Don't Underestimate Pain on Palpation in the Clinical Exam for Achilles Tendinopathy.

Everything was measured at a single visit, so the study cannot show whether greater palpation pain comes from worse tendon structure or whether the two simply occur together in people who already have symptoms. It cannot tell you what will happen over time. Only people with midportion Achilles tendinopathy were studied, and everyone had pain on palpation as part of their diagnosis. The findings say nothing about insertional Achilles problems or about people without pain. The relationships between palpation pain and tendon structure were weak. The regression models accounted for only a small share of the variation in tendon structure, so palpation is a rough signal rather than a precise one. Participants were people who volunteered for an exercise trial, with a wide range of symptom duration (from weeks to years) and the ability to complete hopping and heel rise testing. People who could not perform those tests were not represented in those measures. Not every participant contributed every measure, because of an equipment malfunction and problems measuring some tendons on ultrasound, so the numbers differ slightly between analyses. Pain was not rated at the exact moment the pressure algometer first became painful, so how much pain people felt at that threshold is unknown.

The authors declare they have no conflicts of interest relevant to this work. The work was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Do not read this as palpation pain telling you how damaged a tendon is. The links to tendon structure were weak, all the measurements were taken at one time point so the study cannot show which came first, and only midportion tendons were studied.