Background: Mild-to-moderate knee osteoarthritis (KOA) can be successfully treated using intra-articular hyaluronic acid (IA-HA). The medial infrapatellar (MIP) approach and lateral infrapatellar (LIP) approach are two of the most used techniques for performing IA-HA, but it is still not clear which one is preferable. Objectives: The study aims to find the best knee injection technique between MIP and LIP approaches. Methods: In total, 161 patients were enrolled, divided into two groups (MIP or LIP). Each technique was performed once a week for three weeks. Patients were evaluated using the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Roles and Maudsley Score (RMS) at T0 (before the first injection), T1 (one week after the third injection) and T2 (six months after). Results: NRS, KOOS and RMS showed a statistically significant improvement in both groups at all the detection times, without significant differences. No differences were detected between the groups in terms of systemic effect effusions, while the MIP group presented a mildly higher number of bruises in comparison with the LIP group (p = 0.034). Conclusions: Both the IA-HA techniques are equally effective in measured outcomes. The MIP approach seems to produce some local and transient side effects. So, the choice of the LIP or MIP approach depends on the operator’s skill and experience.

Wheelchair basketball (WB) is an increasingly popular sport that guarantees numerous health benefits for people with disabilities who regularly practice it, such as an improved quality of life and psychophysical well-being. However, WB is a contact and high-stress sport, which exposes players to frequent overloads and injuries, mainly affecting the upper limbs. Therefore, shoulder pain (SP) is the most common musculoskeletal disorder among WB players, forcing them to suspend or abandon this sport activity. This narrative review aims to summarize all the known literature on this topic and to be a starting point for further research. Firstly, it explores the biomechanical causes that lead to SP and the underlying diseases, among which the most recurrent are rotator cuff tendinopathies. Furthermore, this overview deepens the most effective and specific rehabilitation programs for SP in WB players and it emphasizes the need for further studies to trial new rehabilitative protocols using novel technologies to make them faster and more personalized. In this regard, the general recommendation still remains to perform a combination of exercises such as strengthening, endurance and stretching exercises of various durations and intensities. To conclude, the most important prevention strategies are described, underlining the need for constant sport-specific training led by qualified personnel and suggesting some insights on possible new research aimed at improving wheelchair ergonomics, stressing the importance of a multidisciplinary team fully dedicated to the individual athlete.

Background: Traumatic spinal cord injury (SCI) is a neurological disorder that causes a traumatic anatomical discontinuity of the spinal cord. SCI can lead to paraplegia, spastic, or motor impairments. Go-karting for people with SCI is an adapted sport that is becoming increasingly popular. The purpose of this case report is to shed light on the effects of driving a go-kart on a patient with SCI-related spasticity and to deepen understanding of the possible related role of whole-body vibration (WBV) and neuroendocrine reaction. Methods: The patient was a 50-year-old male with a spastic paraplegia due to traumatic SCI. He regularly practiced go-kart racing, reporting a transient reduction in spasticity. He was evaluated before (T0), immediately after (T1), 2 weeks after (T2), and 4 weeks after (T3) a go-kart driving session. On both sides, long adductor, femoral bicep, and medial and lateral gastrocnemius spasticity was assessed using the Modified Ashworth Scale (MAS), and tone and stiffness were assessed using MyotonPro. Results: It was observed that a go-kart driving session could reduce muscle spasticity, tone, and stiffness. Conclusions: Go-kart driving can be a valid tool to obtain results similar to those of WBV and hormone production in the reduction of spasticity.

Wheelchair basketball (WB) is a health and inclusion opportunity for people with disabilities. In the scientific literature, no evidence defines WB as a symmetrical or asymmetrical sport; however, it would be helpful to deepen this aspect because it could improve the quality of training programs and consequently speed up WB performance. In WB, the biomechanical role of the shoulders is crucial. Therefore, the symmetry index and the activation of the bilateral supraspinatus and biceps brachii muscles were investigated to establish, with specific WB tests, whether it is a symmetrical or asymmetrical sport. Ten professional athletes were enrolled in this cross-sectional study. Each athlete was assessed by executing three tests on the field: sprint test, figure 8 test with the ball, and test without the ball. The symmetry index and muscle recruitment of the right and left supraspinatus and biceps brachii muscles were evaluated with a surface electromyograph. In all three tests, there was a positive correlation between muscle activations of the right and left supraspinatus muscles (sprint test: p-value 0.004; figure 8 without the ball: p-value 0.016; figure 8 with ball: p-value 0.009), while no correlation emerged between the muscle activities of the two brachial biceps (sprint test: p-value 0.155; figure 8 without ball: p-value 0.291, figure 8 with ball: p-value 0.9). There was a negative correlation between right biceps brachii muscle recruitment and performance in the figure 8 test without the ball and between right and left supraspinatus muscle recruitment and performance in the figure 8 test with the ball. Finally, no correlation was found between the symmetry index of the supraspinatus and brachial biceps muscles and the performance in the three tests. A p-value < 0.05 was considered significant for all tests. A higher and more symmetrical shoulder muscle recruitment does not lead to a better performance. WB could be regarded as an asymmetrical sport, particularly in sport-specific gestures, where technical skills are more important than muscle strength. Therefore, training should not aim to implement strength and symmetry but to improve the refinement and technical peculiarity of the athletic gesture.

Spine pain (SP) is the most common musculoskeletal disorder that causes transitional forms of motor disability. Considering its affordability and safety, manipulative therapy (MT) stands as one of the primary therapeutic approaches for SP and the related dysfunctional consequences. However, it is still difficult to assess and quantify the results of this treatment since there is a lack of objective evaluation tools in the available scientific literature. Thus, the purpose of this comprehensive review is to summarize the main outcomes used to evaluate the effectiveness of spine manipulations, focusing on their strengths and weaknesses. An extensive review of the PubMed, Cochrane, and Embase databases was performed to identify the literature of the last ten years regarding MT and the related assessment tools. A total of 12 studies met the inclusion criteria. The analyzed literature indicates that a wide range of outcome measures have been used to assess the effectiveness of spine MT. Pain is the main aspect to be investigated but it remains difficult to elucidate since it is strongly linked to various dimensions such as self-perception and psychological aspects. Therefore, it seems necessary to include new tools for evaluating the effects of spine MT, with the aim of exploiting new technologies and taking into consideration the SP biomechanical and biopsychosocial aspects.

Background: Hallux valgus (HV) is one of the most common foot deformities and negatively impacts plantar support. The abductor hallucis (AH) is the most important muscle in the etiopathogenesis of hallux valgus, but the effectiveness of its rehabilitation clashes with the difficulty of identifying the most suitable exercises to activate it. Therefore, the aim of this study was to compare four different therapeutic exercises in the activation of AH in these patients. Methods: In this observational case–control study, 48 patients suffering from hallux valgus of moderate/severe grade, according to traditional radiographic classification and the Manchester scale, were divided into two groups: the case group underwent a monthly rehabilitation protocol for their foot deformity, whereas the control group was only evaluated without any intervention. The exercises were as follows: Toe Spread Out (TSO), Short Foot (SF), Forefoot Adduction (FA), and Flexion of the Metatarsophalanges (FM). Both groups were analyzed at baseline and 1 month later (at the end of rehabilitation for the case group) while performing the four mentioned exercises using a surface electromyograph (sEMG) to record the muscle activity of AH in terms of Root Mean Square (RMS) and Maximum Voluntary Contraction (MVC). Results: FA was the only exercise to determine a statistically significant improvement in AH at the end of the rehabilitation cycle, both in terms of RMS (p = 0.015) and in terms of MVC (p < 0.0001), whereas the other exercises did not produce any change in muscle activity in the comparison between times and groups or in the related interaction. Conclusions: FA seems to be the best exercise to activate and train AH, so rehabilitation programs for patients suffering from hallux valgus should consider this exercise as the starting point for improving plantar support, always considering the specific characteristics of HV. Further studies are needed to deepen the effectiveness of this exercise, with the aim of implementing rehabilitation strategies and rethinking traditional HV therapies, which are currently predominantly surgical.