Background & Aims

Achilles tendinopathy is one of the most common lower limb tendinopathies that, despite treatment, can remain symptomatic long-term.[1, 2] Though it is considered an overuse injury that mainly occurs in physically active people, it can affect men and women of all ages and lifestyles.[3-5] Recently, there has been a growing interest in considering psychological factors, particularly pain-related cognitions, as contributors negatively influencing patient-reported outcomes in patients with Achilles tendinopathy.[6-9] However, evidence regarding the relationship between psychological factors and physical activity levels remains limited. Additionally, central sensitization has been suggested as a relevant factor in some patients with persistent tendinopathy, though the evidence is still conflicting.[10, 11] Therefore, it might be worthwhile to explore the associations between physical activity, pain-related cognitions, and self-reported symptoms of central sensitization.

Methods

This secondary analysis uses baseline data from 130 adult patients with midportion Achilles tendinopathy who participated in a longitudinal cohort study. Physical activity was measured via wrist-worn actigraphy and assessed as daily step count and daily active minutes. The latter includes lightly active minutes, fairly active minutes, and very active minutes, as well as the total active minutes. Kinesiophobia and pain catastrophizing were assessed as pain-related cognitions via the Tampa Scale for Kinesiophobia (TSK) and the Pain Catastrophizing Scale (PCS), respectively. Self-reported symptoms of central sensitization were evaluated using the Central Sensitization Inventory. Linear regression analyses were used to explore the relationship between physical activity behavior, pain-related cognitions, and central sensitization. Participants’ age and sex were included as control variables in the regression analyses.

Results

Following univariable regression analysis, no significant influence was found from the TSK scores (estimate = -70.32; 95% CI [-198.36, 57.71]) on participants’ daily step count. Also, the PCS (estimate = -23.78; 95% CI -116.01, 68.45]) and the CSI scores (estimate = -36.77; 95% CI [-97.49, 23.95]) did not significantly influence daily step count. Likewise, the analysis showed no significant relationship between the TSK (estimate = -1.16; 95% CI [-4.05, 1.73]), the PCS (estimate = -1.09; 95% CI [-3.16, 0.99]), the CSI scores (estimate = -1.16; 95% CI [-1.99, 0.77]) and total active minutes per day. Subsequently, similar analyses were performed for daily lightly active minutes, fairly active minutes, and very active minutes. However, no significant effects were found from the TSK, PCS, and CSI scores on any measures of active minutes.

Conclusions

Results of this secondary analysis indicate that participants’ pain-related cognitions do not significantly influence their daily steps or their time spent being physically active, as determined via actigraphy. In other words, patients with midportion Achilles tendinopathy can remain physically active, regardless of any maladaptive beliefs about pain they might have. In addition, self-reported symptoms of central sensitization are not significantly associated with physical activity behavior. However, as the current analyses are based on cross-sectional data, no conclusions on the long-term impact of pain-related cognitions and self-reported central sensitization can be made. Therefore, further longitudinal research is warranted to better understand the complex interplay between such psychological factors, central sensitization, and physical activity in patients with midportion Achilles tendinopathy.

References

[1]I. F. Lagas, J. L. Tol, A. Weir, S. de Jonge, P. L. J. van Veldhoven, S. M. A. Bierma-Zeinstra, J. A. N. Verhaar, and R. J. de Vos, “One fifth of patients with Achilles tendinopathy have symptoms after 10 years: A prospective cohort study,” J Sports Sci, vol. 40, no. 22, pp. 2475-2483, Nov, 2022.
[2]D. A. Prudêncio, N. Maffulli, F. Migliorini, T. T. Serafim, L. F. Nunes, L. S. Sanada, and R. Okubo, “Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis,” BMC Sports Science, Medicine and Rehabilitation, vol. 15, no. 1, pp. 9, 2023.
[3]H. Riel, C. F. Lindstrom, M. S. Rathleff, M. B. Jensen, and J. L. Olesen, “Prevalence and incidence rate of lower-extremity tendinopathies in a Danish general practice: a registry-based study,” BMC Musculoskelet Disord, vol. 20, no. 1, pp. 239, May 22, 2019.
[4]Y. Wang, H. Zhou, Z. Nie, and S. Cui, “Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis,” Sports Med Health Sci, vol. 4, no. 3, pp. 152-159, Sep, 2022.
[5]C. Hopkins, S. C. Fu, E. Chua, X. Hu, C. Rolf, V. M. Mattila, L. Qin, P. S. Yung, and K. M. Chan, “Critical review on the socio-economic impact of tendinopathy,” Asia Pac J Sports Med Arthrosc Rehabil Technol, vol. 4, pp. 9-20, Apr, 2016.
[6]J. Verges, N. Martinez, A. Pascual, M. Bibas, M. Santina, and G. Rodas, “Psychosocial and individual factors affecting Quality of Life (QoL) in patients suffering from Achilles tendinopathy: a systematic review,” BMC Musculoskelet Disord, vol. 23, no. 1, pp. 1114, Dec 21, 2022.
[7]A. J. Slagers, E. van Veen, J. Zwerver, J. H. B. Geertzen, I. H. F. Reininga, and I. van den Akker-Scheek, “Psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy: a cross-sectional study,” Phys Ther Sport, vol. 50, pp. 145-152, Jul, 2021.
[8]H. P. Smitheman, M. Lundberg, M. Harnesand, S. Gelfgren, and K. Gravare Silbernagel, “Putting the fear-avoidance model into practice – what can patients with chronic low back pain learn from patients with Achilles tendinopathy and vice versa?,” Braz J Phys Ther, vol. 27, no. 5, pp. 100557, Sep-Oct, 2023.
[9]S. Mc Auliffe, L. Bisset, R. Chester, B. K. Coombes, A. Fearon, P. Kirwan, K. McCreesh, K. Mitham, D. Morrissey, S. O’Neill, M. H. Ross, I. Sancho, G. Stephens, P. Vallance, I. van den Akker-Scheek, B. Vicenzino, V. Vuvan, A. Mallows, C. Stubbs, P. Malliaras, and M. Plinsinga, “ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Scoping Review of Psychological and Psychosocial Constructs and Outcome Measures Reported in Tendinopathy Clinical Trials,” J Orthop Sports Phys Ther, vol. 52, no. 6, pp. 375-388, Jun, 2022.
[10]M. L. Plinsinga, M. S. Brink, B. Vicenzino, and C. P. van Wilgen, “Evidence of Nervous System Sensitization in Commonly Presenting and Persistent Painful Tendinopathies: A Systematic Review,” J Orthop Sports Phys Ther, vol. 45, no. 11, pp. 864-75, Nov, 2015.
[11]B. J. Eckenrode, D. M. Kietrys, and S. K. Stackhouse, “Pain Sensitivity in Chronic Achilles Tendinopathy,” Int J Sports Phys Ther, vol. 14, no. 6, pp. 945-956, Dec, 2019.

Presenting Author

Wouter Van Bogaert

Poster Authors

Wouter Van Bogaert

PhD

Pain in Motion (PAIN) research group, Vrije Universiteit Brussel

Lead Author

Morgan N. Potter

PT

Department of Physical Therapy, University of Delaware

Lead Author

Andy K. Smith

PT

Department of Physical Therapy, University of Delaware

Lead Author

Hayley Powell Smitheman

PT

Department of Physical Therapy, University of Delaware

Lead Author

Karin Grävare Silbernagel PT

ATC

Department of Physical Therapy, University of Delaware

Lead Author

Topics

  • Mechanisms: Psychosocial and Biopsychosocial