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.

Temporomandibular joint rehabilitative approaches for children and adolescents affected by juvenile idiopathic arthritis: A systematic review.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, and temporomandibular joints (TMJs) are involved in 39%-78% of patients. AIM: The aim of this systematic review was to assess the effectiveness of conservative approaches in improving TMJ arthritis in children and adolescents affected by JIA. DESIGN: PubMed, Scopus, and Web of Science were systematically searched from the inception until February 25, 2024, to identify observational studies presenting participants with a diagnosis of JIA affecting the TMJ, rehabilitative approaches for TMJ arthritis as interventions, and clinical or radiological assessment of TMJ arthritis as outcome. RESULTS: Of 478 papers suitable for title/abstract screening, 13 studies were included. The studies evaluated the effectiveness of intra-articular (IA) corticosteroid (CS) injections, IA infliximab injections, arthrocentesis alone or in combination with IACS injections, occlusal splint, functional appliance, and physiotherapy. The effectiveness of IACS injections was shown in eight studies. IA infliximab injections did not appear to significantly improve TMJ arthritis. CONCLUSION: Results of this systematic review suggested that conservative treatments, especially IACS injections, might be effective in improving TMJ arthritis in patients affected by JIA. Further studies with a higher level of evidence and more representative samples should be conducted.

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.

Efficacy of a new protocol for the prevention of work-related musculoskeletal disorders in dental hygiene students: A pilot randomized controlled trial.

OBJECTIVE: The purpose of this pilot randomized controlled trial (RCT) was to assess the efficacy of a new muscle stretching and strengthening protocol for the prevention of work-related musculoskeletal disorders (WMSD) in dental hygiene students. METHODS: Students attending the 2nd and 3rd year of a Dental Hygiene Degree Course of a University Hospital were randomly allocated into treatment group (muscle stretching and strengthening sessions) and control group (no treatment). Nordic Musculoskeletal Questionnaire (NMQ), quality of life, the intensity of the pain and the Global Perceived Effect (GPE) Scale were assessed at the baseline (T0), after 4 weeks (T1) and after 16 weeks (T2). RESULTS: Of 37 subjects screened for eligibility, 28 patients (aged 28.25 ± 8.89 years) were enrolled and divided into treatment and control groups. The NWQ showed significant between-group differences in the following regions from T0 to T2: neck (p = 0.0003), shoulders (p = 0.0057) and lower back (p = 0.0136). In terms of pain, a significant between-group difference was reported from T2 (p < 0.001). The GPE demonstrated that the average satisfaction related to the performed treatment was 1.4 ± 0.63. CONCLUSION: The present pilot RCT demonstrated the efficacy of stretching associated with muscle strengthening in decreasing the risk of WMSD, especially for the neck, shoulders and lower back. The potential strength of this model is related to the possibility to perform stretching exercises chairside at work during scheduled breaks, in addition to complementary muscle strengthening sessions at home. Future RCTs are necessary to better investigate the role of this protocol for WMSD prevention.

Efficacy of Proprioceptive Training on Plantar Pressure and Jump Performance in Volleyball Players: A Proof-of-Principle Study.

Volleyball players are often subject to micro-traumatisms of the heel fat pad and ankle injuries. Recently, mat-based proprioceptive training has assumed a key role in recovery from these disorders. Therefore, this proof-of-principle study aimed to assess the efficacy of proprioceptive mat training on plantar pressures and athletic performance in volleyball players. The participants included adult semi-professional volleyball players allocated into two groups: an experimental group, with mat-based proprioceptive and balance training, and a control group, with a sham protocol. For the outcome, we evaluated the barefoot plantar pressure, performing an analysis on a baropodometric resistive platform. The countermovement jump and squat jump were measured using an inertial measurement unit. Nineteen subjects were included in the two groups: the active proprioceptive group (n = 10) or the control group (n = 9). The results show a more uniform redistribution of loads with pressure hindfoot relief in the experimental group compared to the control group (p = 0.021, RBC = 0.67). Moreover, we observed a significant increase in peak landing force and high concentric power development in the experimental group compared to the controls. Focused proprioceptive management provided hindfoot load attenuation by stimulating higher peaks of concentric force in the experimental group compared to the sham group. Even though the study included a small sample, the results obtained in this proof-of-principle study suggest a positive role of proprioceptive stimulation in the inter-seasonal scenario for volleyball players to improve their jump performance and reduce the micro-traumatisms of the heel fat pad and the ankle injury rate. However, further studies performed on larger samples are needed to confirm these preliminary results.

Temporomandibular disorders and neck pain in primary headache patients: a retrospective machine learning study.

OBJECTIVES: To evaluate the linkage underpinning different clinical conditions as painful TMD and neck pain in patients affected by primary headaches. MATERIALS AND METHODS: In this machine learning study, data from medical records of patients with headaches as migraine, tension-type headache (TTH) and other primary ones, referring to a University Hospital over a 10-year period were analysed. VAS was used to evaluate the intensity of the TMD and neck pain. Moreover, the magnetic resonance imaging was used to supplement the clinical data. RESULTS: A total of 300 patients (72 male, 228 female), mean aged 37.78 ± 5.11 years, were included. Higher TMD and neck pain VAS in migraine patients were reported. The machine learning analysis focussed on type of primary headache demonstrated that a higher TMD VAS was correlated to migraine, whereas a higher neck pain VAS was correlated to TTH or migraine. Concerning the TMD type, arthrogenous and mixed TMD were correlated to mild-moderate TMD pain (depending on neck pain intensity), whereas myogenic TMD was correlated to moderate-severe TMD pain. CONCLUSIONS: Machine-learning approach highlighted the complexity of diagnosis process and demonstrated that neck pain might be an influential variable on the belonging to different group of headaches in TMD patients.

Impact of Physical Rehabilitation on Bone Biomarkers in Non-Metastatic Breast Cancer Women: A Systematic Review and Meta-Analysis.

Rehabilitation might improve bone health in breast cancer (BC) patients, but the effects on bone biomarkers are still debated. Thus, this meta-analysis of randomized controlled trials (RCTs) aims at characterizing the impact of rehabilitation on bone health biomarkers in BC survivors. On 2 May 2022, PubMed, Scopus, Web of Science, Cochrane, and PEDro were systematically searched for RCTs assessing bone biomarker modifications induced by physical exercise in BC survivors. The quality assessment was performed with the Jadad scale and the Cochrane risk-of-bias tool for randomized trials (RoBv.2). Trial registration number: CRD42022329766. Ten studies were included for a total of 873 patients. The meta-analysis showed overall significant mean difference percentage decrease in collagen type 1 cross-linked N-telopeptide (NTX) serum level [ES: -11.65 (-21.13, -2.17), p = 0.02)] and an increase in bone-specific alkaline phosphatase (BSAP) levels [ES: +6.09 (1.56, 10.62). According to the Jadad scale, eight RCTs were considered high-quality studies. Four studies showed a low overall risk of bias, according to RoBv.2. The significant effects of rehabilitation on bone biomarkers suggested a possible implication for a precision medicine approach targeting bone remodeling. Future research might clarify the role of bone biomarkers monitoring in rehabilitation management of cancer treatment induced bone-loss.

Oral-Gut Microbiota, Periodontal Diseases, and Arthritis: Literature Overview on the Role of Probiotics.

Periodontal diseases are oral inflammatory diseases affecting the tissues supporting and surrounding the teeth and include gingivitis and periodontitis. Oral pathogens may lead to microbial products spreading into the systemic circulation and reaching distant organs, while periodontal diseases have been related to low-grade systemic inflammation. Gut and oral microbiota alterations might play a role in the pathogenesis of several autoimmune and inflammatory diseases including arthritis, considering the role of the gut-joint axis in the regulation of molecular pathways involved in the pathogenesis of these conditions. In this scenario, it is hypothesized that probiotics might contribute to the oral and intestinal micro-ecological balance and could reduce low-grade inflammation typical of periodontal diseases and arthritis. This literature overview aims to summarize state-of-the-art ideas about linkages among oral-gut microbiota, periodontal diseases, and arthritis, while investigating the role of probiotics as a potential therapeutic intervention for the management of both oral diseases and musculoskeletal disorders.

Oxygen-Ozone Therapy for Reducing Pro-Inflammatory Cytokines Serum Levels in Musculoskeletal and Temporomandibular Disorders: A Comprehensive Review.

To date, the application of oxygen-ozone (O2O3) therapy has significantly increased in the common clinical practice in several pathological conditions. However, beyond the favorable clinical effects, the biochemical effects of O2O3 are still far from being understood. This comprehensive review aimed at investigating the state of the art about the effects of O2O3 therapy on pro-inflammatory cytokines serum levels as a modulator of oxidative stress in patients with musculoskeletal and temporomandibular disorders (TMD). The efficacy of O2O3 therapy could be related to the moderate oxidative stress modulation produced by the interaction of ozone with biological components. More in detail, O2O3 therapy is widely used as an adjuvant therapeutic option in several pathological conditions characterized by chronic inflammatory processes and immune overactivation. In this context, most musculoskeletal and temporomandibular disorders (TMD) share these two pathophysiological processes. Despite the paucity of in vivo studies, this comprehensive review suggests that O2O3 therapy might reduce serum levels of interleukin 6 in patients with TMD, low back pain, knee osteoarthritis and rheumatic diseases with a concrete and measurable interaction with the inflammatory pathway. However, to date, further studies are needed to clarify the effects of this promising therapy on inflammatory mediators and their clinical implications.

Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review.

Temporomandibular disorders (TMD) are a group of musculoskeletal diseases affecting masticatory muscles and temporomandibular joints (TMJ). In this context, the chronic TMD could be considered as a condition with chronic primary orofacial pain, presenting as myofascial TMD pain or TMJ arthralgia. In this context, myogenous TMD may present overlapping features with other disorders, such as fibromyalgia and primary headaches, characterized by chronic primary pain related to dysfunction of the central nervous system (CNS), probably through the central sensitization. This phenomenon could be defined as an amplified response of the CNS to sensory stimuli and peripheral nociceptive, characterized by hyperexcitability in the dorsal horn neurons in the spinal cord, which ascend through the spinothalamic tract. The main objectives of the management of TMD patients are: decreasing pain, increasing TMJ function, and reducing the reflex masticatory muscle spasm/pain. The first-line treatments are physical therapy, pharmacological drugs, occlusal splints, laser therapy, extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and oxygen-ozone therapy. Although all these therapeutic approaches were shown to have a positive impact on the central sensitization of TMD pain, there is still no agreement on this topic in the scientific literature. Thus, in this comprehensive review, we aimed at evaluating the evidence on pain management and rehabilitation for the central sensitization in TMD patients.

Comparative Effectiveness of Orthoses for Thumb Osteoarthritis: A Systematic Review and Network Meta-analysis.

OBJECTIVE: To evaluate the best option among orthoses for carpometacarpal (CMC) osteoarthritis (OA) of the thumb, using a network meta-analysis. DATA SOURCES: Medline, Embase, Cochrane, and ClinicalTrials.gov registry databases were used. PubMed, Embase, Cochrane Controlled Trials Register, Cochrane, and other databases were used without language restrictions. STUDY SELECTION: We searched randomized controlled trials (RCTs) on adults with OA of the thumb by studying any orthosis from the beginning to March 10, 2020. DATA EXTRACTION: Data were extracted and checked for accuracy and completeness by pairs of reviewers. Outcomes were pain and function. Comparative treatment effects were analyzed by random-effects model for direct pairwise comparisons and Bayesian network meta-analyses to integrate direct and indirect evidence. DATA SYNTHESIS: Eleven RCTs involving 619 patients were included. We evaluated 5 groups, for 4 different orthoses: short thermoplastic CMC splint (rigid CMC) (n=5), long thermoplastic carpometacarpal-metacarpophalangeal splint (rigid CMC-MCP) (n=7), short neoprene CMC splint (soft CMC) (n=1), long neoprene CMC-MCP splint (soft CMC-MCP) (n=5), and one as a control group (n=5). Our results show that all splints were superior to placebo to reduce pain intensity and the top-ranked intervention was the rigid CMC-MCP (surface under the cumulative ranking curve analysis [SUCRA], score: 65.4). In function evaluation, we report a 71.6 SUCRA for rigid CMC. CONCLUSIONS: Although the current evidence is unclear on the use of the splint in OA of the thumb, it is not known which orthosis is more effective and whether the orthosis is more effective than other interventions. The network meta-analysis shows that a long thermoplastic splint it is the best choice for pain relief and the short thermoplastic CMC splint is the best treatment to increase function. These results may suggest initial treatment with a long rigid orthosis and then a short rigid orthosis.

Role of Physical Exercise and Nutraceuticals in Modulating Molecular Pathways of Osteoarthritis.

Osteoarthritis (OA) is a painful and disabling disease that affects millions of patients. Its etiology is largely unknown, but it is most likely multifactorial. OA pathogenesis involves the catabolism of the cartilage extracellular matrix and is supported by inflammatory and oxidative signaling pathways and marked epigenetic changes. To delay OA progression, a wide range of exercise programs and naturally derived compounds have been suggested. This literature review aims to analyze the main signaling pathways and the evidence about the synergistic effects of these two interventions to counter OA. The converging nutrigenomic and physiogenomic intervention could slow down and reduce the complex pathological features of OA. This review provides a comprehensive picture of a possible signaling approach for targeting OA molecular pathways, initiation, and progression.

Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes.

Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is needed to determine the most appropriate and optimal timing and formulations in non-steroidal anti-inflammatory drug and opioid management, particularly given the strictness of anti-doping regulations. Indeed, the role of pharmacological therapy in reducing acute traumatic pain in athletes should still be addressed to minimize the timing of return to sport. Therefore, the aim of this comprehensive review was to summarize the current evidence about pain management in the setting of acute injury in elite athletes, providing the most informed strategy for pain relief and performance recovery.

Late Activation of the Vastus Medialis in Determining the Risk of Anterior Cruciate Ligament Injury in Soccer Players.

CONTEXT: Activation time of the quadriceps is important in determining injury risk in professional soccer players. OBJECTIVE: To compare the activation time of the quadriceps and hamstrings muscles during a movement that puts stress on anterior cruciate ligament (ACL) to assess the risk of ACL injury. DESIGN: Case series. SETTING: University laboratory for movement analysis. PATIENTS OR OTHER PARTICIPANTS: Twenty (10 males and 10 females) professional soccer players. INTERVENTION(S): An inertial sensor and 4 electrodes positioned on the quadriceps and hamstrings muscles were used for the surface electromyography. The athlete resting on 1 leg dropped, from a 32-cm-high platform, on the suspended foot (testing leg), without jumping or lowering his center of gravity and maintaining single-leg landing for 5 seconds. Using a software, it is possible to calculate the activation time of the rectus femoris, vastus medialis (VM), biceps femoris, and semimembranosus muscles before ground contact. MAIN OUTCOME MEASURES: To evaluate the activation times of the rectus femoris, VM, biceps femoris, and semitendinosus muscles before ground contact in comparison with the range of normality calculated by the manufacturer. RESULTS: All male soccer players demonstrated a low risk related to the correct activation of all the examined muscles, while female soccer players demonstrated delayed activation of the VM. CONCLUSIONS: Delayed activation of the VM registered in females determines an increase in anterior shear force, which is an important risk factor for incurring an ACL injury. This testing protocol becomes adequate for the screening of high-risk athletes and for targeting interventions to specific imbalances that may increase injury risk.

Correlation Between Timing of Surgery and Outcome in ThoracoLumbar Fractures: Does Early Surgery Influence Neurological Recovery and Functional Restoration? A Multivariate Analysis of Results in Our Experience.

BACKGROUND: Treatment for spinal trauma is affected by both nonmodifiable and modifiable variables. The aim of this study was to compare early surgery with intermediate and late surgery to determine the benefits of spinal reconstruction in neurological recovery and functional restoration in patients with thoracolumbar fractures. METHODS: In order to identify correlations between treatment timing, fracture site, neurological recovery, American Spinal Injury Association (ASIA) score restoration, and rehabilitation prognosis in patients with thoracic and lumbar fractures, we conducted a multivariate analysis of the results of surgery, at our institution, in 166 consecutive patients with unstable thoracolumbar fractures with or without neurological impairment. We conducted a literature review (1988-2012) and compared our results with those already published. RESULTS: Regardless of the location and type of fracture, early surgery resulted in a reduction of median hospital and intensive care unit (ICU) length of stay, as well as a reduction of nosocomial complications. Regardless of the type of fracture and preoperative ASIA score, thoracic fractures had the worst outcome. Early treatment seemed to have better results, depending on the preoperative ASIA score. CONCLUSION: Early surgery in patients with thoracolumbar fractures with incomplete neurological damage could positively affect neurological recovery, functional restoration, length of hospital and ICU stay, and associated comorbidity. Thoracic fractures had the worst outcome. Early surgery seemed to have better results if the initial ASIA score was good. The better the ASIA score on admission, the better was the outcome. Surgical timing did not affect the outcome when the ASIA score was A or E.

Hidden spondylolisthesis: unrecognized cause of low back pain? Prospective study about the use of dynamic projections in standing and recumbent position for the individuation of lumbar instability.

INTRODUCTION: Dynamic X-rays (DXR) are widely recognized as an effective method to detect lumbar instability (LI). They are usually performed with the patient in standing position (SDXR). In our opinion, standing position inhibits micromovements of the lumbar segment interested by the listhesis, thanks to paravertebral muscles antalgic contraction and augmented tone. We aim to demonstrate that DXR in recumbent position (RDXR), reducing the action of paravertebral muscles, can discover hypermovements not evidenced in SDXR. METHODS: Between January 2011 and January 2013, we studied 200 consecutive patients with lumbar degenerative disease with MRI, SDXR, and RDXR. We aimed to find a correlation between low back or radicular pain and the presence of a spondylolisthesis not showed by the SDXR, but showed by the RDXR. RESULTS: We analysed 200 patients: of the 133 not pathologic in SDXR, 43 patients (32.3 %) showed an hypermovement in RDXR (p = 0.0001) without any significant correlation between hidden listhesis and age, sex, or level involved. CONCLUSIONS: The aim of our study is to determine whether in patients with lumbalgy without evidence of listhesis in SDXR, pain can be attributed to a faccettal syndrome or to a spondylolisthesis. Consequence of pain is augmented muscular tone of the paravertebral musculature, particularly in standing position. Augmented muscular tone tries to inhibit the pain generator, attempting to limit the slippage of the involved segment. In patients examined in RDXR, the tone of paravertebral musculature is reduced, showing the hidden spondylolisthesis.

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.

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.