Challenges and Solutions for Musculoskeletal Disorders in Athletes

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Sports Medicine and Sports Traumatology".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 67974

Special Issue Editors


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Guest Editor
Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
Interests: musculoskeletal disorders; osteoarthritis; osteoporosis; sarcopenia; musculoskeletal pain; complex regional pain syndromes; intra-articular injections; neuromuscular disorders; vitamin D
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Guest Editor
Department of Orthopaedics and Traumatology Policlinico Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy
Interests: osteoporosis; bone metabolism; fracture healing; osteoarthritis; age related-bone disorders
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Musculoskeletal disorders are very common health problems in athletes. These conditions affect sport performance and result in withdrawal from training and competitions, with huge costs. Several types and locations of musculoskeletal disorders might occur in athletes according to different sport modality, particularly affecting joints, skeletal muscles, and tendons in most cases. Considering the high frequency of these conditions and their significant impact on sport performance, several studies are focused on investigating their pathogenic mechanisms as well as potential therapeutic approaches.

This Special Issue aims to investigate the biological mechanisms, diagnostic challenges, and rationale of available therapeutic strategies in the field of sport-related musculoskeletal disorders. In particular, the pathways regulating the muscle–bone crosstalk that guides healing processes in skeletal muscle injuries will be investigated. A dedicated paper will provide an evidence-based update on the main instrumental approach, ultrasound imaging, for the diagnosis of soft-tissue injuries in sport practice. Two papers will deal with two emerging painful conditions that require an early diagnosis and appropriate management to avoid disabling consequences: early osteoarthritis and complex regional pain syndrome type I (CRPS I). Finally, six articles will be dedicated to clarifying critical issues of commonly used pharmacological and non-pharmacological interventions to treat sport-related musculoskeletal disorders.

Prof. Dr. Giovanni Iolascon
Prof. Dr. Umberto Tarantino
Guest Editors

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Keywords

  • Injections, intra-articular
  • Hyaluronic acid
  • Osteoarthritis
  • Vitamin D
  • Athletes
  • Sports
  • Tendinopathy
  • Sprains and strains
  • Cartilage diseases
  • Complex regional pain syndromes
  • Musculoskeletal pain

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Published Papers (11 papers)

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Editorial

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4 pages, 257 KiB  
Editorial
Challenges and Solutions for Musculoskeletal Disorders in Athletes
by Giovanni Iolascon, Umberto Tarantino and Antimo Moretti
Medicina 2022, 58(1), 80; https://doi.org/10.3390/medicina58010080 - 5 Jan 2022
Cited by 2 | Viewed by 1879
Abstract
The etymology of the word “athlete” derives from the ancient Greek ἀθλητής (athletés, from âthlos that is, fight, competition) [...] Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)

Review

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11 pages, 477 KiB  
Review
Therapeutic Exercise and Conservative Injection Treatment for Early Knee Osteoarthritis in Athletes: A Scoping Review
by Lucrezia Tognolo, Maria Chiara Maccarone, Stefania De Trane, Anna Scanu, Stefano Masiero and Pietro Fiore
Medicina 2022, 58(1), 69; https://doi.org/10.3390/medicina58010069 - 3 Jan 2022
Cited by 16 | Viewed by 6099
Abstract
Background and Objectives: Recent evidence highlighted a higher prevalence of knee osteoarthritis (kOA) among young and former ex-professional athletes. Although the practice of a highly demanding sport is considered a predisposing factor for the knee joint cartilage degeneration, articular cartilage seems to [...] Read more.
Background and Objectives: Recent evidence highlighted a higher prevalence of knee osteoarthritis (kOA) among young and former ex-professional athletes. Although the practice of a highly demanding sport is considered a predisposing factor for the knee joint cartilage degeneration, articular cartilage seems to positively respond to a moderate load increase. We aim to investigate recent evidence on the conservative management of early kOA in athletes, with a particular emphasis on therapeutic exercise and injection treatment, in order to highlight whether there are any indications that can influence clinical and rehabilitation practice. Materials and Methods: A scoping review was conducted, screening MEDLINE and PEDro databases for studies published over the past twenty years on the topic. Studies in English, with accessible abstracts, were included in the review. The PICO framework was used (P—patient: athletes, I—Intervention: conservative treatment with therapeutic exercise or injection therapies, C—Comparison: not needed, O—Outcomes: clinical outcomes). Clinical trials, randomized controlled trials, and longitudinal studies were considered. Results: Four studies were finally included in the review. Therapeutic exercise seems to have beneficial effects on prevention of cartilage degeneration, on pain reduction, and on physical function enhancement. On the other hand, in mild to moderate stages of kOA the intra-articular viscosupplementation with Hyaluronic Acid showed a medium to long-term improvement in joint pain and function. The Platelet Rich Plasma treatment also showed a significant improvement in pain and function up to 12 months. Conclusions: Despite the heterogeneity of the studies considered, a multimodal treatment combining therapeutic exercise and moderate aerobic activity (such as running) should be indicated to prevent kOA development. In cases of symptomatic kOA it may be indicated to add minimally invasive injection therapy that seems to contribute to the improvement of motor function and symptomatology. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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8 pages, 626 KiB  
Review
Complex Regional Pain Syndrome in Athletes: Scoping Review
by Antimo Moretti, Angela Palomba, Marco Paoletta, Sara Liguori, Giuseppe Toro and Giovanni Iolascon
Medicina 2021, 57(11), 1262; https://doi.org/10.3390/medicina57111262 - 17 Nov 2021
Cited by 12 | Viewed by 3727
Abstract
Background and Objectives: Complex regional pain syndrome (CRPS) is a chronic condition characterized by disproportionate regional pain, usually affecting distal limbs, that follows trauma or surgery. Athletes may develop CRPS because of exposure to traumatic or overuse injuries. The aim of the present [...] Read more.
Background and Objectives: Complex regional pain syndrome (CRPS) is a chronic condition characterized by disproportionate regional pain, usually affecting distal limbs, that follows trauma or surgery. Athletes may develop CRPS because of exposure to traumatic or overuse injuries. The aim of the present study is to review the available literature about CRPS type 1 in athletes. Materials and Methods: We searched two online databases (PubMed and Web of Science), selecting papers aiming at investigating CRPS type 1 (algodystrophy) in athletes. The analysis of databases was made considering original articles published until 30 June 2021, written in English. Results: Fifteen papers (12 case reports, 3 case series) were selected for a total of 20 clinical cases (15 females, 5 males), aged between 10 and 46 years (mean age 18.4 ± 9.8 standard deviation years). Patients included practiced different types of sport (soccer, athletics, gymnastics, basketball). The most involved anatomical sites were lower limbs, and time to diagnosis ranged from 2 days to 4 years. The most used treatments were pharmacological and physical therapies, but sometimes invasive approaches, as regional nerve, or lumbar sympathetic blocks, were provided. The main assessed outcomes were return to activity and pain. Conclusions: Our review suggests a higher prevalence of CRPS type 1 in younger people and in lower limbs than in general population but confirms the higher prevalence in females. However, the number of studies addressing CRPS in athletes is limited, as well as the number of involved patients, considering that only few and heterogeneous case reports were published about this topic. Moreover, the high prevalence of old studies (only 5 available studies in the last 10 years) might have influenced the choice of both assessment tools and management strategies. Despite these limitations, athletes showing disproportionate pain after sport-related injury should be promptly evaluated and treated through a multidimensional approach to avoid long-term consequences of algodystrophy. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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17 pages, 1098 KiB  
Review
Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes
by Alessandro de Sire, Nicola Marotta, Lorenzo Lippi, Dalila Scaturro, Giacomo Farì, Alfonso Liccardi, Lucrezia Moggio, Giulia Letizia Mauro, Antonio Ammendolia and Marco Invernizzi
Medicina 2021, 57(11), 1208; https://doi.org/10.3390/medicina57111208 - 5 Nov 2021
Cited by 27 | Viewed by 6168
Abstract
Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is [...] Read more.
Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is needed to determine the most appropriate and optimal timing and formulations in non-steroidal anti-inflammatory drug and opioid management, particularly given the strictness of anti-doping regulations. Indeed, the role of pharmacological therapy in reducing acute traumatic pain in athletes should still be addressed to minimize the timing of return to sport. Therefore, the aim of this comprehensive review was to summarize the current evidence about pain management in the setting of acute injury in elite athletes, providing the most informed strategy for pain relief and performance recovery. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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9 pages, 308 KiB  
Review
Biophysical Stimulation in Athletes’ Joint Degeneration: A Narrative Review
by Lorenzo Moretti, Davide Bizzoca, Giovanni Angelo Giancaspro, Giuseppe Danilo Cassano, Francesco Moretti, Stefania Setti and Biagio Moretti
Medicina 2021, 57(11), 1206; https://doi.org/10.3390/medicina57111206 - 4 Nov 2021
Cited by 18 | Viewed by 3506
Abstract
Osteoarthritis (OA) is the most prevalent degenerative joint disease and the main cause of pain and disability in elderly people. OA currently represents a significant social health problem, since it affects 250 million individuals worldwide, mainly adults aged over 65. Although OA is [...] Read more.
Osteoarthritis (OA) is the most prevalent degenerative joint disease and the main cause of pain and disability in elderly people. OA currently represents a significant social health problem, since it affects 250 million individuals worldwide, mainly adults aged over 65. Although OA is a multifactorial disease, depending on both genetic and environmental factors, it is reported that joint degeneration has a higher prevalence in former athletes. Repetitive impact and loading, joint overuse and recurrent injuries followed by a rapid return to the sport might explain athletes’ predisposition to joint articular degeneration. In recent years, however, big efforts have been made to improve the prevention and management of sports injuries and to speed up the athletes’ return-to-sport. Biophysics is the study of biological processes and systems using physics-based methods or based on physical principles. Clinical biophysics has recently evolved as a medical branch that investigates the relationship between the human body and non-ionizing physical energy. A physical stimulus triggers a biological response by regulating specific intracellular pathways, thus acting as a drug. Preclinical and clinical trials have shown positive effects of biophysical stimulation on articular cartilage, subchondral bone and synovia. This review aims to assess the role of pulsed electromagnetic fields (PEMFs) and extracorporeal shockwave therapy (ESWT) in the prevention and treatment of joint degeneration in athletes. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
12 pages, 7658 KiB  
Review
Reviewing Bone Marrow Edema in Athletes: A Difficult Diagnostic and Clinical Approach
by Umberto Tarantino, Chiara Greggi, Ida Cariati, Guglielmo Manenti, Matteo Primavera, Paolo Ferrante, Riccardo Iundusi, Elena Gasbarra and Andrea Gatti
Medicina 2021, 57(11), 1143; https://doi.org/10.3390/medicina57111143 - 22 Oct 2021
Cited by 10 | Viewed by 8679
Abstract
Bone marrow edema (BME) is defined as an area of low signal intensity on T1-weighted (T1W) MRI images and associated with intermediate or high signal intensity findings on T2-weighted (T2W) MRI images. BME represents a typical imaging finding that characterizes common stress-related bone [...] Read more.
Bone marrow edema (BME) is defined as an area of low signal intensity on T1-weighted (T1W) MRI images and associated with intermediate or high signal intensity findings on T2-weighted (T2W) MRI images. BME represents a typical imaging finding that characterizes common stress-related bone injuries of professional and amateur athletes. The etiology of stress-related injuries is influenced by numerous factors, including the initiation of a new sports activity or changes in an existing training protocol. The clinical significance of BME remains unclear. However, a correlation between the imaging pattern of BME, the clinical history of the patient and the type of sports activity practiced is essential for correct diagnosis and adequate therapeutic treatment. It is also important to clarify whether there is a specific threshold beyond which exercise can adversely affect the bone remodeling process, as the clinical picture may degenerate into the presence of BME, pain and, in the most severe cases, bone loss. In our review, we summarize the current knowledge on the etiopathogenesis and treatment options for BME and highlight the main aspects that make it difficult to formulate a correct diagnosis and establish an adequate therapeutic treatment. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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9 pages, 648 KiB  
Review
Epidemiology of Musculoskeletal Injuries in Adult Athletes: A Scoping Review
by Francesca Gimigliano, Giuseppina Resmini, Antimo Moretti, Milena Aulicino, Fiorinda Gargiulo, Alessandra Gimigliano, Sara Liguori, Marco Paoletta and Giovanni Iolascon
Medicina 2021, 57(10), 1118; https://doi.org/10.3390/medicina57101118 - 17 Oct 2021
Cited by 27 | Viewed by 8265
Abstract
Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the [...] Read more.
Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the musculoskeletal (MSK) system of adult athletes. Materials and Methods: We performed a scoping review on the Pubmed database limiting our search to 33 Olympic sports. Results: We identified a total of 1022 papers, and of these 162 were examined in full for the purpose of this review. Archery was the sport with the highest risk of injuries to the upper extremities, marathons for the lower extremities, and triathlon and weightlifting for the body bust. In the majority of the sports examined, muscle/tendon strain and ligament sprain were the most common MSK-Is diagnoses, while athletics, karate, and football were the sports with the highest IIRs, depending on the methods used for their calculations. Conclusions: Our scoping review highlighted the general lack and dishomogeneity in the collection of data on MSK-Is in athletes. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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10 pages, 569 KiB  
Review
The Role of Hyaluronic Acid in Sport-Related Tendinopathies: A Narrative Review
by Sergio Crimaldi, Sara Liguori, Pasquale Tamburrino, Antimo Moretti, Marco Paoletta, Giuseppe Toro and Giovanni Iolascon
Medicina 2021, 57(10), 1088; https://doi.org/10.3390/medicina57101088 - 12 Oct 2021
Cited by 16 | Viewed by 5376
Abstract
Tendinopathy is a complex clinical condition with a rising incidence and prevalence, particularly during sports practice. For the return to play in affected patients, adequate functional and structural recovery of the tendon is the ultimate goal, avoiding the high risk of recurrence. In [...] Read more.
Tendinopathy is a complex clinical condition with a rising incidence and prevalence, particularly during sports practice. For the return to play in affected patients, adequate functional and structural recovery of the tendon is the ultimate goal, avoiding the high risk of recurrence. In this perspective, local therapies alongside exercise are showing promising results. Despite evidence suggesting hyaluronic acid (HA) injections as effective in the treatment of tendinopathy, current recommendations about the management of this condition do not include this intervention. HA seems to be an effective therapeutic option for the management of sport-related tendinopathies, but further studies with a larger sample size are needed to confirm available findings. In this narrative review, we analyzed available literature about the rationale of the use of HA in the management of tendon injury and, particularly, in sport-related tendinopathies. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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15 pages, 3325 KiB  
Review
Ultrasound Imaging in Sport-Related Muscle Injuries: Pitfalls and Opportunities
by Marco Paoletta, Antimo Moretti, Sara Liguori, Francesco Snichelotto, Ilaria Menditto, Giuseppe Toro, Francesca Gimigliano and Giovanni Iolascon
Medicina 2021, 57(10), 1040; https://doi.org/10.3390/medicina57101040 - 29 Sep 2021
Cited by 25 | Viewed by 10429
Abstract
Muscle injuries occur frequently in athletes, accounting for more than one-third of sport-related trauma. Athletes most affected by these injuries are those practicing football and track and field, with hamstrings and gastrocnemius-soleus as the mainly involved sites. Muscle injuries lead to loss of [...] Read more.
Muscle injuries occur frequently in athletes, accounting for more than one-third of sport-related trauma. Athletes most affected by these injuries are those practicing football and track and field, with hamstrings and gastrocnemius-soleus as the mainly involved sites. Muscle injuries lead to loss of competitions, long recovery times and risk of re-injury with a consequent increase of the management costs. It is therefore advisable to make an accurate and timely diagnosis to establish appropriate interventions for proper healing in the shortest time. In this context, ultrasound imaging is widely used for diagnosis of musculoskeletal disorders because of several advantages including absence of radiation, portability, good spatial resolution, and the ability to perform dynamic tests. The aim of this review is to address the role of US in the evaluation of athletes with muscle injuries. US may play a pivotal role for the management of sport-related muscle injuries because it is fast and relatively cheap, allowing dynamic muscle assessment and time series evaluation of the healing process. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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9 pages, 517 KiB  
Review
Muscle Regeneration and Function in Sports: A Focus on Vitamin D
by Giovanni Iolascon, Antimo Moretti, Marco Paoletta, Sara Liguori and Ombretta Di Munno
Medicina 2021, 57(10), 1015; https://doi.org/10.3390/medicina57101015 - 25 Sep 2021
Cited by 9 | Viewed by 4932
Abstract
Muscle is one of the main targets for the biological effects of vitamin D. This hormone modulates several functions of skeletal muscles, from development to tissue repair after injury, through genomic and non-genomic mechanisms. Vitamin D deficiency and supplementation seem to significantly affect [...] Read more.
Muscle is one of the main targets for the biological effects of vitamin D. This hormone modulates several functions of skeletal muscles, from development to tissue repair after injury, through genomic and non-genomic mechanisms. Vitamin D deficiency and supplementation seem to significantly affect muscle strength in different populations, including athletes, although optimal serum 25(OH)D3 level for sport performance has not been defined so far. Additionally, vitamin D deficiency results in myopathy characterized by fast-twitch fiber atrophy, fatty infiltration, and fibrosis. However, less is known about regenerative effects of vitamin D supplementation after sport-related muscle injuries. Vitamin D receptor (VDR) is particularly expressed in the embryonic mesoderm during intrauterine life and in satellite cells at all stages of life for recovery of the skeletal muscle after injury. Vitamin D supplementation enhances muscle differentiation, growth, and regeneration by increasing the expression of myogenic factors in satellite cells. The objective of this narrative review is to describe the role of vitamin D in sport-related muscle injury and tissue regeneration. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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Other

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13 pages, 450 KiB  
Systematic Review
Physical Agent Modalities in Early Osteoarthritis: A Scoping Review
by Giulia Letizia Mauro, Dalila Scaturro, Francesca Gimigliano, Marco Paoletta, Sara Liguori, Giuseppe Toro, Giovanni Iolascon and Antimo Moretti
Medicina 2021, 57(11), 1165; https://doi.org/10.3390/medicina57111165 - 26 Oct 2021
Cited by 25 | Viewed by 6832
Abstract
Early osteoarthritis (EOA) still represents a challenge for clinicians. Although there is no consensus on its definition and diagnosis, a prompt therapeutic intervention in the early stages can have a significant impact on function and quality of life. Exercise remains a core treatment [...] Read more.
Early osteoarthritis (EOA) still represents a challenge for clinicians. Although there is no consensus on its definition and diagnosis, a prompt therapeutic intervention in the early stages can have a significant impact on function and quality of life. Exercise remains a core treatment for EOA; however, several physical modalities are commonly used in this population. The purpose of this paper is to investigate the role of physical agents in the treatment of EOA. A technical expert panel (TEP) of 8 medical specialists with expertise in physical agent modalities and musculoskeletal conditions performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP searched for evidence of the following physical modalities in the management of EOA: “Electric Stimulation Therapy”, “Pulsed Electromagnetic field”, “Low-Level Light Therapy”, “Laser Therapy”, “Magnetic Field Therapy”, “Extracorporeal Shockwave Therapy”, “Hyperthermia, Induced”, “Cryotherapy”, “Vibration therapy”, “Whole Body Vibration”, “Physical Therapy Modalities”. We found preclinical and clinical data on transcutaneous electrical nerve stimulation (TENS), extracorporeal shockwave therapy (ESWT), low-intensity pulsed ultrasound (LIPUS), pulsed electromagnetic fields stimulation (PEMF), and whole-body vibration (WBV) for the treatment of knee EOA. We found two clinical studies about TENS and PEMF and six preclinical studies—three about ESWT, one about WBV, one about PEMF, and one about LIPUS. The preclinical studies demonstrated several biological effects on EOA of physical modalities, suggesting potential disease-modifying effects. However, this role should be better investigated in further clinical studies, considering the limited data on the use of these interventions for EOA patients. Full article
(This article belongs to the Special Issue Challenges and Solutions for Musculoskeletal Disorders in Athletes)
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