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/ The Missing Link in Rehab You’re Probably IgnoringPain isn’t always just about tissues, load, or biomechanics.In this episode, Brodie explores one of the most overlooked contributors to prolonged running injuries: the psychosocial side of pain. Drawing from both research and years of working with chronic injury cases, he introduces a 20-question “Pain & Wellness Score” designed to uncover the emotional, cognitive, and social factors that may be quietly influencing your recovery. You’ll learn why some runners continue to struggle despite doing all the “right” rehab exercises, how hypervigilance and fear can amplify symptoms, and why recovery should be approached through a biopsychosocial lens rather than purely mechanical thinking. Brodie also breaks down the science behind chronic pain, nervous system hypersensitivity, catastrophisation, fear of movement, and the powerful role attention plays in symptom intensity. Throughout the episode, Brodie walks listeners through the full questionnaire so they can assess themselves in real time. He explains how low scores may reveal missing pieces in recovery and shares practical interventions that can help calm the nervous system, reduce fear, and improve recovery outcomes. Topics include: Hypervigilance and constantly monitoring symptoms Fear of movement (kinesiophobia) Catastrophisation and emotional amplification of pain The role of social support in recovery How stress, trauma, anxiety, and perfectionist tendencies influence chronic pain Why distraction, enjoyable movement, and positive coping strategies can help The importance of resilience, optimism, and confidence in movement Why scans and conflicting diagnoses can sometimes worsen recovery outcomes Brodie also discusses research on chronic pain neuroplasticity and highlights therapies shown to help regulate the nervous system, including: Cognitive behavioural therapy (CBT) Mindfulness practices Guided meditations and breathing exercises Gradual exposure to feared movements Active coping strategies versus passive coping behaviours If you’ve been stuck in an injury cycle, feel emotionally exhausted by pain, or feel like your rehab is missing something despite doing the exercises correctly, this episode may provide an entirely new perspective on recovery.Resources & Links:Click here to learn about Brodie's Chronic Pain Reset Course

👉 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/ Stem cells are one of the most talked-about frontiers in medicine—but how much of it actually applies to runners dealing with tendon pain?In this episode, I’m joined by orthopaedic surgeon and researcher Chukwuweike Gwam to break down the latest evidence on stem cells and tendon healing. We unpack what stem cells actually are, how they work in the body, and whether they live up to the hype when it comes to treating tendinopathy.We also explore the real-world limitations, risks, and costs—alongside what the future might hold for regenerative medicine in running injuries.If you’ve ever considered injections, biologics, or wondered if stem cells are “the next big thing”… this episode will bring you up to speed.About Chukwuweike Gwam MD: Orthopaedic surgeon (USA) specialising in hip & knee reconstruction MD (Howard University), PhD in Molecular Medicine (Wake Forest), MBA Research focus: regenerative medicine, stem cells, and translational science Passion for improving healthcare access and bringing lab discoveries into real-world treatment Follow him on Instagram:https://www.instagram.com/chukwuweike_g/Key Topics & InsightsWhat Are Stem Cells (In Simple Terms)? Think of stem cells as the body’s “repair reserve” They help regenerate tissue by: Creating new cells Regulating inflammation We all have them—but: Quantity decreases with ageQuality declines significantlyWhy Do We Heal Slower As We Age?It’s not just one factor—it’s a combination: Reduced stem cell quality and number Slower blood vessel formation Reduced cellular signalling Increased “senescent” (non-functioning) cells In other words: your repair system is still there… just less efficient.Stem Cells & Tendon Healing — The TheoryThe idea is simple: Harvest stem cells (fat, bone marrow, etc.) Process them Inject them into the injured tendon The goal: Improve collagen structure Enhance healing response Accelerate recovery But here’s the key point…👉 They are NOT a magic bullet—they’re an adjunct.What the Research Actually ShowsFrom their literature review (2015–2025): ~1,800 papers screened ~150 relevant studies included Findings: Improved collagen alignment (under a microscope) Increased tensile strength (in animal models) No consistent improvement in long-term human outcomes 👉 Especially beyond 6–12 months, results tend to equalise.The Most Interesting FindingIn rotator cuff studies: Stem cells improved early recovery (first ~6 months) But no long-term difference compared to standard treatment Why? Stem cells likely help regulate early inflammation The body eventually “catches up” on its own Why Results Are So InconsistentThis is the biggest limitation:No standardisation. Different sources (fat, bone marrow, skin) Different processing methods Different patient health profiles 👉 Your stem cells ≠ someone else’s stem cellsRisks & Limitations Potential for tumour formation (teratomas) with certain stem cell types High variability in outcomes Mostly animal-based evidence Difficult to control how cells behave once injected Cost vs Benefit (Reality Check) Stem cell injections: ~$3,000–$5,000+ Cortisone: ~$200 Rehab: far cheaper, highly effective In most cases: You’re paying a premium for uncertain benefit.What About PRP? Some benefit for: Tennis elbow Chronic tendinopathy But: Highly variable Not clearly superior to rehab Again, works best alongside loading—not instead of it.Practical Takeaways (For Runners) Stem cells are promising—but not ready for prime time (yet) They may: Speed up early recovery Improve tissue quality (in theory) But: Don’t outperform rehab long-term Are expensive and inconsistent The fundamentals still win: Progressive loading Smart training Patience 📲 Follow Dr. Gwam: https://www.instagram.com/chukwuweike_g/

👉 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/ Tendon pain is often treated as a purely physical problem. Strengthen the tendon, adjust the load, and eventually things should improve.But what happens when the pain persists for months… or even years?In this episode, Brodie speaks with physiotherapist and PhD researcher Jack Mest about a recent systematic review and meta-analysis exploring the psychological profile of people with persistent tendinopathy. The research compared people with chronic tendon pain to healthy controls and uncovered something surprising: fear of movement wasn’t the main psychological factor.Instead, the research found that pain catastrophizing — a negative outlook toward pain and recovery — appeared more common in people with persistent tendinopathy.This episode explores how psychological factors may influence tendon pain, why lower limb injuries may carry a greater psychological burden, and why clinicians need to treat the person behind the injury — not just the tendon itself.If you’re a runner struggling with Achilles pain, plantar fasciopathy, proximal hamstring tendinopathy, or another persistent tendon injury, this conversation will help you understand why recovery can feel so frustrating — and what might help.In This EpisodeBrodie and Jack discuss:Why tendinopathy often becomes a chronic conditionWhat the biopsychosocial model means for tendon rehabThe difference between kinesiophobia (fear of movement) and pain catastrophizingWhy catastrophizing appears more common in persistent tendon painWhy lower limb tendinopathies may have greater psychological impact than upper limb injuriesThe role of beliefs, expectations, and past experiences in shaping painWhy clinicians should ask about patients’ thoughts and fears about their injuryWhether psychological traits are pre-existing or develop after chronic pain beginsPractical advice for runners dealing with long-term tendon painAbout the GuestJack Mest is a physiotherapist and PhD researcher whose work focuses on understanding why tendinopathy becomes chronic and how psychological factors influence tendon pain.His research aims to improve the way clinicians approach tendon rehabilitation by integrating biological, psychological, and social factors into treatment.Follow Jack's research and updates: X (Twitter): @Mest_JackFacebook: Jack Mest PhysioPaper summary: https://www.jospt.org/do/10.2519/jospt.blog.2026017/full/

👉 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/ Contact Dr. Alex Hardy and his team at Dr.hardy@chirurgiedusport.comIn this episode, Brodie is joined by hamstring surgeon Dr. Alex Hardy to break down exactly what to do before and after hamstring surgery. They cover the key differences between acute and chronic injuries, and what that means for your behaviour leading into surgery. For acute avulsions, the priority is speed—getting an MRI quickly and avoiding unnecessary delays—while keeping activity minimal. In contrast, chronic cases and tendinopathies benefit from staying active, maintaining strength and cardio, and avoiding unnecessary deconditioning. A key takeaway: there’s very little you can do pre-surgery to “make things worse,” but there’s a lot you can do to set yourself up for a smoother recovery.The conversation then shifts to post-operative rehab, where patience is critical. Dr. Hardy explains why the first 6 weeks are highly protective (often involving a brace and minimal hamstring loading), followed by a gradual return to movement, strength, and eventually running around the 3–4 month mark. They discuss exercise progressions (starting with closed-chain work, then progressing to open-chain and eccentric loading), common pitfalls like premature overload or slips during early recovery, and when to be concerned about symptoms like persistent pain or sciatic irritation. If you’re considering surgery or currently navigating recovery, this episode gives you a clear, realistic roadmap—what matters most, what to avoid, and how to maximise your outcome

👉 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 answers a flood of listener questions on proximal hamstring tendinopathy (PHT), starting with one of the most common concerns: how to load the tendon without flaring it up. He breaks down why deadlifts are one of the most effective strengthening tools for the upper hamstring, how to manipulate range of motion, weight and frequency, and why “dosage” is the difference between progress and a setback. You’ll learn how to systematically find your sweet spot, adjust frequency as loads get heavier, and avoid the common mistake of jumping in too hard, too soon.The episode also explores more complex cases, including persistent morning pain, uncertainty around diagnosis, and radiating symptoms that may point to something beyond classic PHT. Brodie discusses how to use loading as both a treatment and a diagnostic tool, when to consider alternative causes like lower back involvement, and how nervous system sensitisation and hypervigilance can amplify pain. He finishes with rapid-fire answers on rehab frequency, maintenance loading, and how to modify exercises when other injuries (like low back pain) enter the picture. If you’ve been struggling to balance strengthening with symptom control, this episode offers practical, measured guidance to help you regain confidence and move forward with clarity.

👉 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 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 Episode1. 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 RecoveryWhy 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 ThemHow 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 TakeawaysImaging 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

👉 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 Lasse's website here: https://www.lasselempainen.fi/?lang=enIn 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 SurgeryWhy 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 WindowsWhy 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 MeansWhy 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 InvolvesWhat 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 MistakesWhy 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 TakeawayMost 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.

👉 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, 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

👉 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.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

👉 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/ 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, 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 HEREWhat 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.

👉 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 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