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COMMENTS: REHABILITATION AND SPORTS MEDICINE
Report from the 7th EFSMA-European Sports Medicine Congress and 3rd Central European Congress of Physical Medicine and Rehabilitation, 26–29 October, Salzburg, Austria
During this Congress some very interesting and new scientific results were presented.
Among the highlights was a presentation given by Marta Imamura and her group from Sao Paulo in Brazil, who reported advances in knowledge regarding the pathophysiology of pain among patients with knee osteoarthritis. She suggested that the central nervous system maintains and amplifies the painful condition, such that it is refractory to conventional orthopaedic and rheumatological treatment.
When pain becomes refractory, peripheral and central sensitization mechanisms contribute towards maintaining and amplifying the painful conditions, regardless of the peripheral process that created the pain. Pathological alterations occur in the spinal cord and the cerebral cortex. Thus, in addition to local therapy with analgesics, anti-inflammatory drugs, physical therapy and exercises, treatment of knee osteoarthritis should take into consideration the central nervous system as a therapeutic target. Therapies that modulate the spinal cord and cerebral cortex, including the use of antidepressants, may play a role in managing these patients.
Mattukat et al. from Halle, Germany, presented a 1-year follow-up study of intensive strength, endurance and coordination training, as well as systematic motivation, in the rheumatological rehabilitation of patients with polyarthritis and spondyloarthritis.
The results of the study showed long-term positive changes in many health-related features after rehabilitation, in two different rehabilitation clinics. Twelve months after discharge, the treated participants reported greater physical activity in everyday life than the control group regardless of sex, age or diagnostic group. Indirect costs (especially disability pension) were lower in the treated group. In conclusion, intensive training exercises in fixed groups combined with systematic motivation regarding physical activity is an efficient strategy to support long-term physical activity and reduce indirect costs.
C Nicole and J M Coudreuse from France reported that delayed-onset muscle soreness (DOMS) after intensive sport activities is due to small injuries within the muscle cells and not, as commonly thought, to lactate found in the muscle. Functional effects such as higher risks of injury and necessary recreation time for the healing process should also be considered.
A further interesting study was presented by Alaseirlis et al. from Giannitsa, Greece, comparing surgical and conservative treatment of meniscal tears in athletic and non-athletic patient groups.
Among athletic patients, arthroscopic partial meniscectomy, followed by a supervised rehabilitation programme, showed superior results compared with rehabilitation only. On the other hand, there were no significant differences in scores on knee scoring scales between non-athletic patients treated with arthroscopic partial meniscectomy supplemented with a rehabilitation protocol and those treated solely with rehabilitation. These results might suggest that, in the case of middle-aged patients with degenerative meniscal tears, it is advisable to institute physiotherapy, strengthening and rehabilitation regimes before proceeding to arthroscopic meniscectomy.
Another interesting study was presented by Micallef-Stafrace from Msida, Malta, with co-author Mouza Al Shehhi from the Health and Sports Medicine Centre of the United Arab Emirates Armed Forces in Al Ain, United Arab Emirates. The aim was to investigate the incidence of lower limb injuries in the military and find prevention strategies.
The results showed a high incidence of lower limb injuries, with a predominance of ankle and knee injuries. Most of these occurred during physical training and sporting activity, but an unexpected proportion resulted from motor vehicle accidents. A review of the current scientific evidence on the prevention of injuries during military training led to a number of general recommendations that could be implemented in any military base, but the audit findings also allowed a more specific approach. Hence, changes advised ranged from physical training structure, body weight management and hydration strategies to road safety education.
The conclusion of this study is that most lower limb injuries are preventable. Recognizing this and implementing the appropriate preventative strategies, some of them quite simple, can lead to a remarkable reduction in injury incidence.
Consultant in Rehabilitation and Physical Medicine
Department of Rehabilitation, Vienna Private Clinic,
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