The Future Direction of Chronic Tendon Treatment: What New Pain Science Is Revealing About Tendinopathy

·35 min·2 clips

High-volume injections reduced pain by 30 to 50 millimeters on a 0 to 100 VAS scale.

1. The episode centers on The Run Smarter Podcast and a January 2026 paper on chronic tendinopathy treatment. 2. Brodie, an online physiotherapist and runner, frames the paper as changing how he thinks about tendinopathy care. 3. The core question is whether nerve-targeted treatments can help chronic tendon pain more than traditional tendon-focused approaches. 4. Brodie links the new review to an earlier 2024 paper titled "Is Chronic Tendon Pain Caused By Neuropathy?". 5. He explains neuropathy as dysfunction of peripheral nerves that can produce numbness, weakness, or amplified pain signals. 6. The review searched four databases, screened 200 publications, and included 11 studies after removing duplicates and applying criteria. 7. Those 11 studies covered 254 patients and 257 tendons, with symptom duration ranging from 14 months to 36 months. 8. Eight of the 11 studies focused on mid-portion Achilles tendinopathy, while other studies involved supraspinatus, patellar tendon, and insertional Achilles cases. 9. The paper argues that chronic tendinopathy may involve neurogenic mechanisms, including nociceptive ingrowth and neovascularization. 10. Brodie says that pathologic nerves may correlate with pain-inducing neurotransmitters and a cycle of pain plus neural inflammation. 11. High-volume injections used ultrasound guidance to place large volumes of fluid between the tendon and paratenon. 12. Those injections were associated with pain reductions of 30 to 50 millimeters on a 0 to 100 VAS scale and functional gains of 18 to 31 points. 13. Brodie notes that adding corticosteroid did not consistently beat saline alone in the high-volume injection studies. 14. Sclerosing polidocanol injections aimed to close abnormal blood vessels until Doppler flow disappeared. 15. That approach produced an average VAS drop from about 79 to 58 and patient satisfaction ranging from 50 to 67. 16. Radiofrequency microtenotomy combined fascicle incision, adhesiolysis, and targeted radiofrequency energy on the tendon back surface and paratenon. 17. A single study of 24 patients reported 100% patient satisfaction, near-zero visual analog scores, and rare complications including deep vein thrombosis, nerve injury, and wound infection. 18. Minimally invasive paratenon stripping used a small incision to release adhesions and restore tendon gliding, with one 29-tendon study reporting pain dropping from 8.7 to 2.4 and 73% pain-free. 19. Brodie ends by saying the pattern across techniques points toward modifying the neural environment around the tendon, not just the tendon structure itself. 20. Listeners interested in chronic running injuries and evidence-based rehab will get the most from this episode, while people wanting only simple load-management advice may skip it.

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