New Program to Help with Proximal Hamstring Tendinopathy in Runners

Hi, I’m Dan O'Grady, Physiotherapist, Running Coach, and Former PHT Sufferer

Are you an endurance runner who is tired of battling persistent buttock/hamstring pain that just won't quit?

As someone who has experienced the frustration of proximal hamstring tendinopathy (PHT) firsthand, I understand the challenges you're facing. 

But I'm here to tell you that there is hope, and I'm ready to guide you every step of the way.

With over 20 years of experience working with runners and athletes, I've developed a proven approach to not only eliminate PHT but also enhance your running performance beyond what you thought possible. 

As your dedicated coach and mentor, I'll provide personalized support and guidance to help you reclaim your love for running and enjoy life to the fullest once again.

This isn't just another cookie-cutter program—this is a supported self-management journey with me, Dan O'Grady, by your side.

Using the framework of The Healthy Hamstring Protocol, we'll navigate through the ups and downs, teaching you what to avoid, how to improve your running technique, and how to efficiently recover from PHT. 

And here's the best part:

I guarantee that you'll be back to running from day one, with a vision of growing to be stronger and more resilient than ever before…

So if you're ready to commit to your recovery and take your running to new heights, I'm excited to embark on this journey with you. 

Spaces are limited….so don't miss out on the opportunity to transform your running experience. 

Let's make it happen together—let's get you back to running and enjoying life, guaranteed

Next step, schedule a free 15 min phone call / zoom session with me at your convenience by following this link.  Then we can decide if you’re the right fit for my unique and innovative program. 

This program is available in person or any in the world through an app based online coaching portal.

You can also email  dan@kinfolkwellness.com.au  for any questions. 

Can You Run with Knee OA?

Can You Run with Knee OA?

Here's What You Need to Know!

So you’ve just been diagnosed with knee osteoarthritis (OA)…this is how you might be feeling (Pic 1)…

Pic 1 - This is a common reaction to being diagnosed with knee arthritis…!

There may be many questions running through your head

• What exactly is knee osteoarthritis (OA), and how did I get it?

• What are the best treatment options for managing knee OA?

• Will I need surgery at some point, or are there other alternatives?

• Can I use knee OA as an excuse to skip leg day at the gym forever?

• Can I blame knee OA for my newfound ability to predict the weather with my knees?

But if you’re like me, your most important concern will be:

“Can I still lace up my running shoes and hit the pavement?”

Running: the only sport where you are willing to suffer, sweat, and swear, but somehow still come back for more.

Well, you're not alone!

Many folks in your shoes (pun intended) are curious about the same thing.

Let's dive in and explore whether running with knee OA is a good idea, and how it might even help ease your knee pain.

Understanding Knee Osteoarthritis (OA):

First off, let's talk about knee OA.

The old view of OA is that it a result of wear and tear and inevitable joint degeneration.

This is known as the biomedical model and it offers an overly simplistic view that OA happens when the cartilage in your knee joint starts to wear down, causing pain, stiffness, and all-around discomfort.

It's not exactly an inspiring way to view the problem.

New view of OA:

Thankfully some very smart researchers, clinicians and doctors have come together to provide an updated explanation for knee OA and this involves taking a broader view of knee OA as an integrated whole body problem - that involves inflammation, metabolic health, immune system, diet, nutrition and even things like our beliefs and knowledge.

“Clinical outcomes in OA are influenced by multiple factors, including pain sensitization, psychological distress, muscle strength, BMI, inflammation, disease severity, and comorbidities,39 which may ultimately limit the maximum improvement in pain and function”.https://acrjournals.onlinelibrary.wiley.com/doi/full/10.1002/acr.25313

Essentially we have updated our model from a simple mechanical system (body is a machine that needs fixing) to seeing the body as an ecosystem (capable of positive adaptive and growth given the optimal conditions) that is capable of regenerating given the optimal environmental conditions.

This new approach is no shortage of a revolution and paradigm shift in how we see the body and it’s potential for healing.

It opens the door to many treatment options that were previously not even considered until very recently.

Benefits of Running with Knee OA:

Believe it or not, running can actually have some perks for folks with knee OA:

1. Improved Joint Function: Running can help keep your knee joints flexible and moving smoothly, which is super important when you've got OA.

2. Strengthening Muscles: When you run, you're not just working out your legs – you're also giving those supporting muscles around your knees a good workout. It's like building a sturdy support system for your knees!

3. Weight Management: Running is a great way to burn calories and keep your weight in check. And when you're carrying around less weight, there's less stress on your knee joints.

4. Mood Boost: Ever heard of a runner's high? It's a real thing! Running releases feel-good hormones in your brain, which can help lift your mood and ease stress – definitely a win-win!

Considerations for Running with Knee OA:

Before you lace up those shoes and hit the pavement, here are a few things to keep in mind:

1. Talk to a Pro: It's always a good idea to chat with a healthcare pro before starting any new exercise routine, especially if you've got knee OA. They can give you the lowdown on whether running is safe for you.

2. Take It Slow: Start with a gentle jog or brisk walk, and gradually build up your speed and distance over time. Rome wasn't built in a day, and neither is a runner!

3. Shoe Game Strong: Invest in a good pair of running shoes with plenty of cushioning and support. Your knees will thank you!

4. Watch Your Form: Pay attention to your running technique – aim for a mid-foot strike, keep your posture upright, and try to land softly to reduce impact on your knees.

5. Mix It Up: Running is great, but it's not the only game in town! Mix in some strength training and flexibility exercises to give your knees a well-rounded workout.

Could running actually be the BEST way to protect your knees?

A recent study with 14,000 participants revealed some fascinating insights:

• Non-runners had a HIGHER prevalence of knee pain.

• Running could actually PROTECT your knees by inducing beneficial adaptations through mechanical loading.

But here’s the kicker:

When we try to shield our knees by avoiding movement, we might actually be reinforcing a cycle of pain and fear.

Running, under proper guidance, sends a powerful message to the brain that everything’s OK!

Here are three tips to keep you going strong:

- Maintain a high cadence of 170-180 steps per minute to reduce stress on your knees.

- Invest in well-supported shoes to cushion impact and provide stability.

- Strike a balance between walking and jogging to build endurance while minimizing strain.

"Back to the Body": Charting a New Course in Physiotherapy

In the dynamic field of physiotherapy, a transformative wave is reshaping our traditional approaches to pain and injury.

This evolution, termed "Back to the Body," represents a significant departure from past practices, integrating modern science's revelations with a renewed focus on the body's intricate signals.

As we delve into this shift, it's essential to appreciate the context from which we're moving and the promising direction in which we're headed.

The Traditional Paradigm: A Focus on the Physical

Historically, physiotherapy has been deeply anchored in a biomedical model, concentrating on the body's physical aspects—its joints, muscles, and tissues.

This approach, while foundational, often adopted a reductive lens, aiming to "fix" what was perceived as broken or misaligned.

Diagnoses frequently highlighted deficiencies: a "weak" core, "tight" muscles, or "improper" posture.

While these assessments were made with the best intentions, they inadvertently introduced a nocebo effect, where the negative framing of conditions could exacerbate patients' perceptions of pain and disability, sometimes with minimal relevance to their actual experience of pain.

The Shift Toward Mind and Emotion

The field's expansion to encompass beliefs, emotions, and the broader neurocentric model—largely influenced by the pioneering work of researchers like Lorimer Moseley and David Butler—marked a significant leap.

This phase brought to light the brain's integral role in pain perception, advocating for a more comprehensive understanding that transcends mere physicality.

However, this shift, for all its merits, occasionally led to an overemphasis on the psychological at the expense of the physical.

Patients sometimes felt their pain was being dismissed as purely a construct of the brain, leaving them feeling invalidated and overlooked.

"Back to the Body": A Holistic Reintegration

Today, we stand at the precipice of a new era, inspired by Bud Craig's insights into homeostatic emotions and the complex interplay between mind and body.

"Back to the Body" advocates for a return to a more integrated approach, where pain is recognized as an interoceptive signal—a cue from our body indicating a need for attention and care.

This perspective sees pain not as a mere symptom to be eradicated but as a critical piece of feedback within our body's attempt to maintain balance.

With advancements in technology—such as heart rate variability monitors, blood glucose tracking, and sensors for lactate and inflammatory markers—we're now equipped to decode the body's signals with unprecedented clarity.

This technological leap, combined with principles of load management as outlined by Tim Gabbett, empowers us to identify and respond to the body's cues more effectively, fostering an environment where positive adaptations are more likely.

Empowering Through Understanding

This shift towards an integrated mind-body model is about empowerment and education.

It's about guiding patients to tune into their bodies' messages, recognizing the signals of overload and stress.

It encourages a response to discomfort informed by understanding and mindfulness, rather than fear or the pursuit of immediate fixes.

This approach demystifies the sensations we've labeled as pain, reframing them as part of our body's broader context of response.

Moving Forward

"Back to the Body" heralds a return to physiotherapy's roots, enriched by our journey through the realms of psychology and neuroscience.

It's a call to embrace the body's complexity, leveraging science and technology to deepen our connection with ourselves.

As we chart this new course, we embrace a model of care that is both empowering and educative, one that places the patient's experience at the forefront of the healing process.

In doing so, we not only address pain more effectively but also foster a holistic sense of well-being.

Daniel O’Grady

Unraveling the Metabolic Basis for Tendon Pain

Tendon pain, particularly chronic Achilles tendinopathy, is a challenging condition that can disrupt an active lifestyle especially for runners.

In recent years, researchers have delved into the metabolic underpinnings of tendon pain, shedding light on the role of lactate concentrations.

The Lactate Connection

Lactate, a compound associated with muscle fatigue and soreness, has emerged as a crucial factor in the study of painful chronic Achilles tendinopathy.

A study utilizing microdialysis techniques revealed higher concentrations of lactate in Achilles tendons afflicted by tendinopathy compared to healthy, pain-free tendons.

The significance of this finding lies in the revelation of anaerobic conditions within the painful tendon area.

Understanding the Results

The study's results are a piece of the intricate puzzle of tendon pain.

Let's break down what we can glean from this research:

1. Lactate Accumulation: The higher concentrations of lactate in painful tendons suggest that anaerobic conditions prevail in the affected area. This accumulation of lactate reflects a metabolic imbalance within the tendon, which may contribute to pain perception.

2. Tendon Structure: The study noted structural changes and widening of the tendon in cases of tendinosis. These observations are vital in understanding the pathological processes at play in chronic Achilles tendon.

A Holistic Approach to Tendon Pain Management

Understanding the metabolic basis of tendon pain is just the first step.

To effectively manage and alleviate this pain, we must take a holistic approach:

1. Training Load and Periodization: In the world of sports and physical activity, it's essential to adopt a balanced training load. The 80/20 principle, where 80% of training is in zone 2 (aerobic), can help minimize the risk of overuse injuries like tendinopathy.

2. Lactate Clearance: Optimal lactate clearance is key. Encourage activities that enhance lactate clearance, such as low-intensity exercise, adequate recovery periods, and proper hydration.

3. Therapeutic Modalities: Various therapeutic modalities can play a role in tendon pain management. These include massage, dry needling, and foam rolling, which can aid in reducing muscle tension and promoting blood flow to the affected area.

4. Liver and Kidney Health: Metabolic health is crucial. Liver and kidney health is vital for efficient metabolite clearance, including lactate. Ensure a balanced diet, stay hydrated, and minimize excessive alcohol consumption to maintain these organs' well-being.

5. Hydration: Proper hydration is essential to support overall metabolic processes, including lactate clearance. Staying adequately hydrated aids in reducing the risk of metabolic imbalances contributing to tendon pain.

Conclusion

The metabolic basis for tendon pain, as revealed in the study, offers valuable insights into the pathogenesis of chronic Achilles tendinopathy.

However, it's only one piece of the puzzle. To effectively manage tendon pain, we must adopt a holistic approach.

This approach includes optimizing training load, prioritizing lactate clearance, and utilizing therapeutic modalities to promote pain relief.

Furthermore, maintaining overall metabolic health through hydration and balanced nutrition is paramount.

As we continue to unravel the intricate nature of tendon pain, adopting a holistic approach can help individuals regain their active lifestyles and harmonize with their bodies' natural healing mechanisms.

Research link: High intratendinous lactate levels in painful chronic Achilles tendinosis. An investigation using microdialysis technique