(Part 2) Why one PHT treatment doesn’t work for everyone with Alex Murray

Proximal Hamstring Tendinopathy: Exploring Treatment Variability

In today’s episode, part two of my conversation with Alex Murray, we delve deeper into the complex world of proximal hamstring tendinopathy. If you’ve been struggling with this condition, you’re in the right place. We’re here to help you understand it better, learn about effective evidence-based treatments, and dispel common misconceptions.


Welcome to the podcast designed to empower you on your journey to overcome proximal hamstring tendinopathy. I’m your host, Brodie Sharp, an online physiotherapist, recreational athlete, and someone who’s battled with this condition himself. Whether you’re an athlete or not, this podcast aims to educate and empower you to take the right steps towards conquering this challenging ailment.

Recap from Part One

Before we dive into today’s topic, if you missed part one of our conversation with Alex Murray, I highly recommend you go back and listen to it. Part two builds upon the ideas discussed in part one, so it’ll make more sense if you have the full context.

Understanding the Variability in Treatment

Now, let’s get into the heart of our conversation. When it comes to treating proximal hamstring tendinopathy, it’s important to consider the significant variability in how individuals respond to treatment. It’s not a one-size-fits-all scenario, and here’s why:

The Challenge of Matching Symptoms to Diagnosis

One key challenge is that the symptoms often don’t neatly match a specific diagnosis. Just like a headache can have numerous potential causes, proximal hamstring tendinopathy symptoms can overlap with other conditions. For example, a patient might present with neural symptoms that initially confuse the diagnosis. It’s essential to conduct thorough assessments and scans to rule out other issues, like a neural injury.

The Complexity of Individual Responses

Each person’s body responds uniquely to treatments. While we often focus on average results in research studies, the reality is that not everyone fits the average response. Some individuals may get significantly better, while others may not respond as well or even worsen. This variability can make treatment outcomes unpredictable.

Factors Influencing Treatment Response

Numerous factors can influence how someone responds to treatment:

  • Recovery Time: Some individuals recover more slowly than others. Tendons, for instance, may take 24 to 72 hours to recover fully from exercise. Failing to account for recovery time can affect treatment efficacy.
  • Daily Activities: A person’s daily activities, such as their job or sport, can add significant load and volume to the affected area. Treatment plans must consider these factors to avoid overloading the tendon.
  • Genetics: Genetic factors may play a role in how individuals respond to injuries and treatments. Some people may have a genetic predisposition that affects their healing process.
  • Diet and Lifestyle: Nutritional choices and lifestyle factors can impact healing and recovery. While these may not be the primary drivers of treatment outcomes, they can influence the overall picture.
  • Sport and Movement Patterns: Different sports and movement patterns can either exacerbate or alleviate symptoms. Understanding how an individual moves and the specific demands of their sport is crucial for tailoring treatment.

The Importance of a Coach Approach

Given the complexity and variability of treatment outcomes, adopting a coaching approach can be highly beneficial. Rather than solely focusing on diagnosis and treatment, a coach helps guide the individual through their unique journey to recovery. This involves ongoing communication, adapting to changes, and working together to reach the patient’s goals.

Transparency in Expectations

Health professionals and therapists should be transparent about treatment expectations. Instead of promising certain results, it’s more honest and helpful to acknowledge that treatment outcomes can vary. Patients should understand that if a particular approach doesn’t work, it’s not necessarily their fault or a sign of a severe issue. It’s all part of the learning process to find the most effective path to recovery.

Expanding Beyond Evidence-Based Practice

While evidence-based practice is essential, it’s equally vital to recognize its limitations. Research studies often simplify complex conditions, and results may not apply universally. When dealing with proximal hamstring tendinopathy, embracing a more comprehensive and individualized approach is often necessary.

Going Beyond Evidence-Based Treatment

Relying solely on evidence-based treatment protocols can be limiting, especially when it comes to conditions like proximal hamstring tendinopathy. A more comprehensive strategy considers the unique needs and responses of each patient.

Recognizing the Multifactorial Nature of Pain

Pain is a multifaceted experience influenced by various factors, including beliefs, thoughts, emotions, and past experiences. It’s not solely a result of tissue damage. Therefore, understanding an individual’s pain experience is crucial for tailoring treatment effectively.

The Role of Beliefs and Expectations

A person’s beliefs and expectations can significantly impact their pain experience. If someone believes that an activity or treatment will cause harm, their brain may interpret it as a threat and intensify their pain. Therapists must consider and address these beliefs during treatment.

Being Systematic in Approach

An evidence-based approach isn’t limited to following a specific protocol. Instead, it involves systematic thinking. Therapists should assess each patient’s unique circumstances, beliefs, and responses, then develop a tailored plan that aligns with their goals and needs.


Proximal hamstring tendinopathy is a complex condition, and treatment outcomes can vary widely among individuals. While evidence-based practice provides a foundation, it’s essential to recognize its limitations and embrace a more comprehensive, individualized approach.