Professor Maffulli

Professor Maffulli’s busy week in Italy

Professor Nicola Maffulli – ‘jumping & stretching’

Professor Nicola Maffulli addresses the issues of jumping and stretching, but first there is pizza!

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. Professor Maffulli’s busy week began in Salerno. This was 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 was Salerno, where Professor Maffulli delivered a talk on apophyseal injuries in children’s and youth sports –

Apophysis in young adults talk
Professor Nicola Maffulli
  1. Apophysitis refers to irritation and inflammation of the apophysis. This is 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. This to highlight the frequency and characteristics of these injuries. Also, it was 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,.

Areas timely for developing research – Further studies should consider analytical as well as descriptive components of apophyseal injuries. This allows the identification of new possible risk factors and preventive measures.  It also aids early detection and proper treatment.

At this juncture, Professor Maffulli’s busy week continued, as he ate pizza, then boarded a train to Rome for more pizza. This before heading to a pizza restaurant to prepare for the next day’s conference. This was the Rome Rehabilitation meeting, where guidelines for the conservative management of many musculoskeletal conditions were presented. Professor Maffulli chaired the session on osteoporosis. 

Professor Maffulli - Sports Injuries

2) Jumping exercise preserves bone mineral density and mechanical properties in osteopenic ovariectomized rats even following established osteopenia.

Okubo R1, Sanada LS2, Castania VA3, Louzada MJ4, de Paula FJ5, Maffulli N6,7, Shimano AC3.

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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 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. The study group was 80 x 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 analysed.

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 favourable changes in bone mineral density, bone mechanical properties, and bone formation/resorption markers. To prevent bone loss, use jump training after ovariectomy – even when osteopenia is already established.

Knee. 2017 Aug;24(4):775-781. doi: 10.1016/j.knee.2017.04.017. Epub 2017 May 23.    

Professor Maffulli - Sports Injuries

Static tensioning promotes hamstring tendons force relaxation more reliably than cycling tensioning –

Piedade SR1, Dal Fabbro IM2, Mischan MM3, Piedade C Jr4, Maffulli N5.

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BACKGROUND: Graft elongation might be a major reason for increased anterior laxity after anterior cruciate ligament (ACL) reconstruction. This study analyzed the force relaxation values and their stabilization when single strands of the gracilis and semitendinosus tendons underwent cyclic and static tensioning at 2.5% strain level, and compared the efficiency of static and cyclic tensioning in promoting force relaxation.

Methods – Eighteen gracilis tendons and 18 semitendinosus tendons from nine male cadavers (mean age: 22.44years) were subjected to 10 in vitro cyclic loads at 2.5% strain level, or to a static load at 2.5% strain level.

Results – During cyclic loading, the reduction in force values tended to stabilize after the sixth cyclic load, while, in the case of static loading, this stabilization occurred by the second minute. Comparing static and cyclic loading, the gracilis tendon had similar mechanical responses in both conditions, while the semitendinosus tendon showed greater force relaxation in static compared with cyclic loading.

Conclusions – Considering that the semitendinosus tendon is the main component of the hamstring graft, its biomechanical response to loading should guide the tensioning protocol. Therefore, static tensioning seems more effective for promoting force relaxation of the semitendinosus tendon than cyclic tensioning. The gracilis tendon showed a similar mechanical response to either tensioning protocols.

Surgeon. 2017 Oct;15(5):297-302. doi: 10.1016/j.surge.2017.04.004. Epub 2017 June 7

Professor Maffulli’s busy week

At least WholeLife Clinics’ ( Medical Director didn’t have to travel too far. Recent weeks have included Shanghai and Las Vegas, or Buenos Aires, LA and Houston. All this in the worldwide dissemination of knowledge among peers, which brings so much benefit to patients… and pizza restaurants… across the globe.

Further information on Professor Nicola Maffulli can be found here

Also on the Wholelife Clinics website.

Professor Maffulli - Sports Injuries


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