Advertise on podcast: Overcoming Proximal Hamstring Tendinopathy

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞📄Learn more about Brodie's PHT AI Assistant 🔍 In this episode of the Overcoming Proximal Hamstring Tendinopathy Podcast, Brodie dives into the most commented-on and most challenging questions from the PHT Facebook community over the past 90 days. Rather than quick comment replies, this episode delivers long-form, evidence-based explanations to help you better understand your symptoms, your scans, and your rehab options—especially when things feel confusing or discouraging. If you’ve ever been told “it’s severe,” “you’re too old,” or “it’ll never be the same,” this episode is for you. 🔍 What You’ll Learn in This Episode 1. Severe PHT, Tendon Tears & Bursitis — Is Recovery Still Possible? Why tendon tears on MRI are often part of the tendinopathy spectrum, not a reason to avoid loadingHow to interpret bursitis findings and when they’re clinically relevant vs incidentalWhen ultrasound-guided corticosteroid injections may (or may not) helpWhy age and genetics slow recovery—but don’t prevent itRealistic timelines: why “2–3 years and never the same” is poor adviceKey takeaway: Even severe, chronic PHT can improve with the right loading strategy and recovery environment. 2. Load Management: The Missing Piece in Long-Term Recovery Why slow, progressive strength training is still the gold standard—even in older athletesHow to find the “sweet spot” between challenge and flare-upsWhy setbacks usually come from mismanagement, not irreversible damageThe role of sleep, protein (especially leucine), collagen, hydration, and overall wellness in tendon healing3. “Can I Start Walking Again—or Am I Making It Worse?” Why waiting for zero pain before returning to activity often delays recoveryHow to reintroduce meaningful activities (like dog walking) safely and progressivelyWhy doing something—even 2–5 minutes—can be both physically and mentally therapeuticHow graded exposure applies to walking, running, and all functional goals4. Heel Pain & PHT — Are They Related? Why plantar fasciitis commonly appears alongside PHTHow reduced sitting → increased standing can overload the plantar fasciaPractical strategies for managing both conditions:Footwear and gel insolesSitting vs standing vs kneeling rotationsStep counts, surfaces, and daily load awareness5. Prone Hamstring Curls Flaring You Up? Here’s How to Modify Them How to confirm whether an exercise is actually the irritantWhy double-leg > single-leg is often the right starting pointUsing reduced range of motion strategicallyHow to progress:Double-leg → single-legLoad first vs range firstWhy small, systematic steps matter—especially for sensitive tendons6. Sciatic-Type Pain With PHT — What’s Really Going On? How to tell when symptoms are no longer “pure PHT”Red flags for nerve involvement (pain past mid-hamstring or below the knee)Possible contributors:Nerve sensitivity in chronic painScar tissue or adhesions near the sciatic nerveCompensation patterns (sitting, standing, movement changes)Why assessment matters—and what clinicians look for:Piriformis testingNeurodynamic testsNerve glide exercises and when to use them🎯 Big Picture Takeaways Imaging findings don’t dictate outcomes—management doesSevere or long-standing PHT does not mean you’re “too far gone”Recovery improves when load, recovery, and lifestyle alignIf symptoms spread or change character, don’t guess—get assessedProgress comes from doing the right things consistently, not perfectly

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞📄Learn more about Brodie's PHT AI Assistant 🔍 For years, chronic tendinopathy has been treated as a tendon problem — load it, strengthen it, remodel it. But what if, for some runners, the tendon itself isn’t the main driver of pain anymore? In this episode, Brodie breaks down a new 2026 systematic review that may reshape how we think about stubborn, long-standing tendon pain. The paper explores whether nerve ingrowth and abnormal blood vessels around tendons — not degeneration of the tendon tissue itself — may be the real pain source in chronic cases. We unpack the emerging research, explain each intervention in plain language, and discuss who this may (and may not) apply to — especially runners stuck in repeated rehab cycles despite “doing everything right.” This is early, evolving science. But it’s a fascinating glimpse into where chronic tendon treatment may be heading next. What You’ll Learn in This Episode Why some chronic tendon pain may be neuropathic (nerve-driven) rather than structuralHow abnormal blood vessels and nerves grow into painful tendons over timeWhy traditional loading programs sometimes stop working in very chronic casesWhat “neural modification” treatments aim to do — and why they’re gaining interestThe six intervention categories reviewed in the paper (explained simply)How strong (or limited) the current evidence actually isWhere this research fits alongside exercise-based rehab, not against itInterventions Reviewed (Plain-English Overview) 1. High-Volume Injections (HVIGI / HVDI) Large volumes of fluid are injected around the tendon (not into it) under ultrasound guidance to mechanically disrupt abnormal blood vessels and pain-sensitive nerves. Key takeaway: Consistent short- to medium-term pain and function improvements, especially in people who had failed exercise-based rehab. 2. Sclerosing Polidocanol Injections A chemical agent is injected directly into abnormal blood vessels to deliberately close them down, cutting off blood supply to pain-producing nerves. Key takeaway: Moderate to strong pain reductions in very chronic cases, with outcomes comparable to surgery in some studies. 3. Radiofrequency Microtenotomy A minimally invasive procedure using controlled heat to disrupt nerve ingrowth and abnormal vessels at the tendon–paratenon interface. Key takeaway: Very strong results in a small cohort, but higher risk and limited evidence so far. 4. Minimally Invasive Paratenon Release Scar-like adhesions between the tendon and surrounding tissue are mechanically released to restore tendon movement and reduce nerve irritation. Key takeaway: Large pain reductions and high rates of pain-free outcomes in non-insertional Achilles tendinopathy. 5. Electrocoagulation Therapy Electrical energy is used to seal off abnormal blood vessels surrounding the tendon under ultrasound guidance. Key takeaway: Promising early results, but evidence limited to one small study. 6. Surgical Interventions (Open & Endoscopic) Surgery physically separates the tendon from irritated surrounding tissue and removes abnormal vessels and nerves. Key takeaway: Effective for some, but invasive, with longer recovery and higher risk. The Big Picture Takeaway Across very different procedures, outcomes were surprisingly similar. That points to a common mechanism: 👉 Modifying the neural (nerve-driven) pain environment around the tendon, rather than “fixing” tendon structure itself. This doesn’t replace exercise-based rehab — but it may explain why a subset of runners with long-standing, highly sensitive tendinopathy stop responding to load alone. This research is best viewed as a future direction, not a replacement for good rehab principles.

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞📄Learn more about Brodie's PHT AI Assistant 🔍 Check out Lasse's website here: https://www.lasselempainen.fi/?lang=en In this episode, Brodie sits down with world-leading orthopedic surgeon Dr. Lasse Lempainen, a specialist in complex hamstring injuries, to answer one of the most confusing and anxiety-provoking questions runners face: “How do I know if I actually need surgery — or if rehab is still the right path?” Drawing on decades of surgical experience and extensive research into hamstring avulsions and proximal hamstring tendinopathy (PHT), Dr. Lempainen walks through how he actually makes decisions in real clinical practice — not just what MRI scans show, but how symptoms, function, timelines, and rehab quality all fit together. Together, Brodie and Lasse unpack the gray area that most runners live in: partial tears, chronic pain, mixed scan results, failed rehab attempts, and fear-based decision-making. The result is a balanced, evidence-informed discussion that helps runners understand where surgery fits — and where it doesn’t. What You’ll Learn in This Episode:How Surgeons Decide Who Actually Needs Surgery Why MRI findings alone are never enoughThe importance of correlating scans with clinical function and symptomsWhy some complete avulsions heal well conservatively — and others don’tHamstring Avulsion vs Proximal Hamstring Tendinopathy (PHT) Key differences between acute avulsions, chronic avulsions, and tendinopathyWhy not all “avulsions” are the same (1-tendon vs 3-tendon injuries)When retraction distance matters — and when it doesn’tCritical Timing Windows Why acute avulsions should ideally be operated on within 2–3 weeksWhat happens when diagnosis is delayedWhen chronic injuries become harder (or impossible) to fully restore surgically“Failed Rehab” — What That Really Means Why many runners are told they’ve “failed rehab” when they actually haven’tCommon mistakes in conservative treatment (under-loading, poor progression)When even excellent rehab is unlikely to succeed due to tendon biologyWhat Surgery for PHT Actually Involves What surgeons look for during surgery beyond “tendon thickening”The role of semi-membranosus release, scar tissue, and sciatic nerve involvementWhy surgeons often find structural issues not obvious on standard MRICommon Pre- and Post-Op Mistakes Why under-diagnosis is one of the biggest pre-op risksWhy returning to running too early post-op leads to setbacksThe importance of fixing why the injury happened — not just repairing tissueKey Takeaway Most hamstring injuries — including many cases of PHT — can and should be treated conservatively. But there is a subset of runners where surgery is not only appropriate — it’s the missing piece.This episode helps you understand which group you fall into, without fear-based decisions or false hope.

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞📄Learn more about Brodie's PHT AI Assistant 🔍 In this episode, Brodie breaks down a newly published review paper that takes a deep dive into what’s actually happening inside painful tendons — far beyond the usual “overuse” explanation. You’ll learn how healthy tendons are structured, what changes at a microscopic level when tendinopathy develops, and why pain severity often doesn’t match what shows up on scans. The episode explores how factors like load management, low-grade inflammation, oxidative stress, ageing tendon cells, and overall metabolic health all interact to influence tendon pain and recovery. Brodie also discusses what this emerging science means for real-world rehab — including why rest alone doesn’t work, why exercises sometimes stall progress, and why a more holistic approach is often needed. The episode finishes by looking ahead at future treatment directions, from improved diagnostics to regenerative and molecular therapies, while grounding everything in practical takeaways runners can apply right now. If you’re dealing with persistent tendon pain — especially proximal hamstring or Achilles tendinopathy — this episode will help you understand why recovery can be slow and what actually gives you the best chance of long-term success. 

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞📄Learn more about Brodie's PHT AI Assistant 🔍 In this episode, we break down a brand-new randomized controlled trial comparing individualized physiotherapy with shockwave therapy for proximal hamstring tendinopathy. I walk through how the study was designed, what each treatment involved, and why the results showed no meaningful difference between the two approaches. We also explore the role of education, load management, and compressive tolerance, and what this means for your rehab decisions moving forward. If you’ve ever wondered whether shockwave is worth trying or how it stacks up against a structured strength program, this episode gives you a clear, evidence-based answer. Paper 1: Physiotherapy Compared With Shockwave Therapy for the Treatment of Proximal Hamstring Tendinopathy: A Randomized Controlled TrialPaper 2: Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy: A Clinical Commentary

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞📄Learn more about Brodie's PHT AI Assistant 🔍 For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. Research Deep-Dive: Hamstring Strength & Running Biomechanics This episode reviews the study: “Hamstring Strength and Architectural Properties Are Associated with Running Biomechanics”, including findings from ultrasound imaging, EMG analysis, and 3D running mechanics.  Key Study Questions Do stronger hamstrings create better running mechanics?Do better mechanics help build stronger, longer hamstrings?How do strength, fascicle length, pelvic position, and muscle activation interact?🔎 Main Findings From the Study 1. Stronger Hamstrings = Better Running Mechanics Athletes with higher eccentric hamstring strength had: Higher stride frequency (cadence)Better control of decelerating the swinging legLower ground contact time (improved efficiency)Lower hamstring activation at sub-max speeds → reduced overload 2. Longer Hamstring Fascicles = Safer, More Efficient Loading Runners with longer fascicle lengths showed: Less anterior pelvic tiltLower hamstring activationBetter ability to tolerate late-swing loading (a high-irritation phase for PHT) 3. A Two-Way Relationship Exists Strength ↔ mechanics influence each other. Stronger hamstrings → better running techniqueBetter running technique → better hamstring loading → stronger, longer muscle structure over time This creates a positive adaptation loop. 4. Over-Reliance on the Biceps Femoris = Red Flag Runners with weak or short hamstrings tended to over-activate the biceps femoris long head — the most common site of PHT. Stronger runners shared load better with the medial hamstrings, reducing tendon stress.  🏃 Practical Rehab Takeaways 1. Build Eccentric Strength Eccentric strength is one of the strongest predictors of hamstring injury risk. Examples Brodie recommends: Hamstring slidersWeighted eccentric slidersSingle-leg slidersAssisted → full Nordic dropsDeadlifts (when tolerated) 2. Improve Fascicle Length Eccentric exercises at long muscle lengths help lengthen fascicles naturally — more so than stretching alone. 3. Strengthen the Medial Hamstrings To prevent overload of the biceps femoris: Use toes-in hamstring curlsToes-in slidersToes-in deadlift variations These help redistribute load more evenly across the tendon. 4. Slightly Increase Cadence (~5%) A small increase in stride frequency may reduce late-swing strain and improve running economy. 5. Integrate Running Into Rehab Before adding speed: Build to 30 minutes continuous, easy running → symptom-free Then introduce:Strides (15–20 sec at ~75% speed, 4 reps)Gradual progression based on symptoms the next day Final Thoughts Hamstring strength, muscle architecture, and running technique are deeply interconnected. Improving one helps improve the others — creating a pathway toward better performance and long-term PHT resilience.

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞 For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. Paper Title 1: Porcine Collagen Injection Therapy Affects Proximal Hamstring Tendinopathy in Athletes by Reducing Time to Return to SportPaper Title 2: Estrogen and progesterone exhibit distinct yet coordinated roles in the regulation of tendon extracellular matrix remodeling 

 🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞 For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. In this episode, Brodie reviews brand new research exploring patients’ real-life experiences receiving physio-led rehab vs shockwave therapy for proximal hamstring tendinopathy (PHT). This qualitative study highlights what people found most helpful, frustrating, and effective during rehab—revealing valuable lessons for anyone currently recovering from PHT. Brodie also provides a personal update on his own hamstring rehab and HYROX training progress. Check out the paper here: Education, rapport and convenience are key to participants’ perceptions of receiving physiotherapy or shockwave for proximal hamstring tendinopathy: a qualitative study

 🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. 

 🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. 

 🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. 

🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. In this episode of the Overcoming PHT Podcast, I dive into a valuable supplemental resource created by researchers at La Trobe University as part of their clinical trials on proximal hamstring tendinopathy (PHT). This patient education file breaks down everything from diagnosis to discharge advice—and I highlight the key takeaways that can help you better understand and manage your recovery. What You’ll Learn in This Episode: CHECK OUT THE PAPER HERE Understanding PHT – what causes it, why tendinopathy is the accepted term, and the typical prognosis.Treatment options explained – the pros and cons of rest, injections, surgery, shockwave therapy, and why individualized physiotherapy remains the gold standard.The role of strength training – how heavy, slow resistance can improve muscle strength, tendon stiffness, and even brain-muscle connections.MRI myths – why structural changes don’t always match up with pain and function.Pain monitoring principles – why tendons respond differently, and how to use the 24-hour pain response as a guide.Compression and load management – understanding high vs low tendon loads, how sitting and stretching impact PHT, and why gradual reintroduction is key.Discharge advice – the importance of ongoing strength work, flare-up management, and avoiding extreme “all or nothing” approaches with sitting and stretching.Why This Matters Whether you’re new to PHT or have been struggling for years, this episode gives you a clear, research-backed framework for understanding your pain and making smarter rehab choices. It’s not just my perspective—it’s guidance from some of the leading tendon researchers in the world.

🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. In this episode, Brodie reviews a brand-new 2025 clinical commentary on the treatment of proximal hamstring tendinopathy (PHT) with an individualised physiotherapy approach. The paper, authored by experts including Jill Cook and Aidan Rich, outlines a comprehensive, stage-based rehab protocol grounded in tendinopathy principles and adapted for the unique demands of the hamstring complex. CHECK OUT THE PAPER HERE What you’ll learn in this episode: Why recent systematic reviews still show insufficient evidence for one superior PHT treatment.The three core pillars of the proposed protocol: education, progressive strengthening, and graded exposure to compressive/sport-specific loads.How the five rehab stages work:Isometrics – for pain relief and warm-up effect.Isotonics – to build strength and endurance.Kinetic chain training – targeting glutes, calves, adductors, and lumbopelvic control.Compressive load reintroduction – safely restoring tolerance to hip flexion positions.Energy storage/release drills – for athletes with high-speed or power demands.The importance of pain monitoring, “hurt vs harm” education, and avoiding rapid spikes in load.How to individualise the program based on goals, deconditioning level, and activity demands.Practical tips for combining stages, structuring training cycles, and maintaining long-term tendon health.

🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. 🧠 Episode Summary In this episode, Brodie dives into a newly published paper titled “Female Tendons are from Venus and Male Tendons are from Mars: But Does it Matter for Tendon Health?” by Gerard McMahon and Jill Cook. The paper explores how male and female tendons differ in structure, adaptation, healing, and injury risk—and what it means for those dealing with tendinopathy. 🔍 What You’ll Learn Key structural differences between male and female tendons (size, stiffness, collagen synthesis)Why female tendons may stretch more but adapt less to trainingHow men and women respond differently to tendon rehab protocolsSurprising findings about pain, healing, and tendon blood flowWhether injury prevention or rehab should differ based on sex📌 Key Takeaways Female tendons are more compliant, have lower stiffness, and show slower collagen production—even at rest.Male tendons respond more favorably to traditional rehab (like eccentric loading), often reporting greater pain reduction and functional improvements.Despite men experiencing more frequent tendon injuries in some data, women may be closer to their strain “danger zone” during exercise, possibly increasing injury risk.Women may need longer rehab timelines, heavier resistance training (beyond just eccentrics), and closer attention to recovery, nutrition, and hormonal cycles.Men should be cautious about overloading tendons due to higher force-generating capacity and should still progress gradually.💡 For Runners With Tendinopathy Don’t compare your progress to someone of the opposite sex—recovery is sex-specific.Trust the process: healing may be happening at a microscopic level even if pain relief is slow.Tailor your rehab by considering not just gender, but also age, training history, injury severity, and more.

🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. In this episode, Brodie explores the latest research on vitamin D and its role in tendon health, diving into a 2024 comprehensive review that examines both cell-based and animal studies. You’ll learn how vitamin D influences tendon healing, inflammation, and collagen production—and how low levels could delay your recovery. Plus, Brodie shares practical advice on vitamin D testing, optimal levels, sun exposure, supplementation, and the potential role of vitamin K2. 🧠 What You'll Learn: How tendons respond to training and stress via collagen synthesisWhy vitamin D is like a “site manager” during tendon repairThe difference between in vitro (lab) and in vivo (animal) studiesWhat research shows about vitamin D deficiency and tendon healingThe importance of maintaining adequate vitamin D levels (and what’s considered optimal)Whether supplementation is necessary—and how to combine it with vitamin K2🧪 Research Highlight: Study: Exploring the Impact of Vitamin D on Tendon Health: A Comprehensive Review (2024) 14 studies analyzed: 5 in vitro, 9 in vivo (mostly animal models)Key takeaway: Vitamin D deficiency may impair tendon healing and increase re-injury risk🛠️ Practical Takeaways: Ask your GP for a 25-hydroxyvitamin D blood testAim for blood levels between 75–125 nmol/L for optimal musculoskeletal healthGet sun exposure for 10–30 mins/day (arms and legs, mid-morning or afternoon)Include dietary sources like fatty fish, egg yolks, and fortified foodsSupplement with 1,000–2,000 IU/day if needed; higher doses may require supervisionIf supplementing long-term, consider pairing vitamin D with vitamin K2 to support bone health and calcium balance🎯 Ideal For: Runners and athletes recovering from tendinopathyPeople looking to optimize tendon repair and performanceAnyone curious about the role of micronutrients in injury recovery