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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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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.

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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.)

👉 Complete the 30 Sec Survey & Find Your Best PHT Recovery Plan

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

Contact Dr. Alex Hardy and his team at Dr.hardy@chirurgiedusport.com

In this episode, Brodie is joined by hamstring surgeon Dr. Alex Hardy to break down exactly what to do before and after hamstring surgery. They cover the key differences between acute and chronic injuries, and what that means for your behaviour leading into surgery. For acute avulsions, the priority is speed—getting an MRI quickly and avoiding unnecessary delays—while keeping activity minimal. In contrast, chronic cases and tendinopathies benefit from staying active, maintaining strength and cardio, and avoiding unnecessary deconditioning.

A key takeaway: there’s very little you can do pre-surgery to “make things worse,” but there’s a lot you can do to set yourself up for a smoother recovery.

The conversation then shifts to post-operative rehab, where patience is critical. Dr. Hardy explains why the first 6 weeks are highly protective (often involving a brace and minimal hamstring loading), followed by a gradual return to movement, strength, and eventually running around the 3–4 month mark. They discuss exercise progressions (starting with closed-chain work, then progressing to open-chain and eccentric loading), common pitfalls like premature overload or slips during early recovery, and when to be concerned about symptoms like persistent pain or sciatic irritation.

If you’re considering surgery or currently navigating recovery, this episode gives you a clear, realistic roadmap—what matters most, what to avoid, and how to maximise your outcome

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

In this Q&A episode, Brodie continues answering listener questions about proximal hamstring tendinopathy (PHT), covering topics ranging from long-term maintenance to returning to running after rehab. He explains why the same exercises used in rehabilitation—especially deadlifts—often remain the best way to keep symptoms at bay by maintaining tendon capacity. Depending on a runner’s goals, he also discusses when to add exercises like prone hamstring curls or Nordic curls to support endurance running versus speed work. The key message: keeping the tendon strong and progressively loaded helps reduce the likelihood of symptoms returning.

The episode also addresses common frustrations during recovery, such as lingering sensations during a return-to-run program, setbacks from activities like rowing, and uncertainty about whether PHT ever truly “goes away.” Brodie outlines practical pain-monitoring rules, strategies for adjusting running variables (distance, pace, frequency), and how to identify training factors that may be slowing recovery. He also discusses scenarios such as young athletes with persistent sitting pain, older individuals starting rehab without gym access, and runners balancing rehab with race goals—emphasising that the key to long-term success is gradually building tendon capacity while carefully managing training load and recovery.

👉 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/

In this Q&A episode, Brodie answers a flood of listener questions on proximal hamstring tendinopathy (PHT), starting with one of the most common concerns: how to load the tendon without flaring it up. He breaks down why deadlifts are one of the most effective strengthening tools for the upper hamstring, how to manipulate range of motion, weight and frequency, and why “dosage” is the difference between progress and a setback. You’ll learn how to systematically find your sweet spot, adjust frequency as loads get heavier, and avoid the common mistake of jumping in too hard, too soon.

The episode also explores more complex cases, including persistent morning pain, uncertainty around diagnosis, and radiating symptoms that may point to something beyond classic PHT. Brodie discusses how to use loading as both a treatment and a diagnostic tool, when to consider alternative causes like lower back involvement, and how nervous system sensitisation and hypervigilance can amplify pain.

He finishes with rapid-fire answers on rehab frequency, maintenance loading, and how to modify exercises when other injuries (like low back pain) enter the picture. If you’ve been struggling to balance strengthening with symptom control, this episode offers practical, measured guidance to help you regain confidence and move forward with clarity.