Ep 205. Beyond Load Management: Pain Mechanisms in Tendinopathy with Dr. Brooke Coombes

Help Us Build Better Solutions for Your Practice! 🚀 Take 60 seconds to answer 3 quick questions and help us build new paths to make your practice run smoother. 👉https://forms.gle/LmAh4H1vRKjKqCtW8 🚨Try Hanna Health free for 30 days - a customizable HEP platform where you can use your own videos, edit quickly, and track patient access. Start your trial here: https://bit.ly/4pSkYjP 💡 Are you still treating tendinopathy purely as a "load capacity" or biomechanical failure issue? If you have patients who simply don't improve with isometric exercises or who experience unpredictable pain flare-ups, the problem might not be in the tendon itself, it could be in the nervous system. Grab your notebook! We dive deep into modern pain neuroscience applied to daily clinical practice, busting old myths and bringing you assessment tools you can use in your clinic tomorrow morning. 💭 “We needed to start broadening our minds about pain — whether we can just focus on the tissues or whether we need to think beyond the tissues" - Dr. Brooke Coombes 👉🏻 Dr. Brooke Coombes is a Musculoskeletal Physiotherapist, lecturer, and Postdoctoral researcher at The University of Queensland. She is an internationally recognized expert in tendinopathy and musculoskeletal injuries, with over 65 peer-reviewed publications in prestigious journals such as The Lancet and JAMA. Her impactful research challenges traditional treatments, like corticosteroid injections, and explores how factors such as obesity, diabetes, and exercise affect tendon and muscle health. Utilizing advanced techniques like ultrasound elastography and quantitative pain measurement, Dr. Coombes is currently focused on developing practical clinical tools to help practitioners identify and match specific treatments to a patient’s dominant pain mechanism based on IASP guidelines. 📚In this episode, you'll learn: • Tendinopathy isn't always a loading problem: why pain mechanisms change everything about how you manage these patients • How to tell your pain mechanisms apart: the clinical features and tools that help you discriminate nociceptive, neuropathic, and nociplastic pain in tendons • The research reshaping tendinopathy science: sensitisation patterns, neuropathic-like features, and what the evidence actually says • What personalised tendinopathy care looks like: moving beyond load management to match your approach to the underlying pain mechanism 🔎Brooke's Resource of Information: • Wheeler, PC. Up to a quarter of patients with certain chronic recalcitrant tendinopathies may have central sensitisation: a prospective cohort of more than 300 patients. Br J Pain. 2019 Aug;13(3):137-144. doi: 10.1177/2049463718800352. • Shraim MA, et.al. Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a Delphi expert consensus study. Pain. 2022 Sep 1;163(9):1812-1828. doi: 10.1097/j.pain.0000000000002577. • Rio E, et. al. Sensory Processing in People With and Without Tendinopathy: A Systematic Review With Meta-analysis of Local, Regional, and Remote Sites in Upper- and Lower-Limb Conditions. J Orthop Sports Phys Ther. 2021 Jan;51(1):12-26. doi: 10.2519/jospt.2021.9417. • Cancela-Cilleruelo I, et. al. Presence of Neuropathic-Like Symptoms in Individuals With Painful Tendinopathy/Overuse Injuries: A Systematic Review and Meta-Analysis. Clin J Pain. 2025 Jul 1;41(7):e1292. doi: 10.1097/AJP.0000000000001292. • Coombes BK, et. al. A new integrative model of lateral epicondylalgia. Br J Sports Med. 2009 Apr;43(4):252-8. doi: 10.1136/bjsm.2008.052738. 📲 Brooke's contact information: • b.coombes@uq.edu.au 📩 Don't miss out on podcast updates!📬: https://www.ptprotalk.com/ 👉 Share Your Feedback: https://forms.gle/YspLGAzHph2fVord8 🎙Listen on all platforms: https://bit.ly/45rzffO 🍁 𝗔𝗯𝗼𝘂𝘁 𝐏𝐓 𝐏𝐫𝐨 𝐓𝐚𝐥𝐤 𝐏𝐨𝐝𝐜𝐚𝐬𝐭 🍁 In this channel, you will find Physical Therapy-related content, like interviews with experts that share their views and experiences, providing relevant information to help Physical Therapists to improve their practice and patient care! 📩 Don't miss out on podcast updates!📬: https://www.ptprotalk.com/ 🌐𝐅𝐨𝐥𝐥𝐨𝐰 𝐌𝐞 𝐎𝐧 𝐒𝐨𝐜𝐢𝐚𝐥𝐬 https://www.instagram.com/ptprotalk/ https://www.facebook.com/ptprotalkpodcast https://www.linkedin.com/company/pt-pro-talk/ https://twitter.com/MariHannaParks Spotify: http://bit.ly/3HFJcNQ ✅𝐆𝐄𝐓 𝐈𝐍 𝐓𝐎𝐔𝐂𝐇 📧 📩Email: mariana@ptprotalk.com Support 💁‍♂️ PT Pro Talk Podcast is only possible with the support of forward-looking and innovative companies like: Hanna Health: https://hannahealthhub.com/hep and SaRaHealth: https://bit.ly/saraytb