Why PHT exercises are now affecting the other leg

Title: Understanding Proximal Hamstring Tendinopathy (PHT) and How Exercise Affects It

Subtitle: Exploring the Causes of PHT in the Healthy Leg and Effective Rehab Strategies


Proximal hamstring tendinopathy (PHT) is a debilitating condition that affects many individuals, both athletes and non-athletes alike. In this podcast episode, we will delve into the perplexing scenario of PHT exercises seemingly causing pain in the healthy leg. Our aim is to shed light on the reasons behind this occurrence, the universal principles of load versus capacity, and offer practical solutions for rehab. Join us in unraveling the mysteries of PHT and discover how to take control of your recovery journey.

Understanding Proximal Hamstring Tendinopathy (PHT)

Subtitle: Deconstructing the Condition

Proximal hamstring tendinopathy is a painful condition that affects the hamstring tendons at their attachment site to the ischial tuberosity, a bony prominence in the buttock region. It often leads to symptoms such as buttock pain when sitting and can severely limit one’s ability to engage in physical activities.

Load Versus Capacity: The Fundamental Relationship

Subtitle: Grasping the Key to PHT Development

The core concept in understanding PHT lies in the load versus capacity relationship. Load refers to the stress or strain placed on the hamstring tendons, while capacity refers to the tendon’s ability to tolerate this load. When the load surpasses the tendon’s capacity, PHT can develop. Various factors contribute to the load, including running, strength training, and even prolonged sitting.

The Pain-Rest-Weakness Downward Spiral

Subtitle: Uncovering the Vicious Cycle

When individuals experience PHT, they often respond by resting, hoping to alleviate their pain. This reduction in physical activity can lead to muscle weakness, which in turn diminishes the tendon’s capacity to handle load. This sets in motion a downward spiral of increasing pain, further rest, and more weakness, ultimately worsening the condition.

Why Do PHT Exercises Cause Pain in the Healthy Leg?

Subtitle: Analyzing the Paradox

Susanna’s case brings to light a common puzzle: why do exercises intended to heal or prevent PHT sometimes seem to exacerbate the condition? To understand this paradox, we need to consider several factors, including exercise dosage, frequency, and technique.

Exercise Dosage: The Key to Success

Subtitle: Striking the Right Balance

The exercises designed to target PHT are meant to isolate the hamstring tendons for rehabilitation. However, if the dosage is incorrect – if the exercises are too strenuous or performed too frequently – they can actually worsen the condition. It’s crucial to find the right balance that challenges the tendon without overloading it.

Diminished Capacity on Both Sides

Subtitle: The Ripple Effect of Reduced Activity

When individuals with PHT reduce their physical activity due to pain, it affects not only the injured tendon but also the healthy one. This phenomenon can lead to diminished capacity in both legs, making them more susceptible to PHT. Therefore, the overall capacity of the body should be considered when managing PHT.

Contributing Lifestyle Factors

Subtitle: Beyond Exercise – Lifestyle Matters

Besides exercise, other lifestyle factors like sleep quality, stress management, and nutrition play a significant role in determining the body’s capacity to handle load. Neglecting these aspects can hinder the healing process and contribute to PHT development.

Preventing the Downward Spiral

Subtitle: Strategies for Managing PHT and Maintaining Fitness

Preventing or slowing down the downward spiral in PHT requires a proactive and progressive approach. Here are five essential tips to consider:

  1. Be Proactive: If certain activities exacerbate PHT symptoms, reduce their intensity but continue to engage in them at a manageable level. Avoid complete inactivity.
  2. Be Progressive: Gradually increase the intensity and duration of activities to build your capacity. This step-by-step approach is crucial to avoid setbacks.
  3. Prioritize Overall Health: Adequate sleep, stress management, and a balanced diet are essential for maintaining your body’s capacity to handle load.
  4. Explore Cross Training: If running or specific exercises aggravate PHT, consider cross-training activities like swimming, cycling, or rowing to maintain fitness and strength.
  5. Balanced Rehabilitation: Incorporate a well-rounded rehabilitation program that targets not only the injured area but also the entire kinetic chain. Ensure progressive steps in your rehab plan.


Proximal hamstring tendinopathy can be a challenging condition, but with the right knowledge and a strategic approach to rehabilitation, you can overcome it. By understanding the intricacies of load versus capacity, addressing lifestyle factors, and adopting a proactive and progressive mindset, you can take control of your PHT recovery journey. Remember, knowledge is power, and by following these guidelines, you can work towards a pain-free future.