Overcoming Proximal Hamstring Tendinopathy: Progressing Your Exercises Safely
Proximal hamstring tendinopathy (PHT) can be a challenging condition to manage. In this podcast episode, Brody Sharp, an online physiotherapist and PHT battler himself, delves into strategies for overcoming the fear of progressing exercises. Many individuals with PHT encounter two common scenarios: pain during bodyweight exercises and apprehension about progressing rehab exercises. In this blog-style article, we’ll explore both scenarios and provide practical guidance on how to move forward confidently in your PHT recovery journey.
Scenario 1: Pain with Bodyweight Exercises
Pain During Exercise: When Is It Acceptable?
Experiencing pain during exercise is not uncommon when dealing with PHT. However, it’s essential to understand the boundaries of acceptable pain. Generally, pain rated less than four out of 10 during an activity is considered acceptable. If your pain falls within this range (0-3 out of 10) and settles relatively quickly, usually within 24 hours (or even better, within 12 hours), you are likely within the safe zone for exercise.
Why Tendons Love Slow Heavy Load
Tendons respond positively to slow, heavy loading. This means that bodyweight exercises alone might not provide the stimulus needed for tendon healing and strengthening. The key is to gradually introduce heavier exercises that promote tendon health and function. Slow heavy loads can even have an analgesic effect, reducing pain during daily activities.
To start safely progressing your exercises, consider the following steps:
- Start gradually with exercises like deadlifts.
- Begin with a quarter or half range of movement.
- Use light weights or dumbbells (around 5 kg or 10 lbs).
- Employ a slow tempo (e.g., three seconds down, three seconds up).
- Start with three sets of five repetitions and assess your response.
Remember, these are just starting points, and you can adjust based on your comfort and pain levels. The key is to progress at a pace you’re comfortable with while ensuring that you challenge your tendons.
Scenario 2: Fear of Progression After a Flare-Up
When Progression Goes Wrong
In the second scenario, you may have attempted progressive rehab under the guidance of a physiotherapist but experienced a flare-up. This can be disheartening and lead to fear of further progression. It’s crucial to recognize that if you flared up for an extended period (e.g., seven days), you likely pushed too hard initially.
Returning to Basics
To address this, it’s essential to go back to the basics and find a level of exercise that you can tolerate comfortably. This often involves reducing the load and intensity of your exercises and waiting until your symptoms return to baseline (ideally within 24 hours, or even better, 12 hours). The goal is to build your strength and confidence simultaneously.
Stick to Double-Leg Exercises
Contrary to popular belief, single-leg exercises are not always the best progression from double-leg exercises. Tendons benefit from slow, heavy loads, and double-leg exercises allow for better control of tempo and heavier weights. Balancing on a single leg can introduce unnecessary challenges and anxiety.
- Progress Gradually: Move at a pace you’re comfortable with, and don’t rush your PHT rehabilitation.
- Build Strength and Confidence Together: As you strengthen your tendons, your confidence will also grow, helping you overcome anxiety and apprehension.
- Don’t Rely Solely on Bodyweight Exercises: Tendons require slow, heavy loading to heal and regain strength. Bodyweight exercises alone may not provide the necessary stimulus.
- Tendons Love Slow, Heavy Load: Incorporate exercises like deadlifts into your routine to promote tendon health and alleviate pain.
- Return to Basics After a Flare-Up: If you experience a flare-up, dial back the intensity and wait for your symptoms to return to baseline before progressing again.
In your journey to overcome proximal hamstring tendinopathy, remember that knowledge is power. Be patient, listen to your body, and work with a healthcare professional or physiotherapist to tailor your rehabilitation plan to your specific needs. With the right approach, you can regain your strength, reduce pain, and return to an active and pain-free lifestyle.