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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

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Prediction of running-induced Achilles tendinopathy with pain sensitivity – a 1-year prospective study

René B.K. Brund
  • Corresponding author
  • Sport Sciences, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark
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  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Sten Rasmussen
  • Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  • Orthopaedic Surgery Research Unit, Science and Innovation Center, Aalborg University Hospital, Aalborg, Denmark
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  • De Gruyter OnlineGoogle Scholar
/ Uwe G. Kersting
  • Sport Sciences, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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/ Lars Arendt-Nielsen
  • SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
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/ Thorvaldur Skuli Palsson
  • SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
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Published Online: 2018-11-08 | DOI: https://doi.org/10.1515/sjpain-2018-0084


Background and aims

Achilles tendinopathy is common among runners, but the etiology remains unclear. High mechanical pain sensitivity may be a predictor of increased risk of developing Achilles tendinopathy in this group. The purpose of this study was to investigate whether local pain sensitivity could predict the development of Achilles tendinopathy in recreational male runners. The overall hypothesis was that high pain sensitivity would be related to a higher risk of developing Achilles tendinopathy among recreational male runners.


Ninety-nine recreational male runners were recruited and followed prospectively for 1 year. At baseline and after 500 km of running the pressure pain threshold (PPT) was assessed at the infraspinatus and at the Achilles tendon (AT-PPT). Based on the AT-PPT at baseline, a median split was used to divide the runners into two groups. The high pain sensitivity groups was defined as runners displaying a pain pressure threshold below 441 kPa on the Achilles tendon, while the low pain sensitivity group was defined as runners displaying a pain pressure threshold above 441 kPa on the Achilles tendon, respectively. Subsequently, the cumulative risk difference between the two groups was assessed by using the pseudo-observation method.


High pain sensitivity runners sustained 5%-point (95% CI: −0.18 to 0.08) more Achilles tendinopathy episodes during the first 1,500 km. No significant group differences in risk were found at 100, 250, 500, 1,000 and 1,500 km of running.


No significant association was found between mechanical pain sensitivity in the Achilles tendon and the risk of developing Achilles tendinopathy. However, the risk difference indicated a association between a high mechanical pain sensitivity and an increased risk of developing Achilles tendinopathy. It is plausible that changes in pain sensitivity were masked by unmeasured covariates, such as the differences in progression/regression of training volume and running speed between the two groups. This study was limited in size, which limited the possibility to account for covariates, such as differences in progression/regression of running speed between runners. With the limitations in mind, future studies should control the training volume, speed and running shoes in the design or account for it in the analysis.


Pain sensitivity of the Achilles tendon seems not to be related to an increased risk of developing Achilles pain in relation to running.

Keywords: pain pressure threshold; runners; injury prevention; injury survival; epidemiology; achilles injury


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About the article

Received: 2018-05-12

Revised: 2018-08-29

Published Online: 2018-11-08

Authors’ statements

Research funding: This study was supported by Aalborg University Hospital, Denmark

Conflict of interest: None to declare.

Informed consent: Informed consent was obtained from all participants.

Ethical approval: Ethical approval was obtained from the The North Denmark Region Committee on Health Research Ethics, approval number N-20130074.

Citation Information: Scandinavian Journal of Pain, 20180084, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2018-0084.

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