title: Achilles Tendon pain
title: patient treatment innovation and unraveling immune system contributions
titleType: Subtitle
Creators: name: Post, Andrew
Publisher: name: University of Iowa
Year: 2024
Subjects: Achilles
Chronic
Rehabilitation
Tendinopathy
Pain

description: Chronic pain is considered a public health epidemic and is the primary reason patients seek out healthcare within the United States. While chronic pain impacts an individual’s function and activity level, poorly controlled pain may also negatively impact aspects of life that are not as apparent. This may include an individual’s emotionally well-being and overall quality of life, further warranting the need for utilization of a biopsychosocial approach to patient care. Furthermore, enhanced understanding of the underlying mechanisms that contribute to common musculoskeletal pain conditions may broaden our appreciation of the complexities of pain that reflect the variability within our patient’s pain experience that we see in clinical practice. Therefore, the overall goal of this work was to highlight innovative intervention approaches and underlying immune mechanisms outside of routine clinical practice for chronic Achilles tendinopathy.
description: We first sought to explore the effect of patient education that emphasized a pain neuroscience education approach when added to a progressive tendon loading exercise program compared to a pathoanatomical education program plus exercise on movement-evoked pain, disability, and pain-related psychological factors for individuals with chronic Achilles tendinopathy. Both educational approaches, when added to a tendon loading exercise protocol, resulted in similar reductions in movement-evoked pain, disability, and associated psychological factors while improving physical function. Therefore, clinical-decision making on patient educational content to best match a patient’s needs may assist with improved outcomes through individualization of the plan of care.
description: Next, I demonstrated that physical therapy delivery of interventions related to exercise and patient education through a virtual and hybrid format achieved outcomes that were no worse for pain and function when compared to an in-person format for those with chronic Achilles tendinopathy. During the beginning of the SARS-CoV-2 pandemic, we transitioned our study to a fully virtual format. After the re-opening of in-person human data collection, we offered both a virtual and in-person option to participants (hybrid mode of physical therapy delivery). I tested for the effect of the mode of physical therapy delivery through a non-inferiority analysis. Virtual and hybrid modes of physical therapy delivery demonstrated improvements in pain, physical function, and psychological factors that were no worse than those who completed only in-person physical therapy. Additionally, all three groups demonstrated similar levels of overall perceived improvement, development of therapeutic alliance, and engagement with their home exercise program. Provision of alternative options for completion of physical therapy allows for the incorporation of patient preference into the plan of care and may allow for greater follow-up attendance through enhanced accessibility to best practice for Achilles tendinopathy.
description: Lastly, to explore for potential underlying mechanisms outside of the musculoskeletal system that contribute to Achilles tendon pain, I was able to highlight immune cell population differences through flow cytometry analysis in both the myeloid and lymphoid lineage lines between individuals with chronic Achilles tendinopathy compared to healthy controls. Non-classical monocytes and B cells demonstrated a significant association with alterations in movement-evoked pain for those with chronic Achilles tendinopathy following a tendon loading exercise protocol.