Q&A: Combining Rehab & Run Days/Flare-up Plans/Sciatica Symptoms/Finding a Good PT

Title: Proximal Hamstring Tendinopathy: A Comprehensive Guide to Understanding and Managing


Proximal Hamstring Tendinopathy, often abbreviated as PHT, is a condition that can be a real pain in the butt – literally. In this article, we will delve into this condition, explore its nuances, and provide valuable insights into its management. Whether you are an athlete or not, understanding PHT and its management can empower you to take the right steps toward recovery.

Q&A Session with Brody Sharp

In this Q&A session, we will address common questions about PHT and gain insights from Brody Sharp, an online physiotherapist and a fellow PHT warrior. Brody has created the “Run Smarter” series and is a reputable source for information on PHT.

1. Managing a Flare-Up: What to Do After Pushing Your Limits

Subtitle: Tailoring Your Approach to the Severity of a Flare-Up

When it comes to managing a PHT flare-up, there’s no one-size-fits-all solution. The approach depends on the severity of the flare-up. Brody categorizes flare-ups into mild, moderate, and severe, with each requiring a different strategy. Here’s a breakdown of his recommendations:

Mild Flare-Ups: These are characterized by a slight increase in pain. If you experience a mild flare-up, consider making modifications in your running routine, such as avoiding speed work. In the gym, maintain your regular exercises unless specific activities triggered the flare-up.

Moderate Flare-Ups: If the flare-up is moderate, it’s advisable to take a break from most exercises for a couple of days. Upon returning to the gym, start at 75% capacity and gradually increase as symptoms allow. In running, reduce your volume and monitor how your body responds.

Severe Flare-Ups: For severe flare-ups, Brody recommends a more cautious approach. Take a rest for two to three days, then reintroduce exercises gradually, starting at around 75% capacity in the gym. In running, begin with a reduced volume and proceed based on symptom response. Adjustments may be needed along the way to find the right balance.

Brody emphasizes that learning from flare-ups is crucial in the recovery process. Flare-ups help define your limitations and guide your progress.

2. Running and Strength Training: Finding the Right Balance

Subtitle: Isolating Variables to Determine What Works Best

Jackie raises an essential question about the integration of running and strength training in PHT management. Brody recommends isolating variables to determine what works best for your specific condition. Here’s how to approach this:

Isolating Variables: When starting your PHT rehab, consider separating running and strength exercises to isolate the variables. Begin with a few strength exercises and gradually progress, monitoring your body’s response. Simultaneously, maintain your running routine without any significant changes.

Combining Variables: Once you have confidence in both running and strength exercises, you can start combining them. However, be cautious when increasing the intensity or duration of either activity, as this can help pinpoint any issues.

Incremental Progress: When increasing your strength training or running intensity, do so incrementally and pay close attention to how your body responds. Gradual progress minimizes the risk of flare-ups and helps you identify your limits.

3. Differentiating PHT from Sciatica

Subtitle: Understanding the Distinct Symptoms and Diagnostic Indicators

Mary’s question revolves around differentiating PHT from sciatica, which can sometimes present similar symptoms. Brody provides valuable insights:

Common Sciatica Symptoms: Sciatica often manifests with symptoms below the knee, radiating pain down the leg, pins and needles, burning, or numbness in the feet, and concurrent lower back pain. If you experience these symptoms, consider the possibility of sciatica.

PHT Symptoms: In contrast, PHT typically results in localized pain high up in the hamstring and glute area, without radiating pain below the knee. It may also be non-responsive to typical PHT rehabilitation.

Diagnostic Tests: In-person assessment may involve diagnostic tests that provoke your symptoms. For PHT, tests like the shoe-off test and heel press test can be useful. Sciatica-specific nerve tests may also help confirm or rule out sciatica.

Experiment with Rehabilitation: If you’re uncertain about your diagnosis, you can experiment with PHT rehabilitation. Responsive improvement during PHT rehab indicates a higher likelihood of PHT. If symptoms worsen or remain unchanged, it may suggest a different diagnosis.

4. Finding the Right Physical Therapist or Specialist

Subtitle: Traits of an Effective PT or Therapist for PHT Management

Jackie’s struggle to find the right therapist is a common challenge. Brody shares some qualities to look for in a physical therapist or specialist:

Research and Evidence Focus: Seek a therapist who stays updated with the latest research and evidence-based practices. This ensures you receive the most effective treatments.

Adapts to Change: An effective therapist is open to adjusting their approach based on your progress. They should be willing to modify treatments and methods if needed.

Open to Evolving Views: Therapists who are open to evolving their views based on new evidence are more likely to provide effective care.

Honesty and Transparency: Look for therapists who are honest about their approach and your progress. They should communicate openly about your condition and treatment plan.


Proximal Hamstring Tendinopathy can be a challenging condition, but with the right knowledge and guidance, you can overcome it. Understanding how to manage flare-ups, balance running and strength training, differentiate it from sciatica, and find the right therapist are essential steps in your journey toward recovery. Remember, patience and persistence are key to success in managing PHT.