The effectiveness of pain neuroscience education in the treatment of recreational marathon runners with chronic running related knee injuries

Abstract

Background: Running has a long history as a mode of exercise and in recent years the popularity of running has increased especially in South Africa. However, it may have adverse short- and long-term effects through running-related injuries. For marathon runners, one of the most common consequences of this is injury to the knee joint complex. Recreational runners presenting with injuries have partially recovered from their injury yet continue to experience pain. Which emphasises the necessity for treatment to be more comprehensively through a biopsychosocial model Pain Neuroscience Education (PNE) component, where a greater understanding of how the nervous system processes injury and pain is utilised. Aim: To assess the effectiveness of Pain Neuroscience Education (PNE) combined with chiropractic care versus chiropractic care alone for the reduction of pain due to chronic running-related knee pain in recreational marathon runners within the eThekwini Municipality. Methodology: The study used a quantitative randomised controlled single-blinded design, in which the participants were blinded. The study design followed a phase II randomised clinical trial. Recreational marathon runners from the eThekwini region, both male or female, between the ages of 18 and 65, were recruited for this study. Participants were randomly assigned and received either Pain Neuroscience Education (PNE) and chiropractic care or chiropractic care only. Both Group 1 and 2 had a sample size of 23 each, with a total sample size of 46 participants. Data was captured on a Microsoft Excel spreadsheet and imported into SPSS version 27 for analysis. Results: There was no significant difference between the intervention and control group, with respect to Pain Catastrophization Scale (PCS), and the Lower Extremity Functional Scale (LEFS) recordings. However, both the Intervention and control group under analysis showed a decrease in their Numerical Pain Rating Scale (NRS) readings, where the control group showed a higher mean score (decrease) over time compared to the PNE (intervention group). Conclusion: Chronic running-related knee pain did not change significantly. The findings correlate with the complexity of pain in previous PNE studies. Given the anatomical changes associated with running-related knee injuries, it was not surprising that running activities and range of motion did not change significantly either.