Pain Sensitivity in Chronic Achilles Tendinopathy

Eckenrode, Brian J.; Kietrys, David M.; Stackhouse, Scott K.

doi:10.26603/ijspt20190945

Cited by 27 publications

(19 citation statements)

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“…Case control studies 30 (Hutchison et al, 2013;Abate & Salini, 2019;Azevedo et al, 2009;Cassel et al, 2018;Chimenti et al, 2016;Chimenti et al, 2020;Coombes et al, 2018;Creaby et al, 2017;Eckenrode, Kietrys & Stackhouse, 2019;Gärdin et al, 2016;Hernández-Sánchez et al, 2018;Jewson et al, 2017;Nadeau et al, 2016;Neeter et al, 2003;De Mesquita et al, 2018;Ooi et al, 2015;Pingel et al, 2013;Rabello et al, 2020;Reid et al, 2012;Reiter et al, 2004;Romero-Morales et al, 2019a;Ryan et al, 2009;Sengkerij...…”

Section: Referencesmentioning

confidence: 99%

“…Of the 30 case-control studies, one (Chimenti et al, 2016) investigated insertional Achilles tendinopathy, 15 studies (Hutchison et al, 2013;Abate & Salini, 2019;Azevedo et al, 2009;Creaby et al, 2017;Gärdin et al, 2016;Nadeau et al, 2016;Neeter et al, 2003;Pingel et al, 2013;Reid et al, 2012;Romero-Morales et al, 2019a;Ryan et al, 2009;Sengkerij et al, 2009;Romero-Morales et al, 2019b) investigated midportion Achilles tendinopathy, nine studies (Chimenti et al, 2020;Coombes et al, 2018;Eckenrode, Kietrys & Stackhouse, 2019;Hernández-Sánchez et al, 2018;Ooi et al, 2015;Rabello et al, 2020;Reiter et al, 2004;Verrall, Schofield & Brustad, 2011;Zhang et al, 2017) investigated both insertional and midportion Achilles tendinopathy, with five studies (Cassel et al, 2018;Jewson et al, 2017;De Mesquita et al, 2018) not specifying tendinopathy location (Table 8). As with the previous study types, the most commonly used diagnostic feature was location of pain, which was utilised in 27 of the case-control studies (Hutchison et al, 2013;Abate & Salini, 2019;Chimenti et al, 2016;Chimenti et al, 2020;Coombes et al, 2018;Creaby et al, 2017;Eckenrode, Kietrys & Stackhouse, 2019;Gärdin et al, 2016;…”

Section: Case-control Studiesmentioning

confidence: 99%

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The clinical diagnosis of Achilles tendinopathy: a scoping review

Matthews

Ellis

Furness

et al. 2021

PeerJ

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Background Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains. Methodology A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures. Results A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured. Conclusions There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.

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Section: Referencesmentioning

confidence: 99%

Section: Case-control Studiesmentioning

confidence: 99%

The clinical diagnosis of Achilles tendinopathy: a scoping review

Matthews

Ellis

Furness

et al. 2021

PeerJ

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“…It is typically accompanied by structural changes visible on ultrasound such as thickening of the tendon, a feature which is present early in the development of pathology [2]. The pain of Achilles tendinopathy may be accompanied by altered central nervous system processing, such as reduced conditioned pain modulation and mechanical secondary hyperalgesia [3,4] although others have argued that Achilles tendinopathy pain is primarily driven by peripheral nociception [5] perhaps as a result of local nociceptive substances [2,6].…”

Section: Introductionmentioning

confidence: 99%

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial

Solomons

Lee

Bruce³

et al. 2020

PLoS ONE

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Background The insertion of filiform needles intramuscularly (a.k.a. intramuscular stimulation/dry needling) has been suggested as a possible treatment for various painful musculoskeletal conditions. Our aim was to answer the question, is intramuscular stimulation more effective than sham intramuscular stimulation/dry needling for the treatment of Achilles tendinopathy? Methods 52 participants with persistent midportion Achilles tendinopathy began and 46 completed one of three treatment protocols which were randomly assigned: (G3) a 12-week rehabilitation program of progressive tendon loading plus intramuscular stimulation (n = 25), (G2) the same rehabilitation program but with sham intramuscular stimulation (n = 19), or (G1) a reference group of rehabilitation program alone (as an additional control) (n = 8). The a priori primary outcome measure was change in VISA-A score at 12 weeks-VISA-A was also measured at 6 weeks, and at 6 and 12 months. Secondary outcome measures include the proportion of patients who rated themselves as much or very much improved (%), dorsiflexion range of motion (degrees), and tendon thickness (mm). Results The study retention was 94% at 12 weeks and 88% at 1 year. VISA-A score improved in all three groups over time (p<0.0001), with no significant difference among the three groups in VISA-A score at the start of the study (mean ± SD: G3 59 ± 13, G2 57 ± 17, G1 56 ± 22), at 12 weeks (G3 76 ± 14, G2 76 ± 15, G1 82 ± 11) or at any other timepoint. The percentage of patients who rated themselves as much or very much improved (i.e. treatment success) was not different after 12 weeks (G3 70%, G2 89%, G1 86% p = 0.94), or at 26 (p = 0.62) or

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“…However, factors that contribute to the development and persistence of AT pain are not well understood. Recent evidence suggests that neurobiological pain processes in the peripheral and central nervous systems (CNS) contribute to chronic AT pain [ 3 - 7 ]. Factors that have been associated with AT include centrally mediated mechanisms such as elevated pain, psychological factors (fear of movement and pain catastrophizing) [ 5 , 8 ], and motor dysfunction (heel raise repetitions reduced by pain) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, there is mixed evidence for the presence of altered CNS regulation of nociceptive processing contributing to AT pain [ 4 , 5 ], with some studies indicating reduced conditioned pain modulation (CPM) and/or widespread decrease in pressure pain [ 6 , 7 ], whereas other studies indicate no difference compared with controls [ 4 , 5 ]. Peripheral mechanisms include nociceptive input, as evidenced by decreased pain pressure threshold (PPT) at the site of pain relative to multiple proximal and contralateral areas [ 4 , 5 , 7 ]. An improved understanding of how different physical therapy treatment approaches affect these mechanisms of AT pain could inform clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Effect of Pain Education and Exercise on Pain and Function in Chronic Achilles Tendinopathy: Protocol for a Double-Blind, Placebo-Controlled Randomized Trial

Post¹,

Rio²,

Sluka³

et al. 2020

JMIR Res Protoc

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Background Achilles tendinopathy (AT) rehabilitation traditionally includes progressive tendon loading exercises. Recent evidence suggests a biopsychosocial approach that incorporates patient education on psychosocial factors and mechanisms of pain can reduce pain and disability in individuals with chronic pain. This is yet to be examined in individuals with AT. Objective This study aims to compare the effects on movement-evoked pain and self-reported function of pain education as part of a biopsychosocial approach with pathoanatomical education for people with AT when combined with a progressive tendon loading exercise program. Methods A single-site, randomized, double-blind, placebo-controlled clinical trial will be conducted in a university-based hospital in a laboratory setting and/or by telehealth. A total of 66 participants with chronic (>3 months) midportion or insertional AT will be randomized for the Tendinopathy Education of the Achilles (TEAch) study. All participants will complete progressive Achilles tendon loading exercises over 12 weeks and will be encouraged to continue with self-selected exercises as tolerated. All participants will complete 6-7 one-to-one sessions with a physical therapist to progress exercises in a standardized manner over 8 weeks. During the last 4 weeks of the intervention, participants will be encouraged to maintain their home exercise program. Participants will be randomized to 1 of 2 types of education (pain education or pathoanatomic), in addition to exercise. Pain education will focus on the biological and psychological mechanisms of pain within a biopsychosocial framing of AT. Pathoanatomic education will focus on biological processes within a more traditional biomedical framework of AT. Evaluation sessions will be completed at baseline and 8-week follow-up, and self-reported outcome measures will be completed at the 12-week follow-up. Both groups will complete progressive Achilles loading exercises in 4 phases throughout the 12 weeks and will be encouraged to continue with self-selected exercises as tolerated. Primary outcomes are movement-evoked pain during heel raises and self-reported function (patient-reported outcome measure information system—Physical Function). Secondary outcomes assess central nervous system nociceptive processing, psychological factors, motor function, and feasibility. Results Institutional review board approval was obtained on April 15, 2019, and study funding began in July 2019. As of March 2020, we randomized 23 out of 66 participants. In September 2020, we screened 267 individuals, consented 68 participants, and randomized 51 participants. We anticipate completing the primary data analysis by March 2022. Conclusions The TEAch study will evaluate the utility of pain education for those with AT and the effects of improved patient knowledge on pain, physical function, and clinical outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/19111

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Pain Sensitivity in Chronic Achilles Tendinopathy

Cited by 27 publications

References 0 publications

The clinical diagnosis of Achilles tendinopathy: a scoping review

The clinical diagnosis of Achilles tendinopathy: a scoping review

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial

Effect of Pain Education and Exercise on Pain and Function in Chronic Achilles Tendinopathy: Protocol for a Double-Blind, Placebo-Controlled Randomized Trial

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