Rehab has to be challenging enough to actually make a difference.
Yet every week, I see people doing rehab exercises in the gym that have zero chance of making a difference for the person doing them.
And it’s not that the exercises are “bad” or that the people prescribing them have “no idea” what they’re doing…
It’s simply that we all tend to fall into patterns as a result of the things we see every day.
Since most people aren’t particularly athletic, the standard rehabilitation protocols aren’t going to be difficult enough to help athletic people.
And if they are, they aren’t going to help for very long.
Yesterday, I was meeting with someone who’s been dealing with proximal hamstring tendinopathy (PHT).
If you don’t know anybody who’s experienced PHT, it sucks.
It’s a pain in the ass (literally) and it takes forever to heal.
Now what’s the challenge with PHT?
First, sitting makes it a lot worse and most of us spend a lot of time sitting for our jobs.
One of the best things you can do for PHT is get an adjustable standing desk and keep it in the standing position for 80-90% of your day until the pain has gone away.
Another complication is it tends to happen a lot in fairly athletic people.
I’ve had conversations about knee pain and foot pain and shoulder pain with all sorts of humans, but all of my conversations about PHT are with runners.
That’s not universally true, but it’s been true for me.
Now what tends to be true about runners?
They tend to have fairly strong hamstrings – at least when compared to the general populace.
Unfortunately, when it comes to exercise selection for hamstrings, you start to run into some limitations when it comes to proximal hamstring tendinopathy.
Usually, if a strong person came to me and needed to build stronger hamstrings, we would do a bunch of Romanian deadlifts.
Yet the hinge position at the bottom can cause pain in the tendon for a lot of people with PHT.
So they often aren’t the best choice.
Instead, we often want to choose an exercise that keeps the hip in extension.
What options does that leave us?
Some kind of lying hamstring curl.
Now if you happen to be a member at a gym with a lying hamstring curl, this isn’t a big problem.
You get on the machine, keep your hips down, and just go to work.
Yet a lot of people like to do strength training at home or they might go to a gym without access to a lying hamstring curl.
As a result, we really only have a couple of options.
A lying hamstring curl with a band or a hamstring slider, both of which keep the hip in extension and allow you to train the hamstring well.
The person I was coaching yesterday has incredibly strong hamstrings.
As a result, a lot of the “standard” rehab exercises were useless to her.
She didn’t even feel the muscle working.
But now we have a couple options that will allow her to build strength without flaring the problem in the tendon.
And if you combine that with some simple lifestyle changes – namely a lot less sitting – I expect she’s actually going to start seeing progress for something that’s been an incredibly frustrating injury.
Rehab has to be challenging enough to actually create a stimulus.
If it’s not, then you won’t see progress.
Hope you’re having a great start to your year.