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181. Tendinopathy: Is it weakness or inhibition? with Dr Patrick Vallance

Release Date: 10/08/2026

181. Tendinopathy: Is it weakness or inhibition? with Dr Patrick Vallance

Physio Edge podcast

Your patellar tendinopathy patients are performing a solid, progressive loading program, but their quadriceps still test weaker, with lower maximal force output. Are their quads actually weak, or is muscle inhibition limiting the strength they can access? And how does this change your rehab? In this episode, Dr Patrick Vallance (Ph.D, Physiotherapist, Tendinopathy neuroscientist, Lecturer in Physiotherapy at Monash University) and David Pope explore why force output can be reduced in tendinopathy, and how understanding the mechanisms involved can help you tailor your treatment. You’ll also...

180. Patellofemoral pain 4 - How to get runners back on track (and trails, hills and anywhere else they run!) with Tom Goom

Physio Edge podcast

Patellofemoral pain (PFP) rehabilitation doesn’t end when your patient gets stronger. The real challenge is getting them back to running, training and racing without triggering another flare-up. In this final episode of the four-part series, Tom Goom (Running Physio) and David Pope explore the fourth pillar of successful PFP rehabilitation: a planned return to running. Continuing Alice’s journey from the previous episodes, a HYROX athlete preparing for competition, Tom and David break down exactly how to rebuild running volume, progress training safely, and help runners hit their goals,...

179. Patellofemoral pain 3 - Effective rehab that won't flare their symptoms with Tom Goom

Physio Edge podcast

Strengthening exercises are a key part of successful patellofemoral pain (PFP) rehabilitation. Squats, lunges and single leg squats are often painful early on and can aggravate your patients pain, but on the flip side, we want to build up their tolerance and confidence with these movements. If you introduce an exercise your patient isn’t ready for, progress too quickly, or overload the knee too early, you’ll often flare your patients pain and set their rehabilitation back. In this episode, Tom Goom (Running Physio) and David Pope explore the third pillar of successful PFP treatment:...

178. Patellofemoral pain 2 - What to do when runners won't reduce their training with Tom Goom

Physio Edge podcast

Many runners patellofemoral pain (PFP) is aggravated by the activity they love. They either stop running to let their pain settle, and then it returns as soon as they start back up again, or keep running despite the pain getting worse. They may know (and you may have told them) they should reduce their training….but what happens when they can’t? Or won’t? In this episode, Tom Goom (Running Physio) and David Pope explore the second pillar of successful PFP rehab: education and empowerment. Using the real case of Alice, a HYROX athlete preparing for competition, you’ll discover how and...

177. Patellofemoral pain 1 - Why it has such a high recurrence rate, and what most rehab plans miss with Tom Goom

Physio Edge podcast

Patellofemoral pain (PFP) is one of the most common running injuries, and the high recurrence rate can make it a frustrating injury for patients to experience and clinicians to treat. In this episode, Tom Goom (Running Physio) and David Pope break down why PFP has such a high recurrence rate, and what most rehab plans miss. You’ll also discover: The "Four pillars" framework Tom uses to treat PFP and other running injuries How and when to keep patients running or exercising when it is essential for their mental health and social life How to find a manageable starting point when a...

176. Neck-driven shoulder pain - 5 common misunderstandings. Physio Edge Shoulder Success podcast with Jo Gibson

Physio Edge podcast

When is your patient's shoulder pain from their neck? Are you missing a cervical spine component in your shoulder patients? After a day in clinic reviewing patients with years of unresolved shoulder pain, Shoulder Specialist Physiotherapist Jo Gibson breaks down the five most common mistakes clinicians make when ruling in — or out — the neck. In this podcast, Jo covers: Why you don't need neck pain to have neck-driven shoulder pain (and which pain locations are most pathognomonic) Why referred symptoms below the elbow don't automatically point to the cervical spine Why active range of...

175. Tendinopathy treatment: Your guide to isometrics, isotonics & plyometrics with Dr Ebonie Rio

Physio Edge podcast

Should you prescribe isometric or isotonic exercises for your patient's lower limb tendinopathy? When is it safe to add plyometric loading, and how do you progress running or jumping without flaring your patients tendon pain? Why do some "tricky tendons" refuse to respond to your best loading programs? Dr Ebonie Rio (Post-Doctoral Senior Research Fellow, La Trobe University) reveals the evidence-based answers as she guides you through the clinical reasoning and practical strategies for managing patellar, achilles, and other lower limb tendinopathies. In this conversation, you'll follow...

174. ACJ - The hidden culprit behind stubborn shoulder pain? Physio Edge Shoulder Success podcast with Jo Gibson

Physio Edge podcast

Have any of your shoulder patients improved and then plateaued, unable to regain their full range of movement, or get rid of their painful arc? Sometimes it’s not the cuff, capsule, nerves or neck—it’s the acromioclavicular joint (ACJ) holding things back. In this episode, Jo Gibson sheds light on this often-overlooked contributor to persistent shoulder pain. From real patient case studies to the latest research and simple clinic-ready symptom modification tests, Jo shares practical strategies you can use immediately. Learn how to identify ACJ involvement, and use targeted rehab...

173. Hip flexor pain in runners: Diagnosis, myths, and rehab. Physio Edge Track record: Running repairs podcast with Tom Goom

Physio Edge podcast

Anterior hip pain is often blamed on the hip flexors, but in runners, that’s rarely the diagnosis. So how can you identify the real cause and guide patients to a safe, effective recovery? In this episode, Tom Goom (Running Physio) explores the function of the hip flexors in running, key differentials for anterior hip or groin pain, and practical rehab strategies you can use right away. You’ll discover: Why true hip flexor tendinopathy is uncommon in endurance runners Red flags and key tests to identify bone stress fractures and intra‑articular pathology Early‑stage loading strategies...

172. Shoulder pain assessment & clinical reasoning. Physio Edge Shoulder Success podcast with Jo Gibson

Physio Edge podcast

Your patient presents with shoulder pain, and straight away you need to identify: Is it rotator cuff related shoulder pain, frozen shoulder, instability, or something else entirely? Is it rotator cuff related shoulder pain, frozen shoulder, instability, or something else entirely? Is the pain actually coming from the shoulder? Could it be the cervical spine? Is there a tear that needs urgent referral? Should you order imaging? Refer to a surgeon? Or confidently continue with rehab? In this podcast, Jo Gibson (Upper Limb Rehabilitation Specialist Physio) guides you through a simple,...

More Episodes

In this episode, Dr Patrick Vallance (Ph.D, Physiotherapist, Tendinopathy neuroscientist, Lecturer in Physiotherapy at Monash University) and David Pope explore why force output can be reduced in tendinopathy, and how understanding the mechanisms involved can help you tailor your treatment.

You’ll also discover:

Clinical clues that inhibition may be contributing to your patient’s reduced force output
How inhibition at the brain and spinal cord differs, and why this matters for rehab
The reticulospinal pathway and its role in producing strength and power
How metronome-paced and self-paced exercises may target different neural pathways, and what this could mean for your exercise choices
Why Achilles and patellar tendinopathy may need different treatment approaches, including when to target muscular endurance
How assessing strength, power and endurance helps you identify what each patient’s rehab needs to address
Why researchers are reconsidering TENS and ice as possible adjuncts to exercise for patellar tendinopathy
Where isometrics fit when they don’t relieve pain, and how their role in tendon stiffness could influence your exercise prescription

Throughout the episode, Patrick uses simple analogies and practical exercise examples to make the science easier to understand and apply. He explores what the research can currently tell us, which treatment ideas are still being tested, and how to use this understanding to tailor your rehab to your patients’ needs and goals.

Chapters

0:00 - Introduction
2:28 - Tendinopathy, inhibition and force output
3:10 - Measuring inhibition
8:47 - Why look beyond the tendon?
10:24 - Corticospinal vs reticulospinal pathways
16:01 - Pain and spinal inhibition
22:09 - Power vs control
26:20 - Metronome-paced vs self-paced training
30:50 - What is self-paced training?
36:08 - How to reduce nociceptive drive
39:26 - How to target the reticulospinal pathway
41:16 - How to target the corticospinal pathway
43:19 - Achilles vs patellar tendinopathy
46:08 - Endurance targets
47:36 - Isometrics and tendon stiffness
50:05 - Where the research is heading

Free resources

Podcast handout: your key takeaways from the podcast, plus the full transcript, so you can remember it and apply it with your patients.
Clinical Edge membership: improve your assessment and treatment results, including the new taping video series with Zoe Russell (Specialist Sports Physiotherapist).
Free running injury resources: for the runners and running injuries you treat.

Free resources

Links associated with this episode

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