Limitations of the evidence base

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Tendon pain is often treated as a purely physical problem. Strengthen the tendon, adjust the load, and eventually things should improve.

But what happens when the pain persists for months… or even years?

In this episode, Brodie speaks with physiotherapist and PhD researcher Jack Mest about a recent systematic review and meta-analysis exploring the psychological profile of people with persistent tendinopathy. The research compared people with chronic tendon pain to healthy controls and uncovered something surprising: fear of movement wasn’t the main psychological factor.

Instead, the research found that pain catastrophizing — a negative outlook toward pain and recovery — appeared more common in people with persistent tendinopathy.

This episode explores how psychological factors may influence tendon pain, why lower limb injuries may carry a greater psychological burden, and why clinicians need to treat the person behind the injury — not just the tendon itself.

If you’re a runner struggling with Achilles pain, plantar fasciopathy, proximal hamstring tendinopathy, or another persistent tendon injury, this conversation will help you understand why recovery can feel so frustrating — and what might help.

In This Episode

Brodie and Jack discuss:

• Why tendinopathy often becomes a chronic condition
• What the biopsychosocial model means for tendon rehab
• The difference between kinesiophobia (fear of movement) and pain catastrophizing
• Why catastrophizing appears more common in persistent tendon pain
• Why lower limb tendinopathies may have greater psychological impact than upper limb injuries
• The role of beliefs, expectations, and past experiences in shaping pain
• Why clinicians should ask about patients’ thoughts and fears about their injury
• Whether psychological traits are pre-existing or develop after chronic pain begins
• Practical advice for runners dealing with long-term tendon pain

About the Guest

Jack Mest is a physiotherapist and PhD researcher whose work focuses on understanding why tendinopathy becomes chronic and how psychological factors influence tendon pain.

His research aims to improve the way clinicians approach tendon rehabilitation by integrating biological, psychological, and social factors into treatment.

Follow Jack's research and updates:
 X (Twitter): @Mest_Jack
Facebook: Jack Mest Physio
Paper summary: https://www.jospt.org/do/10.2519/jospt.blog.2026017/full/