Please note that this service is in no way intended to replace the direct relationship with a physician. Sports Fitness Examination Does the sports fitness examination serve only to obtain the certificate required to practise sport, or can it also identify conditions of cardiological or other medical interest? The sports medicine examination, in addition to issuing the fitness certificate, has an even more important objective: to identify, through the medical history, clinical examination, and electrocardiogram, any abnormalities that may raise suspicion of cardiac conditions. In this regard, the Sports Medicine Specialist, in the presence of clinical or instrumental abnormalities, has the responsibility of indicating the need for further investigations. Cardiac abnormalities often require instrumental examinations (echocardiogram, maximal stress test, Holter monitoring, cardiac MRI) and, where appropriate, a consultation with a cardiologist. Only at the end of this pathway will the patient be deemed fit, or alternatively directed towards the most appropriate cardiac care pathway. It should not be forgotten that during the examination, suspicions of many other conditions may also arise (pulmonary, orthopaedic, dermatological, etc.) which do not contraindicate physical activity, but may nonetheless warrant specialist investigations in other fields. Physiotherapy Shockwave therapy – for which conditions is shockwave treatment useful? Shockwaves are high-frequency, high-pressure acoustic (or sound) waves, and are classified as either radial or focused, depending on their application to different conditions. Radial shockwaves are applicable to broader surface areas, while focused shockwaves are used for more localised zones. In terms of how the treatment is delivered, the handpiece, placed on the affected area, transmits sound waves in the order of thousands of pulses per session. The treatment may be uncomfortable in some areas of the body, but the results are good. The main conditions treated include osteoarticular or intramuscular calcifications, tendinopathies — such as epicondylitis (or tennis elbow) — and, with a degree of caution, groin pain (pubalgia). Sessions are typically three in number, spaced approximately ten days apart. Results may be observed even a month after completing the treatment. HYDROTHERAPY – I underwent surgery on my shoulder due to a supraspinatus tendon tear. I have been advised to undergo physiotherapy sessions combined with hydrotherapy. Are these truly necessary for functional recovery? I would assume that surgical intervention was unavoidable, due to a complete tear of the supraspinatus tendon (possibly with other associated injuries). Following surgery, as soon as the surgeon gives the go-ahead, it is essential to undergo physiotherapy treatment. This pathway must be prescribed by a physiatrist or sports medicine specialist. In the early stages, hydrotherapy is often the treatment of choice, combined with manual and assisted work with the physiotherapist. Subsequently, the work will become increasingly active, and guided exercises in the gym will be the solution to your problem. Sports Traumatology ANTERIOR CRUCIATE LIGAMENT INJURY – I am a non-professional athlete and have been diagnosed with an anterior cruciate ligament injury. Is surgery the only option? This is the eternal dilemma faced by all patients, especially those who are active in sport. The first point to consider is whether the injury is complete or involves only a small portion of the anterior cruciate ligament. The second, and fundamental, point is to assess — through clinical examination — the stability of the knee when subjected to stress manoeuvres, including with the use of specific devices (such as the KT-1000 arthrometer). With this in mind, the orthopaedic surgeon may recommend a rehabilitation pathway without surgery, if the knee demonstrates sufficient stability in relation to the specific sport practised by the patient, possibly with the use of a brace during activity. Alternatively, in the opposite case, they will recommend arthroscopic surgery, proposing the most appropriate technique (use of part of the patellar tendon as a neo-ligament, or part of the knee flexor tendons). Afterwards, careful physiotherapy must be carried out, with a return to competitive activity around 6 to 8 months later. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION – I would like some information on how you carry out reconstruction of the anterior cruciate, posterior cruciate, and collateral ligaments. I was involved in an accident and I still have no information about my upcoming surgery. The situation you describe is certainly significant from a surgical standpoint. Much depends on how long ago the accident occurred and whether you have already begun any initial therapeutic interventions. With that said, I can tell you that in general, the collateral ligament can heal spontaneously. As for the cruciate ligaments, if they are completely torn, they cause significant knee instability that may require surgical intervention. For this reason, it is necessary to undergo an orthopaedic assessment, ideally with a knee specialist. KNEE PAIN – For several weeks, without any trauma, I have had severe pain on the inner side of my knee. The only thing I can mention is that I did some light running in the mountains. The causes may be multiple: functional overload, a micro-trauma, and/or a flare-up of a chronic condition. Manage the load by avoiding exertion and applying ice locally in the early stages. If the pain persists, consult an orthopaedic surgeon, sports medicine physician, or physiatrist, who will examine you and indicate the best course of action for a definitive diagnosis and appropriate treatment. KNEE PAIN – For about a month I have been suffering from pain in my left knee without having sustained any type of trauma or contusion. On the advice of my GP, I have booked an MRI but have not yet been able to have it done. Your doctor’s recommendation is correct. While you await the results, I can tell you in advance that if the knee problem is the result of a distortion injury, the treatment is obviously active rest with a specific knee brace. A physiotherapy programme prescribed by a physiatrist will then need to follow. If, on the other hand, the MRI reveals an algodystrophic component, the treatment must be established by an orthopaedic surgeon, who will indicate the appropriate anti-inflammatory therapy and physiotherapy for the case. ANKLE SPRAIN – While playing football I sprained my ankle and now I cannot move it without pain. What kind of investigations should I have to assess the extent of the injury? An ankle sprain (tibiotalar joint) has several degrees of severity. The diagnostic pathway involves a clinical examination and any necessary instrumental investigations such as X-ray and MRI. These investigations can determine whether there is ligamentous or bony involvement. The most commonly affected ligament is the anterior talofibular ligament, which is sometimes associated with a small avulsion fracture at the tip of the fibular malleolus. The choice of treatment is always linked to a specialist assessment (orthopaedic, physiatric, or sports medicine). Treatment always involves a protection phase, a pain reduction phase, and a crucial phase of progressive return to function, with targeted exercises. The entire pathway must be supervised by a physiotherapist and physician. In rare and severe cases, surgical stabilisation may be indicated. ACHILLES TENDON – I am a runner and have been suffering from intermittent Achilles tendon problems for several years, which prevent me from maintaining consistency. Despite performing eccentric and specific strengthening exercises, the problems keep returning and every year I am forced to start from scratch. In this case, the left calcaneus is more prominent than the right, and I was considering possible surgical intervention. Achilles tendon inflammation (tendinitis) is a condition that can be very painful and may also be complicated by degenerative changes in the tissue (tendinopathy). For these reasons, treatment must follow a careful diagnosis (with clinical examination, ultrasound, and in a smaller number of cases, MRI). In light of the failure of conservative treatment, I would recommend a consultation with an orthopaedic surgeon specialising in ankles. ACHILLES TENDON – I have Achilles tendinosis but I am not a suitable candidate for PRP treatment. What other treatments can I access? An innovative therapy consists of EPI (therapeutic percutaneous electrolysis). This minimally invasive technique is indicated primarily for the treatment of degenerative tendon conditions. Under ultrasound guidance, an ultra-fine needle is inserted into the affected area and traversed by a continuous galvanic current, capable of stimulating the healing process. However, do not overlook the most effective therapies: shockwave therapy if you have insertional tendinopathy, and eccentric exercise and strengthening for mid-portion tendinopathy. If you have never tried these treatments, start with these. GROIN PAIN (PUBALGIA) – I am an amateur athlete but for several months I have been unable to carry out my activity due to pain in the pubic region. What could be the cause, and what investigations should be performed? What are the treatment options? The term pubalgia literally means “pain in the pubic region.” In itself, this is not a condition, but simply a symptom that underlies a large number of causes. Among the most common are abnormal loading, hernial conditions, and hip problems such as femoroacetabular impingement. For this reason, diagnosis is not straightforward, and a sports medicine assessment is therefore crucial in the first instance. The pathway will involve a series of investigations (ultrasound, X-ray, MRI) in order to rule out all the main causes and establish an appropriate treatment plan. Should all investigations prove negative, the problem is often simply related to excessive workload. As is often the case, a good physiotherapy programme based on a degree of physical therapy and plenty of guided exercise from the physiotherapist is the solution. JAM INJURY TO THE FINGER – My son, who plays as a goalkeeper, jammed his thumb during training. Nearly 45 days later, the pain and swelling have almost completely resolved, but when he tries to make a fist he still feels pain. What investigations do you recommend to assess and resolve the problem? It is possible that as a result of the jammed finger, a capsulo-ligamentous injury to a phalanx has occurred. This would explain the progressive reduction in pain and swelling, while accounting for the persistence of the other symptoms you describe. It is therefore advisable to carry out instrumental investigations (ultrasound of the finger) and a check-up with an orthopaedic surgeon specialising in the hand. FOOT PAIN – For almost 6 months I have been experiencing a burning sensation combined with sharp pains in both feet. Which specialist should I consult? The symptoms you describe are non-specific, and therefore the first type of consultation may not necessarily be the most appropriate one. Nevertheless, my first recommendation would be to request a consultation with a vascular surgeon, who can perform a colour Doppler ultrasound of the blood vessels of the lower limbs. GONARTHROSIS – I have gonarthrosis, and the pain is probably also connected to very intense physical activity. I would like to understand what you recommend doing (and which type of specialist to consult) in order to resume physical activity. Suffering from gonarthrosis and engaging in intense physical activity are two conflicting situations. It is therefore advisable to assess, with the help of a physiatrist and a trauma specialist, what levels of exertion and joint overload are appropriate, in order to achieve the right balance. From a therapeutic standpoint, there are many options, ranging from physiotherapy tailored to your case, to injections with hyaluronic acid and/or platelet-rich preparations. Physiatry HIP PAIN – I have had pain in the hip area for almost a month; it hurts when I am sitting and in certain lying positions, and in the first part of the day the pain is mild, only to worsen as the day progresses. Can you offer any advice? To answer this question, an examination by a specialist in the musculoskeletal system (physiatrist, sports medicine physician, orthopaedic surgeon) is necessary. After examining you, they may advise you to undergo an instrumental investigation (ultrasound, X-ray, MRI) to confirm the diagnostic hypothesis. An effective treatment begins with a thorough diagnosis. GROIN PAIN – For some time I have been experiencing pain localised to the front of the thigh in the groin area. Following a soft tissue ultrasound, no abnormality was detected, but the pain has not yet disappeared. At present it is not very debilitating, and I feel pain mainly during exercises such as sit-ups, while cycling I feel almost no discomfort. What could it be? Could it be a condition related to hip cartilage damage? Groin pain can have multiple causes and may be of bony, muscular, tendinous, or visceral origin. If you have already had an ultrasound examination that has ruled out soft tissue pathology, I recommend a clinical assessment with a physiatrist or sports medicine physician. During the consultation, the physician will be able to formulate a clinical hypothesis and direct you towards the most appropriate investigations and therapeutic pathway for your situation. CERVICAL PAIN – I suffer from headaches accompanied by a strong sensation of nausea. I suspect the pain may be coming from the cervical spine. What can I do to confirm this? The first thing to do is to confirm or rule out whether your headache is caused by a cervical spine condition. To obtain this assessment, I recommend undergoing a neurological evaluation (which deals with headaches). Should the diagnosis point to a musculoskeletal-degenerative condition, a physiatric consultation and a physiotherapy programme are the solution. BACK PAIN – I have back problems, poor posture, and muscle contractures. Which specialist should I consult? The most appropriate specialist for you at this stage is a physiatrist. During the consultation, this specialist can decide whether to investigate your situation further with instrumental examinations such as X-ray, MRI, or a postural assessment. Based on the findings, the specialist will indicate the individual rehabilitation programme designed specifically for you. PRP: Platelet-Rich Plasma What does PRP consist of? To explain what PRP consists of, we need to reveal what the acronym stands for: Platelet-Rich Plasma. PRP is therefore not a medication. It is, rather, a more or less liquid substance (depending on the indications) with a high platelet content. To obtain this preparation, the process is as follows: a standard venous blood draw is performed on the patient to obtain, from a few cc up to 30 cc of blood. The normality of red blood cells, white blood cells, and platelets is assessed with a simple full blood count. If the values are within the reference ranges, the platelets are concentrated (up to 800,000 or more) in the plasma — the liquid component of blood — through a completely sterile system. The few cc obtained can then be used to treat various conditions. The indications are numerous: in orthopaedics for the treatment of tendinitis and tendinosis, and in cartilage conditions affecting various joints such as the knee or ankle. Further indications exist for treatment in the field of sports medicine in the case of muscle injuries. PRP, in fact, produces an analgesic and anti-inflammatory effect, but above all a reparative and regenerative effect on the damaged structures. PRP is also used in dentistry, orthopaedic surgery, and aesthetic and plastic medicine. MENISCUS – I have medial meniscal degeneration and grade II patellofemoral chondropathy. After a year of physiotherapy and cortisone injections, I find myself back where I started with constant pain in both knees. What treatments or interventions are available to resolve or improve this problem? The knee condition you describe certainly causes pain. There are very valid and more appropriate alternatives for cartilage conditions: treatment with platelet concentrates (PRP), obtained from a sample of your own blood that is appropriately processed, could be a further option — but do not lose sight of rehabilitation with a focus on strengthening. Should the combination of these two treatments prove unsuccessful, you should return to the orthopaedic surgeon for a possible interventional procedure. Baropodometric Examination I am a 40-year-old marathon runner. I would like to know whether, in addition to a good running shoe, custom orthotics are necessary to prevent overload-related pain. For a marathon runner, it is always preferable to avoid overloads that could affect not only the plantar arch but also other delicate structures (Achilles tendons, knees). Orthotics can be useful in this regard, though they are not always necessary — but they must certainly be personalised. I recommend a consultation with an orthopaedic surgeon specialising in the foot, or with a physiatrist, who will indicate whether it is necessary to undergo a static and dynamic baropodometric examination. PLANTAR FASCIITIS – I have been suffering from plantar fasciitis for about six months and have undergone several treatments including injections, tecar therapy, ice, stretching, and ultrasound, without achieving any results. Plantar fasciitis, in addition to being very painful, is also very difficult to treat. The approach to resolving your problem could include: The fabrication of custom orthotics, following precise baropodometric examinations The use of focused shockwaves in cycles of three sessions, to be repeated at intervals of approximately 30 days if necessary Should the treatment prove unsuccessful, a consultation with an orthopaedic surgeon specialising in the foot may be warranted for a possible interventional procedure. Orthopaedics FIFTH METATARSAL – I have been diagnosed with a stress injury to the fifth metatarsal of my left foot. What is it? Is it a fracture? Can it heal? Stress injuries are conditions that, if well managed, are essentially self-resolving, but it is necessary to manage the load — to prevent the stress injury from becoming a fracture — by using two crutches and possibly a brace (such as a ROM Walker). You may bear weight on the foot without overdoing it and for short distances. Keep walking to a minimum. If you decide to use the brace, you may remove it for showering, in bed, and whenever you are not bearing weight on the foot — to move the ankle. Magnetotherapy may be helpful. Swelling is normal but should reduce over the coming days; you can soak the foot in cold water at the end of the day and keep it elevated. A visit to an orthopaedic surgeon or physiatrist will help assess your situation and initiate appropriate treatment. RADIAL HEAD FRACTURE – About a month ago I had my cast removed from my arm following a “radial head fracture.” I did not undergo physiotherapy as prescribed by the doctor. I am now unable to fully extend my arm. I would like to know whether I need any treatment to achieve a prompt recovery. Unfortunately, following cast removal after a radial head fracture, it is essential to undergo a course of physiotherapy rehabilitation. Failing to do so prolongs recovery times and risks preventing a complete restitutio ad integrum — that is, a full return to optimal functional use of the arm. I therefore urge you to consult a physiatrist, who will be able to prescribe the correct physiotherapy pathway taking your needs into account. SCAPHOID FRACTURE – Following surgery on my left foot for a severe scaphoid fracture repaired with three staples many years ago, I have had no major problems to date despite doing heavy work. Recently, however, arthritis has been troubling me; I feel pain even at night and sometimes feel my support giving way. A comprehensive answer requires a physical examination of the foot, assessment of the painful points, and evaluation of its structure. Treatment of a painful foot can involve approaches of varying degrees of invasiveness, from simple load management — by moderating the amount of walking done on individual outings — to the use of custom orthotics, up to minor surgical procedures in selected cases. During acute phases, physiotherapy and pharmacological treatments may be employed. Consult a foot and ankle specialist who will be able to indicate the most appropriate course of action for you. MORTON’S NEUROMA – For about three years I have had a persistent discomfort in my right foot that has worsened over time. About a year ago, an ultrasound diagnosed a probable Morton’s neuroma, and following a subsequent orthopaedic consultation I was advised to use orthotics, also for a mild rotoscoliosis of the spine. If the diagnosis is Morton’s neuroma (and the anatomical location is pathognomonic), the next step is to consult an orthopaedic surgeon specialising in the foot, who will be able to offer either an infiltrative treatment or surgical treatment if necessary. Paediatrics TARSAL NAVICULAR OSTEOCHONDROSIS – My granddaughter has had tarsal navicular osteochondrosis. What is it and how is it treated? Tarsal navicular osteochondrosis is a benign condition with spontaneous resolution that primarily affects male children between the ages of 3 and 8. During acute symptomatic phases, it requires a period of rest, a brief abstention from sporting activity, and symptomatic treatment with ibuprofen. On average, it lasts approximately 2 years and should be monitored clinically and radiographically every 6 to 8 months. Although less commonly, girls may also be affected by the condition described above. With regard to the possible use of medications, it is always preferable to have a paediatric orthopaedic specialist consultation before any prescription is made. Paediatric Orthopaedics POSTURAL ASSESSMENT – At what age is it advisable to have the first orthopaedic examination to check a child’s feet, posture, and back? It is advisable to carry out a first musculoskeletal and neuromotor postural assessment before the age of 6, in order to evaluate the child’s normal skeletal development and to be able to correct any postural abnormalities typical of early childhood. HALLUX VALGUS – My son has an early sign of hallux valgus. How can I intervene? I have been advised either to use a splint or to consider surgery. Juvenile hallux valgus is an abnormality in the growth of the osteoarticular components of the first ray, with a genetic basis, that manifests clinically around the second decade of the child’s life. Generally asymptomatic, it can, in approximately 20–30% of cases, become progressively painful and require a paediatric orthopaedic specialist consultation to evaluate the possible treatment options (orthotic treatment or, more rarely, surgical intervention). To put your mind at rest, book an orthopaedic assessment. Cardiology EXTRASYSTOLES – A few days ago, at a medical centre different from the ones I have attended in previous years, I underwent a sports medicine examination for fitness to play five-a-side football. In previous examinations everything had been fine; however, this time I was told that I have extrasystoles even during exertion, and that I should undergo further cardiological investigations. This seems strange to me, as no problem has ever arisen in the past, and I am not convinced of the need for further investigations. I am also 24 years old and feel well. What do you think? Your case of extrasystoles during exertion — with characteristics you do not specify, but which certainly take on an abnormal significance in terms of quantity and/or quality — requires a second-level examination, as stipulated by established protocols. These consist of cardiological investigations ranging from an echocardiogram, suitable for studying cardiac morphology and kinetics, to the application of a 24-hour Holter monitor. This examination records, over a prolonged period, the presence of cardiac rhythm abnormalities and indicates, in this case too, their quantity and quality. The cardiologist will then send the reports to the sports medicine physician along with their opinion, and the latter will take this into account when deciding whether or not to issue the fitness certificate. In some cases, where certain conditions are suspected, a cardiac MRI may also be requested. Please be aware that all of this would be done for the sake of your health. CHEST PAIN – I have a family history of cardiovascular problems and I have hypertension. Over the past few days I have been experiencing some chest pain and would like to undergo some investigations. I would like to know which investigations to have in order to check my state of health. In the case of chest pain, the first advice is obviously to seek immediate medical assessment — including at an emergency department if necessary. If there is no urgency, I recommend a cardiology consultation. The cardiologist will be able, through clinical examination and an electrocardiogram, to carry out further investigations such as, for example, a stress test and/or request a 24-hour Holter monitor. Based on the findings described above, the specialist will indicate the most appropriate therapeutic pathway for you.

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