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Background: Chronic athletic pubalgia is a frequent sport condition in which the effectiveness of medical treatment has not been proven. Intra-muscular injection of botulinum toxin A may have positive effects on pain in some chronic tendinitis. We aimed to describe the short-term evolution of pain, activity limitations and quality of life, after an injection of the adductor longus with botulinum toxin A, in individuals with chronic athletic pubalgia, for whom medical and/or surgical treatments have failed.Method: We conducted a retrospective observational single-centered study. We included consecutive individuals with chronic athletic pubalgia for whom medical and/or surgical treatments have failed and who were treated with an intra-muscular injection of botulinum toxin A injection (100 International Unit (IU) of botulinum toxin A in the adductor longus) under ultrasound guidance. Participants were assessed 50 days after injection for pain using a numerical rating scale (NRS) (0, no pain, and 100, maximal pain) and for activity limitations and quality of life using the Copenhagen Hip and Groin Outcome Score (HAGOS) (0, worse outcome, and 100, most favorable outcome). Participants were also asked to self-report adverse events.Results: We included 20 participants. Mean age was 34.3 (11.7) years and mean symptom duration was 48.9 (61.6) months. Mean pain decreased from 55.3 (SD [22.4] before injection to 38.3 [21.7], 50 days after injection (p=0.027). Mean HAGOS total score increased from 47.0 (12.1) to 58.6 (10.7). No adverse events were self-reported in participants included in analyses. Serious adverse events were reported in 3 individuals who were not included in analyses because of missing data.Conclusion: We observed a numerical decrease in pain intensity in individuals with chronic athletic pubalgia 50 days after intra-muscular botulinum toxin A injection in the adductor longus. Trial registration number: Clinical Trial: NCT05430893 (24/06/2022)

Chronic low back pain (cLBP) is a public and occupational health problem that is a major professional, economic and social burden. We aimed to provide a critical overview of current international recommendations regarding the management of non-specific cLBP. We conducted a narrative review of international guidelines for the diagnosis and conservative treatment of people with non-specific cLBP. Our literature search yielded five reviews of guidelines published between 2018 and 2021. In these five reviews, we identified eight international guidelines that fulfilled our selection criteria. We added the 2021 French guidelines into our analysis. Regarding diagnosis, most international guidelines recommend searching for so-called yellow, blue and black flags, in order to stratify the risk of chronicity and/or persistent disability. The relevance of clinical examination and imaging are under debate. Regarding management, most international guidelines recommend non-pharmacological treatments, including exercise therapy, physical activity, physiotherapy and education; however, multidisciplinary rehabilitation, in selected cases, is the core treatment recommended for people with non-specific cLBP. Oral, topical or injected pharmacological treatments are under debate, and may be offered to selected and well-phenotyped patients. The diagnosis of people with cLBP may lack precision. All guidelines recommend multimodal management. In clinical practice, the management of individuals with non-specific cLBP should combine non-pharmacological and pharmacological treatments. Future research should focus on improving tailorization.

The purpose of this thesis is to increase our knowledge about the thinking of idiocy behind the formation of the first institutional schools for idiots in the Scandinavian countries. The source materials – publications, articles, documents, photos – has been studied and interpreted through a hermeneutic existential method. The final interpretation is connected to Ludwik Fleck´s theory of thought-style and thought-collective. Thought-style in this context has different aspects: The quality or characteristics of the conception or diagnosis of idiocy The ideas about underlying causes The educational, medical and social measures required The expected results or goals The environmental influence Three historical perspectives are traced in the thesis: a biographical history perspective, an educational/medical and a comprehensive perspective of the history of knowledge. The Nordic thinking of idiocy was strongly influenced from French, Swiss and Prussian forerunners. The first efforts in the Nordic countries were attempted by psychiatrists, theologians and teachers for the deaf and dumb. The precursor in Sweden, a woman, had to connect to the available female/religious strategy of the time for her participation. The study concludes that although the activists spoke about “the time of the idiots” it was also a time for the activists to create possibilities for entrepreneurship and professional careers. The medical knowledge of idiocy was in its infancy. The educational progression was moderate and built upon the theories of the time.