Reduced Achilles tendinopathy symptoms (e.g., stiffness), but not pain, relate to patient-perceived resolution of Achilles tendinopathy: A cross-sectional study

M Murphy; F Bright; G White; R Chimenti; A Mosler; E Rio

doi:10.1016/j.jsams.2025.07.142

Introduction: Studies related to how pain is associated with Achilles tendinopathy dominate current research. However other clinical symptoms, such as the sensation of ‘stiffness’ (rather than the mechanical property) or ‘tightness’ have received substantially less attention, especially regarding patient perception of recovery from tendinopathy. Thus, we aimed to determine whether pain, symptoms and/ or physical function are associated with perceived recovery in people with current or resolved Achilles tendinopathy. Methods: We included people aged over 18 years who reported having either ‘current’ or ‘resolved’ Achilles tendinopathy. Participants completed an online survey, including their demographics and the Tendinopathy Severity Assessment- Achilles (TENDINS-A). We used a single multivariable binary logistic regression to quantify the association of age, body mass index (BMI), sex, TENDINS-A (Pain), TENDINS-A (Symptoms) and TENDINS-A (Physical Function) on recovery status. We reported odds ratio (OR) and 95% confidence intervals (95%CI) to quantify the strength of the association, with significance accepted when p < 0.05. Results: We included 100 cases (n = 63 current tendinopathy, n = 37 resolved tendinopathy). There were no associations of age (OR = 0.999, 95%CI = 0.963 to 1.037, p = 0.974), sex (OR = 0.657, 95%CI = 0.254 to 1.698, p = 0.386) or BMI (OR = 0.963, 95%CI = 0.879 to 1.056, p = 0.427) with whether participants reported having current or resolved Achilles tendinopathy. TENDINS-A (Pain: OR = 1.005, 95%CI = 0.986 to 1.024, p = 0.593) and TENDINS-A (Physical Function: OR = 0.997, 95%CI = 0.982 to 1.012, p = 0.705) were not associated with whether participants reported having current or resolved Achilles tendinopathy. However, TENDINS-A (Symptoms: OR = 0.972, 95%CI = 0.953 to 0.992, p = 0.007) were significantly associated with whether participants reported having current or resolved Achilles tendinopathy. Discussion: As the first study using the TENDINS-A (which quantifies a separate subdomain for pain, symptoms, and physical function) we were able to demonstrate that lower overall Achilles tendinopathy ‘symptom’ severity but not ‘pain’ or ‘physical function’ severity was associated with patient-reported resolution of their Achilles tendinopathy. Specifically, we found that for every 1% greater the TENDINS-A (Symptoms) there was 0.28 lower odds of a participant reporting their tendinopathy has resolved. Impact/Application to the field: This cross-sectional study demonstrated that patient-reported resolution of Achilles tendinopathy was primarily related to ‘symptoms’ such as stiffness, but not pain. The findings of this research are therefore relevant to both researchers and clinicians. For researchers, if the efficacy of interventions is assessed using pain (including severity, duration etc), but not other symptoms (e.g., tightness), there may be a disconnect between patient perceived overall improvement and improvement with pain scores. For clinicians, this research affirms the importance of asking patients about their symptoms and monitoring these descriptors, and not just their pain perception. It also provides an opportunity for education about the relationship between symptoms, pain and exercise load progression in management.

Reduced Achilles tendinopathy symptoms (e.g., stiffness), but not pain, relate to patient-perceived resolution of Achilles tendinopathy: A cross-sectional study

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