Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
Clin Biomech (Bristol). 2023 Oct;109:106073. doi: 10.1016/j.clinbiomech.2023.106073. Epub 2023 Aug 18.
This study aimed to characterize movement-evoked pain during tendon loading and stretching tasks in individuals with Achilles tendinopathy, and to examine the association between movement-evoked pain with the Achilles tendinopathy type (insertional and midportion), biomechanical, and psychological variables.
In this laboratory-based, cross-sectional study, 37 individuals with chronic Achilles tendinopathy participated. Movement-evoked pain intensity (Numeric Rating Scale: 0 to 10) and sagittal-plane ankle biomechanics were collected simultaneously during standing, fast walking, single-leg heel raises, and weight-bearing calf stretch. Description of symptoms, including location of Achilles tendon pain and duration of tendon morning stiffness, as well as pain-related psychological measures, including the Tampa Scale of Kinesiophobia were collected. Linear mixed effects models were built around two paradigms of movement-evoked pain (tendon loading and stretching tasks) with each model anchored with pain at rest.
Movement-evoked pain intensity increased as task demand increased in both models. Lower peak dorsiflexion with walking (β = -0.187, 95% CI: -0.305, -0.069), higher fear of movement (β = 0.082, 95% CI: 0.018, 0.145), and longer duration of tendon morning stiffness (β = 0.183, 95% CI: 0.07, 0.296) were associated with greater pain across tendon loading tasks (R = 0.47). Lower peak dorsiflexion with walking (β = -0.27, 95% CI: -0.41, -0.14), higher dorsiflexion with the calf stretch (β = 0.095, 95% CI: 0.02, 0.16), and insertional Achilles tendinopathy (β = -0.93, 95% CI: -1.65, -0.21) were associated with higher pain across tendon stretching tasks (R = 0.53).
In addition to exercise, the ideal management of Achilles tendinopathy may require adjunct treatments to address the multifactorial aspects of movement-evoked pain.
本研究旨在描述跟腱病患者在进行跟腱负荷和拉伸任务时的运动诱发疼痛，并探讨运动诱发疼痛与跟腱病类型（插入部和中段）、生物力学和心理变量之间的关系。
在这项基于实验室的横断面研究中，共有 37 名慢性跟腱病患者参与。在站立、快速行走、单腿足跟抬高和负重小腿伸展时，同时采集运动诱发疼痛的强度（数字评分量表：0 到 10）和矢状面踝关节生物力学。收集了包括跟腱疼痛的位置和跟腱晨僵持续时间在内的症状描述，以及包括 Tampa 运动恐惧量表在内的疼痛相关心理测量。围绕两种运动诱发疼痛模式（跟腱负荷和拉伸任务）构建了线性混合效应模型，每个模型均以静息时的疼痛为锚定点。
在两个模型中，随着任务需求的增加，运动诱发疼痛的强度均增加。行走时背屈峰值较低（β=-0.187，95%CI：-0.305，-0.069）、运动恐惧较高（β=0.082，95%CI：0.018，0.145）和跟腱晨僵持续时间较长（β=0.183，95%CI：0.07，0.296）与跟腱负荷任务中的疼痛增加相关（R=0.47）。行走时背屈峰值较低（β=-0.27，95%CI：-0.41，-0.14）、小腿伸展时背屈较大（β=0.095，95%CI：0.02，0.16）和插入部跟腱病与跟腱拉伸任务中的疼痛增加相关（R=0.53）。
除了运动，跟腱病的理想治疗可能还需要辅助治疗来解决运动诱发疼痛的多因素方面。
