# Factors Explaining the Severity of Acute Achilles Tendinopathy Among Runners: A Comprehensive Cross-Sectional Analysis

## TL;DR

This study identifies key factors that explain the severity of Achilles tendinopathy in runners, including pain, fear of movement, and tendon size.

## Contribution

The study identifies specific anatomic, biomechanical, and psychological factors that explain AT severity using the VISA-A score.

## Key findings

- Higher kinesiophobia and pain catastrophizing scores are linked to more severe Achilles tendinopathy.
- Pain during single-leg jumps and increased tendon cross-sectional area correlate with higher VISA-A scores.
- The identified factors explain 47% of the variance in VISA-A scores among runners with acute AT.

## Abstract

Achilles tendinopathy (AT) is a prevalent musculoskeletal injury among runners, accounting for approximately 10% of all running-related injuries. AT can result in persistent symptoms and impact the quality of life of runners. The Victorian Institute of Sport Assessment questionnaire (VISA-A) is a widely used self-reported tool for assessing severity of AT. However, the anatomic, biomechanical, psychological, and social factors that influence its score are still poorly understood. The aim of this study is to identify the factors that explain the severity of AT based on the VISA-A score in runners experiencing acute AT.

The VISA-A score will be explained by both biological and psychosocial factors.

Cross-sectional study.

Level 4.

Runners with AT were assessed within 3 months of symptoms onset. The potential explanatory factors assessed included sociodemographic characteristics and medical history, as well as psychosocial, physical, and anatomic (ultrasound imaging) variables.

Participants with AT (n = 84) demonstrated moderate impairments, with a mean VISA-A score of 62.8 (SD, 15.1). Three variables emerged as significant factors explaining AT severity: higher level of kinesiophobia and pain catastrophizing, pain during single-leg jumps, and increased cross-sectional Achilles tendon area on ultrasound imaging. These 3 variables had a moderate capacity (R2 = 0.47) to explain the VISA-A score.

Pain during single-leg jumps, an increased cross-sectional tendon area assessed by ultrasound, and a high score on kinesiophobia and pain catastrophizing questions are associated with higher VISA scores.

These findings provide the basis for the development of more tailored interventions to improve the quality of life and function of runners with acute AT.