Proximal Hamstring Tendinopathy is a horrible condition affecting athletes and non-athletes alike. If you fall victim to the misguided information that is circulating the internet, symptoms can persist for months, sometimes years and start impacting your everyday life. This podcast is for those looking for clear, evidence-based guidance to overcome Proximal Hamstring Tendinopathy. Hosted by Brodie Sharpe, an experienced physiotherapist and content creator, this podcast aims to provide you with the clarity & control you desperately need. Each episode brings you one step closer to finally overcoming your proximal hamstring tendinopathy. With solo episodes by Brodie, success stories from past sufferers and professional interviews from physiotherapists, coaches, researchers and other health professionals so you get world class content. Tune in from episode #1 to reap the full benefits and let's get your rehabilitation back on track!
👉 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/ If your proximal hamstring tendinopathy (PHT) has been lingering for months or even years, there may be a key roadblock keeping you stuck. After speaking with thousands of people struggling with persistent PHT, I’ve noticed the same patterns appearing again and again. In this episode, I break down 5 common reasons why PHT isn’t improving and, more importantly, what you can do differently. We cover: Why relying on PRP, shockwave, massage and other passive treatments may not address the underlying capacity of your tendon. Why bodyweight and low-level exercises can become a roadblock if you never progress beyond them. How the frustrating boom-bust cycle can repeatedly flare your symptoms just as you start making progress. Why your supposedly “easy” running pace may still be too fast for your hamstring tendon right now. When persistent sit-bone pain might not actually be PHT , including other conditions and structures that can produce similar symptoms. I also explain why some pain during strengthening doesn’t necessarily mean you should avoid progressing, how I approach gradual increases in tendon loading, and why running speed needs to be reintroduced carefully. If you feel like you’ve tried everything and your PHT still isn’t improving, this episode may help you identify what’s been missing.
👉 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/ Which PHT Exercises Actually Reduce Pain? with Aidan Rich Isometric exercises have become one of the most commonly prescribed treatments for proximal hamstring tendinopathy (PHT). Many runners and health professionals use bridge holds in the hope of reducing pain, improving confidence, and making exercise more comfortable. But what does the research actually say? In this episode, I sit down with sports and exercise physiotherapist and recent PhD graduate Aidan Rich to discuss his latest study comparing isometric (static) and isotonic (movement-based) hamstring exercises for people with PHT. Aidan has dedicated years of research to understanding proximal hamstring tendinopathy and shares some fascinating insights into what we know, what we don't know, and how current evidence should influence your rehabilitation decisions. In this episode, you'll learn: What isometric and isotonic exercises actually are Why bridge holds became so popular in tendon rehabilitation The groundbreaking research that sparked the "isometric pain relief" movement Whether PHT sufferers experience the same pain-relieving effects seen in other tendon conditions Why some people experience immediate symptom relief while others don't The results of Aidan's randomized crossover trial comparing isometric and isotonic hamstring exercises Whether one exercise type is superior for reducing pain, improving strength, or sitting tolerance What the broader tendon research says about isometrics versus movement-based strengthening Why progression and loading may be more important than exercise type Common mistakes that keep people stuck in rehabilitation When isometric exercises may still have a role in your recovery Practical advice for runners who have been doing bridge holds for weeks or months without improvement Key Takeaways Isometric exercises are not necessarily superior to isotonic exercises for immediate pain relief in PHT. Some individuals experience meaningful pain relief from tendon loading, while others notice very little change. The current evidence suggests exercise progression and appropriate loading are likely more important than the specific contraction type used. Long-term tendon rehabilitation should focus on gradually increasing strength and capacity rather than relying solely on static holds. If your current rehab isn't working, it may be time to reassess your diagnosis, exercise dosage, loading strategy, or overall treatment plan. About Aidan Rich Aidan Rich is a sports and exercise physiotherapist based in Melbourne, Australia. He recently completed a PhD focused on the treatment of proximal hamstring tendinopathy and has worked extensively with endurance athletes, runners, and sporting organizations including Triathlon Australia and Athletics Australia. His research has helped expand our understanding of PHT and provides valuable guidance for clinicians and patients alike. Resources Mentioned Aidan Rich's study: The Effect of Isotonic Versus Isometric Strength Exercise for Pain and Strength in Proximal Hamstring Tendinopathy: A Randomized Crossover Trial
👉 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/ Being sidelined by injury can feel like a double blow. Not only are you dealing with pain and frustration, but you've also lost one of your biggest outlets for stress relief, fitness, and social connection. In this episode, Brodie shares a practical framework to help injured runners stay proactive, maintain perspective, and come back stronger than before. In this episode, you'll learn: Why injury often impacts your mental health more than you expect The "double whammy" effect of losing both running and your stress-relief outlet How to identify the true causes behind recurring injuries Common patterns that keep runners trapped in injury cycles Why injuries can be valuable opportunities to uncover weak links How to use rehab to build resilience rather than simply become pain-free The importance of addressing strength deficits, imbalances, and movement control Cross-training options that can preserve fitness while recovering How to tailor cardio alternatives based on your injury type Brodie's favourite injury-friendly VO₂ max workouts Why many runners benefit from keeping cross-training in their routine long after recovery The overlooked role of strength training for injury prevention, bone health, and long-term performance How muscle mass acts as "metabolic currency" for health and longevity Practical ways to improve sleep, stress management, and recovery during injury The importance of maintaining social connection when you're unable to run Nutrition strategies that can support healing and future performance Why injury can be the perfect time to improve habits that often get neglected during heavy training Key Takeaway An injury doesn't have to be wasted time. By shifting your focus toward rehabilitation, fitness maintenance, strength development, sleep, nutrition, stress management, and social connection, you can emerge from injury healthier, more resilient, and better prepared for future training than before.
👉 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 Ignoring Pain 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/ Latest Research: Tendon Healing, Shockwave Therapy & Hamstring Injury Prevention In this episode, Brodie dives into three recently published research papers that help answer some of the biggest questions surrounding proximal hamstring tendinopathy (PHT) and tendon rehabilitation. From understanding what’s really happening inside a painful tendon, to whether shockwave therapy lives up to the hype, and what we can learn from hamstring injury prevention research, this episode translates the latest science into practical takeaways you can apply to your own recovery. In this episode, you'll learn: Why tendinopathy is far more complex than simple "wear and tear" The emerging role of inflammation, ageing, recovery, sleep and metabolic health in tendon healing Why progressive loading continues to be the cornerstone of successful PHT rehab What the latest evidence says about shockwave therapy and whether it's worth the cost Why exercise-based rehabilitation still outperforms most passive treatment options The surprising findings on ice, cryotherapy and tendon recovery Key lessons from hamstring injury prevention research that can help reduce setbacks and recurrence Why strength, capacity and consistency matter more than stretching alone Whether you're currently struggling with PHT, returning from a hamstring injury, or simply want to stay up to date with the latest tendon research, this episode provides evidence-based insights without the scientific jargon. Key Takeaway: Successful tendon recovery rarely comes down to a single treatment. The strongest evidence continues to support a combination of sensible load management, progressive strengthening, patience, and addressing the broader factors that influence healing—including sleep, stress, recovery, and overall health. There is hope, and understanding the science can help you make better decisions throughout your rehab journey.
👉 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 & Insights What 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 age Quality declines significantly Why 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 Theory The 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 Shows From 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 Finding In 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 Inconsistent This 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 cells Risks & 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/ In this episode, Brodie breaks down a brand-new 2026 systematic review investigating whether collagen supplementation truly improves tendon health, recovery, and performance. With conflicting advice from experts and unclear evidence in the past, this paper helps clarify what actually works—and more importantly, how to apply it to your training. Paper: Collagen Supplementation on Tendon-Related Structural and Performance Outcomes: A Systematic Review Key Takeaways Collagen can improve tendon structure and stiffness —but only when combined with proper strength training Dosage matters : 15–30g appears more effective than lower doses Timing matters : ~60 minutes before training aligns with peak amino acid availability Vitamin C enhances the process , helping collagen synthesis and cross-linking Collagen does NOT improve muscle strength beyond what training alone achieves Bottom line: collagen seems tendon-specific , not a general performance enhancer Training Requirements Must include structured resistance training Target 70–90% of 1RM (heavy loading) Tendons need a strong mechanical stimulus to adapt Collagen without loading = minimal benefit Final Thoughts This paper helps move us from confusion to clarity. Collagen isn’t a magic fix—but when used strategically alongside heavy strength training , it may: Improve tendon structure Increase stiffness Enhance long-term resilience In other words, it’s a potential amplifier—not a replacement—for good rehab and training 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/ 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 Episode Brodie and Jack discuss: Why tendinopathy often becomes a chronic condition What the biopsychosocial model means for tendon rehab The difference between kinesiophobia (fear of movement) and pain catastrophizing Why catastrophizing appears more common in persistent tendon pain Why lower limb tendinopathies may have greater psychological impact than upper limb injuries The role of beliefs, expectations, and past experiences in shaping pain Why clinicians should ask about patients’ thoughts and fears about their injury Whether psychological traits are pre-existing or develop after chronic pain begins Practical advice for runners dealing with long-term tendon pain About the Guest Jack 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_Jack Facebook: Jack Mest Physio Paper 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/ 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=aXZodW5wYzE5a2h0 https://www.instagram.com/nunzicoaching?igsh=bGFqdzZ1b2llZXZn Podcast mention: Tim Ferriss Show episode with Dr. Keith Baar (episode #797). The episode covers: Tendon loading and repair The "Anti-RICE Protocol" (i.e., don't rest — use load as an anti-inflammatory) Isometrics vs. eccentrics for tendon rehab Simple 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/ Contact Dr. Alex Hardy and his team at Dr.hardy@chirurgiedusport.com In 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 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/ 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/ 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 zone The key MRI findings that matter — and the ones that don’t tell the full story How goals, age, chronicity, and function influence the surgery decision When partial tears may (or may not) warrant surgery Why surgery for chronic tendinopathy is often not a “winner operation” Common mistakes athletes make before and after surgery Why pre-op strength, sleep, protein, hydration, and nervous system regulation matter How post-op rehab should be phase-based , not timeline-based The biggest reasons athletes overdo or underdo rehab after surgery What questions you should ask your surgeon before committing Why post-operative protocols are essential — and often missing 🧠 Key Takeaways for Runners MRI findings alone shouldn’t dictate surgery — context matters Chronic tendon pain doesn’t automatically mean “failed rehab” Tendons need time, structure, and progressive loading to recover Surgery can remove pain drivers, but it doesn’t guarantee a “new” tendon Clear rehab phases + 24-hour symptom rules beat rigid timelines Being prepared before surgery often improves outcomes after If you’re unsure, a structured second opinion can prevent rushed decisions In 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/ 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 loading How to interpret bursitis findings and when they’re clinically relevant vs incidental When ultrasound-guided corticosteroid injections may (or may not) help Why age and genetics slow recovery—but don’t prevent it Realistic timelines: why “2–3 years and never the same” is poor advice Key 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 athletes How to find the “sweet spot” between challenge and flare-ups Why setbacks usually come from mismanagement , not irreversible damage The role of sleep, protein (especially leucine), collagen, hydration, and overall wellness in tendon healing 3. “Can I Start Walking Again—or Am I Making It Worse?” Why waiting for zero pain before returning to activity often delays recovery How to reintroduce meaningful activities (like dog walking) safely and progressively Why doing something —even 2–5 minutes—can be both physically and mentally therapeutic How graded exposure applies to walking, running, and all functional goals 4. Heel Pain & PHT — Are They Related? Why plantar fasciitis commonly appears alongside PHT How reduced sitting → increased standing can overload the plantar fascia Practical strategies for managing both conditions: Footwear and gel insoles Sitting vs standing vs kneeling rotations Step counts, surfaces, and daily load awareness 5. Prone Hamstring Curls Flaring You Up? Here’s How to Modify Them How to confirm whether an exercise is actually the irritant Why double-leg > single-leg is often the right starting point Using reduced range of motion strategically How to progress: Double-leg → single-leg Load first vs range first Why small, systematic steps matter—especially for sensitive tendons 6. 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 pain Scar tissue or adhesions near the sciatic nerve Compensation patterns (sitting, standing, movement changes) Why assessment matters—and what clinicians look for: Piriformis testing Neurodynamic tests Nerve glide exercises and when to use them 🎯 Big Picture Takeaways Imaging findings don’t dictate outcomes— management does Severe or long-standing PHT does not mean you’re “too far gone” Recovery improves when load, recovery, and lifestyle align If symptoms spread or change character, don’t guess—get assessed Progress 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/ 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 structural How abnormal blood vessels and nerves grow into painful tendons over time Why traditional loading programs sometimes stop working in very chronic cases What “neural modification” treatments aim to do — and why they’re gaining interest The six intervention categories reviewed in the paper (explained simply) How strong (or limited) the current evidence actually is Where this research fits alongside exercise-based rehab , not against it Interventions 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.
👉 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=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 enough The importance of correlating scans with clinical function and symptoms Why some complete avulsions heal well conservatively — and others don’t Hamstring Avulsion vs Proximal Hamstring Tendinopathy (PHT) Key differences between acute avulsions , chronic avulsions , and tendinopathy Why not all “avulsions” are the same (1-tendon vs 3-tendon injuries) When retraction distance matters — and when it doesn’t Critical Timing Windows Why acute avulsions should ideally be operated on within 2–3 weeks What happens when diagnosis is delayed When 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’t Common mistakes in conservative treatment (under-loading, poor progression) When even excellent rehab is unlikely to succeed due to tendon biology What 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 involvement Why surgeons often find structural issues not obvious on standard MRI Common Pre- and Post-Op Mistakes Why under-diagnosis is one of the biggest pre-op risks Why returning to running too early post-op leads to setbacks The importance of fixing why the injury happened — not just repairing tissue Key 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.
👉 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/ 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 Trial Paper 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.info Run 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 leg Lower 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 tilt Lower hamstring activation Better 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 technique Better 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 sliders Weighted eccentric sliders Single-leg sliders Assisted → full Nordic drops Deadlifts (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 curls Toes-in sliders Toes-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.
👉 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.info Run 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 Sport Paper Title 2: Estrogen and progesterone exhibit distinct yet coordinated roles in the regulation of tendon extracellular matrix remodeling
