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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.

🎉 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, we break down a brand-new randomized controlled trial comparing individualized physiotherapy with shockwave therapy for proximal hamstring tendinopathy. I walk through how the study was designed, what each treatment involved, and why the results showed no meaningful difference between the two approaches. We also explore the role of education, load management, and compressive tolerance, and what this means for your rehab decisions moving forward. If you’ve ever wondered whether shockwave is worth trying or how it stacks up against a structured strength program, this episode gives you a clear, evidence-based answer.

Paper 1: Physiotherapy Compared With Shockwave Therapy for the Treatment of Proximal Hamstring Tendinopathy: A Randomized Controlled Trial
Paper 2: Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy: A Clinical Commentary

🎉 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 🔍

For ALL Other Resources, Visit the Website proximalhamstringtendinopathy.info
Run Smarter AI Assistant: Access personalized, research-based answers to your running and rehab questions. This tool integrates Brodie’s database of research papers and podcast episodes for tailored advice.

Research Deep-Dive: Hamstring Strength & Running Biomechanics

This episode reviews the study: “Hamstring Strength and Architectural Properties Are Associated with Running Biomechanics”, including findings from ultrasound imaging, EMG analysis, and 3D running mechanics.

Key Study Questions

• Do stronger hamstrings create better running mechanics?
• Do better mechanics help build stronger, longer hamstrings?
• How do strength, fascicle length, pelvic position, and muscle activation interact?

🔎 Main Findings From the Study

1. Stronger Hamstrings = Better Running Mechanics

Athletes with higher eccentric hamstring strength had:

• Higher stride frequency (cadence)
• Better control of decelerating the swinging leg
• Lower ground contact time (improved efficiency)
• Lower hamstring activation at sub-max speeds → reduced overload

2. Longer Hamstring Fascicles = Safer, More Efficient Loading

Runners with longer fascicle lengths showed:

• Less anterior pelvic tilt
• Lower hamstring activation
• Better ability to tolerate late-swing loading (a high-irritation phase for PHT)

3. A Two-Way Relationship Exists

Strength ↔ mechanics influence each other.

• Stronger hamstrings → better running technique
• Better running technique → better hamstring loading → stronger, longer muscle structure over time
  This creates a positive adaptation loop.

4. Over-Reliance on the Biceps Femoris = Red Flag

Runners with weak or short hamstrings tended to over-activate the biceps femoris long head — the most common site of PHT.
Stronger runners shared load better with the medial hamstrings, reducing tendon stress.

🏃 Practical Rehab Takeaways

1. Build Eccentric Strength

Eccentric strength is one of the strongest predictors of hamstring injury risk.
Examples Brodie recommends:

• Hamstring sliders
• Weighted eccentric sliders
• Single-leg sliders
• Assisted → full Nordic drops
• Deadlifts (when tolerated)

2. Improve Fascicle Length

Eccentric exercises at long muscle lengths help lengthen fascicles naturally — more so than stretching alone.

3. Strengthen the Medial Hamstrings

To prevent overload of the biceps femoris:

• Use toes-in hamstring curls
• Toes-in sliders
• Toes-in deadlift variations
  These help redistribute load more evenly across the tendon.

4. Slightly Increase Cadence (~5%)

A small increase in stride frequency may reduce late-swing strain and improve running economy.

5. Integrate Running Into Rehab

Before adding speed:

• Build to 30 minutes continuous, easy running → symptom-free
  Then introduce:
• Strides (15–20 sec at ~75% speed, 4 reps)
• Gradual progression based on symptoms the next day

Final Thoughts

Hamstring strength, muscle architecture, and running technique are deeply interconnected. Improving one helps improve the others — creating a pathway toward better performance and long-term PHT resilience.