Effect of Talocrural Joint Manipulation on pain sensitivity for Patients with Achilles Tendinopathy
Location
Suwanee, GA
Start Date
6-5-2025 1:00 PM
End Date
6-5-2025 4:00 PM
Description
Background and Introduction
Recent research indicates that a significant proportion of the benefits of manual therapy arise from neurophysiologic effects, rather than strictly mechanical means. There has, however, been little published literature specific to lower extremity tendinopathies to inform providers about expected neurophysiologic/sensory changes. This research seeks to build knowledge specific to the changes that manual therapy can effect in individuals with Achilles tendinopathy, specifically heat and cold pain thresholds. This study is relevant due to the high prevalence of Achilles tendon pain, coupled with the current documented challenges in the treatment of this population.
Methods
36 adult subjects with Achilles tendon pain for at least 3 months. Individuals were excluded if the involved lower leg had any surgical history, had a steroid injection in the affected area within 6 months, were currently pregnant, or had a connective tissue disorder. A baseline assessment of heat and cold pain thresholds was performed following accepted protocols. Three trials of each test were completed. Subjects assigned to the intervention group received a talocrural joint high velocity, low amplitude manipulation. The control group received a plausible sham of passive ankle movement without moving to the end ranges. Immediately following the application of the intervention or sham all participants were re-tested for heat and cold pain thresholds.
Results
Contrary to the initial hypothesis, neither the treatment nor sham groups showed improved pain thresholds to heat or cold. In contrast, the intervention group showed a trend toward worsened heat tolerances (paired t-test p=.015).
No statistically significant changes were found in the intervention group's cold response nor with either heat or cold in the control group.
Though the primary hypothesis was not confirmed, this research did produce more robust normative data for heat and cold pain thresholds in this population than previously has been published. In this sample of 36 individuals, mean heat pain threshold was 44.51℃ SD=3.22 and cold pain threshold was 9.39℃ SD=10.56.
Conclusion
This research found data contrary to existing theoretical frameworks which had shown a pattern of improvement in pain sensitivity after manual therapy. Several possible explanations exist for this difference, primarily that this specific combination of population, intervention, and outcome assessment had not been previously tested in the identified literature. Additionally, it is conceivable that the manual pressure applied with the intervention could have provided unintended secondary responses influencing pain.
This research did, however, improve upon existing data on normative pain thresholds for individuals with persistent Achilles pain, in that while the means identified in this data were similar, the sample size was larger than other studies found in published literature.
The clinical implications of this research are two-fold, first, it found no improvement in heat or cold pain thresholds in subjects receiving manual therapy compared to those with a sham. Secondly, these findings significantly strengthen the existing dataset related to normative pain thresholds in individuals with Achilles tendon pain.
Embargo Period
5-19-2025
Effect of Talocrural Joint Manipulation on pain sensitivity for Patients with Achilles Tendinopathy
Suwanee, GA
Background and Introduction
Recent research indicates that a significant proportion of the benefits of manual therapy arise from neurophysiologic effects, rather than strictly mechanical means. There has, however, been little published literature specific to lower extremity tendinopathies to inform providers about expected neurophysiologic/sensory changes. This research seeks to build knowledge specific to the changes that manual therapy can effect in individuals with Achilles tendinopathy, specifically heat and cold pain thresholds. This study is relevant due to the high prevalence of Achilles tendon pain, coupled with the current documented challenges in the treatment of this population.
Methods
36 adult subjects with Achilles tendon pain for at least 3 months. Individuals were excluded if the involved lower leg had any surgical history, had a steroid injection in the affected area within 6 months, were currently pregnant, or had a connective tissue disorder. A baseline assessment of heat and cold pain thresholds was performed following accepted protocols. Three trials of each test were completed. Subjects assigned to the intervention group received a talocrural joint high velocity, low amplitude manipulation. The control group received a plausible sham of passive ankle movement without moving to the end ranges. Immediately following the application of the intervention or sham all participants were re-tested for heat and cold pain thresholds.
Results
Contrary to the initial hypothesis, neither the treatment nor sham groups showed improved pain thresholds to heat or cold. In contrast, the intervention group showed a trend toward worsened heat tolerances (paired t-test p=.015).
No statistically significant changes were found in the intervention group's cold response nor with either heat or cold in the control group.
Though the primary hypothesis was not confirmed, this research did produce more robust normative data for heat and cold pain thresholds in this population than previously has been published. In this sample of 36 individuals, mean heat pain threshold was 44.51℃ SD=3.22 and cold pain threshold was 9.39℃ SD=10.56.
Conclusion
This research found data contrary to existing theoretical frameworks which had shown a pattern of improvement in pain sensitivity after manual therapy. Several possible explanations exist for this difference, primarily that this specific combination of population, intervention, and outcome assessment had not been previously tested in the identified literature. Additionally, it is conceivable that the manual pressure applied with the intervention could have provided unintended secondary responses influencing pain.
This research did, however, improve upon existing data on normative pain thresholds for individuals with persistent Achilles pain, in that while the means identified in this data were similar, the sample size was larger than other studies found in published literature.
The clinical implications of this research are two-fold, first, it found no improvement in heat or cold pain thresholds in subjects receiving manual therapy compared to those with a sham. Secondly, these findings significantly strengthen the existing dataset related to normative pain thresholds in individuals with Achilles tendon pain.
Comments
Awarded "Best Clinical Case Study: Runner Up" at PCOM Georgia Research Day 2025