Overcoming Proximal Hamstring Tendinopathy

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Latest Research: Tendon Healing, Shockwave Therapy & Hamstring Injury Prevention
In this episode, Brodie dives into three recently published research papers that help answer some of the biggest questions surrounding proximal hamstring tendinopathy (PHT) and tendon rehabilitation. From understanding what’s really happening inside a painful tendon, to whether shockwave therapy lives up to the hype, and what we can learn from hamstring injury prevention research, this episode translates the latest science into practical takeaways you can apply to your own recovery. 
In this episode, you'll learn:
 Why tendinopathy is far more complex than simple "wear and tear" 
 The emerging role of inflammation, ageing, recovery, sleep and metabolic health in tendon healing 
 Why progressive loading continues to be the cornerstone of successful PHT rehab 
 What the latest evidence says about shockwave therapy and whether it's worth the cost 
 Why exercise-based rehabilitation still outperforms most passive treatment options 
 The surprising findings on ice, cryotherapy and tendon recovery 
 Key lessons from hamstring injury prevention research that can help reduce setbacks and recurrence 
 Why strength, capacity and consistency matter more than stretching alone 
Whether you're currently struggling with PHT, returning from a hamstring injury, or simply want to stay up to date with the latest tendon research, this episode provides evidence-based insights without the scientific jargon.
Key Takeaway:

Successful tendon recovery rarely comes down to a single treatment. The strongest evidence continues to support a combination of sensible load management, progressive strengthening, patience, and addressing the broader factors that influence healing—including sleep, stress, recovery, and overall health. There is hope, and understanding the science can help you make better decisions throughout your rehab journey.

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🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉
For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ 

Stem cells are one of the most talked-about frontiers in medicine—but how much of it actually applies to runners dealing with tendon pain?
In this episode, I’m joined by orthopaedic surgeon and researcher Chukwuweike Gwam to break down the latest evidence on stem cells and tendon healing. We unpack what stem cells actually are, how they work in the body, and whether they live up to the hype when it comes to treating tendinopathy.
We also explore the real-world limitations, risks, and costs—alongside what the future might hold for regenerative medicine in running injuries.
If you’ve ever considered injections, biologics, or wondered if stem cells are “the next big thing”… this episode will bring you up to speed.
About Chukwuweike Gwam MD:
 Orthopaedic surgeon (USA) specialising in hip & knee reconstruction 
 MD (Howard University), PhD in Molecular Medicine (Wake Forest), MBA 
 Research focus: regenerative medicine, stem cells, and translational science 
 Passion for improving healthcare access and bringing lab discoveries into real-world treatment 
Follow him on Instagram:
https://www.instagram.com/chukwuweike_g/
Key Topics & Insights

What Are Stem Cells (In Simple Terms)?
 Think of stem cells as the body’s “repair reserve”
 They help regenerate tissue by:  Creating new cells 
 Regulating inflammation 

 We all have them—but: Quantity decreases with age
Quality declines significantly

Why Do We Heal Slower As We Age?
It’s not just one factor—it’s a combination:
 Reduced stem cell quality and number 
 Slower blood vessel formation 
 Reduced cellular signalling 
 Increased “senescent” (non-functioning) cells 
In other words: your repair system is still there… just less efficient.

Stem Cells & Tendon Healing — The Theory
The idea is simple:
 Harvest stem cells (fat, bone marrow, etc.) 
 Process them 
 Inject them into the injured tendon 
The goal:
 Improve collagen structure 
 Enhance healing response 
 Accelerate recovery 
But here’s the key point…
👉 They are NOT a magic bullet—they’re an adjunct.

What the Research Actually Shows
From their literature review (2015–2025):
 ~1,800 papers screened 
 ~150 relevant studies included 
Findings:
 Improved collagen alignment (under a microscope) 
 Increased tensile strength (in animal models) 
 No consistent improvement in long-term human outcomes 
👉 Especially beyond 6–12 months, results tend to equalise.

The Most Interesting Finding
In rotator cuff studies:
 Stem cells improved early recovery (first ~6 months)
 But no long-term difference compared to standard treatment 
Why?
 Stem cells likely help regulate early inflammation 
 The body eventually “catches up” on its own 
Why Results Are So Inconsistent
This is the biggest limitation:
No standardisation.
 Different sources (fat, bone marrow, skin) 
 Different processing methods 
 Different patient health profiles 
👉 Your stem cells ≠ someone else’s stem cells

Risks & Limitations
 Potential for tumour formation (teratomas) with certain stem cell types 
 High variability in outcomes 
 Mostly animal-based evidence
 Difficult to control how cells behave once injected 
Cost vs Benefit (Reality Check)
 Stem cell injections: ~$3,000–$5,000+ 
 Cortisone: ~$200 
 Rehab: far cheaper, highly effective 
In most cases:
 You’re paying a premium for uncertain benefit.
What About PRP?
 Some benefit for:  Tennis elbow 
 Chronic tendinopathy 

 But:  Highly variable 
 Not clearly superior to rehab 

Again, works best alongside loading—not instead of it.

Practical Takeaways (For Runners)
 Stem cells are promising—but not ready for prime time (yet)
 They may:  Speed up early recovery 
 Improve tissue quality (in theory) 

 But:  Don’t outperform rehab long-term 
 Are expensive and inconsistent 

The fundamentals still win:
 Progressive loading 
 Smart training 
 Patience 

 📲 Follow Dr. Gwam: https://www.instagram.com/chukwuweike_g/

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🎉 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 brand-new 2026 systematic review investigating whether collagen supplementation truly improves tendon health, recovery, and performance. With conflicting advice from experts and unclear evidence in the past, this paper helps clarify what actually works—and more importantly, how to apply it to your training.
Paper: Collagen Supplementation on Tendon-Related Structural and Performance Outcomes: A Systematic Review 
Key Takeaways
 Collagen can improve tendon structure and stiffness—but only when combined with proper strength training 
Dosage matters: 15–30g appears more effective than lower doses 
Timing matters: ~60 minutes before training aligns with peak amino acid availability 
Vitamin C enhances the process, helping collagen synthesis and cross-linking 
 Collagen does NOT improve muscle strength beyond what training alone achieves
Bottom line: collagen seems tendon-specific, not a general performance enhancer

Training Requirements
 Must include structured resistance training
 Target 70–90% of 1RM (heavy loading)
 Tendons need a strong mechanical stimulus to adapt
Collagen without loading = minimal benefit

Final Thoughts
This paper helps move us from confusion to clarity.
Collagen isn’t a magic fix—but when used strategically alongside heavy strength training, it may:
 Improve tendon structure 
 Increase stiffness 
 Enhance long-term resilience 
In other words, it’s a potential amplifier—not a replacement—for good rehab and training principles.

👉 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/ 

Tendon pain is often treated as a purely physical problem. Strengthen the tendon, adjust the load, and eventually things should improve.
But what happens when the pain persists for months… or even years?
In this episode, Brodie speaks with physiotherapist and PhD researcher Jack Mest about a recent systematic review and meta-analysis exploring the psychological profile of people with persistent tendinopathy. The research compared people with chronic tendon pain to healthy controls and uncovered something surprising: fear of movement wasn’t the main psychological factor.
Instead, the research found that pain catastrophizing — a negative outlook toward pain and recovery — appeared more common in people with persistent tendinopathy.
This episode explores how psychological factors may influence tendon pain, why lower limb injuries may carry a greater psychological burden, and why clinicians need to treat the person behind the injury — not just the tendon itself.
If you’re a runner struggling with Achilles pain, plantar fasciopathy, proximal hamstring tendinopathy, or another persistent tendon injury, this conversation will help you understand why recovery can feel so frustrating — and what might help.

In This Episode
Brodie and Jack discuss:
Why tendinopathy often becomes a chronic condition
What the biopsychosocial model means for tendon rehab
The difference between kinesiophobia (fear of movement) and pain catastrophizing
Why catastrophizing appears more common in persistent tendon pain
Why lower limb tendinopathies may have greater psychological impact than upper limb injuries
The role of beliefs, expectations, and past experiences in shaping pain
Why clinicians should ask about patients’ thoughts and fears about their injury
Whether psychological traits are pre-existing or develop after chronic pain begins
Practical advice for runners dealing with long-term tendon pain
About the Guest
Jack Mest is a physiotherapist and PhD researcher whose work focuses on understanding why tendinopathy becomes chronic and how psychological factors influence tendon pain.
His research aims to improve the way clinicians approach tendon rehabilitation by integrating biological, psychological, and social factors into treatment.

Follow Jack's research and updates:
 X (Twitter): @Mest_Jack
Facebook: Jack Mest Physio
Paper summary: https://www.jospt.org/do/10.2519/jospt.blog.2026017/full/

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For all other PHT resources, go to: https://proximalhamstringtendinopathy.info/ 

 In this episode, I sit down with Kirsten—Melbourne local, personal trainer, and someone who knows her way around the gym—yet still found herself stuck in a long and frustrating battle with proximal hamstring tendinopathy (PHT). 
Like many runners and active individuals, Kirsten spent months going in circles. Despite doing all the “right” things—rest, isometrics, backing off training—her symptoms kept returning. Sitting became unbearable, training was inconsistent, and the mental toll started to build. 
But everything changed when she shifted her approach. 
This conversation dives into the exact turning point in her rehab—what worked, what didn’t, and the key mindset shifts that helped her go from constant pain… to full confidence in her training again. 
Instagram mentions: 
https://www.instagram.com/reels/DWHlIU8jffK/
https://www.instagram.com/itsdrglutes?igsh=aXZodW5wYzE5a2h0
https://www.instagram.com/nunzicoaching?igsh=bGFqdzZ1b2llZXZn

Podcast mention:
Tim Ferriss Show episode with Dr. Keith Baar (episode #797). The episode covers:
Tendon loading and repair
The "Anti-RICE Protocol" (i.e., don't rest — use load as an anti-inflammatory)
Isometrics vs. eccentrics for tendon rehab
Simple exercises that can repair tendons (tennis elbow, etc.)