Success Story: Todd Charnetski 11 years of PHT

: On today's success story, Todd Czarniecki and 11 years of hamstring tendinopathy. Welcome to the podcast helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments and of course, bust the widespread misconceptions. My name is Brodie Sharp. I am 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. It has been a while since we've done a success story so I thought we might chuck another one in here. This is a recording from the Run Smarter podcast when I decided to do some success stories and when I was doing them, not all of them were PHT related. I had some plantar fasciitis and other tendinopathies, but this is a really, really good one. I'm excited to give you Todd's story, overcoming. proximal hamstring tendinopathy after 11 years. And yeah, I talk about it. I'll throw in the intro from the Run Smarter podcast episode. So I won't talk too much, but I'm glad that I can deliver you another podcast episode with some positive vibes and some success. So let's take it away. I talked to a lot of runners on social media and a lot of them, particularly those who have suffered from like a chronic issue. Uh, they do. jump onto Facebook groups, they do find a lot of doom and gloom posts and it's really discouraging and I thought what a better way to use this podcast to turn that attitude around and focus on more of the positive benefits. If you have a group of you know thousands of people who are constantly looking for the answers of their injuries, they're constantly posting on or trying to find the answers and That's what people are going to be attracted to because they're looking for comments and they're looking for trying to find the answers. As soon as you go to that Facebook group and scroll through the posts, you're going to find a lot of people who have had injuries for five years, 10 years, 15 years, and are in most cases like unable to run or have lost a considerable amount of function, maybe impeding on their daily life as well. along with a lot of the psychological, emotional frustrations and anxiety and, um, common patterns that you do see with chronic injuries and chronic pain. And you can easily read through a lot of these posts and manifest a lot of worry in yourself in your own injury. And so I've gone out in search of a fair few runners who have had injuries for quite a considerable amount of time. And let's start delving into some success stories. proximal hamstring tendinopathy on both sides since 2007. And he has managed to overcome it all the way in 2018. So he spent 11 years trying to find answers, trying different things and not really making a lot of ground. I don't want to tell you too much right now because the interview is pretty much going through his whole story. All I will say is that it doesn't take 11 years to overcome proximal hamstring tendinopathy. It takes, um, less than a year, several months, once you find the right solution, once you start executing on the right solution in Todd's case anyway. So yeah, let's keep these encouraging positive vibes going and kick off our first success story. Hey Brody, great to be here. My name is Todd Charnetsky. I'm from Green Bay, Wisconsin and pretty active guy. You know, been active in sports all my life. weightlifting and then got even more into running as I've gotten older. I was in my background and really starts in exercise physiology, the fitness industry, I've been in that for many, many years, which kind of goes hand in hand with being active. So, um, more recently I've been in the orthopedic world, you know, working with physicians, uh, rehab recovery. And so I'm kind of in tune with, with the body and, and working out. And, but. Sometimes you're so into your sport, so to speak, running in this case, and even though you have a background and exercise and recovery, sometimes you don't listen to your brain and injuries come on. So most of us as athletes or runners have encountered a lot of different types of injuries. And for me, I've had many, but the biggest one really relates to our conversation today is encountered. lot of proximal hamstring issues back in 2007 training for a half marathon. And, um, you know, just one of those things that we all encounter as runners and any, any runner who's listening knows that you have an acre of pain. You try to run through it and think it's nothing, it's going to go away. And, and in my particular case, I was, you know, following a plan and I wanted to stick to it. And I felt the typical hamstring soreness was. going to go away or I could work through it. And it really got to the point where I pushed too hard and it really became an issue. And not only in that moment, but many years later. So, yeah. And you did do a very good job of sending me an email based on like the history of this and it is quite a long history, like you said, since 2007. So we're looking at like around 13 years or maybe 12, 13 years. Yeah. And you said that you were training for a half marathon. And at that time, would you, would you think that like looking back on now, it was too big of a jump or at that moment, did you think maybe I'm pushing it a bit, but let's just see how I go. Yeah. Well, back at that time and I've done 26 half marathons. So that was probably my 13th, 14th one. So it wasn't a new thing for me. You know, I I've been running at that point since. I've been running since 1985 consistently. So there I am in over 20 years. So you think I would have figured out how to train, which I've done well. And it was just that particular year I was feeling good. My body weight was good. I wanted to just run my best time. So I just kind of refocused, was a little more structured, added a few more miles and more specific workouts geared to our performing well. And So I felt like I was doing all the right things other than I had certainly noticed I had more soreness and just wanted to stay on the plan and that was the thing. And so you ran the half and you said in your email that it was like during or after the half, you start to notice hamstring issues on both sides. And when, when did that actually come on? Was it during the race? Was it afterwards? Well, actually it was in training. Um, You notice the starness and then it got to the point where I was probably. Two weeks, two to three weeks before the half. And it was just like, Holy cow. I'm just not recovering from any type of run or workout. This is just, it hurts to sit. It hurts the walk. Um, so really two weeks before I'm just like, you know, I think I just have to back off here if I want to do this race. So really the two weeks before I, I may have ran maybe once or twice, just saying, you know what, I'm going to try to get this to calm down. and let's do the race. And I did the race. I did phenomenal. I PR'd. It's still my PR. Had a great performance. During the race, it was very, very sore, the hammies. But even when I'm feeling healthy, you're sore during a typical race. But after the race, it was kind of like, all right. The day after, the days after, it was like, all right, this is just not a good situation where there's a lot of burning going on. There's a lot of pain to sit. It hurts the walk. And then, you know, typically I have a lot of soreness for a few days after, but now it's seven days after and it's like, this is just, it's there. It's still burning, it's still hurting. And then I said, you know what? This is more than just typical soreness. I need to go see somebody. So, and that's kind of what I did. I set an appointment up. Since I worked with sports docs and orthopedics, I knew exactly who I wanted to see. So I got in really within a couple of days. He was working in orthopedic clinic with a sports medicine emphasis. So I met with him and first thing he did was x-rays just wants to make sure there's no issues with the bone, stress fractures, if anything jumps out from a skeletal standpoint. And he did x-rays. They looked great there, did an examination. He loaded the tendon and obviously with certain loading exercises through stretching, you know. obviously those things irritated it. So he basically gave me the diagnosis of, you just have a chronic hamstring tendinitis and bursitis, the burning pains and stuff. He kind of thought there might've been more of the one thing going on just because you're in a state of just an acute inflammatory state where you're just getting all this burning and pain and soreness. So his first recommendation was, hey, let's try to calm this down. We're gonna put you on prescription naproxen. Let's take that for a full month, morning and night, take it. And we're also gonna send you to therapy. And then we'll have you come back in a month. Let's see how you're doing. So I kind of followed that plan. I asked them, should I not run? Should I continue to run? He goes, well, He goes, I really don't have a problem with you running, but just be careful, take it easy. So I continued to run. I think obviously after the half, I gave myself a week or two off and then got on the NSAIDs and went to therapy where they did. It was really more treatment of symptoms than actually doing any type of strengthening, stretching. It was more like, hey, we're gonna get you down and do some ice massages, do some ion to pharesis let's try to get that area to calm down. So that was more of the therapy sessions versus, treating the injury, it was more treating the symptoms. So then after one month I went back and during that month it was like, obviously I'm taking meds, after my antiphoresis and ice massage, it'd be like I'd bend over and like, this feels good. It's just kind of numbed it down and so when that would wear off. there'd still be soreness there. So really after a month I'm thinking, hey, I've been on a month of NSAIDs. I think I'm better, but it's still kind of sore. Go in, talk to the doc. And I did this on purpose. Before I saw him, I stopped taking it for at least three days. And sure enough, it just kind of, wasn't to the extent that was a month ago, but it was like, okay, here, it's still pretty darn sore. Very sore when I run. Um, just doesn't feel good and hurts to sit. Um, so I went back to the doc and he goes, all right, I think the next step is to do some cortisone injections. So that's what we did. We did bilateral, um, cortisone and each, uh, upper hammy. And, um, that really, really helped. That took me to the point where my probably knocked off 75% of my discomfort and pain. So I was thinking, hey, well, I'm healed. This is it. This is awesome. You know, a couple of weeks after I'm like, okay, I'm feeling much better. You know, not pain free by no means, but I'm thinking, hey, I'm on top of this. We, you know, I'm still running through all this. Very conscious. I'm not doing anything hard. I'm just out there, you know, jogging. And I really got to a point where Over the upcoming months, it was like, you know what? I have some soreness there, but I'm way, way better than I was back when I was training and after, and so continued to run. And then the next spring, I started gearing up for the half again, and kind of not to the extent, but because I increased my training, it kind of flared up once again. I was like, oh, geez, here we go. And I remember a long car trip, a long road trip. I went to a football game and from Wisconsin, I went to Iowa for a Badger, Wisconsin Badger, Iowa Hawkeye game. And that six hour car ride was just like, oh God, it's just killing me sitting in this seat. And here we go again. And same thing, did the half, got through it. And I went to school, my family practiced dog. I went and got a physical. I was telling him about my hammies, like, ah! I'll inject it. Yeah, you need some more cortisol. I'll inject it. I'm like, just like that. He's like, yeah. So I'm like, okay. So he injected both hammies again. And I'm like, is this a good idea? I don't know. I know enough that you can't keep injecting cortisone in that area. But I let him do it. Same thing. Got better. And then after that, it was never to quite the extent, but it was just always, I think it just started in this process of going from a tendonitis condition and me continuing to run, not doing all the right things, continuing to do races and training and where it just became this, you know what? My body's trying to heal, it's trying to scour over, but you're probably not doing the right things. You know, stupidity has a right. Can I jump in there? There's a few things that I want to jump into. One being like with your... your first, well, the half marathon, the first one you described where you sort of just pushed through, you had a couple of weeks off and then decided to get through and PR your, your half marathon goes to show that if someone is having a tendon issue, the amazing thing that the body can do once the tendons have warmed up, you can still perform at quite a high level, but you just pay for it for like several days, weeks afterwards. And I think that's a good lesson for people to interpret these sort of things. And it's like. A lot of people interpret, Oh, it must be okay to still be able to run because once you've warmed up, like sometimes the pain diminishes significantly almost to a pain free state. And you can almost interpret that like, Oh, running must be okay, but you're just suffering several days after. So that's a really nice lesson. And the other thing being with your therapy, like the initial therapy, you're saying a lot of the attempts were along like symptom relief and what we call manual therapy, it's like the massage, it's the icing, it's the calming down symptoms, which makes you feel better and you're like, Oh, it must be working. But like you said, it's quite short term. And then if you have a, like a wider scope over the course of a month, you've been like, you know what, not really improving. Like I'm feeling good day by day after the treatments, but on a wider scope of things, there really isn't a significant benefit. But what you're saying is that a lot of it was focused on the manual therapy and not necessarily on strength and conditioning. Right. Yeah. And so when you're going through, I think the, um, the NSAIDs like you described is just like the nonsteroidal anti-inflammation medication for those who aren't familiar. You took that for a month as well. And I guess that could be masking a lot of symptoms, a lot of like, um, provocating symptoms. And I guess. I think there's a lot of research to show that long-term NSAIDs aren't very good for tendon conditions anyway, and it possibly could be masking a lot of the stuff and disrupting like interpreting symptoms of what's getting better and what isn't. So not off to a great start, but throughout the first couple of months, were you doing any sort of strength work specifically for the hamstring tendon? Yeah, you know what? Because I've always been big and I mean... back when I was in the fitness industry, I was big into weights and heavy lunges and squats and, and all the things that are good for keeping areas strong. But as I got more into running, you know, I kind of tailored some of that back because you just don't need to have that type of muscle mass when you're running. But I still did, you know, I still was doing lunges. But after I started having the pain, as anybody who's aware, it's kind of not very good to do a lunge because that's really aggravates the condition that stretch under loading. So really not because I didn't want to do it, I really could not do lunges. So I was limited at what I could do. I tried to do some machine weights, the leg curls and I could do some half squats. But because of so much pain, you found that any type of strength exercise that you do is just an irritant. And so I got away from a lot of stuff. I would try to do some standing stuff. you know, using bands, just trying to, you know, knowing, you know, exercise physiology is like, yeah, I still want to work out these muscles, but, you know, but it just seems like whatever I would try to do is just to create like a little flare up, like, you know, I'm used to the normal soreness, but you start to load it a little bit too much. And it'd be like, oh, you know, way more than I wanted. So I found myself doing, you know, really isn't my philosophy now, but I started doing more machines where you're laying down and doing some half leg presses and. and more adduction, abduction, things that just trying to work something without irritating it. But there was a lot of irritation. But during that time, I was doing flexibility stuff, thinking, hey, this is a good thing to do to keep stretching and sitting on ice bags, which again, my philosophy now versus then has totally changed. But it would allow me just to kind of have status quo over the Hey, I can still run. I still have soreness. I can still go do some races and it's just, just hurts. So I'm always managing it. I'm always trying to heat it up before I go do an activity. I'd always iced it after. And it's just became the cycle of just trying to manage the condition. Yeah. And based on your email, it sounds like you were sitting on your, the ice, the ice packs quite a lot. Yeah. I have these little things I'd keep in the freezer, these little packs, um, where I. put a paper, I'd sit down with a little tissue or paper towel underneath and just had two of them, one on each cheek and it would sit on it until it would get warm. Then I'd go grab the other one and sit on that and it'd be this cycle. And especially I would do it after activity. Sometimes in between if I had a lot of burning pain or soreness. So yeah, it was just kind of a cycle of, it just wasn't a happy camper. You get to the point where, you know, I probably bought, purchased every, cushion, wonder cushion pad that, you know, for office chairs, for the car, for everywhere I'd sit on I'd have pads and cushions all over the place. Because anybody with this condition knows that it hurts like heck to sit. And so it got to the point where, you know, you try to avoid sitting, but how do you do that in life when in my job I'm on the road in the car? So it makes it very difficult. And you know, these type of, those types of conditions aren't good for your specific injury. you just try to have the right type of cushion. You try to manage it. But it becomes a challenge. And all through this time too, I'm continuing to run. And then that ultimately led to the next course of action where I decided to get further treatment with PRP. Yeah, so let's, I think it's very tough to go through the storyline over the course of like 13 years. And I guess- Yeah. talking about your experiences with still running, still running with pain, icing constantly trying to manage sitting as best you can. I guess that's over the course of several years. And what you're talking about with the PRP that was in 2014, you, you consulted, uh, um, yeah, the, the orthopedic doctor suggested get scans, get the, um, ultrasound to show what the condition of the, the tendons are like, and then suggested PRP and, um, Tonotomy, is that correct? Yeah, percutaneous tonotomy, which is just really when they're going in, they're just taking a needle and just poking the heck out of the area to try to create a bleeding effect, which ultimately leads to an inflammatory response or a healing response is the goal. And sometimes percutaneous tonotomy, I actually had that done a year previous with one of my other doctors I worked with, where he just said, hey, let me just poke around there a little bit and see if that helps. It was kind of a... a doctor friend who was a sports doc as well. And so let's just poke a little bit. So it created a lot of soreness for a week or so, but ultimately did not make it better. I kind of evaluated three months after and I'm like, I'm not any better than I was previous. So yeah, I decided to, again, I work with sports docs, orthopedic docs, there was this one doctor that respected very highly, I don't know if you're familiar with the TENIX procedure in Australia, but in the US it's basically a procedure where you go in and kind of suck out the disease tissue. And so she was one of the first people in my state to do that, trained on it. And she's also one of the more highly guarded, she's trained in musculoskeletal ultrasound. So I figured, hey, if I'm gonna have a procedure, I want someone who is one of the best in really the state at this point and not only injecting PRP, but using musculoskeletal ultrasound to guide the injections into the tendons. So they're getting in the right spot. So I felt really confident in choosing her. And again, she was a sports medicine physician and she analyzed my tendons under musculoskeletal ultrasound, which she was again, a very strong specialist in that area. So she analyzed my left and my right side, my left side. She was showing me on the screen that, yeah, you clearly have a classic state of tendinosis. And she's saying, here, look at here. You can see the irregularities in the tendon. And, you know, it doesn't look great. I've seen worse, doesn't look great. Then she went to the right side and it was just like, holy cow, this is, she goes, this is a complete mess. You know, you have micro tears. I mean, this is the severest form of tendinopathy that anybody could have without it being torn. Um, so we went through the procedure. She was, I recommend, you know, tonotomy and injecting the platelets PRP in both sides, but she took blood out of the arm and did the centrifuging, the whole process. Um, but because of the severity on the right side, she actually took about 80% of the blood and put it on that side and just kind of squirted the left side. Because the left side is classic, moderate. Um, but the right side just needs a lot of help. So. She just spent a lot of extra time on that right side, doing a lot of poking and injecting the blood platelets more on that side. And so yeah, so it was a successful procedure at the time. She felt good about it. After we were done, the classic question is, hey, can I continue to run? I should be focused on healing up and resting, but it's like a typical runner. When can you get back to doing what you love? And she didn't have any major, major restrictions other than say I wouldn't run for at least a week. You know, let that area calm down. And so I said, well, I'm gonna do the smart thing and I'm gonna wait two or three weeks. I think it was maybe three. I think it might've been two or I didn't run. But yeah, after the procedure as expected, it hurt. I mean, they're going in and creating a lot of damage in the tendon and it just felt like, actually kind of felt like it did years previous when you sit down and you got that burning and that real strong acute pain. But the positive is days, three, four, five days later, it starts to bounce back. And then, so then I was basically in a state of recovery and I asked her what, you know, what would I expect? And she goes, well, you know, it's kind of hard to predict. You think you're going to get the maximum benefits within a three to six month window. So I kind of went with that. And I would say, around that time, I decided to do, and I had been doing a little bit more strength training at this point, back doing some squats, not a lot of heavy lifting, still really wasn't able to do lunges, but was doing squats and some light presses and some things that would cause some irritation, but I always would feel like I could bounce back from it and doing some light curls. I tried to gear my routine a little bit differently after the PRP where I tried to say, you know what, I'm going to take a three or four month period of time where I'm going to rather do my strength work one to two times a week. I'm going to try to do something every other day, but something a little bit different that's targeting, you know, the glutes and the hamstrings. So I kind of did a routine where I was doing a lot of bridge stuff, bridging and I would do a little bit more negative work like on a leg curl machine, I'd go up with two and down with one very slowly, trying to load the area with eccentric exercise because you're here with tendon repair that the more eccentric stuff you do, you know, that's good. So I was conscious of that. So I was doing that three days a week, but just always something a little bit different. And I would find that I had you know, a decent amount of soreness through those three months. So it was really hard to, you know, figure out, hey, is the PRP working? Because I'm really trying to get in and do the strength work in addition and run. So it's like, are all these things creating more irritation? But at the same time, I'm thinking, well, some soreness is good as long as you bounce back from it. So I would say at the end of three months, I would probably say I noticed maybe 10% benefit. I'm gonna send away, I was a little disappointed, but then I'm thinking I'm also doing a little bit extra other stuff. So then the next three months, I decided to back off to the strength work just once a week. Do a lot of the same exercise, just maybe do a little bit more of that one day a week. And then I noticed another, probably another 10 to 20% benefit over the next three months where, okay, I backed off some of the strength work and irritation. I feel like I'm you know, making some progress, another 10 to 20%. Then at six months, I asked her, I said, hey, is this as good as it's gonna get? And she's like, based on my experience, probably at six months it is. So I kind of said, well, all right, I guess I'm better, but you know, I'm not 100% happy. But then over the next six months, I think I had another bump of probably another 10 to 20% benefit. And I told her that, she goes, well, that's a little unusual, but... we'll take it. So I'd say one year post procedure, I was probably 50% better than I was going into it. And so that's late 2015. And I'm thinking, all right, this is what I have. I guess I'm gonna live with it. I'm better. I can at least function a little bit better. I seem to bounce back from strength workouts, runs a little bit quicker. Still have soreness, still soreness to sit, but. I can live with what I have compared to what I had previous. I could still sit down. But by this point, after many years of using pads, I'm still using the pads. You just find that you stand more than you sit anywhere, if you ever go anywhere. You're standing, or everyone else is sitting, and you're standing. It's just the habit you get into. So yeah, so I got better, but I was not cured. Yeah, maybe chime in with a few things. Um, I am very conscious of the impact that language can have when a therapist is communicating to someone and when you got those scans and the doctor was saying, you know, the, the tendon on the right side is just a mess. It is like completely gone or whatever the language they use. What thoughts were going through your head when they were explaining exactly what the condition was like and the severity was like? Yeah, well, I think when she looked at the left side, she was just kind of like, eh, that's typical of what we see. Cause I felt good when she was looking at the right and she was showing me all these weird irregularities, which she called the micro tears. And I didn't know the significance of, obviously my tendons are still attached to the bone. which a lot of people that you've encountered and I've encountered, or especially as we follow the various sites through the internet where some people have detached tendons. And so at least I know, hey, they're still attached. But what crossed my mind was, what's the risk of this completely blowing? And I asked her that, I said, what does this look like? She goes, well, you, I mean, she goes, you do have risk of if you keep... wearing and tearing and grinding on this, where this will just pull away and detach. So she did point that out to me, which obviously it scares you because you don't, you realize that that's supposed to be attached to the bone and not detached. So I was a little concerned, which may be more fired up you the danger. And ultimately, I mean, I wanted to heal, but yeah, it just, you don't like to look at your anatomy and see it in irregularity that. you know, just completely doesn't look right. Yeah. The other question I wanted to delve into was you mentioned like during the recovery of the PRP, you started doing a bit more strength work. Was that under the advice of the doctor or you just decided to do that yourself? Um, you know, she didn't really give me any guidance on that. Um, and she also knew that my background is, you know, exercise physiology and training and, and so she kind of trusted. what I was going to do. I kind of throw out to her. I said, hey, this is kind of what I'm looking at. Obviously I'm not going back to heavy lunges, heavy squats. Are you okay with me doing this? And she was just kind of like, yeah, use your judgment. If something hurts too much, don't do it. See how you respond to the loading. So she kind of really just trusted me based on my background. Yeah, great. And I think it fits the pattern that I understand around loading a tendon in the gym and you were sort of saying, yeah, some exercises were hurting, but I was bouncing back quite quickly. And the guidance that I like to give a lot of my runners with a chronic tendon issue is pain during the exercise is okay if it's under, if it's around like a four out of 10 and below, like those loading is actually healthy for the tendon, but we need to make sure there's not a exacerbation of symptoms afterwards. The next day, that's a clear indication that you've overloaded it. Uh, you did mention that you dropped from three times a week to doing once a week. And you said, but during that once a week, it was more, would you say that was heavier or would you say it was more reps? Would you say that more exercises? I would say, you know, previously when I was doing it three times a week, I would try to do sets of exercises that were different each day. So when I switched back to once a day, I was probably doing all of those exercises on that one day. Um, you know, I wouldn't say I was doing all the volume of those three days previous, but, um, I would, instead of doing, let's say two or three exercises, different ones, three days a week, I would choose maybe three or four to do on that one day a week. Um, and then the next week, if there was something I didn't do the previous, I would, I would mix that in. Um, cause I kind of felt like as I wanted to continue to run. I just, I felt better with just the one day a week strength training. Like I didn't feel like I was sore all week. Um, so that seemed to work okay for me. And those three, four exercises were those the squats, the leg presses, those eccentric leg curls. Were there any others? Yeah, I was doing, um, I was doing different types of things. Um, I was doing some bridging, different types of bridging on the floor. I'd have my foot on a, uh, sometimes on a. know, two legged or one legged on a foam roller just to add a little more balance and stability. I was doing the leg curls. Kind of with the concentric going up with two down with one. I was I would do squats just with either dumbbells in my arms or without any weight. We have another device at the gym I'm at where it's a type of squat press where you put your shoulders under some pads and and lift up. So yeah, I was doing kind of a combination of those things. And I deviated from that later on, I had a little different approach, but those are some of the things I was doing that I thought were reasonable and the right thing to do. Yeah. And listening to your story as well, and talking about the strength training, it's encouraging for me to hear because I like to, I'm very strength and conditioning focus when it comes to a tendon, as long as you're able to tolerate it and listening to your story years and years of like short-term fixes and procedures and um, cortisone injections. It hasn't really been until, like you say, after this PRP that you're really specific in the gym and within the email that you sent previously, you're saying that, um, there was one specific year where you felt almost 50% better with. doing continuing to run, but also upping a little bit more resistance work or tweaking that resistance schedule, I guess a little bit more around that period of time was it any different from what you just described? Um, yeah, you know, then there was a couple of year period where I, um, I was like, Hey, I I'm better. I'm not, I love to be pain free and doing great, but I'm better. And, and I actually started to ramp back up, um, in 2000. Um, so, so PRP was ended 2014, ended 2015. So the spring of 2016, um, at age 50, or I was going to be 50, um, I was going to try to break 20 minutes again in a five K. And I hadn't done that probably since 2007, 2008. And now it's 2016. So I'm just gonna make a run on it. So again, kind of getting back into some more structured workouts. And I wasn't doing heavy miles, but I would be a little more consistent and doing more stuff and dropped a few pounds and kind of got refocused. So yeah, like a week after my birthday, I ran a 1947 5K and I was pumped. I was like, hey, I'm back. and I'm feeling, you know, still soreness, but I'm kind of thinking, hey, I can live with this and function and be okay, age 50, I'm still running in the 19s and I'll take that. So yeah, so I was okay with that. And through, yeah, the next couple of years, I still continued to raise, perform well, I never broke 20 again, but did well. But still, again, still it was a day-to-day thing. It's always on your mind. I still have soreness. Um, but I, at that point, I was kind of thinking, this is just, if I'm going to continue to run and this is going to be the part of my lifestyle forever, it's just something I'm going to have to deal with and I can manage it the way it is right now. And so that was my mindset going forward. Um, at that time as well, what was your, what was your running schedule? Like, what was your strength sessions? Like, were you still icing? Were you still doing any of those? Like, I guess pain. monitoring, alleviating symptoms, that sort of thing. I was continuing to ice. I iced always into 2018. So anytime I do a race or a run, or I would go home and sit on the ice bag, it just became routine. Whether it was good or not, now I kind of believe it wasn't good, but I continued to do that just because it's just what you do. It's, you know, you ice, it's gonna make you feel better. It's supposedly supposed to help you recover. So I did that. over the next period of years, my strength training was still consistent. I generally would do just once a week of strength work. Typically I would do that after a run because running was loading and would cause some soreness. I figured I'm gonna do it on a day when I was loading it anyway, knowing the next day I'd have off from running. So I kind of kept that plan up, which is similar to what I continue to do. But yeah, so yeah, that was still my routine. up into, yeah, like we've discussed into 2018, you know, had a little shift of some things that I had done that kind of took me to the next level. Yeah, let's dive into that, because you did mention 2018, you really turned a corner. Let's dive into it, what happened? Yeah, so it's interesting, is, you know, I had a career for 14 years in the orthopedic world, working. with orthopedic docs and then I made a change. Went to work for another company called H-Wave. It was, well, I didn't actually take the job. I interviewed for it because they had this device that was huge, not only treating pain, but also was awesome for recovery. It's in the sports world, NFL, major league teams, basketball all have the device for recovery tool. So that intrigued me because that's just my background the passion around recovery. So I met with some of the company representatives. And again, I was reluctant to make a career change after 14 years, but they said, hey, go home, take this device and just play around with it. They'd asked me if I had any aches and pains. I mean, I feel pretty good other than these darn hamstrings which have been bothering me for years. And then interviewing with them, they were talking about, well, we have, as a company, we're into... recovery, waking up lymphatics were kind of anti-ice. And they delved into that a little bit more elaborated and kind of a light switched on like, that makes total sense to, I shouldn't be icing disease tendons. Even back to the scan, when the doctor scanned my hamstrings, she goes, you don't have any really any inflammation here. It's just disease tendons. I'm just like, well, why am I icing if I don't have any inflammation? So it's just like a light switch turned on. So at that point, um, I'm like, you know what, I'm going to stop icing my, my hamstrings. So I got this device, which is really just a, uh, it's a electrical stimulator that, uh, creates muscle contractions. Um, it doesn't, a non fatiguing way where you can get your hamstrings pumping your quads pumping. So I started doing that every day for two hours. I stopped icing. Um, and it was weird. that within a two week period of time, as I'm continuing to research this company that, again, I thought I was kind of imagining things where I just felt like, you know, I just feel like my hamstrings feel better after two weeks. Maybe it's just an imagination, maybe it's a two week phase. Is it the device? Is it that I stopped icing? And I'm looking back, did my writing schedule change in the last two weeks? So something was changing. And then I'm, went another two weeks and I noticed another little bump in improvement. And then I ultimately felt like the device was helping the lack of ice. The, the, the message of the company around both of that, how you treat conditions through loading without necessarily fatiguing, stop icing. Let's work on treating the cause of the issue. Let's wake up lymphatics. Let's create flushing. Let's crease, crease more circulation. Um, so I just liked the message of the company and I took that position. And. proceeded to follow my plan. I did alter one thing. I added a one strength exercise, which was kind of weird. And again, whether this added to it, in addition to the stopping icing using the device or just having even just the overall better attitude about things, it was a standing leg hip extension exercise where throughout this process, I saw whatever, obviously you do enough searching on the internet and Twitter and where... This one exercise where you do a standing cable with resistance where you go straight back, squeeze your butt. Oh no, it was you go straight back, a hip extension with your toe out. So you get a really heavy duty butt contraction, but then the negative come forward, straighten your toe out and just slowly come back like a negative with a slightly different foot position. And... And that just, when I started doing that exercise, I was like, man, number one, I really feel my glutes firing and tightening up. And then on the way back, I really felt like that resistance exercise going back with a slightly different toe position, loaded that tendon in a way that I noticed the day after. And I felt like it didn't irritate it. So it was kind of a... a revelation of an exercise that I thought for me was making impact, um, combined with everything else that I was doing, you know, three months later, I was like, my hamstrings are significantly better at this point. I can't necessarily tie it into one exact thing. It is probably a combination of stopping icing using this device on a daily basis, recovering better. And I think that's a part of it too, cause the device actually helps you recover better from workout to workout. So I was getting less soreness or I was responding from the loading I would do in my runs and my strength workout much quicker. And it's almost like I created a better environment within my body to catch up in a way where I could heal while I'm loading and progress. And at least that's my looking back on it. I feel like that's what happened. This podcast episode is sponsored by the Run Smarter Physiotherapy Clinic, which is my own physio clinic where I help treat a wide range of PHT sufferers, both locally in person and all over the world with online physiotherapy packages. In the years I've been self-employed as a physio, close to 70% of my entire caseload has been helping people with proximal hamstring tendinopathy, which is why I decided to launch this podcast. So if you're building upon your own rehab knowledge through the podcast, but still require tailored assistance, I'd love to be on your rehab team. Whether you are a runner or not, head to runsmarter.online to see your available options for working together. If you're still unsure if physiotherapy is right for you, or if you need a rehab second opinion, you can always schedule a free 20 minute injury chat with me. Find the free injury chat button on my website or in the podcast show notes to be taken to my online calendar to book in a time. Was the H-Wave device itself, was it producing any warmth? Was it producing any sensation or was it just like a invisible wave kind of reaction? Yeah, you put electrodes on your muscles and it basically tells them to contract. So you're getting two contractions per second. So you're loading tissue and so you're loading the hamstring tendon. But the neat thing is because of the waveform, it's not creating a fatiguing effect. So I could, I've used it four hours at a time and you're done with it and everything just feels loose and great. So that's why it's a good tool as well from a recovery standpoint, if you're having a hamstring surgery or if you're immobilized, it allows an active recovery while you're not loading as far as walking or creating a different type of heavier load. So as far as warmth, just through general increased circulation, You could say, well, does circulation increase warm? You could say, well, sure. But I forgot to add one other thing. I started doing a little bit more too. And it's like, you know, I'm kind of throwing everything at the kitchen sink, everything at the tendons. I purchased the far infrared heating pad as well. So I started using more heat now instead of ice between workouts. I was really diligent about before I would run to sit on this infrared heating pad to heat up the area so that, you know, if you go out and run on cold tissue, you could maybe create more micro tears or more issues. So I really was focused on really, really warming up tissue, not only before my activity, but you know what? Blood flow. We want more circulation. We want more blood flow going to the tendons. And I figured the fire infrared heat, which is, you know, has good deep penetration versus a typical heating pad. I thought that was a great modality to add. So I contribute some success using that modality as well. And again, that whole package of those changes took me to the point where my left side, really probably at six months, probably into mid 2019, my left side was 100% and I'd say my right side, because of the severity, I'd say 95% healed. And I'm back to that. But right now that's where I'm at right now as well. Fantastic. I think, yeah, there's a few, I wanna delve back into a few things that you did mention. It's unreal that after 10 plus years of this condition, you can bounce back to that level of success. That's awesome to hear. When you're talking about the icing and now that you believe it's probably not the right move, I can, based on my understanding as well, when the term tendonitis well regarded anymore. It used to be very, very common, but now they've changed that terminology to a tendinopathy because that ITIS part signifies inflammation is the primary component. But now they know with a inflamed, whatever you call it, a tendon, there's no inflammation present. Well, it's not the primary driver. There might be a little bit if it's a really reaction based, if it's been like a couple of days or a week or so of a really overloaded tendon, there might be some inflammation. generally speaking, it's not the primary driver. So they've changed that, that terminology from tendonitis to tendinopathy. And then that goes to show years and years of this and using ice, if there's no inflammation, then the ice probably isn't doing anything. And if anything, it's probably the opposite because what we know with the body, the body heals where the blood, blood flows. And there can be certain parts of the body, say with fractures like bone fractures, if there's a reduced blood flow to that area, it takes a longer time to heal. than a fracture of the same severity that's in an app, part of the body part that has a lot of blood flow, it recovers a lot quicker. And so people have worked with me runners who have worked with me know that I am very regimented with how I, um, approach a rehab. And I like to change one component at a time just to see what is effective. And it might just be, let's do a week of changing something up and then let's see how it goes. Let's change one other factor. Let's see how it goes. But for you, it seems like you've changed a whole bunch of things within a couple of weeks and miraculously have like noticed improvement and decided just to keep throwing things at it, which is a great thing as well, because you're getting better, but it's really hard to determine not only which components are the most significant for your recovery, but like what is, what is effective, what isn't effective, what's kind of like a bit of a gray area, what's helped a little, what's helped a lot. kind of hard to tell, but let's go through the summary. So you said that you started using the H wave a couple of hours a day. You started using the infrared after workouts to increase blood flow, like the heating pads, you stopped icing altogether. Um, you started doing a little while you kept your strength and conditioning work consistent, but then added in a hip extension. So there would be a cable attached to what would be, I guess your ankle. And if you're facing the, the weights, you would. keep that leg straight, but extended backwards and then twist the foot a little bit and control the way back in. And you also mentioned in your email as well that you stopped stretching, is that right? Yeah, that, you know, you know, some of this is like a revelation. You know, some of this stuff is like, why are you doing things that are irritating your condition? There's a common sense here that sometimes you fall victim into, well, everybody ices, I should be dicing. Well, stretching is good. Everybody stretches, I should be stretching. And it's like, I know better, but you fall victim into traditional treatment patterns to where like a light switch turned on, it's like, well, no, why am I stretching if that makes it hurt? You know, tendons don't move and stretch. You know, the muscles certainly have a little bit of flexibility there. So if I'm trying to do a stretch, my tendon is getting pulled on and it's irritating the heck out of it. So. I stopped static stretching and really focused more on dynamic movements where you get a stretch response through movement. So rather than do a hamstring static stretch, I would do start with some easy leg swings and then just progress to where they're a little bit a longer range of motion to where you might get a little stretch reflex. Or if I'm laying on the floor with my hands behind my knees, I might extend my leg up, but I'm doing a movement while I'm stretching. So a little bit more dynamic movements, you know, take the muscle through a range of motion versus holding it there and pulling and cranking. Um, so I do feel like that was a benefit too. And to this day, I don't do, I have the certain body parts. I'll do some static stretching, but, um, I just don't think to go and stretch and crank on tissue that's not healthy. I just, that's just not the right thing to do. Yeah. I think if anyone's listened to a few of my blogs around proximal hair string or there's a couple of podcasts, episodes there as well. I don't really recommend static stretching. I think it is like a innate human behavior to want to stretch something that's sore. I think it's like, just like getting a massage as well. People like pain while they're getting massaged. Some people really like that deep tissue sort of thing. Cause it looks like it feels like it's doing something and it feels like you're paying attention to that area. And those who have proximal hair string issues and they stretch and they feel. soreness in that area. It's like, Oh, I'm getting to that area. I'm really trying to focus on that. And I'm stretching it out or, um, yeah, paying attention to it, which I know it's just like an inherent sort of human behavior that we like to do. And like you say, you can fall victim to that, that sensation of, yeah, I just want to get that feeling. And they know over a period of time that it's actually causing irritation, which now the evidence is starting to emerge that static stretching isn't good for hamstring tendons at all. Um, and your most if you want to do something that is painful, it would be to do under like loading of the right amount would be to make sure that there is a little bit of pain during your heavy loading exercises and make sure that it's just not a flare up the next day to know that you've negotiated that dosage quite well. And so I guess your story, even though it's a chronic pain, it's been happening for 10 years plus those conditions still apply. And it seems like you've still responded to those particular recommendations, which is really encouraging to hear. I have a lot of runners that reach out to me on social media and you can see there's Facebook groups of hundreds, thousands of people that have had this for a very long time, and I just wanted to summarize or finish up this interview with just asking, do you have any, do you have any advice, do you have any guidance? Do you have any parts of wisdom for those who have been suffering from this condition for several years? And. starting to maybe lose hope and giving up on trying different things? Anything you want to share? Yeah, you know, obviously, you know, if the nerve is not involved, you know, because some people have chronic pain there where the nerve might be involved, but if you feel like it's just related to the tendon, you know, it's hard to say, well, don't give up when, you know, and I'm a good indicator. I didn't give up after all these years, you know, I still wanted to keep trying things. So I guess I would encourage somebody to try different things. The biggest thing is avoid things that irritate. That's huge. Try some different things. Really have a commitment, because sometimes we're a society where we want to try some stuff, but if we don't get immediate results, we kind of give up. So really make a commitment to take... In hindsight, if I had to do this years back, I probably would have taken off, let's say a three month period of time from running. because it's real difficult to heal this condition if you're trying to continually. The hamstrings just take a tremendous load when you're running and pounding on the pavement. And I'm a outside runner on the roads. And probably the smart thing to do back in the day is, you know what, take the time you need to heal because I just prolong the situation by continually creating more obstacles in the way. So, I guess words of wisdom is, you know, don't give up, try different things. You know, there's a lot of modalities out there you can do. I do feel you need to load tissue as you, I know you do Brody, you have to load the tendon, but you got to find a way to load it in a way that you respond, you recover from it, which is important, which is again, what I liked about H-Wave is you can load it without any soreness at all. So that's certainly an option for people you know, different EMS devices out there can load tissue without causing harm. I think for me, I think that was one step where I could watch TV for two hours and load the tendon, knowing I'm feeding it the nutrition and oxygen and blood flow. That's helpful for healing. In addition to doing some of the other things, as far as the strength work. Um, and then after the strength, we're also recovering from that better. So, you know, it's hard to cause everybody is different. to say what works for one person, what works for another, but I do think you can try different things and not give up. It comes up a lot. A lot of times you'll hear, well, PRP doesn't work. And it's like, well, maybe there's not evidence that it works for certain conditions or even maybe even hamstrings, but does it mean it may not work for you? I'm a big believer in, hey, maybe it's the person who did it didn't know what... he or she was doing. And I seem to choose a practitioner that was an expert in musculoskeletal ultrasound and her technique where I felt like it was a benefit to me. So don't eliminate all options. That's always is an option. And you talk about their stem cells, there's other ways to potentially treat conditions, but there's a lot of frustration out there. I'm on some of those sites as well. You know, you just wanna say don't give up, but then you also realize how it's just such a tough condition because every time you sit down, you're reminded of it. It's a battle. And the other thing I would tell people, if you feel like you're getting better, like for myself, I consider myself still having proximal hamstring tendinopathy. So I'm treating it as a lifetime condition, even though I'm for the most part symptom free. I do everything. the same like I did two years ago. I still sit on the infrared heating pads. I'm still using H-Wave daily. I'm still doing my strength work. I'm still not icing. So for me, if I felt like I stopped any one of those things and I kind of feel like, hey, I'd be high risk for it coming back. So that's certainly advice is because you feel better, don't give up on your treatment. Cool. I might just hone in on a few of those takeaways. One being, yes, try everything. Um, try, try having like a bit of a structure in a regiment around trying new things. If it sounds gimmicky, if it sounds like there's not a lot of evidence, still try it like it might be that thing that finally turns a corner for you. But the other thing that I would mention is if you are, I'd say follow a structure for a couple of weeks up to a month. And if it's not working, then try something else. And I find that I talked to a lot of runners. who have conditions outside of this as well, but they try, I've been doing my strength work and I say, uh, they say, I do my strength work every day or I've done it consistently three times a week for the last six months. It's not getting better. And then you say, well, what are you doing? And it's all just like maybe body weight calf raises or body weight bridges or planks or something that's not really addressing the area. And you say, why are you continuing it for six months? If you haven't seen any benefit within, um, a couple of weeks, I'd say leave up to a month and Like you were saying, you started your strength work and you were 10% better after two, three weeks and you decided to continue or decide to tweak a few things and see if that 20, that 10% turns into 20% turns into 50%. That's a good way to test and tweak. But if you're not seeing any results for several months, there's no way I would have someone continue doing that if you're not testing and tweaking, I guess you agree with that. Yes. Yeah, I definitely agree with that. And, you know, what I hadn't. pointed out to and as you would agree is, you know, when you're running and active, your hamstrings do so much work and you can't underestimate the value of strengthening the glutes, your butt muscles, your glute muscles, because you really want them helping out in some of the work, even walking. I mean, we want your butt muscles helping out in the walk, you don't want your hamstrings doing all the work. So, you know, there's simple things to do, obviously, isolated glute work. But anytime you're doing a squat or a hip extension, you're getting glute work. even just simple butt squeezes. That's one thing I do before my runs now is I do some prehab where I try to activate my glutes. It could be a few bridges, standing squeezes, just wake those up so when I start running they're involved right away. So and that doesn't, even if you're not a runner, I think it's valuable to do those things before you go for a walk or you get up from waking up and you know you're going to be sitting all day. Well, you know, just wake up those muscles. Yeah. A great point. And something that like the research does show and that the experts to elaborate on is definitely, we want to build up the tolerance of the hamstring tendon, but we also want to work the global muscles and definitely the proximal stuff. So every, all the muscles around the hips, a lot of research to show that that's extremely effective. Todd, this was, has been, uh, my mind's blown. I think the, the story that you come up with, how like the, the lists going through all the years, several years. And. trying different things and just really combining it into an hour chat has been really insightful. Hopefully, I know it's going to be very encouraging for a lot of runners that do listen to this and just to know that there is hope and know that there is other methods that, like I said, have turned a real corner for you and to get to the level of success you are now and still doing your still being active with your recovery, still being like preemptive and working on prevention and. this sort of thing. It's an amazing story and it's covered a lot of key points around chronic proximal hamstring tendinopathy and a lot of runners are going to get a lot of value out of this. So thanks for coming on and sharing your story. Hey, my pleasure. I loved it Brody. Thanks. 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.