Tendon pain remains an enigma. Many clinical
features are consistent with tissue disruption—the pain is
localised, persistent and specifically associated with tendon
loading, whereas others are not—investigations do not
always match symptoms and painless tendons can be catastrophically
degenerated. As such, the question ‘what
causes a tendon to be painful?’ remains unanswered.
Without a proper understanding of the mechanism behind
tendon pain, it is no surprise that treatments are often
ineffective. Tendon pain certainly serves to protect the
area—this is a defining characteristic of pain—and there is
often a plausible nociceptive contributor. However, the