Prediction of running-induced Achilles tendinopathy with pain sensitivity – a 1-year prospective study

Abstract Background and aims Achilles tendinopathy is common among runners, but the etiology remains unclear. High mechanical pain sensitivity may be a predictor of increased risk of developing Achilles tendinopathy in this group. The purpose of this study was to investigate whether local pain sensitivity could predict the development of Achilles tendinopathy in recreational male runners. The overall hypothesis was that high pain sensitivity would be related to a higher risk of developing Achilles tendinopathy among recreational male runners. Methods Ninety-nine recreational male runners were recruited and followed prospectively for 1 year. At baseline and after 500 km of running the pressure pain threshold (PPT) was assessed at the infraspinatus and at the Achilles tendon (AT-PPT). Based on the AT-PPT at baseline, a median split was used to divide the runners into two groups. The high pain sensitivity groups was defined as runners displaying a pain pressure threshold below 441 kPa on the Achilles tendon, while the low pain sensitivity group was defined as runners displaying a pain pressure threshold above 441 kPa on the Achilles tendon, respectively. Subsequently, the cumulative risk difference between the two groups was assessed by using the pseudo-observation method. Results High pain sensitivity runners sustained 5%-point (95% CI: −0.18 to 0.08) more Achilles tendinopathy episodes during the first 1,500 km. No significant group differences in risk were found at 100, 250, 500, 1,000 and 1,500 km of running. Conclusions No significant association was found between mechanical pain sensitivity in the Achilles tendon and the risk of developing Achilles tendinopathy. However, the risk difference indicated a association between a high mechanical pain sensitivity and an increased risk of developing Achilles tendinopathy. It is plausible that changes in pain sensitivity were masked by unmeasured covariates, such as the differences in progression/regression of training volume and running speed between the two groups. This study was limited in size, which limited the possibility to account for covariates, such as differences in progression/regression of running speed between runners. With the limitations in mind, future studies should control the training volume, speed and running shoes in the design or account for it in the analysis. Implications Pain sensitivity of the Achilles tendon seems not to be related to an increased risk of developing Achilles pain in relation to running.

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Menthol-Based Topical Analgesic Induces Similar Upper and Lower Body Pain Pressure Threshold Values: A Randomized Trial

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0144 ◽

2021 ◽

pp. 1-7

Author(s):

David G. Behm ◽

Nehara Herat ◽

Gerard M.J. Power ◽

Joseph A. Brosky ◽

Phil Page ◽

...

Keyword(s):

Health Professionals ◽

Pain Sensitivity ◽

Relative Effectiveness ◽

Erector Spinae ◽

Upper Body ◽

Lower Body ◽

Pressure Threshold ◽

Pain Pressure Threshold ◽

Topical Analgesics ◽

Topical Analgesic

Context: Both health professionals and consumers use menthol-based topical analgesics extensively for the temporary relief of pain from musculoskeletal ailments or injury. However, there are no reports of differences in the pain pressure threshold (PPT) or the relative effectiveness of topical analgesics to reduce pain in the upper and lower body muscles and tendons. The objective of this study was to investigate whether differences existed in PPT and relative pain attenuation associated with a menthol-based topical analgesic over a variety of upper and lower body muscles and tendons. Design: Randomized allocation, controlled, intervention study. Methods: Sixteen participants (10 females and 6 males) were tested on their dominant or nondominant side. The order of specific muscle/tendon testing was also randomized, which included upper body (middle deltoid, biceps brachii, and lateral epicondylar tendon) and lower body locations (quadriceps, hamstrings, gastrocnemius, lumbosacral erector spinae muscles, and patellar and Achilles tendons). The PPT was monitored before and 15 minutes following the application of a menthol-based topical analgesic. Results: A menthol-based topical analgesic increased PPT (decreased pain sensitivity) overall (P = .05; 11.6% [2.4%]; d = 1.05) and PPT was higher (P < .0001; 31.5%–44.2%; d = 1.03–1.8) for lower versus upper body locations. Conclusions: Health professionals and the public can be assured of similar reductions in pain sensitivity independent of the location of application of a menthol-based topical analgesic.

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Maximum dorsiflexion increases Achilles tendon force during exercise for midportion Achilles tendinopathy

Scandinavian Journal of Medicine and Science in Sports ◽

10.1111/sms.13974 ◽

2021 ◽

Author(s):

Chia‐Han Yeh ◽

James Calder ◽

Jarrod Antflick ◽

Anthony M.J. Bull ◽

Angela E. Kedgley

Keyword(s):

Achilles Tendon ◽

Achilles Tendinopathy ◽

Tendon Force

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Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: a case series

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000979 ◽

2021 ◽

Vol 7 (1) ◽

pp. e000979

Author(s):

Håkan Alfredson ◽

Lorenzo Masci ◽

Christoph Spang

Keyword(s):

Achilles Tendon ◽

Clinical Symptoms ◽

Fatty Infiltration ◽

Case Series ◽

Achilles Tendinopathy ◽

Level Of Evidence ◽

Plantaris Tendon ◽

Medial Pain ◽

Tendon Insertion ◽

Insertional Achilles Tendinopathy

ObjectivesChronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.MethodsNinety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.ResultsIn 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.ConclusionPlantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidenceIV case series.

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Could Altered Evoked Pain Responsiveness Be a Phenotypic Biomarker for Alzheimer’s Disease Risk? A Cross-Sectional Analysis of Cognitively Healthy Individuals

Journal of Alzheimer s Disease ◽

10.3233/jad-201293 ◽

2020 ◽

pp. 1-7

Author(s):

Raymond R. Romano ◽

Michael A. Carter ◽

Mary S. Dietrich ◽

Ronald L. Cowan ◽

Stephen P. Bruehl ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Healthy Subjects ◽

Pain Sensitivity ◽

Late Onset ◽

Thermal Pain ◽

Apoe4 Allele ◽

Increased Risk ◽

Pain Stimuli ◽

Experimentally Induced

Background: This study evaluated whether the apolipoprotein ɛ4 (APOE4) allele, a genetic marker associated with increased risk of developing late-onset Alzheimer’s disease (AD), was associated with differences in evoked pain responsiveness in cognitively healthy subjects. Objective: The aim was to determine whether individuals at increased risk of late-onset AD based on APOE allele genotype differ phenotypically in their response to experimentally-induced painful stimuli compared to those who do not have at least one copy of the ɛ4 allele. Methods: Forty-nine cognitively healthy subjects aged 30–89 years old with the APOE4 allele (n = 12) and without (n = 37) were assessed for group differences in pain thresholds and affective (unpleasantness) responses to experimentally-induced thermal pain stimuli. Results: Statistically significant main effects of APOE4 status were observed for both the temperature at which three different pain intensity percepts were reached (p = 0.040) and the level of unpleasantness associated with each (p = 0.014). APOE4 positive participants displayed lower overall pain sensitivity than those who were APOE4 negative and also greater overall levels of pain unpleasantness regardless of intensity level. Conclusion: Cognitively healthy APOE4 carriers at increased risk of late-onset AD demonstrated reduced thermal pain sensitivity but greater unpleasantness to thermal pain stimuli relative to individuals at lower risk of late-onset AD. These results suggest that altered evoked pain perception could potentially be used as a phenotypic biomarker of late-onset AD risk prior to disease onset. Additional studies of this issue may be warranted.

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Training volume is associated with pain sensitivity, but not with endogenous pain modulation, in competitive swimmers

Physical Therapy in Sport ◽

10.1016/j.ptsp.2019.04.001 ◽

2019 ◽

Vol 37 ◽

pp. 150-156 ◽

Cited By ~ 2

Author(s):

Kevin Kuppens ◽

Stef Feijen ◽

Nathalie Roussel ◽

Jo Nijs ◽

Patrick Cras ◽

...

Keyword(s):

Pain Sensitivity ◽

Pain Modulation ◽

Training Volume ◽

Endogenous Pain Modulation ◽

Competitive Swimmers

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Mechanotendography in Achillodynia shows reduced oscillation variability of pre-loaded Achilles tendon: a pilot study

European Journal of Translational Myology ◽

10.4081/ejtm.2020.8983 ◽

2020 ◽

Vol 30 (2) ◽

pp. 247-257

Author(s):

Laura Schaefer ◽

Frank Bittmann

Keyword(s):

Achilles Tendon ◽

Rank Correlation ◽

Achilles Tendinopathy ◽

The Body ◽

Mechanical Pressure ◽

Mechanical Oscillations ◽

Pressure Impact ◽

The Subject ◽

The Mean ◽

Intrapersonal Variability

The present study focuses on an innovative approach in measuring the mechanical oscillations of pre-loaded Achilles tendon by using Mechanotendography (MTG) during application of a short yet powerful mechanical pressure impact. This was applied on the forefoot from the plantar side in direction of dorsiflexion, while the subject stood on the ball of the forefoot on one leg. Participants with Achilles tendinopathy (AT; n = 10) were compared to healthy controls (Con; n = 10). Five trials were performed on each side of the body. For evaluation, two intervals after the impulse began (0-100ms; 30-100ms) were cut from the MTG and pressure raw signals. The intrapersonal variability between the five trials in both intervals were evaluated using the arithmetic mean and coefficient of variation of the mean correlation (Spearman rank correlation) and the normalized averaged mean distances, respectively. The AT-group showed a significantly reduced variability in MTG compared to the Con-group (from p = 0.006 to p = 0.028 for different parameters). The 95% confidence intervals (CI) of MTG results were disjoint, whereas the 95% CIs of the pressure signals were similar (p = 0.192 to p = 0.601). We suggest from this work that the variability of mechanical tendon oscillations could be an indicative parameter of an altered Achilles tendon functionality.

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The Effect of Obesity on Achilles Rupture Repair

Foot & Ankle Specialist ◽

10.1177/1938640018816376 ◽

2018 ◽

Vol 12 (6) ◽

pp. 503-512 ◽

Cited By ~ 1

Author(s):

Jeffery S. Hillam ◽

Neil Mohile ◽

Niall Smyth ◽

Jonathan Kaplan ◽

Amiethab Aiyer

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Wound Dehiscence ◽

Comorbid Conditions ◽

Improvement Program ◽

Acs Nsqip ◽

Achilles Tendon Repair ◽

Increased Risk ◽

American College Of Surgeons ◽

Tendon Ruptures

Introduction. Obesity is an increasingly common comorbidity that may negatively affect outcomes following orthopaedic surgery. It is valuable to determine whether obese patients are vulnerable for postoperative complications. The purpose of this study was to analyze data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to determine the effect of obesity on surgical treatment of Achilles tendon ruptures. Methods. Patients who underwent a surgical repair of the Achilles tendon were retrospectively identified through the ACS NSQIP. The patients were divided into 2 cohorts (obese and nonobese), then perioperative and postoperative factors were evaluated for association with obesity. Results. A total of 2128 patients were identified, of whom 887 (41.7%) were classified as obese. Obesity correlated with an increased operative time, 60.9 versus 56.1 minutes. The only postoperative complication associated with obesity was wound dehiscence. Logistic regression adjusted for comorbid conditions demonstrated that obesity was not associated with an increased risk of wound dehiscence. Conclusion. A large segment of the patient population undergoing Achilles tendon repair is obese. Obesity was found to have an increased association with wound dehiscence, likely related to comorbid conditions, following Achilles tendon repair. Obesity was not significantly associated with any other complication. Levels of Evidence: III, Retrospective Cohort Study

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1628 Vaccination for Safe Surgery During The SARS-Cov-2 Pandemic: Modelling Study

British Journal of Surgery ◽

10.1093/bjs/znab258.064 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

Keyword(s):

General Population ◽

Elective Surgery ◽

Risk Difference ◽

Cancer Surgery ◽

Number Needed To Treat ◽

Worst Case ◽

Registration Data ◽

Increased Risk ◽

One Year ◽

The Impact

Abstract Introduction Compared to the general population, in the postoperative period, surgical patients are both at increased risk of SARS-CoV-2 infection and increased mortality in the event of SARS-CoV-2 infection. This study modelled the impact of preoperative vaccination of patients aged ≥70 years having elective inpatient surgery. Method The primary outcome was the number needed to treat (NNT) to prevent one death over one year following SARS-CoV-2 vaccination. Postoperative SARS-CoV-2 incidence and adjusted mortality risk difference for SARS-CoV-2 infection were estimated from the prospective GlobalSurg-CovidSurg Week study (90,146 elective surgery patients across 1,595 hospitals in 115 countries), were used to estimate lives saved by vaccination in the first 30 postoperative days. SARS-CoV-2 case and death registration data from the Office for National Statistics was used to estimate NNTs for the general population. Best and worst-case scenarios were used to describe uncertainty around estimates. Results Among patients aged ≥70 years undergoing any type of surgery, NNT was estimated to be 332 (best case: 213; worst case: 690). NNT was lower in the cancer surgery subgroup (245 [150-545]). This was more favourable than the NNT for vaccination of the general population aged ≥70 (588 [403-1032]). Globally, vaccinating elective surgery patients aged ≥70 years preoperatively was projected to save 27,356 lives in one year compared to vaccinating the same patients after surgery. Conclusions Preoperative pathways should be set up for the vaccination of patients aged ≥70. In settings with limited vaccine availability, elective cancer surgery patients should be prioritised for vaccination.

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Continued Sports Activity, Using a Pain-Monitoring Model, during Rehabilitation in Patients with Achilles Tendinopathy

The American Journal of Sports Medicine ◽

10.1177/0363546506298279 ◽

2007 ◽

Vol 35 (6) ◽

pp. 897-906 ◽

Cited By ~ 138

Author(s):

Karin Grävare Silbernagel ◽

Roland Thomeé ◽

Bengt I. Eriksson ◽

Jon Karlsson

Keyword(s):

Standard Deviation ◽

Exercise Training ◽

Achilles Tendon ◽

Primary Outcome ◽

Initial Period ◽

Treatment Protocol ◽

Training Group ◽

Achilles Tendinopathy ◽

Monitoring Model

Background Achilles tendinopathy is a common overuse injury, especially among athletes involved in activities that include running and jumping. Often an initial period of rest from the pain-provoking activity is recommended. Purpose To prospectively evaluate if continued running and jumping during treatment with an Achilles tendon-loading strengthening program has an effect on the outcome. Study Design Randomized clinical control trial; Level of evidence, 1. Methods Thirty-eight patients with Achilles tendinopathy were randomly allocated to 2 different treatment groups. The exercise training group (n = 19) was allowed, with the use of a pain-monitoring model, to continue Achilles tendon-loading activity, such as running and jumping, whereas the active rest group (n = 19) had to stop such activities during the first 6 weeks. All patients were rehabilitated according to an identical rehabilitation program. The primary outcome measures were the Swedish version of the Victorian Institute of Sports Assessment—Achilles questionnaire (VISA-A-S) and the pain level during tendon-loading activity. Results No significant differences in the rate of improvements were found between the groups. Both groups showed, however, significant (P < .01) improvements, compared with baseline, on the primary outcome measure at all the evaluations. The exercise training group had a mean (standard deviation) VISA-A-S score of 57 (15.8) at baseline and 85 (12.7) at the 12-month follow-up (P < .01). The active rest group had a mean (standard deviation) VISA-A-S score of 57 (15.7) at baseline and 91 (8.2) at the 12-month follow-up (P < .01). Conclusions No negative effects could be demonstrated from continuing Achilles tendon-loading activity, such as running and jumping, with the use of a pain-monitoring model, during treatment. Our treatment protocol for patients with Achilles tendinopathy, which gradually increases the load on the Achilles tendon and calf muscle, demonstrated significant improvements. A training regimen of continued, pain-monitored, tendon-loading physical activity might therefore represent a valuable option for patients with Achilles tendinopathy.

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Pain Pressure Threshold in Cluster Headache Patients

Cephalalgia ◽

10.1046/j.1468-2982.1996.1601052.x ◽

1996 ◽

Vol 16 (1) ◽

pp. 62-66 ◽

Cited By ~ 14

Author(s):

G Bono ◽

F Antonaci ◽

G Sandrini ◽

E Pucci ◽

G Nappi ◽

...

Keyword(s):

Cluster Headache ◽

Pain Perception ◽

Perception Threshold ◽

Temporal Muscle ◽

Mean Values ◽

Pressure Threshold ◽

Pain Pressure Threshold ◽

Pressure Algometer ◽

Symmetrical Points ◽

Symptomatic Side

Pain perception threshold (PFT) in the head was assessed with a pressure algometer in 58 cluster headache (CH) patients (52M, 6F; 41 episodic and 17 chronic). Fourteen patients in cluster period were retested in remission. Thresholds were assessed at 10 symmetrical points on each side of the head and at the deltoid. Compared with controls ( n = 80), CH patients had lower PPT in the head and in the deltoid. PPT was lower on the symptomatic side than on the non-symptomatic side in patients with episodic CH during a cluster period ( p<0.001) and in patients with chronic CH ( p<0.05). This pattern was more evident during a cluster period than during remission ( p<0.05). A reduced PPT did not correlate with illness duration and pain side. The lowest PPT mean values were found at the anterior and intermediate levels of the temporal muscle on the symptomatic side. These results imply a central mechanism underlying the pathogenesis of CH.

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