Tendon pain is currently very topical in sports medicine. The problem is the physician or interventional radiologist or orthopaedist now have several dilemmas to contend with. Several years ago we had conservative care (which largely consisted of some sort of partial or full immobilisation with lengthy rehabilitation) or surgical with lengthy rehabilitation. Now we have two new dimensions that of injectable substrate and one of image guidance. Sports medicine has certainly become for more complex and controversial than it was even five years ago. The substrates I am talking about are numerous.