"What a Difference Some Exercise and Time Makes”

This recent case highlights how patient education, realistic expectations, and a clear rehab plan can shape recovery.

A 69-year-old retired male had been running casually for over 10 years, typically 6–10km every other day from spring through fall. In early November, he felt some lower right glute pain during a run but was able to finish. After resting a week, he attempted another run and developed sharper pain around 2km in, forcing him to walk home. Since then, he had been resting and stretching. He noticed his flexibility improved, but the pain persisted — particularly with a few attempts at running. In January, after a delayed four-hour flight, he developed more significant pain down the back of his right leg. Sitting aggravated it, and a long Christmas dinner was his worst day. The leg pain, and how long it was taking to improve despite doing nothing to aggravate it, were what concerned him the most.

Patient Education
Early on, the priority was providing an explanation for his leg pain. Clinically, this presentation was consistent with proximal hamstring tendinopathy: common in runners and often aggravated by sitting pressure. We discussed the possibility of an initial gluteal strain but questioned it given the relatively low-load nature of distance running. The key message wasn’t obsessing over the perfect label. It was explaining: why sitting hurt, why symptoms evolved, why rest alone hadn’t solved it, what tendons actually need to improve, and how we could tackle both pain points. That led directly into expectations.

Setting Expectations
He was used to minor “niggles” resolving in 1–2 weeks. The concern was this felt different; even different from his prolonged ITB pain years ago, which left him frustrated by unclear explanations and slow progress. With spring approaching, he felt pressure for this to “heal now.” We discussed that tendinopathies are notorious for slower timelines — often 2–8 months depending on duration and loading consistency. This timeframe is not because something is severely damaged, but because tendons adapt gradually. He didn’t love that timeline, but having one was better than uncertainty. Understanding what is typical often reduces anxiety more than promising quick fixes that don’t pan out.

Proper Loading
During his rest period, he had mainly been stretching. Stretching can feel good and reduce pain temporarily, but tendons respond best to progressive resistance training. We introduced three primary exercises: hip thrusts, Romanian deadlifts (RDLs), and floor-sliding hamstring curls. The focus was on progressive loading of the proximal hamstring and glute through hip extension and knee flexion. We also discussed getting creative with loading, since his available weights were light. With hip hinges especially, most people can tolerate going relatively heavy. We kept stretching in the plan since he found it helpful and it wasn’t interfering with recovery, but strengthening became the priority.

Two Weeks Later
At follow-up, the first thing he said was: “What a difference some exercise and time makes.” He reported several days completely free of leg pain; the glute discomfort was still present but improved. He also noticed continued flexibility gains despite doing less static stretching and more strengthening. We progressed his RDL to a split-stance variation to increase single-leg loading without needing heavier weights. Next steps will include further progression and building toward a structured return-to-run plan.

Why This Case Matters
Despite being a running-related injury, improvement didn’t require anything fancy. It required a clear explanation, realistic expectations and progressive loading. Education reduced uncertainty, expectations reduced anxiety, and loading gave the tissue a reason to adapt. This wasn’t about chasing symptoms; it was about rebuilding capacity. It was about restoring capacity. Nothing flashy. Just the sound rehab principles of clear communication, calming things down and building them back up.