Brund René B K, Rasmussen Sten, Kersting Uwe G, Arendt-Nielsen Lars, Palsson Thorvaldur Skuli
Sport Sciences, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Scand J Pain. 2019 Jan 28;19(1):139-146. doi: 10.1515/sjpain-2018-0084.
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.
跟腱病在跑步者中很常见，但其病因仍不清楚。高机械性疼痛敏感性可能是该群体发生跟腱病风险增加的一个预测指标。本研究的目的是调查局部疼痛敏感性是否能预测男性业余跑步者跟腱病的发生。总体假设是，高疼痛敏感性与男性业余跑步者发生跟腱病的较高风险相关。方法：招募了99名男性业余跑步者，并对其进行为期1年的前瞻性随访。在基线时以及跑步500公里后，在冈下肌和跟腱处评估压力疼痛阈值（PPT）（跟腱PPT）。根据基线时的跟腱PPT，采用中位数分割法将跑步者分为两组。高疼痛敏感性组定义为跟腱疼痛压力阈值低于441 kPa的跑步者，而低疼痛敏感性组定义为跟腱疼痛压力阈值高于441 kPa的跑步者。随后，使用伪观察法评估两组之间的累积风险差异。结果：高疼痛敏感性的跑步者在前1500公里中发生跟腱病的次数多5个百分点（95%CI：-0.18至0.08）。在跑步100、250、500、1000和1500公里时，未发现两组之间有显著的风险差异。结论：未发现跟腱的机械性疼痛敏感性与发生跟腱病的风险之间存在显著关联。然而，风险差异表明高机械性疼痛敏感性与发生跟腱病的风险增加之间存在关联。疼痛敏感性的变化可能被未测量的协变量所掩盖，例如两组之间训练量和跑步速度的进展/回归差异，这似乎是合理的。本研究规模有限，这限制了考虑协变量的可能性，例如跑步者之间跑步速度的进展/回归差异。考虑到这些局限性，未来的研究应在设计中控制训练量、速度和跑鞋，或在分析中加以考虑。意义：跟腱的疼痛敏感性似乎与跑步相关的跟腱疼痛风险增加无关。
