Overcoming Proximal Hamstring Tendinopathy

Brodie Sharpe
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  • FITNESS
  • TWICE MONTHLY

Proximal Hamstring Tendinopathy is a horrible condition affecting athletes and non-athletes alike. If you fall victim to the misguided information that is circulating the internet, symptoms can persist for months, sometimes years and start impacting your everyday life. This podcast is for those looking for clear, evidence-based guidance to overcome Proximal Hamstring Tendinopathy. Hosted by Brodie Sharpe, an experienced physiotherapist and content creator, this podcast aims to provide you with the clarity & control you desperately need. Each episode brings you one step closer to finally overcoming your proximal hamstring tendinopathy. With solo episodes by Brodie, success stories from past sufferers and professional interviews from physiotherapists, coaches, researchers and other health professionals so you get world class content. Tune in from episode #1 to reap the full benefits and let's get your rehabilitation back on track!

  1. 1 DAY AGO

    What To Do Before & After Surgery with Dr. Alex Hardy

    👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan 🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉 For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/  Contact Dr. Alex Hardy and his team at Dr.hardy@chirurgiedusport.com In this episode, Brodie is joined by hamstring surgeon Dr. Alex Hardy to break down exactly what to do before and after hamstring surgery. They cover the key differences between acute and chronic injuries, and what that means for your behaviour leading into surgery. For acute avulsions, the priority is speed—getting an MRI quickly and avoiding unnecessary delays—while keeping activity minimal. In contrast, chronic cases and tendinopathies benefit from staying active, maintaining strength and cardio, and avoiding unnecessary deconditioning.  A key takeaway: there’s very little you can do pre-surgery to “make things worse,” but there’s a lot you can do to set yourself up for a smoother recovery. The conversation then shifts to post-operative rehab, where patience is critical. Dr. Hardy explains why the first 6 weeks are highly protective (often involving a brace and minimal hamstring loading), followed by a gradual return to movement, strength, and eventually running around the 3–4 month mark. They discuss exercise progressions (starting with closed-chain work, then progressing to open-chain and eccentric loading), common pitfalls like premature overload or slips during early recovery, and when to be concerned about symptoms like persistent pain or sciatic irritation.  If you’re considering surgery or currently navigating recovery, this episode gives you a clear, realistic roadmap—what matters most, what to avoid, and how to maximise your outcome

    46 min

  2. 10 MAR

    Q&A: My Best Two Exercises, Will Pain Ever Go, Troubleshooting Running Pain, Home Rehab From Scratch

    👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan 🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉 For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/   In this Q&A episode, Brodie continues answering listener questions about proximal hamstring tendinopathy (PHT), covering topics ranging from long-term maintenance to returning to running after rehab. He explains why the same exercises used in rehabilitation—especially deadlifts—often remain the best way to keep symptoms at bay by maintaining tendon capacity. Depending on a runner’s goals, he also discusses when to add exercises like prone hamstring curls or Nordic curls to support endurance running versus speed work. The key message: keeping the tendon strong and progressively loaded helps reduce the likelihood of symptoms returning.  The episode also addresses common frustrations during recovery, such as lingering sensations during a return-to-run program, setbacks from activities like rowing, and uncertainty about whether PHT ever truly “goes away.” Brodie outlines practical pain-monitoring rules, strategies for adjusting running variables (distance, pace, frequency), and how to identify training factors that may be slowing recovery. He also discusses scenarios such as young athletes with persistent sitting pain, older individuals starting rehab without gym access, and runners balancing rehab with race goals—emphasising that the key to long-term success is gradually building tendon capacity while carefully managing training load and recovery.

    43 min

  3. 24 FEB

    Q&A: Deadlift Advice, Pain Remedies, Balancing Training Load, Managing PHT & Back Pain

    👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan 🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉 For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/  In this Q&A episode, Brodie answers a flood of listener questions on proximal hamstring tendinopathy (PHT), starting with one of the most common concerns: how to load the tendon without flaring it up. He breaks down why deadlifts are one of the most effective strengthening tools for the upper hamstring, how to manipulate range of motion, weight and frequency, and why “dosage” is the difference between progress and a setback. You’ll learn how to systematically find your sweet spot, adjust frequency as loads get heavier, and avoid the common mistake of jumping in too hard, too soon. The episode also explores more complex cases, including persistent morning pain, uncertainty around diagnosis, and radiating symptoms that may point to something beyond classic PHT. Brodie discusses how to use loading as both a treatment and a diagnostic tool, when to consider alternative causes like lower back involvement, and how nervous system sensitisation and hypervigilance can amplify pain.  He finishes with rapid-fire answers on rehab frequency, maintenance loading, and how to modify exercises when other injuries (like low back pain) enter the picture. If you’ve been struggling to balance strengthening with symptom control, this episode offers practical, measured guidance to help you regain confidence and move forward with clarity.

    37 min

  4. 10 FEB

    Navigating the Conversation of Surgery with Dr. Luise 'Loopi' Weinrich

    👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan 🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉 For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/  Check out Loopi's Website here: https://www.athletetransitionlab.com/  When proximal hamstring pain just won’t settle, the conversation often turns to surgery — and that’s where confusion, fear, and mixed advice really begin. In this episode, I’m joined by Dr. Luise Weinrich (known as Loopi), an orthopedic and trauma surgeon with extensive experience in hamstring avulsions, surgical repair, and post-operative rehabilitation. With a background as a former elite breakdancer and years working in top German sports orthopaedic hospitals, Luise brings a rare blend of surgical insight and athlete-centred thinking. Together, we unpack the “grey zone” — the large group of runners and athletes who don’t clearly fall into “definitely need surgery” or “definitely don’t” — and how to make smarter, more confident decisions when the path forward isn’t obvious. 🎧 In This Episode, You’ll Learn: Why most proximal hamstring cases sit in a surgical grey zoneThe key MRI findings that matter — and the ones that don’t tell the full storyHow goals, age, chronicity, and function influence the surgery decisionWhen partial tears may (or may not) warrant surgeryWhy surgery for chronic tendinopathy is often not a “winner operation”Common mistakes athletes make before and after surgeryWhy pre-op strength, sleep, protein, hydration, and nervous system regulation matterHow post-op rehab should be phase-based, not timeline-basedThe biggest reasons athletes overdo or underdo rehab after surgeryWhat questions you should ask your surgeon before committingWhy post-operative protocols are essential — and often missing🧠 Key Takeaways for Runners MRI findings alone shouldn’t dictate surgery — context mattersChronic tendon pain doesn’t automatically mean “failed rehab”Tendons need time, structure, and progressive loading to recoverSurgery can remove pain drivers, but it doesn’t guarantee a “new” tendonClear rehab phases + 24-hour symptom rules beat rigid timelinesBeing prepared before surgery often improves outcomes afterIf you’re unsure, a structured second opinion can prevent rushed decisionsIn other words: the goal isn’t just to fix tissue — it’s to make the smartest long-term decision for your body, your sport, and your identity as a runner.

    1 hr

  5. 27 JAN

    Answering Your Hardest Facebook Questions

    👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan 🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉 For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/  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

    30 min

  6. 12 JAN

    The Future Direction of Chronic Tendon Treatment: What New Pain Science Is Revealing About Tendinopathy

    👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan 🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉 For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/  For years, chronic tendinopathy has been treated as a tendon problem — load it, strengthen it, remodel it. But what if, for some runners, the tendon itself isn’t the main driver of pain anymore? In this episode, Brodie breaks down a new 2026 systematic review that may reshape how we think about stubborn, long-standing tendon pain. The paper explores whether nerve ingrowth and abnormal blood vessels around tendons — not degeneration of the tendon tissue itself — may be the real pain source in chronic cases. We unpack the emerging research, explain each intervention in plain language, and discuss who this may (and may not) apply to — especially runners stuck in repeated rehab cycles despite “doing everything right.” This is early, evolving science. But it’s a fascinating glimpse into where chronic tendon treatment may be heading next. What You’ll Learn in This Episode Why some chronic tendon pain may be neuropathic (nerve-driven) rather than structuralHow abnormal blood vessels and nerves grow into painful tendons over timeWhy traditional loading programs sometimes stop working in very chronic casesWhat “neural modification” treatments aim to do — and why they’re gaining interestThe six intervention categories reviewed in the paper (explained simply)How strong (or limited) the current evidence actually isWhere this research fits alongside exercise-based rehab, not against itInterventions Reviewed (Plain-English Overview) 1. High-Volume Injections (HVIGI / HVDI) Large volumes of fluid are injected around the tendon (not into it) under ultrasound guidance to mechanically disrupt abnormal blood vessels and pain-sensitive nerves. Key takeaway: Consistent short- to medium-term pain and function improvements, especially in people who had failed exercise-based rehab. 2. Sclerosing Polidocanol Injections A chemical agent is injected directly into abnormal blood vessels to deliberately close them down, cutting off blood supply to pain-producing nerves. Key takeaway: Moderate to strong pain reductions in very chronic cases, with outcomes comparable to surgery in some studies. 3. Radiofrequency Microtenotomy A minimally invasive procedure using controlled heat to disrupt nerve ingrowth and abnormal vessels at the tendon–paratenon interface. Key takeaway: Very strong results in a small cohort, but higher risk and limited evidence so far. 4. Minimally Invasive Paratenon Release Scar-like adhesions between the tendon and surrounding tissue are mechanically released to restore tendon movement and reduce nerve irritation. Key takeaway: Large pain reductions and high rates of pain-free outcomes in non-insertional Achilles tendinopathy. 5. Electrocoagulation Therapy Electrical energy is used to seal off abnormal blood vessels surrounding the tendon under ultrasound guidance. Key takeaway: Promising early results, but evidence limited to one small study. 6. Surgical Interventions (Open & Endoscopic) Surgery physically separates the tendon from irritated surrounding tissue and removes abnormal vessels and nerves. Key takeaway: Effective for some, but invasive, with longer recovery and higher risk. The Big Picture Takeaway Across very different procedures, outcomes were surprisingly similar. That points to a common mechanism: 👉 Modifying the neural (nerve-driven) pain environment around the tendon, rather than “fixing” tendon structure itself. This doesn’t replace exercise-based rehab — but it may explain why a subset of runners with long-standing, highly sensitive tendinopathy stop responding to load alone. This research is best viewed as a future direction, not a replacement for good rehab principles.

    34 min

  7. 30/12/2025

    When to Operate & When to Rehab with Surgeon Lasse Lempainen

    👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan 🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉 For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/  Check out Lasse's website here: https://www.lasselempainen.fi/?lang=en In this episode, Brodie sits down with world-leading orthopedic surgeon Dr. Lasse Lempainen, a specialist in complex hamstring injuries, to answer one of the most confusing and anxiety-provoking questions runners face: “How do I know if I actually need surgery — or if rehab is still the right path?” Drawing on decades of surgical experience and extensive research into hamstring avulsions and proximal hamstring tendinopathy (PHT), Dr. Lempainen walks through how he actually makes decisions in real clinical practice — not just what MRI scans show, but how symptoms, function, timelines, and rehab quality all fit together. Together, Brodie and Lasse unpack the gray area that most runners live in: partial tears, chronic pain, mixed scan results, failed rehab attempts, and fear-based decision-making. The result is a balanced, evidence-informed discussion that helps runners understand where surgery fits — and where it doesn’t. What You’ll Learn in This Episode:How Surgeons Decide Who Actually Needs Surgery Why MRI findings alone are never enoughThe importance of correlating scans with clinical function and symptomsWhy some complete avulsions heal well conservatively — and others don’tHamstring Avulsion vs Proximal Hamstring Tendinopathy (PHT) Key differences between acute avulsions, chronic avulsions, and tendinopathyWhy not all “avulsions” are the same (1-tendon vs 3-tendon injuries)When retraction distance matters — and when it doesn’tCritical Timing Windows Why acute avulsions should ideally be operated on within 2–3 weeksWhat happens when diagnosis is delayedWhen chronic injuries become harder (or impossible) to fully restore surgically“Failed Rehab” — What That Really Means Why many runners are told they’ve “failed rehab” when they actually haven’tCommon mistakes in conservative treatment (under-loading, poor progression)When even excellent rehab is unlikely to succeed due to tendon biologyWhat Surgery for PHT Actually Involves What surgeons look for during surgery beyond “tendon thickening”The role of semi-membranosus release, scar tissue, and sciatic nerve involvementWhy surgeons often find structural issues not obvious on standard MRICommon Pre- and Post-Op Mistakes Why under-diagnosis is one of the biggest pre-op risksWhy returning to running too early post-op leads to setbacksThe importance of fixing why the injury happened — not just repairing tissueKey Takeaway Most hamstring injuries — including many cases of PHT — can and should be treated conservatively. But there is a subset of runners where surgery is not only appropriate — it’s the missing piece.This episode helps you understand which group you fall into, without fear-based decisions or false hope.

    1hr 13min

  8. 16/12/2025

    What Modern Science Reveals About Tendon Pain & Recovery

    👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan 🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉 For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/   In this episode, Brodie breaks down a newly published review paper that takes a deep dive into what’s actually happening inside painful tendons — far beyond the usual “overuse” explanation. You’ll learn how healthy tendons are structured, what changes at a microscopic level when tendinopathy develops, and why pain severity often doesn’t match what shows up on scans. The episode explores how factors like load management, low-grade inflammation, oxidative stress, ageing tendon cells, and overall metabolic health all interact to influence tendon pain and recovery. Brodie also discusses what this emerging science means for real-world rehab — including why rest alone doesn’t work, why exercises sometimes stall progress, and why a more holistic approach is often needed. The episode finishes by looking ahead at future treatment directions, from improved diagnostics to regenerative and molecular therapies, while grounding everything in practical takeaways runners can apply right now. If you’re dealing with persistent tendon pain — especially proximal hamstring or Achilles tendinopathy — this episode will help you understand why recovery can be slow and what actually gives you the best chance of long-term success.

    43 min
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Proximal Hamstring Tendinopathy is a horrible condition affecting athletes and non-athletes alike. If you fall victim to the misguided information that is circulating the internet, symptoms can persist for months, sometimes years and start impacting your everyday life. This podcast is for those looking for clear, evidence-based guidance to overcome Proximal Hamstring Tendinopathy. Hosted by Brodie Sharpe, an experienced physiotherapist and content creator, this podcast aims to provide you with the clarity & control you desperately need. Each episode brings you one step closer to finally overcoming your proximal hamstring tendinopathy. With solo episodes by Brodie, success stories from past sufferers and professional interviews from physiotherapists, coaches, researchers and other health professionals so you get world class content. Tune in from episode #1 to reap the full benefits and let's get your rehabilitation back on track!

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