Pre-season adductor squeeze test and HAGOS function sport and recreation subscale scores predict groin injury in Gaelic football players

Is hip adductor or abductor strength in healthy athletes associated with future groin pain? A systematic review and meta-analysis

OBJECTIVE

To systematically review the association between hip adduction and abduction strength, and adduction-to-abduction strength ratio in healthy athletes with the occurrence of future groin pain and time-loss groin injuries.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

PubMed, Web of Science, SPORTDiscus, PEDro, Embase, and Scopus.

ELIGIBILITY CRITERIA

Studies included had to (1) measure hip adductor or abductor strength in healthy athletes, (2) conduct a follow-up period to assess the occurrence of groin pain, (3) present strength data separately for participants who remained uninjured and those who suffered an injury and (4) use a prospective design. Risk of bias was assessed according to the Quality in Prognosis Studies tool. The certainty in the evidence appraised was measured using the Grading of Recommendations Assessment Development and Evaluation approach.

RESULTS

Thirteen prospective cohort studies met the inclusion criteria. Overall study risk of bias was rated as low. Players who remained uninjured had stronger adduction strength compared with players who subsequently suffered groin pain (standardised mean differences with 95% CIs (SMD=-0.5, 95% CI -0.92 to -0.09)) and time-loss groin pain (SMD=-0.68, 95% CI -1.31 to -0.06). Trivial effects were observed for abduction strength (groin pain SMD=0.03, 95% CI -0.11 to 0.17; time-loss SMD=-0.07, 95% CI -0.25 to 0.11) and adduction-to-abduction strength ratio (groin pain SMD=-0.02, 95% CI -0.55 to 0.51; time-loss SMD=-0.11, 95% CI -1.11 to 0.89). Age and diagnostic criteria were not significant moderators of the relationship between adductor strength and groin pain (p=0.72 and p=0.12).

CONCLUSION

There is a moderate effect of hip adductor strength on the occurrence of groin pain, while there is no relationship between either abductor strength or the ratio of adductor-to-abductor strength with the occurrence of groin pain.

PROSPERO REGISTRATION NUMBER

CRD42024548630.

Hip adductor strength tests used in the context of sports: practical considerations

Hip and groin injuries are prevalent in team sports involving high-intensity actions and multi-directional activities. A hip adductor strength test is a widely used tool to assess hip adduction strength, which is a key risk factor for these injuries. Despite its common usage, there is a lack of standardized guidelines regarding the measurement protocol, leading to inconsistent and unreliable applications. This review aims to synthesize existing research on hip adductor strength testing, highlighting the importance of developing clear guidelines for its implementation. This review covers various aspects of the test, including pre-test warm-up protocols, body positioning, device placement, test execution, verbal commands, data collection and selection, and timing of tests. Key findings suggest that standardized warm-up routines, consistent body and device positioning, clear verbal commands, and specific criteria for invalidating test trials are critical for enhancing the reliability and accuracy of the test. Furthermore, consistent timing and the documentation of test conditions are essential for effective athlete monitoring and injury prevention. By establishing and adhering to these guidelines, sports scientists and medical personnel can make well-informed decisions about athletes' hip adduction strength, ultimately improving injury prevention and performance outcomes in sports.

Optimizing Conservative Management of Groin Pain in Athletes: Insights from a Narrative Review

Background: Groin pain is a complex and multifactorial condition commonly observed in athletes, often impairing performance and quality of life. While conservative treatments are the first-line approach, the variability in intervention protocols and inconsistent evidence necessitate a comprehensive synthesis of current knowledge. Methods: This narrative review analyzed the available literature on conservative management of groin pain in athletes. A systematic search was conducted across the MEDLINE, Cochrane CENTRAL, Scopus, PEDro, and Web of Science databases. Studies focusing on pain reduction, functional recovery, return-to-sport outcomes, and prevention strategies were included. Findings were synthesized to evaluate the efficacy of conservative interventions and identify gaps in the evidence. Results: Conservative treatments, particularly active rehabilitation and multimodal therapy, demonstrated significant efficacy in reducing pain (50-80%) and improving function, as measured by tools such as the HAGOS score. Return-to-sport rates ranged from 70% to 90%, depending on intervention type and adherence. Screening tools, including the adductor squeeze test, were effective in predicting and preventing groin injuries. However, variability in methodologies, small sample sizes, and a lack of long-term follow-up limited the generalizability of the findings. Conclusions: Conservative management remains a cornerstone for treating groin pain in athletes, offering effective outcomes for pain reduction, functional recovery, and injury prevention. However, standardized protocols and high-quality research are needed to enhance clinical guidance and optimize patient outcomes.

Hip adduction and abduction strength values in NCAA Division I American football players: Strength values and a comparison across position groups

OBJECTIVES

To report hip adduction, abduction, and adduction:abduction strength ratio values in NCAA Division I American football players, and to compare strength values across position groups.

DESIGN

Cross-sectional study.

SETTING

University training facility.

PARTICIPANTS

85 male football players.

MAIN OUTCOME MEASURES

Isometric hip adduction and abduction strength values in the 0° hip-flexion long-lever and 0° hip-flexion short-lever testing positions, using a ForceFrame.

RESULTS

Hip strength values are presented across two testing positions. ANOVA revealed significant differences (p ≤ 0.05) in hip strength between position groups, with medium-to-large effect size (n2 = 0.116-0.284). Skill-position and mid-position players demonstrated significantly greater hip adduction and abduction relative strength in both testing positions, when compared to lineman-position players. In addition, skill-position and mid-position players demonstrated significantly greater hip adduction:abduction strength ratios (0.19-0.20, 24-25%) in the long-lever testing position, when compared to lineman-position players, with large effect size (n2 = 0.178). No significant differences in strength were observed between skill-position and mid-position players. Hip adduction:abduction strength ratios ranged from 0.68 to 0.88 in the long-lever testing position and 1.05 to 1.09 in the short-lever testing position.

CONCLUSION

Significant differences in relative strength exist between position groups of NCAA Division-I football players, in hip adduction, abduction and adduction:abduction ratio.

A comparison of force generation in isometric hip adductor strength exercises: Introducing the weighted isometric Copenhagen Adduction exercise

OBJECTIVES

To compare maximal isometric force generation between hip adductor long-lever squeeze, the Copenhagen Adduction (CA) exercise with body-mass only, and the weighted isometric CA exercise, in rugby union players.

DESIGN

Cross-sectional study.

SETTING

Club training facility.

PARTICIPANTS

Forty-four male, rugby union players.

MAIN OUTCOME MEASURES

Maximum isometric hip adduction squeeze strength in the long-lever testing position, in addition to maximum isometric force data in the isometric CA exercise, and the weighted isometric CA exercise with increasing load.

RESULTS

Significantly greater (p ≤ 0.05) torque (Nm/kg) was observed in athletes when performing a weighted isometric CA exercise with: 105% body-mass (0.22Nm/kg, +6.8%), 110% body-mass (0.44Nm/kg, +13.1%), 120% body-mass (0.80Nm/kg, +22.6%), 130% body-mass (1.16Nm/kg, +31.3%), 140% body-mass (1.58Nm/kg, +40.8%) and 150% body mass (1.96Nm/kg, +48.3%), in comparison to the isometric CA exercise, with large effect size (ES = 1.372-5.196). Significantly greater torque was also observed when compared to the isometric hip adduction long-lever squeeze exercise, with large effect size (ES = 2.022-4.091). Twenty-nine athletes reached one maximum isometric repetition in weighted isometric CAs at either 130% body-mass (n = 16) or 140% body-mass (n = 13).

CONCLUSIONS

The weighted isometric Copenhagen Adduction exercise demonstrates greater force output than the isometric CA and the long-lever squeeze.

Hip Adduction and Abduction Strength Reference Values of Gaelic Football and Rugby Union Players: A Cross-Sectional Study

PURPOSE

The purpose of this research was to report isometric hip adduction and abduction strength reference values of men's and women's Gaelic football and rugby union players and compare values between sexes and between sports.

METHODS

This cross-sectional cohort study consisted of 331 club-level athletes. Maximum isometric hip adduction squeeze and abduction press strength values were measured with a ForceFrame across several testing positions.

RESULTS

Hip adduction squeeze and abduction press strength reference values for men's and women's Gaelic and rugby union footballers were provided with mean and 1 SD. A 2-way analysis of variance demonstrated significant sport × sex interaction main effects for hip adduction squeeze (η2 = .159-.228), abduction press (η2 = .099-.144), and adduction:abduction ratio (η2 = .120). Men demonstrated significantly greater relative (Newtons per kilogram) maximum isometric hip adduction squeeze (15.5%-26.4%, 0.48-1.00 N/kg) and hip abduction press (9.6%-19.6%, 0.20-0.67 N/kg) strength across all testing positions when compared with women of the same sport. Male Gaelic football players demonstrated significantly greater hip adduction (8.7%-14.0%, 0.30-0.52 N/kg) and abduction (6.1%-8.6%, 0.16-0.31 N/kg) strength (Newtons per kilogram) than their rugby counterparts, while no significant between-sports differences in strength were observed between female athletes.

CONCLUSION

Reference values are provided with mean and 1 SD. Sport and sex interaction had significant main effects for hip adduction, abduction, and adduction:abduction ratio, with medium to large effect sizes. Male athletes demonstrate significantly greater hip strength than female athletes of the same sport, and male Gaelic players demonstrate greater hip strength than male rugby players.

A practitioner's guide to isometric hip adduction and abduction test selection: Maximal force, asymmetry, and muscle activity comparisons between assessment positions

The purpose of this study was to compare maximal adduction (ADD) and abduction (ABD) force, ADD to ABD ratio (ADD:ABD), inter-limb asymmetries and muscle activity between five isometric hip strength assessment positions. Twenty male athletes performed the following positions: seated (SE), supine at knees with 0° hip flexion (SK0°) and 45° hip flexion (SK45°), and supine at ankles bilaterally (SABI) and unilaterally (SAUNI). Normalised muscle activity (%EMGmax) of adductor longus (ADDLONG), gracilis (GRAC), gluteus medius (GMED), sartorius (SAR), and lower rectus abdominis (RECABD) were also assessed. Significant main effects of assessment position were identified for relative peak force (rPF) and torque (rT), ADD:ABD, ADD asymmetry, and %EMGmax. Significantly greater ADD and ABD rPF and rT were observed in SE and SK45° compared to SABI and SAUNI. SK45° elicited the highest ADDLONG and GRAC %EMGmax during ADD, with SE and SK45° evoking the highest GMED %EMGmax during ABD. SK0° exhibited significantly higher ADD:ABD compared to all positions except SAUNI. ADD asymmetry was significantly largest in SAUNI, and RECABD %EMGmax was highest in SABI during ADD. This data can inform selection of assessment positions based on whether the primary measures of interest are maximal force and muscle activity, or identifying asymmetries.

Hip adduction and abduction strength values in elite-level male and female youth soccer players: A comparison between sexes, and across age-groups

OBJECTIVES

To report isometric hip adduction squeeze and abduction press strength values of elite-level youth male and female soccer players and examine if differences exist between sexes, and age-groups.

DESIGN

Cross-sectional cohort study.

SETTING

Elite youth soccer academy.

PARTICIPANTS

102 soccer players (n = 64; male, n = 38 female) competing in the national youth soccer leagues from under (U) 14-19 years of age level (U-14, U-15, U-17, U-19).

MAIN OUTCOME MEASURES

Isometric hip adduction and abduction strength values were measured with a ForceFrame in various testing positions.

RESULTS

Isometric hip adduction and abduction strength values are presented. Male U-17 and U-19 players demonstrated significantly greater (p < 0.05) absolute(N) and relative (N/kg) hip adduction and abduction strength than their female counterparts, with large (η2 = 0.068-0.227) and medium-to-large (η2 = 0.049-0.234) effect size, respectively. Significant differences in absolute strength, but not relative strength, were observed for hip adduction and abduction between male age-groups (U-14, U-15, U-17, U-19), with hip abduction strength differences only existing between U-14 and U-17 groups. No significant differences in hip strength were observed between U-17 and U-19 groups for female players.

CONCLUSION

Male youth soccer players have higher absolute and relative hip adduction and abduction strength than females at the U-17 and U-19 level.

Hip and Groin Problems in Female Team-Sport Athletes: A Cross-Sectional Study

Background

Hip and groin problems are common among team-sport athletes. However, few studies have been conducted in female athletes that have used the Doha Agreement classification system to categorize these problems.

Purpose

The purpose of this study was to examine the preseason point prevalence of hip and groin problems in elite female team-sport athletes. Secondary aims were to categorize the groin problems according to the Doha Agreement classification system and to explore the association between hip muscle strength and self-reported hip and groin function.

Study Design

Cross-sectional study.

Methods

Female athletes who participated in various sports underwent preseason assessment of isometric hip adduction and abduction strength, with pain levels recorded during respective contractions, and self-reported function on the Copenhagen Hip and groin Outcome Score (HAGOS). If any athlete reported current hip and groin problems during this screening assessment, a full, standardized clinical hip and groin examination was undertaken. These hip and groin problems were then categorized according to the Doha Agreement classification system. Comparisons between the participants with vs without hip and groin problems were made, and correlational statistics were used to examine relationships between strength and HAGOS scores.

Results

Ninety-one elite female athletes from six different sports were included in the study. Thirteen athletes reported current hip and groin problems, with an overall prevalence rate of 14.3%. Iliopsoas-related groin pain was the most common category diagnosed, accounting for 58.8% of cases, followed by hip-related groin pain (17.6%), adductor-related (11.8%), and inguinal- and pubic-related pain (both 5.9%). No association was found between strength and function.

Conclusion

The hip and groin point prevalence in female athletes documented during preseason appears to be similar to those reported in male athletes. Iliopsoas-related groin pain was the most common clinical entity reported in female athletes in this study. There was no association between hip muscle strength and self-reported hip and groin function.

Level of Evidence

3b.

Lower HAGOS subscale scores associated with a longer duration of groin problems in football players in the subsequent season

Introduction

Groin injuries represent a considerable problem in football. Although the Adductor Strengthening Programme reduced groin injury risk, players can still experience groin symptoms throughout the season. This study aimed to determine whether preseason Copenhagen Hip and Groin Outcome Score (HAGOS) and a history of previous injury can identify individuals at risk of having a longer duration of groin problems the subsequent season, using an 'any physical complaint' definition of injury.

Methods

Preseason HAGOS score and weekly groin problems were registered with the Oslo Sports Trauma Research Center Overuse questionnaire during one full season in 632 male semiprofessional adult players.

Results

The prognostic model showed a decreased number of weeks with groin problems for each increase in HAGOS score for 'groin-related quality of life' (QOL) (IRR=0.99, p=0.003). A 10-point higher 'QOL' score predicted 10% fewer weeks of groin problems. Additionally, previous hip/groin injury was associated with a 74% increase in the number of weeks with symptoms (p<0.001).

Conclusion

The HAGOS questionnaire applied preseason can detect players at risk of getting more weeks with groin problems the following season. The 'QOL' subscale seems to be the superior subscale for estimating subsequent groin problem duration. While HAGOS appears promising in identifying players at risk, previous groin injury is the most robust indicator, showing a substantial 74% increase in weeks with symptoms.

Inter- and intra-session variability of compression strain gauge for the adductor groin squeeze test on soccer athletes

The importance of hip adductor strength for injury prevention and performance benefits is well documented. The purpose of this study was to establish the intra- and inter-day variability of peak force (PF) of a groin squeeze protocol using a custom-designed compression strain gauge device. Sixteen semi-professional soccer players completed three trials over three separate testing occasions with at least 24-h rest between each session. The main findings were that the compression strain gauge was a reliable device for measuring PF within and between days. All intraclass correlations were higher than 0.80 and coefficients of variations were below 10% across the different sessions and trials. Due to the information gained through the compression strain gauge, the higher sampling frequency utilized, portability, and the relatively affordable price, this device offers an effective alternative for measuring maximal strength for hip adduction.

Hip Strength Profiling of Ice Hockey Athletes Across Various Joint-Specific Angles: Monitoring and Injury Implications

ABSTRACT

Secomb, JL, Kelly, M, and Dascombe, BJ. Hip strength profiling of ice hockey athletes across various joint-specific angles: monitoring and injury implications. J Strength Cond Res 37(7): e422-e429, 2023-The purpose of this research was to compare the hip adduction and abduction relative strength, adduction-to-abduction strength ratio (ADD:ABD), and interlimb asymmetries of ice hockey athletes between the typically used bilateral position and 3 unilateral positions in joint-specific angles (0°, 25°, and 50° of hip abduction) relevant to an ice hockey stride. A secondary purpose was to explore any relationships between these measures and hip and groin noncontact injuries, and self-reported pain and disability. Twenty-five semiprofessional male ice hockey athletes (26.7 ± 6.7 years) were assessed for hip abduction range of motion (ROM), hip adduction and abduction relative strength, and completed the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire. Within-subjects repeated-measures analysis of variance revealed a significant effect for the assessment position for adduction ( F1,24 = 52.4, p < 0.01) and abduction relative strength ( F1,24 = 152.1, p < 0.01), ADD:ABD ( F1,24 = 38.9, p < 0.01), and the interlimb asymmetries for each of these variables ( F1,24 = 9.8-12.3; p < 0.01), with large strength differences observed between the bilateral assessment and all unilateral assessment positions for adduction and abduction relative strength. In addition, 4 athletes experienced a noncontact hip or groin injury within 1 month after testing, and when compared with the rest of the cohort ( n = 21) with Welch's t -tests, demonstrated significantly reduced hip abduction ROM (mean difference [MD] = -8.4 ± 2.5°; p < 0.01), sport subscale score for the HAGOS questionnaire (MD = -33.9 ± 7.1; p < 0.01), and a decline in hip adduction relative strength in the unilateral position of 50° compared with the position of 25° hip abduction (MD = -13.4 ± 3.8; p = 0.04). These results suggest that practitioners working with ice hockey athletes may benefit from profiling hip strength in these unilateral joint-specific angle positions because they provide an evidence base to determine the hip strength needs of ice hockey athletes in positions associated with skating performance and noncontact hip and groin injury mechanisms (between 25° and 50° of hip abduction).

[Groin pain in sports games: a systematic review]

BACKGROUND

In sports games, epidemiological data show that groin pain is relatively common and can lead to repeated loss of time. Consequently, it is essential to be aware of the evidence-based prevention strategies. The aim of this systematic review was to examine risk factors and prevention strategies for groin pain and to rank them based on their evidence in sports games.

METHODS

The review was conducted according to the PRISMA guidelines, using a PICO-scheme in the PubMed, Web of Science and SPOLIT databases. We included all available intervention and observational studies on the influence of risk factors and prevention strategies on groin pain in sports games. The methodological quality and level of evidence was assessed using the PEDro-Scale and OCEBM model, respectively. Finally, the quantity, quality and level of evidence was used to rank each risk factor for its grade.

RESULTS

Moderate evidence was found for four risk factors that significantly influence the risk of groin pain: male sex, previous groin pain, hip adductor strength and not participating in the FIFA 11+ Kids. Moreover, moderate evidence was found for the following non-significant risk factors: older age, body height and weight, higher BMI, body fat percentage, playing position, leg dominance, training exposure, reduced hip abduction, adduction, extension, flexion, and internal rotation-ROM, hip flexor strength, hip abductor, adductor, flexor and core strengthening with balance exercises, clinical hip mobility tests and physical capacities.

CONCLUSION

The identified risk factors can be considered when developing prevention strategies to reduce the risk of groin pain in sports games. Thereby, not only the significant, but also the non-significant risk factors should be considered for prioritisation.

Effects of the COVID-19 confinement period on hip strength, flexibility and muscle injury rate in professional soccer players

OBJECTIVES

This study aimed to examine the effects of COVID-19 confinement on hamstring eccentric strength, hip adduction-abduction strength, and posterior chain flexibility in professional male soccer players. We also aimed to investigate whether muscle strength and flexibility would change when the players returned to play after COVID-19 confinement.

METHODS

Thirty professional male soccer (Age; 24.9 ± 4.8 yrs, BMI; 22.7 ± 1.4 kg/m²) players participated in this study. Hamstring eccentric strength, hip abduction-adduction strength and posterior chain flexibility (PCF) were measured before (time 1) and after the home confinement period (time 2) and after return to play (time 3). Repeated measures of ANOVA was used for statistical analysis.

RESULTS

PCF decreased from time 1 to time 2 (p = 0.005) but it increased from time 2 to time 3 (p = 0.03). Hamstring eccentric strength decreased from time 1 to time 2 for both dominant (p = 0.002) and non-dominant (p = 0.04) limbs and no difference was observed between time 2 and time 3 (p > 0.05). Hip abductor and adductor strength did not change between time 1 and time 2 (p > 0.05) but they increased from time 2 and time 3 in the dominant limb (p < 0.05). Five players (16%) had muscle injuries including hamstrings and adductors when they returned to play.

CONCLUSION

This study showed that 8-week COVID-19 confinement had an adverse effect on hamstring eccentric strength and PCF and 3 players had hamstring muscle injuries when they returned to play. Therefore, soccer players can be at risk of hamstring muscle injuries due to long-term detraining. Hip abductor and adductor strength seem not to be negatively affected by 8-week COVID-19 confinement. However, 2 players had adductor strain when they returned to play.

Reliability and validity of common hip adduction strength measures: The ForceFrame strength testing system versus the sphygmomanometer

OBJECTIVES

The criterion validity of the sphygmomanometer was evaluated, relative to the Force Frame strength testing system. Test-retest reliability was assessed for both hip adduction and abduction strength.

DESIGN

Test-retest reliability study and criterion validity study.

PARTICIPANTS

50 asymptomatic, field-sport athletes.

MAIN OUTCOME MEASURES

Maximal isometric hip adduction and abduction strength were measured. Interclass correlation coefficient(ICC_2,1) with confidence intervals were calculated to evaluate reliability of peak strength values. A Pearson product-moment correlation coefficient(r) was calculated to examine criterion validity of the sphygmomanometer as a measure of force when compared to the ForceFrame.

RESULTS

Intra-rater reliability for bilateral adduction testing using both ForceFrame and sphygmomanometer values revealed good-excellent reliability for both the 0° (ICC_2.1 = 0.87-0.90) and 45° (ICC_2.1 = 0.81-0.91) positions. ForceFrame values revealed good-excellent reliability for 0° abduction position and 45° abduction position. A good-moderate relationship (Pearson's r = 0.63) for 0° adduction position, and poor relationship (Pearson's r = 0.40) for 45° adduction position, were found between adduction squeeze values on ForceFrame and sphygmomanometer.

CONCLUSION

Excellent reliability in hip adduction squeeze strength testing for both modes. However, there exists a 'good to moderate'-'fair' relationship between the Force Frame and sphygmomanometer.

Frontal plane lower extremity alignment in adolescent athletes with chronic hip adductor-related groin injury symptoms: A case-control study

OBJECTIVE

To compare trunk and lower extremity frontal plane projection angles (FPPA) during single leg squat (SLS) performance, perceived hip and groin function and symptoms, and isometric hip strength of adolescent athletes with chronic hip adductor-related groin injury (HARGI) symptoms and age, gender, and sport-matched healthy subjects.

DESIGN

Case-control study.

SETTING

Junior Olympic Development Training Centre.

PARTICIPANTS

Twenty-six athletes at 59.1 ± 60 weeks (range = 12-208 weeks) post-index grade II HARGI injury who had continued sport training (injury group) and 26 control group subjects.

MAIN OUTCOME MEASURES

SLS trunk, hip, and knee FPPA, isometric hip strength standardized to bodyweight, and Copenhagen Hip and Groin Outcome Scores (HAGOS).

RESULTS

The injury group had greater bilateral knee FPPA, and greater injury side hip FPPA during maximum SLS. Injury group HAGOS subscale scores were lower than control group scores. Hip abductor, adductor, external rotator, and internal rotator strength was lower at the injury side of the injury group compared to the matched control group limb. Forward stepwise multiple regression analysis of the injury group found that 50% of injury side knee FPPA was predicted by hip internal rotator strength and time post-index HARGI; and 47% of injury side hip FPPA was predicted by other side hip flexor strength and the HAGOS function, sport and recreation subscale score (p = 0.002).

CONCLUSIONS

Greater injury side hip and bilateral knee FPPA during maximum SLS, lower self-reported hip symptom and function scores, and less injury side hip abductor, adductor, external rotator and internal rotator strength suggests that adolescent athletes with chronic HARGI symptoms are at an increased risk for sustaining a non-contact knee injury. Impaired hip internal rotator strength at the side of the chronic HARGI was related to increased knee FPPA, and impaired hip flexor strength at the other side of the HARGI was related to increased hip FPPA. Findings support using SLS performance testing in this athlete group to help determine safe return to sport training readiness.

Monitorización y periodización del rendimiento desde la fisioterapia deportiva ¿Hacia dónde vamos?

RESUMEN Introducción El concepto de monitorización y periodización es un visión que se ha desarrollado en la última década, donde se busca que se pueda tener un control de la carga interna y externa en los deportistas de distintas disciplinas deportivas producidas por el proceso de interacción con variables de prescripción de ejercicio que causan modificaciones a nivel fisiológico, bioquímico, biomecanico, muscular, neuromuscular  ocasionando la tensión en los subsistemas del movimiento corporal humano generando adaptaciones especificas ante una carga determinada la cual puede ser medida mediante el uso de tecnología especifica o test indirectos Metodología Revisión de la literatura con la combinación de palabras clave como Monitoring, Performance, sports training load, Periodization en bases de datos como Pubmed, Ebsco, Medline, Scopus, Science Direct Resultados se pudo identificar 65 artículos que referencian la existencia  de herramientas tecnológicas para realizar un proceso de monitorización y periodización desde la rehabilitación , prevención, control de carga, recuperación y readaptación deportiva que permiten la generación de datos estadísticos y crear perfiles desde cada área de actuación del fisioterapeuta deportivo. Conclusión la fisioterapia es una profesión encargada de muchos procesos deportivos que deben ser monitorizados y generen datos que permitan estandarizar procesos, crear perfiles de seguimiento específicos para facilitar la toma de decisiones desde el equipo biomédico e investigaciones en el deporte de alto rendimiento fusionando la practica con la evidencia científica.

Hip and Groin Pain Prevalence and Prediction in Elite Gaelic Games: 2703 Male Athletes Across Two Seasons

OBJECTIVE

Hip and groin pain is highly prevalent in sub-elite Gaelic Athletic Association (GAA) athletes, but its prevalence at the elite level is unknown. The aims of this study were to report hip and groin pain prevalence in elite male athletes, to report changes in Copenhagen Hip and Groin Outcome Score (HAGOS) across two seasons and to assess if previous hip and groin pain or pre-season HAGOS could predict future hip and groin pain.

METHODS

During the 2017 and 2018 pre-season male Gaelic Players Association (GPA) playing members were invited to complete two questionnaires. The first questionnaire collected demographic information including age, GAA code played (Gaelic football or Hurling) and prevalence of hip and groin pain in the previous season. The second questionnaire was the HAGOS. Step-wise logistic regression models were fitted to HAGOS subscales, to examine if pre-season HAGOS subscale scores could predict future hip and groin pain.

RESULTS

The prevalence of hip and groin pain across the elite GAA cohort was 38%. Hip and groin pain in the previous season was the strongest predictor of future hip and groin pain (r² =0.19, AUC=0.73, 95% CI 1.76-2.27) whereas pre-season HAGOS subscale scores had limited and no additional predictive ability (AUC 0.05-0.18).

CONCLUSIONS

Hip and groin pain prevalence is high in elite male GAA, with one in three athletes reporting pain. Previous season hip and groin pain is the strongest predictor of future hip and groin pain, while pre-season HAGOS scores have limited ability to predict future hip and groin pain.

Hip and groin function and strength in male ice hockey players with and without hip and groin problems in the previous season- a prospective cohort study

OBJECTIVE

To describe and compare hip and groin strength and function of male ice hockey players over one season in players with and without hip and groin problems in the previous season.

DESIGN

Prospective cohort study.

SETTING

Swedish male ice hockey.

PARTICIPANTS

We followed 193 players from 10 teams during the 2017/2018 season.

MAIN OUTCOME MEASURES

Hip adduction and abduction strength, 5 s squeeze test (5SST), and self-reported hip and groin function (Hip and Groin Outcome Score). Changes over the season and differences between players with and without problems in the previous season were analyzed by linear mixed models.

RESULTS

Adduction strength decreased slightly from pre-to mid-season and abduction strength increased slightly over the full season. However, self-reported function or pain did not change. Players with hip and groin problems in the previous season had significantly worse self-reported function, and more groin pain during the 5SST compared to players without. Strength measurments did not differ between groups.

CONCLUSIONS

Hip muscle strength, groin pain, and self-reported function appear to remain stable throughout the season in male ice hockey players. Remaining impairments in players with problems in the previous season suggest that function does not recover by ice hockey participation alone.

Epidemiology and moderators of injury in Gaelic football: A systematic review and meta-analysis

OBJECTIVES

To quantify the incidence, location and severity of injuries in Gaelic football and to identify potential moderators of those injuries.

DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive search strategy of six electronic databases was undertaken independently by two researchers in March 2020. Studies must have prospectively investigated injuries sustained by Gaelic footballers over a minimum duration of six months. The Newcastle-Ottawa Scale was used to assess risk of bias. Studies were combined in a pooled analysis using an inverse variance method.

RESULTS

Twelve prospective cohort studies were eligible. The total injury incidence was 10.7 injuries/1000 h of exposure. Match incidence (55.9 injuries/1000 h) was much higher than training (4.6 injuries/1000 h). The lower limb accounted for over 70% of all injuries, with hamstring injuries ranging from 22 to 24% of all injuries. Non-contact injuries were the most common injury mechanism. Players aged >30 were at greatest risk of injury with incidence risk ratios ranging from 1.2 to 2.3. High aerobic fitness and chronic workloads were associated with reduced risk of injury in elite Gaelic footballers.

CONCLUSIONS

Elite Gaelic football athletes are twelve times more likely to get injured during match play compared to training. The lower limb is the most affected body region, and most injuries occur by non-contact mechanisms. Athlete age of greater than 30, poor aerobic fitness and sudden increments in training workload all increase the likelihood of injury. By understanding the incidence and nature of injuries in Gaelic football, targeted injury prevention strategies can be developed and implemented.

Do hip and groin muscle strength and symptoms change throughout a football season in professional male football players? A prospective cohort study with repeated measures

OBJECTIVES

Groin injuries are common in professional male football and result in significant complaints, time-loss and cost. We aimed to study: 1. Normal values of hip muscle strength and self-reported hip and groin function (Hip And Groin Outcome Score (HAGOS)). 2. Changes in these values throughout the season. 3. If previous (groin) injuries, leg dominance or league were associated with these outcome measures.

DESIGN

Prospective cohort study.

METHODS

313 professional male football players (11 clubs) participated. Player characteristics and previous injuries were registered. Hip muscle strength (hand-held dynamometer) and HAGOS measurements were done at the start, middle and end of the season.

RESULTS

Data from 217 players were analysed. Adduction strength (mean±standard deviation, Nm/Kg) was 3.40±0.72 (start), 3.30±0.65 (mid) and 3.39±0.74 (end) (p=0.186). Abduction strength was 3.45±0.67, 3.14±0.57 and 3.28±0.61 (p<0.001). Adduction/abduction ratio was 1.00±0.21, 1.07±0.22 and 1.05±0.23 (p<0.001). Statistically, the HAGOS-subscale 'Pain' (median [interquartile range]) deteriorated slightly during the season (p=0.005), especially from mid-season (97.5 [90.6-100.0]) to end-of-season (95.0 [87.5-100.0]) (p=0.003). Other subscale scores remained unchanged between time points; 85.7 (symptoms), 100.0 (daily living), 96.9 (sports and recreation) 100.0, (physical activities) and 90.0 (quality of life). Previous injuries were associated with lower HAGOS-scores. Dominant legs had higher abduction strength (p<0.001) and lower adduction/abduction ratio (p<0.001). No differences between leagues were found for hip muscle strength and HAGOS-scores.

CONCLUSIONS

In Dutch male professional football players, hip muscle strength and HAGOS-scores remained relatively stable throughout the season. Pain increased slightly, which while statistically significant, was not clinically relevant.

Past-season, pre-season and in-season risk assessment of groin problems in male football players: a prospective full-season study

OBJECTIVE

We assessed past-season, pre-season and in-season risk factors to investigate their association with an in-season groin problem in male amateur football players.

METHODS

Past-season groin-pain information and pre-season short-lever and long-lever adductor squeeze strength were obtained at baseline, together with anthropometrics (weight, lower limb lever length) and player age. In-season hip-related and groin-related sporting function was monitored every 4 weeks using the Sports and Recreation (Sport) subscale from the Hip And Groin Outcome Score questionnaire (HAGOS (Sport)). Groin problems, including time-loss groin injuries and groin pain irrespective of time loss, were collected over a 39-week competitive in-season. We estimated relative risk (RR), and 95% credibility interval (ICr) from logistic regressions fitted in a Bayesian framework.

RESULTS

Players (n=245) suffering from groin pain during the past-season had 2.4 times higher risk of experiencing a groin problem in the new season (2.40 RR; 95% ICr 1.5 to 3.7). This risk was reduced by 35% (0.65 RR; 95% ICr 0.42 to 0.99) per unit (N·m/kg) increase in the long-lever adductor squeeze test. Player age, short-lever squeeze test and the HAGOS (Sport) scores were not associated with the risk of a groin problem.

CONCLUSIONS

Past-season groin pain increased the risk of a groin problem in the new in-season. This risk was reduced by higher pre-season long-lever adductor squeeze strength. Past-season groin-pain information and long-lever adductor squeeze strength can be quickly obtained during pre-season to identify players with an elevated risk of in-season groin problems. This may be key to reduce these problems in the new season.

The validity of the sphygmomanometer for shoulder strength assessment in amateur rugby union players

OBJECTIVES

To determine the concurrent validity of a sphygmomanometer for assessing shoulder strength in the I, Y and T positions during the athletic shoulder test (ASH test). Force platforms were used as the gold standard measurement tool for this purpose.

DESIGN

Shoulder strength was assessed using force platforms and a sphygmomanometer, both placed on the floor and the participant positioned prone. One rater assessed strength, taking three measurements in each of the I, Y and T positions, using the sphygmomanometer and force platforms. Concurrent validity was calculated using the force platforms as the gold standard device.

SETTING

Data was collected within the treatment room of an amateur rugby club.

PARTICIPANTS

Twenty male amateur rugby players (25.15 years old ± 3.27 years) were recruited for this study.

MAIN OUTCOME MEASURES

Peak force across the shoulder girdle was assessed using the force platforms and sphygmomanometer which provided values in Newtons (N) and millimetres of mercury (mmHg) respectively.

RESULTS

Results showed high concurrent validity (Pearsons r = 0.76-0.81) between the sphygmomanometer and the force platform. Coefficient of determination (r² = 0.59-0.67) showed the sphygmomanometer to have a valid predictive model in the I, Y and T positions.

CONCLUSIONS

The sphygmomanometer is suitable for monitoring force transfer across the shoulder during the ASH test, and is able to quantify peak force in mmHg. The sphygmomanometer enables coaches and clinicians to accurately quantify force production across the shoulder girdle in order to screen and monitor players at a low cost.

The conservative treatment of longstanding adductor-related groin pain syndrome: a critical and systematic review

Longstanding (chronic) adductor-related groin pain syndrome is a widely common problem for athletes in many sports activities which often drastically reduces player activity and performance. The first choice in therapeutic treatment is conservative therapy. The objective of this study is to provide a systematic review regarding conservative treatment for longstanding adductor-related groin pain syndrome present in literature today. Furthermore, this study aims to give a critical vision of the current state of the art of the considered topic. After screening 234 articles, 19 studies following the inclusion criteria were included and summarized in this current systematic review and seven different types of therapeutic interventions were described. Compression clothing therapy, manual therapy together with strengthening exercise and prolotherapy were the therapeutic interventions which showed both the greatest level of strength of evidence (Moderate) and grade of recommendation (D). The remaining four types of therapeutic interventions i.e.: corticoid injection, platelet rich plasma therapy, intra-tissue percutaneous electrolysis and pulse-dose radiofrequency, showed both lower levels of strength of evidence (Conflicting) and grade of recommendation (C). In conclusion the literature available on the conservative treatment for longstanding adductor-related groin pain syndrome is limited and characterized by a low level of evidence. Therefore, our recommendation is to refer only to the few studies with higher level of evidence and at the same time to encourage further research in this area. The intervention showing the greater level of strength of evidence, and the greater grade of recommendation are compression clothing therapy, manual therapy and strengthening exercise, and prolotherapy. Other therapeutic interventions such as intra-tissue percutaneous electrolysis and pulse-dose radiofrequency seem promising but require further studies to confirm their efficacy.

Strength and Power Training in Rehabilitation: Underpinning Principles and Practical Strategies to Return Athletes to High Performance

Injuries have a detrimental impact on team and individual athletic performance. Deficits in maximal strength, rate of force development (RFD), and reactive strength are commonly reported following several musculoskeletal injuries. This article first examines the available literature to identify common deficits in fundamental physical qualities following injury, specifically strength, rate of force development and reactive strength. Secondly, evidence-based strategies to target a resolution of these residual deficits will be discussed to reduce the risk of future injury. Examples to enhance practical application and training programmes have also been provided to show how these can be addressed.

Preseason Hip/Groin Strength and HAGOS Scores Are Associated With Subsequent Injury in Professional Male Soccer Players

DESIGN

Prospective cohort.

OBJECTIVE

To explore the association between preseason assessments of (1) isometric hip adductor and abductor strength using a novel field test and (2) the Copenhagen Hip and Groin Outcome Score (HAGOS) and subsequent hip/groin injury in male professional soccer players.

METHODS

In total, 204 male elite soccer players from 10 professional A-League and English Football League Championship clubs underwent assessments of hip adductor and abductor strength and completed the HAGOS in the 2017-2018 preseason. All subsequent hip/groin injuries were reported by team medical staff. Data reduction was conducted using principal-component analysis. The principal component for the HAGOS and 3 principal components for strength and imbalance measures were entered, with age and prior hip/groin injury, into a multivariable logistic regression model to determine their association with prospectively occurring hip/groin injury.

RESULTS

Twenty-four players suffered at least 1 hip/groin injury throughout the 2017-2018 season. The principal component for between-limb abduction imbalance (peak strength in the preferred kicking limb - nonpreferred limb) (odds ratio [OR] = 0.58; 95% confidence interval [CI]: 0.38, 0.90; P = .011), the principal component for peak adduction and abduction strength (OR = 0.71; 95% CI: 0.51, 1.00; P = .045), and the principal component for the HAGOS (OR = 0.77; 95% CI: 0.62, 0.96; P = .022) were independently associated with a reduced risk of future hip/groin injury. Receiver operating characteristic curve analysis of the whole model revealed an area under the curve of 0.76, which indicates a fair combined sensitivity and specificity of the included variables but an inability to correctly identify all subsequently injured players.

CONCLUSION

Hip abduction imbalance favoring the preferred kicking limb, higher levels of hip adductor and abductor strength, and superior HAGOS values were associated with a reduced likelihood of future hip/groin injury in male professional soccer players. J Orthop Sports Phys Ther 2020;50(5):234-242. Epub 17 Sep 2019. doi:10.2519/jospt.2020.9022.

The Efficacy of Lower-Limb Screening Tests in Predicting PlayerLoad Within a Professional Soccer Academy

CONTEXT

Training exposure has been associated with injury epidemiology in elite youth soccer, where lower-limb musculoskeletal screening is commonly used to highlight injury risk. However, there has been little consideration of the relationship between lower-limb screening and the loading response to soccer activities.

OBJECTIVE

To quantify the efficacy of using screening tests to predict the loading elicited in soccer-specific activities and to develop a hierarchical ordering of musculoskeletal screening tests to identify test redundancy and inform practice.

DESIGN

Correlational.

SETTING

Professional soccer club academy.

PARTICIPANTS

A total of 21 elite male soccer players aged 15.7 (0.9) years.

INTERVENTION

Players completed a battery of 5 screening tests (knee to wall, hip internal rotation, adductor squeeze, single-leg hop, and anterior reach) and a 25-minute standardized soccer session with a Global Positioning System unit placed at C7 to collect multiplanar PlayerLoad data.

MAIN OUTCOME MEASURES

Baseline data on each screening test, along with uniaxial PlayerLoad in the mediolateral, anteroposterior, and vertical planes.

RESULTS

Stepwise hierarchical modeling of the screening tests revealed that dominant leg knee-to-wall distance was the most prevalent and powerful predictor of multiplanar PlayerLoad, accounting for up to 42% of variation in uniaxial loading. The adductor squeeze test was the least powerful predictor of PlayerLoad. Of note, one player who incurred a knee injury within 3 weeks of testing had shown a 20% reduction in knee-to-wall distance compared with peers, and elicited 23% greater PlayerLoad, supporting the hierarchical model.

CONCLUSIONS

There was some evidence of redundancy in the screening battery, with implications for clinical choice. Hierarchical ordering and a concurrent case study highlight dominant leg knee-to-wall distance as the primary predictor of multiaxial loading in soccer. This has implications for the design and interpretation of screening data in elite youth soccer.

The Relationship Between Adductor Squeeze Strength, Subjective Markers of Recovery and Training Load in Elite Rugby Players

Tiernan, C, Lyons, M, Comyns, T, Nevill, AM, and Warrington, G. The relationship between adductor squeeze strength, subjective markers of recovery and training load in elite Rugby players. J Strength Cond Res 33(11): 2926-2931, 2019-The adductor squeeze strength test has become a popular training monitoring marker, particularly in team sports. The aim of this study was to investigate the relationship between adductor squeeze strength scores, subjective markers of recovery and training load in elite Rugby Union players, because of limited research in this area. Nineteen elite male Rugby Union players completed daily monitoring markers (adductor squeeze strength and 5 selected subjective markers of recovery), over a 10-week preseason training period. Rate of perceived exertion (RPE) was collected to determine training load (session RPE; RPE × session duration) and to calculate weekly training load. Spearman's correlation was used to analyze the relationship between adductor squeeze strength scores, subjective markers of recovery, and weekly training load. The results found that where adductor squeeze scores decreased, both perceived fatigue levels (r = -0.335; R = 11.2%; p < 0.001) and muscle soreness (r = -0.277; R = 7.7%; p < 0.001) increased. A weak correlation was found between Monday adductor squeeze strength scores and the previous week's training load (r = -0.235; R = 5.5%; p < 0.001) and Friday adductor squeeze strength scores and the same week's training load (r = -0.211; R = 4.5%; p < 0.05). These results show that adductor squeeze strength may provide coaches with a time-efficient, low-cost objective, player monitoring marker. Additionally, the combination of adductor strength squeeze, with subjective markers, perceived fatigue, and muscle soreness, and appropriately planned training load may help coaches to optimize training adaptations by determining a player's training status.

Adductor squeeze test and groin injuries in elite football players: A prospective study

OBJECTIVE

To examining the relationship between hip adductor strength and groin injury incidence during the competitive season of professional football teams.

DESIGN

Prospective Cohort study.

SETTING

Controlled laboratory environment.

PARTICIPANTS

Seventy-one players volunteered to participate.

MAIN OUTCOME MEASURES

In the pre-season, maximal hip adductor strength was measured by means of the isometric adductor squeeze test. Hip adductor strength, normalized by body mass, was compared between players who suffered a groin injury (n = 18) vs uninjured players (n = 53). Risk ratios (RR) were used to evaluate the likelihood of players to suffer this type of injury.

RESULTS

Most of the reported groin injuries occurred during competitive matches (5.5 per 1000 match hours). Maximal isometric hip adductor strength was lower in the groin-injured group compared with their uninjured counterparts (429.8 ± 100 vs 564 ± 58.7 N, d = -1.58 and 5.40 ± 1.27 vs 7.71 ± 0.89 N/kg, d = -1.88, respectively). Results revealed that values of maximal isometric adductor strength lower than 465.33 N increased the probability to suffer a groin injury by 72%. Furthermore, values of force relative to body mass lower than 6.971 N/kg increased the probability to suffer a groin injury by 83%.

CONCLUSION

The assessment of Hip adductor strength, in addition to other measurements, might help practitioners to determine the probability of suffering an overuse groin injuries in elite football players.

Lower limb injuries in men's elite Gaelic football: A prospective investigation among division one teams from 2008 to 2015

OBJECTIVES

To prospectively investigate incidence and associated time-loss of lower limb injuries in elite Gaelic football. Additionally, to identify sub-groups of elite players at increased risk of sustaining a lower limb injury.

DESIGN

Prospective, epidemiological study.

METHODS

Team physiotherapists provided exposure and injury on a weekly basis to the National Gaelic Athletic Association (GAA) Injury Surveillance Database. Injury was defined using a time-loss criterion. Fifteen different teams participated throughout the 8-year study providing 36 team datasets from 2008 to 2015.

RESULTS

Lower limb injuries (n=1239) accounted for 83.5% (95% CI 82.0-85.0) and 77.6% (95% CI 75.8-79.4) of training and match-play injuries, respectively. Injury incidence was 4.5 (95% CI 3.7-5.2) and 38.4 (95% CI 34.3-42.60) per 1000 training and match-play hours, respectively. One-in-four (25.0%, 95% CI 22.4-27.0) lower limb injuries were recurrent. Non-contact injuries accounted for 80.9% (95% CI 79.2-82.6) of cases. The median team rate was 30 (IQR 24-43) lower limb injuries per season resulting in 840.8 (95% CI 773.3-908.2) time-loss days. Previously injured players had a 2.5-times (OR 95% CI 2.2-2.8) greater risk of sustaining a lower limb injury. Overall, 56.8% of players with a previous lower limb injury sustained another. Incidence was higher for forward players and those aged >25years.

CONCLUSIONS

Lower limb injuries are the most common injury among elite division one Gaelic football teams. Injury risk management should become an ongoing component of a player's development programme and consider injury history, age, and playing position.