When we think about pain, it’s tempting to picture it as a simple warning system: tissue gets damaged, nerves fire, and the brain feels pain. But pain is far more complex. Modern science shows that pain isn’t just about what’s happening in the tendon or joint — it’s shaped by the interaction between your body, brain, and life circumstances.
This is called the biopsychosocial model of pain, and it can be a powerful tool in understanding and recovering from tendon pain, such as surfer’s elbow or tennis elbow.
What Is the Biopsychosocial Model?
The model explains that pain is influenced by three key areas:
- Bio – tissue health, inflammation, muscle strength, and tendon loading.
- Psycho – your thoughts, beliefs, emotions, and past pain experiences.
- Social – your environment and lifestyle, including work demands, sport commitments, social support, and stressors.
These factors constantly interact. Two people can show the same tendon changes on a scan, yet one may feel severe pain while the other feels little or none — because pain is more than just a reflection of tissue damage.
What the Science Shows
Two important pieces of research have changed how we understand pain:
- Moseley & Butler (2017): Pain is a protective mechanism, not a direct measure of tissue damage. The brain weighs up “danger” and “safety” signals before deciding whether to produce pain.
- Buchbinder et al. (2018): Persistent pain is often driven as much by psychosocial factors as by physical ones. Ignoring these factors can slow recovery.
Although these studies focus on back pain, the principles apply directly to tendon injuries.
How This Relates to Tendon Pain
When tendinopathy lasts weeks or months, the tendon isn’t the only issue. The nervous system itself can become more sensitive, sending stronger pain signals even as tissue healing occurs.
Here’s how the three areas often show up:
- Biological: Overloading or underloading the tendon can keep pain going.
- Psychological: Fear of “making it worse” can lead to avoiding movement, causing weakness.
- Social: Work or sport pressures may force you to push through pain, slowing recovery.
Why This Matters for Recovery
A complete rehab plan addresses all three components:
- Biological: Use progressive, targeted exercises to load and strengthen the tendon.
- Psychological: Learn about pain science, set achievable goals, and rebuild confidence in movement.
- Social: Adjust training, work, or home tasks to give your tendon the right balance of load and rest.
This doesn’t mean pain is “in your head.” It means pain is a whole-person experience, and recovery works best when we treat the whole picture — not just the tendon.
The Bottom Line
Tendon recovery isn’t just about fixing tissues — it’s about calming an overprotective pain system and creating the right conditions for healing. By addressing the bio, psycho, and social factors together, you give yourself the best chance to recover fully and get back to the surf, the gym, or whatever activity you love most.
References
Moseley, G. L., & Butler, D. S. (2017). Explain Pain Supercharged. Adelaide: Noigroup Publications.
Buchbinder, R., van Tulder, M., Öberg, B., et al. (2018). Low back pain: a call for action. The Lancet, 391(10137), 2384–2388.
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