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Scoliosis: dance and swimming. Yes or no?

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Is there any particular sport, rather than others, that individuals with scoliosis should choose? 

Two Isico studies have addressed this question, and in so doing they have dispelled the misconception that dance and swimming have a negative impact on scoliosis curves.

The studies in question will be presented in Melbourne, Australia, at the next SOSORT meeting, this year being held from April 27th to May 1st, 2020, during Spine Week.
As their titles show, these studies — Is swimming helpful or harmful in adolescents with idiopathic scoliosis? and The effect of dance on idiopathic scoliosis progression in adolescents — explore the relationship between scoliosis and two types of physical activity: swimming and dance. 

Swimming and scoliosis

A few years ago, a previous Isico study, Swimming and spinal deformities: a cross-sectional study, exploded another myth.
It showed that swimming has no therapeutic benefit; in fact, the swimmers presented greater asymmetry and hyperkyphosis than the individuals who did not swim.
On this basis, it was concluded that swimming has a negative impact on posture and consequently is not an effective form of prevention. 

The aim of our latest study on swimming was to verify the safety of recreational versus competitive swimming in adolescents with idiopathic scoliosis. 

Of 780 patients fulfilling the inclusion criteria, 529 (68%, 420 females, age 12.3 ± 1.3, 16.0 ± 3.6 Cobb degrees) regularly performed sports activities. 63 (12%) were swimmers, and 15 of these were competitive swimmers. 

“Compared with our 2013 study, in this latest research we did not consider healthy subjects” says Alessandra Negrini, Isico physiotherapist.
“We studied a sample of subjects with mild scoliosis (10-25°, mean Cobb angle 16°), not being treated with braces, and therefore only a clinical population. Our aim was to evaluate, on the basis of radiological findings at 12 months, the effect of swimming in individuals who already have a diagnosis of scoliosis and are going through a growth spurt (Risser-0-2, over 10 years of age). The effect of swimming was found to be comparable to that of other sports, and it was also similar in the competitive and the non-competitive swimmers. Age and hump size were the only factors found to influence the risk of worsening. These findings show that there is no reason to demonise swimming, be it recreational or competitive”.
In other words, they show that swimming is no better or worse than other sports.

Dance and scoliosis

Many spine specialists advise their idiopathic scoliosis (IS) patients to stop dancing on account of the risks (increased spinal mobility and flat back) that are potentially associated with the movements typically involved in this form of physical activity.
“The current literature reports a higher prevalence of scoliosis in subjects who practice dance than in their peers who do not dance” says Michele Romano, director of physiotherapy at Isico. ”In this research, we set out to assess the impact, in terms of the progression of idiopathic scoliosis, of dance compared with other sports in a group of adolescents (545 consecutive scoliosis patients)”.

The patients were divided into two groups: a Sport Activity group (SA – 461 participants), whose members performed any kind of sport, and a group of dancers, the Dance Activity group (DA – 84 patients).

“According to the results, the dancers showed a similar risk of progression as the patients performing other types of sport” Romano concluded. “The small sample size is one limit of the study; larger studies are needed in order to verify the effect of practising dance”.

Scoliosis: there is no particular sport that is more recommended than others 

So, what conclusions can be drawn from the two studies? According to the two Isico specialists, at present there is no evidence to suggest that any particular sport should be preferred over others, or that there is any sport that people with scoliosis should avoid.
Given that neither swimming nor dance, two of the activities most often discouraged for those affected by scoliosis, showed negative effects when compared with other sports, it seems unlikely that other types of sport might have a negative impact.
“The scientific evidence tells us that sport is good for us, and while it may not constitute a treatment as such (unlike specific exercises), it may have a positive effect, supporting the improvements recorded by those with scoliosis” says Alessandra Negrini, “as already shown by my study Effect of sport activity added to full-time bracing in 785 Risser 0-2 adolescents with high degree idiopathic scoliosis (which won the Sosort Award 2019). We at Isico have always believed that it is crucial for our patients to carry on doing sport, especially since their treatment can already be an uphill battle for them. In short, being able to carry on doing sport, something many of these youngsters are passionate about, can make it easier for them to accept the treatment.»

Back pain and scoliosis

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What causes back pain? Well, having a back and two legs to begin with! That’s right! As humans, we have one particular body part that is always going to be more exposed than the others to the risk of discomfort and overloading. And that body part is the spine.

You have probably sometimes wondered why certain people who do heavy jobs and spend their entire lives “mistreating their spine” don’t even know what it means to have back pain.

It is well established that “good” or “bad” loading of the spine is a result of its conformation in the sagittal (lateral) plane, in other words, on the distribution of its curves.
Unfortunately, the lateral profile of the spine, meaning the particular way in which the spine’s natural curves, called lordosis and kyphosis, are distributed, does not depend on the will of the individual, but on a genetic predisposition to one pattern or another.

Basically, whether or not we are predisposed to back problems is a matter of luck.

So, what should we do? Simply resign ourselves to the fact that, morphologically speaking, we are among the less fortunate? Simply accept that we are prone to back pain and put up with it, since there’s nothing that can be done?

No, absolutely not! Because back pain, affecting our work, mood and social activities, can really condition our lives!

Things to know

– You have to take care of your back because, for better or worse, it’s yours and it’s the only one you’re ever going to have.

– Taking care of your back means keeping it fit and knowing how to use it properly. So, make sure you do regular physical activity to keep your spinal muscles in shape, but also your leg and arm muscles. What kind of activity? There’s no “best” kind of physical activity; the important thing is to choose something you enjoy and do it at least twice a week, or better still three times. 

– Knowing how to use your back means making sure that you do not spend too long sitting down. You need to alternate sitting with spells of movement. Also learn to sit correctly, and if your work means you have to spend hours sitting at a desk, look at how to set everything (computer, seat, etc.) at the right height. Also, you need to think about how to correctly manage your body under stress, in other words when it is subjected to loads and also during physical effort.

– It is important to learn about the shape of your own spine and how forces are distributed over the body, and then to assess your particular limits and strengths. It can be helpful to do all this with the support of a specialist who can help to familiarise you with your own specific ergonomic and training needs.

What if I have scoliosis?

Even though there is still a lot to be discovered and learned in this field, we know that scoliosis, as it progresses, creates an abnormal alignment of the vertebrae, which is seen both in the frontal plane (as scoliotic curves) and in the sagittal plane (as changes in physiological lordosis and kyphosis).

Indeed, treatment of scoliosis aims to curb this progression and remodel the spine so that, by the time the individual finishes growing, it is as well aligned as possible.

According to scientific studies, if we can achieve good spinal balance in the sagittal plane (in particular, this means maintaining good lumbar lordosis), and if we can keep the scoliotic curves under 25-30°, the scoliosis outcome will not affect the proper functioning of the spine.

In such cases, the risk of back pain will be the same as that seen in people without scoliosis.

In the presence of more severe curves, it is necessary to be even more aware of the need to safeguard the spine. In the knowledge that it is a delicate and vulnerable part of the body, you must take good care of it and do physical activity to keep your back fit.

Dr Donzelli at Oxford University

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Dr Sabrina Donzelli, an Isico physician, participated some weeks ago in a joint programme in collaboration with the Centre for Evidence-Based Medicine in Oxford, together with other 15 students coming from Egypt, Brasil, Ireland, UK, USA, Ghana, Canada, Hong Kong, Malaysia, Lebano and Italia.

The topic of this demanding course was basic and advanced statistical methods for meta-analysis for health professionals designed to provide an overview of different meta-analysis methods and common problems encountered with extracting data. The module is part of the MSc degree in Medical Statistic provided by the department in  Evidence Based Health Care at Oxford University, Dr. Donzelli was admitted to the program in the Academic year 2019. 

Dr Donzelli is currently a teaching assistant for the online program in Principle and Practice in Clinical Research provided by the Harvard University gathering every year more than 400 students from all around the world.

Isis Navarro at Isico headquarter

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Could you tell us about your studies?

I am a PhD Student at Universidade Federal do Rio Grande do Sul. Since 2017, after I completed the SEAS course, I started to have only patients with scoliosis and work just with these patients. In my master’s degree I studied the surface topography as a possibility of easy and three-dimensional tool to evaluate scoliotic patients. I had some publications based on this primary subject.

https://www.sciencedirect.com/science/article/abs/pii/S0966636218303126

http://www.fortunejournals.com/articles/thoracic-idiopathic-scoliosis-establishing-the-diagnostic-accuracy-and-reference-values-of-surface-topography.html

And I have also some articles accepted for publication:

NAVARRO, ISIS J.R.L.; CANDOTTI, CLÁUDIA T. ; FURLANETTO, TÁSSIA S. ; DUTRA, V. H. ; AMARAL, M. A. ; LOSS, JEFFERSON F. . Validation of a mathematical procedure for the cobb angle assessment based on photogrammetry. Journal of Chiropractic Medicine (Print), 2019.

NAVARRO, I. J. R. L.; CANDOTTI, CLÁUDIA T. ; AMARAL, M. A. ; DUTRA, V. H. ; Gelain, G. ; LOSS, JEFFERSON F. . Validation of the measurement of the angle of trunk rotation in photogrammetry. JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, 2019.

What is your profession?

I am a physiotherapist.

Why did you register for the SEAS  course?

I was looking for the SEAS course, and my plan was to travel to Italy to attend the course, but fortunately Michele and Alessandra came to Brazil to teach for the first group in Brazil. I discovered the SEAS approach doing lots of researches on internet, searching for consistent methods of treatment to scoliotic patients to offer to them the best possibility of treatment and results.

What makes the SEAS learning course different from other educational courses and programs?

The more significant advantage of the SEAS course is the clarity of the reasoning behind the technic and the facility to apply what you learned. The SEAS approach allows doing physiotherapy with all type of scoliotic patients, independent of the type or classification of the curve. The teachers were always ready to answer all the questions and help with difficult cases I asked separately.

Are you satisfied with what you have learned? 

Yes. But when you start to practice more and more always news doubts arise. 

If you were asked to recommend the course, what would you say?

The SEAS course is an excellent way to understand the world of scoliosis, its characteristics and the reasoning to treat adequately and accurately. After the course, you will be able to evaluate and treat scoliotic patients based on a method easy to understand and to apply with a high level of scientific evidence.

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.

The pubertal growth spurt: why is it the main risk for scoliosis?

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Scoliosis is known to be a condition that evolves with growth, the latter being a process that starts on the day we are born and ends when we achieve complete bone maturation (that is to say, at between 16 and 18 years of age, depending on our sex as well as various other subjective factors).
Over this long period of time, however, there are some phases in which the rate of growth speeds up, and these are the times when scoliosis is most at risk of worsening.

One of these phases is the “pubertal growth spurt”, a period of marked and rapid physical transformation that starts with the onset of puberty.

In females, the pubertal growth spurt usually starts at the age of around 11-12 years, as opposed to 13-14 years in males.

In this phase, their growth surges, even to the point of becoming twice as fast as before: whereas youngsters grow at a rate of 5-6 cm each year prior to puberty, during the pubertal growth spurt, they can grow by as much as 10-12 cm per year.

The main difference between these two phases is that prepubertal growth mainly involves the lower limbs, whereas in puberty the extra centimetres gained in height are almost entirely attributable to trunk growth. Therefore, in individuals who already have trunk asymmetries or mild curves, this period demands the utmost vigilance, as the situation can worsen very rapidly.

It is worth pointing out that we are talking about young adolescents, who look after their own personal hygiene and will often tend to close the bathroom or bedroom door when they are showering or getting dressed.
This means that parents, however attentive, may only get the chance to really observe their kids’ backs in the summer months, when they are at the sea or swimming pool.
This explains why, in many cases, changes aren’t spotted until months after they have occurred and the scoliosis has already got worse.

The pubertal growth spurt is thus the most dangerous period of growth for those affected by adolescent scoliosis; in early-onset forms (infantile and juvenile scoliosis) it is also necessary to be highly vigilant in the periods 0-3 and 7-8 years, respectively, as these, too, are periods of rapid growth.

In any case, our advice is always to have a paediatrician or family doctor check a child’s back before the start of these rapid growth phases, in order to allow, if necessary, a timely referral to a spine specialist.
If there is already a family history of scoliosis it is recommended to have the youngster checked directly by a spine specialist every 3-4 months.

World Master 2020: let’s go!

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On January 16 the World Master Online officially opened, now in its fifth edition. Participants come from all over the world with the entry of countries like Colombia, Armenia, Norway, Egypt and Mongolia for the first time.
It is the only online International Master that offers the possibility of training on the Rehabilitation Treatment of Scoliosis.
Over the years there have been over 200 participants, coming from 50 countries for 5 continents.
The Online course does not stop growing, so much so that one of the ideas in the pipeline is to expand the editions, starting to work alongside the English one in Chinese, as we have been asked several times.
What do they say about the Master? “I recommend the experts interested in Scoliosis conservative treatment join this course“. And also “The content is extensive, up to date and evidenced-based. This course gives clinicians a profound understanding of scoliosis and non-surgical management”.

For more info please visit the website: www.scoliosismaster.org

Scoliosis and pregnancy: it’s possible!

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The Isico blog www.scoliosi.org is a dedicated space where patients can ask questions and swap experiences. It is also a place where those involved in treating scoliosis can take a more in-depth look at a series of topics and engage with patients.

Here is one of our published posts

“I have scoliosis, can I have children?” We are often asked this question, and we have no hesitation in answering: “Yes, becoming a mother is a great joy that should be experienced without anxiety, even if you have scoliosis.”

It is, in fact, absolutely untrue that if you have scoliosis you can’t have children. A woman with scoliosis can have children. She should simply consult a spine specialist for advice and curve monitoring. 

Moreover, just like any other woman, she can, based on specialist advice from a gynaecologist/obstetrician, opt for a natural delivery or a C-section. 

During pregnancy, the body produces a hormone called relaxin, which serves to “soften” the back and pelvis, allowing the physiological changes necessary for giving birth.

There will be no particular problems during pregnancy itself, as the expanding uterus supports the column and helps to stabilise it. 

After childbirth, however, the back remains very mobile for a few months, and this is the period in which there is an increased risk of a worsening of the curve, not least because the child, no longer supporting his mother’s back from within, will often be in her arms, placing an added strain on her back.
If the scoliosis is severe, it is a good idea to “plan ahead” and take preventive measures. By working out an appropriate exercise plan before pregnancy and continuing to do the exercises right up to the birth, it is possible to prepare effectively for the critical postnatal period when the mother will probably have less time for exercising!

As for the birth itself, epidural anaesthesia may be well possible.
It depends mainly on whether the woman has had spinal fusion surgery, and, if so, on which part of the spine: if the surgery was performed at the level of the dorsal spine and the lumbar spine is free, then there will be no problem. 
If, instead, the lumbar level was also involved in the surgery, the anaesthesiologist will establish which was the last vertebra involved and, on this basis, decide whether or not an epidural is possible.

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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