Sensory and motor deficits exist on the non-injured side of patients with unilateral tendon pain and disability—implications for central nervous system involvement: a systematic review with meta-analysis

Heales, Luke; Lim, Ee Jean; Hodges, Paul W.; Vicenzino, Bill

doi:10.1136/bjsports-2013-092535

Cited by 107 publications

(82 citation statements)

References 54 publications

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“…Considering that the pathogenesis of tendinopathy is suggested to be a centrally mediated process (with bilateral deficits in unilateral tendinopathy), 17 the finding that in the PT patients the greatest effect of the strap was found in the asymptomatic leg is notable. One explanation could be that in the symptomatic knee pain mechanisms interfere with and influence the effect of the strap.…”

Section: Discussionmentioning

confidence: 93%

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

Vries

Akker‐Scheek

Diercks

et al. 2016

Journal of Science and Medicine in Sport

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Section: Discussionmentioning

confidence: 93%

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

Vries

Akker‐Scheek

Diercks

et al. 2016

Journal of Science and Medicine in Sport

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“…Another possible explanation for bilateral proprioceptive impairment in unilateral knee OA is bilateral sensorimotor changes underpinned by central nervous system processes (e.g., unilateral deconditioning leading to strength or skill adaptations bilaterally) (Heales, Lim, Hodges, & Vicenzino, 2013). Bilateral sensorimotor changes have been reported in other musculoskeletal conditions with unilateral presentation such as anterior cruciate ligament injury (Heales et al, 2013) and lateral epicondylalgia (Heales et al, 2013).…”

Section: The Role Of Local Mechanoreceptor Dysfunction In Proprioceptmentioning

confidence: 98%

Proprioceptive impairments associated with knee osteoarthritis are not generalized to the ankle and elbow joints

Shanahan

Wrigley

Farrell

et al. 2015

Human Movement Science

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“…Future work should consider potential relationships between cause and effect, and whether modification of these patterns through interventions modifies pain and the course of the condition requires investigation. The presence of bilateral changes is consistent with previous work (Heales, Lim, Hodges, & Vicenzino, 2014b) and could be interpreted to suggest that the changes are an epiphenomenon and not a cause of pain, that the bilateral changes may be a consequence of pain, or that the asymptomatic arm is a greater risk for future development of the condition.…”

Section: Perspectivesupporting

confidence: 77%

Towards an understanding of motor system impairments in individuals with unilateral lateral epicondylalgia

Heales¹

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Human grip is commonly used in sport and recreational activities and involves the coordinated activation of forearm muscles. Lateral epicondylalgia (LE) is a common musculoskeletal disorder that involves pathology of the tendon of extensor carpi radialis brevis (ECRB) at its insertion onto the lateral epicondyle of the humerus. LE presents clinically as pain provoked by gripping activities and has a major impact on function. This results in days off work and time off sport. Despite considerable research into the pathophysiology of LE, it remains poorly understood whether forearm muscles activity is altered during gripping in individuals with LE. This thesis aimed to comprehensively understand the extent of current knowledge and provide new data of activity of the wrist/forearm muscles in LE.Study 1 clarifies the current understanding of muscle activity in LE by way of systematic review with quantitative analysis. This review identified that studies of individuals with LE revealed altered motor unit morphology, abnormal patterns of muscle activity during resisted wrist extension and tennis strokes, fewer cortical peaks and less distance between cortical representation of muscles (mapped with transcranial magnetic stimulation), and delayed activation of wrist extensor muscles during gripping, when contrasted to pain-free controls. The latter finding was also present on the asymptomatic limb.Importantly, this systematic review identified limited understanding of gripping despite the clinical importance of this task in provocation of LE. The only study that had investigated muscle activity during this task had severe limitations that compromise the interpretation of the results. Limitations included the use of surface electromyography (which does not record from individual muscles), and performance of sustained contraction with high grip force (50% maximum voluntary contraction), which is likely to be provocative of pain in some individuals with LE.On the basis of some evidence of sensorimotor changes in the asymptomatic limb of individuals with unilateral LE, Study 2 was conducted as a systematic review with meta-analysis to determine the extent bilateral differences in sensorimotor function between individuals with unilateral tendinopathy and pain-free controls. Study 2 identified evidence for several sensory and motor system differences, ii and evidence for tendon pathology in the asymptomatic limb of individuals with other unilateral tendinopathies (Achilles tendinopathy) but not LE when contrasted to pain-free controls.On the foundation that tendon pathology was present in asymptomatic limb of individuals with Achilles tendinopathy, Study 3 investigated whether there was a greater prevalence of tendon pathology of the asymptomatic common extensor tendon of individuals with LE than pain-free controls. Unlike the findings in the Achilles tendon, Study 3 did not identify greater tendon pathology in the asymptomatic limb of individuals with unilateral LE than that present in the tendons of pain-free individ...

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Sensory and motor deficits exist on the non-injured side of patients with unilateral tendon pain and disability—implications for central nervous system involvement: a systematic review with meta-analysis

Cited by 107 publications

References 54 publications

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

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

Proprioceptive impairments associated with knee osteoarthritis are not generalized to the ankle and elbow joints

Towards an understanding of motor system impairments in individuals with unilateral lateral epicondylalgia

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