Overcoming Proximal Hamstring Tendinopathy

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞📄Learn more about Brodie's PHT AI Assistant 🔍 In this episode, we break down a brand-new randomized controlled trial comparing individualized physiotherapy with shockwave therapy for proximal hamstring tendinopathy. I walk through how the study was designed, what each treatment involved, and why the results showed no meaningful difference between the two approaches. We also explore the role of education, load management, and compressive tolerance, and what this means for your rehab decisions moving forward. If you’ve ever wondered whether shockwave is worth trying or how it stacks up against a structured strength program, this episode gives you a clear, evidence-based answer. Paper 1: Physiotherapy Compared With Shockwave Therapy for the Treatment of Proximal Hamstring Tendinopathy: A Randomized Controlled TrialPaper 2: Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy: A Clinical Commentary

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞📄Learn more about Brodie's PHT AI Assistant 🔍For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice.Research Deep-Dive: Hamstring Strength & Running BiomechanicsThis episode reviews the study: “Hamstring Strength and Architectural Properties Are Associated with Running Biomechanics”, including findings from ultrasound imaging, EMG analysis, and 3D running mechanics. Key Study QuestionsDo stronger hamstrings create better running mechanics?Do better mechanics help build stronger, longer hamstrings?How do strength, fascicle length, pelvic position, and muscle activation interact?🔎 Main Findings From the Study1. Stronger Hamstrings = Better Running MechanicsAthletes with higher eccentric hamstring strength had:Higher stride frequency (cadence)Better control of decelerating the swinging legLower ground contact time (improved efficiency)Lower hamstring activation at sub-max speeds → reduced overload 2. Longer Hamstring Fascicles = Safer, More Efficient LoadingRunners with longer fascicle lengths showed:Less anterior pelvic tiltLower hamstring activationBetter ability to tolerate late-swing loading (a high-irritation phase for PHT) 3. A Two-Way Relationship ExistsStrength ↔ mechanics influence each other.Stronger hamstrings → better running techniqueBetter running technique → better hamstring loading → stronger, longer muscle structure over time This creates a positive adaptation loop. 4. Over-Reliance on the Biceps Femoris = Red FlagRunners with weak or short hamstrings tended to over-activate the biceps femoris long head — the most common site of PHT. Stronger runners shared load better with the medial hamstrings, reducing tendon stress. 🏃 Practical Rehab Takeaways1. Build Eccentric StrengthEccentric strength is one of the strongest predictors of hamstring injury risk. Examples Brodie recommends:Hamstring slidersWeighted eccentric slidersSingle-leg slidersAssisted → full Nordic dropsDeadlifts (when tolerated) 2. Improve Fascicle LengthEccentric exercises at long muscle lengths help lengthen fascicles naturally — more so than stretching alone.3. Strengthen the Medial HamstringsTo prevent overload of the biceps femoris:Use toes-in hamstring curlsToes-in slidersToes-in deadlift variations These help redistribute load more evenly across the tendon. 4. Slightly Increase Cadence (~5%)A small increase in stride frequency may reduce late-swing strain and improve running economy.5. Integrate Running Into RehabBefore adding speed:Build to 30 minutes continuous, easy running → symptom-free Then introduce:Strides (15–20 sec at ~75% speed, 4 reps)Gradual progression based on symptoms the next day Final ThoughtsHamstring strength, muscle architecture, and running technique are deeply interconnected. Improving one helps improve the others — creating a pathway toward better performance and long-term PHT resilience.

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice.Paper Title 1: Porcine Collagen Injection Therapy Affects Proximal Hamstring Tendinopathy in Athletes by Reducing Time to Return to SportPaper Title 2: Estrogen and progesterone exhibit distinct yet coordinated roles in the regulation of tendon extracellular matrix remodeling 

 🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. In this episode, Brodie reviews brand new research exploring patients’ real-life experiences receiving physio-led rehab vs shockwave therapy for proximal hamstring tendinopathy (PHT). This qualitative study highlights what people found most helpful, frustrating, and effective during rehab—revealing valuable lessons for anyone currently recovering from PHT. Brodie also provides a personal update on his own hamstring rehab and HYROX training progress. Check out the paper here: Education, rapport and convenience are key to participants’ perceptions of receiving physiotherapy or shockwave for proximal hamstring tendinopathy: a qualitative study

 🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. 

 🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. 

 🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice. 

🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice.In this episode of the Overcoming PHT Podcast, I dive into a valuable supplemental resource created by researchers at La Trobe University as part of their clinical trials on proximal hamstring tendinopathy (PHT). This patient education file breaks down everything from diagnosis to discharge advice—and I highlight the key takeaways that can help you better understand and manage your recovery.What You’ll Learn in This Episode:CHECK OUT THE PAPER HEREUnderstanding PHT – what causes it, why tendinopathy is the accepted term, and the typical prognosis.Treatment options explained – the pros and cons of rest, injections, surgery, shockwave therapy, and why individualized physiotherapy remains the gold standard.The role of strength training – how heavy, slow resistance can improve muscle strength, tendon stiffness, and even brain-muscle connections.MRI myths – why structural changes don’t always match up with pain and function.Pain monitoring principles – why tendons respond differently, and how to use the 24-hour pain response as a guide.Compression and load management – understanding high vs low tendon loads, how sitting and stretching impact PHT, and why gradual reintroduction is key.Discharge advice – the importance of ongoing strength work, flare-up management, and avoiding extreme “all or nothing” approaches with sitting and stretching.Why This MattersWhether you’re new to PHT or have been struggling for years, this episode gives you a clear, research-backed framework for understanding your pain and making smarter rehab choices. It’s not just my perspective—it’s guidance from some of the leading tendon researchers in the world.

🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice.In this episode, Brodie reviews a brand-new 2025 clinical commentary on the treatment of proximal hamstring tendinopathy (PHT) with an individualised physiotherapy approach. The paper, authored by experts including Jill Cook and Aidan Rich, outlines a comprehensive, stage-based rehab protocol grounded in tendinopathy principles and adapted for the unique demands of the hamstring complex.CHECK OUT THE PAPER HEREWhat you’ll learn in this episode:Why recent systematic reviews still show insufficient evidence for one superior PHT treatment.The three core pillars of the proposed protocol: education, progressive strengthening, and graded exposure to compressive/sport-specific loads.How the five rehab stages work:Isometrics – for pain relief and warm-up effect.Isotonics – to build strength and endurance.Kinetic chain training – targeting glutes, calves, adductors, and lumbopelvic control.Compressive load reintroduction – safely restoring tolerance to hip flexion positions.Energy storage/release drills – for athletes with high-speed or power demands.The importance of pain monitoring, “hurt vs harm” education, and avoiding rapid spikes in load.How to individualise the program based on goals, deconditioning level, and activity demands.Practical tips for combining stages, structuring training cycles, and maintaining long-term tendon health.

🎉🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🎉For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.infoRun Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice.🧠 Episode SummaryIn this episode, Brodie dives into a newly published paper titled “Female Tendons are from Venus and Male Tendons are from Mars: But Does it Matter for Tendon Health?” by Gerard McMahon and Jill Cook. The paper explores how male and female tendons differ in structure, adaptation, healing, and injury risk—and what it means for those dealing with tendinopathy.🔍 What You’ll LearnKey structural differences between male and female tendons (size, stiffness, collagen synthesis)Why female tendons may stretch more but adapt less to trainingHow men and women respond differently to tendon rehab protocolsSurprising findings about pain, healing, and tendon blood flowWhether injury prevention or rehab should differ based on sex📌 Key TakeawaysFemale tendons are more compliant, have lower stiffness, and show slower collagen production—even at rest.Male tendons respond more favorably to traditional rehab (like eccentric loading), often reporting greater pain reduction and functional improvements.Despite men experiencing more frequent tendon injuries in some data, women may be closer to their strain “danger zone” during exercise, possibly increasing injury risk.Women may need longer rehab timelines, heavier resistance training (beyond just eccentrics), and closer attention to recovery, nutrition, and hormonal cycles.Men should be cautious about overloading tendons due to higher force-generating capacity and should still progress gradually.💡 For Runners With TendinopathyDon’t compare your progress to someone of the opposite sex—recovery is sex-specific.Trust the process: healing may be happening at a microscopic level even if pain relief is slow.Tailor your rehab by considering not just gender, but also age, training history, injury severity, and more.