Overcoming Proximal Hamstring Tendinopathy

🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞📄Learn more about Brodie's PHT AI Assistant 🔍 In this episode 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 loadingHow to interpret bursitis findings and when they’re clinically relevant vs incidentalWhen ultrasound-guided corticosteroid injections may (or may not) helpWhy age and genetics slow recovery—but don’t prevent itRealistic timelines: why “2–3 years and never the same” is poor adviceKey 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 athletesHow to find the “sweet spot” between challenge and flare-upsWhy setbacks usually come from mismanagement, not irreversible damageThe role of sleep, protein (especially leucine), collagen, hydration, and overall wellness in tendon healing3. “Can I Start Walking Again—or Am I Making It Worse?” Why waiting for zero pain before returning to activity often delays recoveryHow to reintroduce meaningful activities (like dog walking) safely and progressivelyWhy doing something—even 2–5 minutes—can be both physically and mentally therapeuticHow graded exposure applies to walking, running, and all functional goals4. Heel Pain & PHT — Are They Related? Why plantar fasciitis commonly appears alongside PHTHow reduced sitting → increased standing can overload the plantar fasciaPractical strategies for managing both conditions:Footwear and gel insolesSitting vs standing vs kneeling rotationsStep counts, surfaces, and daily load awareness5. Prone Hamstring Curls Flaring You Up? Here’s How to Modify Them How to confirm whether an exercise is actually the irritantWhy double-leg > single-leg is often the right starting pointUsing reduced range of motion strategicallyHow to progress:Double-leg → single-legLoad first vs range firstWhy small, systematic steps matter—especially for sensitive tendons6. 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 painScar tissue or adhesions near the sciatic nerveCompensation patterns (sitting, standing, movement changes)Why assessment matters—and what clinicians look for:Piriformis testingNeurodynamic testsNerve glide exercises and when to use them🎯 Big Picture Takeaways Imaging findings don’t dictate outcomes—management doesSevere or long-standing PHT does not mean you’re “too far gone”Recovery improves when load, recovery, and lifestyle alignIf symptoms spread or change character, don’t guess—get assessedProgress comes from doing the right things consistently, not perfectly