Prospective analysis of intrinsic and extrinsic risk factors on the development of <scp>A</scp>chilles tendon pain in runners

Hein, Tobias; Janssen, Pia; Wagner-Fritz, Ursula; Haupt, Georg; Grau, Stefan

doi:10.1111/sms.12137

Cited by 46 publications

(99 citation statements)

References 44 publications

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“…This may be one of many important factors to account for as mechanical pain sensitivity in the Achilles tendon may relate to the risk of Achilles tendinopathy within a certain range of progression. Moreover, the timescale in the present study was kilometers at risk whereas some studies indicate that Achilles tendinopathy is more related to sudden increases in running speed than the distance of running [50][51][52].…”

Section: Limitations and Methodological Considerationscontrasting

confidence: 58%

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

Brund

Rasmussen

Kersting

et al. 2018

Scandinavian Journal of Pain

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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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Section: Limitations and Methodological Considerationscontrasting

confidence: 58%

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

Brund

Rasmussen

Kersting

et al. 2018

Scandinavian Journal of Pain

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“…Full texts of the 38 studies were reviewed independently by two authors (RJ and KOS) and a further 26 were discarded based on the exclusion criteria, leaving 12 eligible prospective studies for final review. [26][27][28][29][30][31][32][33][34][35][36][37] The CASP assessment of each study is outlined in table 2 and supplementary table 2. Five studies did not appear to identify, or attempt to account for, confounding factors.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies involved a running population, 26-28, 30-32, 35-37 two rowing, 29,33 and one triathlon. 34 Three studies recruited elite ESPs 28,29,33 , eight studies recruited a recreational population 26,27,[30][31][32][35][36][37] whilst one study recruited both elite and recreational ESPs. 34 The length of follow-up varied from three months to three years.…”

Section: Resultsmentioning

confidence: 99%

The associations between training load and baseline characteristics on musculoskeletal injury and pain in endurance sport populations: A systematic review

Johnston¹

2017

Physical Therapy in Sport

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Objective: To determine the associations between training load, baseline characteristics (e.g. age or previous injury) and rate of musculoskeletal injury and/or pain specifically within an Endurance Sporting Population (ESP). Design: Prospectively registered systematic review. 3 Methods: Eight electronic databases were searched by two independent reviewers. Studies were required to prospectively monitor both (i) training loads and (ii) musculoskeletal injury and/or pain for >3 months. Methodological quality and risk of bias were determined utilising the Critical Skills Appraisal Program (CASP). Reported effect sizes were categorised as small, medium or large. Results: Twelve endurance sport studies were eligible (running, triathlon, rowing). Increased injury and/or pain risk was associated with: (i) high total training distances per week/month (medium effect size) (ii) training frequency <2 sessions/week (medium effect size) and (iii) both low weekly (<2 hours/week) and high monthly (large effect size) training durations. None of the studies reported internal training load data or acute:chronic workload ratios. Baseline characteristics found to increase the rate of injury and/or pain included: (i) a history of previous injury (medium effect size), (ii) age >45 years (small effect size), (iii) non-musculoskeletal comorbidities (large effect size), (iv) using older running shoes (small effect size) and (v) non-competitive behaviour. Conclusions: This review identifies a range of external training load factors and baseline characteristics associated with an increased rate of injury and/or pain within ESPs. There is an absence of research relating to internal training loads and acute:chronic workload ratios in relation to rate of injury and/or pain within ESPs.

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“…Numerous other intrinsic and extrinsic risk factors have been identified for the development of tendinopathy. Training volume and frequency,61 higher impacts caused by faster training,62 as well as a change in surface density and shock absorption,63 have all been proposed as extrinsic risk factors. In relation to intrinsic risk factors, altered foot function,63 reduced ankle dorsiflexion,64 sex,36 diabetes,65 adiposity,66 muscle weakness67 and genetic factors68 have all been proposed.…”

Section: Discussionmentioning

confidence: 99%

Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis

et al. 2016

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Prospective analysis of intrinsic and extrinsic risk factors on the development of Achilles tendon pain in runners

Cited by 46 publications

References 44 publications

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

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

The associations between training load and baseline characteristics on musculoskeletal injury and pain in endurance sport populations: A systematic review

Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis

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