Learn more about Brodie's Research Database & AI Assistant 📄🔍For MORE Run Smarter Resources 🏃‍♂️📚- Including Free Injury Prevention Courses 🩹🎓- The Run Smarter Book 📖- Access to Research Papers 📄🔍- & Ways to Work with Brodie 🤝👟👉 CLICK HERE! 🎉✨For years, chronic tendinopathy has been treated as a tendon problem — load it, strengthen it, remodel it. But what if, for some runners, the tendon itself isn’t the main driver of pain anymore?In this episode, Brodie breaks down a new 2026 systematic review that may reshape how we think about stubborn, long-standing tendon pain. The paper explores whether nerve ingrowth and abnormal blood vessels around tendons — not degeneration of the tendon tissue itself — may be the real pain source in chronic cases.We unpack the emerging research, explain each intervention in plain language, and discuss who this may (and may not) apply to — especially runners stuck in repeated rehab cycles despite “doing everything right.”This is early, evolving science. But it’s a fascinating glimpse into where chronic tendon treatment may be heading next.What You’ll Learn in This EpisodeWhy some chronic tendon pain may be neuropathic (nerve-driven) rather than structuralHow abnormal blood vessels and nerves grow into painful tendons over timeWhy traditional loading programs sometimes stop working in very chronic casesWhat “neural modification” treatments aim to do — and why they’re gaining interestThe six intervention categories reviewed in the paper (explained simply)How strong (or limited) the current evidence actually isWhere this research fits alongside exercise-based rehab, not against itInterventions Reviewed (Plain-English Overview)1. High-Volume Injections (HVIGI / HVDI)Large volumes of fluid are injected around the tendon (not into it) under ultrasound guidance to mechanically disrupt abnormal blood vessels and pain-sensitive nerves.Key takeaway:Consistent short- to medium-term pain and function improvements, especially in people who had failed exercise-based rehab.2. Sclerosing Polidocanol InjectionsA chemical agent is injected directly into abnormal blood vessels to deliberately close them down, cutting off blood supply to pain-producing nerves.Key takeaway:Moderate to strong pain reductions in very chronic cases, with outcomes comparable to surgery in some studies.3. Radiofrequency MicrotenotomyA minimally invasive procedure using controlled heat to disrupt nerve ingrowth and abnormal vessels at the tendon–paratenon interface.Key takeaway:Very strong results in a small cohort, but higher risk and limited evidence so far.4. Minimally Invasive Paratenon ReleaseScar-like adhesions between the tendon and surrounding tissue are mechanically released to restore tendon movement and reduce nerve irritation.Key takeaway:Large pain reductions and high rates of pain-free outcomes in non-insertional Achilles tendinopathy.5. Electrocoagulation TherapyElectrical energy is used to seal off abnormal blood vessels surrounding the tendon under ultrasound guidance.Key takeaway:Promising early results, but evidence limited to one small study.6. Surgical Interventions (Open & Endoscopic)Surgery physically separates the tendon from irritated surrounding tissue and removes abnormal vessels and nerves.Key takeaway:Effective for some, but invasive, with longer recovery and higher risk.The Big Picture TakeawayAcross very different procedures, outcomes were surprisingly similar.That points to a common mechanism: 👉 Modifying the neural (nerve-driven) pain environment around the tendon, rather than “fixing” tendon structure itself.This doesn’t replace exercise-based rehab — but it may explain why a subset of runners with long-standing, highly sensitive tendinopathy stop responding to load alone.This research is best viewed as a future direction, not a replacement for good rehab principles.

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