The Hidden Psychological Factors Behind Persistent Tendon Pain with Jack Mest

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Mar 8, 2026

Jack Mest, physiotherapist and PhD researcher into tendinopathy, studies how psychology shapes persistent tendon pain. He talks about surprising findings that pain catastrophizing, not fear of movement, is more common in chronic cases. Short discussions cover why lower-limb injuries carry greater psychological burden, how beliefs shape recovery, and when psychologically informed care or referrals may help.

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INSIGHT

Catastrophizing Is More Prominent Than Fear

Pain catastrophizing emerged as the more prominent psychological feature in persistent tendinopathy.
Catastrophizing includes rumination, magnification of threat appraisal, and helplessness rather than exaggerating pain itself.

ANECDOTE

Two Patient Responses That Illustrate Catastrophizing Versus Fear

Jack contrasts two patients: one resigned to 'this will be my life' and another avoiding running for fear of rupture.
This illustrates catastrophizing (helplessness) versus kinesiophobia (avoidance due to perceived fragility).

INSIGHT

Lower Limb Tendinopathy Carries Greater Psychological Burden

The psychological profile differed by region: higher anxiety, depression, and poorer mental health appeared in lower-limb but not upper-limb tendinopathy.
No group differences were found for general self-efficacy or personality traits like neuroticism/extroversion.

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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/