When we think about pain, it’s easy to imagine it as a simple warning signal from the body, something in the tissues is damaged, and nerves send a message to the brain. But pain is actually much more complex. In fact, modern science tells us that pain is not just about the injury itself, but also about how our brain, body, and life circumstances interact.
This is known as the biopsychosocial model of pain and understanding it could aid in your recovery from tendon pain, such as surfer’s elbow or tennis elbow.
What is the Biopsychosocial Model?
The biopsychosocial model explains that pain is influenced by three key areas:
- Bio – the biological side, such as tissue health, inflammation, muscle strength, and load on the tendon.
- Psycho – the psychological side, such as your thoughts, beliefs, emotions, and past experiences with pain.
- Social – the broader life context, such as work demands, sport commitments, social support, and lifestyle stressors.
All three factors are constantly interacting. Two people can have the same tendon changes on a scan, yet one may be in severe pain and the other may have little or no pain at all — because the way pain is experienced is shaped by more than just the tendon tissue.
What the Science Says
Two key research papers have shaped how we now think about pain:
- Moseley & Butler (2017) explain in Explain Pain Supercharged that pain is a protective mechanism, not a direct measure of tissue damage. The brain weighs up danger and safety signals from the body and the environment before deciding whether to produce pain.
- Buchbinder et al. (2018) in The Lancet Low Back Pain Series highlight that persistent pain often has as much to do with psychosocial factors as with physical changes, and that ignoring these factors can slow recovery.
This research isn’t just about back pain — the same principles apply to tendinopathy.
How This Relates to Tendon Pain
If you’ve had tendinopathy for weeks or months, your tendon isn’t just dealing with local changes in collagen structure. Your nervous system can become more sensitive, meaning the brain starts to send stronger pain signals even when the tissue is slowly healing.
Some common examples:
- Biological – Overloading or underloading the tendon can keep pain going.
- Psychological – Worrying that you’re “making it worse” can lead to fear of movement and muscle deconditioning.
- Social – Having to keep working through pain because of job or sport pressures can slow recovery.
Why This Matters for Your Recovery
By recognising all three components, we can create a more complete and effective recovery plan:
- Address the biology – Use progressive, targeted loading to strengthen the tendon and surrounding muscles.
- Support the psychology – Learn about pain science, set realistic goals, and build confidence in movement.
- Consider the social – Adjust work, sport, or home activities to allow for optimal loading and rest.
This isn’t about saying “the pain is in your head” — it’s about understanding that pain is a whole-person experience. That’s why a good tendinopathy rehab plan will look beyond just the tendon itself.
The Bottom Line
Tendon recovery is not only about repairing tissues, it’s about calming an overprotective pain system and creating the right conditions for healing, both physically and mentally. By addressing the bio, psycho, and social aspects together, you’re giving yourself the best chance to get back to the activities you love.
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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