Q&A: Gym Work with PHT, Flare-Up Triggers, Mental Struggles, When to Progress

On today's episode I am answering your PhD questions. Welcome to the podcast that gives you the most up-to-date evidence-based information on PhD rehab. My name is Brody, I am an online physio, but I've also managed to overcome my own battle with PhD in the past, and now I've made 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. When I asked for your PhD questions, I was originally intending for this to be two episodes. So Q&A, one and two, and as you knew from the previous episodes, like a flood of questions have come in, and so we have about 30 plus questions, and I'm like, "Okay, this needs to be three episodes," but since saying that, more questions have come in, and I can see that in a lot of these questions, there are multiple questions within the questions, and so I think this might have to be drawn out to a fourth episode. So we'll do this as number three, and I'm pretty sure there'll be plenty left over for another episode coming in next time, which I hope you're okay with. I mean, the more questions and the more value you get, hopefully no matter what these questions are and how I answer them, hopefully you'll find the benefit to help overcoming your own PhD. So let's kick it off. We've got one coming in from Sean, who says, "Is it okay to continue work on other leg muscles in the gym while rehabbing my PhD?" For example, a squat's okay, see the leg presses, leg extensions. Should I reduce the weight, so I don't cause an imbalance of opposing muscle groups in the legs? Okay, thanks for your question, Sean. Let's dive into this. Definitely work on other muscle groups in the gym. It helps mentally, rather than just only having to do core or upper body, I think mentally it helps people still staying proactive and working as many muscle groups as possible, but it also helps prevent de-conditioning. So if you are, let's just say a runner, and you can't run right now because of PhD, and if there's an exercise to help preserve the strength and conditioning and endurance and power of your calf and Achilles and foot muscles and your quads and your knees and your hips, if there's a way that we can continue preserving and if anything, building upon the strength and capacity of everything else, then let's do that because when the PhD is in a position to return to running or return to higher volumes of running or return to speed work, you're better equipped for that because we've just preserved a lot more. So many reasons why I say try to work as many muscle groups as you can. In terms of what's okay, what exercises do I recommend? It depends on trial and error. It depends on your unique scenario. I've seen a lot of people with PhD that really struggle with squats for some reason, whereas others are totally fine with squats, especially deeper squats, I think would be a bit more of a risk. It might just pull on the tendon with deeper squats that might just be a bit more provocative for some people and not for others. So trial and error is required. You can start doing squats, start with half range of movement, start with light weights. If your symptoms feel fine, you can work on the depth, slowly reintroducing deeper and deeper squats until you sort of reach your own, I guess, functional depth with your squat. But if that's okay, then you can slowly start applying the weights that we're using. Trial and error and little experiments to see what you can tolerate. The same should be said for the leg press. On paper should be fine. Leg extensions or knee extensions. So when you sit on a machine and you've got the weighted pads at the front of your shins and then you straighten out your leg against resistance, it should be fine. Depending because people have different tolerances to sitting. So if you can't sit and it's really irritated for like two minutes, if you can't sit normally at a desk for two minutes, you probably wouldn't have a great time doing seated knee extensions. But there are other ways we can work the quadricep muscle while squats will do that. Leg press will definitely do that. So there are other ways we can work that muscle group without having to sit. But if you can sit and you can tolerate say 30 minutes of sitting in your office chair or at a meeting, surely a couple of minutes sitting in a doing a seated knee extension machine should be fine. So I recommend you do that. Don't shy away from small amounts of sitting if larger amounts of sitting isn't tolerated. If you are a runner, I would say definitely prioritize the calves. Keep a good calf routine in there because if you're in the gym and you have one of those machines that have the weighted pads at your shoulders, when you stand and then you can just do calf raises against resistance, really puts much load on the hamstring, particularly that bear hamstring hardly gets any. So work the calves, maintain the calf strength and that will be good for when you have to build upon your running in the future. Upper body should be fine. The only thing that I've seen people run into or the problem that people run into would be if they're doing like bicep curls, every single set they put their weights down, they pick them up off the floor and they're kind of doing like a full range of movement like squat or lunge or deadlift looking hinge pattern to pick up the weights, to physically pick up the weights and start their set. If they're picking up, putting them down, picking up, putting them down constantly through various upper body exercises that might irritate. And I say might because some people can totally be totally fine with it. However, my recommendation is if you're unsure or you notice that it does irritate you, hey, just put the weights on a box, on a player box or something at hip height and then you could just pick up the weights and put down the weights from that height and that should be fine. Thanks for the question, Sean, because I get asked a lot like, ask what's okay, our calf raises okay, you know, you name the exercise. And my answer is like, just see how symptoms feel. Like if you're unsure, start really conservatively, start with the lightweight, you know, small range of movement, just see how your symptoms feel, your body will tell you whether it's okay to do it or not. So, you know, play around with that. And to your point about imbalancing or the imbalance of opposing muscle groups, like maybe you're over developing your quads and under developing your hamstrings. I don't worry too much about that because they're compound movements. If you do a squat, you're working on your knees, you're working on your ankle range of movement, you're working on your glutes, which is at the back, as well as your quads, as well as your lower back strength, as well as the tolerance to your knees, hips, there's like so much benefit you can reap from doing these sort of exercises, rather than just being like, oh, I don't really want to get my quads too strong. If my hamstrings aren't too strong, I wouldn't worry too much about that. Next question or questions come from Caroline, who says, hi, Brody, thank you for the opportunity of asking my questions regarding pHT. I have a few and hope you and your listeners may be interested in these topics. Post rehab, is it normal to experience a flare-up? If so, is there a certain number of flare-ups that you would consider to be problematic? I'll get to part two and part three of your questions later, but let's tick these off one at a time. Okay, our flare-ups okay, is it part of the normal experience and when will they be problematic? I would say flare-ups are normal, like we shouldn't get too worried about flare-ups, but we need to learn from them and we need to make adjustments from every flare-up so that they are less often and less severe over time so that as we negotiate this journey of rehab flare-ups are less and less and less and hopefully the severity or the average severity of pain becomes less and less and less because we're learning and we're getting stronger as we go through this. With my injuries, you know, I have flare-ups, I have setbacks, but I learn each time. I might talk about one of my ongoing, well my current knee issue that I have at the moment, I might bring that up in some later questions, but we learn. If someone was to go for a run and they run a little bit too fast and they're flare-up for three days, let's learn from that. Let's make sure whenever you feel good and you feel like it's hard just ready to pick the speed back up again. Remember what happened last time. Sure, increase the speed if you feel ready, but maybe not as much as that one that caused the flare-up. Maybe we need to give and create small, lurk progressions amongst that so that if we end up overshooting things a little bit, it doesn't lead to a flare-up. Sure, it might lead to maybe 24 to 48 hours of slight increase in sensitivity and again, we'll learn from that. But each time there's just little experiments that we're learning and acting upon so that we become more resourceful, we understand more about this condition and where our limitations are and the progress. we have in place and making sure that those progressions are adequate enough. They're not big jumps, they're just small sensible adjustments and if we do that accordingly then you know where learning and becoming more resilient because of it. It might not be progressions that lead to flare-ups, it might be sitting for too long, it might be too much stress, not enough sleep, these sorts of things which we go back to the drawing board and be okay. What did I do this time? What can I do differently if anything so I can learn from it and then as we go through this journey hopefully the strength training is picking up hopefully you're tolerating heavier weights more running successfully and we're just being more robust as we go through our journey so to sum up that question don't get too frustrated and bummed out about flare-ups because they are a part of the journey we are constantly experimenting and sometimes we experiment to learn where our limitations are that's fine. Sometimes we have to go on a car trip or a plane flight or sit in meetings or you know move house that requires a lot of manual lifting and sometimes we have flare-ups because of those and we can't necessarily learn a lot from that apart from you know maybe doing things slightly differently but that's why flare-ups are just part of the journey but hopefully we learn hopefully make adjustments and hopefully as time goes on these flare-ups are less and less and the severity is reduced. When it becomes problematic is if I talk to someone who says yep I have a flare-up every two weeks is this this this I'm not too sure what causes it but it just keeps happening that's when I think it would become problematic because we're not learning we're not gathering data and we're not changing anything that being different so I guess that's when it becomes a bit of an issue. Caroline continues to say what has been your most challenging experience with a client who has PhD? This really got me thinking because I wasn't too sure when I first read the question I'm like hmm all right what do I actually think about this question? I can't point to anything really specific however as like certain categories of clients that I do see the ones that can be the most challenging would be ones that you know pain is very chronic so several several years of having this pain but the symptoms themselves may be not matching exactly PhD maybe there's some distal symptoms maybe there's some aggravating and easing factors that don't necessarily fit some parts of the component fit PhD but others don't and then when we start treating it like PhD some of it gets better but some of it doesn't and we're struggling to identify what else is going on that's where it becomes quite tricky especially as a online therapist typically we can through a few like in-home tests and looking at the behavior of symptoms and the onset of symptoms and certain responses we can deduce that it's most likely this is PhD let's treat it as such but there's some cases we like hmm okay maybe maybe this is PhD maybe there's something else and then I can't really do much in terms of like an online perspective apart from suggesting that someone goes see their local therapist and see if they can do a rundown do a full assessment evaluation and see if they think otherwise what happens if we poke on other structures does it reproduce your symptoms can we do a full assessment of the lower back those sorts of things but often is the case where the person that has eventually come to me has been through the ringer of local therapists and being passed around several different therapists to scans and those sorts of things and they've lost faith in their local therapist and community that we're kind of stuck like I'm not entirely sure what's going on they require an in-person assessment they're not too trusting of seeking out that local assessment and so second opinions can be a little bit tough that's when I would say the sort of rehab journey does become a bit more challenging and the other I guess scenario that I would say fits this category would be okay symptoms are very chronic and there is a what I would call a strong link between the fluctuation of symptoms and someone's same mental state or their psychosocial components of their rehab there's a lot of hypervigilance a lot of fear a lot of anxiety and through me trying to communicate other interventions that aren't just the mechanical sense of do heavier dead lives or be more careful with your progressions from a mechanical point of view it falls on deaf ears a little bit and they're not as open-minded to seek or add in alternative approaches to their rehab like some parasympathetic activation techniques breathing techniques diving into their fears and their anxieties and their mental state looking at their sleep and nutrition and other components that we know dampen or amplify pain signals just doesn't resonate with them doesn't fear whether that's my communication of how important this stuff is and why it matters is lacking or whether it's just a stubborn I just have a tendin to get my tendon better type of person that can sometimes be challenging and as we've seen in some success stories it has some people have had some resilience to accepting that at least a part of their pain presentation has to do with their mental state if they improve their mental state they see improvements we've seen success stories where that has happened someone's finally changed and converted their belief to be like maybe there is something else going on let me double down on the emotional psychological elements of my recovery and then they just accelerate in terms of how much they improve we've seen that but just sometimes it falls on deaf ears and that can sometimes be quite challenging okay Caroline part three we have what would be your approach to someone with chronic PhD who is struggling not just with physical symptoms but also mentally for example believing they will never get over this injury and thinking they will never be able to run normally again okay this kind of ties into what I was talking about before but what my advice would be again hard to answer because some people's response they respond differently to different interventions if I was to tell someone just to focus on positive thinking like you know I don't think they would land quite well but sometimes I say that and it does land really well if reading this question resonates with the people that are listening I would say definitely read the book rebound it's by Carrie Cheetle I've had her on the Run Smarter Podcast a while ago and it's sort of around the concept of okay you're not a runner you are an athlete change your identity from a runner to an athlete and instead of running being your sport now rehab is your sport you focus the same amount of dedication the same love the same curiosities as you would with running you are now doing with your rehab you are now a athlete consider yourself well-rounded let's just focus on the rehab now being your sport with the same amount of dedication that reframing can help a lot of people the other thing I would say is like okay focus on the positives there are a lot of things you can do with focusing on the positives I currently have a knee injury that's quite stubborn it's been going on for probably the best part of four or five weeks and initially was brought on by okay going for a long run and then playing basketball which like at the time I think I was capable of so I'm not kicking myself being like I knew that was stupid I knew that was too much on paper I thought it was a little bit of a risk but a risk I was willing to take on and just really really saw I initially thought it was patellar femoral pain because in this knee I have had patellar femoral pain in the past and I'm like okay let me just treat it like patellar femoral pain I know how to treat it let's do as such just didn't get better following that protocol so I'm like hmm okay that's interesting calm down a bit enough for me to play basketball again but making the sensible approach instead of playing full-core basketball I just played half-core basketball and just seeing how that would go and again really fled me up but I was trying to think of positives when it was really fled up I woke up the next morning probably the worst it's ever felt but I could feel that for those health professionals out they're listening the medial joint line of the knee was tender I thought it was around the kneecap but it wasn't until it was really really sore I was thinking actually it's not actually around the kneecap my pain is more off to the side more in the joint line of the knee so that got me thinking about an additional or a different diagnosis which led me to treat it slightly differently so I was actually grateful that it was more fled up otherwise I'd be heading down the patellar femoral pain path for a long time so right about way of I can see a silver lining and I can actually see a positive for my knee being fled up and that just made me feel a little bit better mentally made me feel a bit better and that then led to like I'm not not currently running at the moment, but it led me to thinking how can I be more resourceful if I can't run? Okay, what can I do? Well, I want to train for high rocks races. There's none this year until December, but I've been in the background kind of doing offseason high rocks stuff and gave me a good excuse. I haven't done sled pushes and sled pulls in months and I know that's one of my weakest links in high rocks and I know that's not really going to flare up my knee because I've been doing rowing and that's been okay. So the sled pull squat motion that I need would be okay. And I don't really use my knee quite as much when I do sled pushes. So let me get out the sled and it was me, a way for me, mentally being proactive in working on my weak links in high rocks while I'm not running and just yesterday got out the sled and had my daughter who's now 12 kilos, stand on the sled while I was pushing that so she had a good time. I had a good time and I'm not just disappointed and frustrated and inactive with this knee issue. And you know what the past couple of days I've actually felt like I'm on a good trajectory. I actually might try a run later on today because I've been feeling so good. That being on the treadmill, that being like a walk run type of thing and mixing a whole bunch of cardio cross training stuff with the ski ogg. Actually I'm not doing too much too soon. But like I say, flare up, I took away some positives and I'm considering rehab being my sport, I'm considering being a well-rounded athlete. It's not just fixated on running because if my whole identity is wrapped up in being a runner and I can't run, it's mentally really really challenging. So I would recommend that. I do have some tough moments though. I do look down at my watch, my gum and that I have on which you know I used to tell the time. But at the top of the screen, it has my weekly mileage and it's stated zero for two weeks now. So there is a bit of a mental bum over time. I look down at my watch to look at the time and I see those two 0.0 on top of my screen. Yeah, bit of a bummer. But then I just try to flood in the positives and try to refocus because I do think it's like back to cognitive behavioral therapy CBT. How you think determines how you feel determines how you act and it all starts with thinking. You know, you feel frustrated, you feel bummed out, you feel like devastated. That's only because the thinking has come first. You've thought about all the running you can't do. You've thought about all the pain, you've thought about all the races you've completed in the past, the PBs that you've got, how fast you were running, how much you loved that. Now you can't do. It's always started with the thinking that then is developed into how you're feeling. And so as soon as I see those zeros on my screen, I think about the positives. I think about what I can do instead of what I can't do. That changes how I feel. I feel more optimistic. I feel happier. I feel like I can head in a more positive direction, which then determines how I act. I act being more resourceful coming up with workouts that I know are fine for the need, but I'm being more productive because of it. All those sorts of things. So if you are feeling a bit of a slump, you're feeling like mentally things are struggling. Try those, try reading the book, try a few things I've talked about, but hundreds of the things out there that you can do. Recovery from PhD 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. But these are just a few ideas. We have Joanne, who says, "Hi, Brody, I'm nearing the end stage of recovery from PhD. I followed the podcast religiously when I was newly diagnosed and helped me tremendously overcome this injury. So thank you. My question is, I am doing 30 kilo deadlifts, three sets of 10 twice a week. And I'm also doing power single leg jumps on the effective side, on the effective side, three sets of 10 twice a week. My pain is a one out of 10 with no pain 24 hours later. I am not a runner, however I walk 13Ks daily. That's a lot. What other end of range exercises do you recommend me to work on? First of all, congrats on your rehab. To date, it sounds like you've made tremendous progress. So well done. I'm not sure what you mean by end of range exercises. I thought, like typically when someone says that, they mean like end of range of movement through the exercises, like a full range of movement, squat or a full range of movement deadlift or something like that. So, hoping on the same train of thought, what other end of range exercises would you recommend? Well, first of all, like if things are working really, really well for you and you're seeing a good carryover in your walking, you're seeing a good carryover into, I don't know if sittings, bothersome or distairs or just day-to-day stuff. If everything is moving the needle and you're progressing in all of those, just do those exercises that are working for you. Let's not complicate things and just get better and better and better at them. If you're doing three sets of 10, 30 kilos, I would say we can approve upon the weight of those deadlifts, like we could be working up closer towards body weight or lifting your weight in weight. So, you know, slowly work up that and maybe that just continues moving the needle for you. If that's the case, let's not complicate things. Let's just progress. However, if you do plateau, if you are progressing the deadlift and progressing your power, single leg jumps and you're just not overcoming that last bit of pain, sure, we can throw in some other exercises. I would possibly do maybe lunges, seems to be in line with your goals or your physical activity levels of walking. So, just starting off with body weight lunges and then slowly work on doing heavier and heavier stuff, maybe three sets of six on each side. But like I say, we can just not make things too complicated and just get really, really good the exercises you're currently doing because apparently they're working for you. So, let's do that. It's a good message for a lot of people who are listening because I often jump on chats with a lot of people with PhD and they're doing six exercises and they're wondering what exercises they, what other exercises they can be doing to help accelerate this process, whereas I only just peel back everything and I just assign like three to five exercises and just get really, really good at those. And if we're not seeing the progress we're like, let's swap out those exercises. Let's find another three or let's swap out only one of those exercises and give you another one. Yeah, we don't want to spread ourselves too thin with too many exercises. But I hope that helps answer your question, Joanne. Next one we have is Steven, who says, "Hi, Brody, I've been loving all the content super helpful as I navigate PhD. My question is, is there anything you'd focus on when warming up for a run while recovering from PhD? I'm planning to cautiously try out running short distances at a slow pace. Thanks for all your helpful content. Thank you, Steven, for this question. It doesn't matter too much about warm-ups. I think if you're doing a slow jog as an exercise, like your warm-up can be the slow jog. Your warm-up can be a walk, a faster walk, a walk-up hill, or something like that. The purpose of a warm-up is to prepare the body for what it's about to do. And that can just be walking and then it can just be a very, very slow jog or jogging on the spot even. That would prepare your body for the slow run that you're about to do. So you can do that and just not complicate things too much. However, people can add in a layer of complication. If it helps them, if it physically helps their symptoms, you can do some dynamic warm-ups. You can do some high knees. You can do some heel flicks. You can do some leg swings. Like those sort of dynamic walks can be okay, but it's not essential. You don't have to do it. You can do it only if it feels good for you. But a lot of people that do those things, they feel indifferent when going for a slow jog. Different story of someone wanting to do speed work or someone wants to do power-based stuff or heel sprints or faster running. We would definitely spend time doing a better warm-up. But like I say, we don't need to complicate things. If it's pain that's something we want to address, if say when you start running, initially straight away it's a two out of ten pain. We want to try to calm that down. We might start off with some isometrics. If you feel that you personally have an analgesic effect or you have dampened pain from doing some loading exercises. And then that takes your initial two out of ten pain when running. running towards zero out of 10 or one. Let's do that. That might be some bridges. That might be some long leave of bridges. That might be doing some deadlifts. We don't want to push it to fatigue though. We don't want to lift too heavy. We probably do like 50% of your workout weight or only do two sets of bridges so that you feel like there's good load going through the tendon. You get that analgesic effect. Yet you don't have too much fatigue or really stressing out that tendon too much. We want to try and find that balance. So if you personally have an analgesic effect for that group of people that do have some unpleasant symptoms initially into their run, maybe that's something you can do and work into your warmup. Next question comes in from Harvey who says, I wonder if you can speak about assessing at what pace should I work through strengthening exercises such as gradually increasing the weights, the reps, the days between heavy workouts, the amount of sitting, et cetera. As someone who has had chronic PhD and also being a senior, I find it doesn't take that much increase in the items I mentioned to cause soreness that may last for days or occasionally even a flare up. This can set my schedule back timing wise or even slightly reduce the amount I am lifting temporarily. Does the amount of time for, I think this is a separate question. Does the amount of time for hamstring recovery from strength workouts and other uses of the hamstring also indicate the overall strength of the affected PhD tendon? As always, Brodie, I appreciate your insights on overcoming PhD. Okay, thanks for your question, Harvey. Let's break this down. So in terms of like progressing your exercises like when to progress, there's certain guidelines that I like to follow or certain, there's like four buckets I like to tick to know that you're okay to progress to the next phase. So number one, symptoms allow. We're following our pain rules. We're following symptoms during your workout or during your run or during whatever challenging about that might be. Symptoms, pain, generically speaking, less than a four out of 10. Returns back to baseline in less than 24 hours. Improves symptoms, improve, week by week. For ticking those buckets, particularly the first two, we know this time, your body's telling you it's okay, it's tolerated that amount of exercise or tolerated that challenging sequence. So symptoms during the activity are fairly mild and don't irritate afterwards. We're okay. That's the first bucket I want you to tick. The second bucket I want you to tick is just are you able to maintain good quality, good technique, good tempo? Is the quality of that exercise being maintained throughout all the sets, all the reps? If so, we're handling that okay, we can tick that box. The third box is just the overall level of difficulty. How difficult are you finding to move that weight to lift it, to put it down? If your effort is like an eight out of 10, nine out of 10, we don't want to progress that exercise. Let's stay at that weight for several weeks, let that overall effort level calm down before then we progress. So box number one, overall level of, box number one is your pain rules, making sure it's all okay. Box number two is making sure you maintain good quality and technique. Number three, the overall effort is manageable. And the fourth box I like to tick is just listening to the rest of the body. Like if you are doing your dead lifts, focus away from the hamstring, how is your lower back? How is your grip strength? If you are doing squats, how are your knees? Like how's the rest of the body feeling? For ticking all of those boxes, in my eyes you are ready to progress to the next phase. Now this brings me to the next point, how much risk are we wanting to put on to the progressions that you're making? If you are lifting your, if you're progressing your dead lifts, do we progress by five pounds? Do we progress by 10 pounds? Do we progress by one pound? Do we add one pound to only one set? Like how big of an adjustment do we need to make? Harvey, if you are finding yourself tolerating a certain dosage and then you progress and it leads to a flare up and it's hard to calm down and then once it's calm down, you feel okay, you're ready to progress, you progress, there's another flare up. My guess is like your steps of progressing might be a little bit too much for you. And so a lot of people just generically say, I'll do three sets of 10. Let me do three sets of 10, 50 pounds and then I'll do three sets of 10, 55 pounds and then I'll do three sets of 10, 60 pounds. Like that's a common sort of progression that a lot of people find themselves. However, we can be more creative than that. I like to fluctuate the reps a little bit. So typically I would say okay, someone do three sets of eight dead lifts at 50 pounds. Then we're gonna drop those three sets of eight to three sets of six, but we're gonna increase the weight from 50 to 55. Then the next time we increase progression, we're gonna keep the weights the same, but we're gonna increase the reps from three sets of six back up to three sets of eight and then we're progressing yet again, we drop it back down to six, increase the weight. So we're hovering around an eight to six rep range and just fluctuate in the weights as we do that. However, I recognize that a lot of people are on their limit and we need to make those progressions even smaller. So in that case, I usually say all right, let's just say we're doing three sets of eight, 50 pounds. Continue doing those 50 pounds, but for the first two sets, the last set and only the last set, let's increase it by two and a half pounds. And who knows, maybe we'd drop that down to five. So we're doing your first two sets, identical, two sets of eight, 50 pounds, the third set, one set of five and adding on two and a half pounds. Hey, that's a progression. And then if that's tolerated, maybe we take that last set back up to eight reps. And then who knows, we could just progress from there, but these are very, very small progressions that you can do, it's still progressing. And if it doesn't seem like it's a lot, once you know you can tolerate that, if you're ticking these boxes and you're doing your heavy workouts twice a week, that's two opportunities per week to progress. So instead of progressing once every three weeks, you're progressing six times in three weeks, but by smaller and smaller amounts, you're going to find yourself in a better position in two months time as opposed to the traditional option with less risk, because if at any stage, that is too much for you, you're not going to be flared up for several days. You're just going to know there's a bit of an annoyance there for several hours and we then maybe stay at that stage. We're not taking on, we're not layering on as much risk when we do that. So that's only for the people that in Harvey's case might be flaring up every time they progress or they're really reaching close to their maximum weight that they're lifting, but these are just ways we can be more resourceful. The other bit of advice I would have for this question is make sure we're only progressing one variable at a time, particularly in Harvey's case, noticing that progressions lead to flare ups. Just progress one exercise when it's time to progress that way where just controlling the variables if there is a flare up, we know exactly what it is. But outside of training, if you notice that there is a day where, you know, you're just on your feet more often, maybe you have to sit longer, maybe you are a bit more stressed, recognize these scenarios being like, now's probably not the time for me to progress in the gym because maybe that's too much for me 'cause you might progress your deadlifts by five pounds, but then you have to sit for longer than usual in a stressful environment that's more stressful than usual and then you flare up the next day. It's just the combination of things has led to that rather than the progression of the deadlift themselves in isolation. So just pick your moments, pick your days where you're like, okay, now's the time to progress. The other part of this question was to do with like the overall recovery, is it indicative of strength if I find that it's taking longer to recover the amount of hamstring recovery time from these strength workouts? There's a few things. I typically say for flare ups, the stronger the tendon is, the more resilient the tendon is when subjected to a flare up, it doesn't last as long. Like people, surprise themselves when they bounce back from flare ups a lot quicker than they expected because they are starting to establish some strength. They're lifting heavier than they thought in the gym and those sorts of things. So I typically find a correlation there. However, when we're talking about doing a heavy strength workout, there's muscle soreness after that workout, how long are you sore for after that workout? It will depend on a lot of things. Might depend on strength, but not necessarily. Yes, age is a factor. We do know the more advanced in age you are, the longer it takes for your body to bounce back to heal, have this collagen turnover, get through this muscle protein synthesis, like just the overall recovery process does take a bit longer. So there's that. But there's also, you know, nutrition comes into it. Are you giving yourself the right amount of protein? We need protein, the right amount of amino acids, to start restoring the body. That's what protein does. And so if you have adequate amounts of protein in your diet, and you're putting your body through strength training and expecting to bounce back in recover, it will take longer. We know people that aren't sleeping that well. That's a component like that's when we rejuvenate and restore and bounce back when we get a good quality sleep. Stress would be a factor in that as well. So suffice to say all of these domains, all of these elements in everyday life will impact how long it takes you to bounce back from a workout. It's not just about how strong a tendon is or a muscle is. Other factors are involved. So hopefully that helps. Okay, so that covers this episode's list of questions. They have been very thought-provoking. Very good questions that I think will benefit a lot of people and a lot of circumstances. So hopefully you found these answers helpful and we'll catch you in the next episode. 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 could personally connect with me, including a free 20-minute injury chat to discuss your current rehab and any tweaks you might need to make. While done, but taking active role in your rehab, find the sneak to content like this, and together we can start ticking off all of your rehab goals and finally overcome your PhD.