22nd December 2017: The Italian Job; a busy week for Professor Maffulli - by Geoff Bavin & Nicola Maffulli
Q: What do the cities of Salerno and Rome, and our Medical Director, Professor Nicola Maffulli, have in common? A: They are all of Italian origin… and, of course, a love of Pizza. That’s not all, though. On Thursday, 20th November, Nicola was in Salerno to talk on the epidemiology of proximal femoral fractures and novel surgical techniques in this field. Not a lot of people know that. Then again, because of his first name, many people people who haven’t met Nicola don’t even know that he’s a man. He is. He even sometimes wears a tie to prove it. Yes, we know, women can wear ties too….!
First up in Salerno, Professor Maffulli delivered a talk on apophyseal injuries in children’s and youth sports -
Apophysitis refers to irritation and inflammation of the apophysis, a secondary ossification centre which acts as an insertion site for a tendon. It is a common overuse injury in young athletes. In a growing athlete, the apophysis is susceptible to injury because of repetitive stress or an acute avulsion injury.The authors reviewed the current English literature regarding apophyseal injuries affecting young athletes, to highlight the frequency and characteristics of these injuries, to clarify risk factors and specific prevention measures, and to identify future research objectives.
SOURCES OF DATA: The authors performed a comprehensive search of the medical literature, using the Medline database, including all English articles. Various combinations of the Keywords 'injury', 'sports', 'athletic injuries', 'avulsion fractures', 'physeal', 'physis', 'apophysis', 'apophysitis', 'growth plate' were used.
AREAS OF AGREEMENT: Growth benefits from a moderate physical activity.
AREAS OF CONTROVERSY: Growth deficit may occur in young athletes involved in intensive practice of sport following apophysitis.
GROWING POINTS: Apophyseal injuries occurring during sport are less common than overall rate of injuries affecting the adolescent population. Growth disturbance occurs only rarely after an apophyseal injury.Further studies should consider analytical as well as descriptive components of apophyseal injuries, to allow the identification of new possible risk factors and preventive measures and to help early detection and proper treatment as well.
AREAS TIMELY FOR DEVELOPING RESEARCH: Further studies should consider analytical as well as descriptive components of apophyseal injuries, to allow the identification of new possible risk factors and preventive measures and to help early detection and proper treatment as well.
At this juncture, Nicola ate pizza, then boarded a train to Rome for more pizza before heading to a pizza restaurant to prepare for the next day’s conference - the Rome Rehabilitation meeting, where guidelines for the conservative management of many musculoskeletal conditions were presented. Professor Maffulli chaired the session on osteoporosis. In addition, the guidelines based, among others, on those that the Italian Society of Muscles Ligaments and Tendons (of which Professor Maffulli is the President) on tendinopathy, were presented at this meeting.
2) Jumping exercise preserves bone mineral density and mechanical properties in osteopenic ovariectomized rats even following established osteopenia.
The effects of jump training on bone structure before and after ovariectomy-induced osteopenia in rats were investigated. Jumping exercise induced favourable changes in bone mineral density, bone mechanical properties, and bone formation/resorption markers. This exercise is effective to prevent bone loss after ovariectomy even when osteopenia is already established.
INTRODUCTION: The present study investigated the effects of jump training on bone structure before and after ovariectomy-induced osteopenia in 80 10-week-old Wistar rats.
METHODS: Forty rats (prevention program) were randomly allocated to one of four equal groups (n = 10): sham-operated sedentary (SHAM-SEDp), ovariectomized (OVX) sedentary (OVX-SEDp), sham-operated exercised (SHAM-EXp), and OVX exercised (OVX-EXp). SHAM-EXp and OVX-EXp animals began training 3 days after surgery. Another 40 rats (treatment program) were randomly allocated into another four groups (n = 10): sham-operated sedentary (SHAM-SEDt), OVX sedentary (OVX-SEDt), sham-operated exercised (SHAM-EXt), and OVX exercised (OVX-EXt). SHAM-EXt and OVX-EXt animals began training 60 days after surgery. The rats in the exercised groups jumped 20 times/day, 5 days/week, to a height of 40 cm for 12 weeks. At the end of the experimental period, serum osteocalcin, follicle-stimulating hormone (FSH) dosage, dual X-ray absorptiometry (DXA), histomorphometry, and biomechanical tests were analyzed.
RESULTS: The OVX groups showed higher values of FSH and body weight (p < 0.05). DXA showed that jump training significantly increased bone mineral density of the femur and fifth lumbar vertebra (p < 0.05). The stiffness of the left femur and fifth lumbar vertebra in the exercised groups was greater than that of the sedentary groups (p < 0.05). Ovariectomy induced significant difference in bone volume (BV/TV, percent), trabecular separation (Tb.Sp, micrometer), and trabecular number (Tb.N, per millimeter) (p < 0.05) compared to sham operation. Jump training in the OVX group induced significant differences in BV/TV, Tb.Sp, and Tb.N and decreased osteoblast number per bone perimeter (p < 0.05) compared with OVX non-training, in the prevention groups. Osteocalcin dosage showed higher values in the exercised groups (p < 0.05)
CONCLUSIONS: Jumping exercise induced favorable changes in bone mineral density, bone mechanical properties, and bone formation/resorption markers. Jump training is effective to prevent bone loss after ovariectomy even when osteopenia is already established.
This piece is subtitled ‘A busy week for Professor Maffulli’, but at least WholeLife Clinics’ (www.wholelifeclinics.com) Medical Director didn’t have to go as far afield as recent trips to Shanghai and Las Vegas (a busier week!), or Buenos Aires, LA and Houston, in the worldwide dissemination of knowledge among peers which brings so much benefit to patients… and pizza restaurants… across the globe.