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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
