Q&A: Recovery timeframes & your rehabilitation ladder

Overcoming Proximal Hamstring Tendinopathy: Your Ultimate Guide


Welcome to the podcast where we dive deep into the world of proximal hamstring tendinopathy (PHT). In this episode, we’re going to address some common questions related to PHT, including recovery timeframes and the crucial rehabilitation ladder. Whether you’re an athlete or not, our goal is to empower you with the knowledge and strategies needed to conquer this challenging condition.

Setting the Scene

Firstly, a quick note about the echoey sound in today’s recording – I’ve recently moved into a new space that’s being transformed into a physio clinic, so bear with me as we work through this transition. Now, let’s get into the questions from our audience.

Understanding the Rehab Ladder

Jane, a chronic PHT sufferer, shared her frustration with flare-ups after strength training. To address this, we’ll introduce the concept of the rehab ladder. Think of it as a series of rungs, with the bottom representing your current capacity and the top your goals. To avoid flare-ups, you must progress gradually, one rung at a time. This ensures that you’re stimulating and adapting the tendon without overloading it.

Personal Example

To illustrate this point, let’s look at a personal example. I had pes anserinus tendinopathy for years, but it never fully flared up. It wasn’t until I stopped running and focused on strength training that it finally resolved. The key was gradually introducing running-specific rehab exercises, like short runs followed by walks.

Factors to Consider

When progressing exercises, consider variables like sets, reps, weight, speed, and range of motion. These factors determine how much stress your tendon experiences. It’s essential to start conservatively and gradually increase these variables as your tendon adapts.

Managing Flare-Ups

If a flare-up occurs, you can use short-term pain relief strategies, such as pain medication or isometric exercises. Limit activities that aggravate the tendon and pay attention to your body’s signals during recovery. Remember that pain is multifactorial and influenced by various factors, including stress.

Finding the Right Balance

Angela faced challenges returning to cycling without flare-ups. To build tolerance for cycling, mimic the pedal stroke with specific strength exercises. Modify your cycling technique, including intensity, cleats, position, and seat type. Ensure your pedal stroke is gentle and gradually build up.

Addressing Chronic Pain

Angela also asked if pain ever goes away entirely. Chronic pain can persist beyond tissue healing, making it complex. It’s crucial to focus on building tendon capacity and resilience, as well as managing flare-ups. Expect mild setbacks but recognize that they’ll be less severe and shorter-lived as your tendon grows stronger.

When Does Rehab End?

Jen, who has made significant progress, wonders when she can return to training without constant tracking. While rehab is never truly over, it becomes less of a concern as you strengthen your tendon and follow smart training practices. Even as you regain more freedom, always prioritize gradual progression and injury prevention.


In conclusion, recovering from proximal hamstring tendinopathy requires patience, dedication, and a systematic approach. By understanding the rehab ladder, considering essential variables, and managing flare-ups, you can achieve your goals and regain your active lifestyle. Keep in mind that rehab is an ongoing process, but with the right strategies, you can enjoy a pain-free future.