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Which PHT Exercises Actually Reduce Pain? with Aidan Rich

Isometric exercises have become one of the most commonly prescribed treatments for proximal hamstring tendinopathy (PHT). Many runners and health professionals use bridge holds in the hope of reducing pain, improving confidence, and making exercise more comfortable.

But what does the research actually say?

In this episode, I sit down with sports and exercise physiotherapist and recent PhD graduate Aidan Rich to discuss his latest study comparing isometric (static) and isotonic (movement-based) hamstring exercises for people with PHT.

Aidan has dedicated years of research to understanding proximal hamstring tendinopathy and shares some fascinating insights into what we know, what we don't know, and how current evidence should influence your rehabilitation decisions.

In this episode, you'll learn:

• What isometric and isotonic exercises actually are
• Why bridge holds became so popular in tendon rehabilitation
• The groundbreaking research that sparked the "isometric pain relief" movement
• Whether PHT sufferers experience the same pain-relieving effects seen in other tendon conditions
• Why some people experience immediate symptom relief while others don't
• The results of Aidan's randomized crossover trial comparing isometric and isotonic hamstring exercises
• Whether one exercise type is superior for reducing pain, improving strength, or sitting tolerance
• What the broader tendon research says about isometrics versus movement-based strengthening
• Why progression and loading may be more important than exercise type
• Common mistakes that keep people stuck in rehabilitation
• When isometric exercises may still have a role in your recovery
• Practical advice for runners who have been doing bridge holds for weeks or months without improvement

Key Takeaways

• Isometric exercises are not necessarily superior to isotonic exercises for immediate pain relief in PHT.
• Some individuals experience meaningful pain relief from tendon loading, while others notice very little change.
• The current evidence suggests exercise progression and appropriate loading are likely more important than the specific contraction type used.
• Long-term tendon rehabilitation should focus on gradually increasing strength and capacity rather than relying solely on static holds.
• If your current rehab isn't working, it may be time to reassess your diagnosis, exercise dosage, loading strategy, or overall treatment plan.

About Aidan Rich

Aidan Rich is a sports and exercise physiotherapist based in Melbourne, Australia. He recently completed a PhD focused on the treatment of proximal hamstring tendinopathy and has worked extensively with endurance athletes, runners, and sporting organizations including Triathlon Australia and Athletics Australia. His research has helped expand our understanding of PHT and provides valuable guidance for clinicians and patients alike.

Resources Mentioned

• Aidan Rich's study:
  The Effect of Isotonic Versus Isometric Strength Exercise for Pain and Strength in Proximal Hamstring Tendinopathy: A Randomized Crossover Trial