Excerpt 4 of 8 · Tendinopathy

Tendons don't need tiptoeing

When runners walk in with lower limb tendinopathy, the tendon is rarely the real problem — it’s the damn stories they’ve been told. Fear-avoidance beliefs and kinesiophobia creep in, fueled by misinformation, worst-case thinking, and the occasional overconfident provider.

Or worse… they’ve already been talked into a corticosteroid shot or some overpriced PRP fantasy promising a “cascade of healing events” (cue magic hands). You know — PRP(uh)-lease.

The truth? It was mismanagement of load that got them into trouble, and it’s thoughtful, progressive loading that gets them out. Sounds simple, but it’s not. Because when fear takes over, maladaptive thoughts and behaviors follow, and these need to be met head-on.

In this clip from Clinical Running Essentials, I walk through how I approach this all-too-common — and often bungled — scenario:

Here's what I cover:

• What patients have been told — and how to help them reframe the situation
• Why I don't lose sleep over tendons rupturing under slow, heavy loading
• The metaphors that land — mooring ropes, wool sweaters, and reams of paper
• The trap of relying on imaging (which is rarely necessary) — and how to think critically when you see structural changes
• Why belief-shifting isn't fluff — it's the foundation of getting people back to function