🎉 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 Q&A episode, Brodie continues answering listener questions about proximal hamstring tendinopathy (PHT), covering topics ranging from long-term maintenance to returning to running after rehab. He explains why the same exercises used in rehabilitation—especially deadlifts—often remain the best way to keep symptoms at bay by maintaining tendon capacity. Depending on a runner’s goals, he also discusses when to add exercises like prone hamstring curls or Nordic curls to support endurance running versus speed work. The key message: keeping the tendon strong and progressively loaded helps reduce the likelihood of symptoms returning.

The episode also addresses common frustrations during recovery, such as lingering sensations during a return-to-run program, setbacks from activities like rowing, and uncertainty about whether PHT ever truly “goes away.” Brodie outlines practical pain-monitoring rules, strategies for adjusting running variables (distance, pace, frequency), and how to identify training factors that may be slowing recovery. He also discusses scenarios such as young athletes with persistent sitting pain, older individuals starting rehab without gym access, and runners balancing rehab with race goals—emphasising that the key to long-term success is gradually building tendon capacity while carefully managing training load and recovery.

🎉 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 Q&A episode, Brodie answers a flood of listener questions on proximal hamstring tendinopathy (PHT), starting with one of the most common concerns: how to load the tendon without flaring it up. He breaks down why deadlifts are one of the most effective strengthening tools for the upper hamstring, how to manipulate range of motion, weight and frequency, and why “dosage” is the difference between progress and a setback. You’ll learn how to systematically find your sweet spot, adjust frequency as loads get heavier, and avoid the common mistake of jumping in too hard, too soon.

The episode also explores more complex cases, including persistent morning pain, uncertainty around diagnosis, and radiating symptoms that may point to something beyond classic PHT. Brodie discusses how to use loading as both a treatment and a diagnostic tool, when to consider alternative causes like lower back involvement, and how nervous system sensitisation and hypervigilance can amplify pain.

He finishes with rapid-fire answers on rehab frequency, maintenance loading, and how to modify exercises when other injuries (like low back pain) enter the picture. If you’ve been struggling to balance strengthening with symptom control, this episode offers practical, measured guidance to help you regain confidence and move forward with clarity.

🎉 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 🔍

Check out Loopi's Website here: https://www.athletetransitionlab.com/

When proximal hamstring pain just won’t settle, the conversation often turns to surgery — and that’s where confusion, fear, and mixed advice really begin.

In this episode, I’m joined by Dr. Luise Weinrich (known as Loopi), an orthopedic and trauma surgeon with extensive experience in hamstring avulsions, surgical repair, and post-operative rehabilitation. With a background as a former elite breakdancer and years working in top German sports orthopaedic hospitals, Luise brings a rare blend of surgical insight and athlete-centred thinking.

Together, we unpack the “grey zone” — the large group of runners and athletes who don’t clearly fall into “definitely need surgery” or “definitely don’t” — and how to make smarter, more confident decisions when the path forward isn’t obvious.

🎧 In This Episode, You’ll Learn:

• Why most proximal hamstring cases sit in a surgical grey zone
• The key MRI findings that matter — and the ones that don’t tell the full story
• How goals, age, chronicity, and function influence the surgery decision
• When partial tears may (or may not) warrant surgery
• Why surgery for chronic tendinopathy is often not a “winner operation”
• Common mistakes athletes make before and after surgery
• Why pre-op strength, sleep, protein, hydration, and nervous system regulation matter
• How post-op rehab should be phase-based, not timeline-based
• The biggest reasons athletes overdo or underdo rehab after surgery
• What questions you should ask your surgeon before committing
• Why post-operative protocols are essential — and often missing

🧠 Key Takeaways for Runners

• MRI findings alone shouldn’t dictate surgery — context matters
• Chronic tendon pain doesn’t automatically mean “failed rehab”
• Tendons need time, structure, and progressive loading to recover
• Surgery can remove pain drivers, but it doesn’t guarantee a “new” tendon
• Clear rehab phases + 24-hour symptom rules beat rigid timelines
• Being prepared before surgery often improves outcomes after
• If you’re unsure, a structured second opinion can prevent rushed decisions

In other words: the goal isn’t just to fix tissue — it’s to make the smartest long-term decision for your body, your sport, and your identity as a runner.

🎉 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 of the Overcoming Proximal Hamstring Tendinopathy Podcast, Brodie dives into the most commented-on and most challenging questions from the PHT Facebook community over the past 90 days.

Rather than quick comment replies, this episode delivers long-form, evidence-based explanations to help you better understand your symptoms, your scans, and your rehab options—especially when things feel confusing or discouraging.

If you’ve ever been told “it’s severe,” “you’re too old,” or “it’ll never be the same,” this episode is for you.

🔍 What You’ll Learn in This Episode

1. Severe PHT, Tendon Tears & Bursitis — Is Recovery Still Possible?

• Why tendon tears on MRI are often part of the tendinopathy spectrum, not a reason to avoid loading
• How to interpret bursitis findings and when they’re clinically relevant vs incidental
• When ultrasound-guided corticosteroid injections may (or may not) help
• Why age and genetics slow recovery—but don’t prevent it
• Realistic timelines: why “2–3 years and never the same” is poor advice

Key takeaway: Even severe, chronic PHT can improve with the right loading strategy and recovery environment.

2. Load Management: The Missing Piece in Long-Term Recovery

• Why slow, progressive strength training is still the gold standard—even in older athletes
• How to find the “sweet spot” between challenge and flare-ups
• Why setbacks usually come from mismanagement, not irreversible damage
• The role of sleep, protein (especially leucine), collagen, hydration, and overall wellness in tendon healing

3. “Can I Start Walking Again—or Am I Making It Worse?”

• Why waiting for zero pain before returning to activity often delays recovery
• How to reintroduce meaningful activities (like dog walking) safely and progressively
• Why doing something—even 2–5 minutes—can be both physically and mentally therapeutic
• How graded exposure applies to walking, running, and all functional goals

4. Heel Pain & PHT — Are They Related?

• Why plantar fasciitis commonly appears alongside PHT
• How reduced sitting → increased standing can overload the plantar fascia
• Practical strategies for managing both conditions:
  • Footwear and gel insoles
  • Sitting vs standing vs kneeling rotations
  • Step counts, surfaces, and daily load awareness

5. Prone Hamstring Curls Flaring You Up? Here’s How to Modify Them

• How to confirm whether an exercise is actually the irritant
• Why double-leg > single-leg is often the right starting point
• Using reduced range of motion strategically
• How to progress:
  • Double-leg → single-leg
  • Load first vs range first
• Why small, systematic steps matter—especially for sensitive tendons

6. Sciatic-Type Pain With PHT — What’s Really Going On?

• How to tell when symptoms are no longer “pure PHT”
• Red flags for nerve involvement (pain past mid-hamstring or below the knee)
• Possible contributors:
  • Nerve sensitivity in chronic pain
  • Scar tissue or adhesions near the sciatic nerve
  • Compensation patterns (sitting, standing, movement changes)
• Why assessment matters—and what clinicians look for:
  • Piriformis testing
  • Neurodynamic tests
  • Nerve glide exercises and when to use them

🎯 Big Picture Takeaways

• Imaging findings don’t dictate outcomes—management does
• Severe or long-standing PHT does not mean you’re “too far gone”
• Recovery improves when load, recovery, and lifestyle align
• If symptoms spread or change character, don’t guess—get assessed
• Progress comes from doing the right things consistently, not perfectly

🎉 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 years, chronic tendinopathy has been treated as a tendon problem — load it, strengthen it, remodel it. But what if, for some runners, the tendon itself isn’t the main driver of pain anymore?

In this episode, Brodie breaks down a new 2026 systematic review that may reshape how we think about stubborn, long-standing tendon pain. The paper explores whether nerve ingrowth and abnormal blood vessels around tendons — not degeneration of the tendon tissue itself — may be the real pain source in chronic cases.

We unpack the emerging research, explain each intervention in plain language, and discuss who this may (and may not) apply to — especially runners stuck in repeated rehab cycles despite “doing everything right.”

This is early, evolving science. But it’s a fascinating glimpse into where chronic tendon treatment may be heading next.

What You’ll Learn in This Episode

• Why some chronic tendon pain may be neuropathic (nerve-driven) rather than structural
• How abnormal blood vessels and nerves grow into painful tendons over time
• Why traditional loading programs sometimes stop working in very chronic cases
• What “neural modification” treatments aim to do — and why they’re gaining interest
• The six intervention categories reviewed in the paper (explained simply)
• How strong (or limited) the current evidence actually is
• Where this research fits alongside exercise-based rehab, not against it

Interventions Reviewed (Plain-English Overview)

1. High-Volume Injections (HVIGI / HVDI)

Large volumes of fluid are injected around the tendon (not into it) under ultrasound guidance to mechanically disrupt abnormal blood vessels and pain-sensitive nerves.

Key takeaway:
Consistent short- to medium-term pain and function improvements, especially in people who had failed exercise-based rehab.

2. Sclerosing Polidocanol Injections

A chemical agent is injected directly into abnormal blood vessels to deliberately close them down, cutting off blood supply to pain-producing nerves.

Key takeaway:
Moderate to strong pain reductions in very chronic cases, with outcomes comparable to surgery in some studies.

3. Radiofrequency Microtenotomy

A minimally invasive procedure using controlled heat to disrupt nerve ingrowth and abnormal vessels at the tendon–paratenon interface.

Key takeaway:
Very strong results in a small cohort, but higher risk and limited evidence so far.

4. Minimally Invasive Paratenon Release

Scar-like adhesions between the tendon and surrounding tissue are mechanically released to restore tendon movement and reduce nerve irritation.

Key takeaway:
Large pain reductions and high rates of pain-free outcomes in non-insertional Achilles tendinopathy.

5. Electrocoagulation Therapy

Electrical energy is used to seal off abnormal blood vessels surrounding the tendon under ultrasound guidance.

Key takeaway:
Promising early results, but evidence limited to one small study.

6. Surgical Interventions (Open & Endoscopic)

Surgery physically separates the tendon from irritated surrounding tissue and removes abnormal vessels and nerves.

Key takeaway:
Effective for some, but invasive, with longer recovery and higher risk.

The Big Picture Takeaway

Across very different procedures, outcomes were surprisingly similar.

That points to a common mechanism:
👉 Modifying the neural (nerve-driven) pain environment around the tendon, rather than “fixing” tendon structure itself.

This doesn’t replace exercise-based rehab — but it may explain why a subset of runners with long-standing, highly sensitive tendinopathy stop responding to load alone.

This research is best viewed as a future direction, not a replacement for good rehab principles.

🎉 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 🔍

Check out Lasse's website here: https://www.lasselempainen.fi/?lang=en

In this episode, Brodie sits down with world-leading orthopedic surgeon Dr. Lasse Lempainen, a specialist in complex hamstring injuries, to answer one of the most confusing and anxiety-provoking questions runners face:

“How do I know if I actually need surgery — or if rehab is still the right path?”

Drawing on decades of surgical experience and extensive research into hamstring avulsions and proximal hamstring tendinopathy (PHT), Dr. Lempainen walks through how he actually makes decisions in real clinical practice — not just what MRI scans show, but how symptoms, function, timelines, and rehab quality all fit together.

Together, Brodie and Lasse unpack the gray area that most runners live in: partial tears, chronic pain, mixed scan results, failed rehab attempts, and fear-based decision-making. The result is a balanced, evidence-informed discussion that helps runners understand where surgery fits — and where it doesn’t.

What You’ll Learn in This Episode:
How Surgeons Decide Who Actually Needs Surgery

• Why MRI findings alone are never enough
• The importance of correlating scans with clinical function and symptoms
• Why some complete avulsions heal well conservatively — and others don’t

Hamstring Avulsion vs Proximal Hamstring Tendinopathy (PHT)

• Key differences between acute avulsions, chronic avulsions, and tendinopathy
• Why not all “avulsions” are the same (1-tendon vs 3-tendon injuries)
• When retraction distance matters — and when it doesn’t

Critical Timing Windows

• Why acute avulsions should ideally be operated on within 2–3 weeks
• What happens when diagnosis is delayed
• When chronic injuries become harder (or impossible) to fully restore surgically

“Failed Rehab” — What That Really Means

• Why many runners are told they’ve “failed rehab” when they actually haven’t
• Common mistakes in conservative treatment (under-loading, poor progression)
• When even excellent rehab is unlikely to succeed due to tendon biology

What Surgery for PHT Actually Involves

• What surgeons look for during surgery beyond “tendon thickening”
• The role of semi-membranosus release, scar tissue, and sciatic nerve involvement
• Why surgeons often find structural issues not obvious on standard MRI

Common Pre- and Post-Op Mistakes

• Why under-diagnosis is one of the biggest pre-op risks
• Why returning to running too early post-op leads to setbacks
• The importance of fixing why the injury happened — not just repairing tissue

Key Takeaway

This episode helps you understand which group you fall into, without fear-based decisions or false hope.

🎉 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, Brodie breaks down a newly published review paper that takes a deep dive into what’s actually happening inside painful tendons — far beyond the usual “overuse” explanation. You’ll learn how healthy tendons are structured, what changes at a microscopic level when tendinopathy develops, and why pain severity often doesn’t match what shows up on scans. The episode explores how factors like load management, low-grade inflammation, oxidative stress, ageing tendon cells, and overall metabolic health all interact to influence tendon pain and recovery.

Brodie also discusses what this emerging science means for real-world rehab — including why rest alone doesn’t work, why exercises sometimes stall progress, and why a more holistic approach is often needed. The episode finishes by looking ahead at future treatment directions, from improved diagnostics to regenerative and molecular therapies, while grounding everything in practical takeaways runners can apply right now. If you’re dealing with persistent tendon pain — especially proximal hamstring or Achilles tendinopathy — this episode will help you understand why recovery can be slow and what actually gives you the best chance of long-term success.

🎉 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 Trial
Paper 2: Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy: A Clinical Commentary