Isokinetic Medical Group

Bologna, Italy

Isokinetic Medical Group

Bologna, Italy
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McCall A.,University Of Lille Unite Of Recherche Pluridisciplinaire Sport | Carling C.,Institut Universitaire de France | Nedelec M.,University Of Lille Unite Of Recherche Pluridisciplinaire Sport | Davison M.,Isokinetic Medical Group | And 3 more authors.
British journal of sports medicine | Year: 2014

PURPOSE: Little is known about injury prevention practices in professional football clubs. The purpose of this study was therefore to determine the current perceptions and practices of premier league football clubs internationally concerning risk factors, testing and preventative exercises for non-contact injuries.METHODS: A survey was administered to 93 premier league football clubs internationally. The survey included four sections: (1) persons involved in the injury prevention programme: position, quantity, role, qualification; (2) perceptions regarding non-contact injury risk factors; (3) tests used to identify non-contact injury risk and (4) non-contact injury prevention exercises used, their perceived effectiveness and implementation strategies.RESULTS: 44 surveys were successfully returned (47%). The position of physiotherapist was the most represented position in the injury prevention programme. The top five perceived risk factors in rank order were previous injury, fatigue, muscle imbalance, fitness and movement efficiency. The five most commonly used tests to identify injury risk (in rank order) were functional movement screen, questionnaire, isokinetic dynamometry, physical tests and flexibility. The top five exercises used by clubs were (also in rank order) eccentric exercise, balance/proprioception, hamstring eccentric, core stability and, sharing the fifth position, Nordic hamstring and gluteus activation.CONCLUSIONS: The survey revealed the most common perceptions and practices of premier league football clubs internationally regarding risk factors, testing and preventative exercises. The findings can enable reduction of the gap between research and practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.


Kon E.,Rizzoli Orthopaedic Institute | Filardo G.,Rizzoli Orthopaedic Institute | Drobnic M.,University of Ljubljana | Madry H.,Saarland University | And 2 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2012

Conservative approach is usually the first choice for the management of the knee degeneration processes, especially in the phase of the disease recognized as early osteoarthritis (OA) with no clear lesions or associated abnormalities requiring to be addressed surgically. A wide spectrum of treatments is available, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as minimally invasive procedures involving injections of various substances aiming to restore joint homeostasis and provide clinical improvement and possibly a disease-modifying effect. Numerous pharmaceuticals have been proposed, but since no therapy has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level, the use of pharmacological agents should be considered with caution by assessing the risk/benefit ratio of the drugs prescribed. Both patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. A combination of these therapeutic options is a more preferable scenario, in particular considering the evidence available for non-pharmacological management. In fact, exercise is an effective conservative approach, even if long-term effectiveness and optimal dose and administration modalities still need to be clarified. Finally, physical therapies are emerging as viable treatment options, and novel biological approaches are under study. Further studies to increase the limited medical evidence on conservative treatments, optimizing results, application modalities, indications, and focusing on early OA will be necessary in the future. Level of evidence IV. © 2011 Springer-Verlag.


Villa S.D.,Isokinetic Medical Group | Kon E.,Rizzoli Orthopaedic Institute | Filardo G.,Rizzoli Orthopaedic Institute | Ricci M.,Isokinetic Medical Group | And 3 more authors.
American Journal of Sports Medicine | Year: 2010

Background: Despite improvement in treatment for articular cartilage lesions, prolonged recovery still precludes early return to competitive sports. The challenge of postoperative rehabilitation is to optimize return to preinjury activities without jeopardizing the graft. Hypothesis: Intensive rehabilitation after second-generation arthroscopic autologous cartilage implantation (Hyalograft C) facilitates graft maturation and safely allows for early return to competition without jeopardizing clinical outcome at longer follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: The outcome of 31 competitive male athletes with International Cartilage Repair Society grade III-IV cartilaginous lesions of the medial or lateral femoral condyle or trochlea were evaluated at 1-, 2-, and 5-year follow-up. The athletic cohort was compared with a similar control cohort of 34 nonathletic patients who were treated with autologous chondrocyte implantation. The athletic cohort followed a 4-phase intensive rehabilitation protocol. Eleven of the patients in this cohort were also treated with an isokinetic exercise program and on-field rehabilitation. The patients in the control cohort completed only phase 1 of rehabilitation. Results: When comparing the 2 groups, a greater improvement in the group of athletes was achieved at 5-year follow-up (P =.037) in the self-assessment of quality of life and International Knee Documentation Committee subjective evaluation at 12 months and at 5 years of follow-up (P =.001 and P =.002, respectively). When analyzing the return to sports activity, 80.6% of the athletes returned to their previous activity level in 12.4 ± 1.6 months; athletes treated with the on-field rehabilitation and isokinetic exercise program had faster recovery and an even earlier return to competition (10.6 ± 2.0 months). Conclusion: For optimal results, autologous chondrocyte implantation rehabilitation should not only follow but also facilitate the process of graft maturation. Intensive rehabilitation may safely allow a faster return to competition and also influence positively the clinical outcome at medium-term follow-up.


Kon E.,Rizzoli Orthopaedic Institute | Filardo G.,Rizzoli Orthopaedic Institute | Berruto M.,Gaetano Pini Orthopaedic Institute | Benazzo F.,Clinica Ortopedica e Traumatologica | And 3 more authors.
American Journal of Sports Medicine | Year: 2011

Background: Soccer is a highly demanding sport for the knee joint, and chondral injuries can cause disabling symptoms that may jeopardize an athlete's career. Articular cartilage lesions are difficult to treat, and the increased mechanical stress produced by this sport makes their management even more complex.Hypothesis: To evaluate whether the regenerative cell-based approach allows these highly demanding athletes a better functional recovery compared with the bone marrow stimulation approach.Study Design: Cohort study; Level of evidence, 2.Methods: Forty-one professional or semiprofessional male soccer players were treated from 2000 to 2006 and evaluated prospectively at 2 years and at a final 7.5-year mean follow-up (minimum, 4 years). Twenty-one patients were treated with arthroscopic second-generation autologous chondrocyte implantation (Hyalograft C) and 20 with the microfracture technique. The clinical outcome of all patients was analyzed using the cartilage standard International Cartilage Repair Society (ICRS) evaluation package. The sport activity level was evaluated with the Tegner score, and the recovery time was also recorded.Results: A significant improvement in all clinical scores from preoperative to final follow-up was found in both groups. The percentage of patients who returned to competition was similar: 80% in the microfracture group and 86% in the Hyalograft C group. Patients treated with microfracture needed a median of 8 months before playing their first official soccer game, whereas the Hyalograft C group required a median time of 12.5 months (P =.009). The International Knee Documentation Committee (IKDC) subjective score showed similar results at 2 years' follow-up but significantly better results in the Hyalograft C group at the final evaluation (P =.005). In fact, in the microfracture group, results decreased over time (from 86.8 ± 9.7 to 79.0 ± 11.6, P <.0005), whereas the Hyalograft C group presented a more durable outcome with stable results (90.5 ± 12.8 at 2 years and 91.0 ± 13.9 at the final follow-up).Conclusion: Despite similar success in returning to competitive sport, microfracture allows a faster recovery but present a clinical deterioration over time, whereas arthroscopic second-generation autologous chondrocyte implantation delays the return of high-level male soccer players to competition but can offer more durable clinical results. © 2011 American Orthopaedic Society for Sports Medicine.


Buckthorpe M.W.,Loughborough University | Buckthorpe M.W.,Isokinetic Medical Group | Pain M.T.G.,Loughborough University | Folland J.P.,Loughborough University
PLoS ONE | Year: 2013

Bilateral deficit (BLD) describes the phenomenon of a reduction in performance during synchronous bilateral (BL) movements when compared to the sum of identical unilateral (UL) movements. Despite a large body of research investigating BLD of maximal voluntary force (MVF) there exist a paucity of research examining the BLD for explosive strength. Therefore, this study investigated the BLD in voluntary and electrically-evoked explosive isometric contractions of the knee extensors and assessed agonist and antagonist neuromuscular activation and measurement artefacts as potential mechanisms. Thirteen healthy untrained males performed a series of maximum and explosive voluntary contractions bilaterally (BL) and unilaterally (UL). UL and BL evoked twitch and octet contractions were also elicited. Two separate load cells were used to measure MVF and explosive force at 50, 100 and 150 ms after force onset. Surface EMG amplitude was measured from three superficial agonists and an antagonist. Rate of force development (RFD) and EMG were reported over consecutive 50 ms periods (0-50, 50-100 and 100-150 ms). Performance during UL contractions was compared to combined BL performance to measure BLD. Single limb performance during the BL contractions was assessed and potential measurement artefacts, including synchronisation of force onset from the two limbs, controlled for. MVF showed no BLD (P = 0.551), but there was a BLD for explosive force at 100 ms (11.2%, P = 0.007). There was a BLD in RFD 50-100 ms (14.9%, P = 0.004), but not for the other periods. Interestingly, there was a BLD in evoked force measures (6.3-9.0%, P<0.001). There was no difference in agonist or antagonist EMG for any condition (P≥0.233). Measurement artefacts contributed minimally to the observed BLD. The BLD in volitional explosive force found here could not be explained by measurement issues, or agonist and antagonist neuromuscular activation. The BLD in voluntary and evoked explosive force might indicate insufficient stabiliser muscle activation during BL explosive contractions. © 2013 Buckthorpe et al.


Roi G.S.,Isokinetic Medical Group | Tinti R.,Isokinetic Medical Group
Accident Analysis and Prevention | Year: 2014

Requests for medical assistance during an amateur road cycling race, which included 56,700 cyclists over 6 consecutive races between 2006 and 2011, were analysed with the aim of improving injury prevention and medical coverage. Medical assistance was requested by a small percentage of participants (1.7 ± 1.0%), but the actual number seeking assistance was quite high due to the large total number of participants (162 ± 51). 0.17% of all participants did not finish the race for medical reasons. No fatal injuries were recorded. The incidence rate of requests for medical assistance was 0.108/1000 km, and the incidence of withdrawal was 0.011/1000 km of the race. Of all medical requests, those due to direct trauma caused by falls accounted for 63%, requests for overload injuries accounted for 4% and requests for non-traumatic complaints accounted for 22% of the total; 11% of requests were not classified. Weather conditions may affect the type and the incidence of requests: requests for traumatic injuries increase if raining; requests for heat-related illnesses if hot. Prevention techniques are aimed at guaranteeing and promoting health and safety and should be implemented by both the race organisers and the cyclists. © 2014 Elsevier B.V. All rights reserved.


Rees J.D.,University of Cambridge | Stride M.,Isokinetic Medical Group | Scott A.,University of British Columbia
British Journal of Sports Medicine | Year: 2014

It is currently widely accepted among clinicians that chronic tendinopathy is caused by a degenerative process devoid of inflammation. Current treatment strategies are focused on physical treatments, peritendinous or intratendinous injections of blood or blood products and interruption of painful stimuli. Results have been at best, moderately good and at worst a failure. The evidence for non-infammatory degenerative processes alone as the cause of tendinopathy is surprisingly weak. There is convincing evidence that the inflammatory response is a key component of chronic tendinopathy. Newer anti-inflammatory modalities may provide alternative potential opportunities in treating chronic tendinopathies and should be explored further.


Mithoefer K.,Chestnut Medical | Della Villa S.,Isokinetic Medical Group
Cartilage | Year: 2012

Background: The ability to return to football (soccer) presents a critical aspect for successful treatment of articular cartilage injury in the football (soccer) player. Methods: Information about sports participation after articular cartilage repair was collected from the literature. Special focus was placed on data in football athletes with information on return rate, timing of return, level of postoperative competition, and the ability to compete in the sport over time. Results: Twenty studies describing 1,469 athletes including football players with articular cartilage injury were reviewed. Average return to sport was 79% without a significant difference in return rate or postoperative level of play between cartilage repair techniques. Time to return varied between 7 to 17 months, with the longest time for autologous chondrocyte transplantation (ACI). Advanced sport-specific rehabilitation was able to reduce recovery time. Durability of results was best after ACI, with up to 96% continued sport participation after more than 3 years. Player age, time between injury and treatment, competitive level, defect size, and repair tissue morphology affected the ability to return to play. Sports participation after cartilage repair generally promoted joint restoration and functional recovery. Conclusions: Articular cartilage repair allows for a high rate of return to high-impact sports including football, often at the preinjury competitive level. The time of return and durability can be variable and depend on repair technique and athlete-specific factors. Advanced, sport-specific rehabilitation can facilitate return to football. © SAGE Publications 2012.


McCall A.,University of Lille Nord de France | Carling C.,LOSC Lille Metropole Football Club | Carling C.,University of Central Lancashire | Davison M.,Isokinetic Medical Group | And 4 more authors.
British Journal of Sports Medicine | Year: 2015

Purpose: To systematically review the scientific level of evidence for the 'Top 3' risk factors, screening tests and preventative exercises identified by a previously published survey of 44 premier league football (soccer) teams. Also, to provide an overall scientific level of evidence and graded recommendation based on the current research literature. Methods: A systematic literature search (Pubmed [MEDLINE], SportDiscus, PEDRO and Cochrane databases). The quality of the articles was assessed and a level of evidence (1++ to 4) was assigned. Level 1++ corresponded to the highest level of evidence available and 4, the lowest. A graded recommendation (A: strong, B: moderate, C: weak, D: insufficient evidence to assign a specific recommendation) for use in the practical setting was given. Results: Fourteen studies were analysed. The overall level of evidence for the risk factors previous injury, fatigue and muscle imbalance were 2++, 4 and 'inconclusive', respectively. The graded recommendation for functional movement screen, psychological questionnaire and isokinetic muscle testing were all 'D'. Hamstring eccentric had a weak graded 'C' recommendation, and eccentric exercise for other body parts was 'D'. Balance/proprioception exercise to reduce ankle and knee sprain injury was assigned a graded recommendation 'D'. Conclusions: The majority of perceptions and practices of premier league teams have a low level of evidence and low graded recommendation. This does not imply that these perceptions and practices are not important or not valid, as it may simply be that they are yet to be sufficiently validated or refuted by research. © 2015, BMJ Publishing Group. All rights reserved.


Buckthorpe M.,Loughborough University | Buckthorpe M.,Isokinetic Medical Group | Pain M.T.G.,Loughborough University | Folland J.P.,Loughborough University
Experimental Physiology | Year: 2014

The study aimed to assess the influence of fatigue induced by repeated high-force explosive contractions on explosive and maximal isometric strength of the human knee extensors and to examine the neural and contractile mechanisms for the expected decrement. Eleven healthy untrained males completed 10 sets of voluntary maximal explosive contractions (five times 3 s, interspersed with 2 s rest). Sets were separated by 5 s, during which supramaximal twitch and octet contractions [eight pulses at 300 Hz that elicit the contractile peak rate of force development (pRFD)] were evoked. Explosive force, at specific time points, and pRFD were assessed for voluntary and evoked efforts, expressed in absolute terms and normalized to maximal/peak force. Maximal voluntary contraction force (MVCF) and peak evoked forces were also determined. Surface EMG amplitude was measured from three superficial agonists and normalized to maximal compound action potential area. By set 10, explosive force (47-52%, P < 0.001) and MVCF (42%, P < 0.001) had declined markedly. Explosive force declined more rapidly than MVCF, with lower normalized explosive force at 50 ms (29%, P = 0.038) that resulted in reduced normalized explosive force from 0 to 150 ms (11-29%, P ≤ 0.038). Neural efficacy declined by 34%, whilst there was a 15-28% reduction in quadriceps EMG amplitude during voluntary efforts (all P ≤ 0.03). There was demonstrable contractile fatigue (pRFD: octet, 27%; twitch, 66%; both P < 0.001). Fatigue reduced normalized pRFD for the twitch (21%, P = 0.001) but not the octet (P = 0.803). Fatigue exerted a more rapid and pronounced effect on explosive force than on MVCF, particularly during the initial 50 ms of contraction, which may explain the greater incidence of injuries associated with fatigue. Both neural and contractile fatigue mechanisms appeared to contribute to impaired explosive voluntary performance. © 2014 The Physiological Society.

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