Overcoming Proximal Hamstring Tendinopathy: Your Questions Answered

In today’s episode, we dive into another Q&A session to address all your burning questions about proximal hamstring tendinopathy (PHT). This podcast is your ultimate guide to understanding this condition, debunking misconceptions, and discovering effective evidence-based treatments. I’m Brodie Sharp, an online physiotherapist, recreational athlete, and a fellow PHT warrior. Whether you’re an athlete or not, this podcast aims to educate and empower you in your journey to conquer this challenging condition.

Should Hamstring Pain Location Affect Your Rehab Approach?

Our first question comes from Shastri, who experiences hamstring pain located right behind the knee, closer to the attachment point. Shastri wonders if the same exercise and recovery regime as PHT should be applied.

While it’s the same muscle, the location of the pain matters. Proximal hamstring tendinopathy (PHT) focuses on the tendons closer to the origin, specifically where they attach to the sitting bone. Rehabilitating these tendons requires tailored exercises that gradually build up their tolerance to compression. On the other hand, hamstring tendons located more distally, behind the knee, don’t require the same level of compression tolerance.

For those with distal hamstring issues, exercises like hamstring curls, long lever bridges, or bridges with straight legs can be effective. However, it’s crucial to ensure that the diagnosis is accurate, as pain behind the knee could also indicate other conditions like popliteus muscle issues, pes anserine tendon or bursa problems, ITB syndrome, or a Baker’s cyst.

Determining the Right Weight for Exercise Progression

Next, Alicia has a two-part question. First, she wants to know if there’s a formula or calculation to determine the maximum weight for specific exercises like deadlifts. Second, once she’s in the maintenance phase, can she reduce the weight and still maintain effectiveness?

When it comes to progressing with weights, there’s no universal formula because individual factors vary. To determine your progression, consider the following:

1. Symptoms: Continue progressing as long as you are experiencing manageable symptoms. If your symptoms improve but still persist, gradually increase the weight to challenge your tendons further.
2. Demands: Consider your athletic or daily life demands. Different goals require different levels of strength and resilience. Tailor your exercise program accordingly.
3. Future Goals: Think about your long-term objectives. Ensure your tendon’s capacity exceeds any potential future goals to maintain a robust, resilient tendon.

Regarding the maintenance phase, reducing the weight slightly, from 70 pounds to 60 pounds in your example, can be acceptable as long as it still helps you maintain your desired activity levels and fitness goals. Remember, it’s harder to gain strength than to maintain it, so you can afford to reduce the weight slightly without significant drawbacks.

Cardio Options for PHT Sufferers

Kimber, a long-distance runner who enjoys marathons and 50Ks, is willing to take a break from running to focus on PHT recovery. She’s looking for cardio alternatives that won’t aggravate her condition.

Here are some cardio options to consider:

1. Dial Back Running: If possible, continue running but reduce the intensity, speed, or distance to minimize strain on your tendons.
2. Elliptical Trainer: This low-impact machine replicates a running motion without the same eccentric demands on your hamstrings.
3. Walking and Hiking: Fast walking or hiking can provide a great workout while resembling running mechanics.
4. Cycling: While it can be hit or miss for some, cycling is worth trying. Start slowly and gradually increase intensity if it doesn’t aggravate your symptoms.
5. Create a Cardio Circuit: Combine various exercises like jumping rope, push-ups, tricep dips, star jumps, and burpees to create your own cardio circuit tailored to your fitness level.
6. Swimming: Swimming offers a low-impact cardiovascular workout. Test it out to see if it suits your condition.

The key is to find an alternative that allows you to maintain your cardiovascular fitness while reducing the risk of aggravating your PHT.

Progressing with Low-Level Pain: Understanding Baseline Symptoms

Julia’s question revolves around whether it’s acceptable to progress with low-level but stable pain post-exercise or if being pain-free should be the goal.

It’s not necessary to aim for complete pain-free exercises. Instead, focus on your baseline symptoms, which may not always be pain-free. Your baseline symptoms might be at a one or two on a pain scale, but they should remain stable over time.

Remember these guidelines:

• Pain during exercise should generally be less than a four out of ten.
• Pain should return to baseline in less than 24 hours.
• Symptoms should show a gradual improvement week by week.

It’s important to strike a balance between challenging your tendons enough for them to adapt and not pushing yourself into excessive discomfort. Additionally, keep in mind that pain perception can be influenced by psychological and social factors, so individualize your approach based on your unique circumstances.

PHT rehabilitation is a nuanced process, and it’s crucial to work with a healthcare professional who can tailor your program to your specific needs and monitor your progress. Keep these tips in mind as you continue your journey to overcome proximal hamstring tendinopathy.

This episode of the Proximal Hamstring Tendinopathy podcast is sponsored by the Run Smarter series, which offers a comprehensive video course to complement the podcast’s content. If you’re looking to take your knowledge to the next level and access visual resources and exercises, check out the course and take advantage of the VIP offer provided in the show notes.

Thank you for tuning in, and best of luck with your PHT rehab journey. Stay empowered and take control of your recovery!