Introduction

Overcoming Proximal Hamstring Tendinopathy: Introducing Speed and Hills

Welcome to this episode of our podcast, where we delve into the world of proximal hamstring tendinopathy (PHT) and explore how to introduce speed and hill training into your rehab routine. We’re here to provide you with valuable insights, evidence-based treatments, and dispel common misconceptions about this challenging condition. I’m Brodie Sharp, an online physiotherapist, recreational athlete, creator of the Run Smarter series, and a fellow PHT battler. Whether you’re an athlete or not, this podcast aims to educate and empower you to take the right steps in conquering PHT.

Understanding the Question

The Importance of Proper Introduction

Today’s episode was inspired by a question from one of our listeners, Kylie Walker. She raised a crucial query during one of our Q&A sessions on social media. Kylie’s question is particularly relevant to many runners dealing with PHT, as they often wonder about the best approach to introduce speed and hill training back into their routine after building up a pain-free base. In this episode, we will explore the reasons behind this caution, the nuances of introducing speed and hill work, and provide practical guidance for your PHT rehabilitation journey.

The Caution in Introducing Speed and Hills

Understanding the Risks

Before diving into the specifics of introducing speed and hill training, it’s essential to understand why caution is warranted. Both speed work and hill training can potentially exacerbate PHT symptoms, especially if introduced prematurely. Let’s begin by examining the impact of speed work.

Speed Work and Its Demands on the Hamstrings

When you increase your running speed, your hamstrings are subjected to substantial stress. During the swing phase of running, as your leg moves from a bent position to a more extended one, your hamstrings are engaged in eccentric control, meaning they contract while lengthening. This eccentric control is essential for decelerating the swinging leg before it makes contact with the ground. Running at higher speeds increases the demand on your hamstrings for this eccentric control.

The Dangers of Introducing Speed Too Quickly

Rehabilitation and adaptation principles teach us that overdoing it too soon can lead to setbacks. Even if you’ve reached a point of pain-free running in your rehab, introducing speed work prematurely can push your limits and exceed your adaptation zone. It’s crucial to avoid returning to high-speed running too hastily, as it’s a common trigger for PHT.

The Challenges of Running Uphill

Running uphill presents its own set of challenges. When running uphill, your foot is placed on a more elevated surface, causing your hips to flex more and the hamstring tendon to experience increased compression. Similar to exercises like squats and deadlifts, hill training can be problematic if your tendon isn’t accustomed to compression. Therefore, caution is needed when incorporating uphill running into your rehab.

Introducing Speed and Hills

There’s No Right or Wrong, But There’s a Method

Now that we’ve discussed the reasons for caution, let’s address the central question: Should you introduce speed or hill training first after building a pain-free running base? The good news is there’s no definitive right or wrong answer; it depends on your preferences and how your body responds. However, it’s crucial to introduce these components separately, not simultaneously. Here’s why:

Gradual Introduction Is Key

Starting with either speed work or hill training is acceptable, as long as you proceed gradually and methodically. You can choose to begin with speed and later incorporate hills or vice versa. What’s important is to avoid introducing both simultaneously in a single session. The key is gradual progression.

The Variables to Control

To safely reintroduce speed and hills, it’s essential to break down the training components into variables you can control. These variables include the duration, incline, and speed of your runs. By meticulously managing these factors, you can determine how well your tendon tolerates the workload.

Introducing Hill Training

A Step-by-Step Approach

Let’s start with a closer look at hill training and how to gradually reintroduce it into your rehab. The variables to consider for hill training include the incline, duration, distance, and running speed. Here’s an example of a step-by-step approach:

1. Begin Conservatively

Suppose you have access to a hill with a 5% incline and a length of approximately 100 meters. Start conservatively with a slow jog covering half the distance (50 meters), followed by walking the remaining 50 meters. You can then continue with your regular run.

2. Progress Incrementally

Gradually increase the challenge by adding repetitions. For instance, you can perform four or five repeats of the jog-walk pattern on the hill, keeping a close eye on your symptoms over the next 24 hours. If there are no significant symptoms beyond your baseline, you can proceed to the next step.

3. Increase Speed and Distance

Once you’re confidently tolerating the initial challenge, consider increasing the speed of your hill runs. You can start by doing two repetitions at a faster pace and the rest at your normal speed. Continue to build up until all repetitions are faster.

4. Adjust the Incline

If you feel comfortable with the incline you initially chose, you can gradually introduce a more challenging hill with a steeper incline. Repeat the process, gradually increasing the incline as your tendon adapts.

Introducing Speed Work

A Gradual Approach to Speed

Now let’s shift our focus to reintroducing speed work into your rehab program. Speed work covers a spectrum of running intensities, from sprinting to faster-paced jogging. The key is to gradually increase the intensity while closely monitoring your symptoms.

The “Walk-Run” Approach

Consider approaching speed work in a way similar to a “walk-run” program. Many are familiar with the concept of gradual progression in programs like Couch to 5K. Apply this principle to your speed work by starting with predominantly walking and incorporating short running intervals.

Progression and Symptom Monitoring

As you progress through the program, gradually increase the running portions while keeping the walking segments consistent. Monitor your symptoms carefully over 24 hours to assess whether the incremental increase in intensity is well-tolerated. This methodical approach allows your tendon to adapt at a manageable pace.

Troubleshooting and Adjustments

Adapting Your Rehab as Needed

In both hill training and speed work, it’s crucial to control variables, document your progress, and adjust your rehab as needed. If you experience flare-ups or discomfort, consider troubleshooting:

Addressing Compression Tolerance

If hill training leads to discomfort, it may be due to a lack of compression tolerance in your tendon. In this case, focus on incorporating compression exercises into your strength training, such as deadlifts, single-leg deadlifts, rocket jumps, and Nordic dips. These exercises can help build tolerance to compression.

Adjusting Eccentric Training

For those struggling with speed work, consider incorporating faster eccentric training into your rehab. This could involve performing exercises like hamstring curls or deadlifts with an emphasis on quicker eccentric contractions to adapt your tendon to speed.

Conclusion

Empowering Your Recovery

In conclusion, there’s no one-size-fits-all approach to introducing speed and hill training in PHT rehab. The key is to start conservatively, control variables, document your progress