Pain in tendinopathy often settles long before the tendon shows meaningful structural change. And that’s not a problem—it’s how the system is designed to recover.

If you want to learn more about this topic, you can watch Peter Malliaras's lecture here:

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Here’s what’s really happening.

1. Confidence and Control Reduce Pain Sensitivity

When patients learn that movement is safe—not harmful—the nervous system becomes less protective.
This shift in self-efficacy often leads to noticeable pain relief, even if the tendon itself hasn’t changed yet.

2. Graded Exposure Builds Trust in Movement

Slowly reintroducing load helps the brain realise:
“Hurt doesn’t equal harm.”
As predictability increases, pain becomes less threatening, and flare-ups reduce.

3. Reduced Catastrophizing Calms the System

Changing thoughts from “something is wrong” to "this is sensitive, but safe" decreases protective muscle guarding and improves movement quality—both of which lower pain.

4. Improved load management reduces irritation

Adjusting training volume, speed, or frequency decreases mechanical stress on the tendon.
The result? Calmer symptoms without any actual structural change yet.

5. Strength training improves function before structure

Heavy, slow loading improves:

✔ Muscle capacity

✔ Tendon stiffness

✔ Movement efficiency

These functional changes reduce pain long before the tendon shows visible adaptation.

The Bottom Line

Pain relief in tendinopathy is often a nervous system success story, not a structural one.
The person heals—through confidence, control, education, and smart loading—well before the tendon fully catches up.

If you want to learn more about this topic, you can watch Peter Malliaras's lecture here:

Click here

Source:
From the lecture ‘Tendinopathy Rehabilitation Principles and New Clinical Framework' by Prof. Peter Malliaras.