Role of the Flexion Relaxation Phenomenon in the Analysis of Low Back Pain Risk in the Powerlifter: A Proof-of-Principle Study.

INTRODUCTION: Unlike the most common training approaches for bodybuilding, powerlifting programs are generally based on maximum and submaximal loads, putting enormous stresses on the lumbar spine. The flexion relaxation phenomenon evaluation is a clinical tool used for low back pain (LBP) assessment. This study aimed to evaluate the role of the flexion relaxation phenomenon in the analysis of LBP in the powerlifters. METHODS: Healthy professional powerlifters participated in the study. In fact, we divided the participants into a LBP-low-risk group and a LBP-high-risk group, based on a prior history of LBP. Outcome measures included flexion relaxation ratio (FRR) and trough surface electromyography collected during trunk maximum voluntary flexion; furthermore, during a bench press lifting, we measured the height of the arched back (ARCH), using a camera and the Kinovea video editing software, to consider a potential correlation with the risk of LBP. RESULTS: We included a group of 18 male (aged 24-39 y) powerlifters of 93 kg category. We measured a nonsignificant mean difference of ARCH between low-risk LBP group and high-risk LBP subjects. Curiously, maximum voluntary flexions were both above the threshold of 3.2 µV; therefore, with an absence of appropriate myoelectric silence, on the contrary, the FRR ratios were higher than 9.5, considering the presence of the phenomenon, exclusively for the low-risk group. The lumbar arched back measurement data did not report any association with the LBP risk, regarding the maximum voluntary flexion value, and even more than the FRR there is a relationship with the presence or the absence of LBP risk. CONCLUSIONS: FRR could be considered as a useful parameter for studying the risk of LBP in powerlifting. The FRR index not only refers to the possible myoelectric silence of the lumbar muscles in trunk maximum forward flexion but also takes into account the energy value delivered by the lumbar muscles during the flexion. Furthermore, we can indicate that the size of the powerlifter ARCH may not be a determining factor in the occurrence of LBP.

Effectiveness of High-Power Laser Therapy via Shear Wave Speed Analysis on Pain and Functioning in Patients with Lateral Epicondylitis: A Proof-of-Concept Study.

Background: Lateral epicondylitis (LE) causes lateral elbow pain due to the overuse of the common extensor tendon. Several therapies have been proposed for pain relief and functional recovery, including physical therapy, minimally invasive injection approaches, and physical agent modalities such as laser therapy. Methods: Our study evaluates the impact of high-power laser therapy (HPLT) on pain and functioning. The HPLT protocol consists of 10 daily sessions using a LASERIX PRO device. The healthy elbow of each participant was also considered as a control group. The outcomes assessed were the Numerical Rating Scale (NRS) for pain, QuickDASH questionnaire for functionality, and shear wave velocity (SWS) through ultrasonography. Assessments were conducted at baseline (T0), post-treatment (T1), and 2-week follow-up (T2). Results: Sixteen participants (81.2% male, mean age 40.4 ± 5.53 years) completed the study. Post-treatment, pain significantly decreased (NRS: T0 6.13 ± 0.96; T1 2.75 ± 1.69; p < 0.001), functionality improved (QuickDASH: T0 69.88 ± 10.75; T1 41.20 ± 3.78; p < 0.001), and shear wave velocity increased (SWS (m/s): T0 1.69 ± 0.35; T1 2.56 ± 0.36; p < 0.001). Conclusions: At the 2-week follow-up, pain relief was maintained, and shear wave velocity showed no further significant change. Shear wave velocity assessments might be considered a useful diagnostic tool. However, further research is needed to support the role of HPLT and shear wave velocity in the rehabilitation management of LE.

Oxygen-ozone therapy for pain relief in patients with trapeziometacarpal osteoarthritis: a proof-of-concept study.

PURPOSE: Trapeziometacarpal osteoarthritis (TMC-OA) is a prevalent hand disorder affecting a growing number of people worldwide. While a multidisciplinary approach might provide additional advantages, the analgesic and anti-inflammatory role of intra-articular oxygen-ozone (O2O3) injections combined with physical therapy is still unknown. To assess the impact of a multimodal therapeutic approach combining O2O3 injections with physical therapy in patients with TMC-OA. MATERIALS AND METHODS: A prospective open-label study conducted in the Physical and Rehabilitation Medicine Unit of the "Renato Dulbecco" University Hospital of Catanzaro. We assessed patients with TMC-OA who had not responded to standard medical therapy. Participants received O2O3 therapy and targeted physical therapy for 4 weeks. Pain relief, muscle strength, and physical functioning were assessed at baseline and after 4, 12 and 24 weeks (respectively T0, T1, T2, and T3). RESULTS: Seventeen patients with a mean age of 67.1 ± 6.1 years were included in the study. Short-term improvements in pain intensity were observed (T0: 6.221 ± 1.514; T1: 3.172 ± 1.1451; p < .001) and were maintained over a 24-week follow-up period (T0: 6.221 ± 1.514; T3: 4.393 ± 1.438; p: 0.006). Significant changes were reported also in terms of muscle strength and physical functioning. O2O3 therapy was well-tolerated with no adverse effects. CONCLUSIONS: A combination of O2O3 injections and physical therapy might be considered in patients with TMC-OA. Further investigation is warranted to assess the effectiveness of O2O3 therapy in managing TMC-OA.

The addition of intra-articular trapeziometacarpal O₂O₃ injections to physical therapy is safe and reliable for thumb osteoarthritisO₂O₃ injection could be considered a second-line mini-invasive approach option when simple analgesic and non-pharmacologic interventions have failed, and surgical treatment is not yet indicatedO₂O₃ injections in combination with physical therapy may provide benefits in terms of pain relief in patients with TMC joint OA in whom previous conventional medical therapy has been unsuccessful.

Efficacy of rehabilitation interventions on functioning in patients with hemophilic arthropathy: A systematic review with meta-analysis.

BACKGROUND: Hemophilic arthropathy is a detrimental condition that crucially affects functional outcomes in hemophilic patients. In recent years, due to the advances in systemic therapies, growing attention has been raised in the rehabilitation field in order to improve functional outcomes of hemophilic patients. However, the optimal rehabilitation modalities in these patients are far from being fully characterized. OBJECTIVE: The present study aimed to assess the effects of different rehabilitation interventions on physical functioning and health-related quality of life of hemophilic arthropathic patients. METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Five databases were systematically searched for randomized controlled trials (RCTs) published until June 22nd, 2023. The selection criteria included adult patients with hemophilia A and B receiving rehabilitation interventions. The outcomes were muscle strength, physical function, pain intensity, physical performance, and health-related quality of life. RESULTS: Out of 1,743 identified records, 17 studies were included in the qualitative synthesis. Rehabilitation interventions were categorized into exercise intervention, fascial therapy, and multimodal intervention. The findings suggested positive outcomes in terms of muscle modifications, range of motion improvements, joint health enhancements, pain intensity reduction, and quality of life improvements. More in detail, meta-analyses showed significant improvements in pain intensity [ES: -1.10 cm (-1.37, -0.82), p< 0.00001], joint health [ES: -1.10 (-1.38, -0.82), p< 0.00001], In accordance, exercise interventions showed significant benefits in terms of joint health [ES: -2.54 (-3.25, -1.83), p< 0.00001)] and quality of life [ES: 1.17 (0.48, 1.86), p< 0.0000)]. CONCLUSION: Rehabilitation interventions have a positive impact on functional outcomes and health-related quality of life of hemophilic arthropathic patients. Further studies are needed to better elucidate the role of a comprehensive intervention combining different rehabilitation approaches to treat hemophilic arthropathy.

Efficacy of rehabilitative therapies on otologic symptoms in patients with temporomandibular disorders: A systematic review of randomised controlled trials.

BACKGROUND: The term temporomandibular disorder (TMD) indicates a set of musculoskeletal conditions involving temporomandibular joint (TMJ), masticatory musculature, and related anatomical structures. Pain is the most common clinical manifestation of TMD, and the auditory system might be involved and affected, through tinnitus, dizziness, otalgia and ear fullness sensation. OBJECTIVES: The aim of this systematic review of randomised controlled trails (RCTs) was to evaluate the efficacy of rehabilitative approaches on otologic symptoms in patients with TMD. METHODS: PubMed, Scopus and Web of Science were systematically searched from the inception until 8th October 2023 to identify RCTs presenting participants with a diagnosis of TMD associated with otologic signs and symptoms, rehabilitative approaches as interventions, and modification of the otological symptoms as outcome. RESULTS: Out of 931 papers suitable for title/abstract screening, 627 articles were assessed for eligibility. Five studies were included reporting the efficacy of occlusal splint therapy, low-level laser therapies, and physical therapy in patients diagnosed whit secondary otalgia or tinnitus associated with TMD. No RCTs evaluating other otologic symptoms, ear fullness, dizziness or vertigo were found. CONCLUSIONS: Results of this systematic review suggested that rehabilitative approaches might be effective in improving secondary otalgia and tinnitus in TMD patients. Thus, further RCTs with a higher level of evidence and more representative samples should be conducted to better understand the effects of TMD therapy on otologic complains.

Aesthetic Rehabilitation Medicine: Enhancing Wellbeing beyond Functional Recovery.

Although rehabilitation medicine emphasizes a holistic health approach, there is still a large gap of knowledge about potential interventions aimed at improving overall wellbeing through cosmetic interventions. Therefore, this narrative review investigates the role of different rehabilitative techniques in enhancing aesthetics, quality of life, and psychosocial wellbeing for patients with disabilities. The study follows the SANRA framework quality criteria for a narrative review. Literature searches across PubMed/Medline, Web of Science, and Scopus identified articles focusing on rehabilitation strategies within the aesthetic rehabilitation domain. The review identified evidence supporting injection procedures, such as Botulinum Toxin, Platelet-Rich Plasma, Hyaluronic Acid, Ozone, and Carboxytherapy, and assessing their applications in several disabling disorders. Additionally, physical therapies like Extracorporeal Shock Wave Therapy, Laser Therapy, Microcurrent Therapy, Tecar Therapy, and physical exercises were explored for their impact on cutaneous microcirculation, cellulite treatment, wound healing, and scar appearance improvement. Lastly, the manuscript underlines the role of manual therapy techniques in addressing both physical discomfort and aesthetic concerns, discussing their effectiveness in adipose tissue therapy, scar tissue mobilization, and regional fat thickness reduction. Taken together, this review emphasizes the role of a multidisciplinary approach, aiming to provide valuable insights into potential benefits for both functional and aesthetic outcomes.

Efficacy of Rehabilitative Techniques on Pain Relief in Patients with Vulvodynia: A Systematic Review and Meta-Analysis.

OBJECTIVE: Vulvodynia is a chronic clinical condition characterized by provoked or non-provoked vulvar pain for at least 3 months of unknown etiology. The onset of vulvodynia involves a complex interplay of peripheral and central pain mechanisms, such as pelvic floor muscle and autonomic dysfunction, and interpersonal factors. A stepwise approach of pelvic floor physical therapy as medical management is suggested. In this scenario, by this meta-analysis of randomized controlled trials, we aimed to evaluate the efficacy of rehabilitation interventions in patients with vulvodynia. METHODS: On 13th October 2022, PubMed, Scopus, and Web of Science were systematically searched for randomized controlled trials that assessed the efficacy of the rehabilitative approach to pain during intercourse in patients with vulvodynia. The quality assessment was performed with the Cochrane risk-of-bias tool for randomized trials. The trial registration number is CRD42021257449. At the end of the search, 9 studies were included for a total of 332 patients. A pairwise meta-analysis was performed to highlight the efficacy of rehabilitative approaches for reducing pain during intercourse, as measured with a visual analog scale or a numerical rating scale. RESULTS: Meta-analysis showed that all these rehabilitative approaches had an overall effect size of -1.43 (95% CI = -2.69 to -0.17) in decreasing vulvodynia pain in terms of the visual analog scale. In the subgroup analysis, a significant effect size in acupuncture (effect size = -2.36; 95% CI = -3.83 to -0.89) and extracorporeal shockwave therapy (effect size = -2.94; 95% CI = -4.31 to -1.57; I2 = 58%) was observed. According to the Cochrane risk-of-bias tool, a low risk of bias for outcome selection in 89% of studies. CONCLUSIONS: Findings from this meta-analysis suggested that the physical agent modalities and complementary medicine techniques in people with vulvodynia appear to be more effective than placebo, sham, or waiting list. Further evidence on physical agent modalities and complementary therapies are warranted in the future. IMPACT: This was the first systematic review and meta-analysis of randomized controlled trials to provide evidence on the efficacy of rehabilitation interventions in patients with vulvodynia.

Role of the Gut Microbiota in Osteoarthritis, Rheumatoid Arthritis, and Spondylarthritis: An Update on the Gut-Joint Axis.

Dysregulation of the gut microbiota and their metabolites is involved in the pathogenic process of intestinal diseases, and several pieces of evidence within the current literature have also highlighted a possible connection between the gut microbiota and the unfolding of inflammatory pathologies of the joints. This dysregulation is defined as the "gut-joint axis" and is based on the joint-gut interaction. It is widely recognized that the microbiota of the gut produce a variety of compounds, including enzymes, short-chain fatty acids, and metabolites. As a consequence, these proinflammatory compounds that bacteria produce, such as that of lipopolysaccharide, move from the "leaky gut" to the bloodstream, thereby leading to systemic inflammation which then reaches the joints, with consequences such as osteoarthritis, rheumatoid arthritis, and spondylarthritis. In this state-of-the-art research, the authors describe the connections between gut dysbiosis and osteoarthritis, rheumatoid arthritis, and spondylarthritis. Moreover, the diagnostic tools, outcome measures, and treatment options are elucidated. There is accumulating proof suggesting that the microbiota of the gut play an important part not only in immune-mediated, metabolic, and neurological illnesses but also in inflammatory joints. According to the authors, future studies should concentrate on developing innovative microbiota-targeted treatments and their effects on joint pathology as well as on organizing screening protocols to predict the onset of inflammatory joint disease based on gut dysbiosis.

Obesity and Cancer Rehabilitation for Functional Recovery and Quality of Life in Breast Cancer Survivors: A Comprehensive Review.

Obesity is a global health challenge with increasing prevalence, and its intricate relationship with cancer has become a critical concern in cancer care. As a result, understanding the multifactorial connections between obesity and breast cancer is imperative for risk stratification, tailored screening, and rehabilitation treatment planning to address long-term survivorship issues. The review follows the SANRA quality criteria and includes an extensive literature search conducted in PubMed/Medline, Web of Science, and Scopus. The biological basis linking obesity and cancer involves complex interactions in adipose tissue and the tumor microenvironment. Various mechanisms, such as hormonal alterations, chronic inflammation, immune system modulation, and mitochondrial dysfunction, contribute to cancer development. The review underlines the importance of comprehensive oncologic rehabilitation, including physical, psychological, and nutritional aspects. Cancer rehabilitation plays a crucial role in managing obesity-related symptoms, offering interventions for physical impairments, pain management, and lymphatic disorders, and improving both physical and psychological well-being. Personalized and technology-driven approaches hold promise for optimizing rehabilitation effectiveness and improving long-term outcomes for obese cancer patients. The comprehensive insights provided in this review contribute to the evolving landscape of cancer care, emphasizing the importance of tailored rehabilitation in optimizing the well-being of obese cancer patients.

Impact of yoga asanas on flexion and relaxation phenomenon in women with chronic low back pain: Prophet model prospective study.

Chronic nonspecific low back pain (NSLBP) is a prevalent condition with socioeconomic and healthcare challenges. The flexion-relaxation phenomenon (FRP) evaluation is a valid clinical tool for low back pain (LBP) assessment. Yoga, a holistic mind-body practice, has been explored as an LBP intervention. This study aimed to evaluate the impact of yoga asanas on the FRP in women with NSLBP. The study included healthy and chronic NSLBP females who underwent an eight-session yoga asanas program, with the first session conducted in-clinic and the rest delivered with tele-approach. Outcome measures included pain intensity, flexion-relaxation ratio (FRR), and trough surface electromyography collected during trunk maximum voluntary flexion (MVF). The study included 11 healthy and 10 NSLBP women. Repeated measures test in chronic NSLBP group showed a significant decrease in pain intensity after the 4 weeks follow-up (visual analog scale [VAS]: 6.80 ± 1.48 vs. 3.30 ± 1.25; p < 0.001) and an FRR improvement after the intervention (5.12 ± 0.93 vs. 9.49 ± 0.92; p < 0.001). VAS and FRR effect sizes were 0.77 and 0.47, respectively. Therefore, we performed a Prophet evaluation to assess FRR trends, finding a growth rate (k) of 0.405 ± 0.448, with a forecast 1 month after the end of the intervention approaching the trend line of the control group. The findings suggested that tele-yoga asana might have a positive impact on pain intensity and the FRP in chronic LBP. Further research is warranted to confirm the long-term effects of yoga for managing LBP.

Effects of intensive rehabilitation on functioning in patients with mild and moderate Charcot-Marie-Tooth disease: a real-practice retrospective study.

Charcot-Marie-Tooth (CMT) disease is one of the most common inherited neuropathies and can lead to progressive muscular weakness, pes cavus, loss of deep tendon reflexes, distal sensory loss, and gait impairment. There are still no effective drugs or surgical therapies for CMT, and supportive treatment is limited to rehabilitative therapy and surgical treatment of skeletal deformities. Many rehabilitative therapeutic approaches have been proposed, but timing and cadence of rehabilitative intervention are not clearly defined, and long-term follow-up is lacking in literature. The aim of this real-practice retrospective study was to assess the effectiveness of an intensive neurorehabilitation protocol on muscle strength and functioning in CMT patients. We analyzed data of patients with diagnosis of mild to moderate CMT. The rehabilitation program lasted 2-4 h a day, 5 days a week, for 3 weeks and consisted of manual treatments, strengthening exercises, stretching, core stability, balance and resistance training, aerobic exercises, and tailored self-care training. Data were collected at baseline (T0), after treatment (T1), and at the 12-month mark (T2) in terms of the following outcome measures: muscle strength, pain, fatigue, cramps, balance, walking speed, and ability. We included 37 CMT patients with a median age of 50.72 ± 13.31 years, with different forms: demyelinating (n = 28), axonal (n = 8), and mixed (n = 1). After intensive rehabilitation treatment, all outcomes significantly improved. This improvement was lost at the 1-year mark. Taken together, these findings suggest that an intensive rehabilitation program improves short-term symptoms and functional outcomes in a cohort of inpatients affected by mild to moderate CMT.

Efficacy of proprioceptive neuromuscular facilitation on functioning in patients with bilateral hip osteoarthritis: A pilot randomized controlled trial.

BACKGROUND: Hip osteoarthritis (OA) is a chronic progressive disease that impresses a noticeable burden to society and healthcare systems. Physical exercise constitutes the first-line hip OA treatment approach, nevertheless, there is currently no gold standard method to treat this disease. OBJECTIVE: To evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) on functioning in patients with hip OA. METHOD: A pilot randomized controlled trial (RCT) was carried out on patients with painful bilateral hip OA with a body mass index (BMI) < 30 kg/m2. After the randomization, the experimental group was treated with PNF protocol and the control group with conventional physical therapy (10 sessions of manual therapy, 5 sessions/week for 2 weeks). The Harris Hip Score (HHS) was the primary outcome, whereas we assessed as secondary outcomes: pain, range of motion, and muscle strength of hip, physical performance, and quality of life. RESULTS: Twenty patients (40 hips) were enrolled and randomized into two groups: PNF group (mean age: 70.7 ± 8.07; BMI: 25.1 ± 3.07; 7 females and 3 males) and control group (mean age: 74.9 ± 10.72; BMI: 26.8 ± 3.78; 6 females and 4 males). The results showed a statistically significant improvement of HHS in the study group (T1: 90.6 ± 5.63) than in the control group (T1: 77.3 ± 10.9) (between-group p value < 0.001). Three months after the treatment we have statistically significant maintenance in the PNF group (T2:89.6±6.32, within-group ΔT0-T2 p< 0.01) while the control group did not maintain the improvements recorded at T1 (T2: 71.4 ± 15.8). CONCLUSION: The results of this pilot RCT showed that incorporating PNF exercises into the rehabilitation program yielded notable enhancements in improving lower limb function, strength and ROM in hip OA patients. Nonetheless, further prospective studies including wider sample size are needed to implement scientific knowledge on this physical therapy approach, in patients with hip osteoarthritis.

Risk of injury and kinematic assessment of the shoulder biomechanics during strokes in padel players: a cross-sectional study.

BACKGROUND: Padel players commonly suffer from shoulder pain and the particularly high incidence is probably linked to the high frequency of strokes. In addition, due to the repetitive technical gesture, an adequate technique is essential in terms of performance and injury risk prevention. Aim of this study was to objectively evaluate shoulder kinematic during the athletic gesture to analyze the risk factors linked to padel strokes. METHODS: Professional and amateur padel players underwent a three-dimensional motion analysis of the padel strokes utilizing optoelectronic and surface electromyography systems (BTS Bioengineering, Garbagnate Milanese, Milan, Italy). RESULTS: Twelve padel players were included in this study (10 professional players in Group A and 10 amateurs in Group B). Experience influences the execution of padel strokes with a significant difference between group A and B in terms of gleno-humeral rotation and scapular tilt. Moreover, a subgroup analysis revealed that male players execute voleè with a higher external rotation (P=0.043), and forehand with a higher scapular tilt (P=0.044). CONCLUSIONS: The results confirm that the high ranges of motion of the overhead strokes could rise the risk of slap lesion, impingement, and glenohumeral internal rotation deficit. However, a correct execution of the athletic gesture is linked with a dynamic stabilization of the humeral head. In conclusion, the kinematic analysis could help in the early identification of the kinematic alteration to build a tailored rehabilitation plan based on the athlete's needs.

Influence of hand grip strength test and short physical performance battery on FRAX in post-menopausal women: a machine learning cross-sectional study.

BACKGROUND: Impaired physical performance and muscle strength are recognized risk factors for fragility fractures, frequently associated with osteoporosis and sarcopenia. However, the integration of muscle strength and physical performance in the comprehensive assessment of fracture risk is still debated. Therefore, this cross-sectional study aimed to assess the potential role of hand grip strength (HGS) and short physical performance battery (SPPB) for predicting fragility fractures and their correlation with Fracture Risk Assessment Tool (FRAX) with a machine learning approach. METHODS: In this cross-sectional study, a group of postmenopausal women underwent assessment of their strength, with the outcome measured using the HSG, their physical performance evaluated using the SPPB, and the predictive algorithm for fragility fractures known as FRAX. The statistical analysis included correlation analysis using Pearson's r and a decision tree model to compare different variables and their relationship with the FRAX Index. This machine learning approach allowed to create a visual decision boundaries plot, providing a dynamic representation of variables interactions in predicting fracture risk. RESULTS: Thirty-four patients (mean age 63.8±10.7 years) were included. Both HGS and SPPB negatively correlate with FRAX major (r=-0.381, P=0.034; and r=-0.407, P=0.023 respectively), whereas only SPPB significantly correlated with an inverse proportionality to FRAX hip (r=-0.492, P=0.001). According to a machine learning approach, FRAX major ≥20 and/or hip ≥3 might be reported for an SPPB<6. Concurrently, HGS<17.5 kg correlated with FRAX major ≥20 and/or hip ≥3. CONCLUSIONS: In light of the major findings, this cross-sectional study using a machine learning model related SPPB and HGS to FRAX. Therefore, a precise assessment including muscle strength and physical performance might be considered in the multidisciplinary assessment of fracture risk in post-menopausal women.

Effectiveness of cryo plus ultrasound therapy versus diathermy in combination with high-intensity laser therapy for pain relief in footballers with muscle injuries: A prospective study.

BACKGROUND: Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes. OBJECTIVE: The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries. METHODS: A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury. RESULTS: Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p< 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier. CONCLUSION: HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers.

Multidisciplinary Rehabilitation after Hyaluronic Acid Injections for Elderly with Knee, Hip, Shoulder, and Temporomandibular Joint Osteoarthritis.

Osteoarthritis (OA) is a prevalent degenerative joint condition characterized by cartilage deterioration, joint inflammation, and functional limitations, particularly impacting the elderly population. Rehabilitation and hyaluronic acid (HA) injections are common therapeutic approaches routinely used in clinical practice, but their synergistic potential is far from being fully characterized. Thus, the aim of this narrative review was to elucidate the multilevel benefits and synergies of integrating these two approaches in multidisciplinary OA rehabilitation. This narrative review follows the scale for the assessment of narrative review articles (SANRA) criteria and involves a comprehensive literature search from July to August 2023. Two independent reviewers screened studies, including those involving human subjects with OA, rehabilitation strategies, and outcomes following HA injection, published in English. Results: HA injections might improve joint biomechanics, reducing friction, absorbing shocks, and potentially regulating inflammation. Rehabilitation plays a pivotal role in strengthening muscles, increasing the range of motion, and enhancing overall function. Optimizing rehabilitation following HA injection might provide additional benefits in joint health. OA management requires a multidisciplinary approach integrating HA injections, rehabilitation, and personalized care. Challenges in patient adherence and healthcare resources currently exist, but emerging technologies offer opportunities to enhance patient engagement and monitoring optimizing sustainability and outcomes of patients with knee, hip, shoulder, and temporomandibular joint OA.

Effects of multidisciplinary rehabilitation in a patient with Ehlers-Danlos and Behçet's syndromes: a paradigmatic case report according to the narrative medicine.

PURPOSE: Narrative Medicine complements the clinically centered approach, which focuses on the analytical and sanitary aspects, with the illness- and disorder- centered models, which deal respectively, with personal coping and social perception of a condition. Hypermobile Ehlers- Danlos Syndrome and Behçet's Disease are two rare multisystemic chronic disease experienced a myriad of clinical symptoms, psychological distress, and poor quality of life. The purpose of this report is to describe application of a multidisclipinary rehabilitation intervention according to the narrative medicine. CASE DESCRIPTION AND INTERVENTION: a 35-year-old woman with a 23-year history of Hypermobile Ehlers-Danlos Syndrome and Behçet's Disease was admitted. A multimodal rehabilitation approach was implemented and described through the patient's feelings and expected short-, medium-, and long- terms goals. Moreover, she reported her feeling with periodical interview by her therapist. HISTORY PATIENT: The patient was seen for 32 weeks. A decreased pain, as well as improved function was recorded immediately post-intervention. CONCLUSION: Narration is not just an interpretation of the illness experience, but the result of reshaping the interpretations of the story that both patient and health professional. This discipline provides enrichment of care, especially when combined with rehabilitation in chronic disease, by paying attention to and using even in the therapeutic phase the stories of patients, family and health care personnel, giving the opportunity to define a tailored effectiveness rehabilitation approach at the light of the different points of view of the subjects.

Narrative Medicine might play a key role in an interpretation of the illness experience to implement a multidisciplinary tailored rehabilitation approach.Narrative Medicine can help understand discomfort and difficulty associated with rehabilitation activities, thereby enhancing patient motivation and participation in interdisciplinary care.The Ehlers­Danlos Syndrome is a heterogeneous group of heritable connective tissue disorders representing a challenge in rehabilitation.Behçet's Disease is a rare multisystemic chronic disease experiencing an impaired function and a poor quality of life.A patient-oriented multimodal rehabilitation showed to be a useful approach in the case with both diseases, with a reduction of pain and an improvement of functioning.

Impact of COVID-19 Era on the Anterior Cruciate Ligament Injury Rehabilitation: A Scoping Review.

The surgical intervention rate and the subsequent rehabilitation plan for anterior cruciate ligament (ACL) injury was crucially affected by the COVID-19 pandemic due to the necessity in the face of the emergency. This review aimed to evaluate potential persistent and residual symptoms after COVID-19 disease, including fatigue and neuromuscular disorders. A scoping review design and methodology were used due to the exploratory nature of the research question, according to literature searches on PubMed/Medline, Scopus, Web of Science (WoS), and Physiotherapy Evidence Database (PEDro) electronic databases using the following keywords: "Anterior Cruciate Ligament", "ACL", "SARS-CoV-2", and "COVID-19". Undertraining and muscular knee imbalance might cause inefficient movement strategies, lack of knee stability, and increasing load with negative implications in ACL injuries. In the post-surgery period, during COVID-19, telerehabilitation approaches appeared to be successfully applied to maintain strength and range of motion in this condition. However, no definitive data are available regarding the most effective interventions. This scoping review showed the influence of the COVID-19 pandemic and associated restrictions on postoperative and rehabilitative care of ACL injuries.

Cryo plus Ultrasound Therapy, a Novel Rehabilitative Approach for Football Players with Acute Lateral Ankle Injury Sprain: A Pilot Randomized Controlled Trial.

BACKGROUND: Acute lateral ankle sprains are common injuries among athletes, but the optimal treatment strategies in elite athletes are still debated. This proof-of-concept study aimed to assess the impact of cryo-ultrasound therapy on the short-term recovery of football players with acute lateral ankle sprains. METHODS: Semi-professional football players with grade I or II lateral ankle sprains were randomly assigned to the experimental group (receiving cryo-ultrasound therapy combined with conventional physical therapy) or control group (sham cryo-ultrasound therapy combined with conventional physical therapy). Pain intensity and physical functioning were assessed by the Numeric Rating Scale (NRS) and Foot and Ankle Disability Index (FADI) at baseline (T0) at the end of treatment (T1), after one month (T2), and two months after treatment (T3). RESULTS: After the study intervention, significant between groups differences were reported in terms of pain relief (NRS: 4.08 ± 1.29 vs. 5.87 ± 1.19; p = 0.003) and physical function (FADI: 50.9 ± 10.3 vs. 38.3 ± 11.5; p = 0.021). However, no significant between group differences were reported at T2 and T3. No adverse effects were reported. CONCLUSIONS: Cryo-ultrasound therapy combined with conventional physical therapy can accelerate recovery and early return to sport in elite football players with acute lateral ankle sprains. While this study contributes valuable insights into the potential benefits of cryo-ultrasound therapy, further investigations with a longer follow-up are needed to validate and optimize the application of physical agent modalities in the management of ankle injuries.

Effects of blood flow restriction on spine postural control using a robotic platform: A pilot randomized cross-over study.

BACKGROUND: Blood flow restriction (BFR) training improves muscle strength and functional outcomes, but the proprioceptive implications of this technique in the rehabilitation field are still unknown. OBJECTIVE: The present study aimed at assessing the effects of BFR in terms of stabilometric and balance performance. METHODS: In this pilot randomized cross-over study, healthy young adults were included and randomly assigned to Groups A and B. Both groups underwent a postural assessment with and without wearing a BFR device. Study participants of Group A underwent postural baseline assessment wearing BFR and then removed BFR for further evaluations, whereas subjects in Group B performed the baseline assessment without BFR and then with BFR. Stabilometric and balance performance were assessed by the robotic platform Hunova, the Balance Error Scoring System (BESS), the self-reported perceived balance (7-point Likert scale), and discomfort self-rated assessment. Moreover, the safety profile was recorded. RESULTS: Fourteen subjects were included and randomly assigned to Group A (n: 7) and Group B (n: 7). Significant differences were shown in balance tests in static conditions performed on the Hunova robot platform in terms of average distance RMS (root-mean-square) with open eyes (OE), anteroposterior (AP) trunk oscillation range with OE, mediolateral (ML) average speed of oscillation with OE, and total excursion AP range with closed eyes (CE) (BFR: 3.44 ± 1.06; without BFR: 2.75 ± 0.72; p= 0.041). Moreover, elastic balance test showed differences in Romberg index (BFR: 0.16 ±0.16; without BFR: 0.09 ± 0.07; p= 0.047). No adverse events were reported. CONCLUSION: Taken together, our data showed that BFR affects balance performance of healthy subjects. Further studies are needed to better characterize the possible role of BFR treatment in the context of a specific rehabilitation protocol.