The Hidden Dangers hindering your tendon recovery

: today's episode, the hidden dangers hindering your tendon recovery. 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'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. is a big one. It is a key lesson. It's another chapter of my ebook. So we'll hear that in a second. Let me just explain. If you are looking, if you're thinking about your tendon, you're thinking that it can tolerate a certain amount of load. So that if you put it through, say, three sets of doing deadlifts, 10 kilos, three sets of 10, that is applying a certain load. And if your tendon itself can tolerate a certain amount, let's say it can tolerate three sets of 10, but it cannot tolerate three sets of 20. There's somewhere in the middle where there's this adaptation sweet spot where it starts recovering, it starts getting stronger, it adapts, but too much exceeds slow capacity, and then it undergoes a reaction. We're looking at purely from a max capacity, like a tissue loading perspective. However, there are certain factors in day-to-day life that influence how much that tendon can tolerate. There are certain environmental factors and certain behaviors and certain snapshots in time where that tendon might not be able to tolerate three sets of 10. Maybe on a Monday it can tolerate three sets of 10, but something might happen, these hidden dangers throughout the week where at the end of the week, it might not be able to tolerate three sets of 10. And that's why I call these the hidden dangers, which is what we're going to dive into today. We're going to tune into injury prone Pete, see what he's up to, and we're going to use this iceberg analogy as well and find or uncover these hidden dangers. So we're here for that now, and then we'll dive into the post recording where I'll give a bit of a summary. What do we have today? We have stress less, the hidden dangers that reduce your capacity to adapt. What does that mean exactly? There are certain lifestyle factors and decisions that we do make that impact our overall general health, and that can dramatically impact our ability to recover and for our soft tissues to tolerate load. So in the past, we've mainly been revolving around tissue loading and not exceeding our maximum capacity. So if you have an external force, that we're applying so we're thudding the ground every time. We want to make sure that all of our tissues are able or resilient enough to tolerate those loads. But now we've flipped the equation and we're starting to look at tissue capacity and mainly like the intrinsic factors that influences our body to tolerate load. Once again before I discuss any further let's check in with Pete. So Pete was just... I just finished seeing his physio. We talked about cadence. He started increasing his cadence. Um, and let's, let's touch base and see what, what he's got going on. So I'll bring up the ebook. All right. Several months had passed and injury prone Pete built up his endurance to 10K, but was starting to become a bit complacent. He needed another challenge, a marathon. Because Pete is a great student. He took on board all of the principles that. The physio taught him and allowed himself 10 months to prepare. Following a running plan designed by his physio, his endurance built up to 25Ks over 6 months. Then life threw Pete a curveball. He accepted a job promotion which included greater responsibilities and a slight increase in work hours for the return of a handsome pay increase. This increase in work hours disrupted Pete's running schedule. But he cleverly solved the problem by waking up just a little bit earlier to fit in his long run. After two weeks of following his training plan to a T, Pete developed kneecap pain at the 20k mark. This left Pete completely puzzled. Okay, so let's break down this concept which is discussed in the e-book. So, this principle is often ignored by physios and athletes alike. Your maximum capacity line is not static. It will be manipulated by lifestyle influences that can impact your body's ability to heal and tolerate load. Factors such as psychological stress, poor quality sleep, are big culprits, but overall health decisions like poor diet, smoking, long term anti-inflammation medication can all lower that maximum capacity line. We used the job promotion as an example. but other scenarios such as death in the family, moving house, having a newborn, the stress of competition and contagious illnesses are also common scenarios or common situations that you might be placed in. So in the ebook there's a graph which is the same graph we've been discussing this entire time. We have our minimum capacity zone, we have our adaptation zone and above that we have our maximum capacity and injury zone. So we see Pete going through his training plan, hitting his adaptation zone and continues to apply the same amount of load, just very gradually and stays within that adaptation zone. But as soon as that promotion comes about with the increased stress and the poor quality that he is applying. So he develops knee pain. So if I could simply put this, if you have a runner who's running 20Ks a week and is well rested, he has a healthy nutrition, a positive attitude on life, the body will better tolerate loads than if that same individual was to still run 20Ks a week but have poor nutrition, physical or mental stress is a has disrupted sleep, gut issues, a history of uh, cortisone injections or anti-inflammation medication. All of these can impact the body's ability to heal. It was super important that I put this chapter in because a lot of clients, um, do everything right. They understand the plan, they understand a running plan, gradually increasing their loads. They understand the biomechanical load, the adaptation. increasing gradually, all that sort of stuff, but they still end up developing injuries. And they wouldn't even think of just general health questions or just a general health screening that could be an influence. So what do we know? So we know that poor nutrition or malnutrition can cause things like gut inflammation and cause inflammation around the entire body, which can can lead to a lack of recovery. So making sure not only are you getting longer sleep or good quantity of sleep, but make sure that quality of sleep is important as well. We know that smoking delays healing times. I hope to God you're not a runner that smokes. I don't think I've ever seen one in my life. But we do know post-op clients and people that are injured if they are smokers. For any injury, if they are a smoker. it will delay healing times. The more you smoke, the more the body struggles to heal. What do we know about anti-inflammations like NSAIDs? That can be things like aspirin and ibuprofen. Taking these medications create weakness within the tissues of the body, and that includes the bone, that includes ligaments, tendons, and muscles. So we really wanna make sure that if you do take anti-inflammation medication, it is just for the short term. and we try and avoid as much as we can long-term use. If you have to take long-term use for some health issues, it needs to be considered if you were to apply load to the body and if you're progressing load and training for an event, that sort of thing. I see footy players that have recurring knee pain and the knee will swell up after a game and so they just take anti-inflammation tablets before the game and it's just a disastrous scenario. So Pete's change in lifestyle, meant a reduction in his sleep and just taking on the promotion means like more stress during the day but also would lead to worry or stress during the night which can impact his quality of sleep as well. I did a blog about sleep a few months ago and it helps bring forth the argument of the importance of sleep and linking it to injury. I've just got it up here. Let me just read a few. I just quote a few studies in there So to start off there's a study 2014 that found that adolescent individuals who slept less than eight hours per night were on average 70% more likely to report an injury than those who slept for more than eight hours These findings were backed up by a different author P von Rosen et al 2016 that found athletes reaching the sleep recommendation during weekdays reduced the odds of injury by 61%. And not only injury, there was a Cohen et al. 2009 found that those who slept less than 7 hours were nearly 3 times more likely to develop an infection compared to those who slept more than 8 hours. Most of the studies around this revolve around adolescent individuals, so those attending high school, but illustrates the point that I'm trying to make. I thought I'd also just briefly mention REM sleep. So rapid eye movement sleep is like a phase throughout your sleep, which can also impact recovery. And I have been studying sleep the past couple of months, and the experts say that your REM third of your sleep. So if you sleep from 10 till 7, it's the last couple of hours. So about from 4 o'clock, 4am to 7am is when REM sleep is most available and you're in that zone more prominently. So for Pete's scenario, getting up just that little bit earlier to go for his long run, he might think he's sacrificing just an hour. or an hour and a half of his overall sleep, but he might be reducing his REM sleep by 80% or 50% depending on how much sleep is cutting down. So it's another important thing to think about. 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. In our Become a Smarter Runner Facebook group, we had a lady who shared her experience with chronic hip, glute, leg issues going on for years. And it wasn't until some members of the group asked about her general health and connected some gut inflammation as the missing piece to her recovery. And she changed her diet to a less. Inflammatory diet and she's seeing incredible improvements. So even that is just a really good example of these hidden dangers. And that's one reason why the subtitle of this episode is marked the hidden dangers because we just don't know about these things. We go for years and years just getting injury after injury or a really chronic injury and we don't ask ourselves these general health questions. The same can be said for REDS which is Relative Energy Deficiency which is a syndrome that is mainly affected teenagers. It used to be mainly for females but you're starting to see males develop this syndrome as well. And it's just a combination of things like, um, poor bone density, lack of nutrition, being underweight and for females having a disturbance in their menstruation or infrequent menstrual periods. And just the combination of these factors, um, leave you really injury prone. You can develop things like stress fractures and just overuse injuries really, really easily. And these kind of combine with each other. If you get poor nutrition, lack of good quality foods and eating leads to loss of body weight, which leads to poor bone density anyway. And then just the cycle just repeats itself and it just manifests itself really quickly and can be quite dangerous. And so how does this apply to our iceberg analogy? Haven't brought this up in a couple of episodes. If you can envision a iceberg that is your own iceberg and reflects the resilience of your body, you want your iceberg as big as you can. You want it as robust as you can to reduce your likelihood of injury. And so if we could manipulate the iceberg itself, we could manipulate the environment that the iceberg is in and manipulate the waves that are around this iceberg. If we have waves that crash into this iceberg, a whole stream of water hits the wall of the iceberg and starts trickling down. The iceberg freezes that water, contributing to the overall mass and the overall size of the iceberg, and just gradually over time that iceberg gets bigger, more resilient. Certain waves will be small trickles of water, which don't influence the iceberg at all, which can be things like walking to work. But we can also get big waves that could potentially harm your iceberg. So if we get big tidal waves, which would be a sprint session, hill session, 20 K is more than what you're used to. For some people's icebergs that don't have the ability to tolerate or absorb that wave, it could lead to damage, could lead to pieces breaking off and reducing its robustness. So how does this apply to today's principle? If you can think of the internal structure of your iceberg, if that's been compromised. So if you look at poor quality sleep, all these things that we've discussed, the density within the iceberg, if that's compromised, then that can also influence the iceberg's ability to tolerate these waves. What was once like a medium wave that could strike the iceberg? Nothing happens to the iceberg, it absorbs it, it freezes the water and becomes bigger. Now, if it's a bit more fragile and the internal structure has been compromised, that same level of wave might not be absorbed as easily and can even break some pieces off and lead to an injury. So, I want you to really take a wider scope of your general health and start questioning a few things around sleep, around diet. Personally, I have been, like I said, I've spent the last couple of months looking into sleep. I have purchased myself an Aura Ring, which is pretty much like a health tracking device. I wear it when I go to sleep and it gives me health metrics, gives me my sleep score and my readiness score. So from 0 to 100, how well have I slept? And it has several parameters and sleep stages throughout the night. and my readiness score is the combination of activity and my sleep score and a few other health metrics like my resting heart rate throughout the night, how quickly my heart rate lowered throughout the night and a higher score means that I can, my body's recovered well and that I can exercise harder the next day. And sometimes if I've worked out too much or done a race or done a couple of days in a row, my body won't recover as well and my readiness score won't be as high. So the next day I either take a rest or make sure that my sessions aren't as hard. I have also over the past couple of years just been slightly, slowly tweaking my diet for the better, just slow incremental steps to improve my health. I've spent the last several years doing a low FODMAP diet which reduces my gut inflammation and I've spent the last two months or so significantly reducing my sugar which I know is a natural inflammatory food. And so yeah, just um. Do some self-reflection. What could you do? Start thinking about the entire body or facets of your life. Is there any area that you might need to improve little tweaks here and there, especially if you're prone to injuries, especially if you're trying to overcome a chronic injury? In the future, I want to dedicate a whole series of episodes on this one topic. And that's just another idea I have moving forward and maybe getting some. expert opinions on because it's something that we don't learn as physios, but can be extremely important. So I'm doing my own independent study, but there's still a lot that I could learn myself. And as I'm going through this journey of learning, you guys are going to learn along with me. So there's the ebook chapter and just want to chime in again to see how this applies to proximal hamstring tendinopathy. The first thing I want to mention now is Think of your body having two switches or two states that it can be in. One is its fight or flight exercise, you know, push through power, push through your rehab exercises, this fight or flight response where the hormones are telling the body we need to move, we need to take action. Think of that. That's one state. The second state is our rest and recovery state. So the hormones change, we go from this like adrenaline to more of a, okay now it's time to settle, now it's time to digest, now it's time to process what has happened, it's time to recover. So we have this exercise and recovery states. The body can't be in the two states at once. And the hormones definitely switch so that it's able to recover. If you say, do a bout of exercise and you say, okay, time to recover. It's not going to do so. It needs time for those hormones to switch, needs time for you to relax, unwind, and then that's when the real recovery happens. Think and self-reflect on your state of, your emotional state, because things like stress, depression, anxiety, not only do they increase the levels of pain that you experience, but it constantly puts you into this fight or flight state. And it's... almost if you're constantly in a stressed state, anxious state, your body can't switch into that recovery mode. So that's obviously going to have its repercussions and be hindering big time when it comes to your tendon recovery. I will mention this in later episodes, but when it comes to recovery, this is a key point that we need to make. And if we talk about this proximal hamstring tendinopathy, a lot of times when it's irritated and aggravated people find it quite hard to sleep because the hip like is flexed a little bit sometimes a bit adducted and the tendon gets a little bit twisted and it can be quite sore at night and it wakes you up and therefore you're losing quality of sleep and as we know from these hidden dangers sleep is one of the most important things to recovery and can definitely um if you're lacking in sleep, you're lacking in recovery and you're lacking in this tendon sort of rebounding and being able to become stronger. So sleep aside, really highlight the importance of stress and emotional stress and putting yourself in stressful positions and anxious positions because it is a very frustrating condition and people can very easily be triggered with anxiety and stress and so if you're constantly dwelling on that and you're constantly switched into this fight or flight stress state, your body is not going to be able to unwind, it's not going to be able to recover and process, which is where all the magic happens within your rehab. So keep that in mind, be very clear, self-reflect, and if you find that is a big issue for you, you definitely need to start implementing some strategies in ways you can unwind and ways that you can switch that body into recovery mode. Keep that in mind, I hope you enjoyed today's episode and learned a lot. We'll catch you next time. 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.