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Motor imagery training decreases pain on loading in people with moderate Achilles tendinopathy: A preliminary randomised cross-over experiment

LEVEL OF EVIDENCE: 2B SUMMARY Background. Achilles tendinopathy (AT) is characterised by pain with loading e.g. hopping. Disruption in the working body schema may contribute to pain. We tested this idea by ‘training’ the working body schema through motor imagery and testing loading pain. Methods. 6 participants with mid-portion AT entered this preliminary cross–over study. They received two randomised motor imagery training interventions 1) Specific laterality training using images of feet; 2) Sham training using images of the hand. After each condition, they performed 10 submaximal hops and reported their pain intensity (VAS in mm) and Time to Ease (s) afterwards. Participants were blinded to the study hypotheses. Results. Mean Pain Intensity was significantly lower after specific laterality training compared to sham (β coefficient = -13.17, 95% CI -21.3 to – 5.0, p=0.005). Mean Time to Ease was not significantly different between conditions (β coefficient = -38.67, 95% CI – 91.0 to 13.7, p=0.13). The order of testing was not significantly associated with either measure (Pain Intensity: F(1,9)=0.05, p=0.83; Time to Ease: F(1,9)=0.001, p=0.98). Conclusions. Participants reported less pain with hopping after specific laterality training than after sham training suggesting disruption of the body schema may contribute to pain and disability in Achilles tendinopathy.