Do patients with chronic patellar tendinopathy have an altered somatosensory profile? – A Quantitative Sensory Testing (QST) study

Abstract

The prevalence of tendinopathies in sports is high. The etiology and pain mechanisms of tendinopathies are not completely understood. Currently, little is known whether, or to which degree, somatosensory changes within the nervous system may contribute to the pain in tendinopathies. We conducted a patient controlled study in which we used the standardized QST protocol developed by the German Research Network on Neuropathic Pain. This protocol consists of seven different tests that measures 13 somatosensory parameters and can be seen as the gold standard to measure somatosensory function. Twelve athletes with clinically diagnosed chronic patellar tendinopathy (PT) mean duration 30 months (range 6-120) and 20 controls were included in the study. In two of the 13 QST parameters namely Mechanical Pain Threshold (P < 0.05) and Vibration Disappearance Threshold (P < 0.5) injured athletes were significantly more sensitive for the applied stimuli. None of the athletes had signs of Dynamic Mechanical Allodynia. Reduced mechanical pain thresholds or pinprick allodynia reflects the involvement of central sensitization upon the myelinated (Aδ-fibre) nociceptive input. From this explorative study, we conclude that sensitization may play a prominent role in the pain during and after sports activity in patella tendinopathy patients.

The effect of a patellar strap on knee joint proprioception in healthy participants and athletes with patellar tendinopathy

“…[18][19][20] On the other hand, sensitisation might also be present in the symptomatic knee. 21 As a result, PT patients may be more responsive to sensory stimulation and thus also have enhanced proprioception in the symptomatic knee. As a patellar strap may influence both -albeit to a different extent -this can lead to less obvious results in the symptomatic knee.…”

Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education

“…It is known that in patients with pain syndromes such as: fibromyalgia (Meeus and Nijs, 2007;Staud, 2011;Vierck, 2006); persisting traumatic neck pain (Herren-Gerber et al, 2004;Jull, Sterling, Kenardy, and Beller, 2007;Sterling, 2008;Sterling, Jull, Vicenzino, and Kenardy, 2003;Sterling, Treleaven, Edwards, and Jull, 2002); tension-type headache (Buchgreitz et al, 2008); migraine (de Tommaso et al, 2012); subacromial impingement syndrome (Paul, Soo Hoo, Chae, and Wilson, 2012); tennis elbow (Coombes, Bisset, and Vicenzino, 2012;FernandezCarnero et al, 2009); nonspecific arm pain (Moloney, Hall, and Doody, 2013); low back pain Roussel et al, 2013;Staud, 2011); pelvic pain (Farmer et al, 2011;Yang et al, 2003); chronic fatigue syndrome (Meeus et al, 2008); osteoarthritis (Mease, Hanna, Frakes, and Altman, 2011;Staud, 2011;Suokas et al, 2012); rheumatoid arthritis (Meeus et al, 2012); and tendinopathy (van Wilgen et al, 2013), the pain often cannot be explained (solely) by an obvious anatomic defect or tissue damage. In fibromyalgia, chronic whiplash, chronic fatigue syndrome, and irritable bowel syndrome CS is merely the predominant underlying pain mechanism (Nijs et al, 2012;Nijs, Van Houdenhove, and Oostendorp, 2010;Staud, 2011).…”

“…According to Woolf and Salter (2000) CS is operationally defined as an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity. CS is characterized by generalized hypersensitivity of the somatosensory system (Coombes, Bisset, and Vicenzino, 2012;Fernandez-Carnero et al, 2009;Moloney, Hall, and Doody, 2013;van Wilgen et al, 2013), resulting in amplification of signaling and eventually even pain without nociceptive input.…”

Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations

“…10,20,31 There is a paucity of literature on this issue, with only 1 study demonstrating reduced mechanical pain threshold in individuals with patellar tendinopathy. 90 Despite the lack of supporting literature, the authors have occasionally encountered typical central sensitization features in patients with patellar tendinopathy, often associated with multiple failed injections and/ or surgery. Careful pain mapping may identify diffuse sensitivity to manual palpation and more diffuse rather than localized pain on tendon loading.…”