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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

4 Issues per year

CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

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Volume 18, Issue 3

Pain mapping of the anterior knee: injured athletes know best

Ebonie RioORCID iD: http://orcid.org/0000-0002-6854-929X / Michael GirdwoodORCID iD: http://orcid.org/0000-0001-6477-7263 / Jake Thomas
  • La Trobe Sport and Exercise Medicine Centre (LASEM), La Trobe University, Bundoora VIC, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Christopher Garofalo
  • La Trobe Sport and Exercise Medicine Centre (LASEM), La Trobe University, Bundoora VIC, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Lauren V. FortingtonORCID iD: http://orcid.org/0000-0003-2760-9249 / Sean DockingORCID iD: http://orcid.org/0000-0001-7051-7548
Published Online: 2018-05-18 | DOI: https://doi.org/10.1515/sjpain-2018-0046


Background and aims

Research investigating differences in pain location and distribution across conditions is lacking. Mapping a patient’s pain may be a useful way of understanding differences in presentations, however the use of pain mapping during a pain provocation task has not been investigated. The aim of this study was to assess the reliability of patient and clinician rated pain maps during a pain provocation task for the anterior knee.


Participants were recruited from a larger study of professional Australian rules football players (n=17). Players were invited to participate if they reported a current or past history of patellar tendon pain. No clinical diagnosis was performed for this reliability study. Participants were asked to point on their own knee where they usually experienced pain, which was recorded by a clinician on a piloted photograph of the knee using an iPad. Participants then completed a single leg decline squat (SLDS), after which participants indicated where they experienced pain during the task with their finger, which was recorded by a clinician. Participants then recorded their own self-rated pain map. This process was repeated 10 min later. Pain maps were subjectively classified into categories of pain location and spread by two raters. Pain area was quantified by the number of pixels shaded. Intra- and inter-rater reliability (between participants and clinicians) were analysed for pain area, similarity of location as well as subjective classification.


Test-retest reliability was good for participants (intraclass correlation coefficients [ICC]=0.81) but only fair for clinicians (ICC=0.47) for pain area. There was poor agreement between participants and clinicians for pain area (ICC=0.16) and similarity of location (Jaccard index=0.19). Clinicians had good inter- and intra-rater reliability of classification of pain spread (k=0.75 and 0.67).


Participant completed pain maps were more reliable than clinician pain maps. Clinicians were reliable at classifying pain based on location and type of spread.


Clinicians should ask patients to complete their own pain maps following a pain provocation test, to elicit the most reliable and consistent understanding of their pain perception.

Keywords: pain; tendinopathy; pain mapping; tendon; knee; sports medicine


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About the article

Corresponding author: Dr. Ebonie Rio, La Trobe Sport and Exercise Medicine Centre (LASEM), La Trobe University, Bundoora VIC 3086, Australia

Received: 2018-03-02

Revised: 2018-04-10

Accepted: 2018-04-14

Published Online: 2018-05-18

Published in Print: 2018-07-26

Authors’ statements

Research funding: This project was supported by the Australian Football League Research Board Priority Grant (2016). ER is supported by NHMRC early career research fund.

Conflict of interest: None declared.

Informed consent: Informed consent was gained from all participants.

Ethical approval: This research was approved by La Trobe University Human Research Ethics Committee (S15-224).

Author contributions: ER, SD, LV were involved in designing the research. ER, SD, JT, CG were involved in piloting and data collection. ER, MG, LV, SD were involved in data analysis, and manuscript preparation. All authors have read and approved the paper.

Citation Information: Scandinavian Journal of Pain, Volume 18, Issue 3, Pages 409–416, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2018-0046.

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