Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes

Effectiveness of physical agent modalities for pain relief in injured athletes: A systematic review

IntroductionFrom a rehabilitation perspective, various approaches can be applied to help athletes overcome injury, including drugs, physical agent modalities (PAMs) with conventional physical therapy. This systematic review aimed to evaluate the impact of physical agent modalities (PAMs) for pain relief in injured athletes.MethodsPubMed, Scopus, and Web of Science were systematically searched from inception until May 8th, 2024. The papers were considered eligible for review in compliance with the conditions determined by the following PICO model: P) Participants: injured athletes; I) Intervention: magnetic therapy, TENS, lasertherapy, ultrasound therapy, diathermy, and extracorporeal shockwave therapy (ESWT); C) Comparator: NA; O) Outcome measure: any pain assessment. PROSPERO registration number: CRD42024532304ResultsStudy selection reported a total of 785 records, resulting in 484 articles after duplicate removal. After the title and abstract screening, 433 papers were excluded and 51 articles were evaluated for eligibility. Therefore, 21 studies were included, involving a total of 806 subjects: 10 ESWT, 1 Cryotherapy, 2 Cryo + ultrasound, 3 diathermy, 1 NMES, 1 TENS, 2 Laser therapy, 1 combined procedure.ConclusionsThe systematic review indicated potential effectiveness of PAMs in managing and reducing pain in sport-related injuries. Taken together, our findings suggested a positive role of ESWT in term of pain relief, also considering that these PAMs are the most used in these subjects. However, the high heterogeneity of the results could not consent to define the specific effect of the single PAMs.

Effects of Autologous Tenocyte Injection for Overuse and Degenerative Tendinopathies: A Systematic Review

Background: The term tendinopathy commonly describes a series of alterations in the tendon, leading in functional impairment and pain, treated with several approaches, including exercises, physical agents, and injection therapies. Among the latter, autologous tenocyte injection (ATI) involves harvesting tenocytes from a healthy tendon of the patients and then isolating the tenocytes and culturing for 4-5 weeks. To date, there is still a lack of consensus about the efficacy of ATI in improving pain and function; therefore, the present review aimed to assess the role of ATI in the treatment of chronic tendinopathies. Methods: Two authors conducted a comprehensive search across PubMed Medline, Web of Science, Scopus, Cochrane Library, and Google Scholar (PROSPERO: CRD42024565211). From 174 articles, we finally included 5 articles. Results: The main effect obtained was the pain relief and, consequently, the improvement of patients' quality of life. The clinical improvement is also evident at MRI in which it is possible to see a progressive reduction with a general disappearance of the T2 signal hyperintensity between 4 months and 1 year. All the articles agree on the safety of ATI in chronic tendinopathies. Conclusions: ATI might represent a safe and valuable option in the management of chronic tendinopathies as a second line treatment in the case of resistant tendinopathies, with a minimal risk of side effects.

Effectiveness of cryo plus ultrasound therapy versus diathermy in combination with high-intensity laser therapy for pain relief in footballers with muscle injuries: A prospective study

BACKGROUND

Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes.

OBJECTIVE

The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries.

METHODS

A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury.

RESULTS

Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p< 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier.

CONCLUSION

HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers.

Postural Analysis Using Rasterstereography and Inertial Measurement Units in Volleyball Players: Different Roles as Indicators of Injury Predisposition

Background and Objectives: Acute and chronic injuries are frequent in volleyball. Biomechanics of sport-specific tasks can influence the risk of injury, which is also related to specific court positions. We investigated posture at raster-stereography, balance, and dynamic tasks using inertial motion units to find differences between roles, which can be predictive of a higher risk of injury. Materials and Methods: We cross-sectionally evaluated amateur volleyball athletes. Participants were divided into roles as outside hitters, setters, middle blockers, and opposite hitters. We excluded the "libero" position from our analysis. Results: Sixteen players were included in the analysis. A statistically significant difference was found in left lower limb stiffness among the outside hitter and setter groups. Conclusions: Differences in stiffness might be related to the different training and the different abilities among the two groups. Raster-stereography is extending its indications and should be implemented for non-invasive postural analysis. The use of inertial motion units provides objective measurements of variables that could go unrecognized within a clinical evaluation; its use should be considered in injury preventive programs.

Use of pharmaceuticals amongst athletes tested by Anti-Doping Norway in a five-year period

Introduction

The aim of the study was to map the use of pharmaceuticals by Norwegian athletes registered on doping control forms (DCFs) in a five-year period to examine general and some class specific use of pharmaceuticals across sports and athlete levels.

Method

Anonymous data from DCFs collected in 2015-2019 were manually entered into a database using the Anatomical Therapeutic Chemical (ATC) system for classification of the pharmaceuticals. Variables entered were year of control, gender, age group, athlete level, sport, test type, nationality, and pharmaceuticals (and dietary supplements) used.

Results

Pain killers in the ATC groups M01 A (Nonsteroidal anti-inflammatory drugs - NSAIDs) and N02 B (other analgesics), and anti-asthmatics in ATC groups R03 A and R03 B were the most frequently used pharmaceuticals. National level athletes reported more use of pharmaceuticals (1.4 ± 1.7 pharmaceuticals per form) than recreational level athletes (0.9 ± 1.2). The highest proportion of DCFs containing information about at least one pharmaceutical were found in speed skating (79.1%), alpine skiing (74.0%), rowing (72.4%) and cross-country skiing (71.7%). Painkillers were most frequently used in muscular endurance sports (30.4% and 21.2 % for M01A and N02 B, respectively) and ball and team sports (17.9% and 17.0%). Use of hypnotics was reported from ice-hockey players and alpine skiers in around 8% of the cases.

Coclusion

Use of anti-asthmatics was most often reported amongst athletes specially exposed to cold, chemicals and heavy endurance training. Athletes in specialized sports requiring high levels of strength and/or endurance reported a higher use of pharmaceuticals out-of-competition compared to in-competition, while there was no such difference in complex sports, such as team, gymnastic, aiming and combat sports.

With or without straps? A pilot study to investigate whether restraint devices affect the wheelchair basketball players' performance

BACKGROUND

Wheelchair basketball (WB) represents a great physical activity, rehabilitation, and integration opportunity for people with disability. Straps are wheelchair accessories used to ensure safeness and stability. Nevertheless, some athletes report feeling limited in movements because of these restraint devices. The aim of this study was thus to deepen whether straps could affect performance and cardiorespiratory effort in WB players' athletic gesture and furthermore whether sport performance could be influenced by experience, anthropometric features, or classification score.

METHODS

Ten WB elite athletes were enrolled in this observational cross-sectional study. Speediness, wheelchair maneuverability, and sport-specific skills were evaluated with 3 tests: 20-m straight line test (test 1), figure 8 test (test 2), and figure 8 with ball test (test 3); all tests were performed with and without straps. Cardiorespiratory parameters (blood pressure [BP], heart rate, and oxygen saturation) were registered before and after tests. Anthropometric data, classification score, and practice's years were collected and compared with test results.

RESULTS

Performance significantly improved in all tests wearing straps (test 1 P = 0.007, test 2 P = 0.009, and test 3 P = 0.025). No significant variation in cardiorespiratory basic signs emerged before and after the tests, with or without straps (systolic BP P = 0.140, diastolic BP P = 0.564, heart rate P = 0.066, and oxygen saturation P = 0.564). A statistically significant relation between test 1 with straps and classification score (coefficient = -0.25; P = 0.008) and test 3 without straps and classification score (coefficient = 1.00; P = 0.032) was found. No further relations emerged between test results and anthropometric data, classification score, and practice's years ( P > 0.05).

CONCLUSIONS

These findings demonstrated that straps, as well as ensuring safety and preventing injuries, also improve the WB performance, stabilizing the trunk and implementing upper limb skills, without exposing players to excessive cardiorespiratory and biomechanical stresses.

Cryo plus Ultrasound Therapy, a Novel Rehabilitative Approach for Football Players with Acute Lateral Ankle Injury Sprain: A Pilot Randomized Controlled Trial

BACKGROUND

Acute lateral ankle sprains are common injuries among athletes, but the optimal treatment strategies in elite athletes are still debated. This proof-of-concept study aimed to assess the impact of cryo-ultrasound therapy on the short-term recovery of football players with acute lateral ankle sprains.

METHODS

Semi-professional football players with grade I or II lateral ankle sprains were randomly assigned to the experimental group (receiving cryo-ultrasound therapy combined with conventional physical therapy) or control group (sham cryo-ultrasound therapy combined with conventional physical therapy). Pain intensity and physical functioning were assessed by the Numeric Rating Scale (NRS) and Foot and Ankle Disability Index (FADI) at baseline (T0) at the end of treatment (T1), after one month (T2), and two months after treatment (T3).

RESULTS

After the study intervention, significant between groups differences were reported in terms of pain relief (NRS: 4.08 ± 1.29 vs. 5.87 ± 1.19; p = 0.003) and physical function (FADI: 50.9 ± 10.3 vs. 38.3 ± 11.5; p = 0.021). However, no significant between group differences were reported at T2 and T3. No adverse effects were reported.

CONCLUSIONS

Cryo-ultrasound therapy combined with conventional physical therapy can accelerate recovery and early return to sport in elite football players with acute lateral ankle sprains. While this study contributes valuable insights into the potential benefits of cryo-ultrasound therapy, further investigations with a longer follow-up are needed to validate and optimize the application of physical agent modalities in the management of ankle injuries.

Impact of COVID-19 Era on the Anterior Cruciate Ligament Injury Rehabilitation: A Scoping Review

The surgical intervention rate and the subsequent rehabilitation plan for anterior cruciate ligament (ACL) injury was crucially affected by the COVID-19 pandemic due to the necessity in the face of the emergency. This review aimed to evaluate potential persistent and residual symptoms after COVID-19 disease, including fatigue and neuromuscular disorders. A scoping review design and methodology were used due to the exploratory nature of the research question, according to literature searches on PubMed/Medline, Scopus, Web of Science (WoS), and Physiotherapy Evidence Database (PEDro) electronic databases using the following keywords: "Anterior Cruciate Ligament", "ACL", "SARS-CoV-2", and "COVID-19". Undertraining and muscular knee imbalance might cause inefficient movement strategies, lack of knee stability, and increasing load with negative implications in ACL injuries. In the post-surgery period, during COVID-19, telerehabilitation approaches appeared to be successfully applied to maintain strength and range of motion in this condition. However, no definitive data are available regarding the most effective interventions. This scoping review showed the influence of the COVID-19 pandemic and associated restrictions on postoperative and rehabilitative care of ACL injuries.

Role of Physiotherapy and Physical Agent Modalities for Musculoskeletal Disorders: Present and Future

Musculoskeletal disorders are believed to be the second most frequent cause of disability worldwide [...]

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.

Pain and Psychological Readiness to Return to Sport in Elite Volleyball Players: A Cross-Sectional Study

Pain is modulated by multiple factors. A relevant psychological process peculiar to athletes and which could be associated with pain is Psychological Readiness to Return to Sport (PRRS). The analysis of this association in competition context is particularly important.

OBJECTIVE

To determine the correlation between the PRRS and pain intensity in elite volleyball players during their participation in a continental sporting event.

METHODS

A cross-sectional study was conducted. Data from 107 male volleyball players (23.50 ± 4.08 years of age) participating in the South American Volleyball Championship were used. The athletes answered a self-report questionnaire on the day the championship began regarding their history of injuries in the previous six months. The athletes who declared injuries were asked about the current pain intensity using the Pain Numeric Rating Scale (NRS) and Psychological Readiness to Return to Sport using the Injury-Psychological Readiness to Return to Sport scale (I-PRRS).

RESULTS

43.93% (n = 47) of the athletes (23.70 ± 3.54 years) reported an injury in the six months prior to the championship. They presented a median on the NRS of three (interquartile range (IQR), 2-5), and 54 (IQR, 46-58) on the I-PRRS. The Spearman's Rho correlation test showed an inversely and moderate correlation (r_s = -0.36; p = 0.011; CI: -0.64--0.08) between pain intensity and PRRS.

CONCLUSIONS

In male elite volleyball players who participate in a Continental Championship in South America, higher levels of PRRS was correlated to lower pain intensity.

Effects of Probiotic Supplementation on Sports Performance and Performance-Related Features in Athletes: A Systematic Review

This review aims to evaluate the effects of probiotic supplementation on performance and performance-related conditions in athletes by evaluating randomized controlled studies from the MEDLINE (Pubmed), Web of Science, Scopus, and SPORTDiscus (EBSCO) databases. From a total of 2304 relevant articles, 13 studies fulfilled the inclusion criteria. Seven studies concern endurance athletes, one to rugby players, three refer to non-specified athletes, one to badminton players, and one involves baseball players. The evidence suggests that the integration of athletes' diets with some bacterial strains and also the consumption of multi-strain compounds may lead to an improvement in performance and can positively affect performance-related aspects such as fatigue, muscle pain, body composition, and cardiorespiratory fitness. However, the type of supplementation and sport is very variable among the studies examined. Therefore, to obtain more solid evidence, further controlled and comparable studies are needed to expand the research regarding the possible repercussions of probiotics use on athletes' performance.

A Systematic Review of the Relationship between Workload and Injury Risk of Professional Male Soccer Players

The number of studies on the relationship between training and competition load and injury has increased exponentially in recent years, and it is also widely studied by researchers in the field of professional soccer. In order to provide practical guidance for workload management and injury prevention in professional athletes, this study provides a review of the literature on the effect of load on injury risk, injury prediction, and interpretation mechanisms. The results of the research show that: (1) It appears that short-term fixture congestion may increase the match injury incidence, while long-term fixture congestion may have no effect on both the overall injury incidence and the match injury incidence. (2) It is impossible to determine conclusively whether any global positioning system (GPS)-derived metrics (total distance, high-speed running distance, and acceleration) are associated with an increased risk of injury. (3) The acute:chronic workload ratio (ACWR) of the session rating of perceived exertion (s-RPE) may be significantly associated with the risk of non-contact injuries, but an ACWR threshold with a minimum risk of injury could not be obtained. (4) Based on the workload and fatigue recovery factors, artificial intelligence technology may possess good predictive power regarding injury risk.

Effects of hyaluronic acid injections on pain and functioning in patients affected by tendinopathies: A narrative review

BACKGROUND

Tendinopathies are overuse tendon injuries showing load-dependant pain, stiffness, weakness of movement in the affected area, and impairment in the movements. The scientific interest on the role of Hyaluronic Acid (HA) for the management of tendinopathies has been increased due to its anti-inflammatory and lubricative properties.

OBJECTIVE

To collect evidence regarding the effectiveness and safety of HA injections in reducing pain in patients affected by tendinopathies.

METHODS

A scientific literature search was conducted using the PubMed, Medline and PEDro electronic databases. The databases were searched since their inception until July 2021. The search was limited to English language articles. Different combinations of the terms and MeSH terms "tendinopathy", "tendinosis", "tendinitis", "hyaluronic acid", "hyaluronate", "infiltration", "hyaluronic injections", "viscosupplementation" connected with various boolean operators were used for other electronic databases.

RESULTS

One hundred and one records were identified from the selected databases plus three additional papers identified by the authors through other sources. After removing duplicated papers and title/abstract screening, 19 studies were included in our review (eight papers on shoulder, three on elbow, four on hand, one on knee, and three on ankle).

CONCLUSION

The results showed that none of the studies report severe adverse effects and most of them support the use of HA injections in tendinopathies, with a special attention to pain reduction and functional assessment. Further studies are warranted to better investigate effects and methods of administration of HA in tendinopathies.

Effects of Probiotics Supplementation on Risk and Severity of Infections in Athletes: A Systematic Review

The aim of this review was to appraise the literature on the effects of probiotics supplementation on gastrointestinal (GI) and upper respiratory tract infection (URTI) risk and prognosis in athletes. The search was conducted using the following electronic databases: MEDLINE (PubMed); Web of Science; Scopus; and SPORTDiscus (EBSCO). According to the PRISMA guidelines, randomized controlled studies performed on healthy athletes with a note dose of probiotics supplementation were considered. From the 2304 articles found, after eliminating reviews and studies on animals and unhealthy subjects and after screening of titles and abstracts, 403 studies were considered eligible. From these, in accordance with the inclusion and exclusion criteria, 16 studies were selected, ten of which concerned endurance athletes. The majority of the studies reported beneficial effects of probiotics in reducing the risk of developing the examined infections or the severity of related symptoms. However, due to the differences in formulations used and populations analyzed in the available studies, further research is needed in this field to achieve stronger and more specific evidence.

Osteoporosis in Light of a New Mechanism Theory of Delayed Onset Muscle Soreness and Non-Contact Anterior Cruciate Ligament Injury

Osteoporosis is a disorder, with a largely unknown pathomechanism, that is often marked as a “silent thief”, because it usually only becomes undisguised when fractures occur. This implies that the pathological damage occurs earlier than the sensation of pain. The current authors put forward a non-contact injury model in which the chronic overloading of an earlier autologously microinjured Piezo2 ion channel of the spinal proprioceptor terminals could lead the way to re-injury and earlier aging in a dose-limiting and threshold-driven way. As a result, the aging process could eventually lead the way to the metabolic imbalance of primary osteoporosis in a quad-phasic non-contact injury pathway. Furthermore, it is emphasised that delayed onset muscle soreness, non-contact anterior cruciate injury and osteoporosis could have the same initiating proprioceptive non-contact Piezo2 channelopathy, at different locations, however, with different environmental risk factors and a different genetic predisposition, therefore producing different outcomes longitudinally. The current injury model does not intend to challenge any running pathogenic theories or findings, but rather to highlight a principal injury mechanism.

How Do Male Football Players Meet Dietary Recommendations? A Systematic Literature Review

The aim of this review was to determine whether male football players meet dietary recommendations according to a UEFA expert group statement and to identify priority areas for dietetic intervention, including training periodization and field position. A database search of PubMed, Web of Science, EBSCO and Scopus was performed. To be included within the final review, articles were required to provide a dietary intake assessment of professional and semi-professional football players. A total of 17 studies met the full eligibility criteria. Several studies showed insufficient energy and carbohydrate intake compared to the recommendations. A majority of athletes consume adequate protein and fat intakes compared to the recommendations. In addition, several studies showed the insufficient intake of vitamins and minerals. This systematic review showed that football players do not meet the nutritional recommendations according to the UEFA expert group statement. Future research should be focused on how to apply nutritional recommendations specific for athletes in accordance with training periodization and positions on the field.

Monitoring Psychometric States of Recovery to Improve Performance in Soccer Players: A Brief Review

In order to maximize adaptations and to avoid nonfunctional overreaching syndrome or noncontact injury, coaches in high-performance sports must regularly monitor recovery before and after competitions/important training sessions and maintain well-being status. Therefore, quantifying and evaluating psychometric states of recovery during the season in sports teams such as soccer is important. Over the last years, there has been substantial growth in research related to psychometric states of recovery in soccer. The increase in research on this topic is coincident with the increase in popularity obtained by subjective monitoring of the pre-fatigue state of the players before each training sessions or match with a strong emphasis on the effects of well-being or recovery state. Among the subjective methods for players’ control, the Hooper index (HI) assesses the quality of sleep during the previous night, overall stress, fatigue, and delayed-onset muscle soreness. Additionally, the total quality of recovery (TQR) scale measures recovery status. The HI and TQR recorded before each training session or match were affected by the variability of training load (TL) and influenced the physical and technical performances, and the affective aspects of soccer players. Researchers have recommended wellness monitoring soccer players’ psychometric state of recovery before each training session or match in order to detect early signs of fatigue and optimize high-level training performance. This method allows for better detecting signs of individual fatigue and allows coaches to adapt and readjust the TL, and avoid physical and technical gaps in order to improve the performance of soccer players.

Advance in the Diagnostics and Management of Musculoskeletal Diseases

Musculoskeletal disorders are a broad spectrum of diseases, affecting muscles, bones, ligaments, and tendons worldwide [...].

A randomized controlled trial concerning the implementation of the postural Mézières treatment in elite athletes with low back pain

OBJECTIVE

This study aimed to evaluate the impact of adding the Mézières Method (MM) to the standard rehabilitation protocol for the elite athletes with low back pain (LBP) in reducing lumbar pain than only using the traditional rehabilitation protocol treatment. The disciplines considered in this study were soccer, rhythmic gymnastics, and basketball.

DESIGN

Randomized controlled trial.

SETTING

Training Camp.

PARTICIPANTS

One hundred thirty-nine elite athletes with low back pain of whom 69 were assigned to the experimental group.

INTERVENTION

The intervention consists of treatment with three lying postures in a 40-minutes long session twice a week. The session goal was to focus on breathing exercises, spine mobility, and stretching of the back muscles, with particular attention to the diaphragmatic, paravertebral, and latissimus dorsi muscles.

OUTCOME MEASURES

Assessments as Visual Analogue Scale (VAS), Sit and Reach flexibility test, Roland-Morris Questionnaire, and health status questionnaire (SF12) were used.

RESULTS

The evaluation of all outcomes in 4 measurement periods of the study (baseline, 4, 12, and 24 weeks) showed a significant difference between groups. Also, at the 6-month of the intervention, a significant difference in the means (SD) was observed in pain (VAS), back flexibility (Sit & Reach) and back disability (QRM) outcomes in favor of the experimental group with a medium-large effect size comparing with the control group.

CONCLUSION

The MM approach can also be applied in established conventional protocols to alleviate pain and functionality. The obtained results include improving the quality of life of the athletes and their physical and emotional states.

Clinical trial registration number ID: NCT03849053.

Epidemiology and Risk Factors of Table-Tennis-Related Injuries: Findings from a Scoping Review of the Literature

Background and Objectives: Table tennis represents one of the fastest ball games in the world and, as such, is characterized by unique physiological demands. Despite its popularity, there is a dearth of data related to table-tennis-related risk factors and injuries. Therefore, the present review was conducted to fill in this gap of knowledge. Material and Methods: The present review was designed as a scoping review. Eleven online databases were searched with no language/date limitations. Results: Forty-two investigations were retained in the present review. These studies indicated that tenosynovitis, benign muscle injuries, strains, and sprains were the most common injury types. In order, the most commonly affected anatomical regions were the lower limb, shoulder, spine, knee, upper limb, and trunk. When comparing the injury occurrence between training and competition, the results were contradictory. National/international athletes had higher indices of injury than regional players, even though other investigations failed to replicate such findings. According to some scholars, there was a difference between female and male athletes: in females, more injuries involved the upper limbs when compared to men who had more injuries to the lower limbs, while other studies did not find differences in terms of gender. Conclusions: Table tennis is generally considered at lower risk for injuries than other sports. However, the present scoping review showed that injuries can occur and affect a variety of anatomic regions. Sports scientists/physicians could utilize the information contained in the current review for devising ad hoc programs to adopt an effective/appropriate prevention strategy and to monitor table tennis players' training load and to achieve maximal fitness, as these will reduce the risk of injuries. However, most of the studies included in our scoping review are methodologically weak or of low-to-moderate evidence, being anecdotal or clinical case reports/case series, warranting caution when interpreting our findings and, above all, further high-quality research in the field is urgently needed.

Match Analysis, Physical Training, Risk of Injury and Rehabilitation in Padel: Overview of the Literature

Padel is a racket sport that has been gaining great popularity and scientific interest in recent years. It could be considered to be a high-intensity intermittent sport with valuable cardiovascular and neuromuscular benefits; however, the risk of injury cannot be neglected. To date, there is still a gap of knowledge in the scientific literature on this emergent sport. Therefore, the present review aims to synthetize the current knowledge on padel game dynamics to better characterize the main risk factors, the injury rate and characteristics, and the most effective rehabilitative treatment strategies. PubMed, Scopus, Cochrane, and PEDro were screened up to January 2022 to identify eligible studies focusing on padel players as participants. Out of 160 records, we included 19 studies, which were focused on match analysis, anthropometric and physical training, the risk of injury, and rehabilitative interventions. The results showed that the high action velocity and the sudden changes in direction during a padel match could represent a risk factor for injuries, especially in untrained players. However, the high heterogeneity of the studies in the literature hinders our ability to draw any strong conclusions, and the results should be carefully considered. Future research should address the lack of knowledge on injury mechanisms and type to implement a tailored rehabilitation program.

Effectiveness of Rehabilitation through Kinematic Analysis of Upper Limb Functioning in Wheelchair Basketball Athletes: A Pilot Study

Wheelchair basketball is one of the most popular Paralympic sports, including players with different diagnoses. To date, there is scarce evidence on shoulder functionality in wheelchair basketball players, and there is no consensus on a shoulder injury prevention program in these athletes. Therefore, in the present pilot study, we aimed to evaluate the effects of a comprehensive rehabilitative approach on shoulder ROM, muscle activity, and functioning in wheelchair basketball athletes. We included adult wheelchair basketball athletes playing in the Italian Second League who completed an 8-week comprehensive rehabilitative program, based on education to avoid upper limb pain injuries, preventive exercises, and improvement of ergonomics through kinematic analysis. We administered the Wheelchair User’s Shoulder Pain Index (WUSPI) and the Kerlan-Jobe Orthopaedic Clinic (KJOC) questionnaire to evaluate pain experienced during functional activities, and used kinematic analysis integrated with sEMG to evaluate shoulder function and propulsion pattern. A sample of 10 wheelchair athletes (33.75 ± 6.42 years) were assessed. After the intervention there was a significant (p < 0.05) difference in WUSPI score (27.0 ± 18.5 vs. 25.0 ± 21.5) and in KJOC score (89.3 ± 10.4 to 95.4 ± 9.1). Moreover, there was a significant improvement in scapular upward rotation, abduction, and extra-rotation of the glenohumeral joint. Propulsion techniques improved in pattern and acceleration. This approach played a key role in improving upper limb function, reducing the incidence of pain and cumulative trauma disorders. However, the small sample size could affect the generalizability of results. In conclusion, healthcare professionals should monitor wheelchair athletes, assessing the patient’s function, ergonomics, equipment, and level of pain, and introducing specific exercises to prevent upper limb injuries.

Efficacy of Radiofrequency as Therapy and Diagnostic Support in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysis

Radiofrequency (RF) is a minimally invasive procedure used to interrupt or alter nociceptive pathways for treating musculoskeletal pain. It seems a useful tool to relieve chronic pain syndromes, even if, to date, solid evidence is still needed about the effectiveness of this therapy. By this systematic review and meta-analysis, we aimed to evaluate the efficacy of RF in treating musculoskeletal pain. PubMed, Medline, Cochrane, and PEDro databases were searched to identify randomized controlled trials (RCTs) presenting the following: patients with chronic musculoskeletal pain as participants; RF as intervention; placebo, anesthetic injection, corticosteroid injection, prolotherapy, conservative treatment, physiotherapy, and transcutaneous electrical nerve stimulation as comparisons; and pain and functioning as outcomes. Continuous random-effect models with standardized mean difference (SMD) were used to compare the clinical outcomes. Overall, 26 RCTs were eligible and included in the systematic review. All of them analyzed the efficacy of RF in four different regions: cervical and lumbar spine, knee, sacroiliac (SI) joint, shoulder. The outcomes measures were pain, disability, and quality of life. A medium and large effect in favor of the RF treatment group (SMD < 0) was found for the shoulder according to the Visual Analogical Scale and for the SI joint according to the Oswestry Disability Index. A small effect in favor of the RF treatment group (SMD > 0) was found for the spine according to the 36-item Short Form Survey. Non-significant SMD was found for the other outcomes. RF represents a promising therapy for the treatment of chronic musculoskeletal pain, especially when other approaches are ineffective or not practicable. Further studies are warranted to better deepen the effectiveness of RF for pain and joint function for each anatomical region of common application.

Challenges and Solutions for Musculoskeletal Disorders in Athletes

The etymology of the word "athlete" derives from the ancient Greek ἀθλητής (athletés, from âthlos that is, fight, competition) [...].