Article Text

Download PDFPDF
Patellar and Achilles tendinopathies are predominantly peripheral pain states: a blinded case control study of somatosensory and psychological profiles
  1. Melanie L Plinsinga1,
  2. Cornelis P van Wilgen2,3,4,
  3. Michel S Brink5,
  4. Viana Vuvan1,
  5. Aoife Stephenson1,
  6. Luke J Heales1,6,
  7. Rebecca Mellor1,
  8. Brooke K Coombes7,
  9. Bill T Vicenzino1
  1. 1 School of Health and Rehabilitation Sciences: Physiotherapy, University of Queensland, St Lucia, Brisbane, Australia
  2. 2 Transcare Transdisciplinary Pain Management Center, Groningen, The Netherlands
  3. 3 Pain in Motion Research Group, Brussels, Belgium
  4. 4 Department of Physiotherapy and Rehabilitation Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
  5. 5 Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  6. 6 School of Human Health and Social Sciences, Department of Physiotherapy, Central Queensland University, Rockhampton, Australia
  7. 7 School of Biomedical Sciences, University of Queensland, St Lucia, Brisbane, Australia
  1. Correspondence to Professor Bill T Vicenzino, School of Health and Rehabilitation Sciences Building 84A, The University of Queensland, Brisbane, Qld 4072, Australia; b.vicenzino{at}


Study design Case–control design.

Background Tendinopathy is characterised by pain on tendon loading. In persistent cases of upper limb tendinopathy, it is frequently associated with central nervous system sensitisation, whereas less commonly linked in the case of persistent lower limb tendinopathies.

Objectives Compare somatosensory and psychological profiles of participants with persistent patellar (PT) and Achilles tendinopathies (AT) with pain-free controls.

Methods A comprehensive battery of Quantitative Sensory Testing (QST) was assessed at standardised sites of the affected tendon and remotely (lateral elbow) by a blinded assessor. Participants completed the Victorian Institute of Sports Assessment, a health-related quality of life questionnaire, the Hospital Anxiety and Depression Scale and the Active Australia Questionnaire. Independent t-test and analysis of covariance (sex-adjusted and age-adjusted) were performed to compare groups.

Results Participants with PT and AT did not exhibit differences from controls for the QST at the remote site, but there were differences at the affected tendon site. Compared with controls, participants with PT displayed significantly lower pressure pain threshold locally at the tendon (p=0.012) and fewer single limb decline squats before pain onset, whereas participants with AT only displayed fewer single heel raises before pain onset, but this pain was of a higher intensity.

Conclusion PT and AT appear to be predominantly local not widespread pain states related to loading of tendons without significant features of central sensitisation.

Level of evidence Level 4.

  • chronic pain
  • central sensitization
  • pain threshold
  • athletic injuries
  • jumper’s knee

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This trial was funded by the National Health and Medical Research Council (NHMRC) Program Grant (#631717). MLP is supported by the International Postgraduate Research Scholarship (IPRS)/ University of Queensland Centennial Scholarship (UQcent).

  • Competing interests None declared.

  • Patient consent No participant identifying data are included within the paper.

  • Ethics approval Medical Research Ethics Committee of the University of Queensland.

  • Provenance and peer review Not commissioned; externally peer reviewed.