Why Tendon Pain Keeps Coming Back with Dr Lorenzo Masci
Tendon pain is one of the most common issues seen in both sport and everyday life, yet tendinopathy remains widely misunderstood.
In this episode, we sit down with Dr Lorenzo Masci, Consultant in Sport and Exercise Medicine, to explore how tendon injuries develop, why some cases become chronic, and what actually drives successful recovery.
With extensive experience managing complex tendon conditions in both elite athletes and the general population, Dr Masci shares a practical and evidence-based perspective on conditions such as Achilles tendinopathy, patellar tendinopathy, and proximal hamstring injuries.
We break down what tendinopathy really is, how tendon injuries differ from muscle injuries, and why recovery often requires a very different approach than most people expect.
A key focus of the conversation is the role of imaging and investigations. Dr Masci explains why scans don’t always correlate with pain, the common mistakes clinicians and patients make when interpreting imaging findings, and why clinical presentation should often guide treatment more than structural changes alone.
We also explore the foundations of tendon rehabilitation, including load management, building tendon capacity, and how to progress safely from pain back to performance. The discussion covers why many people either underload or overload tendons during rehab, and how finding the right balance is critical for long-term recovery.
Beyond rehabilitation, we discuss where treatments such as shockwave therapy, PRP, and injection-based interventions fit into tendon management, what the evidence actually shows, and when these treatments may or may not be appropriate.
Finally, Dr Masci explores the growing understanding that tendon health is influenced by far more than mechanics alone. We discuss the links between metabolism, hormones, inflammation, lifestyle, and tendon pathology, and why clinicians increasingly need to think beyond the tendon itself when managing recurrent or persistent injuries.
🎙️ In This Episode, We Cover
• What tendinopathy actually is
• Why tendon injuries differ from muscle injuries
• The role of scans and imaging in tendon pain
• Why imaging findings don’t always match symptoms
• Common mistakes when interpreting scans
• How to “get someone out of trouble” with a painful tendon
• Load management and tendon rehabilitation principles
• Building tendon capacity safely
• How to progress from pain back to performance
• Shockwave therapy and what the evidence says
• PRP and injection-based treatments
• Why some tendon problems become chronic
• The role of the nervous system in chronic tendon pain
• Metabolic health and its relationship with tendinopathy
• Hormones, menopause, and tendon health
• Lifestyle, inflammation, and recovery
• Tendon stiffness, elasticity, and injury prevention
• The biggest mistakes people make during rehab
🎯 Who This Episode Is For
• Anyone dealing with ongoing tendon pain or injury
• Runners and athletes managing Achilles, patellar, or hamstring issues
• People struggling with recurrent or chronic tendinopathy
• Clinicians and therapists interested in tendon rehabilitation
• Anyone looking to better understand tendon health and recovery
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At Mayfair Health, we specialise in recovery, performance, and proactive wellness. If you’re managing ongoing pain, rehabilitating from injury, or looking to optimise your long-term health and movement, our multidisciplinary team is here to help.
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