Posture as a model of mechanosensitivity: the “Biotensegrity”

The Human body must be considered as a complex motor biosystem where homeostasis and regional state or segmental state functions are inseparable from general ones and the control circuit is not linear-causality type, ie stimulus and reaction, but it is an interactive system made up of a large number of interconnected circuits. Recent research paves the way for a new interpretation of connective tissue functions, understood as a true “communicative network” within the model of mechanical sensitivity that sees cells as a kind of “metal mesh” where elastic fibers, from cytoplasmic space, reach internal structures such as chromatin, allowing the cell to respond directly and immediately to the forces applied to the cell membrane. Moreover, we know today that, through specific membrane proteins (integrins), the connective system is able to interact with cellular mechanisms. Unlike the nervous system, the endocrine and the immune system, the myofascial apparatus presents a more archaic but not least important method of communication: the mechanical one. It “simply” pulls and pushes communicating thus from fiber to fiber, from cell to cell and from internal and external environment through mechanical signal transduction systems. We can, therefore, speak of biotensegrity bone-muscle-fascial system, that is the faculty of a system to stabilize mechanically through a game of tension and decompression forces that are divided and equilibrated. The alterations of these forces determine pathological conditions that may affect the various sensory, central, motor, soft tissues subsystems with a progressive deterioration of the delicate compensatory mechanisms, causing the onset of postural disorder that is exacerbated by tissue suffering and results also in a morfological damage

THE FOOT-GROUND REACTION IN THE SOCCER PLAYER

Soccer is a sport of movement and contact with the basic aim to gain on and to hold the ball. The development's possibility of an action, at any frequency, is strictly correlated to the balance between internal and external forces. The purpose of this study is to confront the foot-ground reaction in male (40) and female (15) elite soccer players by means of a dinarnometric plateform, both during a normal gait and a running at 10 kmh. Results: The parameters of foot-ground reaction in both the groups show a significant identity concerning the Fz, Fy and Fx components, The morphology of the vectograms in male and in female players is the same. The only difference between male and female player concerns the first value of Fz parameter: in the male group, this is bigger of 15% of the b.w

Nonsteroidal Anti-inflammatory Drugs: Integrated Approach to Physical Medicine and Rehabilitation

Inflammation is an immediate response to damage; in acute phase, it is a form of defense for body and it aims to restitutio ad integrum, in the chronic form itself becomes disease. This mechanism determines inflammatory diseases that are a group of clinical disorders which are characterized by abnormal inflammatory responses such as osteoarthritis, in myalgic syndromes (like fibromyalgia or miofascial sindrome), in some forms of headache, in peripheral vascular disease, in many malignancies. In Physical and Rehabilitation Medicine, the use of analgesic drugs (including NSAIDs) is a crucial resource inside a complex bioprogressive rehabilitative project. A part of the classic use per os is characterized by a serious and systemic side effect and there is also a possibility to administer drugs through other routes. Antalgic and rehabilitative mesotherapy (ARM) is a minimally invasive technique consisting of subcutaneous injections of bioactive substances. Other alternatives are represented by iontophoresis, phonophoresis, phytotherapy, and topical application. The purpose of this chapter is to give an overview about the state of the art regarding the use of NSAIDs in physical medicine and rehabilitation

Venous insufficiency and foot dysmorphism: effectiveness of visco-elastic rehabilitation systems on veno-muscle system of the foot and of the calf.

Chronic venous disease is very common and widespread. Chronic Venous Insufficiency (CVI) is a condition characterized by hypertension of the venous system of the lower limbs which manifests itself through a large range of symptoms. The main cause of (CVI) is hypertension of the venous system of lower limbs, which in most cases is due to reflux for the incontinence of the valvar system of veins. Other causes are related to obstruction of the venous outflow, or at a reduced venous emptying due to inefficiency of the system of the veno-muscular pumps of the calf and of the foot. The purpose of this study was to evaluate if the use of a non-invasive rehabilitative model, which is characterized by two different visco-elastic insoles, is effective both to reduce postural imbalances and to improve the efficiency of the veno-muscular pumps of the foot and of the calf using photoplethysmography in reflected light. Fifty (50) patients suffering from flatfoot and ped cavus, were studied doing a stabilometric and baropodometric test to evaluate the angle of the foot and the podalic angle. Patients were evaluated by examining vascular examination and venous reography in basal condition, using corrective visco-elastic insoles for the correction of dysmorphisms that we were studying. An improvement of the angle of the Right and Left axis (p<0.05) and the podalic angle (p<0.001), using the right insole both in the flatfoot and cavus foot, was shown by the podobarographic examination. A not important tendency to improvement was also shown by the use of non-specific insole in both pathologies. The vascular examination showed an improvement of 38% in venous emptying capacity of the foot/calf veno-muscular pump in cavus foot with the specific "B" insole (p<0.002). An important improvement of 24%, using the specific "A" insole (p<0.05), was documented in flatfoot. The photoplethysmography examination documented a significant improvement of the venous emptying capacity of foot-calf veno-muscular system due to the use of specific insoles for the studied dysmorphism, with an improving tendency even with the use of non-specific insoles. The hemodynamic improvement is correlated with the improvement of the analyzed biomechanical parameters: contact time, lenght of the halfstep, podalic angle and angle of the foot. The partial normalization of biomechanical parameters allows a reorganization of relationships of forces between ground and foot, as well as the improvement of the function of the subtalar joint, causing a partial recovery of the complex physiological mechanism of activation of the veno-muscular pumps of the foot and of the calf

PLANTAR FASCIITIS: AN UPDATE ON CLINICAL AND BIOMECHANICAL FEATURES

Plantar fasciitis is an inflammatory condition, characterized by pain in the medial, central and lateral plantar compartments, accompanied by stiffness. The purpose of this study is to compared 30 runner affected by plantar fasciitis to a. control group and to point out 1) the different areas of pain and referred pain, 2) the isokinetic muscular performance of the plantar flexor muscle, by means of a Cibex 6000 isokinetic dynamometer and tests performed concentrically and eccentrically at 30, 60, 90, 180 deg/sec. 3) the data of the foot-ground reaction got by means of a. dynamometric platform. Results: In all the three sectors of plantar fascia there are different areas of pain and referred pain. An high incidence of plantar flexor muscle strength deficits has been showed both during concentric and eccentric contraction, and in addition the ankle range of motion is reduced. The gait analysis has shown a persistent alteration of the foot-ground reaction's parameters. The Aa. present the results of the treatment based on the correction of biomechanical deficits with follow-up of three years

The Role of Physical Medicine and Rehabilitation in Shoulder Disorders

Shoulder pain is a common problem and it is responsible for a high proportion of patients presenting to general practice, causing work absenteeism and claims for sickness. A lot of factors and conditions can contribute to shoulder pain. The most prevalent cause is rotator cuff tendinitis; its relevance is correlated not only to its high prevalence rate but also to the fact that is disabling, causing high direct and indirect cost in industrialized country. Other causes of shoulder pain are shoulder impingement syndrome, calcific tendonitis, frozen shoulder, etc. In this context, physical medicine and rehabilitation plays a fundamental role. The conservative approach consists of several interventions. The aim is to decrease shoulder pain and to regain shoulder function, with the goal to reduce the degree of impingement, decreasing swelling and inflammation, and to minimize the risk of further injuries. The purpose of this chapter is to give an overview about shoulder disorders and their conservative treatment by means of physical therapy

Sarcopenia in Chronic Illness and Rehabilitative Approaches

Primary sarcopenia is considered to be age-related when no other cause is evident, other than aging itself. Secondary sarcopenia should be considered when one or more other causes are evident, such as multiple chronic conditions. Previous studies have reported that low muscle strength and impaired physical performance can be found in chronic diseases, including metabolic disease (diabetes, hypertension, and obesity), arthritis, osteoporosis, cancer, chronic kidney disease, chronic obstructive pulmonary disease, neuromuscular disease, and chronic infection. The development of preventive and therapeutic strategies against secondary sarcopenia and wasting disorders in general is an epidemiological need. The planning of a complex rehabilitation program in sarcopenia associated to chronic conditions, in the context of a comprehensive treatment, is made up of a nutritional support, exercise, correction of lifestyles, and the use of advanced physical energies. Therefore, for the purposes of the optimal management, it is essential to identify the pathogenesis and clinical characteristics that can affect the different rehabilitative treatment

Rehabilitation in Sarcopenic Elderly

Sarcopenia is a complex problem and an important emerging field in rehabilitation of the elderly. In 2010, the European working group on sarcopenia in older people (EWGSOP) described sarcopenia as a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength, associated with a risk of adverse outcomes such as physical disability, poor quality of life and death. This field of rehabilitation has been defined as ‘evaluative, diagnostic and therapeutic interventions whose purpose is to restore functional ability or enhance residual functional capability in elderly people with disabling impairments’. With growing numbers of frail older people, there is an increasing need for appropriate geriatric rehabilitation services. Definitely, sarcopenia needs a specific rehabilitation program to improve muscular mass and strength that must be integrated with a global approach with the aim to recover postural assessment, amplify sensory‐motor systems, in order to gain the necessary information for proper motor planning, to reduce risk of falls. Several physical agents in medicine permit to treat sarcopenia, like vibrations or electrical stimulation. The aim of this chapter is to give an overview about rehabilitative medicine for sarcopenia, highlighting the state of the art, presenting the most significative clinical researches and giving some inputs to set a rehabilitation protocol