Overcoming Proximal Hamstring Tendinopathy

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ In this episode, I sit down with Kirsten—Melbourne local, personal trainer, and someone who knows her way around the gym—yet still found herself stuck in a long and frustrating battle with proximal hamstring tendinopathy (PHT). Like many runners and active individuals, Kirsten spent months going in circles. Despite doing all the “right” things—rest, isometrics, backing off training—her symptoms kept returning. Sitting became unbearable, training was inconsistent, and the mental toll started to build. But everything changed when she shifted her approach. This conversation dives into the exact turning point in her rehab—what worked, what didn’t, and the key mindset shifts that helped her go from constant pain… to full confidence in her training again. Instagram mentions: https://www.instagram.com/reels/DWHlIU8jffK/https://www.instagram.com/itsdrglutes?igsh=aXZodW5wYzE5a2h0https://www.instagram.com/nunzicoaching?igsh=bGFqdzZ1b2llZXZnPodcast mention:Tim Ferriss Show episode with Dr. Keith Baar (episode #797). The episode covers:Tendon loading and repairThe "Anti-RICE Protocol" (i.e., don't rest — use load as an anti-inflammatory)Isometrics vs. eccentrics for tendon rehabSimple exercises that can repair tendons (tennis elbow, etc.)

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ In this Q&A episode, Brodie continues answering listener questions about proximal hamstring tendinopathy (PHT), covering topics ranging from long-term maintenance to returning to running after rehab. He explains why the same exercises used in rehabilitation—especially deadlifts—often remain the best way to keep symptoms at bay by maintaining tendon capacity. Depending on a runner’s goals, he also discusses when to add exercises like prone hamstring curls or Nordic curls to support endurance running versus speed work. The key message: keeping the tendon strong and progressively loaded helps reduce the likelihood of symptoms returning. The episode also addresses common frustrations during recovery, such as lingering sensations during a return-to-run program, setbacks from activities like rowing, and uncertainty about whether PHT ever truly “goes away.” Brodie outlines practical pain-monitoring rules, strategies for adjusting running variables (distance, pace, frequency), and how to identify training factors that may be slowing recovery. He also discusses scenarios such as young athletes with persistent sitting pain, older individuals starting rehab without gym access, and runners balancing rehab with race goals—emphasising that the key to long-term success is gradually building tendon capacity while carefully managing training load and recovery.

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ Check out Loopi's Website here: https://www.athletetransitionlab.com/ When proximal hamstring pain just won’t settle, the conversation often turns to surgery — and that’s where confusion, fear, and mixed advice really begin.In this episode, I’m joined by Dr. Luise Weinrich (known as Loopi), an orthopedic and trauma surgeon with extensive experience in hamstring avulsions, surgical repair, and post-operative rehabilitation. With a background as a former elite breakdancer and years working in top German sports orthopaedic hospitals, Luise brings a rare blend of surgical insight and athlete-centred thinking.Together, we unpack the “grey zone” — the large group of runners and athletes who don’t clearly fall into “definitely need surgery” or “definitely don’t” — and how to make smarter, more confident decisions when the path forward isn’t obvious.🎧 In This Episode, You’ll Learn:Why most proximal hamstring cases sit in a surgical grey zoneThe key MRI findings that matter — and the ones that don’t tell the full storyHow goals, age, chronicity, and function influence the surgery decisionWhen partial tears may (or may not) warrant surgeryWhy surgery for chronic tendinopathy is often not a “winner operation”Common mistakes athletes make before and after surgeryWhy pre-op strength, sleep, protein, hydration, and nervous system regulation matterHow post-op rehab should be phase-based, not timeline-basedThe biggest reasons athletes overdo or underdo rehab after surgeryWhat questions you should ask your surgeon before committingWhy post-operative protocols are essential — and often missing🧠 Key Takeaways for RunnersMRI findings alone shouldn’t dictate surgery — context mattersChronic tendon pain doesn’t automatically mean “failed rehab”Tendons need time, structure, and progressive loading to recoverSurgery can remove pain drivers, but it doesn’t guarantee a “new” tendonClear rehab phases + 24-hour symptom rules beat rigid timelinesBeing prepared before surgery often improves outcomes afterIf you’re unsure, a structured second opinion can prevent rushed decisionsIn other words: the goal isn’t just to fix tissue — it’s to make the smartest long-term decision for your body, your sport, and your identity as a runner.

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ 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 EpisodeWhy 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 InjectionsA 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 MicrotenotomyA 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 ReleaseScar-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 TherapyElectrical 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 TakeawayAcross 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.

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ 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.

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ 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 BiomechanicsThis 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 QuestionsDo 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 Study1. Stronger Hamstrings = Better Running MechanicsAthletes 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 LoadingRunners 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 ExistsStrength ↔ 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 FlagRunners 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 Takeaways1. Build Eccentric StrengthEccentric 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 LengthEccentric exercises at long muscle lengths help lengthen fascicles naturally — more so than stretching alone.3. Strengthen the Medial HamstringsTo 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 RehabBefore 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 ThoughtsHamstring 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.

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ 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

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ 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.

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ 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 HEREUnderstanding 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 MattersWhether 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.

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ 🧠 Episode SummaryIn 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 LearnKey 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 TakeawaysFemale 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 TendinopathyDon’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.

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ Guest: Dr. Ian Seels | Specialist Musculoskeletal Physiotherapist🧠 Episode SummaryIn this thought-provoking episode, Brodie chats with Dr. Ian Seels, a private musculoskeletal physiotherapist with over 35 years of experience and a co-author of the paper The Relevance of Diet in Musculoskeletal Clinical Practice – A Narrative Review. Together, they explore the emerging science behind how diet influences inflammation, pain, and injury recovery—with a particular focus on what this means for recreational runners.If you're battling persistent niggles, chronic tendon pain, or just want to run pain-free into your later years, this episode offers a fresh perspective you might not have considered: what you eat could be the missing link in your recovery journey.🔍 What You’ll LearnWhy inflammation matters more than weight when it comes to injury and painHow a high-carb Western diet may be quietly sabotaging your recoveryThe 3 pillars of "active management" for injury: mechanical, mental, and metabolicThe basics of an anti-inflammatory diet (very low carb, high fat, moderate protein)The difference between nutritional ketosis vs. metabolic acidosisHow to train your body to burn fat instead of carbs for enduranceSimple ways to reduce oxidative stress and support your gut healthWhy omega-3 to omega-6 balance is critical for joint and tendon healthLabel-reading tips that might surprise even the most health-conscious runnersWhether CRP and ketone testing is worth doing to track inflammation🧪 Practical Takeaways for RunnersA 4–6 week anti-inflammatory diet “trial” could help reduce pain and improve energyReducing processed foods and increasing healthy fats can shift you into a less inflamed stateBerries, leafy greens, herbs, and spices are powerful sources of antioxidantsKetone testing can “gamify” your dietary changes and provide real-time feedbackOmega-3s from oily fish, grass-fed meats, and free-range eggs support healing🛠️ Resources Mentioned📄 Paper: The Relevance of Diet in Musculoskeletal Clinical Practice – A Narrative Review📺 YouTube: Diet, Health and the Wisdom of Crowds (2018)🌐 LowCarbDownUnder.com.au – A go-to hub for evidence-based low-carb/keto nutrition

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ In Part 3 of this special series, Brodie tackles more insightful questions from listeners navigating their PHT recovery journey. With practical advice and personal stories, this episode is packed with actionable takeaways for anyone dealing with chronic hamstring pain.🧠 Topics Covered:Training other leg muscles during rehab: Are squats, leg presses, and calf raises safe? What about creating muscle imbalances?Flare-ups after rehab: Are they normal? When should you start worrying?Toughest client experiences: Brodie shares the most challenging cases he's worked with—and the common thread between them.Psychological struggles: How to shift your mindset when it feels like you’ll never get better.End-stage rehab guidance: For those almost fully recovered, how to know what exercises to keep, drop, or progress.Running warm-ups: What’s necessary when reintroducing running post-injury?Strength progression pacing: How to safely increase weights, reps, or volume—especially for seniors or those easily flared up.Does slower recovery = weaker tendon? Brodie breaks down the myths and shares what really influences recovery time.🧰 Key Takeaways:Keep training unaffected muscles to prevent deconditioning and stay mentally engaged.Flare-ups are learning opportunities—not failures.Progress rehab slowly and smartly—especially if you're prone to setbacks.Your mindset matters. Reframing rehab as your new “sport” can be a game-changer.Progress only one variable at a time—reps, weight, or frequency—not all at once.Recovery time from soreness is multifactorial: nutrition, sleep, age, and stress all play a role.📚 Brodie Mentions:Book: Rebound by Carrie Jackson Cheadle (A great read for injured athletes struggling with identity and motivation.)