• tendon
• tendinopathy
• muscle

You can pick up any recent issue of BJSM and a consistent theme arises: exercise is good. Whether we are talking rehabilitation, performance or prevention, exercise is medicine. Mechanotransduction is central to adaptation where local cells detect mechanical stimuli and respond positively to increase the load capacity of the tissue.1 However, our understanding of adaptation and how certain tissues increase their load capacity is incomplete. Furthermore, when discussing adaptation and load capacity of the pathological and painful tendon, research has primarily focused on the local tissue, with little appreciation for the involvement of multiple systems involved in adaptation.

Pathology and pain in musculoskeletal medicine are poorly linked. A large proportion of the asymptomatic population exhibit pathology on imaging.2 3 This highlights several things (that are not new):

1. we have no gold standard of diagnosis (it cannot be imaging for most tissues, as pathology on imaging is evident in people without symptoms);

2. pain is complex, and not always linked to nociception;

3. lastly, and the focus of this piece—that the body is capable of achieving pain-free function due to adaptation in response …