Potential Nervous System Sensitization in Patients With Persistent Lower Extremity Tendinopathies: 3 Case Reports

Area of Science:

• Orthopedics
• Sports Medicine
• Pain Management

Background:

• Tendinopathy frequently causes pain and limits function, with persistent symptoms in some patients despite standard treatments.
• Emerging research suggests a potential link between nervous system sensitization and the development of chronic tendinopathy.
• Understanding and addressing specific pain mechanisms may enhance treatment efficacy for refractory tendinopathy.

Observation:

• Three patients with chronic tendon pain and disability, unresponsive to prior treatments, presented with signs of central pain mechanism dysfunction.
• Interventions included joint mobilization, pain neuroscience education, and aerobic exercise tailored to address central sensitization.
• Patients received 5 sessions over 8 weeks, showing significant improvements in pain, function, and pressure pain thresholds.

Findings:

• All three patients achieved clinically significant improvements in pain and self-reported function.
• Pressure pain thresholds normalized, indicating reduced nervous system sensitization.
• Symptomatic running was achieved at discharge, with sustained improvements at the 1-year follow-up.

Implications:

• Tendinopathy may involve nervous system dysfunction beyond local tendon pathology.
• Integrating pain neuroscience education and central pain mechanism treatments may be beneficial for chronic tendinopathy.
• This approach may offer a more comprehensive strategy for managing persistent tendinopathy and improving patient outcomes.