What Brodie has learnt from Proximal Hamstring Tendinopathy

: On today's episode, what I have learned from proximal 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'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. Tio, uh, hopefully enjoyed last episode talking or listening to my journey overcoming six years of tendonopathy. Even though it wasn't PhD, uh, hopefully it took a lot away from it. Today I am drawing from another episode from the run smarter podcast. It was, I think I spent about a month going through one episode, me talking through an injury that I have had and what I've learned from that injury. And I did that on the Monday and then on the Friday, I would release an episode of, uh, an interview episode of someone sharing their success story, overcoming a certain injury. And so I did that back and forth for about a month, doing this one, two punch of me sharing my story and then telling another success story and worked really well. And so I've grabbed the episode on PhD from that, um, from that time of the Run Smarter podcast. And So obviously it needs to be shared on this podcast because you can take a lot away from it. And know that I've had proximal hamstring tendinopathy, I've probably had it several times now, mainly talking about in this episode when I first developed it, why I first developed it, and what's helped me overcome it. I don't think I'm out of the woods. I know in the future, if I do skew my training or if I do overload certain things that proximal hamstring tendon might resurface but I also know that my tendons are very strong. I do keep them very strong currently and any particular flare up will subside quite quickly and I can still maintain a good level of exercise, a good level of fitness while it is a little bit sore. I know exactly what to do which is the lessons I'm trying to teach you guys as well. Anything else I need to mention before diving into the episode? Oh I guess... If you haven't subscribed to the podcast, if you do have Apple Podcasts and you haven't subscribed yet, please do so because then you get notified whenever an episode does come out and you get notified on your screen about the title and then if it intrigues you, you go download it. And yeah, if you don't subscribe, if you're on Spotify, I don't think you can subscribe to podcasts these days on Spotify, but if you have Apple Podcasts or another Android podcast channel where you can subscribe, please do so. I'm seeing a lot of people sharing this podcast to people who might have proximal hamstring tendinopathy or other health professionals who might be interested in learning about PHT. Thank you very much for sharing. Hopefully it's on the forefront of your mind whenever you have someone who is suffering from PHT. If they make a comment on social media or if they have a chat to you in person, if you think this podcast is right for them and you think they'll learn a lot from it, please direct them to the podcast. that's how we get new listeners. I think in this episode I do comment a little bit on the previous episode I did at the time of recording was me trying to overcome knee pain or patella femoral pain. I thought I'd leave that little snippet in there because there are some key takeaways and all the other nonsense I talk about I decided to cut out. So hopefully you enjoy this snippet that I have created for you on the Run Smarter podcast. We're continuing our series what discussing what I have learned as I've gone through several running injuries in the past. And this by no means is no exception. The high hamstring tendinopathy is super common with a lot of runners that I work with. And yes, I have dealt with this myself in the past. I'm enjoying this. I'm enjoying this what I'm calling the one-two punch. The, you know, the solo episodes where I'm teaching what I've learned myself and then... Later in the week, I do an interview with someone who teaches me a lot of things and hopefully teaches you a lot of things as well so I'm really enjoying this combination and will continue for pretty much as long as I go through a list of injuries that I've had which turns out to quite a lot and it's good to illustrate that everyone makes mistakes and what is What the difference is from every single mistake that I've made what I have learnt and what I'm now applying in the future for what I have learnt. Hopefully you're doing the same because you know runners do learn from their mistakes, well most of us do anyway. It's recognising the lessons and recognising perhaps training errors, perhaps being too motivated, too driven sometimes, perhaps it's misconceptions or lack of knowledge or just not implementing the right knowledge. So yeah, very important that we recognise this and we apply it moving forward to reduce our risk of injury in the long run. Last episode, we talked about patellar tendinopathy. The lessons that I learned from that, just a quick little recap. Lesson number one, your weak links will resurface. Don't just modify your activities so that your symptoms subside. Don't just continuously avoid these aggravating factors. We need to try and tackle your weak links head on because as soon as you change up your routine as soon as you try and do something new, that injury will resurface. The second lesson I learned that was the effectiveness of isometrics and applying that to a tendinopathy, lesson number three, that we don't just need to rest and wait for the pain to get to zero and some of these will carry over really nicely into today's lesson. So if we listened last episode around the patella tendinopathy. still early in my running career. And I got through the half marathon fine. I'm not sure if I told you, but I was originally planning for a half marathon with my sister, but because I started getting quite fit quite quickly, I decided to change that half marathon that was in October and convert it to a full marathon. And so that's within, it was eight to 10 months of me running. So it was... not unachievable, but then I decided to do the half marathon in July and see how I went and then progress on through that, which is probably too much of a jump now looking back on it, but I did have a few niggles through the patellar tendon and through the calves, that sort of thing. But got through it unscathed, relatively unscathed. And once I completed the full marathon, I wanted to keep my body guessing. That was in October. Moving into summer, I wanted to try doing some triathlons. and this is where the high hamstring tendinopathy arose and it was due to perhaps doing too much, too soon and working out that doing the sprint work, which I'll talk about in a second, doing a lot of the sprint work because the triathlon is a lot shorter, potentially caused this flare-up or this tendinopathy. Before I continue further, I will recommend if you tendon episodes that I do have. So I've got a list here. So episode 21 is talking tendons and tendinopathy 101. If you're not too sure about tendinopathy, how it behaves, why it reacts, please go back to that episode because I'm going to assume this is kind of prior knowledge for a lot of people and move straight into what I've learned with a little bit more advanced kind of teachings you could call it. So go back to episode 21. where we talk about the original like kind of tendinopathy principles. Episode 22 focuses on tendinopathy rehab and prevention. And then episode 23 talks specifically about hamstring, achilles and gluteal tendinopathy. Go back to those episodes if you haven't listened to them. So I'll assume that's kind of prior knowledge and we'll talk about what I have now learnt. My three lessons for high hamstring tendinopathy. Okay, so number one, the first lesson that I've learnt is the importance or what's such a high impact that speed has. And going back to my story, training for a marathon, I was fit, I felt quite resilient after getting through that marathon. I felt like I was quite a strong runner. And it just goes to show that as soon as you start implementing some sort of speed work, that these these injuries still might occur. Even if you're trained, if you're built for a marathon, if you've got the marathon capacity, as soon as you back off and start doing some sprint work, these might arise. So yeah, there are some studies done. Tim, Dawn, I don't know what the, can't remember what the year of the study was. Maybe 2016. I have it, actually I think I have it up here. Ta-da-da. Bear with me here, I'm just gonna scroll through. I've got the title right in front of me, 2012. So in 2012, Tim Dawn had and other colleagues published this paper. The title of the paper was Muscular Strategy Shift in Human Running, Dependence of Running Speed on the Hip and Ankle Muscle Performance. So did a really nice job of looking at the force requirements of different muscles at different speeds. And there are certain muscles in particular, so say the calves that have a huge demand. but it doesn't necessarily change too much with speed. Those like six to eight times your body weight, especially through the soleus, six to eight times your body weight pretty much starts even at relatively low levels of speed. So it's still working at quite a high amount. The hamstrings however, just significantly jump up, jump up, jump up, jump up, the faster and faster you run, it just goes through stages where it just ramps up, ramps up, ramps up. And if you can try and imagine, This is what I like to envision. The amount of force that's required for your hamstrings, every single step that you take, if you increase your speed, and let's just say that hamstring goes from just like a slow jog to a fast run, that's almost like three to four times what it's usually doing. And that's three to four times the force, every single step. And then you times that step by tens of thousands of times depending how far you're running. and that's a significant accumulation of load compared to what it's used to doing. And so that's why we need to really pay attention to that if we are changing speed. We do it just like we do mileage, just like we do weekly mileage. We do it for every other component. We wanna make sure that we introduce it slowly. We wanna make sure that we introduce it with minute steps and we wanna make sure that we introduce it so that the body adapts and gets stronger. These are back to our universal principles in season one. So... the speed combined with the compression. So I'm not too sure how much hills I was doing, but just for the runner in general, if you're running uphill, sometimes it's with a lot of force, but the act of just trying to climb up an elevated terrain means that the hamstring goes under more compression. Cause when you first place your foot down on the ground, if it's uphill, then the hip has more compression against the tendon. You'll learn those in those earlier episodes. But with the triathlons, not only was I doing a lot more sprint work But I was also doing a lot of cycling and a lot of hard cycling sessions Then you got to get off the bike and you got to try and run essentially as fast as you can for four or five K So just that was a huge jump and hence this is why I Developed the high hamstring tendinopathy. So make sure your body is ready and Make sure you're always incorporating some sort of speed in your workouts So if I was training for my marathon, I would go back and do some speed work, whether it's once a fortnight or just getting my tendons ready for some sort of speed, because it just wasn't one of the buckets. I had the endurance bucket done. I think I had some sort of strength because I still was doing a lot of gym, but just that fast acting plyometric power base, I just wasn't implementing enough. And so that's why I decided, or I've come to the conclusion of why my hamstring flared up. So it's principle number one, just recognise the importance of speed and the impact that speed has. 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. Number two is the, the compression. When you are rehabbing your high hamstring tendinopathy want to make sure that all of your strength exercises does start to introduce some level of compression and also recognize that it's fine to start doing your exercises into low levels of pain. And this is a mistake that a lot of runners have when it comes to a proximal hamstring tendinopathy, they make this mistake quite often, is that one, they're too scared to push into low levels of pain during their exercise, and two, they find the compression of the tendon is starting to flare them up, so they just avoid that altogether. And really, this turned a corner in my own rehab because I was doing some strength work, I was doing my... hamstring curls, I was doing some Swiss ball exercises, but it wasn't, the effectiveness of the rehab wasn't until I hit a really nice dosage sweet spot. And the sweet spot for me at that point in time, based on the strength that I had and the stability that tendon had, was working heavier exercises, was creating more pain during my exercises, and I was doing those painful exercises more frequently. And... I'll go into some exercises later in this episode, but the compression was really sparking up maybe a 4 or 5 out of 10 pain for me during that set, but I found during the second set, third set, fourth set, that pain was actually settling down and it was actually going down to a 2 or sometimes a 1 or 2 out of 10 pain. And so during my third and fourth set, I'd actually increase the weight or increase the range of movement or increase the speed. so that I was pushing myself back up to that four out of five out of 10 pain. And that's where I really turned a corner in my rehab. And so this is where it comes into the education part of things. And know that it's fine to load these tendons because a lot of people with proximal hamstring tendinopathy, they have a bit of anxiety and fear, like I was saying before. Some have a belief that their tendon might undergo further damage or their tendon... might snap if they overload it too much. It's calming down these fears and know that your tendons are actually so resilient and they're so strong, they're actually gonna tolerate so much load. It might be a bit painful, but as long as it stays low levels of pain and the symptoms are stable after the exercise and stable the next day, these are all signs that you're tolerating those loads really well. And then what the body does, the body adapts, the body gets stronger and you start to... kick up a gear, you start to kick start that rehab process. So that would be a really nice trick for you and something that you can really implement really nicely. Once you have the right education, once you know that low levels of pain are okay, and we're not trying to aim for zero level of pain during your exercises and making sure that they're stable afterwards and the next day. Tender levels, like I think we talked about this last episode, we talked about the Battella tendon and the pain levels. So we can move on. Now let's dive into my last lesson which is actually coming up with some strength exercises that has really helped me. So let me just scroll down on my page. So exercises that really helped me during my rehab. One being the speed, all those sort of things. One that I really, really liked doing was hip what I call hip dips, they're kind of like, most people understand what Nordic hamstring curls are. You're on your knees, you have your feet, you have your heels locked into place with something. Sometimes people like to tuck it under their bed or couch or something. And then upright on your knees, you're lowering your body as slowly and controlled as you can. That's what a standard Nordic curl is. But what I like to do is have that same starting position, hands on hips, and you just dip forward, and all you do is dip forward at the hips. And what that does is eccentrically load the hamstrings, but also eccentrically loads the hamstrings into compression. So we're getting the body to tolerate higher levels of compression, and we're eccentrically loading the hamstrings, which is what's required for running. So it does a lot of really nice things. Deadlifts and single leg deadlifts were a really nice introduction into my program because it follows a very similar trait. It has the eccentric component and eccentric into compression. So that really, really helped me. I started off slow. I started off with really reduced ranges of movement, but then progressed so that I was lifting heavier and I was doing faster speed work. So I was slowly going down that deadlift action, but then I was quickly coming back up. So incorporating a little bit more power. And then once I was able to tolerate the compression, really good adequate levels of strength. Once everything was really stable and symptoms were starting to calm down, I started to do more and more power based exercises. So you might have seen on Instagram, I released this a couple of weeks ago, wall balls where I've just got this really heavy medicine ball and I squat down and on my up phase of the squat, I throw the ball up against the wall. It hits the wall, comes back and I catch it in a half sort of come down to the full squat and then launch myself back up, throw the ball up, so we're sort of just catching and releasing this ball high up on the wall and doing squats in between. So we're compressing that tendon and we're producing a lot of force in the upward direction and once I was able to tolerate that, you know, running is pretty easy after that. Jumping rocket jumps. I'm not too sure if people are familiar with rocket jumps, but if you have a step or if you have a box, you're putting one foot up on that box. that's your starting position, and then you're just launching yourself into the air from that elevated position, and then coming back down, I think I've got a couple of Instagram videos on that one, but you can just YouTube rocket jumps. So that's what I've done. I've slowly built up my strength, then I've slowly started to increase the level of compression, then I've started to increase my levels of speed. And I was just listening to another podcast where Tom Goom, was a guest and he was talking about his paper on proximal hamstring tendinopathy. And he said that if he was to rewrite that whole paper, one thing that he would add is that proximal hamstring tendinopathy requires like three types of exercises. One being knee flexion. So that would be some prone hamstring curls or just if you lie on your stomach, you have a band around your ankles or ankle weight and you just curl your ankle towards your hips. That's just a standard like knee flexion exercise. That would be one type of exercise. The other would be the hamstrings working into hip extension because that's also what the hips do. So doing some variation of bridges, single leg bridges, bridges with the feet on a swiss ball, those sort of things. And then the other being eccentric. So that would be what I was talking about with deadlifts or those hip dips, those Nordic hip dips. So those are the three that Tom Goom would recommend that every rehab needs to have, but you need to know that your hamstrings can tolerate it and that all goes with, you know, what dosage, how many sets, how many reps, how much rest in between, all those would just depend on the individual. So a bit of recap, let me scroll back up because I've got all these. Okay, number one for the lessons that I've learned, recognize the impact that speed has when you start to implement some sort of speed or heel repeats, those sort of things. want to make sure that we're slowly adapting. Number two, we want to rehab into compression. And we also don't mind if that slow levels of pain during that exercise. We definitely don't want to aim for zero or pain-free exercises. And the third, just those exercises that have helped me, those naughty kip dips, deadlifts, single-leg deadlifts, and then progressing into wall balls, jumping, rocket jumps, all those power-based exercises. So that's what I have for you today, high hamstring tendinopathy. Hopefully we're, we've covered a lot. Um, hopefully you've learned a lot. If it's kind of gone over your head a little bit, you're not too sure why hamstring flares up or what this whole compression thing is all about. Please go back to, um, those episodes that are listed before. So episode 21, 22, 23 and 33. 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.