Background & Aims

Midportion Achilles tendinopathy is an injury characterized by pain in the Achilles tendon during activity (i.e., movement-evoked pain (MEP)), and during palpation, but typically not at rest(1,2). Pain with hopping is an assessment for midportion Achilles tendinopathy that can be quickly and easily measured and captures MEP in this clinical population(3). MEP is an important assessment tool that can be used to assess functional tasks and inform patient care. However, MEP evaluation and treatment is an emerging area of research, and the impact of MEP across clinical pain populations remains unclear(4). Therefore, the aim of this study was to assess the relationship between MEP during hopping, the Patient-Reported Outcomes Measurement Information System (PROMIS) 29 v2.0(5,6), and pain pressure threshold to determine if MEP with hopping gives us insight regarding an individual’s functional status or pain sensitivity.

Methods

Data from 175 participants (99F, 47±13y, 28.6±6.3 BMI) was collected at baseline from an ongoing clinical trial examining the effects of exercise in individuals with midportion Achilles tendinopathy. Participants filled out the PROMIS at the baseline visit prior to testing. T-scores for the seven domains of health (Anxiety, Depression, Fatigue, Pain Interference, Physical Function, Sleep Disturbance, Ability to Participate in Social Roles and Activities) were calculated and used in the analysis. Average pain intensity over the last week was assessed using a single question from the PROMIS (0-10 scale). MEP during hopping was assessed using the numeric pain rating scale (0-10); participants reported their peak pain during a single leg hopping test, consisting of up to 25 single leg hops. Pain Pressure Threshold (PPT) at the midportion of the Achilles tendon was measured using a mechanical algometer (SBMedic).

Results

MEP during hopping was significantly correlated with PPT at the Achilles (r = -0.161, p=0.040), PROMIS Pain Interference (r = 0.266, p<0.001), PROMIS Physical Function (r = -0.292, p<0.001), and average pain intensity over the last week (r = 0.452, p<0.001). In contrast, there were no significant relationships between MEP during hopping and the other PROMIS health domains of Anxiety, Depression, Fatigue, Sleep Disturbance, or Ability to Participate in Social Roles and Activities.

Conclusions

MEP during hopping is weakly correlated to PPT of the Achilles tendon, and the PROMIS Pain Interference and Physical Function domains, and moderately correlated with average pain intensity over the last week suggesting that MEP may differ from and/or provide additional clinical information when paired with other clinical pain and health measures. These preliminary findings indicate that MEP during hopping may be an appropriate and clinically feasible method to assess pain during functional activities. However, measuring only the peak pain during hopping may not be able to fully capture MEP in this population due to the quick nature of the test. Future work should consider assessing MEP at various timepoints during other pain provoking activities such as running to capture changes in pain throughout the duration of the activity and provide a more thorough assessment of movement evoked pain.

References

1.Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train. 2020;55(5):438-447. doi:10.4085/1062-6050-356-19
2.Scott A, Squier K, Alfredson H, et al. ICON 2019: International scientific Tendinopathy Symposium consensus: clinical terminology [published online August 9, 2019.] Br J Sports Med. doi:10.1136/bjsports-2019-100885
3.Silbernagel KG, Gustavsson A, Thomeé R, Karlsson J. Evaluation of lower leg function in patients with Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2006;14(11):1207-1217. doi:10.1007/s00167-006-0150-6
4.Corbett DB, Simon CB, Manini TM, George SZ, Riley JL 3rd, Fillingim RB. Movement-evoked pain: transforming the way we understand and measure pain. Pain. 2019 Apr;160(4):757-761. doi: 10.1097/j.pain.0000000000001431. PMID: 30371555; PMCID: PMC6424644.
5.Hays RD, Spritzer KL, Schalet BD, Cella D. PROMIS®-29 v2.0 profile physical and mental health summary scores. Qual Life Res. 2018 Jul;27(7):1885-1891. doi: 10.1007/s11136-018-1842-3. Epub 2018 Mar 22. PMID: 29569016; PMCID: PMC5999556.
6.Cella D, Riley W, Stone A, Rothrock N, Reeve B, Young S, et al. Initial item banks and first wave testing of the Patient-Reported Outcomes Measurement Information System (PROMIS) network: 2005–2008. Journal of Clinical Epidemiology. 2010;63(11):1179–1194.

Presenting Author

Katie Butera

Poster Authors

Andy K. Smith, PT, DPT, MS

PT, DPT, MS

Department of Physical Therapy, University of Delaware

Lead Author

Katie Butera

University of Delaware

Lead Author

Karin Grävare Silbernagel PT

ATC

Department of Physical Therapy, University of Delaware

Lead Author

Topics

  • Assessment and Diagnosis