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 Episode

• Why some chronic tendon pain may be neuropathic (nerve-driven) rather than structural
• How abnormal blood vessels and nerves grow into painful tendons over time
• Why traditional loading programs sometimes stop working in very chronic cases
• What “neural modification” treatments aim to do — and why they’re gaining interest
• The six intervention categories reviewed in the paper (explained simply)
• How strong (or limited) the current evidence actually is
• Where this research fits alongside exercise-based rehab, not against it

Interventions 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 Injections

A 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 Microtenotomy

A 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 Release

Scar-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 Therapy

Electrical 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 Takeaway

Across 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.

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! 🎉✨

Chronic plantar fasciitis can quietly strip away your confidence, your identity as a runner, and eventually your belief that running is even possible again.

In today’s episode, Jon shares his seven-year battle with stubborn plantar fasciitis—and how he went from barely being able to walk in the morning to completing trail marathons at age 59.

This is not a story about a magic treatment or a quick fix. It’s about patience, progressive strength, smarter recovery, and changing the way you think about pain. If you’ve tried everything and feel like you’re running out of options, this conversation will resonate deeply.

What We Cover in This Episode

Jon’s long road with plantar fasciitis

• How his symptoms started, disappeared, then returned worse than ever
• Why years of rest, stretching, and passive treatments didn’t solve the problem
• What “first-step pain” taught him about whether he was improving or regressing

Why many plantar fasciitis treatments fail

• Over-stretching and aggressive rehab that actually delayed healing
• Why ticking “strength training” off the list too early is a common mistake
• The difference between doing exercises and loading tissue correctly

The turning point

• The mindset shift that stopped the injury from controlling his life
• How slow, progressive calf strengthening rebuilt tissue capacity
• Why learning not to catastrophize flare-ups changed everything

Strength training that actually worked

• The calf exercises that gave the biggest return on investment
• How he progressed from double-leg to single-leg loading safely
• Rep ranges, frequency, and why patience mattered more than intensity

Recovery beyond rehab

• How improving sleep quality accelerated his progress
• Nutrition changes that supported training and recovery
• Why recovery became non-negotiable as he got older

Where Jon is now

• Running pain-free most days after years of struggle
• Completing half marathons, mountain runs, and a self-supported trail marathon
• How he’s approaching goals differently to stay healthy long-term

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! 🎉✨

Matt is a repeat guest from the Doctors of running and a running shoe fanatic!

Our discussion on today's episode starts with shoe expiry dates. Matt gives his opinion on when it is time to buy new running shoes and what variables play a role in running shoe wear and tear.

Next, we explore the different features of a shoe that you need to consider when buying a new pair. Matt discusses comfort, flexibility, stability, upper, drop, weight and many other features.

Matt also shares his recommendations on shoe brands for beginner runners, performance-minded runners and his take on maximalist versus minimalist.

Follow Matt's work by visiting the doctors of running website, youtube, podcast and insta.