When to Operate & When to Rehab with Surgeon Lasse Lempainen from Overcoming Proximal Hamstring Tendinopathy

In 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 Surgery

Why MRI findings alone are never enough
The importance of correlating scans with clinical function and symptoms
Why some complete avulsions heal well conservatively — and others don’t

Hamstring Avulsion vs Proximal Hamstring Tendinopathy (PHT)

Key differences between acute avulsions, chronic avulsions, and tendinopathy
Why not all “avulsions” are the same (1-tendon vs 3-tendon injuries)
When retraction distance matters — and when it doesn’t

Critical Timing Windows

Why acute avulsions should ideally be operated on within 2–3 weeks
What happens when diagnosis is delayed
When chronic injuries become harder (or impossible) to fully restore surgically

“Failed Rehab” — What That Really Means

Why many runners are told they’ve “failed rehab” when they actually haven’t
Common mistakes in conservative treatment (under-loading, poor progression)
When even excellent rehab is unlikely to succeed due to tendon biology

What Surgery for PHT Actually Involves

What surgeons look for during surgery beyond “tendon thickening”
The role of semi-membranosus release, scar tissue, and sciatic nerve involvement
Why surgeons often find structural issues not obvious on standard MRI

Common Pre- and Post-Op Mistakes

Why under-diagnosis is one of the biggest pre-op risks
Why returning to running too early post-op leads to setbacks
The importance of fixing why the injury happened — not just repairing tissue

Key Takeaway

Most 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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MEDICAL & EDUCATIONAL DISCLAIMER

The information provided in the Overcoming Proximal Hamstring Tendinopathy (PHT) Podcast, YouTube channel, associated websites, social media, and other educational content produced by Brodie Sharpe is provided for general educational and informational purposes only. It is not intended to constitute, and should not be relied upon as, individual medical, physiotherapy, diagnostic or treatment advice.

Although Brodie Sharpe is a qualified physiotherapist, consuming this content does not establish a physiotherapist-patient or other healthcare professional-patient relationship. Any discussion of symptoms, diagnoses, rehabilitation strategies, exercises, loading programs, running modification, medications, supplements, injections, medical procedures or other treatment options is general in nature and may not be appropriate for your individual circumstances.

Musculoskeletal pain can have multiple causes, and symptoms that appear consistent with proximal hamstring tendinopathy or another tendon disorder may arise from other conditions. Appropriate assessment, diagnosis and treatment depend upon an individual's medical history, symptoms, examination findings, medications, health conditions, training history and other factors that cannot be adequately assessed through general online content.

Do not use this content as a substitute for assessment, diagnosis or treatment from an appropriately qualified healthcare professional.

Before starting, stopping or substantially modifying an exercise or rehabilitation program, medication, supplement, injection, procedure or other treatment discussed in this content, seek advice from an appropriately qualified healthcare professional who can consider your individual circumstances.

Exercise, rehabilitation and medical treatments carry inherent risks. These may include increased pain, symptom flare-ups, aggravation of an existing condition, new injury, adverse reactions or other complications. Individual responses vary and no particular outcome, improvement, recovery timeframe or return to sport can be guaranteed. If an activity or intervention causes significant, unusual or worsening symptoms, stop and seek appropriate professional advice.

References to research, clinical studies, treatment approaches, products or opinions of guests are provided for educational purposes. Scientific evidence evolves over time, may be incomplete or conflicting, and findings from research populations may not apply to every individual. Discussion of a treatment or product does not necessarily constitute an endorsement or recommendation for its use. Views expressed by podcast guests or other contributors are their own and do not necessarily represent the views of Brodie Sharpe.

To the extent permitted by applicable law, Brodie Sharpe and associated businesses, contractors and contributors accept no liability for loss, injury, damage or adverse outcomes arising from reliance upon or use of this general educational content. Nothing in this disclaimer is intended to exclude, restrict or modify any right, guarantee, remedy or liability that cannot lawfully be excluded, restricted or modified under applicable law.

If you believe you may have a serious injury or medical condition, or you develop severe, rapidly worsening or otherwise concerning symptoms, seek prompt assessment from an appropriately qualified healthcare professional. In an emergency, contact your local emergency service.

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