THE ROLE OF ORTHOTICS IN THE FOOTBALL

The prevention of injury of foot is the true focus of the biomechanical approach applied to the foot in the sports medicine. This work will analyse the roles of the orthotics devices in the treatment of some injuries of the foot in the soccer players. The pathological processes that can developed in the foot are caused by either simple acute traumas from contact or microtraumas from repeated stressed to the foot. Method and Material: We have examined and treated 120 soccer players afflicted from foot’s pathologies from overload. The follow up is 2 years. The diagnostic approach has included an objective examination with a diagnostic X-rays images, and after an evaluation of reaction behaviour of the ground with the foot. The ground reaction was analyzed during both walking and running, to define as precisely as possible the characteristics of pressures and forces aging on the foot. Results: in our clinic we have realized that the treatment of foot’s injuries (tab.1) involves beyond a biomechanical control with orthotics and after a propioceptional rehabilitative programme for 1 month. The results of the pathologies’ treatment with plantar orthotics have demonstrated that this method has a positive interaction ( tab.2) in the control of the foot’s biomechanical disorders. Discussion: Several studies support the impression that orthotic devices reduce biomechanical stress and the incidence of injury. Taunton et al. have demonstrated a decrease in calcaneal eversion during the support phase of running and Bates et al. have demonstrated a reduction in the period and in the maximum extent of pronation in running wearing orthotic devices. Our experience about the use of the plantar orthotic is that the orthotic devices should be of elastic and absorbing at various level material because our data suggest that controlling the velocity of eversion is more important than controlling the degree of eversion, and also that with those materials is possible to good reduce the vertical forces that are applied on the plantar surface of the foot and to well control the good aliment of the leg with the foot. The technical construction should be related to the pattern of the individual ground reaction. Conclusion: The plantar orthotic is an ideal support able to control excessive motion of S.T.J. and to reduce the vertical and horizontal forces and the rotational movement of the foot

Modifications Of Joint Mobility Range Induced By Eccentric Contraction

Dynamic eccentric contraction causes muscle damage consisting of: myofibrills disorganization, Z-lines disruption and cell membrane lesions. This damage is indirectly evidenced by a massive, delayed (4th-5th day) CK release in the serum. Negative work induces also a clinical condition defined as "Delayed Onset Muscle Soreness" (DaMS), characterized by delayed onset (8-24h) muscle pain, lowering in muscle pain threshold (24-4Bh), swelling of the exerted limb (72h). Stiffness and restricted range of movement in the joints related to the exerted muscles are also described, but the phenomena are less investigasted. The aim of this study was to evaluate the range of knee joint mobility before and after a standardized eccentric effort. Twelve healthy runners, aged 24-35 years, were examined. They performed a step-test (20' duration, 15 cycles/min), to exert the quadriceps femoris muscle of one side eccentrically. The day before the test, all the subjects underwent evaluation of Pressure Pain Threshold (PPT) of the exerted muscle and Passive Joint Mobility (PJM) of the knee. These evaluations were repeated immediately after the test and on the following 6 days; on the same days, the perceived pain was also measured by means of a force-transducer equipped with a 2.5 cm diameter rounded probe and a digital analyser (unit:Kg/f), applied on 12 pre-established spots on the quadriceps muscle surface; the mean of the 12 recordings was taken as, the final threshold value. PJM was measured by means of a manual goniometer on prone subjects; the exerted lower limb was moved from the rest position to the maxmal pain-free flexion; the degree at which the subject felt the minimum discomfort was recorded. Student's "ttest" for paired data was employed for statistical analysis. PPT showed a significant decrease after 24 and 4Bh in the exerted muscle, while pain reached maximum value at the 4Bh measurement. PJM showed a significant reduction 24-72h after the effort. DaMS is a complex phenomena, whose explanation is still unclear; particularly the temporal dissociation between symptoms and signs of muscle damage. The reduction of PJM has been attributed to edema of the connective tissue, due to the eccentric contraction stress. However the maximal thickness of the eccentrically exerted limb is usually found at 72h, while the reduction of PJM starts at 24h. The results of the present study show that the temporal pattern of PJM reduction is fairly similar to that of pain and hyperalgesia. This could suggest a reflex origin of the phenomenon, due to painful symptoms, through a tonic activation of antagonist muscles

PAIN FROM PLANTAR FASCIITIS

Introduction: Fasciitis of the foot is an inflammatory condition characterized by pain in the medial, central and lateral sectors of the sole accompanied by stiffness. The aim of this study was to examine and interpret the features of the pain focus in this condition from a clinical and esthesiological point of view and in relation to the objective findings of a biomechanical evaluation. Material and Method: Twenty-two subjects (17males, 5 females), aged 19-51 years were examined who practised sport regularly; all presented pain in the sole of the foot. Each subject underwent a clinical and esthesiological examination with measurement of pain thresholds to electrical stimulation of the skin, subcutaneous tissue and muscle in the trigger point zone and unaffected controlateral area and also an evaluation of biomechanical parameters related to function by means of an analysis of the foot-ground reaction and peak force revealed by isokinetic dynamometer. The patient were then fitted with a corrective insole and re-subjected to the above examinations after 30 and 60 days. Results: The subjects were divided into 3 groups on the basis of the TrP site and area of referred pain, as follows:Group A (12 cases) had fascial pain in the calcaneum attachment. The objective examination showed an active TrP determining referred pain in the median part of the sole of the foot. Group B ( 8 cases) had pain localized in the middle third of the medial part of the fascia. The objective examination showed an active TrP causing pain radiating disto-proxiamlly to the attachment of the peroneus muscle at the base of the V metatarsus. The esthesiological evaluation of these groups showed lowered pain thresholds in the skin and muscle compared with the controlateral areas. The isokinetic examination revealed a significant decrease in the peak force in concentric contraction and peak force in eccentric contraction. The foot-ground reaction were abnormal for same spatial and temporal components. A significant reduction of the painful symptoms was observed in these subjects after 30 days with corrective insole, together with a normalization of locomotion. After 60 days, the pain had disappeared and there was an objective reduction of the irritability of the TrPs and absence of the target zone. The esthesiological examination of the pain threshold to electrical stimulation of the skin and muscle showed a further increase with respect to the previous control. All components of the foot-ground reaction were improved. Conclusion: These results show that pain from fasciitis of the sole of the foot is due to an abnormality of movement which gives rise to an imbalance of the force and flexibility of the flexor muscle in this area. The improvement of the ground-foot reaction brings about a gradual disappearance of the painful symptoms

The FOOT GROUND REACTION ON THE SOCCER AND RUGBY PLAYER

Introduction The body’s motion must be interpreted a succession of elementary movements that can be studied as the combination of translational and rotational motions. The correct expression of a motion is dependent on the balance between internal and external forces. The vector and scalar characteristics of the reaction are related to the physical and mechanical characteristics of two structures coming in contact Methods and Materials The analysis is performed during the normal strike and the running of the soccer and the rugby player. We have used a dynamometric platform Kistler that provided the complete progression of the foot ground reaction which deve1opes during the stage of placing of the fool on the ground.24 soccer p layers of Italian national team and 40 soccer players with high ability and performance and 50 rugby players are examined and the tests are correlated with a control reference group of normal subjects. Results The analysis of the soccer players’ foot-ground reaction on the sagittal plane has revealed: during the normal strike an impact phase characterized by high force both maximum and medium and high velocity of progression of application's point. A support phase characterized by velocity of progression of application point lower compared to the impact phase and by the backward inclination of vectors. A propulsive phase with a presence of a peak of force lower than the first one in the contact phase and with rotational moment significantly increased compared to the normal. The trace diagram show a wider extension of internal rotation during the contact phase and movement with a predominance of an external rotation during the support phase. The analysis of the rugby players' fool-ground reaction has revealed on the sagittal plane: during the normal strike an impact phase with high force both maximum and medium and high velocity of progression of application's point. In comparison of the soccer player’s ground reaction the data show values reduced of force during the impact phase. A support phase shows backward inclination of vectors and a reduced velocity of progression compared to the impact phase. A propulsive phase demonstrate a presence of a peak of force same that the first one during the contact phase. On the horizontal plane, the trace diagram shows a normal extension of internal rotation and a significantly extension of external rotation. Conclusions: The ground reaction pattern of the professional soccer player is repetitive, typical and different by the pattern of the vectorial diagram of the rugby player

PRINCIPLES OF APPLIED BIOMECHANICS ON THE RACE WALKERS: IMPROVEMENT IN PERFORMANCE WITH A PLANTAR ORTHOSIS

When race walking it is essential to attain and maintain for a period of time the maximal speed with minimal expenditure of energy, in observance of the prescribed standards. To achieve this end, optimizing the physical carriage is indispensable. This may be done in two ways: I) by reducing those force component hat ace employed along directions of application that do no concur with the sense of progression, since they interfere with and disperse part of the energy; and 2) by increasing the vectorial components that have the same direction as the forward movement. The aim of our work was to verify the modifications that are induced by the use of plantar orthoses , as reflected by parameters of biomechanical performance on the race walker: Under standard reference conditions, we studied the kinematics and ground reaction of 10 highly-trained Athletes. With reference to report that confirmed previous study by us and other authors, we verified the modifications induced by the applications of special dynamic plantar orthoses. The ground reaction appeared to be optimized by the use of these orthoses through the following mechanisms: 1) a diminution of the sagittal force components that are opposed to the direction of movemen6 2) a diminution of the transverse edgewise components that are not useful to the progression, and 3) an increase in the reclamation of useful elastic energy stored by the functional unit, the 'musculo-skeletal footwear system”

ASTHMA AND MAST CELL BIOLOGY

Asthma is a chronic inflammatory disease of the lung and its pathophysiology is initiated by mast cell activation in response to the antigen binding to IgE receptor as well as by TH2 cell activation. Mast cells are well established effector cells in asthma where they exacerbate the inflammatory response, playing a key role in early phase, degranulating and increasing histamine. Human mast cells possess high affinity IgE receptors and are ubiquitous but predominantly localized in mucosal and connective tissue and are distributed along blood vessels. There are two types of mast cells: connective tissue mast cells (TC) and mucosal mast cells (T mast cells). TC mast cells contain more heparin, whereas T mast cells contain more chondroitin sulfate. In asthma, mast cell activation can trigger degranulation, releasing secretory granule complex and preformed mediators, such as histamine and proteases, along with the synthesis of leukotrines and prostaglandins, and induction of cytokines and chemokines. Leukotrine inhibitors and omalizumab, which inhibits IgE, both relieve the asthma exacerbation when administered to humans and permit to reduce the use of other drugs. The release of cytokines by mast cells, such as TNF-alpha, IL-1, IL-6 and IL-33, participate in the pathogenesis of asthma. Stress worsens asthma, and this effect is also mediated by mast cell activation through the release of cytokines. Administration of IL-33 in experimental animals provokes pathological effects in the mucosal tissues and augments antibody IgE and IgA in blood vessels. Here, we report the impact of mast cell biology in asthma pathogenesis

Characterization of the stimulation output of four devices for focal muscle vibration

Different devices for mechano-acoustic muscle vibration became available on the market in the last ten years. Although the use of these vibrators is increasing in research and clinical settings, the features of their stimulation output were never described in literature. In this study we aimed to quantify and compare the stimulation output of the four most widespread pneumatic devices for focal muscle vibration available on the market. A piezoelectric pressure sensor was used to measure the pressure profile generated by the four selected devices in the following experimental conditions: i) measurement of the output changes associated with variations of the stimulation amplitude for three stimulation frequencies (100 Hz, 200 Hz, and 300 Hz); ii) measurement of the output changes during a 20-min long stimulation at constant frequency (300 Hz) and amplitude; iii) measurement of the output changes associated with the progressive activation of all stimulation channels at constant frequency (200 Hz) for different amplitudes. The maximum peak-to-peak amplitudes of the pressure waves were in the range 102 mbar - 369 mbar (below the maximum values declared by the different manufacturers). The shape of the pressure waves generated by the four devices was quasi-sinusoidal and asymmetric with respect to the atmospheric pressure. All output features had a remarkable intra- and inter-device variability. Further studies are required to support the technological improvement of the currently available devices and to focus the issues of vibration effectiveness, limitations, proper protocols, modalities of its application and assessment in neuromuscular training and rehabilitation

Idiopathic facial palsy: umbrella review of systematic reviews and meta-analyses

Idiopathic facial palsy is the most common disease of the VII cranial nerve. There are many treatments to facilitate recovery from this condition: pharmacological, surgical, rehabilitative, but the effectiveness of some of these treatments, especially the latter, is still under discussion. The purpose of this umbrella review of systematic reviews is to analyse the literature in order to investigate the different rehabilitation interventions in patients suffering from idiopathic facial palsy. A scientific literature search was carried out from January 2009 until August 2019, using Mesh the terms "facial palsy", "Bell's Palsy", "idiopathic facial nerve palsy", combined with "rehabilitation" and "therapy". Initially all the systematic reviews and meta-analyses of the last 10 years concerning rehabilitation treatments for the recovery of injured functions in facial palsy were included. Given the heterogeneity of the studies in the literature, which do not differentiate the different causes of facial palsy, all the causes of idiopathic facial palsy were included in the review. The research resulted in 94 published systematic reviews but only 6 were considered in respect to the inclusion criteria. All studies agree on the lack of high-quality scientific work to be able to say that Bell's physiotherapy treatments for facial palsy are effective, in particular with regard to recovery times during the rehabilitation process. Future studies are needed, in order to highlight the therapeutic implications of the different rehabilitation methods, with standardized protocols, in patients suffering from facial palsy of different aetiology