🎉 Sign up for the FREE PHT 5-Day Course HERE 🎉🗓️ Book a free 20-minute Injury Chat with Brodie 📞📄Learn more about Brodie's PHT AI Assistant 🔍Check out Lasse's website here: https://www.lasselempainen.fi/?lang=enIn this episode, Brodie sits down with world-leading orthopedic surgeon Dr. Lasse Lempainen, a specialist in complex hamstring injuries, to answer one of the most confusing and anxiety-provoking questions runners face:“How do I know if I actually need surgery — or if rehab is still the right path?”Drawing on decades of surgical experience and extensive research into hamstring avulsions and proximal hamstring tendinopathy (PHT), Dr. Lempainen walks through how he actually makes decisions in real clinical practice — not just what MRI scans show, but how symptoms, function, timelines, and rehab quality all fit together.Together, Brodie and Lasse unpack the gray area that most runners live in: partial tears, chronic pain, mixed scan results, failed rehab attempts, and fear-based decision-making. The result is a balanced, evidence-informed discussion that helps runners understand where surgery fits — and where it doesn’t.What You’ll Learn in This Episode:How Surgeons Decide Who Actually Needs SurgeryWhy MRI findings alone are never enoughThe importance of correlating scans with clinical function and symptomsWhy some complete avulsions heal well conservatively — and others don’tHamstring Avulsion vs Proximal Hamstring Tendinopathy (PHT)Key differences between acute avulsions, chronic avulsions, and tendinopathyWhy not all “avulsions” are the same (1-tendon vs 3-tendon injuries)When retraction distance matters — and when it doesn’tCritical Timing WindowsWhy acute avulsions should ideally be operated on within 2–3 weeksWhat happens when diagnosis is delayedWhen chronic injuries become harder (or impossible) to fully restore surgically“Failed Rehab” — What That Really MeansWhy many runners are told they’ve “failed rehab” when they actually haven’tCommon mistakes in conservative treatment (under-loading, poor progression)When even excellent rehab is unlikely to succeed due to tendon biologyWhat Surgery for PHT Actually InvolvesWhat surgeons look for during surgery beyond “tendon thickening”The role of semi-membranosus release, scar tissue, and sciatic nerve involvementWhy surgeons often find structural issues not obvious on standard MRICommon Pre- and Post-Op MistakesWhy under-diagnosis is one of the biggest pre-op risksWhy returning to running too early post-op leads to setbacksThe importance of fixing why the injury happened — not just repairing tissueKey TakeawayMost hamstring injuries — including many cases of PHT — can and should be treated conservatively. But there is a subset of runners where surgery is not only appropriate — it’s the missing piece.This episode helps you understand which group you fall into, without fear-based decisions or false hope.

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