A Closer Look at Localized and Distant Pressure Pain Hypersensitivity in People With Lower Extremity Overuse Soft-Tissue Painful Conditions: A Systematic Review and Meta-Analysis

Author:

Plaza-Manzano Gustavo12,Fernández-de-las-Peñas César34,Cleland Joshua A5,Arias-Buría José L12,Jayaseelan Dhinu J6ORCID,Navarro-Santana Marcos J78

Affiliation:

1. Universidad Complutense de Madrid Radiology, Rehabilitation and Physiotherapy Department, , Madrid, Spain

2. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos , Madrid, Spain

3. Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón Department of Physical Therapy, , Madrid, Spain

4. Universidad Rey Juan Carlos Cátedra Institucionalen Docencia, Clínica e Investigaciónen Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, , Madrid, Spain

5. Tufts University School of Medicine Doctor of Physical Therapy Program, , Boston, Massachusetts , USA

6. The George Washington University Department of Health, Human Function and Rehabilitation Sciences, , Washington, DC , USA

7. Universidad Católica de Ávila (UCAV), Calle Canteros s/n Faculty of Health, , Ávila, Spain

8. Faculty of Health, Universidad Camilo José Cela VALTRADOFI Research Group, Department of Physiotherapy, , Villanueva de la Cañada , Spain

Abstract

Abstract Objective The nociceptive pain processing of soft-tissue overuse conditions is under debate because no consensus currently exists. The purpose of this meta-analysis was to compare pressure pain thresholds (PPTs) in symptomatic and distant pain-free areas in 2 groups: participants with symptomatic lower extremity overuse soft-tissue conditions and controls who were pain free. Methods Five databases were searched from inception to December 1, 2021, for case–control studies comparing PPTs between individuals presenting with symptomatic lower extremity tendinopathy/overuse injury and controls who were pain free. Data extraction included population, diagnosis, sample size, outcome, type of algometer, and results. The methodological quality (Newcastle-Ottawa Quality Assessment Scale) and evidence level (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Meta-analyses of symptomatic, segmental related, and distant pain-free areas were compared. Results After screening 730 titles and abstracts, a total of 19 studies evaluating lower extremity overuse conditions (Achilles or patellar tendinopathy, greater trochanteric pain syndrome, plantar fasciitis, and iliotibial band syndrome) were included. The methodological quality ranged from fair (32%) to good (68%). Participants with lower extremity overuse injury had lower PPTs in both the painful and nonpainful areas, mirrored test-site, compared with controls (affected side: mean difference [MD] = −262.92 kPa, 95% CI = 323.78 to −202.05 kPa; nonaffected side: MD = −216.47 kPa, 95% CI = −304.99 to −127.95 kPa). Furthermore, people with plantar fasciitis showed reduced PPTs in the affected and nonaffected sides at segmental-related (MD = −176.39 kPa, 95% CI = −306.11 to −46.68 kPa) and distant pain-free (MD = −97.27 kPa, 95% CI = 133.21 to −61.33 kPa) areas compared with controls. Conclusion Low- to moderate-quality evidence suggests a reduction of PPTs at the symptomatic area and a contralateral/mirror side in lower extremity tendinopathies and overuse conditions compared with pain-free controls, particularly in plantar fasciitis and greater trochanteric pain syndrome. Participants with plantar fasciitis showed a reduction of PPTs on the affected and non-affected sides at a segmental-related area (very low-quality evidence) and at a remote asymptomatic area (moderate-quality evidence). Impact Some overuse peripheral pain conditions may be more associated with pressure pain sensitivity than others. Accordingly, examination and identification of conditions more peripherally, centrally, or mixed mediated could potentially lead to more specific and different treatment strategies.

Publisher

Oxford University Press (OUP)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

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