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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Persistent pain in the Achilles tendon is often caused by partial ruptures leading to a hypoxic state in the tissues, insufficient healing, and a remaining, immature, and painful scar. The rupture is caused by overuse and conservatively treated with orthotic devices to reduce tendon load and physiotherapy to correct training errors and strength the muscle-tendon unit. Significant partial ruptures seem to respond poorly to conservative measures and do not improve with time. Surgical treatment with excision of degenerated tissue which leads to complete pain relief and full restoration of function with long-standing effects in most cases is why persistent Achilles tendon pain due to partial rupture preferably should be treated surgically.
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PMID:Partial Achilles tendon tears. 142 96

Knee problems are the most common injury sustained in both male and female runners. Other problems include toe and forefoot injuries, inferior heel and arch pain, shin splints, ankle pain, calf and Achilles tendon pain, groin and hip pain, and stress fractures. The average total treatment for all injuries required 4.2 physician visits. Orthotics were used for more than 60% of the injuries, with successful results. A thorough understanding of running injuries should assist the physician in the treatment of these problems.
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PMID:Patterns of lower-extremity injury in 224 runners. 611 May 10

We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 +/- 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of the noninjured side. A comparison group of 15 recreational athletes with the same diagnosis and a long duration of symptoms had been treated conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes of shoes or orthoses, physical therapy, and in all cases also with ordinary training programs. In no case was the conventional treatment successful, and all patients were ultimately treated surgically. Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.
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PMID:Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. 961 96

In an ongoing prospective study of 14 recreational athletes (12 males and 2 females, mean age 44.2 +/- 7.1 years) with unilateral chronic Achilles tendinosis, we investigated the effect of treatment with heavy-loaded eccentric calf-muscle training. Pain during activity (recorded on a VAS scale) and isokinetic concentric and eccentric calf-muscle strength (peak torque at 90 degrees /second and 225 degrees /second) on the injured and noninjured side were evaluated. In this group of patients, we examined areal bone mineral density (BMD) of the calcaneus after 9 months (range 6-14 months) of training. BMD of the injured side (subjected to heavy-loaded eccentric training) was compared with BMD of the noninjured side. Before onset of heavy-loaded eccentric training, all patients had Achilles tendon pain which prohibited running activity, and significantly lower concentric and eccentric plantar flexion peak torque on the injured compared with the noninjured side. The training program consisted of 12 weeks of daily, heavy-loaded, eccentric calf-muscle training; thereafter the training was continued for 2-3 days/week. The clinical results were excellent-all 14 patients were back at their preinjury level with full running activity at the 3 month follow-up. The concentric and eccentric plantar flexion peak torque had increased significantly and did not significantly differ from the noninjured side at the 3 and 9 month follow-up. There were no significant side-to-side differences in BMD of the calcaneus. There was no significant relationship between BMD of the calcaneus and calf-muscle strength. As a comparison group, we used 10 recreational athletes (5 males and 5 females) mean age 40.9 years (range 26-55 years), who were selected for surgical treatment of chronic Achilles tendinosis localized at the 2-6 cm level. Their duration of symptoms and severity of disease were the same as in the experimental group. There were no significant side-to-side differences in BMD of the calcaneus preoperatively, but 12 months postoperatively BMD of the calcaneus was 16.4% lower at the injured side compared with the noninjured side. Heavy-loaded eccentric calf-muscle training resulted in a fast recovery in all patients, equaled the side-to-side differences in muscle strength, and was not associated with side-to-side differences in BMD of the calcaneus. In this group of middle-aged recreational athletes, BMD of the calcaneus was not related to calf-muscle strength.
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PMID:Bone mass in the calcaneus after heavy loaded eccentric calf-muscle training in recreational athletes with chronic achilles tendinosis. 1020 22

In this investigation, we show the presence of both free glutamate (microdialysis) and glutamate NMDAR1 receptors (immunohistochemical analyses of tendon biopsies), in tendons from patients with chronic Achilles tendon pain (Achilles tendinosis) and in controls (pain-free tendons). The NMDAR1 immunoreaction was usually confined to acetylcholinesterase-positive structures, implying that the reaction is present in nerves. Glutamate is a potent pain mediator in the human central nervous system, and in animals it has been shown that peripherally administered glutamate NMDA receptor antagonists diminish the response to formalin-induced nociception. Our present finding of glutamate NMDA receptors in human Achilles tendons might have implications for pain treatment.
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PMID:Glutamate NMDAR1 receptors localised to nerves in human Achilles tendons. Implications for treatment? 1135 54

Overuse injuries are the most frequent type in badminton, generally localized in the legs. An earlier study found 32% of young Swedish elite badminton players to have experienced disabling pain in the Achilles tendon region during the previous 5 years. The present investigation examined the prevalence and characteristics of painful conditions in the Achilles tendon region in 32 middle-aged competitive badminton players by means of questionnaire and physiotherapist's examination. Pain in the Achilles tendon region was reported by 44%, either presently or during the past 5 years, generally localized in the middle portion of the tendon. Symptoms had lasted 2 weeks-1 year (96 days). On the competition days 22% of the reported pain currently in the region. Age was found to be correlated to Achilles tendon pain, but there was no relationship between symptoms of pain and body mass index, gender, training quantity, or years of playing badminton. In conclusion, Achilles tendon pain seems to be relatively common among Swedish middle-aged competitive badminton players, particularly in the older ones.
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PMID:Painful conditions in the Achilles tendon region: a common problem in middle-aged competitive badminton players. 1181 23

Injuries involving the Achilles tendon and manifested as chronic tendon pain are common, especially among recreational athletes. In a pilot study on a small group of patients with chronic painful mid-portion Achilles tendinosis, eccentric calf-muscle training was shown to give good clinical results. The aim of this prospective study was to investigate if the previously achieved good clinical results could be reproduced in a larger group of patients, and also to investigate the effects of eccentric calf-muscle training in patients with chronic insertional Achilles tendon pain. Seventy-eight consecutive patients, having chronic painful Achilles tendinosis at the mid-portion (2-6 cm level) in a total of 101 tendons (55 unilateral and 23 bilateral), and thirty consecutive patients with chronic insertional Achilles tendon pain in 31 tendons (29 unilateral and one bilateral) were treated with eccentric calf-muscle training for 12 weeks. Most patients were recreational athletes. Evaluation of the amount of tendon pain during activity was recorded on a visual analogue scale (VAS), before and after treatment. In 90 of the 101 Achilles tendons (89%) with chronic painful mid-portion Achilles tendinosis, treatment was satisfactory and the patients were back on their pre-injury activity level after the 12-week training regimen. In these patients, the amount of pain during activity, registered on the VAS-scale (mean+/-SD), decreased significantly from 66.8+/-19.4 to 10.2+/-13.7. On the contrary, in only ten of the tendons (32%) with chronic insertional Achilles tendon pain was treatment satisfactory, with a significant decrease on the VAS-scale (mean+/-SD), from 68.3+/-7.0 to 13.3+/-13.2. Our conclusion is that treatment with eccentric calf-muscle training produced good clinical results in patients with chronic painful mid-portion Achilles tendinosis, but not in patients with chronic insertional Achilles tendon pain.
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PMID:Chronic Achilles tendon pain treated with eccentric calf-muscle training. 1294 35

The purpose of this double-blind study was to evaluate the effects of iontophoresis with dexamethazone to iontophoresis with saline solution on patients who had acute (less than 3 months) pain from the Achilles tendon, in terms of range of motion, muscular endurance, pain and symptoms. Twenty-five patients (15 men and 10 women), aged between 18 and 76 years (mean=38), were evaluated before and after 2 weeks of treatment with iontophoresis, as well as after 6 weeks, 3 and 6 months and 1 year. Two groups were treated for 2 weeks with iontophoresis for each treatment. Three ml of dexamethazone were used for the experiment group (n=14) and 3 ml of saline solution for the control group (n=11). Both groups then followed the same rehabilitation programme for 10 weeks. Good reliability was found for the toe-raise and range of motion tests. Poor reliability was, however, found for the pain on palpation test, which was therefore excluded. No difference was found between or within groups for the toe-raise test. Several significant improvements were seen in the experiment group but not in the control group, in the range of motion test, pain during and after physical activity, pain during walking and walking up and down stairs, morning stiffness and tendon swelling. Even though the small sample size limits the possibilities to draw definite conclusions, we conclude from the present study, using a double-blind, randomised approach and a 1-year follow-up period, that positive effects from using iontophoresis with dexamethazone were found in the treatment of patients with acute Achilles tendon pain.
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PMID:Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain. 1461 59

Local injections of the sclerosing substance Polidocanol has been demonstrated to give good clinical results in a pilot study on patients with chronic Achilles tendinopathy. In this study, 20 consecutive patients (9 men and 11 women, mean age 50 years) with chronic painful mid-portion Achilles tendinopathy were randomised to injection treatment with either Polidocanol (5 mg/ml) (group A) or Lidocaine hydro-chloride (5 mg/ml) + Adrenaline (5 microg/ml) (group B). Both substances have a local anaesthetic effect, but Polidocanol also has a sclerosing effect. The patients and the treating physician were blinded to the substance injected. The short-term effects were evaluated after a maximum of two treatments, 3-6 weeks apart. Before treatment, all patients had structural tendon changes and neo-vascularisation demonstrated with US and colour doppler. Under US and colour doppler-guidance, the injections targeted the area of neo-vascularisation just outside the ventral part of the tendon. For evaluation, the patients recorded the severity of Achilles tendon pain during tendon loading activity, before and after treatment, on a VAS. Patient's satisfaction with treatment was also assessed. At follow-up (mean 3 months) after a maximum of two treatments, 5/10 patients in group A were satisfied with the treatment and had a significantly reduced level of tendon pain (p < 0.005). In group B, no patient was satisfied with treatment. In the pain-free tendons, but not in the painful tendons, neo-vascularisation was absent after treatment. After completion of the study, treatment with Polidocanol injections (Cross-over in group B and additional treatments in group A) resulted in 10/10 and 9/10 satisfied patients in group A and B, respectively. In summary, injections with the sclerosing substance Polidocanol have the potential to reduce tendon pain during activity in patients with chronic painful mid-portion Achilles tendinopathy.
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PMID:Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial. 1568 35

The cause of pain in Achilles tendinopathy is thought to be related to the presence of neovascularization in the tendon as seen on color Doppler ultrasound. Asymptomatic pathology has been observed in patellar tendons of elite athletes. The purpose of this study was to examine the prevalence of Achilles tendon pain and the characteristics of Achilles tendons in a young athletic population. Sixty-four varsity athletes underwent color Doppler ultrasound imaging to determine tendon thickness, presence of degeneration and neovascularization. The presence of swelling and tenderness was determined, and Achilles tendon pain was rated on three visual analogue scales (VAS) (pain during exercise, pain at rest, pain during daily activities) as well as on the VISA-A scale. Tendon symptoms were not related to the presence of neovascularization. There was a low prevalence of Achilles tendinopathy, tenderness, and neovascularization in this population. Neovascularization was seen in both a painful and a non-painful tendon.
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PMID:Achilles tendon pain intensity and level of neovascularization in athletes as determined by color Doppler ultrasound. 1707 25


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