The Effects of Noxious Electrical Stimulation and Eccentric Exercise on Mechanical and Thermal Pain Sensitivity in Recreational Runners with Achilles Tendinopathy.
Scott K Stackhouse, Brian J Eckenrode, Kathleen C Madara
PMID 39906048WHAT IT FOUND
16 runners with chronic Achilles pain reported better function and showed less pressure and heat sensitivity after one week of painful electrical stimulation followed by eccentric calf, core, stretch exercises and running education.
Because treatments were sequenced, the effect of any single part is unclear.
Key findings
01By one-month follow-up, average LEFS improved by 9.6 points and VISA-A by 19.4 points, both above stated clinically important change thresholds.
02Pressure pain threshold at the painful Achilles rose by 2.5 kg after one week of NxES and by 4.3 kg during the eccentric exercise phase, each above the reported minimal detectable change of 2.05 kg.
03Heat pain threshold rose by 3.8°C during eccentric exercise, exceeding the minimal detectable change; heat temporal summation did not change significantly during the NxES week or the eccentric exercise week but fell by 23.7 mm by follow-up, exceeding the minimal detectable change.
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What it does not show
There was no control group and only 16 participants, so improvements could reflect natural recovery, repeated testing, or other factors. NxES, eccentric calf exercises, core strengthening, stretches, and running education were given in sequence, so the contribution of any one treatment cannot be separated. Participants were active recreational runners with chronic Achilles pain, so results may not apply to less active people or acute/subacute Achilles pain. One enrolled participant withdrew because an undisclosed cardiac history was revealed during treatment, reducing the analysed group. Running volume was managed with a pain-monitoring model and education, and variations in running activity could have influenced symptoms or pain sensitivity. The paper notes no reliability data for Achilles pressure, heat, and temporal summation testing in people with Achilles tendinopathy. Baseline pressure pain thresholds were much larger than in other studies, possibly due to fixing the ankle in neutral dorsiflexion/plantarflexion.
Declared interests
The authors have no disclosures.
The easy way to misread this
Do not conclude that noxious electrical stimulation caused the improvements. There was no control group, and NxES was followed by eccentric calf exercises, core strengthening, stretches, and running education, so the contribution of any single component cannot be separated.