Understanding widespread symptoms

: On today's episode, understanding widespread symptoms. 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. This came in from a Q&A request, I guess you could say. It came from Mark Saturn, who is talking about, oh, he submitted a question during one of my Q&As, and I thought it was such a nice question with a fair few things to delve into, a few things to consider. So I thought I'd just make it a little mini solo episode, not too sure how long this would go for, but I think it's worth. it's rights in as an individual episode and Mark writes, I'd like to understand how an injured damaged weak tendon can go to such, um, can produce such widespread symptoms. In addition to tendon pain, I get chronic muscle tightness in my hamstrings, my thigh, calf, hip, groin and buttock. I also get nerve pain through the whole entire leg. these symptoms get particularly worse through a flare up. And it can be hard to remain focused on the rehab with such widespread symptoms. And it feels like it would help me keep focused if I was to understand why this is happening. So thanks for your question, Mark. I think it's a real insightful question with I think people experience this particular presentation on different severities. You know, sometimes we have pain and symptoms that don't make sense, that don't fit a very classic PHT. It's not often, well, it's sometimes just localized purely to the area, but like you'd experience maybe during a flare up, some of those symptoms just don't fit the boundaries and don't fit the characteristics like normal PHT. And so I've just wrote down a few ideas. I've wrote down a few reasons of why this, you might be experiencing this sort of, um, presentation, but I think it starts off with a bit of a disclaimer because firstly, there's so many different reasons why people experience pain or produce pain and therefore it's impossible to say this is why you are getting this particular pain. This is why you have this particular presentation. So I'll attempt to bring more understanding to the topic and try and allay a lot of confusion that you might have. Mark as well as anyone else who might be experiencing similar symptoms or similar characteristics, but it's not me saying this is why you experience this. It's my attempt into trying to bring understanding because I could say one thing that might be I could say like you produce this pain because of X, Y, Z, but it might not be because we know that pain is so complex. We know that there's a lot of interplay. There's this biopsychosocial mix of why you experience pain or the severity of pain that you experience. And so very, very hard. So my first, I guess the first thing that I've written down is that chronic muscle tightness that Mark reports and I think a lot of you might be able to agree on and Mark was saying he gets constant chronic muscle tightness in the hamstrings, the thigh, the calf, the hip, groin and buttocks. And what makes me think of is when people are in pain, they tighten up, they tense up, they move differently. I am, I've seen this a lot of times, not just with PHT, but just working in clinics. people who have back pain, people who have hamstring pain, glute pain, no one likes being in pain. And what we try and do is we try and move in a way or protect in a way that reduces the pain or tries our best to protect us from producing high levels of pain. And so that's what the body does. The body does has this reaction of saying, this area is in trouble, let's protect it, let's tighten up, let's tense, let's... avoid movement to that area in some cases, just to try and protect the area. It's like a defense mechanism. And so what that does is causes you to tense up. And sometimes if that's done in a chronic nature, if it's done over long periods of time, moving differently, the body just isn't used to that and starts tightening up and becoming sore or have the sensation of tightness, I should say. But also people get tense. We know people get tense when they're frustrated, when they're stressed because they are in pain. A lot of people are fed up with pain itself. They get very stressed or confused or frustrated, all those sort of emotions that cause you to, first of all, amplify pain signals, but also to tense up as well. Because when you, like I said, when you tense up, you're trying to avoid pain. You're trying to move differently. sit differently, you're trying to walk differently, trying to bend over differently. Like how many people with PHT are just fearful of sitting down and fearful of bending over to pick something up off the ground because they don't want to stretch the tendon or they don't want to compress the tendon because in the past it's either fled them up or if they got to pick something up off the floor, they notice a stretching pain in their tendon. They don't want that to happen. So they start reorganizing how they... move throughout the world and what happens with the muscles, they get overworked, they get fatigued, they get sore. We see it very commonly in low back pain and this is very coincidental that I'm talking about this but I've recently just this morning had a flare up of low back pain. I was doing my deadlifts in the gym, I was doing my 60 kilograms increased from three sets of 10 to three sets of 12 and was about to increase the weight but going... Halfway through my second set, felt a little ping in my lower back and I've since been uncomfortable since. It is a low back episode that I'm very familiar with. It comes at probably every six months if I overdo things and I think I was very sensible at this stage. I'm not too sure why it would arise now. I did change my computer chair and have since felt the need for more lumbar support. And yesterday I did a fair bit of sitting. So maybe my back was just in a wrong position for a long period of time. Felt fine this morning, but for whatever reason, my deadlifts have tweaked my back a little bit, and so now I find myself moving a bit differently. I'm very, it's very hard for me to straighten all the way up. And I know as this develops over a couple of days, my muscles tend to get very fatigued all the way up my back, sometimes all the way up to my shoulders because I'm moving differently. And some of these muscles that try and compensate what they are is big powerhouse muscles. And I like to describe this with a lot of clients, particularly if they have low back pain, you have certain muscles that are used to being switched on and they stay switched on for hours. They can tolerate that. A lot of posture muscles are very good at doing this. But you also have big powerhouse muscles that aren't designed to constantly switch on for hours. They're designed to, if you need to lift something heavy, they switch on and then when you put it down, they switch off and relax and recover. And sometimes when you're in pain, these muscles, these powerhouse muscles that are designed to produce power, switch on, then switch off and recover. they stay activated for long periods of time, just while you're moving differently, while you're tense, and they just get super overworked. It's not what they're built for. And then it can start to produce a lot of these widespread symptoms. And that's why when I have low back pain for the first day, it's pretty localized. And then as the days go on, as I move differently, just trying to stay out of pain or just unable to straighten up due to like stiffness and pain, all of those symptoms start um, creeping up further up into my back. So potentially that's, um, a cause and might strike a chord with you or resonate with you based on you know what I've just described. Um, so that's what I had to write it down when it comes to chronic muscle tightness. The other one was the nerve pain. So Mark was saying that he also gets nerve pain throughout the whole leg. These symptoms are particularly worse through So when it comes to nerve pain, we know that particularly with PHT, we've done episodes on this in the past, that's very closely associated with the sciatic nerve. When the tendon attaches onto that sitting bone, very close proximity is that sciatic nerve that can get irritated in PHT. In some cases, it can produce symptoms like pins and needles. It can produce symptoms like a burning sensation that travel further down the leg. sometimes below the knee. And so this could probably explain, demonstrate why those particular symptoms exist. And we know that with nerve pain, we know sometimes it can just be like an ache. Sometimes it can be just like this irritation without movement, sometimes laying in bed, you can feel this soreness even like say, lying on your stomach or something when the tendon isn't. under any compression, any load, any stretch, and these sensations can be produced. And that's mainly just due to the nerve just being irritated and sending symptoms where the nerve travels. And in that case, sometimes it's good to settle down the flare up and then that calms down the nerve symptoms. But it can also be nice to, if it sticks around, to do some nerve mobility exercises with your health professional as well to calm things down. So that's chronic tight, trying to explain the chronic tightness. It's trying to explain the nerve pain. Um, I've got a few other things that I've got written down in regards to like other widespread symptoms or the causes for widespread symptoms and a couple of other tips, which we'll dive into now. 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 PhD 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. Okay the third topic that I have written down here is just other widespread symptoms and what how we can I guess make sense of anything that's a bit more widespread. The topic around chronic pain. because we know that, well, first of all, in Mark's instance, he says he's experiencing chronic pain, chronic muscle tightness, all that sort of stuff. But we know that if someone does have an injury for more than six months, that tends to blend into what we call chronic pain or have more relevance around the science of chronic pain. And just in general, when people do have a symptom or have an injury for longer than a couple of weeks. pain borders just become less defined. It's just what the body does, it's just what we naturally know about injuries. I know that in the injuries that I've had in the past, say for example, butalafemoral pain, I see a lot of people that start off with really localized pain around the borders of the knee. If that gets ignored or mismanaged and carries on for several months, those pain margins just become less defined and Now it's all around the kneecap or sometimes around to the side of the knee or sometimes the entire knee in general. And you can see this with a lot of injuries. And so the PHT same rules apply the longer that you've had it for sometimes just the chronic nature in general just becomes a little bit more widespread. And in fact, when it's when you have a treatment plan and you have a management plan in place, a good sign that what you're doing is working is the pain can still be just as severe, but starts to become more localized. So if you start to develop a treatment plan, and as the weeks go on, the pain is still the same, sitting is still the same, however, it's not traveling down the leg as much, it's not radiating into the hip as much, instead, it's just becoming more localized straight underneath the sitting bone. That's actually a good sign that treatment is working. And That's sort of what we need to discuss, what we need to highlight when it comes to chronic pain, just the nature of how it behaves. But other widespread symptoms, we like, if you do have chronic symptoms, we know a few things happen. We need to rely less on the mechanical side of things. So if we're talking about Mark and trying to make sense of symptoms, trying to make sense of widespread symptoms or random flare ups and frustrated with losing focus of the treatment because symptoms aren't making sense. We know that when chronic pain occurs sometimes the symptoms become less mechanical. When I say mechanical I mean say sitting or lifting or running, doing exercise, anything where you're putting external force on your body and a spike in the demands of your body, what you're placing on the body increases the point to something that's very tangible, something that's okay, I did this, my body demands this, it may have been too much, that's why I have an increase symptom, that's why I have an increase amount in symptoms. But when it comes to something that's quite chronic in nature, sometimes you can just have a random flare up for no particular reason. Sometimes it's more psychologically driven. Sometimes it's more emotionally driven. Sometimes you can just have a day of just being really frustrated about the injury or frustrated that you're in pain or constant thoughts, maybe you've got like this negative spin on a particular day about thoughts of not getting better or what the future is going to look like and that may be a worse day symptom wise than previous so no mechanical properties attached to it, but still sparks symptoms. And so that's why the it's important to kind of write down not only, you know, the mechanical things that you do throughout the day, but also your mood, also frustrations, also thoughts, what the day was particularly like. And that's why things like distraction can be quite nice for people in chronic pain, coming up with hyper focused on the particular area or hyper focused on, you know, the future or the frustrations with rehab in the past or just pain in general. And so we know this to be the case with a lot of like chronic nature, sometimes it's just less mechanical, those symptoms, sometimes we need to make a link to the psychological and the emotional and the social side of things as well. And just things become more sensitized. This is might help mark might help you with your symptoms, just keeping in mind that as an injury, if it stays there for a long period of time, just the structure itself, the pain signals, the alert system just becomes more sensitized, just becomes more hyper aware, hyper focused, hyper vigilant around the particular injured site, because we want to protect the area and just as it develops over the years that alarm system, that warning system, the pain system just becomes super sensitive and so what might produce pain, what might be fairly innocent, maybe it's just bending forward or maybe it's just doing a set of deadlifts with really lightweight. The alarm system kind of freaks out or overreacts and that can produce symptoms just because of that highly sensitized state and Um, back to the, the emotional side of things as well, producing symptoms, sometimes confusion, if you just are really confused about your management, confused about where, what to do moving forward, sometimes that can produce random flare ups as well and can produce like thoughts can provoke symptoms. So, um, keep that in mind. Uh, so the tight muscles just, uh, sometimes due to people just tensing up, moving differently, acting differently, just trying to protect the area. It's important that we do highlight a few, I guess, reassurances, telling people that they can bend forward, that it's okay if the tendon itself is a little bit sore when you bend forward. You should still act in a certain way, still try and move in a free kind of sensation. I know if I have a PHT flare up, even though deadlifts produce a bit of pain, deadlifts are very good for me. I do know that sitting isn't increasing my level of damage. I know that bending forward to pick something up off the floor, even if I feel a tight pulling in the hamstring, that's totally safe to do. And so I do try and move more fluently and I do try and move as if I didn't have any symptoms and the body is going to calm itself down and slow itself down even just now while I have this back pain. trying to sit normally trying to make sure my back is relaxed when I do sit and not trying to tense up when I'm moving I'm trying to move the best way that I can it's hard at the moment but trying to move in the most fluent way that I possibly can and sometimes that's quite reassuring for some people to know it's okay to do those things and so some final tips as we sign off I've got no four tips here one Listen to the pain episodes. If you haven't listened to the pain episodes earlier in the podcast, very important that you grasp these sorts of concepts and so have a listen. Sometimes it takes a few, a few rounds. I know when I learned about chronic pain in university, it just went straight over my head, but it's not until I revisited over and over again, that the concept and the understanding of it just start to make a whole lot of sense. And then it all just kind of comes together. So you might need to listen to it a couple of more times. The second tip I have, document your symptoms, not only what you do mechanically, but how you're feeling, what your mood is like, what your sleep was like, how like your diet, are you eating healthy, maybe you had a rough patch of a week of just eating trash food. Just document those sort of symptoms and document those sort of behaviors to try and come to terms with patterns in your symptoms. The other one that I had written down, try to move with freedom, try to move without say bending with, um, bending forward to pick something up off the floor. I know I speak with PhD people all the time and they say, yeah, I'm feeling a lot better. I'm a lot more confident. Um, I feel like I've really turned a corner. I feel like I'm getting better. And then I ask them, okay, how is sitting or how is like bending forward? Oh no, I don't bend forward anymore. Oh no, I don't sit anymore. I just stand all day. Um, that is a bit of a fear driven behavior. Um, so we want to make sure that we allay those fears and gets you to start returning back to everyday life and everyday movements. Um, and yeah, just like sitting without fear as well. It's a, it's a, um, fair common presentation. I say, or people just, they think that sitting produces more pain in the tendon or contributes to the pathology of the tendon and should I've got early episodes that you probably have already listened to and already know about, but it's worth, um, rehashing this and like sitting is completely safe. Just pay attention to symptoms. Always have the goal in mind to if you can't sit for more than 10 minutes, well under 10 minutes now your tolerance. And so you get strong in the gym, get strong into compression. So like squats and deadlifts. And as you start to get better with compression, your attending can tolerate more compression, you can tolerate more sitting and should not be avoided, should be encouraged. And we just like anything. start with a little bit and slowly build your way up and the tendon will adapt along with it. And so hope this made sense. Again, might be an episode that you might need to replay, but thanks again for your question, Mark. I will be releasing Q&A's in the next, I think maybe once a month, I think is a good ratio for a Q&A. But whenever someone submits a question that like nuanced sub topics to it. That's probably worthy of a solo episode. Then, um, I definitely consider it and add it to the list of my things to do. So, yep, hopefully enjoyed good luck with your recovery and your rehab this week. Until next time, take care. 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.