Matt’s (Second) PHT Success Story

On today's episode we have Matt's second success story. Welcome to the podcast that gives you the most up-to-date evidence-based information on P-HT rehab. My name is Brody, I am an online physio, but I've also managed to overcome my own battle with P-HT in the past and now I've made it my mission to give you all the resources you need to overcome this condition yourself. So with that let's dive into today's episode. We have a slightly different success story today because we have Matt who has been on, he was on episode 95 back in April 2023. So we're looking at two years ago talking about his P-HT on the left side and how he managed to overcome that. But in the past year or so has struggled with P-HT on the right side being quite stubborn, hard to get rid of, but has managed to learn some additional insights to overcoming this right P-HT. And so not only is there a lot of insights to help you with your rehab, but also helps reflect on the reality that totally eradicating P-HT and getting rid of it for good is a really tough endeavor and we can learn tons of insights and we can learn from every little injury, every little setback, every little flare-up to be more resilient moving forward. So you're going to love Matt's episode if you want to listen to episode 95. Before listening to this it would be a nice continuation yet listening to the first episode with Matt is not a prerequisite. So up to you, no doubt you're going to enjoy this interview so let's take it away. Matt thank you very much for coming on for the second time onto the podcast. Yeah my pleasure thanks for having me buddy. Let's bring people up to speed. Well first of all if people haven't listen to the first episode and they want to learn more about you do you mind introducing yourself and what your fitness background was like? Yeah with pleasure so I'm French Canadian runner 42 years old I've been doing endurance sports for about 25 years used to be road cyclists and cross-country skier and now I've been running for about 10 years. I trained five six days a week. I just give you an idea like my fast is 10k's like 37 minutes so not that great. Still pretty good. I mean I'm reasonably satisfied with it and my fastest mile is 541 and that's what I dream for. I'm like obsessed with I'd love to run a five-minute mile. I'm not sure that's going to happen in my lifetime but maybe an age-graded five-minute mile. And yeah so that's that's pretty much the kind of runner that I am. Last time you were on you were talking about your success story and talking about negotiating PhD and we're on again to talk about a second PhD instance that you had but from when we recorded our last episode which was a couple of years ago how are things going? How are things leading up or just prior to this new injury where you're still fit and active still you know at a what you consider a good performance? Yeah still training like like normally once I had gotten rid of PhD after having it on the left leg for about a year. I thought I was like done with this injury I thought I had it like figured out. I came on your podcast like really excited to share my hard-gained lessons with the world and basically I got it again but but on the second leg and it took me another full year to get rid of it. So now I'm back and I've got I'm like more assurance than I did when I first came that now I figured it out and I'm excited to share with your listeners what I learned. Excellent how long ago did this right side start if I talk in time frame wise? I was started about March last year so about a year ago. Okay right and what was happening in the your training or anything around that time that you think might have contributed? So two months before was January 1st so January 1st like a lot of people I was starting a new training cycle I read yet another training book running book and decided okay I'm gonna try this one and this particular book had a big emphasis on strides and strides like strides every five ten minutes like so you're running you're doing your slow run but you're interspersing strides and their strides and uphill sprints and I also started training in a gym again and the combination of the two strides and the sprints and the weightlifting and all that I injured my hamstring the right hamstring but it was like a strain you know like I like I pulled the muscle kind of like a near the knee so nothing to do with PhD but near the knee and it took about two months to get over that like I you know I recovered a little bit in a week and then injured you again and so within two months that was that was over but after a couple weeks after that was healed then I started to feel like a very mild PhD symptoms on the right leg so what I assume is that while I had this hamstring strain my hamstring was weak and it probably got weaker during that period and so it became like vulnerable to PhD. Kacha I can't like the amount of people that have PhD or recurrence of PhD due to speed work is very very common it's just such a it's so closely linked to speed and hamstring load hamstring demand that it's no wonder with not only runners in general but runners who have the ambitions of running fast that the likelihood of these things setting in is quite high so interesting kind of correlation there talk us through symptoms like what so was it a very gradual onset around about that time or was it quite sudden? Yeah very gradual so like that pain in the pain in the butt and this time sitting was was never a problem so before the left leg I'd issue sitting this one never had me pain while sitting but it was basically sort of the same thing just sort of creeps up on you think this is maybe just like muscle soreness or it lingers and that classic test there where you're like taking off your shoe like pulling your heel towards like your body while standing that was like more and more sensitive as time went on so I eventually came to terms with just the horrifying idea that I had now PhD on the other leg what was your initial reactions like emotionally I mean you're very experienced with managing and dealing with PhD where was your mindset at when that when the onset occurred when it started wasn't too bad because I felt like I had the tools to get through it like I felt like okay I understand this injury all I need to do is what I did with the left leg with the initial like that was injured so I just started basically starting to do like hamstring strength work again like the classic exercises we can go through them but basically that's what I did I applied the same protocol that I had done with my left leg and and it just didn't prove for like almost a year it didn't improve even if I I was doing what I had done with with my left leg can you give any potential reasons why I'm I'm not sure exactly why so basically it just for your listeners what I was doing is strength work at home so I have like minimal equipment I have like two 45 pound plates not dumbbells I have like the plates and my idea was what I'd work with the left leg was do whatever is painful whatever is the most painful will solicit the muscle intended I should say in the way that it's like it needs the most strength thing so that was that was like my training principle so for me what what hurt the most was single leg a dead list so I did single leg a dead list I did an exercise I did like you're like in a bridge and then you slide one leg out I don't know if that's that the hamstring slide is yeah I would usually call them hamstring sliders and then maybe hamstring gliders so you're like standing with like a plate like something sliding gliding underneath your leg and then you glide back like a backward lunge and then hike yourself back with the standing leg yeah and second would be like similar to a backwards lunge but you're just sliding instead of stepping yeah exactly yeah that I did like the equivalent of like a bird dog with like elastic bands like pushing my leg back while I'm like all on all fours otherwise a ham hip extension standing hip extension so I'm just standing on both feet I've got a band around both both feet and I pull the leg backwards so that's what I was doing and I would do that so I would I would do that like I tried all sorts of intensities weights like repetitions I tried it every day I won't point to get that numbing effect I really like that like when I would do it I would just I would feel it less during the day so that would help me like get you know just like go run and and be annoyed by it less. So I like all three of these. like all the different extras. I also did like Bulgarian split squats also with relatively light weights. So I did that and whatever hurt the most I would do and I was able to manage it well. So so I think maybe this may would have worked for me if I had if I was like you know like like really injured like if I had like a like if I had a lot of symptoms but I was like at a 1 to 2 on 10 basically the entire time like I was able to keep running I was able to keep training relatively normally whatever this constant soreness so I wasn't able to like shake it off completely it was like the last like the last inch the last bit that I just couldn't achieve with that program. So when you first got this injury was the pain higher than a 1 to 2 and that's the 1 to 2 is the best it got. Now it basically stayed or it like stayed around there because I think because I like I had experienced it before I knew how to like manage it. So for running what helped me for running is running uphill I think for some people running uphill is worse. For me is like almost you know symptom-free running uphill so I could do intervals running uphill. So whenever it was like I would feel like symptoms creeping up I'd run uphill or I'd I have a really geeky piece of equipment called an elliptical which is amazing. It's like an elliptical machine but on wheels highly recommended so I really enjoyed so I would do that and I would have less symptoms with that but never like zero I tried resting like between like training cycles I took like one or two weeks off and that that didn't make it better in fact that I think made it worse so it was like the downward spiral there that you often talk about. So I felt like I tried everything and I was desperate and I was like this close to reaching out to you like Brody helped I don't know what I can do anymore and finally I tried something in that work. Gotcha and that was after 12 months of just trying different whites different frequencies different intensities and all that sort of stuff. Yeah exactly so about maybe 9 to 10 months of basically you know lots of different hand-tree exercises at home and targeting what hurt the exercise that hurt the most I would do those. Would symptoms fluctuate much with running or fluctuate much with like heavy strength exercises or anything like that? They would fluctuate like you know some weeks it would be less like I think it's almost gone and then it would come back and a little bit more so it fluctuates between zero and two way would say. Okay so if you had like a longer run or a faster run or something like that it wouldn't be worse off the next day. It could be yeah like depending on what the training that I did it could be like better or worse the next day. Okay yeah just not getting completely better so you sort of managing it enough to be completely like very subtle but yet just not 100% yeah exactly yeah. Okay gotcha and so what changed? What adjustments did you make in your rehab plan to start seeing improvements? So again ended the year so New Year's resolution I decided okay I'm gonna I'm gonna get back in the gym. I gotta get back in the gym not necessarily for this you know for this for PhD but just like in general I'm gonna reintroduce strength training into my program and I'm gonna you know go on start a new training cycle so I started going to the gym and I decided okay I gotta shake things up with the with my approach to managing PhD so I'm gonna focus less on you know painful movements and I'm just gonna do I'm gonna I'm gonna try like a kitchen sink approach I'm gonna try like a whole bunch of different things but full body so you know like with emphasis on the lower leg but basically like your classic full body runners strength program so so I'd go to the gym and I would run before so I do my run workout before and then on a treadmill and then I would do the weights and I would try to get out of there within 30 to 35 minutes so like 35 30 to 35 minutes of strength training after my run workout and I would do that twice a week and in order to get as much variety as possible I would only do one set of all the exercises so like one good set like one set like near failure some exercise I would do like like one warm up like easy warm up set like the dead lift and other like other like power exercise I would do like one quick sort of warm up set but the rest just one set a big variety so I would I'd be able to squeeze it about 15 exercises and those 15 exercises I selected them out of a bank of maybe 20 to 25 exercises that I have in my head or a list of exercises that I have and I would just cycle through them and do about 15 of those 20 to 25 every time I would go to the gym so twice a week. How strong were you prior to starting this new going back into the gym because you were doing some strength at home and you said you were doing your single like dead lifts and that sort of stuff how heavy were you lifting at home. At home at home it's like I was doing a lot of like eccentric stuff so it wasn't like heavy weights but it felt like there was a lot of resistance but a lot of it was like was eccentric I also did a I bought a sled so that's something like I have fun with like I push and pull like the sled so I was doing that as like sort of general strength work but I was doing it mostly like all very targeted hamstring stuff but with not with like the heavy heavy weights so it was like it was like the maximum you get with like the home exercises like say like the hamstring glide for example I would you know I would do maybe like you know maybe eight to ten reps like really slow down but really like whenever it was like whenever it was painful I would like really like just drive it as much as I could like hold it as much as I could so even if it wasn't like like big actual weights I felt like I was still putting a lot of tension on the muscle intended. Yep okay gotcha recovery from PHA has never been simpler if you've been struggling with this condition and you're not sure what to do next I've put together something to help. LinkedIn the show notes is a 30 second questionnaire literally just six multiple choice questions and based on your answers I'll point you towards the most effective next step for your situation because over the years I've created a range of resources from free education to structured self-guided programs all the way up to working with me directly all of which are aimed to strip away the mountain of misinformation about recovering from this diagnosis and taking out all the guesswork that leaves people like you overwhelmed. If that sounds helpful don't wait until the end of this episode click on the link in the show notes now and I'll guide you from there because you did mention in our last episode that like for you the more painful meant more effective and so you sort of flint into that more. Yeah okay and would you say it was a similar weight and intensity when you went back into the gym because if you're doing one set and the rep range is a 15, 20, 25 that sort of stuff seems like the overall intensity and weights would be similar. I increased the weights so when I was in the gym there I had access to like actual like you know barbells and weights and you know just general equipment so I like that increased the weight okay the exercises like changed but it definitely increased the weight so I would do one good set like maybe six to ten reps depending on depending on the exercise so because I was in the gym like I had access I had access to equipment so I was doing like should we go through like the exercises that I was doing yeah this may be clarification because I thought you said you were going through 15, 20, 25 reps oh no I was going I had a bank like a pool of exercises okay a selection of like 15 to 20 sorry like 20 to 25 exercises and each time I would go to the gym I would I would select like 15 out of that pool or bank of 20 to 25 exercise and just cycle through them. Where did you get those exercises from? I guess just like with time like just what I felt was like most I guess running specific okay like where like the you like the the fundamentals I would say like the fundamentals okay and where did you get the idea to do one set of 15 on exercises? That was mostly for I know that's not like the classic approach is generally like you know do your two to three sets and and I wanted to do this I wanted to keep it short like between 30 and 35 minutes and I wanted to do something that gave me the biggest bang for my buck and I did want to like come back to the gym like you know the double two day two workouts a day those years are over like I'm not the name right I have a son now, I'm not doing that anymore. So I wanted to do it in the same session. And I don't know, really. I wanted to get them-- I wanted to try everything. I was wondering, OK, maybe it's not the hamstring. Maybe it's like I need more glute strength. Or maybe I need more glutmete, or maybe it's the inductor. I didn't know what could help. So I just figured I want to try as many things as possible. And so if I do the standard three sets within half an hour, I'll do maybe five exercises, six exercises, something like that. But if I do only one set, I can get more variety. And I can also get some-- a bit of a cardio workout, because I'm like, good intensity. I'm not really resting that much. I'm going from one exercise to the next. So that's why I decided to try one set. Gotcha. Let's go through the exercises, because I'm curious to say what you had in your repertoire. So before I do, for your listeners, I don't think these are-- I don't know if-- like what in this combination of exercise actually worked. Like I don't know if it was the deadlift. I don't know if it was the split squat. I don't know. I can't say if one exercise in particular changed things. But what I do know is that doing this sort of general, all-round program that basically covers all the bases, that got me symptom-free within two months. So the first exercise that I do, and I do it most times, is a shallow squat for power. So just pumping up kind of a quarter squat, some people call it quarter squat. So like a very shallow squat and as fast as possible, maybe like 12. So you're going down slowly a bit fast back up? Yeah. But like both pretty quickly, but a little more emphasis like on the speed, on the-- Yeah. Going back up. That's a pretty classic running exercise. You see that come up pretty often. At least I do. So quarter squats for power, quarter power squats. Then I would do a full squat, so like a deep squat, like, as to grass, or whatever you call it. For the slam board. So like with a 15 degree slam board, so I could get down lower. I would have it like the weight in front. So I guess a deep front squat. Yeah. So the bar is in front of you, like on your collarbones. And the slam board is downwards, so that your heels are higher than your toes. Yeah, exactly. Yeah. I really like that for me. That I really like that. Actually, I bought the slam board and donated to my gym, because I really like doing-- like, let's see the only way I can get a good feeling doing a deep squat. So full squat with that, or deep squat with the slam board. Then a sumo deadlift. So I don't do the regular deadlift. I don't know if it's because my physiology, like I have long femurs or something, but I just feel more comfortable with the sumo deadlift. Like, can you explain the same idea for that? The sumo is like, you know, you imagine the classic sumo position, like their legs sort of like a little bit wider than a shoulder width apart, and they're like a little bit pointing towards the outside. I sometimes point them a little bit like straighter than an actual sumo. So, but just a wide stance. You could call it a wide stance deadlift. Yeah. With your knees and toes kind of pointing outwards externally rotated. Yeah, exactly. But just slightly-- Just slightly 45 degrees. Yeah, OK. Slightly. I think sometimes I-- yeah, just slightly pointing outwards. I just feel more comfortable that way. And I don't know, with the deadlift, yeah, I just feel more comfortable. I lift more. And I think if my gym had-- I think it's called a hex bar. I think I would be able to do that. But something about the deadlift, I just prefer the sumo stance. Gotcha. Yeah. Next, Bulgarian split squat. So that's-- I'm sure your listeners are familiar with that one. I find that one more-- Hello, to unfamiliar. Let's go. So it's like a squat with your rear foot, your rear leg elevated onto like a chair or a bench or a box or something. And then it was going down into a lunch position coming back up. Yeah. So that one really-- there's something about it. Like in the end range, when you're almost fully standing, there's something about that one that feels like that really targets the PhD area really well, at least for me. Like at the top range of the movement, once I'm almost standing fully straight. So Bulgarian split. And then the classic hamstring curl machine. Yeah. Is that lying on your stomach or seated? Yeah, lying on the stomach. Yeah. Inclined back extension? OK. Can you go through that? So that machine that's hard to describe, just like basically something that's like diagonal. And then your hips, the front of your thighs are like against like a pad. And then you would like dip your head down, and you'd do it to the floor, and then raise back up. Yeah. If anyone wants to Google like a lower back, hyper extension strengthening, that usually that would come up. So designed for strengthening the lower back, but your high hamstring does get a pretty good pull or load through that as you dip down and come back up. Did you notice any symptoms when you were doing that exercise? Yeah. I noticed that when I really worked my hamstring and glutes as well. Yeah. So yeah. I think it would depend slightly where that pad, how high that pad goes up your leg, hip, hip crease. From my experience, because I've done this a bit in the past, if the pads are slightly higher, you do work your lower back a little bit more. I mainly did it for lower back strengthening. And so that tended to help me. But yeah, if the pads are sort of, I guess, like higher or just like high thigh, then your hamstrings would need to be recruited to pull you back up. So you can have slight variations based on the purpose. So did that one. So in-clinback extension. Then I did-- I don't know why I did this, but I did like a whole made. This is a whole made one. It's on a leg press machine. So like a horizontal leg press machine, not the one with a-- like that's like where your feet are high up. So a whore's on to leg press machine. But instead of sitting on it, I would be on like on all fours, like sort of the bird dog position. And I would just kick my leg out like a bird dog. So bird dog on a leg press machine. Yeah, gotcha. Some people might-- I don't know, that could maybe Google like cold a scooter. I think some people can do it not necessarily in four point kneeling, but like standing, single leg standing, and then kicking back against the leg press machine, depending on the setup. But someone Googles like a scooter. Maybe that can pop up. But hopefully most people are familiar with the well-compaint to picture of what you're explaining. I think some gyms have like specifically like they have glue machines where you sort of like kick back. So sort of in that spirit, something like where I could do like the bird dog movement, the Rift Weight. Gotcha. OK, what's next? Then I would cycle through one glued meat exercise. So the whole bunch, like the classic ones, you know, like we have a band and you're monster walking. Side stepping, yeah, against resistance. Hip air plane. I really like-- I find that one like really does something different to me, the hip air plane. Can you explain this? You know what that is? Where you're basically-- you're standing on one leg and your whole body is parallel to the floor. And then you open up towards one side and then-- OK. --whole is back. Hip air plane. Yeah. So if you're looking at like if you're standing on the left leg, your right hip is traveling up towards the ceiling. Yeah. Gotcha. Yeah. You're tough to describe. I mean, you're very good at-- this stuff like describe this exercise. So a glued meat exercise. So lots of hip air planes, the standard like crabs. Crab. Crab walks. All clamshells. Yeah, exact clamshells. You know, just cycling through different ones. One a doctor exercise. So they're Copenhagen. I don't know why it's called like that. I don't know. I don't know either. What's the relationship with the city? So Copenhagen, I would do a lot or just like pulling a band like towards the inside. I would then do a hip flexor exercise. So different ones, just pulling a band or pulling a kettlebell while standing. These probably don't have anything to do with the PhD, but I would just throw them in there. And then I would do a calf exercise. So different kinds of calf exercises. I don't think also that really helped with the PhD, but I wanted to have something like sort of balanced. Gotcha. OK. And so you would pick about 15 of these exercises. You'd go through one set. You would keep to about a set of six to eight for some of those exercises, particularly like the ones that require some heavy heaviness. You mentioned earlier that you were symptom-free within two months. Do you think that was quite a linear progression or did it take some time for you to notice it? OK. I'm on the right track here. like how did that progress? - Before I answer that question, so one thing I wanted to just specify. about the exercises. I would also throw in like some other things like kettlebell swings, sometimes like some sled work. You know, I throw in like Nordic curls sometimes. You know, I'm just sort of like throwing in a lot of different things. I thought that was like really helpful because it's like varying the the joint angles. It's varying like the area and the muscle that's or muscle or tendon that's working. It's like working through different ranges of motion. So really like the the key like focus was just variety. The one set was a good set. So it's not like a warm-up set. Like I'm getting within like one or two reps of a failure. So and the 15 exercise that I would do each session would also include some other things that I didn't name because they have nothing to do with the hamstring. So upper body exercises. So I would you know, so I would do maybe like 10 lower body and like five like upper body. So yeah, to get back to your question. So PhD to me was tricky really tricky about the treatment and maybe you've noticed with yourself and with your patients is like treating it as like watching paint dry. Like it just doesn't get better like you know like a classic like like injury like a springing your hamster your ankle for example like or it's more linear. It's like it's almost like you have to put it on the back burner to like maintain your sanity because I felt like if I was just focusing on too much like day to day just like it just it was just like depressing. So when I started this gym program I just told myself like I'm just not gonna like I'm not gonna think about it and I'll just reassess in like a month or two and see where I am because anyways I could maintain like my running I was you know it was reasonably able to you know train like I wanted to train. So so I just told myself I'll just I'll just not think about it and see what happens in you know maybe four to six weeks and what I noticed is after about four weeks I could see like notable improvement. I could see like well this is like you know some days is like some some weeks it was like basically plateauing like the one one one on 10 you know pain level some weeks it would like dip down but in general there was a general tendency and in the reduction of symptoms over that month. So one month of it like noticeably getting better but not in a linear fashion like just sort of like watching pain dry like just slowly getting better and then between month one and month two that's where it went from like getting better to completely resolved. Gotcha yeah it's it's can almost slowly creep up on you to begin with and then have to slowly creep away to resolution and yeah it's it's a tough thing but that's why some of these pain rules that we have it's like okay pain you can be in a little bit of pain during but it needs to return back to baseline within 24 hours just as the general but the third pain rule that I like to always say is it needs to have this improvement. I like to say week by week but sometimes it could be a month by month depending on howling you've had it for but that long term trend needs to be there to know that you're doing something or to know that the tendon is healing. So it's good that you had that effect and some people can have this injury for 12 months I think they're always gonna have it but to your profit like just take some slight adjustments and then better in a couple of months which is great to have that turnaround. Yeah I was I was I was really thinking like oh geez I'm stuck like I'm stuck like I that's what I thought with the first leg I'm stuck with this I got rid of it and I got it the second leg and after like several months like man maybe I'll stuck with it on this leg and I also thought I also thought maybe my gait is off like maybe my something with my biomechanics I'm like stressing the hamstrings more when I run than I should be like they're always overworking maybe I don't run properly or maybe there's something about like my the way that I run that I'm just always gonna have this like vulnerability with PhD and maybe there is like maybe maybe I overwork my hamstrings but if I if I go to the gym if I do like exercises like like I'm doing I feel like I can run as like as much as I want to and and not get PhD at least that's how it is now and I'm I'm touching wood. It's funny where our mind goes when we're injured because I see that time and time again even in with myself it's like I'll be training for this high rocks race and do a lot of squats and wall balls and that's all stuff and they'll get this hit pain and they'll be like yeah I think there's a hip impingement on this side maybe I'm just not cut out for high rocks races maybe I should just stick to something else and maybe something's off and then that will like if the pain continues for a few months is like you know reassuring that yeah I shouldn't be doing this there's something off there's something going wrong but then soon as that injury goes away I'm like I don't even know what I was thinking about and people think that about running as well they think biomechanics they think something like a muscle imbalance or a leg length discrepancy and unfortunately a lot of health professionals like if you go to a health professional some will say yeah your glutes aren't switching on or this left glute is inactivating properly or you need to a stronger core or you have one leg longer than the other or all those sorts of things um looking back on a taking step back and looking globally at your presentation hey you're running fast you're you've got this uh yeah sure we would have a look at your running mechanics but generally speaking you want to run fast and you want to run like do that quite often and you have these ambitions to run a fast mile to run a fast 5k like all those will work your handshake very hard and that's going to be the the biggest rock in the whole loading cycle rather than if you are slightly activating your handshake more than your quad or if your glutes aren't as strong and all those sorts of things so um yes I do get it and a lot of people who are injured will start to have those worries concerns, confusions about yeah maybe I do have one leg longer than the other doesn't really stack up in the research in terms of um correlation to injuries or injury risk um but yeah to your point as soon as you adjust get better like those fears and worries tend to tend to go away yeah I'm really glad uh what's uh a bit what I like with the rehab side of things is trying to keep to one variable at a time and the frustrating thing about this success stories is a ton of variables as you've mentioned like it's it's important that we talk about these things but um there was a few changes to your rehab that I think is worth highlighting and like we say we're never going to know what was the one component or multiple components that led to this um you know resolving but yes things did start getting slightly heavier in the gym you were pushing very close to um or like one to two reps away from failure so that is a stark difference to the load that you were doing at home so we could say that the heavier load might have something to do with it the changes of exercises might have something to do with it um but the other thing that you mentioned was you were running before the loading um for about was it 25 to 30 minutes or something like that running like a you know regular workouts you're like maybe 45-50 minutes yeah um I listen I recently released a podcast episode with Keith bar I'm not sure have you listened to that episode yeah okay you might be interested to this one so like uh when it comes to what he was explaining is with the tendon um there's a certain portion of that tendon that's that's undergoing that tendon opathy that has this reaction this um the collagen fibers are getting a bit um screwed up and cut the scar formation starts to develop um and the tendon wants to protect itself and doesn't want more damage and so what it does is this component called stress shielding and if you were to load up the tendon it all the load goes straight through the healthy portion and totally bypasses the affected portion that that has all those like mixed up collagen stuff so that you cause that stress shielding and if you if it's a if it's a strong sort of component it goes straight through it and that scar tissue never heals because it's just being directly bypassed and in fact it it starts to get worse because tendons like load and if it keeps getting bypassed then it just keeps getting worse however what he was mentioning is if we can find a way to fatigue certain portions of that strong tendon it's starting to slack off a little bit and we can start exposing a bit of load through that scar tendon and it starts getting the right signals it started like oh this is load this is load that I have an experience with quite some time and it starts to send the signals of these are the directions of the collagen fibers that I need to realign with because it's in the direction of the load this is uh adaptation stimulus and all those sorts of things and one thing that he did mention was fatiguing the unit and then doing your strength training and so the fact that you went for a run for 45 minutes and somewhat maybe leading the healthy portions that tend into fatigue a bit earlier would then expose your scar pathological portions of that tendon to start experiencing some loads. So maybe there's a portion to that as well. I found that little element that you added in quite fascinating after relating to that Keith Bar interview. That's really interesting. Yeah, that's a factor I hadn't thought about like the sequencing of the strength training like right after the the running whereas before I would have done it like as far apart as possible and often like before the running. So it could have been that could have been like the added weight or like the variability exercise more like complete compound movements. So yeah, I'm not sure exactly what it was that did the scale, but it was like it was so black and white like I like you know so black and white that that was it and the way I feel now like it just it completely shifted things just basically going to the gym 30 minutes after after a run workout. Kinshund Sync approach as many exercises possible within those 30 minutes twice a week that did it for me. Excellent. Okay, so we've gone through two rounds of PhD now based on this second bout. Is there anything you would have changed in hindsight? I just would have gone to the gym sooner. I would have stopped doing the exercises at home. I would have stopped focusing strictly on like the painful movements. I would have started doing heavier weights more complete exercises not just the painful movements but like just general compound general strength exercises. Basically what I'm doing now. I just would have done that sooner. Yeah, like hindsight 2020 and I think everyone would probably answer exactly the same, but what I did like about it was that you did try to change different things like even though things weren't working doing the stuff at home. Like you said you tried, oh let me try resting. Oh, let me try some like bumping up the intensities. Let me try the different frequencies like you were still experimenting because one thing I like get frustrated with is someone trying something the same thing for 12 months not getting any better for the 12 months and then wondering why things haven't changed. But to your point you had tried to make some adjustments. Just finally made the right adjustment. It just took 12 months to do so. Yeah, I think one of the reasons why I was like sticking with what I was doing for so long is because I had a success story. I talked to you on this podcast. I had proof that something worked. So sort of sticking with that for too long I think. Gotcha. And otherwise I think I would have switched things up earlier. Yeah. Any final takeaways or any messages for someone who might be struggling with pH-C that you think might be helpful? I hope that anyone out there who's got this sort of like mild, manageable but persistent case of PhD like one to two on 10 in terms of pain and that's having trouble shaking it off. I hope that if there's any listeners who are experiencing that right now just my message would be like keep hope like the get back to zero like it's there it's possible and it might be just around the corner. What worked for me was a general strength training program at the gym reasonably heavy weights twice a week with like the fundamental compound movements deadlift squats. You know like the main like mainstays of classic running programs. So I'm really I'm really excited to be able to share it and I hope like it's helpful for for your listeners. There's one thing maybe I wanted to add as well is about eight months ago. So while I had PhD I decided to also change up my training. I think I was getting bored in general. Polarized training like just the training that everyone does now in my like from my understanding like slow running, repeler with like some you know twice a week like intervals or you know the classic polarized training that everyone's doing. We're starting to like eat away at me like the slow runs just like just so boring and then when you do the the hard intervals like you're just cooked and you know they're not they're no fun because they're just like always like really hard so it's like I the hard really hard and really slow. I just I just got really bored of them. I've been doing that for like 10 years and I did that before in other sports as well. So I came across a book called the easy interval method. You heard about it? I have yeah yeah you heard about it so so I don't I'm not here to promote this book but I decided to give it a try and basically this book it's like light intervals every day. It's like instead of going like a nine on ten in terms of like the difficulty you're more like a six or seven but you're doing it every day so every time there's no more slow running. Every day you're doing light intervals so from 100 to 200 to 400 to a thousand meters and you're going slower in those intervals than you would like in the classic polarized approach but you're going from like 800 meter speed like 800 meter pace at for the 100 meter intervals all the way up to like half marathon pace for the longer thousand meter intervals. So you're you're doing basically like slight speed work at every at every session. So I started that about nine months ago and and I'm still doing it now and I have no no PhD symptoms so the reason I'm mentioning it is because I think a lot of people who have PhD like tend to stay away from from speed work and because that's where you get the most symptoms I think at least from my experience and from from what I've heard. So I'm on this program now run it doing speed work light speed work every single day and I'm able to do that symptom free because of the strength training work that I'm doing. So I'm stoked about that and I think my my last like realization the last realization I like to share it's a personal opinion but I think running makes you weak like I think we think it like makes you strong but in my opinion it makes you weak in a way and if you want to run well and not be injury prone there's like no substitute for the gym. I'm going to keep going to the gym for the rest of my life now. If I stop I know like PhD or some other like tendon injuries like around the corner. So that's like I think my main takeaway my main like lesson from the last 12 months. The gym strength work in complement to running is a non-negotiable at least for me. Okay well said. I think like going back to the start of this conversation when you you had PhD on the left side and you're like yep I've got this I've got rid of this for good and then you've got PhD on the right side and you're just like really frustrated and like I'm going to have this forever like I think it's useful to finish with a bit of like expectations about injuries and how like runners themselves should like move forward like what mentality we should have because I constantly hear people being like I just want to get rid of PhD I just want to eradicate it from my life never to come back and I just want to be injury free and like those sorts of things and that's great it's great goal to have a great thing to implement to sort of focus towards. However realistically if you want to run fast if you want to run a fast mile 5K half marathon full marathon like you're going to be stressing your body and sometimes you might just nudge into an overloaded state and sometimes that those symptoms come back and if we have these ambitions to better ourselves and continue triggering adaptation and keep going going going you know every now and then we're going to fall across that overloaded line and symptoms might come back and so what I usually have for as a realistic expectation for some is we want to if there are some signs that injuries emerge and we catch it really early and we have a slight adjustment to your training plan and then move forward without a loss of fitness I think where some people go wrong is there's a slight sensation or early signs of symptoms they ignore it they keep training it gets worse and then they have to take a huge reduction in their training volume all like a big start making big sacrifices big restrictions in order to overcome this injury what we want to do is have these really subtle adjustments slight dialing back slightly dialing up dialing back dialing up based on how symptoms emerging and we're catching them really early so that over the you know 5 10 years span we haven't really lost fitness we continue to build up we continue to build up capacity and function listening to our body along the way rather than people just going through these big boom bust cycles and being really harsh on themselves and if these injuries keep coming back being like oh am I ever going to get rid of this I want this gone for the rest of my life I never want to experience it again what am I doing wrong I think mentally that's it's quite hard to live that those high expectations it's hard to live with those those things and so maybe it's a bit reassuring for some people who are listening hey if you are pushing yourself if you are racing if you're wanting to run far run fast like these injuries are just part of life we want to try to catch them early makes subtle adjustments get back without losing fitness get back to another training block symptom free you know that they are goals to have but reassurance to know if it does come back hey it's part of life let's make adjustments let's be resourceful and learn from that past little hiccup that we had. So we're more resilient moving forward. I think that's a good final message to finish on anything else you want to mention before we sign off. Um, I've got one little thing. It's not a little thing. It's a really big thing actually. Um, I just want to on behalf of the running community, I just want to say a huge thank you to you for everything that you're doing. Um, you know, this, this podcast you have, like what an amazing resource. Like there are tons you go see at the average physio and they have no clue what you have. And like, there's a lot of people who are like, you know, stuck with this thing and they're desperate and they don't know what to do. And, um, you know, the fact that you're putting all this information together, like a really specific injury. You've got a podcast dedicated to this like specific injury. Like I think that's amazing. And it's, it's like saved me. Uh, it was a huge lifeline for me. Um, and, um, I just want to tell you like I'm really grateful and I know you're helping like tons of people and I just want to say like thank you and keep doing what you're doing. Appreciate you. Yeah. Uh, I think this story has been great for a number of reasons. One, the fact that you've had it again and then can overcome it and learn a bunch of lessons from that. How's people who do have a resurgence or a PhD on the other side and another one? They think themselves as a failure. I should have learned by now. But, you know, like I say, this is life and the fact that we now have this success story, I haven't really, I don't think I've had a repeat success story on here. So it's good that you've managed to reach out. I'm very happy that you're considering me and this podcast and helping this community to reach out and share because it wasn't on my accord. You just reached out to me via email. So, appreciate you for doing that and helping others in doing so. And so thanks for coming on. Yeah. Thanks for your effort. If you are looking for more PhD resources, then check out my website link in the show notes. There you will find my free PhD five day course, other online content and ways you can personally connect with me, including a free 20 minute injury chat to discuss your current rehab and any tweaks you might need to make. Well done for taking active role in your rehab. By listening to content like this and together we can start ticking off all of your rehab goals and finally overcome for PhD.