one and it will pull on the other in opposite directions. And so, right, the theory is there. And I think it does make sense in theory, but I am skeptical. It seems that type of advice, while yes, I think is extremely common for PTs, doctors, online stuff, I probably even followed a similar narrative when I very first graduated from physio. But I feel like this, this sort of narrative is in the same camp as leg length discrepancy, scoliosis, like any sort of pelvic tilt, any sort of muscle imbalance or glutes not switching on or your core is not switching on or delayed activation, we know all of those things are common narratives that have been proposed but don't show up in the research. Um, very common to think that someone with a leg length discrepancy has one leg longer than the other might feel, might be activating muscles on one side and deactivating muscle on the other side, or cause the pelvis to tilt or cause the spine to collapse or cause a whole bunch of things and then, um, trigger a whole bunch of issues. But we know that's not the case. Research doesn't show that. Research does show that 90% of the population have some sort of leg length discrepancy. So vast, vast majority of the population. And that vast, vast majority is less than five millimeters in terms of their difference. And so, you know, one, two, three, four mil difference. And we know you need 20 mil to have some biomechanical change. and the people that do have more than 20 mil, that's less than 1% of the population. And even so, I would say, even though their biomechanics have changed, they've probably adapted to it. Anyway, we've seen, you know, you just watch the Paralympics, they have a lot of discrepancy from right to left. Well, some of the athletes, you see them running and they limp, and you see them jumping over a high jump, and they, you know, limp up to... or some of them are not mechanically fluent or balanced right to left, but they work. They're not injured, they're performing at high rates and their bodies have adapted to what their bodies have adapted to because they've grown up with that impediment or they've had it for several, several years. And so the same thing can be said for scoliosis, for pelvic tilts, for leg length discrepancies, your body has adapted to it. And what we would what would definitely cause problems if it's an abrupt change. So if you had perfect leg length yesterday, and then had a four mil leg length discrepancy tomorrow, that would you definitely run into trouble because your body hasn't had the time to adjust to that very, very small difference. And yeah, that's, that's sort of the narrative and, but like I say, there's no research to show. Um, so back to this. pelvic tilt, hip flexor stuff. Like I say, everyone's anatomy is different. I believe like my pelvis is definitely anterior tilted more so than the rest of the population. I remember looking at photos of me in the mirror, playing basketball, going to the gym, just all of my mechanics for my whole life, very anterior tilted, even like being a physio. and then having to study physio and people like, you know, look at your form, look at your technique, look at your anatomy, look at your mechanics, you know, definitely I was more anteriorly tilted. I think that's just how, what my body is. Would I, because of that, am I more adapted to maybe developing PhD in the future? Maybe, possibly, if I do the wrong things. But everyone adapts to their own anatomy. if they do the right things. So it's hard to believe that tight hip flexes can be so, so tight that actually pulls you into an anterior tilt. Maybe a slightly favoring one tilt more than the other, but I would say if you're born with anterior tilt, you can't do much about it at the same time. Research will show that, well, let me just go with this. If I did have an anterior tilt, and I do, some physios have told me, oh, you just need to get some massage of your back muscles and release your hip flexors and strengthen your glutes. And so what we're doing is if we're looking at a seesaw, we're tightening the loose side of the seesaw and we're loosening the tight side of the seesaw to try and balance things out. But the body doesn't really work that way. Well, I believe the body doesn't really work that way. First of all, if we do some releasing, some massage and some stretches, that's very, very short lived. But if we strengthen what is loose, you know, it's very, very hard to change your mechanics in your, how you position yourself. Anyway, we know this from running. We know if someone has a, their knee collapses in or their hip drops. Um, you can assume, oh, their glutes are really weak. Let's strengthen up their glutes as much as possible to try and correct those alignments. We know that if you spend months and months and get really, really strong glutes, put them back on the treadmill and they run exactly the same as what they did before. However, they might feel better because those structures are now stronger and they can tolerate a higher capacity, but their biomechanics are exactly the same. If you don't give any other cues, all you do is strengthen them up, don't give them any other cues and just say, run on this treadmill, they'll run exactly the same, they'll still have that same knee collapsing in pelvis drop, and those sorts of things. And so I would of translate this over to the same situation of okay if we have this anterior tilt let's strengthen the glutes let's strengthen the abdominals the lower abdominals and try and get that seesaw to pull and straighten out my guess would be that you'd do all this strengthening you'd feel a lot better because you are stronger but your pelvic tilt would be exactly the same that's what i believe but i could be wrong and if i am wrong try it out Like if someone has told you have tight hip flexors and you need to stretch them in order to balance things out, try some hip flexors, like stretches are safe, hip flexors, stretches are safe, they're easy to do. Try it out for four weeks and see if there's any difference. See if there's any difference in your symptoms, see if there's any difference in your posture. And if there is, fantastic, then we're testing and tailoring for you as an individual and your individual response. So, you know, I can always fall back to that if, if needed, because I know I could be wrong. I know research could emerge in the next decade and I could be completely wrong because I've been completely wrong in the past and yeah, happy to admit that. So, um, what, again, continuing of what does work, you can find what works for you, but what I have seen work for many is the heavy strength stuff. So you would see in the success stories, people try stretches, they don't get better. People try the heavy strength and they do get better. And so that's... that's a counter narrative or the counter argument to the we just need to pull your pelvis back into position. Well, what's working for most is counter to that narrative. So maybe something else is going on. Hopefully that helps Melissa, you're probably a little bit more confused and maybe more people are confused. But hopefully I've helped articulate my thoughts around that because it is a big topic. That does rile me up sometimes. Okay, lastly, how do you know when to increase your weights in your strength training program? It has been several weeks slash months since I've increased any of my weights, but they still feel challenging. After my last flare up, my baseline never returned to zero pain and hovers between a one to a two, and sometimes sitting for really long periods can be a bit uncomfortable again. So, I am not sure if I am at a plateau or if maybe I should try to increase some of my weights very slowly and incrementally as I have done in the past. This is another question coming in from Melissa, so thanks for submitting this one. This will definitely help a lot of people because this might, this is a very common scenario. Let me just start off by saying for those who... like the conditions for progressing a strength training program, like when to progress the weights for most of you have assigned this four conditions that you need to meet. So I'll get into the particulars in a second, but the four conditions for most people progressing through their strength training is one, we need to make sure that symptoms allow. So we progress when symptoms allow, meaning for most pain during the exercise is less than a 4 out of 10, returns back to baseline less than 24 hours. So symptoms allow. Condition number two is the overall level of difficulty. So if that, if you're weighted step ups or if you're deadlifts or an 8 out of 10 difficulty, maybe wait for you to get a bit stronger before we then try out something a bit heavier. Number three is just making sure form and technique are maintained. So if you are doing deadlifts or squats or lunges, making sure that we've got a, not perfect, but technique and form are maintained throughout set one, set two, set three. And the fourth condition is just the rest of the body allows. So while number one was symptoms allow, talking about your hamstring tendon, this is paying attention to the rest of the body because we know that people can get stiff and sore lower backs when they progress their deadlifts. or knee pain when they do their step ups. And we wanna make sure the rest of the body is adapting and getting stronger as we progress. And if we do that too quickly, we don't want another injury surfacing. So in normal circumstances, those are the four conditions that we need to meet and need to pass before then moving to the next progression in your strength training. As Melissa said, these exercises still feel challenging. but also said that you've stayed at this same level for weeks slash about a month. If it's been a month, I would say, try progressing some of these exercises. It might be very gradual, but I have seen a lot of people say that, man, my step-ups are really challenging. I've got 15 pounds in each hand. I'm stepping up and I'm just gassed by the end of the set. If that, that's fine. But if that still happens for three weeks straight, I would say, let's just try, just try heavier. And they might move those 15 pounds to 17 and a half pounds in each hand. And they might feel exactly the same. It might still be an eight out of 10. And they actually surprised themselves of they didn't really feel that much different. And then they moved to 20 pounds in each hand a couple of weeks later. and find that it's not much different. Random way of saying, just try it out. If it's unachievable, once you do make that progression, then I would say, okay, go back to that other level, or maybe we manipulate the height of the step for heavier weights, maybe we lower the step and apply heavier weights. Maybe we just do heavier weights for the second set and the first and third set are back to your weights that you're used to. there are other ways we can gently guide you into some progression so you can continue getting stronger. So yeah, you can try those things out. But then we have this other part of your scenario, Melissa, which is your baseline symptoms. So saying that you used to be have a zero out of 10 baseline, but now it's a one or two. And so unsure if am I back to baseline? Can I progress. I believe we should redefine your baseline. Maybe for everyone else, just listening, your baseline can maybe be a two week average. So, or your past two weeks and what the average was like. So Melissa, if your baseline, well, if you are now hovering at your best, a 1 or a 2 out of 10, I would then do your strength and then see if it's a 1 or a 2 out of 10 the next day, or see what your sitting patterns are like the next day. And if it's still a baseline, which is now your new redefined baseline of a 1 or a 2 out of 10, then we can progress. Well, we can meet that condition to then progress. And who knows, maybe I've seen this done a few times before. Maybe if you then progress the deadlifts, the weights, maybe that baseline can actually get back to zero because we are applying heavier weights and meeting better conditions for the tendon to heal. Give it a try. I'd like to hear and who knows, if you start applying that weight, you start getting to that zero out of 10, post it on Slack. I would love to see that reaction. and help encourage other people as well to progress. So progression should always be top of mind when it comes to strength training. Yes, we do need to meet certain conditions, but it should always be top of mind, not get too complacent and fearful as opposed to when adding on the weights. We can do it in a very safe, very gradual manner. And so if you do have any other questions, post it on Slack. I know over the festive season, the amount of input and contribution tends to dampen a little bit. I know my podcast downloads, um, get lower around December, January, as people are busier and busier, but, um, always here, um, here to answer all your questions and, um, help, you know, broadcast your wins and all that sort of stuff along the way. So well done. over the last couple of weeks. I look forward to seeing how you will go in the next two weeks. And yeah, we'll catch you then. 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.