Association Between Localized Achilles Tendon Movement-Evoked Pain and Core Health-Related Domains in Individuals with Chronic Achilles Tendinopathy

Current understanding of tendinopathy extends beyond a localized pain diagnosis and includes a multidimensional patient perspective. The purposes of this study were to 1) identify targetable core health-related domains for tendinopathy (disability, psychological variables, pain, factors associated with quality of life) and 2) establish associations between localized Achilles tendon movement-evoked pain (MEP) and core health-related domains in individuals with chronic Achilles tendinopathy (AT). 24 individuals with chronic AT (50% female, Age: 43.9±16.6, BMI: 30.2±6.7kg/m2, Duration of pain: 38.7±39.1months) and 24 controls matched for age, sex, and BMI were enrolled for two one-on-one visits over 24-hours. On Day 1 and 2, participants completed patient reported outcomes (VISA-A, TSK-17, PROMIS-sleep) and functional assessments (maximal standing dorsiflexion stretch, 6-minute walk test, maximum number of heel-raises). An aggregate MEP score was calculated utilizing all functional assessments [(dorsiflexion MEP + 6-minute walk test MEP + maximal heel-raises MEP) – Pre-test resting pain]. Over Days 1 and 2, those with chronic AT reported greater disability (VISA-A, AT: 51.4±17.2, Control: 75.1±17.0, p<0.01), elevated kinesiophobia (TSK-17, AT: 35.0±6.2 Control: 31.1±3.9, p=0.01), and higher aggregate MEP (AT: 6.3±3.4, Control: -0.04±1.1, p<0.01) but no difference in sleep disturbance (PROMIS-sleep, AT: 51.0±10.8, Control: 49.6±5.7, p=0.55). Univariate analysis demonstrated change in aggregate MEP for those with AT from Day 1 to Day 2 was associated with sleep disturbance (r=0.55, p=0.01) but not the VISA-A (r=0.08, p=0.72) or TSK-17 (r=0.11, p=0.60). Clinical evaluation of multiple domains may assist with implementation of a biopsychosocial approach for individuals with chronic AT.