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Kraszewski A, Argentieri E, Harris K, Toresdahl B, Drakos M, Hillstrom H, Allen A, Nwawka OK. Association Between Patellar Tendon Abnormality and Land-Jump Biomechanics in Male Collegiate Basketball Players During the Preseason. Orthop J Sports Med 2024; 12:23259671241242008. [PMID: 38686323 PMCID: PMC11057346 DOI: 10.1177/23259671241242008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 05/02/2024] Open
Abstract
Background Patellar tendinopathy is a degenerative condition that predominantly affects jumping athletes. Symptoms may be subtle or nonexistent at preseason, but structural abnormalities may be present. Assessing patellar tendon abnormality (PTA) through magnetic resonance imaging (MRI) and ultrasound (US) and classifying symptoms using the Victorian Institute for Sport Assessment-Patellar tendon (VISA-P) may provide useful insights if combined with biomechanics measurements. Purpose To (1) assess whether land-jump biomechanical patterns are associated with clinically pertinent PTA as seen on imaging and through VISA-P scores and (2) model the contributing risk and accuracy of biomechanics to classify PTA and symptomatic observations. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 26 National Collegiate Athletic Association Division I and II male basketball players (n = 52 limbs) were recruited during the preseason. We collected VISA-P scores, bilateral PTA through US and MRI morphology measurements, and bilateral 3-dimensional lower extremity kinematics and kinetics measurements from a land-jump test from an 18-inch-high (45.7-cm-high) box. Statistically, each limb was treated independently. The association of biomechanics with PTA and symptoms (VISA-P score <80) was tested with multivariate models and post hoc tests. Logistic regression modeled relative risk and accuracy of biomechanical variables to classify PTA and symptomatic limbs. Results There were 19 to 24 limbs with PTA depending on US and MRI measurements. Differences in hip and knee kinematic strategies and ground-reaction loads were associated with PTA and symptomatic limbs. Peak landing vertical ground-reaction force was significantly decreased (169 ± 26 vs 195 ± 29 %body weight; P = .001), and maximum hip flexion velocity was significantly increased (416 ± 74 vs 343 ± 94 deg/s; P = .005) in limbs with versus without PTA on imaging. Knee flexion at the initial contact was decreased in symptomatic versus healthy limbs (17°± 5° vs 21°± 5°, respectively; P = .045). Regression models classified PTA limbs and symptomatic limbs with 71.2% to 86.5% accuracy. Hip and knee maximum flexion velocity and vertical ground-reaction force variables were most common across models observing clinically pertinent PTA. Conclusion Our findings suggested that functional kinematic and kinetic biomechanical strategies at the hip and knee were associated with PTA, identified on imaging, and symptomatic limbs.
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Affiliation(s)
| | - Erin Argentieri
- University of California–Berkeley, Berkeley, California, USA
| | - Kindred Harris
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | - Mark Drakos
- Hospital for Special Surgery, New York, New York, USA
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Sara LK, Gutsch SB, Bement MH, Hunter SK. Plantar Flexor Weakness and Pain Sensitivity Cannot Be Assumed in Midportion Achilles Tendinopathy. EXERCISE, SPORT, & MOVEMENT 2023; 1:1-7. [PMID: 38222444 PMCID: PMC10786321 DOI: 10.1249/esm.0000000000000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Introduction/Purpose The purpose of this study was to determine the following in persons with midportion Achilles tendinopathy (AT): 1) maximal strength and power; 2) neural drive during maximal contractions and contractile function during electrically evoked resting contractions; and 3) whether pain, neural drive, and contractile mechanisms contribute to differences in maximal strength. Methods Twenty-eight volunteers (14 AT, 14 controls) completed isometric, concentric, and eccentric maximal voluntary contractions (MVCs) of the plantar flexors in a Biodex™ dynamometer. Supramaximal electrical stimulation of the tibial nerve was performed to quantify neural drive and contractile properties of the plantar flexors. Pain sensitivity was quantified as the pressure-pain thresholds of the Achilles tendon, medial gastrocnemius, and upper trapezius. Results There were no differences in plantar flexion strength or power between AT and controls (isometric MVC: P = 0.95; dynamic MVC: P = 0.99; power: P = 0.98), nor were there differences in neural drive and contractile function (P = 0.55 and P = 0.06, respectively). However, the mechanisms predicting maximal strength differed between groups: neural drive predicted maximal strength in controls (P = 0.02) and contractile function predicted maximal strength in AT (P = 0.001). Although pain did not mediate these relationships (i.e., between maximal strength and its contributing mechanisms), pressure-pain thresholds at the upper trapezius were higher in AT (P = 0.02), despite being similar at the calf (P = 0.24) and Achilles tendon (P = 0.40). Conclusions There were no deficits in plantar flexion strength or power in persons with AT, whether evaluated isometrically, concentrically, or eccentrically. However, the mechanisms predicting maximal plantar flexor strength differed between groups, and systemic pain sensitivity was diminished in AT.
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Affiliation(s)
- Lauren K Sara
- Harvard Medical School, Cambridge, MA, USA
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Savannah B Gutsch
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | | | - Sandra K Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
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Çelik Ö, Şencan S. Bracing or kinesio taping in the management of lateral elbow tendinopathy: A prospective, randomized single-blinded trial. J Bodyw Mov Ther 2023; 36:235-243. [PMID: 37949566 DOI: 10.1016/j.jbmt.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 06/01/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim of the study was to compare the effects of forearm counter force brace (FCB) and kinesio taping (KT) on pain severity, grip strength and functionality of patients with lateral elbow tendinopathy (LET). METHODS The study was planned as a prospective, randomized and assessor-blinded study with 1-month follow-up period. Seventy-two patients, diagnosed as LET were randomly assigned to FCB (n = 41) or KT (n = 31) groups. In the FCB group, the patients were informed and instructed to wear the brace for three weeks continuously. In the KT group, tape was applied once a week for four weeks with muscle inhibition and fascia correction techniques. The outcome measures were pain pressure threshold (PPT), maximal pain-free hand grip strength measurement and patient-rated tennis elbow evaluation questionnaire (PRTEE). The assessments were performed at the baseline, immediately after treatment and one month later after treatment. RESULTS PPT and grip strength were significantly increased over time in both groups. Pain, function and total scores of PRTEE were significantly decreased in both FCB and KT groups. The effect size of the improvement in PRTEE function score was within acceptable clinical significance in the KT group. However, there was no significant difference between groups. CONCLUSIONS Pain severity, grip strength and functionality of patients with LET improved over time in both FCB and KT groups. However, neither was superior in the management of LET.
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Affiliation(s)
- Öznur Çelik
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkiye.
| | - Süreyya Şencan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkiye
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Plaza-Manzano G, Fernández-de-Las-Peñas C, Cleland JA, Arias-Buría JL, Jayaseelan DJ, Navarro-Santana MJ. A Closer Look at Localized and Distant Pressure Pain Hypersensitivity in People With Lower Extremity Overuse Soft-Tissue Painful Conditions: A Systematic Review and Meta-Analysis. Phys Ther 2022; 102:pzac119. [PMID: 36124704 DOI: 10.1093/ptj/pzac119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/25/2022] [Accepted: 07/07/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The nociceptive pain processing of soft-tissue overuse conditions is under debate because no consensus currently exists. The purpose of this meta-analysis was to compare pressure pain thresholds (PPTs) in symptomatic and distant pain-free areas in 2 groups: participants with symptomatic lower extremity overuse soft-tissue conditions and controls who were pain free. METHODS Five databases were searched from inception to December 1, 2021, for case-control studies comparing PPTs between individuals presenting with symptomatic lower extremity tendinopathy/overuse injury and controls who were pain free. Data extraction included population, diagnosis, sample size, outcome, type of algometer, and results. The methodological quality (Newcastle-Ottawa Quality Assessment Scale) and evidence level (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Meta-analyses of symptomatic, segmental related, and distant pain-free areas were compared. RESULTS After screening 730 titles and abstracts, a total of 19 studies evaluating lower extremity overuse conditions (Achilles or patellar tendinopathy, greater trochanteric pain syndrome, plantar fasciitis, and iliotibial band syndrome) were included. The methodological quality ranged from fair (32%) to good (68%). Participants with lower extremity overuse injury had lower PPTs in both the painful and nonpainful areas, mirrored test-site, compared with controls (affected side: mean difference [MD] = -262.92 kPa, 95% CI = 323.78 to -202.05 kPa; nonaffected side: MD = -216.47 kPa, 95% CI = -304.99 to -127.95 kPa). Furthermore, people with plantar fasciitis showed reduced PPTs in the affected and nonaffected sides at segmental-related (MD = -176.39 kPa, 95% CI = -306.11 to -46.68 kPa) and distant pain-free (MD = -97.27 kPa, 95% CI = 133.21 to -61.33 kPa) areas compared with controls. CONCLUSION Low- to moderate-quality evidence suggests a reduction of PPTs at the symptomatic area and a contralateral/mirror side in lower extremity tendinopathies and overuse conditions compared with pain-free controls, particularly in plantar fasciitis and greater trochanteric pain syndrome. Participants with plantar fasciitis showed a reduction of PPTs on the affected and non-affected sides at a segmental-related area (very low-quality evidence) and at a remote asymptomatic area (moderate-quality evidence). IMPACT Some overuse peripheral pain conditions may be more associated with pressure pain sensitivity than others. Accordingly, examination and identification of conditions more peripherally, centrally, or mixed mediated could potentially lead to more specific and different treatment strategies.
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Affiliation(s)
- Gustavo Plaza-Manzano
- Radiology, Rehabilitation and Physiotherapy Department, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain
- Cátedra Institucionalen Docencia, Clínica e Investigaciónen Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Madrid, Spain
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - José L Arias-Buría
- Radiology, Rehabilitation and Physiotherapy Department, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Dhinu J Jayaseelan
- Department of Health, Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC, USA
| | - Marcos J Navarro-Santana
- Faculty of Health, Universidad Católica de Ávila (UCAV), Calle Canteros s/n, Ávila, Spain
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, Spain
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Association between Body Weight and Body Mass Index and Patellar Tendinopathy in Elite Basketball and Volleyball Players, a Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10101928. [PMID: 36292375 PMCID: PMC9601617 DOI: 10.3390/healthcare10101928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022] Open
Abstract
The features of Patellar-Tendinopathy are (1): pain localised to the inferior pole of the patellar; (2): the presence of load-related pain. Body-Weight and Body-Mass-Index, as two easily-measured variables, could potentially aid the prediction of PT. This review aims to establish relationships between Body-Weight and Body-Mass-Index and Patellar-Tendinopathy via synthesising the evidence from prospective-cohort and cross-sectional studies in elite basketball and volleyball players. Seven databases (PubMed, EMBASE, CINAHL, Google Scholar, Health-Management-Information-Consortium, National-Technical-Information-Service, ClinicalTrial.gov) and citation chasing were used to identify English peer-review articles from 2000 to 2022. An adapted version of the Newcastle-Ottawa scale was used for critical appraisal. Two reviewers were involved in literature searching, data extraction, and quality review. Two prospective cohort and five cross-sectional studies met the inclusion criteria, providing 849 subjects (male:female: 436:413). Five studies found BW is associated with PT. Three studies found a relationship between BMI and PT. Six out of seven studies were classified as very good studies. All studies were level IV evidence. The very low certainty evidence suggests an association between BW and PT. There is moderate certainty evidence that BMI is associated with PT. These preliminary findings should be treated cautiously due to the lack of strong evidence.
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Previtali D, Mameli A, Zaffagnini S, Marchettini P, Candrian C, Filardo G. Tendinopathies and Pain Sensitisation: A Meta-Analysis with Meta-Regression. Biomedicines 2022; 10:1749. [PMID: 35885054 PMCID: PMC9313266 DOI: 10.3390/biomedicines10071749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 12/02/2022] Open
Abstract
The presence of pain sensitisation has been documented and reported as being a possible cause of treatment failure and pain chronicity in several musculoskeletal conditions, such as tendinopathies. The aim of the present study is to analyse existing evidence on pain sensitisation in tendinopathies comparing the local and distant pain thresholds of healthy and affected subjects with distinct analysis for different tendinopathies. PubMed, Cochrane Central Register, Scopus, and Web Of Science were systematically searched after registration on PROSPERO (CRD42020164124). Level I to level IV studies evaluating the presence of pain sensitisation in patients with symptomatic tendinopathies, documented through a validated method, were included. A meta-analysis was performed to compare local, contralateral, and distant pain thresholds between patients and healthy controls with sub-analyses for different tendinopathies. Meta-regressions were conducted to evaluate the influence of age, activity level, and duration of symptoms on results. Thirty-four studies out of 2868 were included. The overall meta-analysis of local pressure pain thresholds (PPT) documented an increased sensitivity in affected subjects (p < 0.001). The analyses on contralateral PPTs (p < 0.001) and distant PPTs (p = 0.009) documented increased sensitivity in the affected group. The results of the sub-analyses on different tendinopathies were conflicting, except for those on lateral epicondylalgia. Patients’ activity level (p = 0.02) and age (p = 0.05) significantly influenced local PPT results. Tendinopathies are characterized by pain sensitisation, but, while features of both central and peripheral sensitisation can be constantly detected in lateral epicondylalgia, results on other tendinopathies were more conflicting. Patients’ characteristics are possible confounders that should be taken into account when addressing pain sensitisation.
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Affiliation(s)
- Davide Previtali
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland; (A.M.); (C.C.); (G.F.)
| | - Alberto Mameli
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland; (A.M.); (C.C.); (G.F.)
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Paolo Marchettini
- Fisiopatologia e Terapia del Dolore, Dipartimento di Farmacologia, Careggi Università di Firenze, 50134 Firenze, Italy;
- Terapia del Dolore, Centro Diagnostico Italiano, 20147 Milan, Italy
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland; (A.M.); (C.C.); (G.F.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland; (A.M.); (C.C.); (G.F.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Foot and Lower Limb Clinical and Structural Changes in Overuse Injured Recreational Runners Using Floating Heel Shoes: Preliminary Results of a Randomised Control Trial. SENSORS 2021; 21:s21237814. [PMID: 34883818 PMCID: PMC8659959 DOI: 10.3390/s21237814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/19/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
Foot-strike and the associated load rate are factors related to overuse injuries in runners. The purpose of this study was to analyse structural and functional changes in runners using floating heel running shoes, compared with runners using conventional footwear. A randomised control trial was conducted. Twenty runners with overuse injuries were followed over a 12-week gait retraining programme using floating heel running shoes or their conventional footwear. Pain was measured with pressure pain thresholds (PPTs), structural changes were measured with ultrasonography, and severity and impact of injury was scored on the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC-O). Statistical differences were found between groups after the intervention (p < 0.001), with a medium size effect SE = 0.8, and the floating heel running shoes group reached higher PPTs values. Participants using floating heel running shoes showed higher OSTRC-O scores than those using their conventional footwear (p < 0.05), with higher scores after the intervention (p < 0.05). A 12-week gait retraining programme using floating heel running shoes had positive effects on the injury recovery process when compared to the use of conventional footwear, with significant differences in terms of pain and impact on sports activity.
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Plinsinga ML, Meeus M, Brink M, Heugen N, van Wilgen P. Evidence of Widespread Mechanical Hyperalgesia but Not Exercise-Induced Analgesia in Athletes With Mild Patellar Tendinopathy Compared With Pain-Free Matched Controls: A Blinded Exploratory Study. Am J Phys Med Rehabil 2021; 100:946-951. [PMID: 33350645 DOI: 10.1097/phm.0000000000001673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to assess centrally induced pain processing with pressure pain thresholds bilaterally and remotely in active volleyball and basketball athletes with mild patellar tendinopathy compared with asymptomatic control athletes. Secondary objective was to explore the role of exercise-induced analgesia during a training session in athletes with patellar tendinopathy. DESIGN In this exploratory study, pressure pain thresholds of 21 patellar tendinopathy athletes and 16 age- and sex-matched asymptomatic team members were measured by a blinded assessor bilaterally on the patellar tendon and unilaterally on the elbow extensor tendon with a pressure algometer before, during, and after a regular training session. RESULTS Patellar tendinopathy athletes had a significantly higher average body mass index compared with asymptomatic athletes (mean difference 1.75 kg/m2; 95% confidence interval = 0.35-3.15, P = 0.02). At baseline, athletes with patellar tendinopathy showed lowered pressure pain thresholds in the affected knee (P = 0.001), unaffected knee (P < 0.001), and elbow (P = 0.01) compared with controls. No clear patterns were identified to explain between-group differences in pressure pain thresholds before, during, and after exercise. CONCLUSIONS This exploratory study found primary and secondary mechanical hyperalgesia in athletes with patellar tendinopathy compared with asymptomatic athletes. Further research is required on the effects of an acute exercise bout on pain thresholds in this population.
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Affiliation(s)
- Melanie Louise Plinsinga
- From The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia, Queensland, Australia (MLP); Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (MM); Pain in Motion International Research Group, Brussels, Belgium (MM, PvW); Movant Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium (MM); Centre for Human Movement Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands (MB, NH); Transcare Transdisciplinary Pain Management Centre, Groningen, the Netherlands (PvW); and Department of Physiotherapy and Rehabilitation Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium (PvW)
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Mansur NSB, Pereira VF, Cunha HCM, Nunes CG, Ferreira DS, Sato VN, Yamada AF, Matsunaga FT, Belloti JC, Tamaoki MJS. DIAGNOSIS OF THE ACHILLES INSERTIONAL TENDINOPATHIES BY ALGOMETRY. PAIN MEDICINE 2021; 22:2670-2675. [PMID: 34387348 DOI: 10.1093/pm/pnab255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Diagnosis of Achilles insertional tendinopathies (AIT) is based on pain by tendon palpation. However, there is no consensus or standard regarding the amount of force to be used during the evaluation. The algometry is a method of measuring the pressure applied in a specific region and can be a method for determining diagnosis values. GOAL To determine a cut-off value for Pain Threshold (PT) in the assessment of AIT. DESIGN This is a prospective case-control study of diagnostic accuracy, to develop a diagnostic criterion. METHODS Forty asymptomatic individuals and forty patients with insertional Achilles tendinopathy, matched by age and sex, were evaluated, and submitted to algometry for PT and for Visual Analogical Scale (VAS) levels with 3 kg/f at the insertion of the calcaneal tendon by two different evaluators. Inter-observer reproducibility was accessed through the interclass correlation index (ICC). Sensitivity and specificity calculation of PT and of VAS were calculated and plotted on a ROC (Receiver Operator Characteristic) curve. RESULTS The lowest ICC found was 0.788. Regarding the diagnosis through TP, the 4.08 kg/f mark showed the best relation between sensitivity and specificity (92.5% and 92.5%, respectively). Algometry values lower than 4.08 were considered positive for disease. For the diagnosis of TIA through VAS with 3 kg/f, the value of 2.98 was determined (sensitivity of 92.5% and specificity of 97.5%). CONCLUSION The algometry showed to be a simple and reliable method for diagnosing AIT. Values for PT under 4.08 kg/f were found predictors of the disease.
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Affiliation(s)
| | - Vinícius Felipe Pereira
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo
| | | | - Carlos Gilberto Nunes
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo
| | - Danilo Santos Ferreira
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo
| | - Vitor Neves Sato
- Department of Radiology, Escola Paulista de Medicina, Federal University of São Paulo
| | | | - Fabio Teruo Matsunaga
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo
| | - João Carlos Belloti
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo
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Flix-Díez L, Delicado-Miralles M, Gurdiel-Álvarez F, Velasco E, Galán-Calle M, Lerma Lara S. Reversed Polarity bi-tDCS over M1 during a Five Days Motor Task Training Did Not Influence Motor Learning. A Triple-Blind Clinical Trial. Brain Sci 2021; 11:brainsci11060691. [PMID: 34070256 PMCID: PMC8225177 DOI: 10.3390/brainsci11060691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 12/04/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been investigated as a way of improving motor learning. Our purpose was to explore the reversal bilateral tDCS effects on manual dexterity training, during five days, with the retention component measured after 5 days to determine whether somatosensory effects were produced. In this randomized, triple-blind clinical trial, 28 healthy subjects (14 women) were recruited and randomized into tDCS and placebo groups, although only 23 participants (13 women) finished the complete protocol. Participants received the real or placebo treatment during five consecutive days, while performing a motor dexterity training program of 20 min. The motor dexterity and the sensitivity of the hand were assessed pre- and post-day 1, post 5 days of training, and 5 days after training concluded. Training improved motor dexterity, but tDCS only produced a tendency to improve retention. The intervention did not produce changes in the somatosensory variables assessed. Thus, reversal bi-tDCS had no effects during motor learning on healthy subjects, but it could favor the retention of the motor skills acquired. These results do not support the cooperative inter-hemispheric model.
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Affiliation(s)
- Laura Flix-Díez
- Department of Physical Therapy, University of Valencia (UV), 46003 Valencia, Spain;
| | - Miguel Delicado-Miralles
- Instituto de Neurociencias de Alicante (UMH-CSIC), 03550 Sant Joant d’Alacant, Spain; (M.D.-M.); (E.V.)
| | - Francisco Gurdiel-Álvarez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine University of Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - Enrique Velasco
- Instituto de Neurociencias de Alicante (UMH-CSIC), 03550 Sant Joant d’Alacant, Spain; (M.D.-M.); (E.V.)
| | - María Galán-Calle
- Health Sciences Faculty, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain;
| | - Sergio Lerma Lara
- Health Sciences Faculty, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain;
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Correspondence: ; Tel.: +34-91-5035900 (ext. 255)
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Comparison of Pain Measures Between Tendons of Elite Basketball Players With Different Sonographic Patterns. J Sport Rehabil 2021; 29:142-147. [PMID: 30526260 DOI: 10.1123/jsr.2018-0240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/04/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT The prevalence and negative consequences of the symptoms surrounding patellar tendinopathy constitute an important problem for sports medicine professionals. The identification of potential pain mediators is, therefore, of major interest to improve both the prevention and management of this injury. OBJECTIVE To compare the pain experienced by elite male adult basketball players and patterns of patellar tendon abnormalities. Also, to identify whether structural and vascular sonographic abnormalities (focal area of hypoechogenicity, thickening, and neovascularization [NV]) are equal in determining pain perceptions. DESIGN An observational study with professional basketball teams (ACB-Spanish league). PARTICIPANTS A total of 73 male basketball players (mean age 26.8 y). MAIN OUTCOME MEASURES Patellar tendon ultrasonography images. Pain scores were compared between the identified patterns. Multiple regression analysis was used to examine the relative importance of abnormalities. RESULTS Of the 146 tendons, 91 had some degree of sonographic abnormality. Three main patterns were identified: I (1 structural abnormality without NV), II (2 structural abnormalities without NV), and III (2 structural abnormalities and NV). A total of 31 tendons (21.2%) exhibited pattern I, 46 (31.5%) presented pattern II, and 13 tendons (8.9%) exhibited pattern III. The mean visual analog scale and the Victorian Institute of Sport assessment questionnaire-patellar tendon (VISA-P) scores for pattern III were significantly different (P < .05) compared with patterns I and II; however, the pain pressure threshold (PPT) scores were not. NV was significantly associated with worsened scores for all pain measures; however, the focal area of hypoechogenicity was only associated with PPT scores. CONCLUSION Patterns of sonographic abnormalities, including NV, demonstrated greater pain. Although NV determined scores for the visual analog scale, VISA-P, and PPT, the presence of focal area of hypoechogenicity on its own is a determining factor for the PPT. This study suggests that the combination of 2 or more sonographic abnormalities may help explain pain variations among basketball players.
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Sensory Processing in People With and Without Tendinopathy: A Systematic Review With Meta-analysis of Local, Regional, and Remote Sites in Upper- and Lower-Limb Conditions. J Orthop Sports Phys Ther 2021; 51:12-26. [PMID: 33383996 DOI: 10.2519/jospt.2021.9417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To synthesize results of somatosensory processing tests in people with upper- and lower-limb tendinopathy, compared to controls. DESIGN Systematic review with meta-analysis. LITERATURE SEARCH Four electronic databases (MEDLINE, CINAHL Plus, SPORTDiscus, and Embase) were searched. STUDY SELECTION CRITERIA Included studies measured a domain of sensory processing and compared a tendinopathy group to a healthy control group. DATA SYNTHESIS Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Upper- and lower-limb conditions were compared and outcomes were examined by measurement site (local, regional, or remote to location of pain). RESULTS Of the 30 studies included, 18 investigated lateral elbow tendinopathy. The most commonly assessed outcome measures were pressure pain threshold (PPT) and thermal pain threshold. There was moderate evidence for local and regional reduction of PPT in upper-limb tendinopathies, but not at remote sites. In lower-limb tendinopathies, there was conflicting evidence regarding reduced PPT at local sites and limited evidence of normal PPT at remote sites. There was moderate evidence of sensitization of thermal pain threshold at local sites in upper-limb tendinopathies and limited evidence of no difference in thermal pain threshold in lower-limb tendinopathies. Findings across other domains were variable. CONCLUSION Sensory processing was different between upper-limb tendinopathy and lower-limb tendinopathy. Upper-limb tendinopathies showed signs consistent with primary and secondary hyperalgesia, but lower-limb tendinopathies did not. There was mixed evidence for primary hyperalgesia and limited evidence against secondary hyperalgesia. J Orthop Sports Phys Ther 2021;51(1):12-26. doi:10.2519/jospt.2021.9417.
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Extracorporeal Shock Wave Therapy Immediately Affects Achilles Tendon Structure and Widespread Pressure Pain Thresholds in Healthy People: A Repeated-Measures Observational Study. Am J Phys Med Rehabil 2020; 98:806-810. [PMID: 31021822 DOI: 10.1097/phm.0000000000001203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Extracorporeal shockwave therapy is a common clinical treatment for tendinopathy, yet negative effects on tendon structure have been shown in animal studies. This study aimed to investigate the effect of extracorporeal shockwave therapy in healthy participants (i.e., no Achilles tendon pain or pathology). DESIGN This study examined the effect of three bouts of weekly extracorporeal shockwave therapy for 3 wks in 13 healthy participants. Outcomes measures assessed were as follows: (a) Achilles tendon structure, quantified using ultrasound tissue characterization (before and 3 hrs after extracorporeal shockwave therapy), (b) pressure pain thresholds, over the Achilles tendon and common extensor tendon origin (before, immediately after, and 3 hrs after extracorporeal shockwave therapy), and (c) hop pain (before and immediately after extracorporeal shockwave therapy). RESULTS There was a significant reduction in echo type I (P < 0.05) and increase in echo type II (P < 0.05) at 3 hrs after the first extracorporeal shockwave therapy session that recovered to baseline levels before week 2. There were no significant changes in ultrasound tissue characterization echo pattern observed in subsequent sessions. There were increased pressure pain thresholds immediately after extracorporeal shockwave therapy at the common extensor tendon origin but no significant change at the Achilles tendon. Pressure pain thresholds returned to baseline at 3 hrs after extracorporeal shockwave therapy. There were no significant changes in pressure pain threshold in subsequent sessions. CONCLUSIONS Extracorporeal shockwave therapy resulted in transient changes to tendon structure and widespread hyperalgesia.
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Meir R, Chapman N, Whitting JW, Crowley-McHattan ZJ. A Strategy for Assessing Acute (Transient) Pain or Discomfort in the Strength and Conditioning Environment. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ho KY, Harty M, Kellogg J, Teter K, Lee SP, Chang YJ, Bashford G. Patellar tendon morphology in trans-tibial amputees utilizing a prosthesis with a patellar-tendon-bearing feature. Sci Rep 2019; 9:16392. [PMID: 31704989 PMCID: PMC6841932 DOI: 10.1038/s41598-019-52747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/22/2019] [Indexed: 11/09/2022] Open
Abstract
A patellar-tendon-bearing (PTB) bar is a common design feature used in the socket of trans-tibial prostheses to place load on the pressure-tolerant tissue. As the patellar tendon in the residual limb is subjected to the perpendicular compressive force not commonly experienced in normal tendons, it is possible for tendon degeneration to occur over time. The purpose of this study was to compare patellar tendon morphology and neovascularity between the residual and intact limbs in trans-tibial amputees and healthy controls. Fifteen unilateral trans-tibial amputees who utilized a prosthesis with a PTB feature and 15 age- and sex- matched controls participated. Sonography was performed at the proximal, mid-, and distal portions of each patellar tendon. One-way ANOVAs were conducted to compare thickness and collagen fiber organization and a chi-square analysis was used to compare the presence of neovascularity between the three tendon groups. Compared to healthy controls, both tendons in the amputees exhibited increased thickness at the mid- and distal portions and a higher degree of collagen fiber disorganization. Furthermore, neovascularity was more common in the tendon of the residual limb. Our results suggest that the use of a prosthesis with a PTB feature contributes to morphological changes in bilateral patellar tendons.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA.
| | - Michelle Harty
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - Jessica Kellogg
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - Kelly Teter
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - Yu-Jen Chang
- Division of Physical Therapy, West Virginia University, 64 Medical Center Drive, P.O. Box 9226, Morgantown, WV, 26506, USA
| | - Gregory Bashford
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, 230 L. W. Chase Hall, P. O. Box 830726, Lincoln, NE, 68583, USA
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Benítez-Martínez JC, Valera-Garrido F, Martínez-Ramírez P, Ríos-Díaz J, Del Baño-Aledo ME, Medina-Mirapeix F. Lower Limb Dominance, Morphology, and Sonographic Abnormalities of the Patellar Tendon in Elite Basketball Players: A Cross-Sectional Study. J Athl Train 2019; 54:1280-1286. [PMID: 31483151 DOI: 10.4085/1062-6050-285-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Patellar tendinopathy is common in basketball players, and structural ultrasound abnormalities can be found in symptomatic and asymptomatic tendons. Lower limb dominance may also be a critical load factor, potentially leading to overloading of the patellar tendon. OBJECTIVE To describe and compare the prevalence by lower limb dominance of patellar tendons with structural and vascular abnormalities and to describe the morphologic measures of tendons without abnormalities among adult male elite basketball players. DESIGN Cross-sectional study. SETTING Medical center of a professional basketball team in the Spanish league. PATIENTS OR OTHER PARTICIPANTS A total of 73 adult male elite basketball players (146 patellar tendons; age = 26.8 ± 4.9 years, height = 198.0 ± 0.1 cm, mass = 95.4 ± 11.4 kg). MAIN OUTCOME MEASURE(S) We used ultrasound to screen the patellar tendons for the presence of structural and vascular abnormalities. Tendons were categorized as abnormal if they demonstrated a focal area of hypoechogenicity, thickening, or neovascularization. We also examined the cross-sectional area and thickness of tendons without abnormalities. Prevalence and morphologic measures were compared by limb dominance. RESULTS A total of 35 players (48%) had bilateral abnormalities, whereas 21 (28.7%) had unilateral abnormalities. Among the 91 abnormal tendons, 90 (61.6% of 146 tendons) exhibited a focal area of hypoechogenicity, 59 (40.4% of 146 tendons) exhibited thickening, and 14 (9.6% of 146 tendons) exhibited neovascularization. No group differences were detected between the dominant and nondominant limbs. Among the 55 normal patellar tendons, 34 were bilateral (from 17 players) and 21 were unilateral. Approximately 25% (n = 14) of all 55 normal tendons had a cross-sectional area that was greater than 182.8 mm2 and a thickness greater than 7.2 mm. Among the 34 bilateral normal tendons, no group differences were observed between the dominant and nondominant limbs for either cross-sectional area or thickness. CONCLUSIONS The prevalence of abnormal tendons was high among adult male elite basketball players, and bilateral presentations were more frequent. Structural abnormalities were most common.
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Affiliation(s)
| | | | | | - José Ríos-Díaz
- Centro de CC de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, Spain
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De Oliveira Silva D, Rathleff MS, Petersen K, Azevedo FMD, Barton CJ. Manifestations of Pain Sensitization Across Different Painful Knee Disorders: A Systematic Review Including Meta-analysis and Metaregression. PAIN MEDICINE 2018; 20:335-358. [DOI: 10.1093/pm/pny177] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Danilo De Oliveira Silva
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), Presidente Prudente, Brazil
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Michael Skovdal Rathleff
- SMI, Faculty of Medicine
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Fábio Mícolis de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Christian John Barton
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
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Rio EK, Ellis RF, Henry JM, Falconer VR, Kiss ZS, Girdwood MA, Cook JL, Gaida JE. Don’t Assume the Control Group Is Normal—People with Asymptomatic Tendon Pathology Have Higher Pressure Pain Thresholds. PAIN MEDICINE 2018; 19:2267-2273. [DOI: 10.1093/pm/pny117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ebonie K Rio
- La Trobe Sport and Exercise Medicine Research Centre, College of Science Health and Engineering, La Trobe University, Bundoora, Australia
| | - Richard F Ellis
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jono M Henry
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Victoria R Falconer
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Zoltan S Kiss
- Imaging @ Olympic Park, Melbourne, Victoria, Australia
| | - Michael A Girdwood
- La Trobe Sport and Exercise Medicine Research Centre, College of Science Health and Engineering, La Trobe University, Bundoora, Australia
| | - Jill L Cook
- La Trobe Sport and Exercise Medicine Research Centre, College of Science Health and Engineering, La Trobe University, Bundoora, Australia
| | - Jamie E Gaida
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia
- Discipline of Physiotherapy, University of Canberra, Australia
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Alqarni AM, Manlapaz D, Baxter D, Tumilty S, Mani R. Test Procedures to Assess Somatosensory Abnormalities in Individuals with Peripheral Joint Pain: A Systematic Review of Psychometric Properties. Pain Pract 2018; 18:895-924. [PMID: 29350873 DOI: 10.1111/papr.12680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/11/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties (PMPs) to be used in clinical practice. The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain (PJP). METHODS A comprehensive electronic literature search was conducted in 7 databases from inception to March 2016. The Quality Appraisal for Reliability Studies (QAREL) checklist and the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) tool were used to assess risk for bias of the included studies. Level of evidence was evaluated based on the methodological quality and the quality of the measurement properties. RESULTS Forty-one studies related to PJP were included. The majority of included studies were considered to be of insufficient methodological quality, and the level of evidence for PMPs varied across different test procedures. The level of evidence for PMPs varied across different test procedures in different types of PJP. Hand-held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability, agreement, and responsiveness, simultaneously, when it was investigated in patients with chronic knee osteoarthritis. CONCLUSIONS This systematic review identified that the level of evidence for PMPs varied across different testing procedures to assess somatosensory abnormalities for different PJP populations. Further research with standardized protocols is recommended to further investigate the predictive ability and responsiveness of reported test procedures in order to warrant their extended utility in clinical practice.
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Affiliation(s)
- Abdullah Mohammad Alqarni
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Donald Manlapaz
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Pazzinatto MF, de Oliveira Silva D, Barton C, Rathleff MS, Briani RV, de Azevedo FM. Female Adults with Patellofemoral Pain Are Characterized by Widespread Hyperalgesia, Which Is Not Affected Immediately by Patellofemoral Joint Loading. PAIN MEDICINE 2016; 17:1953-1961. [DOI: 10.1093/pm/pnw068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Evidence of Nervous System Sensitization in Commonly Presenting and Persistent Painful Tendinopathies: A Systematic Review. J Orthop Sports Phys Ther 2015; 45:864-75. [PMID: 26390275 DOI: 10.2519/jospt.2015.5895] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review. Objectives To elucidate if there is sensitization of the nervous system in those with persistent rotator cuff (shoulder), lateral elbow, patellar, and Achilles tendinopathies. Background Tendinopathy can be difficult to treat, and persistent intractable pain and dysfunction are frequent. It is hypothesized that induction or maintenance of persistent pain in tendinopathy may be, at least in part, based on changes in the nervous system. Methods The PRISMA guidelines were followed. Relevant articles were identified through a computerized search in Embase, PubMed, and Web of Science, followed by a manual search of reference lists of retained articles. To be eligible, studies had to include quantitative sensory testing and evaluate individuals diagnosed with a persistent tendinopathy of the rotator cuff (shoulder), lateral elbow, patella, or Achilles tendon. Methodological quality assessment was evaluated with the Newcastle-Ottawa Scale. Results In total, 16 full-text articles met the criteria for inclusion, of which the majority were case-control studies with heterogeneous methodological quality. No studies on Achilles tendinopathy were found. Mechanical algometry was the predominant quantitative sensory testing used. Lowered pressure pain threshold was observed across different tendinopathies at the site of tendinopathy, as well as at other sites, the latter being suggestive of central sensitization. Conclusion Although more research on sensory abnormalities is warranted, it appears likely that there is an association between persistent tendon pain and sensitization of the nervous system. This evidence is primarily from studies of upper-limb tendinopathy, and caution should be exercised with inference to lower-limb tendinopathy. J Orthop Sports Phys Ther 2015;45(11):864-875. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5895.
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Stackhouse SK, Taylor CM, Eckenrode BJ, Stuck E, Davey H. Effects of Noxious Electrical Stimulation and Eccentric Exercise on Pain Sensitivity in Asymptomatic Individuals. PM R 2015; 8:415-24. [PMID: 26247163 DOI: 10.1016/j.pmrj.2015.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/10/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Achilles tendinopathy is a common overuse injury in running and jumping athletes. Currently, we do not understand why some conservative interventions (eg, noxious electrical stimulation and eccentric training) may reduce the pain associated with tendinopathy. OBJECTIVE To determine whether noxious electrical stimulation (NES) or eccentric contractions would alter pain sensitivity around the asymptomatic Achilles tendon. DESIGN A double-blind trial with block-randomization by gender into 3 intervention arms: NES, eccentric contractions, or low-intensity cycling. PARTICIPANTS A total of 40 volunteers with no current pain conditions started the study, and 39 completed follow-up testing. METHODS Participants underwent 2 baseline sessions to assess pain sensitivity response stability of pressure pain threshold (PPT), heat pain threshold (HPT), and heat temporal summation (HTS) over the Achilles tendon. Immediately after the second baseline session, participants performed 1 session of an intervention and were tested immediately postintervention and the next morning. Eccentric-only plantarflexor exercise was performed (4 sets of 15 repetitions) using full bodyweight and slow, 5-second contractions. Noxious electrical stimulation was applied to the Achilles for 20 minutes and dosed to the subjects' pain tolerance. Low-intensity cycling was dosed (60-70 W for 20 minutes) to minimize occurrence of exercise-induced hypoalgesia. The PPT was the primary outcome measure. RESULTS For PPT, both NES (P < .001) and eccentric (P = .003) groups were less sensitive to pressure immediately posttreatment, and the eccentric group maintained this effect through the next morning (P = .043). No group differences were seen for HPT, but the NES (P = .031) and eccentric (P = .036) groups had less HTS the next morning. CONCLUSIONS A single session of eccentric exercise and NES can produce immediate and next-day reductions in pain sensitivity in asymptomatic adults. The immediacy of these effects points toward a neurophysiologic mechanism. Future research needs to be performed in clinical populations and to assess any cumulative effects to repetitive intervention.
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Affiliation(s)
- Scott K Stackhouse
- Department of Physical Therapy, Arcadia University, 450 S. Easton Rd, Glenside, PA 19038(∗).
| | - Christine M Taylor
- Student, Department of Psychology, Arcadia University, Glenside, PA (when work was performed)(†)
| | | | - Erica Stuck
- Student, Department of Physical Therapy, Arcadia University, Glenside, PA (when work was performed)(§)
| | - Helen Davey
- Student, Department of Physical Therapy, Arcadia University, Glenside, PA (when work was performed)(‖)
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