Biomechanical stress in the context of competitive sports training triggers enthesitis

Document Type
Issue Date
Issue Year
Simon, David
Kleyer, Arnd
Bayat, Sara
Knitza, Johannes
Valor-Mendez, Larissa
Schweiger, Marina
Schett, Georg
Tascilar, Koray
Hueber, Axel J.


To evaluate the influence of mechanical stress on the development of immediate enthesitis. Methods

The BEAT study is an interventional study that assessed entheses in competitive badminton players before and immediately after a 60-min intensive training session. Power Doppler (PD) signal and Gray scale (GS) changes were assessed in the insertion sites of both Achilles tendon, patellar tendons, and lateral humeral epicondyles and quantified using a validated scoring system. Results

Thirty-two badminton players were included. One hundred ninety-two entheseal sites were examined twice. The respective empirical total scores for PD examination were 0.1 (0.3) before and 0.5 (0.9) after training. Mean total GS scores were 2.9 (2.5) and 3.1 (2.5) before and after training, respectively. The mean total PD score difference of 0.4 between pre- and post-training was significant (p = 0.0014), whereas no significant difference for the mean total GS score was observed. Overall, seven participants (22%) showed an increased empirical total PD score. A mixed effects model showed a significant increase of PD scores after training, with a mean increase per site of 0.06 (95% CI 0.01 to 0.12, p = 0.017). Conclusions

Mechanical stress leads to rapid inflammatory responses in the entheseal structures of humans. These data support the concept of mechanoinflammation in diseases associated with enthesitis.

Journal Title
Arthritis Research & Therapy