Q&A: Chronic & Complicated PHT Questions

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In this PHT Q&A episode, Brodie tackles some of the more complex and challenging questions submitted by listeners.

Can you still recover after 30+ years of proximal hamstring tendinopathy? How do you know whether you're pushing hard enough or too hard with strength training? And what role do age, hormones, stress and the nervous system play when symptoms just won't settle?

Brodie also explores several tricky diagnostic presentations, including PHT that hurts with sitting but not running, sciatic nerve involvement, pain behind the knee, previous hamstring avulsions and why PHT is still so commonly mistaken for conditions such as piriformis syndrome, lumbar pathology and deep gluteal syndrome.

Topics covered include:

How to know whether you're loading your tendon too much or not enoughThe three key pain and progression rules Brodie uses during PHT rehabWhether PHT can still improve after 30+ yearsWhy chronic tendon degeneration doesn't necessarily prevent a full return to functionThe "treat the donut, not the hole" approach to degenerative tendonsHow chronic pain, hypervigilance and nervous-system sensitivity can influence symptomsWhether age significantly slows tendon recoveryHow rehab may need to change for someone in their 60sPerimenopause, menopause, estrogen and progesterone: what we currently know about tendon healthWhether hormonal fluctuations could explain sudden PHT flare-upsPsychological stress, pain sensitivity and recoveryThe current evidence for low-level laser therapy / photobiomodulationNutrition considerations for tendon recovery, including protein, collagen and vitamin CWhether it can still be PHT if sitting hurts but running doesn'tSciatic nerve involvement and when nerve mobility exercises may be usefulWhy pain behind the knee warrants further investigationWhether PHT needs to be tender when you press directly over the tendonThe possible relationship between a previous proximal hamstring avulsion and later gluteal tendon problemsWhy PHT is still frequently misdiagnosedWhy greater awareness of PHT among clinicians and patients mattersThroughout the episode, Brodie reinforces an important principle: rehab progression should be based on how your body responds, rather than arbitrary tim