Muscles

Tourette Syndrome (TS) is a neurodevelopmental disorder depicted by the occurrence of tics and accompanying behavioral problems that commonly appear during childhood. Tics, both motor and vocal, may cause musculoskeletal pain. Both acute and chronic muscle pain have been recognized as a common comorbid aspect of TS-related tic disorders in childhood. The pain most reported in children includes cervical, throat, shoulder, ocular, and joint pain, with most children reporting musculoskeletal pain in more than one part of the body. The impact of muscular pain caused by motor and phonic tics can negatively affect a child’s quality of life. This review describes the association and causation of musculoskeletal pain in childhood tics and TS, which are commonly under recognized and diagnosed. An analysis of the presence of musculoskeletal pain, the severity of the pain, the location of the pain and the movement incapacity due to pain in children is reviewed. Pharmacological and non-pharmacological interventions known to improve musculoskeletal pain in children are highlighted with supportive frameworks evaluated. Further research is needed to better understand musculoskeletal pain cause(s) and prevalence along with age-appropriate assessment methods and outcomes measures. Motor- and phonic-related musculoskeletal pain should be recognized as a common comorbid characteristics of TS and tic disorders in childhood. Such recognition may lead to greater therapeutic opportunities for this problematic condition.

Objectives: This clinical commentary presents a four-pillar rehabilitation framework implemented in the elite football setting of OFI Crete FC and designed to facilitate the return of football players to training and competitive play. The framework is structured around five core components: (a) effective load management during training and matches, (b) individualized rehabilitation programs and injury prevention strategies integrated within the recovery phase, (c) a novel on-field rehabilitation framework, and (d) an extended secondary prevention plan. Methods: This comprehensive approach was implemented over a three-year period with the OFI Crete FC football team and involved 87 elite professional players between the ages of 17 and 35. Throughout this time, 180 injuries were documented, ranging from mild to severe injuries. Results: The outcome illustrated that only 40% of these injuries led to players missing official matches, while the recurrence or follow-up injury rate was limited to just 10%. Over the course of the three years, a steady 60% decline in injury rates was observed. Conclusions: These findings emphasize the crucial importance of training load management, the integration of injury prevention strategies throughout the rehabilitation process, and the early initiation of on-field rehabilitation. Within the clinical setting of OFI Crete FC, the implementation of this integrated rehabilitation framework was associated with favorable observations in injury incidence, player absence days, and return-to-play timelines, which may reflect that the approach has potential benefits while remaining observational in nature.

Neuromuscular electrical stimulation (NMES) has been shown to provide health benefits similar to those of exercise. The aim of this study was to quantify the acute physiological effects of multiple muscle stimulation on the whole body and individual muscles. Nine healthy young adults were tested. NMES of eight muscle groups was performed with NMES stimulators. The vastus lateralis, biceps femoris, medial gastrocnemius, and tibialis anterior muscles of both legs were stimulated for ten minutes with twitch stimulations at the highest comfortable stimulation current. Whole-body metabolism was measured using a metabolic cart. A finger pulse oximeter and a tri-axial accelerometer were used to measure heart rate and muscle fatigue, respectively. Muscle metabolism (mVO₂) was measured using near-infrared spectroscopy (NIRS) during short periods of ischemia. Femoral artery blood flow was measured using Doppler ultrasound. Whole-body VO₂ and heart rate increased moderately by 36% and 22%, respectively, after 10 min of NMES. NMES increased mVO₂ by 12-fold higher than resting on average, with the gastrocnemius having the smallest increase and the vastus lateralis having the greatest increase. Peak diastolic blood flow velocity was significantly reduced by 50% after 10 min of NMES. Simultaneous lower-body NMES moderately improved whole-body metabolism, muscle metabolism, and blood flow, increasing our understanding of the beneficial effects of NMES.