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A Brace classification study

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The study Brace Classification Study Group (BCSG): part one – definitions and atlas, published by Scoliosis and Disorders,  represents the first part of the SOSORT consensus in addressing the definitions and providing a visual atlas of bracing.
Prof. Stefano Negrini, Scientific Director of Isico, is one of the authors who belong to a panel of professionals named the Brace Classification Study Group. 
Prof. Negrini explains: “The current increase in types of scoliosis braces defined by a surname or a town makes scientific classification essential. Currently, it is a challenge to compare braces and specify the indications of each brace. A precise definition of the characteristics of current braces is needed“. 
As such, the International Society for Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) mandated the Brace Classification Study Group (BCSG) to address the pertinent terminology and brace classification.
The BCSG introduced several pertinent domains to characterize bracing systems.
The domains are defined to allow for analysis of each brace system. The BCSG has reached a consensus on 139 terms related to bracing and has provided over 120 figures to serve as an atlas for educational purposes. 
During the annual meeting of the International Society for Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) in Athens in 2008, Prof. Negrini presented a new classification under the acronym BRACE MAP.
BRACE MAP derives from the following terms: Building, Rigidity, Anatomical classification, Construction of the Envelope, Mechanism of action, and Plane of action. Each item was composed of two to seven classificatory elements defined using one or two letters in order to refer specifically to the characteristics of the brace throughout the classification.  
“A visual atlas of various brace types is provided – ends prof. Negrini – This is the first clinical terminology tool for bracing related to scoliosis based on the current scientific evidence and formal multidisciplinary consensus”.

How often should a brace be changed?

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Receiving their first brace is a key moment in the treatment of youngsters affected by spinal deformities.
This is the brace that shows them exactly what the treatment consists of. They learn about the pads, which are carefully positioned to correct their back; they become familiar with the fastener and how to adjust it to the right tightness, as well as how the brace sits under the armpits. They also have to get used to the shoulder pads and, quite simply, the weight of the plastic.

Surprising as it may seem, some youngsters even grow quite attached to their first brace as, over the weeks and months, it starts to become a part of their daily life and less of a problem. This “friend”, which they sometimes find irritating, especially early on, gradually feels less and less bulky, and in fact there will eventually come a point when it is too small. After all, while the brace stays the same, the youngster inside it grows of course!

For this reason, a new brace will be needed from time to time. It certainly isn’t possible to use the same one from the start to the end of the treatment. But there are also other reasons why a brace needs to be replaced, the first and most obvious being that, like any object used on a daily basis and for a number of hours each day, it starts to wear out. Indeed, after a time, it is subject to breaking, or some of its parts may no longer be intact.

A further reason, and this is perhaps the most important, is that the brace, especially the first one, moulds the youngster’s back so much that after a few months it becomes necessary to construct a new one adapted to its changing volumes. Unless braces are updated to take this aspect into account, they simply cannot work at full efficiency.

The young scoliosis patient’s back changes not only as an effect of the brace, but also because he/she is normally still growing.
In this stage of development, it is perfectly normal to get taller and heavier. A brace can usually tolerate slight increases in height and weight, but when these are more marked it will start to feel uncomfortable. Even just looking at the youngster in his/her brace can be enough to tell you that the time has come to start thinking about getting a new one made.  
From the second brace onwards, more time can usually elapse between braces. It may even be enough to get a new one about once a year.

Youngsters are often anxious at the prospect of changing their brace, fearing that the new one will be uncomfortable. Actually, however, they are unlikely to experience the same discomfort they had at the very start of the treatment.
In fact, in most cases they will find the new brace is more “comfortable”, given that it replaces one that had become too short and tight, and so no longer adequate. Furthermore, having already had to get used to wearing a brace, these “experienced” patients will be better able to recognise, quickly, any problems with the new one.
This will allow them to give the orthopaedic technician clear feedback, useful for making it fit better.  

A comparison of the Chêneau and Sforzesco braces

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Unfortunately, it has become common to think of braces in the same way as we do drugs. But before we go any further, we need to make one thing clear: whereas we all know that aspirin is not the same as paracetamol, in the case of a brace, the name doesn’t really mean anything specific.
A brace is a product that is made-to-measure for the individual patient, and therefore the success of bracing treatment depends not on the name of the brace, but on how correctly it has been constructed for the particular patient. If the pads are incorrectly positioned, or if the brace is constructed so that it sits too low or presses too much on one side, it may even contribute to worsening rather than improving the scoliosis. 

The names of the different braces, therefore, are meaningful only to those who prescribe them. 

Finally, adding to the confusion, Dr Chêneau gave his name to two completely different types of brace: the first Chêneau is much more symmetrical than the second one, which, on the other hand, is clearly asymmetrical. Although the second Chêneau brace is the one most commonly used worldwide, we prefer to use the first one, for two reasons: first of all, it is discreet (practically invisible under clothes) and second, in constructing it, we are able to apply the same principles that characterise the Sforzesco, which is the brace developed at our own centre. For this reason, the Chêneau that we use at Isico has been given a new name: we call it the Sibilla- Chêneau, in honour of Dr Sibilla, a pioneer of our school.

So, how do the Sibilla-Chêneau and the Sforzesco differ? They differ in several features, which determine the choice of one over the other on a case-by-case basis. The decision to prescribe one type of brace rather than another must always be taken by a medical specialist.

Let’s start with the material: the Sibilla-Chêneau, used at Isico, is of monovalve construction and it is made of polyethylene, whereas the Sforzesco has two valves and is made from a much more rigid material. Its two parts are linked to posterior fasteners, and there is sometimes an aluminium rod at the back, too. Being more rigid, the Sforzesco has shown the same efficacy as the old system of plaster casting, but with the huge advantage of being removable for bathing/showering.

The Sibilla-Chêneau tends to be used to treat milder cases with less rigid scoliotic curves; it is also preferred for pre-pubertal patients. The Sforzesco, on the other hand, is used for more severe scoliosis with more rigid curves (for example, in youngsters with greater bone maturation). 

In some cases, patients start off with a Sibilla-Chêneau brace but subsequently switch to a Sforzesco one if the scoliosis becomes too aggressive (a decision reflecting the concept that the treatment should evolve gradually): on a hypothetical treatment scale, we can say that the Sforzesco (a super-rigid brace) is one step up from the Sibilla-Chêneau (a rigid brace).

At Isico, both these braces are prepared in accordance with the SPoRT (Symmetrical, Patient-oriented, Rigid, Three-dimensional) concept of bracing.

 “Symmetrical” means that the brace, externally, appears almost perfectly symmetrical, which makes it unobtrusive and helps to replicate the natural shape of the human body. In other words, for aesthetic reasons, it is outwardly symmetrical. By contrast, internally the brace acts asymmetrically, exerting a three-dimensional corrective action on the deformity. 

The brace is defined “Patient-oriented” on account of its wearability, and therefore tolerability. Being very closely fitting, it moves with the patient, and it does not restrict arm and leg movements at all. Furthermore, since it is easy to conceal, patients accept it readily, rather than merely putting up with it.

The term “Rigid” refers to the type of material used.

Finally, “Three-dimensional” refers to the corrective action of this type of brace on the spine; technically speaking, the brace pushes in a down-up direction; overall, the transmission of the corrective forces to the spine is carefully balanced in such a way as to obtain optimal correction in all three planes of space, without any of the three being allowed to dominate.

As explained at the start, another type of Chêneau brace is also used worldwide; in Italy, we call this the Chêneau 2000: it is an asymmetrical brace that uses expansion chambers. It remains clearly asymmetrical, even externally.  We, on the other hand, prefer to use the symmetrical version of the Chêneau, in order to respect the SPoRT concept mentioned above and also because it favours compliance. Indeed, applying our school of thought, we have obtained, in our patients, the best bracing results recorded anywhere in the world, and this is thanks, in part, to the type of braces we use. Naturally, braces only work if patients actually wear them, and the easier they are to conceal under clothes, the more patients will wear them.

Active self correction and stabilization: an Isico letter to the editor

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It has just been published a letter to the editor  “The active self-correction component of scoliosis-specific exercises has results in the long term, while the stabilization component is sufficient in the short term” in the scientific journal Prosthetics and Orthotics International. 

“This is a comment to the study “Core stabilization exercises versus scoliosis-specific exercises in moderate idiopathic scoliosis treatment” –explains dr. Alessandra Negrini, Isico physiotherapist and author of the letter – the authors of the research compared two groups included Scientific Exercises Approach to Scoliosis (SEAS) and core stabilization. Scoliosis-specific exercise schools like SEAS include two main components: active self-correction (ASC) and stabilization. Consequently, a common intervention was provided to the two groups (stabilization) in this study, while the SEAS group also received ASC”.

Follow-up X-rays were taken after only 4 months. According to the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT)/Scoliosis Research Society (SRS) criteria, these results should be classified as a very short-term assessment. No significant difference was found between the two interventions. The patients were more adherent to the brace than to the exercise therapy. “Unfortunately, the authors did not mention if there was a difference in the adherence to bracing between the groups: this variable is expected to impact the results more than the type of exercises -adds dr. Negrini – Experts agree that stabilization exercises are more important during the first treatment phase (when the brace maintains for many hours every day the alignment of the spine and exercises are aimed to counteract muscle impairment). Exercises in ASC are more important in maintaining the obtained results when the brace weaning phase starts, when the patients should live sustaining in correction their spine without the brace support”. 

It is important for the future to determine when to start ASC: immediately (even if it could add nothing to stabilization) or when weaning starts (when it could be too late)?

The full letter: https://pubmed.ncbi.nlm.nih.gov/32524898/

Friends and brace

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Adolescence and bracing are two challenges that can be difficult to face simultaneously. 

In our view, this is perfectly natural and understandable.

Adolescence is usually perceived as a difficult phase during which young people are still immature, tend to be irrational, and struggle to control their emotions. However, research studies focusing on the development of the adolescent brain have recently debunked these myths, allowing adolescence to be understood, from a more modern perspective, as a life stage characterised by numerous possibilities, great creativity, and a desire to experiment.

However, it is also a time of great changes, when youngsters are particularly vulnerable. Their increasing need for freedom and independence sees them looking outside their immediate family; accordingly, friends assume a more and more central role, becoming the basis and starting point for building their self-awareness and personal identity.

At this age, then, finding yourself faced with the prospect of wearing a rigid brace for up to 23/24 hours a day certainly isn’t easy.

A young person who has just been prescribed a brace can experience many different emotions, which vary from individual to individual: some will feel angry, others sad; some may be fearful or feel ashamed.

Shame is an emotion that stems from the fear that others will judge us. What are my friends going to say when they see me in a brace? What will they think if they find out I have scoliosis? 

In adolescence, precisely because this is a time when we are still working out who we are, we can be particularly sensitive to the opinions of others; we want to fit in, and we fear rejection. 

For these reasons, having to wear a brace can be seen as an obstacle to the formation of friendships and early romantic attachments. It becomes a secret to be kept strictly within the family. Some youngsters try to keep their brace hidden under their clothes and avoid physical contact with others, to the point of avoiding those activities in which their brace would have to be exposed, and thus depriving themselves of a whole series of experiences. 

In this way, they become victims of their own secret.

Hiding a brace requires a lot of effort. Is it really the best thing to do?

Even though hiding is a natural and automatic response when we feel ashamed, it is also the most harmful. Instead, the least natural and least automatic (i.e. “telling the truth” and showing yourself) is the most beneficial! When you find out that you have to wear a brace, the best thing to do is to tell your friends and classmates about it immediately. Although this might seem difficult, it is far easier than trying to keep the fact a secret. Start by telling your closest friends, and then gradually share the news with everyone else.

You really have nothing at all to be ashamed of. Quite the opposite: you should be proud of what you are doing in order to have a healthy back!

Authors: Irene Ferrario, psychologist and Antonella Napolitano, physiotherapist

Summer in a brace

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Summer is here at last and it is finally time to go on your long-awaited summer holidays. The problem is, you have to take a particularly annoying friend with you – your back brace, which is particularly difficult to put up with at this time of year. Yes, spending summer in a brace is another challenge you are about to face, and one that perhaps had not occurred to you until now.

Prospecting to spend your summer in a brace, you are probably starting to think that this piece of plastic can turn, what should be a fun-filled time, into a nightmare!  

So, what can you do about it?

First of all, it is important to understand that this is a challenge that you need to tackle head on, with the vital support of your family, but also drawing on your own resources. In the end, everyone finds themselves having to rise to challenges of some kind in their teenage years. Whatever these consist of, extreme sports or expeditions in the great outdoors, letting someone know how you feel about them, or working out how to respond to a first declaration of love, you, as adolescents, are probably already realising that now is the time to show just what you are made of!

The best thing is to draw on all your reserves of determination and self-discipline. It is also important to listen to good advice. For example, make sure you make the most of your brace-off time each day, and if you are a full-time brace wearer, why not consider spending your holidays somewhere cooler, such as up in the mountains?  

How can I stick to my prescribed brace-wearing time and still enjoy my holidays?  

Unfortunately, when your scoliosis is still “evolving” and liable to worsen spontaneously, deciding to reduce your brace-on time is very risky. Stopping scoliosis from progressing is already very difficult, and if it does worsen it is very difficult to reverse the trend and “correct” the damage.
We understand that the summer is a particularly difficult time if you wear a brace, and that you have to make many sacrifices. However, if you don’t take your treatment seriously, you could end up in the same position as many adults who have your same problem: they avoid going to the swimming pool or seaside because they feel embarrassed being seen in a swimming costume, and in their case, it’s too late to do anything about it.
So, try to stay determined in your battle against scoliosis, also in the summertime, because in the end, the results will make all your efforts worth it.

How can I best manage my brace-wearing time?

The main thing is to make the most of the hours when you can leave your brace off, and it might also be worth choosing to spend your holidays somewhere cooler, such as up in the mountains, especially if you have to wear your brace round the clock. If you are travelling by plane, we recommend that you take your medical prescription with you, translated into other languages as necessary.

In hot weather, there are some simple things you can do to prevent minor problems and discomfort: wash frequently and change your t-shirt often (do this quickly so as not to be out of your brace for too long). You may also want to apply thin panty liners to the brace where it fits under the armpits; these can be changed frequently, especially in the summer, when you sweat more.

In most cases, it is fine to keep your brace on when you go in the sea or in the swimming pool. In other words, these activities don’t have to be concentrated in your hours of “freedom”: you can simply bathe in your brace. Before you do, though, just bear in mind the following rules, take care, and remember that unfortunately not all braces allow you to do this.

Six rules for bathing if you wear a brace:

  • If you wear a Thermobrace device, this must be removed before you enter the water. Do not leave it in the sun, and put it back in place when you have finished bathing. 
  • If you have been in the sea, you will need to rinse the brace well in freshwater to get rid of the saltiness.
  • Dry the brace thoroughly.
  • Do not use hot air from a hairdryer to dry the brace pads and do not expose your brace to the summer sun, because the sun can overheat the metal parts and, as well as making them hot, will cause them to dilate. Basically, as the brace heats up, the holes where the hinges are attached to the plastic shells will expand and become deformed. The danger is that this can ruin the brace, because as the brace subsequently cools down, the metal part will return to its original size while the plastic will remain permanently enlarged and deformed.
  • If the brace pads are covered in Alcantara®, let them dry out thoroughly, as this material is easily spoiled.
  • As an extra precaution, you could use a stretchy seamless fabric tube to “line” your brace before going in the water (SOFT-TUBE or a similar product).

WARNING!

  • You cannot bathe or swim with your brace on if the strip protecting your abdomen is made from leather (another material that will be spoiled if it is allowed to get wet: you must first replace it with a plastic one (talk to your orthopaedic technician about this);
  • If you are trying out your brace, or just about to do so, contact the orthopaedic laboratory for more information, and to find out about the procedures to follow for your type of brace;
  • It is important to follow the above precautions carefully: a brace is a medical device and you should not let it get damaged through negligence.

Do not go in water where you are out of your depth, even if you can swim!

Don’t forget you can find lots more information and instructions in our handbook “Do you wear a brace? Here is Isico’s advice”:

you can download it from the Isico website.

Scoliosis: can it harm the lungs?

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Can scoliosis harm the respiratory system? Patients often ask us this question, as it is an aspect that particularly worries them.

The main purpose of the rib cage – we have 12 ribs – is to protect vital organs such as the heart and lungs.

Scoliosis, as we know, takes the form of spinal abnormalities in the three planes of space: the spine presents lateral curvature in the frontal plane, rotates on itself in the horizontal plane, and is shifted forward or back in the sagittal plane, increasing or decreasing lordosis and kyphosis (the spine’s natural curves).
The ribs, being closely linked to the spine, adapt to these abnormalities, and develop changes of their own. This explains why people can be concerned that scoliosis may impair the respiratory function or vital capacity of the lungs.

Let us try and clear up some of these issues, drawing on relevant scientific research data.  

First of all, the latest studies have shown a correlation between impaired lung function and scoliosis only in very severe cases (i.e. curves greater than 80°).

Let us clarify a further point: the alterations of the trunk and rib cage caused by the spinal deformity should not be considered solely from the perspective of the size (in degrees) of the curve; indeed, although this is certainly a significant parameter, it is not the only one. A patient who, despite having severe scoliosis, retains a well-balanced back with regard to other parameters, such as thoracic kyphosis, could have better function than one with less severe curvature of the spine.
As we know, “flat back” (a posture characterised by markedly reduced kyphosis) is a negative consequence of scoliotic curvature of the thoracic spine; this is why, in daily clinical practice and in the construction of braces, we try to avoid this phenomenon, which is also related to reduced lung capacity.

Other important factors that should be evaluated, and not underestimated, are lifestyle and quality of life. Keeping active and doing physical activity designed to improve respiratory fitness can undoubtedly make the difference in terms of maintaining adequate respiratory capacity.
Essentially, the risk of mild or medium scoliosis harming the respiratory system is very low. Meanwhile, in the presence of very severe scoliosis, the size of the curve may not be the only factor determining the correlation with decreased respiratory capacity, since other factors, both anatomical and lifestyle related, can also come into play.  

Studies along these lines are ongoing, their aim being to shed as much light as possible on these aspects, so as to be able to offer patients the best possible treatments, both preventive and conservative.

Friends and bracing

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Adolescence and bracing are two challenges that can be difficult to face simultaneously. And, in our view, this is perfectly natural and understandable.
Adolescence is usually perceived as a difficult phase during which young people are still immature, tend to be irrational, and struggle to control their emotions. However, research studies focusing on the development of the adolescent brain have recently debunked these myths, allowing adolescence to be understood, from a more modern perspective, as a life stage characterised by numerous possibilities, great creativity, and a desire to experiment.

However, it is also a time of great changes, and it is these that make this a period in which youngsters are particularly vulnerable. Their increasing need for freedom and independence sees them looking outside their immediate family; accordingly, friends assume a more and more central role, becoming the basis and starting point for building their self-awareness and personal identity.

At this age, then, finding yourself faced with the prospect of wearing a rigid brace for up to 23 hours a day certainly isn’t easy.

A young person who has just been prescribed a brace can experience many different emotions, which vary from individual to individual: some will feel angry, others sad; some may be fearful or feel ashamed.

Shame is an emotion that stems from the fear that others will judge us.

What are my friends going to say when they see me in a brace? What will they think if they find out I have scoliosis? 

In adolescence, precisely because this is a time when we are still working out who we are, we can be particularly sensitive to the opinions of others; we want to fit in, and we fear rejection. 

For these reasons, having to wear a brace can be seen as an obstacle to the formation of friendships and early romantic attachments. It becomes a secret to be kept strictly within the family.
Some youngsters try to keep their brace hidden under their clothes and avoid physical contact with others, to the point of avoiding those activities in which their brace would have to be exposed, and thus depriving themselves of a whole series of experiences. In this way, they become victims of their own secret.

Hiding a brace takes some doing. Is it really the best thing to do?

Even though hiding is a natural and automatic response when we feel ashamed, it is also the most harmful. Instead, the least natural and least automatic (i.e. “coming clean” and showing yourself) is the most beneficial! When you find out that you have to wear a brace, the best thing to do is to tell your friends and classmates about it immediately. Although this might seem difficult, it is far easier than trying to keep the fact a secret. Start by telling your closest friends, and then gradually share the news with everyone else.

You really have nothing at all to be ashamed of. Quite the opposite: you should be proud of what you are doing to have a healthy back!


Living “In self-correction”. Is it possible?

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First of all, what is self-correction?

Kids who have scoliosis and perform SEAS exercises regularly know well what it is.
Scoliosis modifies the physiological position of the column and causes a deformity in the three planes of space.

Seen from behind, there is that curve that is easily recognizable in radiographies: the spine, instead of being straight, bends to the side.

Seen in profile, the curves that are normally present (lumbar lordosis, dorsal kyphosis, cervical lordosis) and which guarantee elasticity and the ability to absorb the recoils, are modified, often diminishing: those who have scoliosis usually seem more straight than the other kids. Finally, seen from above, the column rotates on itself, making the so-called “hump” come out, which is nothing but a part of the ribs or back muscles that move backwards to the side. Practically back, while bending sideways, twists. All these changes result in a loss of height.

Self-correction is a correction of all these anomalies. The goal is to take back the spine where it should be if there was no scoliosis, in a physiological position.

Self-correction allows the patient to achieve greater symmetry and a more well-balanced back in the sagittal plane. 
Acquiring the technique from the outset and applying it as often as possible in daily life should be the goal. 

The movements that make up the self-correction have strange names: translation… derotation… kyphotisation… antigravity support…

At the beginning, performing them is as difficult as pronouncing them. Still, starting with a good awareness of your body and your deformity in space, you gradually become confident, and kids manage to “unroll” their column by straightening it in a few tenths of a second.

It is the self-correction that makes every single scoliosis-specific exercise effective, because without it every exercise would be devoid of the therapeutic purpose, thus becoming a simple sport exercise.

The difficult thing for physiotherapists is not so much choosing the most suitable exercises, but the best self-correction for that particular kid in that moment of his growth and his therapy. Unfortunately, a poorly chosen, poorly adapted, poorly performed self-correction, could even make the exercises harmful.

As soon as kids learn how to perform their self-correction in the exercises, the therapist begins to ask them something that seems difficult to achieve: maintaining this correction in everyday life.

The first step is to do it here and there during the day: it is suggested to remember it for example at the sound of the bell at school, in the elevator, walking… Slowly, one is simply asked never to relax completely, until he accomplishes to live in self-correction.

But… is it possible?

Many kids confirm that it is possible, so much so that towards the end of the therapy many say: “Relaxing on the side of the curve annoys me, I don’t feel right on that side…”.

At this point, the most important goal of the therapy has been achieved, and the back of these kids will remain stable, without the risk of starting to bend again during adulthood.

A Christmas Carol from Isico

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Our very best wishes for Christmas and 2020: a whole new year for each of us to “shape” as we like! 

Our greetings come to you with a story.
More than just a trip down memory lane (to the bike rides and dripping lollipops of our youth), “Liquorice Wheels” is a story of hope: a reminder that things work out for the best, most of the time!

Thanks to Roberto Angero, father  of a young Isico patient, who shared with us “his” story and we want to share this story with you as our Christmas Carol for this year.

Liquorice Wheels

Every kid in town would stop to watch him, especially when he reared up for more than a dozen consecutive pedal turns. He could do that – we counted them! He would lift his BMX like a tamed horse and then, balancing on the back wheel, would twist the handlebars, first right and then left. He could steer while rearing, too, and even jump up onto the pavement.

In the afternoon, after homework, we would wait for him on the playing field. He was always the last to appear, and you couldn’t leave without him. Simone was the one with the best bike — the best not because it was new, but because it had belonged to his cousin, who had been in a gang war.

That’s what he used to tell us at least. Simone showed us all the scratches the bike had acquired during various raids, but the thing that amazed us was that sticker on the crossbar with “Iron Maiden” written on it. Simone told us that only gang leaders had that sticker. I believed it because I once saw one on my brother’s friend’s Vespa. Surely, he must have been a gang leader, too, because everyone else just had a Garrelli scooter, and no sticker! Once everybody had arrived at the playing field, we could leave, with Simone in the lead. Elisa, who had a Graziella (ladies’ bicycle), was the prettiest in the group, but she would only ever talk with Simone, and sometimes with Sandrino, too. Filippo, instead, rode a red Saltafoss (mountain bike) with a gearbox, and I remember that he used to make us laugh a lot because he could imitate all our teachers. 

Then there was Tommy, who always brought the ball, which he kept in a plastic bag hanging from his handlebars. Jessica, meanwhile, used her mother’s bike, which had a basket, and she could barely reach the pedals. I remember she wasn’t as pretty as Elisa, and she also wore a strange body brace because she said she had a crooked back, but she always had a great supply of sweets. Sandrino was always the one with a new bike — he used to say that his father was rich —, but he never let anyone have a go. On just one occasion he let Elisa have a ride in exchange for a kiss on the cheek, but that was the one and only time. He was very possessive with his belongings.

The group also included Carlo and Marco, the “little twins”, who were inseparable. They had identical bikes, and they both rode one-handed because the other hand was always holding a lollipop, which dripped to the elbow. Actually, they weren’t twins at all. They had been friends since kindergarten, but they did look very similar, maybe because of all the time they spent together! Then there was me. With my gold coloured bike. Always bringing up the rear. 

Simone usually led the group, and we all fell in behind him, including me, of course. We moved in single file, except for Carlo and Marco, who rode side by side. Whenever Simone decided to go faster, we all had to speed up, but we made sure we never overtook him. We used to go round town that way. Our town, Somma, seemed very little at the time, and we felt like the whole place belonged to us.

There was a group of younger kids that we often encountered, and when we did Simone would rear up, leaving them astonished. On the other hand, we were always careful to avoid the older groups. We were scared of them, although Simone always said that they would never stick around if his cousin were with us! Our bike ride usually ended up at Paradise Street, which was legendary! It was a hilly road that made for a thrilling ride. We would all stop at the top of the first hump. We kept in line, except for Marco and Carlo, and no one ever went before Simone did. The second to go was always Filippo, who would imitate our maths teacher as he careered headlong down the hill, leaving us doubled up with laughter. Brilliant!

Gradually, all the others followed suit, racing down like there was no tomorrow. Jessica and I, on the other hand, almost never took part because we were afraid of falling off. Well, I was afraid of falling off. Jessica didn’t want to ruin her mother’s bike, or so she said! So, we would wait for the others, eating sweets together. After Paradise Street, we would make our way to the playing field. Tommy would get the ball out, while Simone and Filippo formed the teams. These were never even, of course. I always ended up with Marco, Carlo and Jessica. They weren’t much good at football and, what’s more, they always put me in goal. The other team always scored loads of goals, and at the end of the match Simone would tell me I had been lucky because, if his cousin had been there, they would have scored many more. And I let myself believe it.

In those days, evening always came far too fast. You started to hear someone’s mum calling in the distance, usually Sandrino’s, and we knew it was time to call it a day. 

Simone was always the first to go home, quickly followed by Elisa. Tommy would put the football back in its bag, while Filippo would do one of his famous imitations, such as our religious education teacher in a temper, screaming at everyone in a falsetto voice.

Those were the last laughs of the evening. I had to go home, too. I usually said goodbye to Jessica first who, in exchange, gave me a liquorice wheel, while the twins went off together as usual, happily challenging each other to an armpit raspberry contest!

Today, 30 years later, sitting on a bench near those places (now gone) where we used to play, I am lost in thought. The memories of the past blend with thoughts of the present. I find myself remembering how I was always the last one and Simone the cool one.

No one would think that seeing him today: once the blond “golden guy”, now he is overweight, grizzled and balding. He doesn’t have a secure job, and is constantly looking for some “cousin” to liven up his dull life. I also thought about everyone else. For example, about Marco and Carlo, who, years later, still seek each other out just like they did as small children: a brotherly bond that will last forever. I think about Elisa, who used to run after a thousand cool guys like Simone, in the futile hope of finding her Prince Charming among them. Today, she’s still as beautiful as ever; after three divorces, she has now moved on to yet another flashy entrepreneur. Tommy hasn’t changed either: he’s just as “public-spirited” as he always was. Back then he was the one who always thought to bring a ball, now he’s the one likes to get a round of beers in for everyone, especially if Filippo is there. Filippo still loves to entertain everyone, and the more beer he drinks, the more he shoots his mouth off, cracking us all up! Unfortunately, we’ve seen little of Sandrino since his dad’s company went bankrupt, and he had to start learning to get by on his own. By all accounts, he’s not doing too well: he drives a dilapidated van now and has maybe even moved away.

And so that just leaves me. I used to feel like I was at the back of the queue in life, but now I have come to realise I am the luckiest of the bunch. I still have my old friends, but mainly I have Jessica, my lovely wife — now with a perfectly straight back —, who has been by my side all these years, making sure I’m never short of love and affection, or sweets! There’s no point hiding the fact: I’ve always been mad about her!


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