Talking About the Festive Flare-Up

: On today's episode, we're talking about the festive flare up. Welcome to the podcast helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments and. bust the widespread misconceptions. My name is Brody Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. Welcome back. Happy New Year. Thanks for joining me. I have decided to schedule this episode. I was going to discuss another topic, but I have been seeing so many clients and just people with PHT reaching out, people with other running related injuries reaching out because this time of year people are experiencing flare ups. whether they can think of a reason why, or they can't think of a reason why, for a lot of you, there's just a random sort of flare up. And I've been jumping on, for those who aren't familiar, so I'm an online physio and the bulk, vast, vast majority, about 70% at the moment of my clients, PhD clients. And a lot of them are jumping onto calls and saying, yep, I've had this flare up, I'm not sure why, I'm not sure what it is, but what can we do? And I've just been having the same conversation, like for the last five or so days, just with all of my clients and thought I'd do a podcast episode on it. So it's kind of like a bit of a, a public service announcement, but also a good time to sort of recognise why some flare ups can happen. We're talking around pain sensitivity, because sometimes if it doesn't make sense, if it doesn't make mechanical sense, There can be other influences that can cause a flare up. What do I mean when I say mechanical sense? So from a physio perspective, it's like a load dependent response. So if you say, okay, I increased my running from 20 minutes to 30 minutes, and then I had a flare up. Well, that makes mechanical sense because you've tried to increase your load. If you've gone from doing your deadlifts and you've progressed your deadlifts and you're a bit sore afterwards, it makes mechanical sense because there's that relationship between load and an increase in symptoms. But sometimes it doesn't happen. Sometimes you can continue everything that you can and for whatever reason, you're like, okay, my sitting has been exactly the same. My deadlifts exactly the same. My running hasn't progressed whatsoever. just for whatever reason, today, I have increased pain. And so that's when we sort of draw away from the load, the mechanical load side of things and think, okay, are there other influences that change pain sensitivity? So the nervous system is responsible for delivering the pain. What influences are there that can increase that sensitivity? because if that becomes more sensitive than usual, if your nervous system is a bit more wound up, if it's a little bit more sensitive, then yes, you can experience a flare up without anything happening. So, purely by coincidence, I have chose five topics around the festive season that can increase your pain sensitivity and I'll start with S. So I think that just helps. create a little bit more engagement. Um, well, I came up with mainly for that increased pain sensitivity. But the fifth one I put, which I'll talk about now is sitting. That does it. That's a mechanical load response, but in the festive season, there's a lot more sitting. You're traveling, um, traveling to see family. A lot of people are on flights. A lot of people are on, um, car rides, uh, but even just sitting down for a Christmas dinner. even just, you know, socializing a little bit more, just a little bit more sitting. So that is definitely a component that is mechanical that we need to factor in. So it might not be your running, might not be your deadlifts, they can stay the same, but you know, unbeknownst to you, unless you keep track of it, you could be sitting for 45 minutes to 60 minutes more per day, and unless you're tracking these things, you might not realize, and all of a sudden, you know, you're... tendons are a little bit more sore. So I thought I'd address that, but these others we have on here do increase the pain sensitivity side of things. Like I say, they all start with S. Let's get into stress. Stress is a very prominent part of the festive season, whether we like it or not. Some people are affected by stress more than others. Me on one side don't get stressed too much. My girlfriend... gets quite stressed, but it doesn't necessarily need to be negative stress. Um, it can be like just a bit overwhelmed. It can be, um, just knowing that you have a lot on your calendar. You might not be negatively influenced or like have anxiety driven thoughts about a social gathering, but you know, your heart rate might be up a little bit. Um, just a lot going on. When there's a lot going on, sometimes our cortisol increases, sometimes our noradrenaline increases and that influences pain sensitivity. So let me break this down a little bit because some of you might not be listening during the festive season. Some people might be listening to this media and have not much going on, but still an important component to grasp because even when you're injured, it can be very, very stressful. This condition, PHT, can influence a lot of people's lives in other domains other than their athletic endeavors. Some people really stress about going out to have dinner with someone or sit down at a movie or socialize and feel embarrassed that they have to stand up all the time. So that stress can impact the recovery process. So what happens is when you are stressed, your body releases certain hormones and certain chemicals. The chief among them are cortisol and noradrenaline. What these two things do are increase your heart rate, increase your blood pressure, increase like, just they prime you for action, because when you're stressed, your body kind of has this fight or flight response. If you're familiar with this, it's, you know, back to evolutionary times. You want stress, you want, like when you're in a stressful situation, you wanna be able to run from danger. You want to spring into action as soon as you're able to do so and not have this long weighted warm up build up to then sprint. And so what the body does put in a stressful situation saying we might be in a bit of danger we may we may not but we need to be prepared in case something does jump out at us danger does emerge and we just sprint away. And so that evolutionary trait carries over into day to day circumstances. When you are stressed you're worried you. visualizing or catastrophizing things that could happen. And all of a sudden, your heart rate starts increasing, your blood pressure starts increasing, your breath rate starts increasing, you're priming yourself for action, even though you're not really wanting to do that, but it's an innate kind of automatic response, but does influence the sensitivity side of things. So your nervous system just gets primed and it's ready to go. And if that happens over a long period of time, the... sensitivity of those nerves can be heightened. And so if you do have pain, that can trigger that response. So in a similar vein, emotions, thoughts, feelings, all those sorts of things can increase pain sensitivity as well. I've done earlier episodes on chronic pain and how it can impact people's recovery, just because those negative emotions, thoughts, feelings, negative mindsets states that you put yourself in, kind of has this really unhelpful loop of if you're in pain, you know, it's you're miserable, you constantly think about like, am I always going to have this, am I always going to have to stand up during work, and that sort of perpetuates more of a catastrophizing momentum and then because you're catastrophizing and these thoughts are coming in that triggers more pain and then you get more worried and more anxious and so you know perpetuates this cycle and that has the ability to heighten that sensitivity and so put yourself in a stressful situation the festive season got a lot of things on got a lot of presents to buy got a lot of family things gathering socially um a lot is happening you need to cook you need to clean you need to prepare and then that can that emotional side, the psychological side can increase pain sensitivity. So we had sitting, we had stress. Third one I have down is sugar. So now we're talking about the diet side of things and I've done diet episodes in the past. Um, I don't think I have released my interview with Rowena field on this podcast yet I've done on the run smarter podcast, but she's a researcher looking at. certain diets, mainly keto or like low carb diets and how it influences chronic pain. And is seeing a lot of promising research come out to show that a keto or a low carb sort of diet, people with chronic pain are improving. They're getting their pain levels are decreasing and mainly following the premise that sugars, so carbs are essentially a sugar. They're just digested and processed in a different way. I'm not a dietician. I'm not going to pretend that I know a lot about that whole molecular side of things, but you have your refined sugars which are like, you know, absorbed or processed a lot quicker. And then you have your carbs, which are sort of stored. They both break down and they both become glycogen or glucose and then stored as glycogen. So it's a roundabout way of the same thing. And so sugar essentially can, as we hypothesize in this research emerging, can influence pain sensitivity. And, you know, I'm guilty of this as well. My sugar intake has increased dramatically over this time of the year. We are gifting, you know, soft drinks or sodas and chocolates and, you know, cakes, just everything to do with family and food and all that sort of stuff. It's, yeah, it's, it's an element that we need to consider and sort of make some changes in our diet. And it only takes maybe a couple of days, you know, to process that. And your body would sort of calm down and desensitize that relationship. So sugar, definitely up there. We need to keep that in mind. What's the next one that I have? Ah yes, we are talking about spirits. 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. When I say spirits, I mean the alcohol version. I wanted all of these to start with S and this was kind of my work around that doesn't really make sense but I just wanted to keep to S. So when I say spirits, I mean all type of alcohol. Alcohol does have the ability to increase pain sensitivity. Mainly when it comes to chronic pain, there's a lot of research that I follow and there was a really, really good podcast about chronic low back pain. I cannot remember the name of it now. Bear with me while I type it in. Okay. It is called Empowered Beyond Pain podcast and has Peter O'Sullivan and a couple of his colleagues. Peter O'Sullivan is a heavy researcher. into low back pain and pain in general. So if you like this podcast for being kind of science minded and research backed, you would love that if you want to truly understand chronic pain. And they talk about the general well being of a human. You know, talk about stress as well but smoking, the like lack of exercise, the stress. And they mentioned alcohol as just one of those factors just to work at your overall wellbeing in terms of dealing with chronic pain and sort of managing that. And yes, I have seen myself, I have seen other clients when they increase their alcohol intake, their pain increases pain sensitivity. And so festive season, it's especially New Year's Eve celebrations. A lot of people are getting involved in that. Um, so like I say, this, it's probably not like these sort of tips aren't saying don't do these things. Um, you probably shouldn't because it's not great for your health, but, um, you don't have to not do it either. You just have to recognise, okay, this is me being in a temporary state of increased sensitivity. I'll get back to managing my stress, managing my sugar, um, myself included. Uh, I'll be probably. because I've been gifted a lot of chocolates and stuff over Christmas break. I'll get through those and then I'm back to sort of detoxing myself and reducing my sugar intake. But recognizing that if I was injured, hey, this is just a phase of my life where I'm not doing more damage. I'm just making these decisions. And if I do have some moments where there's increased sensitivity, well, let's just accept it for what it is. and know that when I start making these corrections that things will start calming down. Because that's what a lot of us need, reassurance and just recognizing, it makes sense of the whole thing because one of the bad things about a flare-up that doesn't make sense is it sort of perpetuates that worry, the fear, the anxiety, like I have no idea why this flare-up has come on. And so you start to worry, but... Hopefully this episode is creating that reassurance and making sense of these patterns. I had one client in particular, just in the last week, said, yep, I've, I talked to her through the sitting, the stress, the sugar, alcohol, all those sorts of things. And she just decreased her for two, three days and she's feeling a lot better. And who knows, who knows if it was a sugar, if it was something else, but. Sometimes that reassurance is what we need and is nice and encouraging. So let's go through our S's again. We had sitting, stress, sugar, spirits, or in brackets, alcohol. The last one that I have, top points if you've guessed it already, but it is sleep. Sometimes New Year's Eve, Christmas Eve, Christmas Day. A lot of us are lacking in the sleep department, particularly if you're stressed, stress. and lack of sleep kind of goes hand in hand. But our sleep mode, when you enter sleep mode, it's the body processing everything, both physically and psychologically. And you've got this time to unwind, your heart rate goes down, your parasympathetic nervous system sort of kicks into gear. You sort of just unwind, have time to process everything. And in that process, your nervous system settles itself down. you have lack of sleep, especially if it's combined with stress, you don't have that time to digest and process and negotiate the psychological side of things. And if you go a couple of days without sleep, or if you go a couple of days of poor sleep, yeah, your pain sensitivity starts to increase. And this goes, this hones in on my questioning for a lot of clients who you can Just get a sense that their severity of pain isn't that it doesn't, it doesn't match the level of dysfunction and the level of strength that they have. Sometimes I can look at a client and they're doing deadlifts, they're doing their strength work, they're running and you know, quite highly functional, but their pain levels are just through the roof and sometimes they have couple of rest days and their pain is still just through the roof. It's like the severity of the pain levels is just, it just seems like it's a lot higher. And they're looking at sevens and eights out of tens. Like what's going on here? And so that's when I like to, when that pattern does emerge, just, just prompt a few questions. What's your stress like? What's your sleep? They're usually the conversations I like to have. And If they do say, oh, I'm a shocking sleeper, I get four or five hours per night, but I'm constantly up, I can't really get a good continuous string a couple of hours together. And, you know, I'm one to be quite anxious. Like I've been quite depressed in the past, depressed about this injury, but also a lot of other things going on in my life, moving house, having a kid, going through a divorce. Like certain situations that are just highly, highly stressful. That's where we need to open up that conversation and say, well, at least recognise that this could be influencing pain sensitivity. And it can be a game changer for some, it could be reassuring for some and allow them to be proactive in how they manage their stress, try and come up with some sleep strategies because they know, okay, if I work on my sleep strategy now, this is actually going to help my recovery, both the pain side of things and the recovery, the physical recovery. because that's what your body needs. I've said it a lot on this podcast and on the Run Smarter podcast, but sleep is the best recovery tool you have. You know, if you stack all the passive treatments, you're talking about stretching, foam rolling, massage, gun, getting a massage, dry needling, acupuncture, you name it. You stack all of those on top of one another and it won't equal the benefits of getting a good night's sleep. And so that's why it's so, so important that we address these things and we at least recognise this is an area of your life that we need to get better at, particularly those who have that high pain sensitivity, particularly those who have been going through a week or so of really poor sleep and they're experiencing a flare up. These are the moments that you need to sort of capture and say, you know what, let's start getting really proactive with this. So, bit of a recap. The festive flare up, which I've just dubbed. I thought it was quite clever. Sitting, sugar, sleep, stress, and alcohol spirits, whatever you wanna call it. I was driving home from my beach house, or my girlfriend's beach house, just a couple of hours ago. And I told her about these S's and she was trying to guess them all. And we sort of came up with a sixth one, and that was schedule. So like your schedule's thrown off a bit in these holidays. So you may not be doing your rehab as consistently. You might not have access to the weights that you did, like either gyms are closing or the weights that you have at home, you don't have access to because you're traveling. You might not be as consistent with your routine in terms of your rehab. You might be running with... you know, someone else, it might be running alone, like, you know, schedules are just thrown off this time of year, which could lead to you having less control of the mechanical side of things. So I guess if we were to put a sixth in there, with my girlfriend and I combining our brain power to come up with this content, we would say schedule. So keep that in mind as well, just throwing in a sixth one there for you is a bit of bonus. So hopefully you enjoyed. Um, I do have another success story in the pipes coming up in the next couple of weeks, um, have something about strength training progressions. Um, and I've got another one coming up from the run smarter podcast. I'm bringing it across to here, but good luck with your rehab. Hopefully this provides a lot of reassurance about this time of year. And if you're not listening to this around the festive season, um, at least recognise these factors when it comes to stressful scenarios and just moments of disruption throughout the year. So good luck with your rehab this week and thanks for listening. 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.