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Exploring biomarkers of change in movement-evoked pain in Achilles tendinopathy: A secondary analysis of a randomized controlled trial
Journal article   Peer reviewed

Exploring biomarkers of change in movement-evoked pain in Achilles tendinopathy: A secondary analysis of a randomized controlled trial

Adam J. Janowski, Andrew A. Post, Alberto Marcos Heredia-Rizo, Laura A. Frey-Law, Emine O. Bayman, Kathleen A. Sluka and Ruth L. Chimenti
Clinical biomechanics (Bristol), Vol.131, 106706
01/2026
DOI: 10.1016/j.clinbiomech.2025.106706
PMCID: PMC12626106
PMID: 41207117
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC12626106/View
Open Access

Abstract

Movement-evoked pain contributes to disability, yet factors that predict improvement in pain with rehabilitation remain largely unknown. We aimed to identify predictors and response biomarkers of the reduction in movement-evoked pain intensity with rehabilitation in individuals with Achilles tendinopathy (AT). Individuals with AT (n = 65) were evaluated at baseline and after 8-weeks of rehabilitation. Pain (Numeric Rating Scale, 0 to 10) was collected during increasingly difficult tendon-loading (resting, walking, heel raises) and stretching (resting, standing, calf stretch) tasks. Psychological, ankle biomechanics, and clinical variables were collected. Linear mixed effects models were built around two paradigms of pain (tendon loading and stretching tasks) to determine variables predictive of change in pain (predictive biomarkers) and variables that changed along with change in pain (response biomarkers) with rehabilitation. Lower ankle dorsiflexion during walking (β = 0.178, 95 %CI:0.06, 0.29), higher ankle dorsiflexion during stretching (β = −0.111, 95 %CI:-0.174, −0.05), a lower Victorian Institute of Sports Assessment- Achilles (VISA-A) score (β = 0.031, 95 % CI:0.010, 0.054), and younger age (β = 0.047, 95 %CI:0.022, 0.072) at baseline predicted a greater reduction in pain. For response biomarkers, reductions in duration of tendon stiffness (β = 0.018, 95 %CI: 0.001, 0.036), increases in ankle dorsiflexion during walking (β = −0.15, 95 %CI:-0.285, −0.016), reductions in depression (β = 0.109, 95 % CI:0.041, 0.178), and reductions in kinesiophobia (β = 0.151, 95 %CI:0.083, 0.219) were associated with greater reductions in pain. AT type was not associated with pain. Regardless of AT type, kinesiophobia, ankle dorsiflexion, and clinical factors may be important factors to consider as predictors and/or response indicators for reductions in movement-evoked pain with rehabilitation. Study Registration: https://clinicaltrials.gov/study/NCT04059146 •Kinesiophobia decreased along with reduced movement-evoked pain with rehabilitation.•Lower baseline ankle dorsiflexion with walking predicted a greater reduction in pain.•Lower baseline function predicted a greater reduction in pain.•Achilles pain site (insertion vs. midportion) did not predict pain reduction.
 Biomechanics Chronic Pain Achilles tendon Exercise therapy Global rating of change Kinesiophobia

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