Postural evaluation and risk of musculoskeletal injuries in professional male rugby players: a proof-of-principle study.

BACKGROUND: Rugby is the most played contact sport in the world and is characterized by muscle-tendon structures injuries due to trauma. Posture in ideal balance allows the maximum effectiveness of a gesture in absence of pain, and an adequate posture might have a role in trauma related sport prevention. Aim of this proof-of-principle study was to investigate if sports activity might cause postural changes in National League rugby players and whether it correlates with an increased risk of injuries. METHODS: Male rugby players from a National League were included in the study. The athletes underwent a postural questionnaire, an analysis of plantar support (3D-PodoScanalyzer; Diasu by Sani Corporate, Rome, Italy) and a postural-evaluation (Formetric4D; DIERS International GmbH, Schlangenbad, Germany). The tests were performed at T0 (on-season), T1 (off-season) and T2 (preseason). RESULTS: Twenty-six male rugby players, mean aged 22.5 years old, were included. The analysis of plantar support showed statistically significant variability in 6 values: left Arch Index (P=0.004), right Staheli Index (P=0.042), midfoot symmetry (P=0.030), isthmus symmetry (P=0.048), arch length symmetry (P=0.027), height of the left plantar arch (P=0.009). The postural evaluation showed statistically significant variability in only two values: rotation of the pelvis (P=0.013) and kyphotic angle (P=0.050). CONCLUSIONS: The data of our study show, during the intense phases of the championship, a prevalence of injuries to the left lower limb and an increase in the cavity of the ipsilateral foot. The study also shows that the training conducted by the athletes examined improves the values of the pelvic rotation and the kyphotic angle.

Neuropathic Pain and Rehabilitation: A Systematic Review of International Guidelines.

BACKGROUND: Neuropathic pain is an injury or disease of the central and/or peripheral somatosensory nervous system, and it has a significant impact on quality of life, especially since it is often refractory to treatment. Rehabilitative intervention is considered in various guidelines on neuropathic pain treatment, although not in an organic nor detailed way. The aim of this systematic review was to analyze the most indicated therapeutic strategies, providing rehabilitative recommendations in the management of neuropathic pain. METHODS: A systematic review was performed according to PRISMA guidelines. The scientific search, carried out until July 2020, considered guidelines in English language of the last thirteen years. RESULTS: Six guidelines were analyzed, from which emerges that a multidisciplinary approach, comprehensive of pharmacologic and nonpharmacologic interventions, should drive neuropathic pain management. A relevant role in non-pharmacological intervention is played by rehabilitation, through an adequate tailored rehabilitation program and physical therapies. CONCLUSION: This analysis highlights the importance of rehabilitation but also the lack of evidence on various rehabilitative practices. Arises hence the need for further studies in this field to better define a rehabilitative treatment strategy.

Acute effect of whole-body vibration at optimal frequency on muscle power output of the lower limbs in older women.

OBJECTIVE: The aim of this study was to identify the frequency of whole-body vibration (WBV) that elicits the greatest improvement in lower limb power output after an acute exposure in older women, with the hypothesis that an individualized optimal vibration frequency (OVF) would be more effective than a fixed vibration frequency. DESIGN: Maximal power output was measured during a double leg press on an isoinertial dynamometer in nine women with a mean (SD) age of 71 (3) yrs, 1 and 5 mins after WBV on a platform at three different frequencies, in a random order: 20 Hz, 50 Hz, and OVF, determined for each subject by identifying the frequency corresponding to the maximal electromyographic muscle response. RESULTS: The mean (SD) OVF was 33 (2.5) Hz. The 25.9% increase in maximal power output after 1 min of WBV at OVF was significantly higher (P < 0.05) than the 14.3% increase after 1 min of WBV at 20 Hz. Similarly, the 32.1% increase in maximal power output after 5 mins of WBV at OVF was significantly higher (P < 0.01) than the 16.1% and 16.3% increase after 5 mins of WBV at 20 Hz and 50 Hz, respectively. CONCLUSIONS: Frequency of WBV should be prescribed in an individualized fashion, within the range of 30-35 Hz in this target population of older women.

A description of skeletal manifestation in adult case of morquio syndrome: radiographic and MRI appearance.

We report on a rare case of Morquio syndrome, an autosomal recessive mucopolysaccharidosis including type IVA, a deficiency of N-acetylgalctosamine-6-sulfatase and type IVB a deficiency of ß-galactosidase. A 43-year-old female patient affected by IVB Morquio syndrome underwent instrumental investigation. Conventional plain films of the entire spine, pelvis, chest and knees together with magnetic resonance imaging of the entire column, hip, knees, and ankles demonstrated the characteristics of skeletal changes of this disease. The main abnormalities were platyspondily and hypoplasia of the odontoid process, genua valga deformity and severe multiple degenerative changes of the hips, knees, and ankle joints. Radiographs and above all magnetic resonance imaging are crucial to provide substantial information about the gravity, evolution of the skeletal and joints changes, and the rehabilitation strategies to be followed.

Comparison between the effects of trigger point mesotherapy versus acupuncture points mesotherapy in the treatment of chronic low back pain: a short term randomized controlled trial.

OBJECTIVE: The goal of this study was to compare the effects of trigger point (TRP) mesotherapy and acupuncture (ACP) mesotherapy in the treatment of patients with chronic low back pain. DESIGN: Short term randomized controlled trial. SETTING: 62 subjects with chronic low back pain were recruited at outpatients Physical Medicine and Rehabilitation Clinic at the University of Rome "La Sapienza" in the period between July 2006 and May 2008. INTERVENTION: Study subjects were assigned to receive 4 weeks treatments with either trigger point mesotherapy (TRP mesotherapy, n=29) or acupoints mesotherapy (ACP mesotherapy, n=33). MAIN OUTCOME MEASURES: Pain intensity with a pain visual analogic scale (VAS) and verbal rating scale (VRS) and pain disability with McGill Pain Questionnaire Short Form (SFMPQ), Roland Morris Disability Questionnaire (RMQ) and Oswestry Low Back Pain Disability Questionaire (ODQ). RESULTS: ACP mesotherapy shows a more effective results in VRS and VAS measures in the follow-up (p(VRS)=<.001 and p(VAS)=<.001). The SF-MPQ measure shows a better results for ACP instead of TRP with statistically significant differences between groups and time (p=.035). Participants reported a slight discomfort at the time of the inoculation, and 15% reported slight neck pain in ACP mesotherapy group. CONCLUSIONS: Our results suggest that the response to ACP mesotherapy may be greater than the response to TRP mesotherapy in the short term follow-up. This technique could be nevertheless a viable option as an adjunct treatment in an overall treatment planning of CLBP.

Localized hyperthermia induced by microwave diathermy in osteoarthritis of the knee: a randomized placebo-controlled double-blind clinical trial.

PURPOSE: To investigate the effects of hyperthermia on knee osteoarthritis (OA) in a randomized placebo-controlled double-blind clinical trial. METHODS: Sixty-three patients with clinical evidence and radiographic confirmation of knee OA (Kellgren and Lawrence grades II and III) were randomized to either three 30-min sessions of hyperthermia per week for 4 weeks were administered using a 433.92 MHZ microwave generator or receive placebo treatment (machine not turned on) for same number of sessions. The Western Ontario McMaster Universities (WOMAC) questionnaire and the Timed Up and Go test (TUGT), a performance-based measure of function, were obtained at baseline (week 0), at the end of treatment (week 4), and at final follow-up (week 16). RESULTS: The treatment group showed a significant decrease in the overall WOMAC score and each of its components, and in the TGUG test between the beginning (week 0) and the end of treatment (week 4), as well as at final follow-up (week 16). In the placebo group, a significant fall was only visible in the pain subscore at week 4. However, the mean improvement was only 1 point and was lost at final follow-up (P=0.332). There was a significant difference in pain -7.4 pre-post (P<0.01), -8.1 pre-follow-up (P<0.01); stiffness -4.6 pre-post (P<0.01), -5.1 pre-follow-up (P<0.01); activities daily living (ADL) -30.9 pre-post (P<0.01), -33.2 pre-follow-up (P<0.01); and WOMAC total score -43 pre-post (P<0.01), -46.4 pre-follow-up (P<0.01); and in TGUG test -2.4 pre-post (P<0.01), -2.9 pre-follow-up (P<0.01) between the treatment and placebo group over the whole length of the trial. CONCLUSIONS: A 433.92 MHz microwave hyperthermia regimen showed beneficial effects in patients with moderate knee OA to reduce pain and to improve their physical function. LEVEL OF EVIDENCE: I.

Field evaluation of paralympic athletes in selected sports: implications for training.

PURPOSE: The purpose of this study was 1) to describe the acute cardiorespiratory and metabolic responses of Paralympic athletes participating in the following five sports: Nordic sit skiing (NS, n = 5), wheelchair distance racing (WR, n = 6), wheelchair basketball (WB, n = 13), wheelchair fencing (WF, n = 6), and wheelchair tennis (WT, n = 4); and 2) to examine the relationship between field test performance and laboratory measures of aerobic fitness of these Paralympic athletes. METHODS: Each athlete completed an incremental arm cranking exercise test to determine ventilatory threshold (VT) and peak oxygen uptake (VO2peak). Subsequently, field assessments were carried out using a telemetric system to measure the cardiorespiratory responses in their respective sport. RESULTS: VT and VO2peak (both expressed in milliliters per kilogram per minute) of athletes competing in NS (38.3 +/- 5.76 and 51.0 +/- 6.92 mL x kg(-1) x min(-1)) and WR (35.5 +/- 5.96 and 48.1 +/- 6.35 mL x kg(-1) x min(-1)) were significantly higher (P < 0.05) than those competing in WB (26.0 +/- 2.13 and 36.9 +/- 3.70 mL x kg(-1) x min(-1)), WF (23.2 +/- 3.96 and 34.4 +/- 5.81 mL x kg(-1) x min(-1)), and WT (24.0 +/- 2.30 and 33.1 +/- 2.85 mL x kg(-1) x min(-1)). In the field tests, the average V O2, higher in NS and WR than in WB, WF, and WT, during NS, WR, WB, WF, and WT was 79.4% +/- 3.30%, 84.4% +/- 2.10%, 72.1% +/- 5.72%, 73.0% +/- 3.10%, and 73.0% +/- 1.91%, respectively, of VO2peak. There was a strong linear relationship between VO2 measured during the field tests and VT and VO2peak (R2 = 0.92 in each case). CONCLUSIONS: Athletes regulated their average work intensity during the field tests in the five Paralympic sports to approximate their individualized VT measured during incremental arm cranking exercise test, and this intensity was within the range recommended by the American College of Sports Medicine to improve cardiorespiratory fitness in well-trained subjects. In addition, performance of Paralympic athletes in these sports was highly dependent upon athletes' aerobic fitness.

Calcific tendinopathy of the rotator cuff. Conservative management with 434 Mhz local microwave diathermy (hyperthermia): a case study.

PURPOSE: To report the effects of local microwave diathermy (hyperthermia) at 434 Mhz on calcific tendinopathy of the shoulder in two middle aged patients. METHODS: Two middle-aged women with calcific tendinopathy of the shoulder were treated with local microwave diathermy (hyperthermia) at 434 Mhz three times a week for four weeks. Plain radiographs and ultrasonography demonstrated calcific deposits in the area of infraspinatus or supraspinatus. Shoulder Pain and Disability Index (SPADI) and passive Range of Motion (ROM) were used to assess the response to treatment. RESULTS: At the end of the treatment period, the improvement as measured by the SPADI score was respectively 30% for the first patient and 40% for the second patient with an improvement of the shoulder passive ROM for both patients. The calcific deposits seen on the initial radiographs and ultrasonography were no longer visible. At 1 year follow-up, both patients continued to be symptom free. CONCLUSIONS: Hyperthermia is a safe option in the management of calcific tendinopathy of the shoulder. Prospective randomized controlled studies with long term assessment are needed to further document its therapeutic efficacy.

The effects of a whole-body vibration program on muscle performance and flexibility in female athletes.

OBJECTIVE: This randomized controlled study was designed to investigate the short-term effects of an 8-wk whole-body vibration protocol on muscle performance and flexibility in female competitive athletes. DESIGN: Twenty-six young volunteer female athletes (ages 21-27 yrs) were randomized to either the vibration group or control group. The vibration intervention consisted of an 8-wk whole-body vibration 3 times a week employed by standing on a vertical vibration platform. As outcome measures, three performance tests (counter-movement jump, extension strength of lower extremities with an isokinetic horizontal leg press, and a sit-and-reach test for flexibility) were performed initially and after 8 wks. RESULTS: A total of 24 athletes completed the study properly. In the vibration group (n = 13) whole-body vibration induced significant improvement of bilateral knee extensor strength (P < 0.001), counter-movements jump (P < 0.001), and flexibility (P < 0.001) after 8 wks of training. No significant changes were found for all the outcome measures for the control group (n = 11). CONCLUSIONS: Whole-body vibration is a suitable training method to improve knee extension maximal strength, counter-movement jump, and flexibility in a young female athlete if it is properly designed. Not only do the optimal frequency, amplitude, and g-forces need to be identified but also the level of muscle activation that would benefit more from vibration stimulation. The improvement of flexibility is important not only for performance but also for the prevention of muscle-tendon injury.

Short-term effectiveness of hyperthermia for supraspinatus tendinopathy in athletes: a short-term randomized controlled study.

BACKGROUND: Hyperthermia has been introduced as a physical therapy modality for soft tissue injuries. HYPOTHESIS: The authors tested the null hypothesis that there are no short-term differences after the use of hyperthermia, ultrasound, and exercises for tendinopathy of the supraspinatus tendon. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: The authors studied 37 athletes (29 men, 8 women; mean age, 26.7 +/- 5.8 years; range, 19-43 years) with supraspinatus tendinopathy who had had symptoms between 3 and 6 months. Subjects were randomly assigned to 3 groups. Group A (n = 14) received hyperthermia at 434 MHz. Group B (n = 12) received continuous ultrasound at 1 MHz at an intensity of 2.0 w/cm(2) 3 times a week. Group C (n = 11) undertook exercises, consisting of pendular swinging and stretching exercises 5 minutes twice a day every day. All interventions were undertaken for 4 weeks. Subjects were evaluated at baseline, immediately on completion of treatment, and at 6 weeks after the end of the intervention using mean pain score for pain at night, during movement, and at rest on a visual analog scale; pain on resisted movement and painful arc on active abduction between 40 degrees and 120 degrees on a 4-point scale; and Constant score. RESULTS: Patients who received hyperthermia experienced significantly better pain relief than did patients receiving ultrasound or exercises: group A, 5.96 to 1.2 (P = .03); group B, 6.3 to 5.15 (P = .10); group C, 6.1 to 4.9 (P = .09). CONCLUSION: Hyperthermia at 434 MHz appears safe and effective in the short term for the management of supraspinatus tendinopathy.