Evidence of nervous system sensitization in commonly presenting and persistent painful tendinopathies: a systematic review

Plinsinga, Melanie L., Brink, Michel S., Vicenzino, Bill and Van Wilgen, C. Paul (2015) Evidence of nervous system sensitization in commonly presenting and persistent painful tendinopathies: a systematic review. Journal of Orthopaedic & Sports Physical Therapy, 45 11: 864-875. doi:10.2519/jospt.2015.5895


Author Plinsinga, Melanie L.
Brink, Michel S.
Vicenzino, Bill
Van Wilgen, C. Paul
Title Evidence of nervous system sensitization in commonly presenting and persistent painful tendinopathies: a systematic review
Journal name Journal of Orthopaedic & Sports Physical Therapy   Check publisher's open access policy
ISSN 0190-6011
1938-1344
Publication date 2015-11-01
Year available 2015
Sub-type Article (original research)
DOI 10.2519/jospt.2015.5895
Open Access Status Not Open Access
Volume 45
Issue 11
Start page 864
End page 875
Total pages 12
Place of publication Alexandria, VA United States
Publisher American Physical Therapy Association
Collection year 2016
Language eng
Formatted abstract
Objectives
To elucidate if there is sensitization of the nervous system in those with persistent rotator cuff (shoulder), lateral elbow, patellar, and Achilles tendinopathies.

Background
Tendinopathy can be difficult to treat, and persistent intractable pain and dysfunction are frequent. It is hypothesized that induction or maintenance of persistent pain in tendinopathy may be, at least in part, based on changes in the nervous system.

Methods
The PRISMA guidelines were followed. Relevant articles were identified through a computerized search in Embase, PubMed, and Web of Science, followed by a manual search of reference lists of retained articles. To be eligible, studies had to include quantitative sensory testing and evaluate individuals diagnosed with a persistent tendinopathy of the rotator cuff (shoulder), lateral elbow, patella, or Achilles tendon. Methodological quality assessment was evaluated with the Newcastle-Ottawa Scale.

Results
In total, 16 full-text articles met the criteria for inclusion, of which the majority were case-control studies with heterogeneous methodological quality. No studies on Achilles tendinopathy were found. Mechanical algometry was the predominant quantitative sensory testing used. Lowered pressure pain threshold was observed across different tendinopathies at the site of tendinopathy, as well as at other sites, the latter being suggestive of central sensitization.

Conclusion
Although more research on sensory abnormalities is warranted, it appears likely that there is an association between persistent tendon pain and sensitization of the nervous system. This evidence is primarily from studies of upper-limb tendinopathy, and caution should be exercised with inference to lower-limb tendinopathy.
Keyword Athletic injuries
Central sensitization
Chronic pain
Pain threshold
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Health and Rehabilitation Sciences Publications
 
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