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Clinics and Practice
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Musculoskeletal Pain and Rehabilitation
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Musculoskeletal Pain and Rehabilitation

A special issue of Clinics and Practice (ISSN 2039-7283).

Deadline for manuscript submissions: 28 February 2025 | Viewed by 9018

Special Issue Editor

Dr. Giacomo Farì

E-Mail Website
Guest Editor
Department of Experimental Medicine (Di.Me.S.), University of Salento, 73100 Lecce, Italy
Interests: rehabilitation; sport medicine; musculoskeletal pain; osteoarthritis; paralympics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Musculoskeletal pain is one of the most burdensome problems in healthcare. It is affecting millions of people and represents an incredible social problem, both in terms of the inability to work and the economic consequences. Pharmacologic therapy is the most diffuse method of management, but frequently it is not enough, even using different classes of analgesics together in the so-called "multimodal analgesia". Rehabilitation is an important support for the management of patients affected by chronic musculoskeletal pain, and, in the majority of cases, it results in extremely valid support. This Special Issue of Clinics and Practice aims to make clear the real advantages and limits of rehabilitation in the treatment of these 

Dr. Giacomo Farì
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pain
  • analgesia
  • musculoskeletal pain
  • rehabilitation
  • pharmacologic therapy

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Published Papers (8 papers)

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Research

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16 pages, 397 KiB  
Article
Addressing Rotator Cuff-Related Shoulder Pain: Findings from a Greek Regional Observational Study Utilizing a Clinical Case Scenario
by Eleftherios Paraskevopoulos, Anna Christakou, Andrew Smythe, Eleni Kapreli, Maria Papandreou, Charalambos Papacharalambous, Kyriakos Pavlou and George M. Pamboris
Clin. Pract. 2025, 15(2), 30; https://doi.org/10.3390/clinpract15020030 - 31 Jan 2025
Viewed by 232
Abstract
Background: Rotator cuff-related shoulder pain (RCRSP) is a prevalent musculoskeletal issue, encompassing various shoulder conditions. While exercise typically forms the foundation of conservative treatment, there exists ongoing discourse regarding the effectiveness and role of passive treatments. International guidelines recommend initial conservative management, [...] Read more.
Background: Rotator cuff-related shoulder pain (RCRSP) is a prevalent musculoskeletal issue, encompassing various shoulder conditions. While exercise typically forms the foundation of conservative treatment, there exists ongoing discourse regarding the effectiveness and role of passive treatments. International guidelines recommend initial conservative management, with surgery considered only after failed conservative treatment. However, recent studies reveal discrepancies between recommended practices and actual clinical management. The aim of the study was to assess current practices in managing RCRSP among Greek physiotherapists, with a focus on understanding the alignment of these practices with international guidelines for conservative treatment. Methods: A cross-sectional survey was conducted among Greek physiotherapists to assess current practices in managing RCRSP. The survey, adapted from previous studies, collected demographic data and assessed clinical reasoning through a vignette-based approach. Responses were analyzed for alignment with guideline-recommended care. Results: Out of over 9000 contacted physiotherapists, 163 responded. A majority expressed a specific interest in shoulder pain (85%). Patient education (100%) and exercise (100%) were widely endorsed, with limited support for imaging (44%), injection (40%), and surgery (26%). Younger respondents were less inclined towards surgical referral (p = 0.001). Additionally, adjunctive interventions like mobilization (66%) and massage therapy (58%) were commonly employed alongside exercise and education. Treatment duration typically ranged from 6 to 8 weeks, with exercises reviewed weekly. Conclusions: The study highlights a consistent preference for conservative management among Greek physiotherapists, aligning with international guidelines. However, there are variations in practice, particularly regarding adjunctive interventions and exercise prescription parameters. Notably, there is a disparity between recommended and actual use of certain modalities. Full article
(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)
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12 pages, 4623 KiB  
Article
Microbial Spectrum, Intraoperative Findings, and Postoperative Outcomes in Native Knee Joint Infections: A Retrospective Analysis
by Jonas Roos, Britta Mangels, Max Jaenisch, Matthias Dominik Wimmer, Thomas Martin Randau, Christian Prangenberg, Kristian Welle and Martin Gathen
Clin. Pract. 2024, 14(6), 2725-2736; https://doi.org/10.3390/clinpract14060215 - 16 Dec 2024
Viewed by 631
Abstract
Background: Native knee joint infections, while uncommon, present a serious condition predominantly instigated by bacteria such as Staphylococcus aureus. Without timely intervention, they can result in joint destruction or sepsis, with risk factors encompassing preexisting medical conditions and iatrogenic procedures. The diagnostic [...] Read more.
Background: Native knee joint infections, while uncommon, present a serious condition predominantly instigated by bacteria such as Staphylococcus aureus. Without timely intervention, they can result in joint destruction or sepsis, with risk factors encompassing preexisting medical conditions and iatrogenic procedures. The diagnostic process includes a comprehensive patient history, clinical evaluation, laboratory testing, imaging studies, and microbiological investigations. Treatment typically involves joint aspiration and arthroscopy. This study aims to examine and establish correlations between diagnostic criteria and treatment modalities, enhancing the speed and specificity of future therapeutic strategies. Materials and methods: The present study is a retrospective cohort study conducted at a 1200-bed university clinic between 2007 and 2017, with an in-depth examination of patient details, symptoms, treatments, and outcomes. A scoring system was developed to classify the severity of knee joint impairment, categorizing patients on the basis of hospital stay duration, surgeries, and postoperative factors such as recurring symptoms, pain, and range of motion. Results: This study of 116 patients with knee joint infections revealed that clinical symptoms such as pain, swelling, and effusion are common but not definitive for diagnosis. Laboratory analysis revealed no significant differences in CRP or leukocyte counts between cultures positive or negative for pathogens. Hospital stay and disease severity are influenced by factors such as age, sex, presence of polyarthritis, neutrophil count, and type of pathogen, with higher weight and cortisone treatment associated with poorer outcomes. Conclusions: This study highlights the diagnostic challenges in native knee joint infections, revealing the need for comprehensive approaches given the nonspecificity of clinical symptoms and laboratory findings. This underscores the importance of advancing research through standardized methodologies and prospective studies to increase the accuracy of diagnosis and the effectiveness of treatment in this field. Full article
(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)
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15 pages, 814 KiB  
Article
Effect of a Physical Exercise Intervention on Physical Function Parameters and Blood Analytical Changes in Lung Cancer Survivors: A Feasibility Study
by Teresa Soria-Comes, María Climent-Gregori, Inmaculada Maestu-Maiques, Ignacio Inchaurraga-Álvarez, Ferrán Cuenca-Martínez, Omar Cauli and Francisco M. Martínez-Arnau
Clin. Pract. 2024, 14(5), 2202-2216; https://doi.org/10.3390/clinpract14050173 - 18 Oct 2024
Viewed by 1808
Abstract
Background: Lung cancer carries a high burden of systemic symptoms, including in survivors, leading to a reduced quality of life (QoL). We assessed whether a 12-week multicomponent supervised exercise programme, including muscular strength and aerobic training, was beneficial in patients who had undergone [...] Read more.
Background: Lung cancer carries a high burden of systemic symptoms, including in survivors, leading to a reduced quality of life (QoL). We assessed whether a 12-week multicomponent supervised exercise programme, including muscular strength and aerobic training, was beneficial in patients who had undergone surgery for early non-small cell lung cancer (NSCLC) in terms of physical performance, QoL, and metabolic and nutritional analytical parameters. Methods: Physical performance was measured by gait speed, handgrip strength, 30 s sit-to-stand (30s-STS) test repetitions, distance covered in the 6 min walk test (6MWT), and the Short Physical Performance Battery (SPPB) score. QoL was assessed with the EORTC-QLQ-C30 questionnaire. Blood glucose, cholesterol, triglycerides, total proteins, albumin, pre-albumin, creatinine, c-reactive protein, insulin-growth factor 1 (IGF-1), and the haemoglobin and hematocrit percentages were measured before and after the intervention in order to observe any beneficial effects related to metabolic markers. Results: After the intervention, the mean scores for the 6MWT (p < 0.001), STS (p < 0.001), 6MWT (p < 0.01), and SPPB (p < 0.01) had significantly improved. However, handgrip strength and nutritional analytical were unchanged. The EORTC-QLQ-C30 functions and symptoms significantly improved after the intervention (p < 0.05 and p < 0.01, respectively). A significant decrease in cholesterol, triglycerides, and IGF-1 and a significant increase in pre-albumin in blood was also observed post-intervention (p < 0.05). Conclusions: This supervised, community-based 12-week multicomponent was feasible (adherence rate 70.35%) and provided benefits not only to physical performance but also to the quality of life of patients with NSCLC. Full article
(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)
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16 pages, 869 KiB  
Article
Chronic Pain in Spanish Physiotherapy Practice: Treatment Challenges and Opportunities in Diverse Healthcare Settings—A Qualitative Study
by Ángeles Díaz-Fernández, Esteban Obrero-Gaitán, Irene Cortés-Pérez, Ana Raquel Ortega-Martínez, María Catalina Osuna-Pérez, Noelia Zagalaz-Anula, María del Rocío Ibancos-Losada and Rafael Lomas-Vega
Clin. Pract. 2024, 14(5), 2089-2104; https://doi.org/10.3390/clinpract14050165 - 10 Oct 2024
Viewed by 1635
Abstract
Background/Objectives: Physiotherapists face significant challenges in managing chronic pain; a complex condition best addressed through a biopsychosocial (BPS) approach. Although substantial evidence exists globally, research specific to Spain remains limited. This study explores the experiences and challenges Spanish physiotherapists encounter in integrating BPS [...] Read more.
Background/Objectives: Physiotherapists face significant challenges in managing chronic pain; a complex condition best addressed through a biopsychosocial (BPS) approach. Although substantial evidence exists globally, research specific to Spain remains limited. This study explores the experiences and challenges Spanish physiotherapists encounter in integrating BPS elements across public and private healthcare settings. Methods: Semi-structured interviews with 12 experienced physiotherapists were conducted, using a qualitative approach with purposive sampling and reflexive thematic analysis. The analysis, grounded in a constructivist/interpretivist framework, allowed themes to emerge naturally from the data, supported by relevant quotes. Results: Three primary themes were identified: (1) challenges in implementing the BPS approach, including patient resistance and limited training; (2) facilitators for adopting the BPS model, such as multidisciplinary support and positive patient outcomes; and (3) emotional and psychological aspects of the physiotherapists. The findings highlight the complexities of chronic pain management in physiotherapy, emphasizing the need for enhanced psychological training, integrated multidisciplinary care, early diagnosis, and effective family involvement. These insights are critical for improving both patient care and physiotherapist well-being. Conclusions: This study provides valuable guidance for future strategies, focusing on educational enhancements, multidisciplinary collaboration, healthcare policy reform, and emotional support for physiotherapists within the Spanish healthcare context. Full article
(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)
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Review

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20 pages, 436 KiB  
Review
Collagen Injections for Rotator Cuff Diseases: A Systematic Review
by Rocco Aicale, Eugenio Savarese, Rosita Mottola, Bruno Corrado, Felice Sirico, Raffaello Pellegrino, Danilo Donati, Roberto Tedeschi, Luca Ruosi and Domiziano Tarantino
Clin. Pract. 2025, 15(2), 28; https://doi.org/10.3390/clinpract15020028 - 28 Jan 2025
Viewed by 452
Abstract
Background: Because of its anatomy and function, the rotator cuff (RC) is vulnerable to considerable morbidity. The prevalence of RC diseases (RCDs) among the general population is 5–39%, reaching over 30% in patients older than 60. The aim of the present systematic review [...] Read more.
Background: Because of its anatomy and function, the rotator cuff (RC) is vulnerable to considerable morbidity. The prevalence of RC diseases (RCDs) among the general population is 5–39%, reaching over 30% in patients older than 60. The aim of the present systematic review is to investigate the effects of the use of collagen injections in the treatment of RCDs. Methods: A systematic search of scientific electronic databases (such as PubMed, Scopus and Web of Science) was performed up to November 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent authors conducted the search and assessed the articles. The inter-rater reliability for the quality assessment was measured using Cohen’s kappa coefficient, while the Modified Coleman Methodology Score (CMS) was applied to evaluate the methodological quality of the articles included in this systematic review. Results: A total of eight articles were included, with the overall quality of the included articles being evaluated as fair. Despite the use of different types of collagen and injection protocols, as well as the different scores applied, each included study showed clinically relevant improvements. However, given the high degree of heterogeneity of the included studies, we cannot draw conclusions regarding which type of collagen and injection protocol are best for RCD treatment. Discussion: Collagen administration for RCDs seems to be effective at reducing pain and improving function, as well as the tendon structure, especially in partial tears and RC tendinopathy. High-quality, prospective studies with long-term follow-up are necessary to validate the findings of the articles included in this systematic review. Full article
(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)

Other

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12 pages, 3694 KiB  
Case Report
Multi-Ligament Reconstruction in an Adolescent Female Affected by Congenital Femoral Deficiency and Complete Anterior and Posterior Cruciate Ligament agenesis: A Case Report
by Simone Giusti, Maria Beatrice Bocchi, Edoardo De Fenu, Osvaldo Palmacci and Ezio Adriani
Clin. Pract. 2025, 15(1), 1; https://doi.org/10.3390/clinpract15010001 - 24 Dec 2024
Viewed by 554
Abstract
Purpose: Multi-ligament reconstruction in adolescent patients affected by congenital femoral deficiency is an extremely rare and delicate surgical procedure. There are very few reported cases of complete anterior and posterior cruciate ligament agenesis in these patients. Methods: We present a complex case of [...] Read more.
Purpose: Multi-ligament reconstruction in adolescent patients affected by congenital femoral deficiency is an extremely rare and delicate surgical procedure. There are very few reported cases of complete anterior and posterior cruciate ligament agenesis in these patients. Methods: We present a complex case of a 16-year-old girl affected by congenital femoral deficiency and ipsilateral tibial hypoplasia who was treated successfully for a complete agenesis of the anterior (ACL) and posterior (PCL) cruciate ligament with single-sitting ACL and PCL reconstruction. Results: The adolescent patient was successfully reconstructed with excellent clinical results. Conclusions: Knee MRI (Magnetic Resonance Imaging) should be requested in all patients affected by congenital femoral deficiency to exclude ligamentous agenesis. Where present, these should be reconstructed at an early stage as soon as limb-lengthening procedures are completed. If still skeletally immature, physeal-sparing surgical techniques should be implemented. Full article
(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)
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22 pages, 2219 KiB  
Systematic Review
Biochemical Mechanisms and Rehabilitation Strategies in Osteoporosis-Related Pain: A Systematic Review
by Giorgia Natalia Iaconisi, Rachele Mancini, Vincenzo Ricci, Danilo Donati, Cristiano Sconza, Riccardo Marvulli, Maurizio Ranieri, Marisa Megna, Giustino Varrassi, Simone Della Tommasa, Andrea Bernetti, Loredana Capobianco and Giacomo Farì
Clin. Pract. 2024, 14(6), 2737-2758; https://doi.org/10.3390/clinpract14060216 - 19 Dec 2024
Cited by 1 | Viewed by 887
Abstract
Background/Objectives: Osteoporosis causes a bone mass reduction and often determines acute and chronic pain. Understanding the biochemical and neurophysiological mechanisms behind this pain is crucial for developing new, effective rehabilitative and therapeutic approaches. This systematic review synthesizes recent advances in muscle–bone interactions and [...] Read more.
Background/Objectives: Osteoporosis causes a bone mass reduction and often determines acute and chronic pain. Understanding the biochemical and neurophysiological mechanisms behind this pain is crucial for developing new, effective rehabilitative and therapeutic approaches. This systematic review synthesizes recent advances in muscle–bone interactions and molecular pathways related to osteoporosis-associated pain. Methods: We carried out a systematic review including studies published from 2018 to 2024 using PubMed, Scopus, clinicaltrials.gov and Cochrane Library. The Cochrane Collaboration tool was used to assess bias risk. The review adhered to PRISMA guidelines and is registered with PROSPERO (CRD42024574456); Results: Thirteen studies were included. It emerged that osteoporosis causes progressive bone loss due to disruptions in biochemical processes and muscle–bone interactions. This condition is also closely associated with the development of pain, both acute and chronic. Key findings include the role of the miR-92a-3p/PTEN/AKT pathway and the impact of muscle–bone disconnection on bone health. Mechanotransduction is critical for bone maintenance. Effective pain management and rehabilitation strategies include physical therapy and physical exercise, yoga, Pilates, and cognitive behavioral therapy (CBT); they all improve pain relief and functional outcomes by enhancing muscle strength, flexibility, and balance. Pharmacological options such as NSAIDs, opioids, and new agents like SHR-1222, along with surgical interventions like percutaneous vertebroplasty, offer additional pain reduction, especially when included in individualized rehabilitation projects; Conclusions: This review highlights advancements in understanding osteoporotic pain mechanisms and identifies promising treatments. Integrating targeted therapies and rehabilitation strategies can enhance patients’ pain relief. Full article
(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)
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16 pages, 1635 KiB  
Systematic Review
Current Evidence on and Clinical Implications of Vitamin D Levels in Pain and Functional Management of Knee Osteoarthritis: A Systematic Review
by Bianca Georgescu, Adelina Elena Cristea, Doinița Oprea, Andreea Alexandra Lupu, Liliana-Elena Stanciu, Erdin Borgazi, Bogdan Marian Caraban, Viorela Mihaela Ciortea, Laszlo Irsay and Mădălina Gabriela Iliescu
Clin. Pract. 2024, 14(5), 1997-2012; https://doi.org/10.3390/clinpract14050158 - 26 Sep 2024
Viewed by 2132
Abstract
Background: Osteoarthritis is a common chronic disease that affects quality of life and increases public health costs. Knee osteoarthritis is a frequent form, marked by joint degeneration, pain, stiffness, and functional restrictions. Factors such as age, genetics, joint injuries, obesity, and vitamin D [...] Read more.
Background: Osteoarthritis is a common chronic disease that affects quality of life and increases public health costs. Knee osteoarthritis is a frequent form, marked by joint degeneration, pain, stiffness, and functional restrictions. Factors such as age, genetics, joint injuries, obesity, and vitamin D deficiency can affect knee osteoarthritis progression. While the exact link between vitamin D and osteoarthritis is still being studied, recent research indicates that low vitamin D levels might influence the articular cartilage’s structure and function, potentially accelerating osteoarthritis. This review aims to analyze the last decade of research on vitamin D’s role in osteoarthritis. Methods: A systematic review of the literature was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Relevant studies from the last ten years were included to evaluate the association between vitamin D levels and knee osteoarthritis. The inclusion criteria were studies examining the role of vitamin D in cartilage health and osteoarthritis progression and the potential clinical implications for disease management. Results: This review identified a variety of studies exploring the connection between vitamin D and osteoarthritis, with mixed findings. Conclusions: The relationship between vitamin D and knee osteoarthritis remains inconclusive, highlighting the need for further research. An updated evaluation of the literature is crucial for osteoarthritis management strategies and to potentially include vitamin D supplementation in therapeutic protocols. Full article
(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)
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