Efficacy of core stability in non specific chronic low back pain

Background: Management of chronic low back pain (cLBP) is often multidisciplinary, involving a combination of treatments, including therapeutic exercises. Core stability exercises aim to improve pain and disability in cLBP increasing spinal stability, neuromuscular control, and preventing shear force that causes injury to the lumbar spine. The purpose of this study was to review the available evidence about the effectiveness in reducing pain and improving disability of core stability exercises for non-specific cLBP. (2) Methods: We perform a systematic research on common Medline databases: PubMed, Pedro, and Cochrane Library. Search results were limited to articles written in English and published between January 2005 and November 2020.The search provided a total of 420 articles. Forty-nine articles met the inclusion criteria and 371 articles were excluded. (3) Results: Core stability provides great therapeutic effects in patients with non-specific chronic low back pain reducing pain intensity, functional disability, and improving quality of life, core muscle activation, and thickness. Evidences suggest that core stability is more effective than rest or no/minimal intervention and combination with other types of exercise for cLBP have shown grater efficacy. (4) Conclusion: Core stability could be proposed in a comprehensive approach in cLBP, the combination with other modalities of therapeutic exercise should be promoted. Patient compliance is crucial to determine the efficacy of the intervention

The role of detraining in tendon mechanobiology

INTRODUCTION: Several conditions such as training, aging, estrogen deficiency and drugs could affect the biological and anatomo-physiological characteristics of the tendon. Additionally, recent preclinical and clinical studies examined the effect of detraining on tendon, showing alterations in its structure and morphology and in tenocyte mechanobiology. However, few data evaluated the importance that cessation of training might have on tendon. Basically, we do not fully understand how tendons react to a phase of training followed by sudden detraining. Therefore, within this review, we summarize the studies where tendon detraining was examined. MATERIALS AND METHODS: A descriptive systematic literature review was carried out by searching three databases (PubMed, Scopus and Web of Knowledge) on tendon detraining. Original articles in English from 2000 to 2015 were included. In addition, the search was extended to the reference lists of the selected articles. A public reference manager (www.mendeley.com) was adopted to remove duplicate articles. RESULTS: An initial literature search yielded 134 references (www.pubmed.org: 53; www.scopus.com: 11; www.webofknowledge.com: 70). Fifteen publications were extracted based on the title for further analysis by two independent reviewers. Abstracts and complete articles were after that reviewed to evaluate if they met inclusion criteria. CONCLUSIONS: The revised literature comprised four clinical studies and an in vitro and three in vivo reports. Overall, the results showed that tendon structure and properties after detraining are compromised, with an alteration in the tissue structural organization and mechanical properties. Clinical studies usually showed a lesser extent of tendon alterations, probably because preclinical studies permit an in-depth evaluation of tendon modifications, which is hard to perform in human subjects. In conclusion, after a period of sudden detraining (e.g., after an injury), physical activity should be taken with caution, following a targeted rehabilitation program. However, further research should be performed to fully understand the effect of sudden detraining on tendons

Extracorporeal shockwaves therapy versus hyaluronic acid injection for the treatment of painful non-calcific rotator cuff tendinopathies: preliminary results

Rotator cuff tendinopathy is the most common cause of painful shoulder. The treatment is mainly conservative and several therapeutic approaches have been proposed, including NSAIDs, physiotherapy, injections and physical therapies. The aim of the current study is to compare the clinical effectiveness of low molecular weight hyaluronic acid (LMW-HA) injection versus low-energy Extracorporeal Shock-Wave Therapy (ESWT) until 3 months of follow-up for the management of painful non-calcific rotator cuff tendinopathies, evaluating also the trend over time between the groups

I.S.Mu.L.T - Rotator cuff tears guidelines

Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources

Indirect Rectus Femoris Injury Mechanisms in Professional Soccer Players : Video Analysis and Magnetic Resonance Imaging Findings

OBJECTIVE: To describe injury mechanisms and magnetic resonance imaging (MRI) findings in acute rectus femoris (RF) injuries of soccer players using a systematic video analysis. DESIGN: Descriptive case series study of consecutive RF injuries from November 2017 to July 2022. SETTING: Two specialized sports medicine hospitals. PARTICIPANTS: Professional male soccer players aged between 18 and 40 years, referred for injury assessment within 7 days after a RF injury, with an available video footage of the injury and a positive finding on an MRI. INDEPENDENT VARIABLES: Rectus femoris injury mechanisms (specific scoring based on standardized models) in relation to RF muscle injury MRI findings. MAIN OUTCOME MEASURES: Rectus femoris injury mechanism (playing situation, player/opponent behavior, movement, and biomechanics), location of injury in MRI. RESULTS: Twenty videos of RF injuries in 19 professional male soccer players were analyzed. Three different injury mechanisms were seen: kicking (80%), sprinting (10%), and change of direction (10%). Isolated single-tendon injuries were found in 60% of the injuries. Of the kicking injuries, 62.5% included complete tendon ruptures, whereas both running injuries and none of the change of direction injuries were complete ruptures. The direct tendon was involved in 33% of the isolated injuries, and the common tendon was affected in all combined injuries. CONCLUSIONS: Rectus femoris injuries typically occur during kicking among football players. Most of the RF injuries involve a complete rupture of at least one tendon. Kicking injuries can also affect the supporting leg, and sprinting can cause a complete tendon rupture, whereas change of direction seems not to lead to complete ruptures.publishedVersionPeer reviewe

Low Molecular Weight Hyaluronic Acid (500–730 Kda) Injections in Tendinopathies—A Narrative Review

Tendinopathies are common causes of pain and disability in general population and athletes. Conservative treatment is largely preferred, and eccentric exercise or other modalities of therapeutic exercises are recommended. However, this approach requests several weeks of consecutive treatment and could be discouraging. In the last years, injections of different formulations were evaluated to accelerate functional recovery in combination with usual therapy. Hyaluronic acid (HA) preparations were proposed, in particular LMW-HA (500–730 kDa) for its unique molecular characteristics in favored extracellular matrix homeostasis and tenocyte viability. The purpose of our review is to evaluate the state-of-the-art about the role of 500–730 kDa in tendinopathies considering both preclinical and clinical findings and encourage further research on this emerging topic

Impact of oestrogen deficiency and aging on tendon: concise review

The knowledge about tendons and tenocyte biological behaviour during aging and, especially, oestrogen deficiency is limited. Women differ from men with regard to muscle and tendon, most likely due to differences in sex hormones activity and tissue response. To-date the interest in metabolic factors that may induce tendon disorders is growing. The aim of this paper is to elucidate the current findings in the correlation between oestrogen deficiency, aging and tendon pathology and to encourage future researches to ameliorate assessment and management of tendinopathies in postmenopausal women

Efficacy of eccentric exercise for lower limb tendinopathies in athletes

Tendinopathies represent one of the most frequent sport injuries and their correct treatment is a crucial issue in sport medicine practice. In most of the cases, these multifactorial conditions are related to overuse and it is characterized by activity-induced pain, local tenderness and swelling. Although tendinopathies are common, their treatment is not easy. Currently, it is generally accepted that the management of tendinopathies should include early functional exercises. Eccentric Exercise (EE) is considered a fundamental therapeutic resource, especially for the treatment of Achilles and patellar tendinopathy. In our review we analyze the use of EE for the treatment and prevention of the lower limb tendinopathies, evaluating the adopted programs and efficacy, the possible mechanisms of the healing process and the action of EE on tendon structure. Treatments with EE are useful to improve symptoms and function in lower limb tendinopathies, but more evidences are necessary to establish the adequate dose-response and to determine long-term effects