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Neuville AJ, Benge CL, Tjong VK, Lund BS, Baer GS, Walczak BE. Risk Factors for Athletic Pubalgia in Collegiate Football Student-Athletes: A Retrospective Cohort Study. Sports Health 2023; 15:760-766. [PMID: 36171687 PMCID: PMC10467470 DOI: 10.1177/19417381221121127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Athletic pubalgia (AP) is an increasingly recognized injury among young athletes. This study aimed to evaluate the characteristics associated with AP in college football players. HYPOTHESIS Repetitive explosive movements that require aggressive core muscle activation results in AP in collegiate football players. STUDY DESIGN Retrospective cohort design. LEVEL OF EVIDENCE Level 3. METHODS Football student-athletes at a single Division I collegiate institution from January 2010 to December 2019 were included in the study. The primary outcome measure was surgery for AP. The odds of AP were determined using logistic regression, with the dependent variable being whether or not the student-athlete received AP surgery. Independent variables included Olympic weightlifting (OWL) exposure, primary playing position (skill position vs nonskill position), and body mass index (BMI). RESULTS A total of 1154 total student-athlete exposures met the inclusion criteria. Of the 576 student-athletes exposed to OWL (OWL occurred throughout entire calendar year), 20 developed AP, whereas 7 student-athletes not exposed to OWL (OWL was not performed at any point during calendar year) developed AP. Student-athletes exposed to OWL had a 2.86 (95% CI, 1.25-7.35; P = 0.02) times higher odds of AP than players not exposed after controlling for primary playing position and BMI. Skill position players had a 9.32 (95% CI, 1.71-63.96; P = 0.01) times higher odds of AP than nonskill position players when controlling for BMI and OWL training. CONCLUSION Modifiable factors that increase exposure to repetitive explosive activities, such as OWL and playing a skill position, may be important considerations in developing AP. CLINICAL RELEVANCE The cause of AP is multifactorial and poorly understood. Identifying factors associated with AP informs athletes, athletic trainers, physicians, and coaches.
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Affiliation(s)
- Alexander J. Neuville
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Evanston, Illinois
| | - Clint L. Benge
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Vehniah K. Tjong
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Evanston, Illinois
| | - Brian S. Lund
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Geoffrey S. Baer
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Brian E. Walczak
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Cotellessa F, Puce L, Formica M, May MC, Trompetto C, Perrone M, Bertulessi A, Anfossi V, Modenesi R, Marinelli L, Bragazzi NL, Mori L. Effectiveness of a Preventative Program for Groin Pain Syndrome in Elite Youth Soccer Players: A Prospective, Randomized, Controlled, Single-Blind Study. Healthcare (Basel) 2023; 11:2367. [PMID: 37685401 PMCID: PMC10486402 DOI: 10.3390/healthcare11172367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
Groin pain syndrome (GPS) is a prevalent issue in soccer. This study assessed the effectiveness of a new preventive protocol on GPS for youth soccer players. The protocol included targeted stretching and strengthening exercises for the adductor and core muscles from preseason to midseason. A questionnaire and two pain provocation tests were used for the evaluation. Mild GPS required positive results in at least two evaluations, while severe GPS was associated with pain incompatible with engagement in any activity confirmed by diagnostic ultrasound. Forty-two elite male athletes (aged 16.9 ± 0.7 years) participated in the study, with half of them assigned to the usual training (control group) and the remaining athletes undergoing the preventive protocol (treatment group) for 24 weeks. GPS rates were 14.3% (three diagnoses: two mild, one severe) in the treatment group and 28.6% (six diagnoses: three mild, three severe) in the control group. Toward the end of the season, three players, one from the treatment group and two from the control group had to stop playing due to severe GPS problems. In addition, one player in the control group stopped midseason. Even though the reduction in the risk of developing GPS was not significant (relative risk of 0.50 ([95%CI 0.14 to 1.74], p = 0.2759), the halved incidence of severe GPS and the increased muscle strength related to the treatment (p = 0.0277) are encouraging data for future studies.
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Affiliation(s)
- Filippo Cotellessa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
| | - Matteo Formica
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
- Orthopedic Clinic, Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Maria Cesarina May
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Marco Perrone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
| | - Andrea Bertulessi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Vittorio Anfossi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Roberto Modenesi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
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Zilles G, Grim C, Wegener F, Engelhardt M, Hotfiel T, Hoppe MW. [Groin pain in sports games: a systematic review]. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2023; 37:18-36. [PMID: 36878218 DOI: 10.1055/a-1912-4642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
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.
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Affiliation(s)
- Gabriel Zilles
- Bewegungs- und Trainingswissenschaft, Sportwissenschaftliche Fakultät, Universität Leipzig, Leipzig, GERMANY
| | - Casper Grim
- Osnabrücker Zentrum für Muskuloskelettale Chirurgie, Klinikum Osnabrück, Osnabrück, GERMANY
| | - Florian Wegener
- Bewegungs- und Trainingswissenschaft, Sportwissenschaftliche Fakultät, Universität Leipzig, Leipzig, GERMANY
| | - Martin Engelhardt
- Osnabrücker Zentrum für Muskuloskelettale Chirurgie, Klinikum Osnabrück, Osnabrück, GERMANY
| | - Thilo Hotfiel
- Osnabrücker Zentrum für Muskuloskelettale Chirurgie, Klinikum Osnabrück, Osnabrück, GERMANY
| | - Matthias Wilhelm Hoppe
- Bewegungs- und Trainingswissenschaft, Sportwissenschaftliche Fakultät, Universität Leipzig, Leipzig, GERMANY
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Nielsen MF, Ishøi L, Juhl C, Hölmich P, Thorborg K. Pain provocation tests and clinical entities in male football players with longstanding groin pain are associated with pain intensity and disability. Musculoskelet Sci Pract 2023; 63:102719. [PMID: 36736197 DOI: 10.1016/j.msksp.2023.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/20/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Clinical examination of male football players with longstanding groin pain can be considered difficult. Pain provocation tests are used to examine and classify longstanding groin pain into clinical entities as adductor-, iliopsoas-, inguinal-, and pubic-related. It is unknown if pain provocation tests and clinical entities are associated with pain intensity and disability. OBJECTIVES To investigate if the number of positive pain provocation tests and clinical entities are associated with pain intensity and disability, measured by the Copenhagen 5-Second Squeeze Test (5SST) and the Copenhagen Hip and Groin Outcome Score (HAGOS), respectively. DESIGN Cross-sectional. METHOD Forty male football players (age: mean 24 years [SD: 3.2]; height: mean 182 cm [SD: 5.7]; weight: mean 78 Kg [SD: 6.6]) with longstanding groin pain for a median of 8.5 months (IQR: 4-36) were included. The players underwent a bilateral groin examination with 33 pain provocation tests and were classified with clinical entities (0-7) based on the test findings. RESULTS The number of positive pain provocation tests (median 10, range 2-23) correlated with pain intensity (5SST: rs = 0.70 [95% CI: 0.50, 0.83]) and disability (HAGOS subscales Sport: rs =-0.62 [95% CI: -0.81, -0.36], Pain: rs = -0.38 [95% CI: -0.69, -0.06], Symptoms: rs = 0.52 [95% CI: -0.73, -0.24], ADL: rs = -0.48 [95% CI: -0.71, -0.18]). The number of clinical entities (median 3, range: 1-7) showed similar but weaker correlations to pain intensity and disability. CONCLUSIONS In male football players with longstanding groin pain, the number of positive pain provocation tests and clinical entities shows weak to strong correlations with pain intensity and disability. Consequently, when pain intensity and disability are severe, a higher number of pain provocation tests may be positive, and more clinical entities may be present.
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Affiliation(s)
- Mathias F Nielsen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark.
| | - Lasse Ishøi
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark
| | - Carsten Juhl
- Research Unit Musculoskeletal Function and Physiotherapy, Department of Sport Science and Clinical Biomechanics (IOB), University of Southern, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark
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Heijboer WMP, Weir A, Vuckovic Z, Fullam K, Tol JL, Delahunt E, Serner A. Inter-examiner reliability of the Doha agreement meeting classification system of groin pain in male athletes. Scand J Med Sci Sports 2023; 33:189-196. [PMID: 36259124 PMCID: PMC10092143 DOI: 10.1111/sms.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 08/18/2022] [Accepted: 10/02/2022] [Indexed: 01/11/2023]
Abstract
The Doha agreement classification is used to classify groin pain in athletes. We evaluated the inter-examiner reliability of this classification system. We prospectively recruited 48 male athletes (66 symptomatic sides) with groin pain between 10-2017 and 03-2020 at a sports medicine hospital in Qatar. Two examiners (23 and 10 years of clinical experience) performed history taking, and a standardized clinical examination blinded to each other's findings. Examiners classified groin pain using the Doha agreement terminology (adductor-, inguinal-, iliopsoas-, pubic-, hip-related groin pain, or other causes of groin pain). Multiple entities were ranked in order of perceived clinical importance. Each side was classified separately for bilateral groin pain. Inter-examiner reliability was calculated using Cohen's Kappa statistic (κ). Inter-examiner reliability was slight to moderate for adductor- (κ = 0.40), inguinal- (κ = 0.44), iliopsoas- (κ = 0.57), and pubic-related groin pain (κ = 0.12), substantial for hip-related groin pain (κ = 0.62), and slight for "other causes of groin pain" (κ = 0.13). Ranking entities in order of perceived clinical importance improved inter-examiner reliability for adductor-, inguinal-, and iliopsoas-related groin pain (κ = 0.52-0.65), but not for pubic (κ = 0.12), hip (κ = 0.51), and "other causes of groin pain" (κ = 0.03). For participants with unilateral groin pain classified with a single entity (n = 7), there was 100% agreement between the two examiners. Inter-examiner reliability of the Doha agreement meeting classification system varied from slight to substantial, depending on the clinical entity. Agreement between examiners was perfect when athletes were classified with a single clinical entity of groin pain, but lower when athletes were classified with multiple clinical entities.
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Affiliation(s)
- Willem M P Heijboer
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands.,REHABfysio, Rotterdam, The Netherlands
| | - Adam Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.,Sport medicine and exercise clinic Haarlem (Sport en Beweeg Kliniek), Haarlem, The Netherlands
| | - Zarko Vuckovic
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Karl Fullam
- DBC Chartered Physiotherapy Clinic, Institute for Sport & Health, University College Dublin, Dublin, Ireland
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Institute for Sport and Health, University College Dublin, Dublin, Ireland
| | - Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
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Dupré T, Potthast W. Are sprint accelerations related to groin injuries? A biomechanical analysis of adolescent soccer players. Sports Biomech 2022:1-13. [PMID: 36260511 DOI: 10.1080/14763141.2022.2133740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/04/2022] [Indexed: 10/24/2022]
Abstract
Groin injuries have one of the highest incidences in soccer and can be career threatening, especially for adolescents, due to their high recurrence rate. Quick accelerations have been connected to groin injuries along with kicking and change of directions. Purpose of this study was to examine the hip joint kinematics, kinetics and the muscle forces of adductor longus and gracilis during first ground contact of a linear sprint acceleration performed by adolescent soccer players. Twenty-two male participants were investigated with 3D motion capture and two force plates. Inverse dynamics were used to calculate the kinematics, kinetics and muscle forces. The kinematics show a constant extension during the stance phase and a quick transition from an abduction to an adduction movement at 90% stance, which coincides with the highest forces in adductor longus and gracilis. This indicates a high load on the adductor muscles due to eccentric contractions combined with high muscle forces in the adductors. Compared to previously investigated inside passing and change of direction movements, adductor muscle forces and angular velocities are higher in this study. Therefore, it is suggested that sprint accelerations are likely to be connected to the development of groin injuries in adolescent soccer players.
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Affiliation(s)
- Thomas Dupré
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
- Department of Exercise Science, Olympic Training Centre Rhineland-Palatinate/Saarland, Mainz, Germany
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
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Midseason Screening for Groin Pain, Severity, and Disability in 101 Elite American Youth Soccer Players: A Cross-Sectional Study. Clin J Sport Med 2022; 32:501-507. [PMID: 34759181 DOI: 10.1097/jsm.0000000000000987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To (1) systematically screen for groin pain and type in young elite soccer players and (2) assess whether hip and groin-related severity and disability differed between players with different levels of groin pain and tenderness. DESIGN Cross-sectional observational. SETTING Elite American soccer academy at midseason. PARTICIPANTS One hundred one academy soccer players (mean age 14.3 ± 1.8 years). INTERVENTION All players underwent clinical examinations to classify groin pain by the Doha agreement taxonomy. MAIN OUTCOME MEASURES Tests for groin-related severity and disability included the Copenhagen 5-second squeeze test, Copenhagen Hip and Groin Outcome Score (HAGOS), and Hip Outcome Score (HOS). Players were stratified into 3 groups: those with groin pain, those with tenderness, and those with no groin pain or tenderness. RESULTS Twenty-two players (22%) reported groin pain. Adductor-related groin pain was the most common (n = 14), followed by iliopsoas-related (n = 3), and pubic-related (n = 2). Multiple locations were present in 3 players. Thirty-nine players (39%) did not have groin pain but were tender to palpation in 1 or more structures related to the Doha agreement taxonomy. Copenhagen 5-second squeeze test differentiated between players with and without groin pain (groin pain vs tenderness group: P = 0.011; groin pain vs no groin pain group P < 0.001). Four HAGOS subscales (pain, symptoms, sport/recreation, and quality of life) differentiated between players with and without groin pain ( P < 0.05). CONCLUSIONS One in five academy soccer players experiences groin pain with adductor-related most common during a midseason screening. Both Copenhagen 5-second squeeze test and HAGOS subscales can differentiate between players with and without groin pain.
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Risk Factors for Groin Pain in Male High School Soccer Players Undergoing an Injury Prevention Program: A Cluster Randomized Controlled Trial. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Little is known about the risk factors for developing groin pain in high school soccer players. Therefore, the purpose of the study is to investigate the risk factors for developing inguinal pain in high school soccer players who are undergoing an injury prevention program. A cluster randomized controlled trial was conducted on 202 high school soccer players. Players were allocated to either group A (3 schools, 66 players) receiving the Copenhagen adduction exercise (CAE) alone, or group B (2 schools, 73 players) receiving the CAE and Nordic hamstrings exercise, or group C, the control group without any intervention (2 schools, 63 players). Hip range of motion (ROM) and strength measures were assessed prior to a groin injury prevention program and used in univariate and multivariate analysis to predict development of groin pain. Logistic regression analysis identified that hip abduction ROM and eccentric adductor strength of the dominant leg were factors in the development of groin pain. Increased abduction ROM and decreased eccentric adductor muscle strength of the dominant leg were risk factors for the development of groin pain.
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Pérez-Gómez J, Adsuar JC, Alcaraz PE, Carlos-Vivas J. Physical exercises for preventing injuries among adult male football players: A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:115-122. [PMID: 33188962 PMCID: PMC8847925 DOI: 10.1016/j.jshs.2020.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/30/2020] [Accepted: 09/17/2020] [Indexed: 05/19/2023]
Abstract
BACKGROUND Football is the most practised sport in the world and is associated with the risk of injuries in the players. Some studies have been published that identify injury prevention programs, but there is no review of the full body of evidence on injury prevention programs for use by football coaches. The aim of this article was to carry out a systematic review of published studies on injury prevention programs for adult male footballers, identify points of common understanding and establish recommendations that should be considered in the design of injury prevention strategies. METHODS PubMed and EMBASE databases were used to identify relevant published articles using the following keywords: "soccer" AND "injury" AND "prevention". RESULTS A total of 2512 studies were identified initially, but only 11 studies met the inclusion criteria, and their outcomes are presented. Results revealed that injury prevention programs in football have focused on strength training, proprioceptive training, multicomponent programs (balance, core stability, and functional strength and mobility), and warm-up programs. CONCLUSION Based on results from the studies analyzed, football players can lower the incidence of match and training injuries by participating in dynamic warm-up programs that include preventive exercises before games or during training sessions, and by adding strength, balance, and mobility training to the training sessions.
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Affiliation(s)
- Jorge Pérez-Gómez
- Health, Economy, Motricity and Education (HEME) Research Group, Faculty of Sports Sciences, University of Extremadura, Caceres 10003, Spain
| | - José Carmelo Adsuar
- Health, Economy, Motricity and Education (HEME) Research Group, Faculty of Sports Sciences, University of Extremadura, Caceres 10003, Spain
| | - Pedro E Alcaraz
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia 30107, Spain; Faculty of Sport Sciences, Catholic University of Murcia, Murcia 30107, Spain
| | - Jorge Carlos-Vivas
- Health, Economy, Motricity and Education (HEME) Research Group, Faculty of Sports Sciences, University of Extremadura, Caceres 10003, Spain.
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Alonso-Calvete A, Lorenzo-Martínez M, Padrón-Cabo A, Rey E. Effects of Copenhagen Adduction Exercise on the Architectural Characteristics of Adductors in U-17 Male Soccer Players: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412956. [PMID: 34948565 PMCID: PMC8701296 DOI: 10.3390/ijerph182412956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
Groin injuries are one of the most prevalent in male soccer players, especially due to the hip adductor muscles’ weakness which is considered as a risk factor in these injuries. The Copenhagen adduction (CA) exercise has been demonstrated to increase the strength of adductor muscles, but its effects on the architectural characteristics of adductor muscles have not been studied yet. This study aimed to analyze the effects of the CA exercise on the muscle thickness of the adductors. Twelve male U-17 soccer players were randomized into two groups: the control group with no intervention and the experimental group with an intervention based on an eight-week training with CA exercise. The muscle thickness of adductors was measured before and after the intervention using ultrasound imaging. A significant increase in muscle thickness was found in both control (p = 0.002) and experimental group (p < 0.001), but the experimental group did not show additional effects in comparison with the control group. In conclusion, an 8-week CA exercise intervention does not increase the muscle thickness of adductors in U-17 soccer players more than their regular training.
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Affiliation(s)
- Alejandra Alonso-Calvete
- Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, 36310 Pontevedra, Spain; (A.A.-C.); (M.L.-M.); (E.R.)
| | - Miguel Lorenzo-Martínez
- Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, 36310 Pontevedra, Spain; (A.A.-C.); (M.L.-M.); (E.R.)
| | - Alexis Padrón-Cabo
- Department of Physical Education and Sport Science, Faculty of Sports Sciences and Physical Education, University of Coruña, 15001 A Coruña, Spain
- Correspondence: ; Tel.: +34-670-088-148
| | - Ezequiel Rey
- Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, 36310 Pontevedra, Spain; (A.A.-C.); (M.L.-M.); (E.R.)
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11
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Schaber M, Guiser Z, Brauer L, Jackson R, Banyasz J, Miletti R, Hassen-Miller A. The Neuromuscular Effects of the Copenhagen Adductor Exercise: A Systematic Review. Int J Sports Phys Ther 2021; 16:1210-1221. [PMID: 34631242 PMCID: PMC8486394 DOI: 10.26603/001c.27975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Groin strains are one of the most common time-loss injuries in athletes. The Copenhagen Adductor Exercise (CAE) eccentrically strengthens the adductors and may function to prevent adductor strains, similar to the eccentric mechanism in which the Nordic Hamstrings exercise acts to prevent hamstring strains. OBJECTIVE The purpose of this study was to systematically review the literature on the CAE and its effects on adductor muscle strength and muscle activity in athletes. STUDY DESIGN Systematic Review. METHODS A systematic search of the literature was performed in the following databases: Pubmed; Medline (EBSCO); Sportdiscus; Scopus; Web of Science; CINAHL; Proquest; Cochrane Library; Physiotherapy Evidence Database (PEDro). Inclusion criteria consisted of 1) implements CAE, 2) includes athletes of any age participating in at least one sport, 3) study type is a cohort study or randomized control trial. Studies were excluded if they were not written in English or did not measure strength as an outcome. Data were extracted on eccentric hip adductor strength (EHAD), eccentric hip abductor strength (EHAB), EHAD:EHAB ratio, and electromyography (EMG) activity of the adductor muscles. Quality assessment was performed on all included studies using Quality Assessment Tool for Quantitative Studies. RESULTS Five articles were identified for inclusion, four of which received a strong rating, and one a moderate rating on the Quality Assessment Tool for Quantitative Studies. The CAE significantly increased EHAD in four of the four studies that examined it; significantly increased EHAB and EHAD:EHAB in three of the three studies that examined them, and increased the EMG activity of the adductors in the dominant leg 108%. CONCLUSION Overall, the CAE increases EHAD, EHAB, EHAD:EHAB, and EMG activity in the hip adductors in male soccer players. The increase in strength may reduce adductor muscle injuries, although more research needs to be done in this area to identify a clear relationship between the CAE and groin injury prevention. LEVEL OF EVIDENCE 1b.
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12
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Breen D, Farrell G, Delahunt E. The clinical assessment of hip muscle strength in professional rugby union players. Phys Ther Sport 2021; 52:115-120. [PMID: 34481341 DOI: 10.1016/j.ptsp.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
Groin/hip injuries are prevalent in rugby union (RU). Assessment of hip muscle strength is important when designing bespoke injury prevention and rehabilitation programmes. OBJECTIVE The primary aim of this study was to determine normative values of hip muscle strength in elite-level RU players. A secondary aim of this study was to compare the Copenhagen Hip and Groin Outcome Score (HAGOS) between players with and without a history of groin/hip injury. DESIGN Cross-sectional cohort study. SETTING Professional RU club. PARTICIPANTS 58 male professional RU players competing in the PRO14 league elite club level competition. MAIN OUTCOME MEASURES Handheld dynamometry eccentric strength values of hip abduction (ABD), adduction (ADD), internal rotation (IR) and external rotation (ER), HAGOS. RESULTS Players' dominant (DOM) and non-dominant (NDOM) hip strength values were, 2.38 and 2.34 N m/kg for ABD, 2.79 and 2.71 N m/kg for ADD, 2.69 and 2.55 N m/kg for IR, and 2.65 and 2.54 N m/kg for ER. ADD:ABD strength ratio was 1.17 ± 0.26 for the DOM limb and 1.16 ± 0.24 for the NDOM limb. There was no clinically significant difference in strength between players' DOM and NDOM limbs. Players with a history of groin/hip injury scored lower on four of the HAGOS subscales (pain; symptoms; sport; quality of life) compared to those without a history of groin/hip injury. CONCLUSIONS This study may help establish normative hip strength and HAGOS values for elite-level RU players. The results presented have important implications for the assessment of hip muscle strength and could provide clinical markers for return-to-play following injury.
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Affiliation(s)
- David Breen
- The Performance Team MCFC Academy, Manchester City FC, CFA Etihad Campus, 400 Ashton New Road, Manchester, England, United Kingdom.
| | - Garreth Farrell
- Medical Department, Leinster Rugby, Newstead Building A, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin 4, Ireland.
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13
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The dominant leg is more likely to get injured in soccer players: systematic review and meta-analysis. Biol Sport 2021; 38:397-435. [PMID: 34475623 PMCID: PMC8329968 DOI: 10.5114/biolsport.2021.100265] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 12/26/2022] Open
Abstract
In soccer (football), dominant limb kicking produces higher ball velocity and is used with greater frequency than the non-dominant limb. It is unclear whether limb dominance has an effect on injury incidence. The purpose of this systematic review with meta-analysis is to examine the relationship between limb dominance and soccer injuries. Studies were identified from four online databases according to PRISMA guidelines to identify studies of soccer players that reported lower extremity injuries by limb dominance. Relevant studies were assessed for inclusion and retained. Data from retained studies underwent meta-analyses to determine relative risk of dominant versus non-dominant limb injuries using random-effects models. Seventy-four studies were included, with 36 of them eligible for meta-analysis. For prospective lower extremity injury studies, soccer players demonstrated a 1.6 times greater risk of injury to the dominant limb (95% CI [1.3-1.8]). Grouped by injury location, hamstring (RR 1.3 [95% CI 1.1-1.4]) and hip/groin (RR 1.9 [95% CI 1.3-2.7]) injuries were more likely to occur to the dominant limb. Greater risk of injury was present in the dominant limb across playing levels (amateurs RR 2.6 [95% CI 2.1-3.2]; youths RR 1.5 [95% CI 1.26-1.67]; professionals RR 1.3 [95% CI 1.14-1.46]). Both males (RR 1.5 [95% CI 1.33-1.68)] and females (RR 1.5 [95% CI 1.14-1.89]) were more likely to sustain injuries to the dominant limb. Future studies investigating soccer injury should adjust for this confounding factor by using consistent methods for assigning limb dominance and tracking use of the dominant versus non-dominant limb.
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14
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Chaari F, Rebai H, Boyas S, Rahmani A, Fendri T, Harrabi MA, Sahli S. Postural balance impairment in Tunisian second division soccer players with groin pain: A case-control study. Phys Ther Sport 2021; 51:85-91. [PMID: 34303123 DOI: 10.1016/j.ptsp.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare postural balance outcomes between soccer players with and without groin pain (GP). DESIGN Case-control study. SETTING Laboratory. PARTICIPANTS Fifty-four soccer players, 27 with GP (GP group: GPG) and 27 healthy ones (control group: CG). MAIN OUTCOME MEASURES Static and dynamic postural balance were assessed with a force platform and Y-balance test (Y-BT), respectively. Hip abduction, internal rotation (IR), external rotation (ER) and total rotation (TR) of both limbs were evaluated. RESULTS The GPG exhibited significant higher centre of pressure values in the bipedal posture only on the foam surface in eyes opened and closed compared to controls. Besides, they had lower anterior, posteromedial and posterolateral reach distances and composite Y-BT score on the injured limb (IL) compared to non-injured limb (NIL) and dominant-limb (DL) of the CG. Moreover, they showed lower abduction, IR, ER, and TR on the IL compared to NIL and DL. CONCLUSIONS Dynamic unipedal postural balance disorder could be one of the limiting factors of performance in soccer players with non-time loss GP. Hence, postural balance data in these players could enable sport coaches and physical therapists to better understand the mechanisms contributing for performance decrease.
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Affiliation(s)
- Fatma Chaari
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Haithem Rebai
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Sébastien Boyas
- Le Mans University, MIP, EA, 4334, Laboratory "Movement, Interactions, Performance", Faculty of Sciences and Technologies, Department of Sport Sciences, Le Mans, France.
| | - Abderrahmane Rahmani
- Le Mans University, MIP, EA, 4334, Laboratory "Movement, Interactions, Performance", Faculty of Sciences and Technologies, Department of Sport Sciences, Le Mans, France.
| | - Thouraya Fendri
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Mohammed A Harrabi
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Sonia Sahli
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
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15
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Candela V, De Carli A, Longo UG, Sturm S, Bruni G, Salvatore G, Denaro V. Hip and Groin Pain in Soccer Players. JOINTS 2021; 7:182-187. [PMID: 34235383 PMCID: PMC8253608 DOI: 10.1055/s-0041-1730978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 04/18/2021] [Indexed: 10/29/2022]
Abstract
Purpose The aim of this article is to illustrate the recent framework necessary to standardize studies on groin pain and review the existing literature on groin pain in football. Methods The common pathological processes underlying groin pain such as muscle, tendon or ligament strain, bone injury or fracture, sport hernia, bursitis, osteitis pubis, and hip-related diseases have been reviewed and current management options have been considered. Results Groin pain is considered a pain in pubic or lower abdominal or adductors region which can be monolateral or bilateral. It is common in high-intensity team sports and can negatively affect an athlete's professional carrier, causing serious disruption in the performance. Despite a high prevalence of groin pain in athletes, diagnosis and management of the underlying pathological processes remain a challenge for surgeons, radiologists, and physiotherapists alike. Conclusion A multidisciplinary approach is essential for patients with groin pain allowing prompt diagnosis and initiation of treatment thus facilitating more rapid return to play and preventing potential long-term sequelae of chronic groin pathology.
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Affiliation(s)
- Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Angelo De Carli
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza," Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Sofia Sturm
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Giorgio Bruni
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza," Italy
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
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16
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Esteve E, Casals M, Saez M, Rathleff MS, Clausen MB, Vicens-Bordas J, Hölmich P, Pizzari T, Thorborg K. Past-season, pre-season and in-season risk assessment of groin problems in male football players: a prospective full-season study. Br J Sports Med 2021; 56:484-489. [PMID: 33692032 DOI: 10.1136/bjsports-2020-102606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Ernest Esteve
- Universtiy School of Health and Sport (EUSES), University of Girona, Girona, Catalunya, Spain
| | - Marti Casals
- Sport and Physical Activity Studies Centre (CEEAF), Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Catalunya, Spain.,Servicios Médicos, Futbol Club Barcelona, Barcelona, Catalunya, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health, GRECS, University of Girona, Girona, Catalunya, Spain.,CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Comunidad de Madrid, Spain
| | - Michael Skovdal Rathleff
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | - Mikkel Bek Clausen
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hovedstaden, Denmark.,Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Kobenhavn, Hovedstaden, Denmark
| | - Jordi Vicens-Bordas
- Sport and Physical Activity Studies Centre (CEEAF), Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Catalunya, Spain.,NEOMA Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Catalunya, Spain
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hovedstaden, Denmark
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hovedstaden, Denmark.,Physical Medicine and Rehabilitation-Copenhagen (PMR-C), Amager-Hvidovre Hospital, Copenhagen University, Hvidovre, Denmark
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17
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Dekker TM, Uppstrom TJ, Emerson CP, Vickers RF, Greditzer HG. Magnetic Resonance Imaging Findings of Core Muscle Injuries in High Level Athletes. Curr Sports Med Rep 2021; 20:157-163. [PMID: 33655997 DOI: 10.1249/jsr.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Core muscle injuries are common injuries in athletes involved in high speed side-to-side acceleration movements. The term core muscle injury encapsulates several different injuries that occur in the pelvic region that have similar presentations. Along with a good history and physical examination, magnetic resonance imaging (MRI) can be a helpful tool in the diagnostic process. Correct orientation and protocols are needed to show the correct anatomy with an MRI. Furthermore, to determine the exact etiology of the core muscle injury, it is important to know which structures are likely to be involved and be able to recognize the patterns of injury on imaging.
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Affiliation(s)
- Timothy M Dekker
- Department of Sports Medicine, The Hospital for Special Surgery, New York, NY
| | - Tyler J Uppstrom
- Department of Orthopedic Surgery, The Hospital for Special Surgery, New York, NY
| | | | | | - Harry G Greditzer
- Department of Radiology and Imaging, The Hospital for Special Surgery, New York, NY
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18
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Serner A, Lichau O, Reboul G. Evaluation of the bent knee fall out test pre- and post- an adductor longus tenotomy. Phys Ther Sport 2021; 48:196-200. [PMID: 33508695 DOI: 10.1016/j.ptsp.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the immediate effect of an adductor longus tenotomy on the results of the bent knee fall out test, and whether there was a correlation between pre-tenotomy measures and the magnitude of change. DESIGN Observational study. METHODS We included recreational to elite athletes with longstanding adductor-related groin pain (specifically adductor longus insertion pain) undergoing unilateral or bilateral full adductor longus tenotomy. The bent knee fall out test was performed immediately prior and immediately after the surgical procedure. We used Wilcoxon signed-rank test to compare test results pre- and post-tenotomy, and Spearman's rho (rs) to analyse correlation between pre-tenotomy values and the magnitude of change in the bent knee fall out test. RESULTS We consecutively included 60 male adult athletes. There was a statistically significant difference (p < 0.001) in the bent knee fall out result from pre-surgery (median 11.5 cm [IQR 9-15], range 5-25 cm) to post-surgery (median 8 cm [IQR 6-10], range 3-15 cm). The mean difference was 3.9 ± 2 cm, range 0-11 cm, corresponding to a large effect size, d = 1.92. There was a moderate correlation between the bent knee fall out measurement pre-tenotomy and the difference from pre-to-post, rs = 0.75, p < 0.001. CONCLUSION The bent knee fall out measurements changed considerably immediately after an adductor longus tenotomy, showing that the test is assessing adductor longus flexibility in male athletes with longstanding adductor-related groin pain. There was a moderate correlation between the bent knee fall out measure pre-tenotomy and the magnitude of change.
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Affiliation(s)
- Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Sport City Street, PO Box, 29222, Doha, Qatar.
| | - Olivier Lichau
- Hôpital Pellegrin, Centre Hospitalier Universitaire, Place Amélie Raba Léon, 33000, Bordeaux, France; Hernia Center, Clinique du sport, Bordeaux-Mérignac, 4 Rue Georges Negrevergne, 33700, Mérignac, France
| | - Gilles Reboul
- Hernia Center, Clinique du sport, Bordeaux-Mérignac, 4 Rue Georges Negrevergne, 33700, Mérignac, France
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19
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Nassis GP, Massey A, Jacobsen P, Brito J, Randers MB, Castagna C, Mohr M, Krustrup P. Elite football of 2030 will not be the same as that of 2020: Preparing players, coaches, and support staff for the evolution. Scand J Med Sci Sports 2021; 30:962-964. [PMID: 32424904 DOI: 10.1111/sms.13681] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Affiliation(s)
- George P Nassis
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, SDU Sport and Health Sciences Cluster, University of Southern Denmark, Odense, Denmark
| | - Andrew Massey
- Medical Department, Liverpool Football Club, Liverpool, UK
| | | | - Joao Brito
- Portugal Football School, Portuguese Football Federation, Lisbon, Portugal
| | - Morten B Randers
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, SDU Sport and Health Sciences Cluster, University of Southern Denmark, Odense, Denmark.,School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Carlo Castagna
- Fitness training and Biomechanics Laboratory, Italian Football Federation (FIGC), Technical Department, Coverciano (Florence), Italy
| | - Magni Mohr
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, SDU Sport and Health Sciences Cluster, University of Southern Denmark, Odense, Denmark.,Centre of Health Science, Faculty of Health, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Peter Krustrup
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, SDU Sport and Health Sciences Cluster, University of Southern Denmark, Odense, Denmark.,Sport and Health Sciences, University of Exeter, Exeter, UK
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20
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Khaitin V, Bezuglov E, Lazarev A, Matveev S, Ivanova O, Maffulli N, Achkasov E. Markers of muscle damage and strength performance in professional football (soccer) players during the competitive period. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:113. [PMID: 33569415 PMCID: PMC7867942 DOI: 10.21037/atm-20-2923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The present study investigated the impact of competitive soccer on the short-term changes in isometric strength of the adductor muscle group during the competitive season. Methods In this cohort study we evaluated the association between a serum marker of muscle damage [creatine phosphokinase (CPK)] and isometric strength of the adductor muscles of the hip in 30 professional football players (age: 26.7±2.9 years) during two seasons of the national top-level championship. Serum CPK level was determined the day before the match, 12–20, 36–48, 60–72 h after the match. The maximum voluntary isometric contraction force of the adductor muscles complex was determined immediately after having taken blood samples. Results There was evidence of a statistically significant positive association between age, body mass index (BMI), percentage of body fat, and muscle strength, and between weight and muscle strength. There was evidence of a statistically significant negative association between the level of CPK and the maximum isometric strength of the adductors of soccer players. Changes in CPK levels were associated with the muscle strength recovery trend (P<0.001). The strength/CPK ratio at different time points had a U-shaped curve. Conclusions Exercise induced muscle damage significantly affects the strength of the adductor muscle group of professional soccer players during the competitive period. The lower the CPK level, the greater the athletes' strength at a given time point. Also, the greater the decrease in CPK level, the greater the rate of strength restoration.
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Affiliation(s)
- Vladimir Khaitin
- Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia.,FC Zenit, Saint-Petersburg, Russia
| | - Eduard Bezuglov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Federal Research and Clinical Center of Sports Medicine and Rehabilitation of Federal Medical Biological Agency, Moscow, Russia.,High Performance Sport Laboratory, Moscow Witte University, Moscow, Russia
| | - Artemii Lazarev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,High Performance Sport Laboratory, Moscow Witte University, Moscow, Russia
| | - Sergey Matveev
- Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia
| | - Olga Ivanova
- Lomonosov Moscow State University, Moscow, Russia
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, England.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, England
| | - Evgeny Achkasov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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21
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Daniels KAJ, King E, Richter C, Falvey É, Franklyn-Miller A. Changes in the kinetics and kinematics of a reactive cut maneuver after successful athletic groin pain rehabilitation. Scand J Med Sci Sports 2020; 31:839-847. [PMID: 33098142 DOI: 10.1111/sms.13860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/19/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
Athletic groin pain (AGP) is a chronic, painful condition which is prevalent in players of field sports that require rapid changes of direction. Following successful rehabilitation, systematic changes have been observed in the kinetics and kinematics of pre-planned change of direction maneuvers, providing insight into potential foci for rehabilitation monitoring and for the assessment of interventions. However, changing direction in field sports is often reactive rather than pre-planned, and it is not known whether such post-rehabilitation changes are seen in reactive maneuvers. We analyzed the stance phase kinetics and kinematics of a 90° reactive cutting maneuver in 35 AGP patients before and after a successful exercise intervention program. Following the intervention, transverse plane rotation of the pelvis toward the intended direction of travel increased, and the body center of mass was positioned more anteriorly relative to the center of pressure. Ankle dorsiflexion also increased, and participants demonstrated greater ankle plantar flexor internal moment and power during the second half of stance. These findings provide insight into mechanical variables of potential importance in AGP, as identified during a maneuver based on a common sporting task.
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Affiliation(s)
- Katherine A J Daniels
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Queen's School of Engineering, University of Bristol, Bristol, UK.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Life Sciences, University of Roehampton, London, UK
| | - Chris Richter
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Life Sciences, University of Roehampton, London, UK
| | - Éanna Falvey
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Andy Franklyn-Miller
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
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22
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Núñez JF, Fernandez I, Torres A, García S, Manzanet P, Casani P, Suarez-Arrones L. Strength Conditioning Program to Prevent Adductor Muscle Strains in Football: Does it Really Help Professional Football Players? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176408. [PMID: 32887522 PMCID: PMC7504263 DOI: 10.3390/ijerph17176408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/16/2022]
Abstract
Coaches at the professional level are often concerned about negative side effects from testing and intensive resistance training periods, and they are not willing to base their training prescriptions on data obtained from semiprofessional or amateur football players. Consequently, the purpose of this study was to analyze the reliability and effectiveness of two adductor injury active prevention programs using the adductor/abductor ratio and deficit between legs, on the basis of adduction-abduction power output during the exercises proposed, in professional football players. Forty-eight professional football players undertook complementary strength training for the adductor and abductor muscles in their dominant and non-dominant legs, once or twice a week throughout the playing season. The volume of the session was determined by the adductor/abductor ratio and the deficit between legs in the last session training measured. The number and severity of muscle injuries per 1000 h of exposure were recorded. Both prevention programs showed a very low rate of adductor injury (0.27 and 0.07 injuries/1000 h) with mild-to-moderate severity, maintaining a balance in percentage asymmetry between dominant and non-dominant legs for adductor (10.37%) and in the adductor/abductor ratio (0.92) in top professional football players throughout the season. The strength conditioning program proposed can help to prevent adductor muscle injuries in top professional football players.
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Affiliation(s)
- Javier F. Núñez
- Department of Sports and Informatics, Sport Faculty, University of Pablo de Olavide of Sevilla, 41013 Sevilla, Spain;
- Correspondence: ; Tel.: +34-606-204-313
| | - Ismael Fernandez
- Physical Trainer Coach of Valencia C.F, 46010 Valencia, Spain; (I.F.); (S.G.)
| | | | - Sergio García
- Physical Trainer Coach of Valencia C.F, 46010 Valencia, Spain; (I.F.); (S.G.)
| | - Pablo Manzanet
- Physical Trainer Coach of Villarreal C.F., 12540 Vila-Real, Spain;
| | - Pascual Casani
- Head of Medical Staff of Valencia C.F., 46010 Valencia, Spain;
| | - Luis Suarez-Arrones
- Department of Sports and Informatics, Sport Faculty, University of Pablo de Olavide of Sevilla, 41013 Sevilla, Spain;
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Effectiveness of Field-Based Resistance Training Protocols on Hip Muscle Strength Among Young Elite Football Players. Clin J Sport Med 2020; 30:470-477. [PMID: 30418198 DOI: 10.1097/jsm.0000000000000649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to examine the effects of an 8-week progressive resistance training program on hip joint muscles' strength measures, using the Copenhagen adduction (CA) and the sliding hip (SH) exercises. DESIGN Prospective randomized controlled trial. SETTING Sport training and medical centers. PARTICIPANTS Forty-two young male football athletes (age 17.5 ± 1.1 years; height 178.3 ± 3.2 cm; body mass 66.1 ± 8.6 kg) allocated to a CA, SH, and matched control (C) group. INTERVENTIONS Two weekly sessions of CA and SH. MAIN OUTCOME MEASURES Maximal eccentric strength test for the hip adductor (EHAD) and maximal eccentric strength test for the hip abductor (EHAB) muscles, and the relative EHAD/EHAB ratio assessed through a break test in the side-lying position. RESULTS No significant differences between groups were found at baseline for any of the assessed variables (all P > 0.053). The CA group had a significant strength increase in the right and left leg (d = 2.11, d = 1.9, respectively). The SH group also had a significant strength increase in the right and left leg (d = 1.68 and d = 1.67, respectively). The CA group presented EHAD/EHAB improvements in the right and left leg (d = 0.84 and d = 1.14, respectively). The SH group also presented EHAD/EHAB improvements in the right and left leg (d = 1.34 and d = 1.44, respectively). CONCLUSIONS Both exercises' protocols were effective in inducing significant increases on EHAD, EHAB, and EHAD/EHAB ratio when compared with the control group. Practitioners should be aware of the training effectiveness of both protocols.
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Evaluation of Muscle Injuries in Professional Football Players: Does Coach Replacement Affect the Injury Rate? Clin J Sport Med 2020; 30:478-483. [PMID: 30113968 DOI: 10.1097/jsm.0000000000000640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the incidence and characteristics of muscle injuries in professional football players and to assess if coach dismissal may be related with muscle injuries within 1-month period from the dismissal. DESIGN Prospective cohort study during 3 consecutive seasons. SETTING Turkish Super League football teams. PARTICIPANTS One hundred eighteen male football players. MAIN OUTCOME MEASURES Data on time-loss muscle injuries confirmed using magnetic resonance imaging were recorded, including type, body part, duration, and lay-off time, and training session and match exposure times. The muscle injury rate was evaluated at 2 weeks and 30 days after coach dismissal. RESULTS In total, 124 muscle injuries were recorded, with injury incidences of 2.3 muscle injuries per 1000 hours of exposure overall, 1.2 in training sessions, and 13.6 in matches. Injury time loss ranged from 3 to 67 days (median, 13 days). Eighteen percent of the injuries (n = 23) were recurrent; no association was found between recurrence rate and the player's age or position (P = 0.15, P = 0.27, respectively). Recurrent injuries caused more severe injuries (26.1%, P = 0.02) and longer median lay-off time (P = 0.01). During the study, teams A and B replaced 7 and 3 coaches, respectively. The injury incidence increased to 5.3 per 1000 hours of exposure in the 2 weeks after the coach dismissal, and decreased to 4.5 within 1 month of coach dismissal. CONCLUSION Given the link between coach dismissal and increased rates of muscle strain injuries, increased attentiveness to preventing muscle injuries during coaching transitions and to the impact of new training regimens is required by trainers and medical teams.
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The conservative treatment of longstanding adductor-related groin pain syndrome: a critical and systematic review. Biol Sport 2020; 38:45-63. [PMID: 33795914 PMCID: PMC7996386 DOI: 10.5114/biolsport.2020.97669] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/12/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
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.
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Esteve E, Clausen MB, Rathleff MS, Vicens‐Bordas J, Casals M, Palahí‐Alcàcer A, Hölmich P, Thorborg K. Prevalence and severity of groin problems in Spanish football: A prospective study beyond the time‐loss approach. Scand J Med Sci Sports 2020; 30:914-921. [DOI: 10.1111/sms.13615] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/12/2019] [Accepted: 12/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ernest Esteve
- Sportclínic Physiotherapy and Sports Training Centre Girona Spain
- School of Health and Sports Sciences (EUSES) Universitat de Girona Salt Spain
| | - Mikkel Bek Clausen
- Department of Orthopedic Surgery Sports Orthopedic Research Center (SORC‐C) Copenhagen University Hospital Amager‐Hvidovre Denmark
- Bachelor's Degree Programme in Physiotherapy Faculty of Health and Technology University College Copenhagen Copenhagen Denmark
| | - Michael Skovdal Rathleff
- SMI Department of Health Science and Technology Faculty of Medicine Aalborg University Aalborg Denmark
- Department of Occupational Therapy and Physiotherapy Aalborg University Hospital Aalborg Denmark
| | - Jordi Vicens‐Bordas
- Sportclínic Physiotherapy and Sports Training Centre Girona Spain
- School of Health and Sports Sciences (EUSES) Universitat de Girona Salt Spain
- Department of Medical Sciences Universitat de Girona (UdG) Girona Spain
| | - Martí Casals
- Sport and Physical Activity Studies Centre (CEEAF) University of Vic – Central University of Catalonia Barcelona Spain
| | - Albert Palahí‐Alcàcer
- Sportclínic Physiotherapy and Sports Training Centre Girona Spain
- Nursing Faculty Universitat de Girona (UdG) Girona Catalonia Spain
| | - Per Hölmich
- Department of Orthopedic Surgery Sports Orthopedic Research Center (SORC‐C) Copenhagen University Hospital Amager‐Hvidovre Denmark
| | - Kristian Thorborg
- Department of Orthopedic Surgery Sports Orthopedic Research Center (SORC‐C) Copenhagen University Hospital Amager‐Hvidovre Denmark
- Physical Medicine and Rehabilitation – Copenhagen (PMR‐C) Amager‐Hvidovre Hospital Copenhagen University Hvidovre Denmark
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Stevenson K, Bleakley C, Tak I, Langhout R, Saligari R, Glasgow P. Active posterior pelvic tilt range of motion is decreased in soccer players with chronic groin pain: A case‐control study. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- K. Stevenson
- Faculty of Life and Health Sciences Ulster University Newtownabbey Northern Ireland
| | - C. Bleakley
- Faculty of Life and Health Sciences Ulster University Newtownabbey Northern Ireland
- Department of Physical Therapy Congdon School of Health Science High Point University High Point NC USA
| | - I.J.R. Tak
- Physiotherapy Utrecht Oost Utrecht The Netherlands
- Academic Center for Evidence‐Based Sports Medicine (ACES) Amsterdam The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS) Amsterdam The Netherlands
| | - R.F.H. Langhout
- Academic Center for Evidence‐Based Sports Medicine (ACES) Amsterdam The Netherlands
- Physiotherapy Dukenburg Nijmegen The Netherlands
- Department of Orthopaedics and Sports Traumatology Amsterdam University Medical Centre Amsterdam The Netherlands
- Masters Program in Manual Therapy SOMT Amersfoort The Netherlands
| | - R. Saligari
- Active Health Solutions County Down Holywood Northern Ireland
| | - P. Glasgow
- Faculty of Life and Health Sciences Ulster University Newtownabbey Northern Ireland
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Serner A, Weir A, Tol JL, Thorborg K, Yamashiro E, Guermazi A, Roemer FW, Hölmich P. Associations Between Initial Clinical Examination and Imaging Findings and Return-to-Sport in Male Athletes With Acute Adductor Injuries: A Prospective Cohort Study. Am J Sports Med 2020; 48:1151-1159. [PMID: 32182099 DOI: 10.1177/0363546520908610] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Time to return-to-sport (RTS) after acute adductor injuries varies among athletes, yet we know little about which factors determine this variance. PURPOSE To investigate the association between initial clinical and imaging examination findings and time to RTS in male athletes with acute adductor injuries. STUDY DESIGN Cohort study (Prognosis); Level of evidence, 2. METHODS Male adult athletes with an acute adductor injury were included within 7 days of injury. Standardized patient history and clinical and magnetic resonance imaging (MRI) examinations were conducted for all athletes. Athletes performed a supervised standardized criteria-based exercise treatment program. Three RTS milestones were defined: (1) clinically pain-free, (2) completed controlled sports training, and (3) first full team training. Univariate and multiple regression analyses were performed to determine the association between the specific candidate variables of the initial examinations and the RTS milestones. RESULTS We included 81 male adult athletes. The median duration for the 3 RTS milestones were 15 days (interquartile range, 12-28 days), 24 days (16-32 days), and 22 days (15-31 days), respectively. Clinical examination including patient history was able to explain 63%, 74%, and 68% of the variance in time to RTS. The strongest predictors for longer time to RTS were pain on palpation of the proximal adductor longus insertion or a palpable defect. The addition of MRI increased the explained variance with 7%, 0%, and 7%. The strongest MRI predictor was injury at the bone-tendon junction. Post hoc multiple regression analyses of players without the 2 most important clinical findings were able to explain 24% to 31% of the variance, with no added value of the MRI findings. CONCLUSION The strongest predictors of a longer time to RTS after acute adductor injury were palpation pain at the proximal adductor longus insertion, a palpable defect, and/or an injury at the bone-tendon junction on MRI. For athletes without any of these findings, even extensive clinical and MRI examination does not assist considerably in providing a more precise estimate of time to RTS.
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Affiliation(s)
- Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Adam Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Erasmus MC Center for Groin Injuries, Department of Orthopaedics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Amsterdam University Medical Centers, Academic Medical Center, Amsterdam Movement Sciences, Academic Center for Evidence Based Medicine, Amsterdam IOC Center, Amsterdam Collaboration for Health and Safety in Sports, Amsterdam, the Netherlands
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | | | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Radiology, University of Erlangen-Nürnberg & Universitätsklinikum Erlangen, Erlangen, Germany
| | - Per Hölmich
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
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29
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Lundgårdh F, Svensson K, Alricsson M. Epidemiology of hip and groin injuries in Swedish male first football league. Knee Surg Sports Traumatol Arthrosc 2020; 28:1325-1332. [PMID: 30895331 PMCID: PMC7148259 DOI: 10.1007/s00167-019-05470-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/04/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to investigate the incidence, pattern, and burden of hip/groin injuries in Swedish professional male football players over five consecutive seasons. METHODS Injury history from 16 football teams in the Swedish male first football league was evaluated during five consecutive seasons. The team's medical staff recorded team exposure and time-loss injuries prospectively between 2012 and 2016. RESULTS In total, 467 time-loss injuries located in the hip/groin area were recorded among 1,687 professional male football players, with an overall incidence and burden of 0.82/1,000 h and 15.6/1,000 h, respectively. There appeared to be an increased risk of hip/groin injuries during the last two seasons (2015-2016); however, the difference was not statistically significant (n.s). Recurrent injury rate was relatively low (14%), and overuse injuries accounted for the majority of injuries and absence days. Muscle injuries were the main injury type, while kicking and sprinting/running were the primary causes of injury. Goalkeepers had the lowest percentage of injuries and absence days. CONCLUSION Hip/groin injuries are a substantial problem in football, but does not seem to be an increasing phenomenon in the Swedish male first football league. Index and overuse injuries accounted for the majority of injuries and absence days. Thus, the focus should be on preventing hip/groin injuries to lower the injury rate. These new findings should be taken into consideration when designing and implementing preventive training interventions. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Filip Lundgårdh
- Department of Health Sciences, Swedish Winter Sport Research Centre, Mid Sweden University, Östersund, Sweden
| | - Kjell Svensson
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Centre, Karolinska Institutet, Stockholm, Sweden
| | - Marie Alricsson
- Department of Sports Science, Linnaeus University, 391 82, Kalmar, Sweden.
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Han JS, Sugimoto D, McKee-Proctor MH, Stracciolini A, d'Hemecourt PA. Short-term Effect of Ultrasound-Guided Iliopsoas Peritendinous Corticosteroid Injection. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1527-1536. [PMID: 30380165 DOI: 10.1002/jum.14841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Treatment for iliopsoas tendinopathy includes ultrasound (US)-guided iliopsoas peritendinous corticosteroid injection. Evidence is lacking regarding US-guided iliopsoas injection efficacy in patients with iliopsoas tendinopathy and intra-articular (IA) hip abnormalities. The purpose of this study was to examine the efficacy of US-guided iliopsoas corticosteroid injection for iliopsoas tendinopathy in patients with and without IA hip abnormalities. METHODS This work was a prospective study evaluating patients aged 12 to 50 years with iliopsoas tendinopathy. Participants completed a Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaire before and 6 weeks after injection. The main outcome measure was the change in HOOS subcategory scores. Independent variables included time and hip status. Normal hips were compared to abnormal hips with IA abnormalities. A 2-way repeated measures analysis of covariance with effect size (η2 ) was used to determine injection effects on HOOS scores before and 6 weeks after injection. RESULTS A total of 178 patients (154 female and 24 male) were analyzed. Time effects were found for both normal and abnormal hips in all HOOS subcategories: symptoms (P = .041; η2 = 0.050), pain (P = .001; η2 = 0.184), activities of daily living (P = .011; η2 = 0.076), function in sports and recreation (P = .001; η2 = 0.151), and quality of life (QOL; P = .001; η2 = 0.193). Significant differences between normal versus abnormal hips were found in the sports and recreation (P = .032; η2 = 0.056) and QOL scores (P = .001; η2 = 0.135). CONCLUSIONS In patients with iliopsoas tendinopathy, US-guided iliopsoas corticosteroid injection improved outcomes regardless of coexisting IA hip abnormalities. Patients without IA hip abnormalities showed greater improvement in sports and recreation and QOL scores compared to patients with IA hip abnormalities. Ultrasound-guided iliopsoas injection for iliopsoas tendinopathy may advance short-term care and help continue with nonsurgical treatment regimens.
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Affiliation(s)
- Julie S Han
- Departments of Orthopedics, Division of Sports Medicine
| | - Dai Sugimoto
- Departments of Orthopedics, Division of Sports Medicine
- Harvard Medical School, Boston, Massachusetts, USA
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Maxwell H McKee-Proctor
- Departments of Orthopedics, Division of Sports Medicine
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Andrea Stracciolini
- Departments of Orthopedics, Division of Sports Medicine
- Medicine, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Pierre A d'Hemecourt
- Departments of Orthopedics, Division of Sports Medicine
- Harvard Medical School, Boston, Massachusetts, USA
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
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31
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Desmyttere G, Gaudet S, Begon M. Test-retest reliability of a hip strength assessment system in varsity soccer players. Phys Ther Sport 2019; 37:138-143. [PMID: 30959443 DOI: 10.1016/j.ptsp.2019.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate test-retest reliability of a hip strength assessment system (GroinBar). DESIGN Test-retest reliability study. SETTING Laboratory. PARTICIPANTS Twenty asymptomatic varsity soccer players. MAIN OUTCOME MEASURES Maximal isometric hip strength (adduction, abduction, internal and external rotation, flexion and extension) was assessed using the GroinBar. Intraclass correlation coefficient (ICC) and relative standard error of measurement (SEM) were calculated to evaluate reliability of peak (ICC3,1) (highest peak within 3 trials) and average peak (ICC3,3) (average of 3 trials) force and rate of force development (RFD). Hotelling's T2, were also used to compare bilateral and reciprocal ratios between dominant and non-dominant leg. RESULTS ICC for both peak force and RFD values revealed moderate to good reliability (0.53-0.88 and 0.61-0.84, respectively), whereas reliability was good to excellent regarding their average values (0.77-0.95 and 0.81-0.92, respectively). SEM of average peak force and RFD values (4.1-9.4% and 8.2-13.9%, respectively) were lower than that of peak force and RFD values (5.7-13.0% and 10.7-19.1%, respectively). No significant difference was found in bilateral and reciprocal force ratios between dominant and non-dominant leg. CONCLUSIONS The GroinBar is a reliable tool to assess hip muscle function in athletic populations and could be used for player screening and follow-up.
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Affiliation(s)
- Gauthier Desmyttere
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC, H7N 0B6, Canada.
| | - Sylvain Gaudet
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC, H7N 0B6, Canada
| | - Mickael Begon
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC, H7N 0B6, Canada
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Moreno-Pérez V, Travassos B, Calado A, Gonzalo-Skok O, Del Coso J, Mendez-Villanueva A. Adductor squeeze test and groin injuries in elite football players: A prospective study. Phys Ther Sport 2019; 37:54-59. [PMID: 30856592 DOI: 10.1016/j.ptsp.2019.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- V Moreno-Pérez
- Sports Research Centre, Miguel Hernandez University of Elche, Avda. de La Universidad s/n, 03202, Elche, Alicante, Spain.
| | - B Travassos
- Departamento de Ciências do Desporto, Universidade da Beira Interior, Convento de Sto. António. 6201-001, Covilhã, Portugal.
| | - A Calado
- Rio Ave Rendimento, Rio Ave FC, Rua Sancho I, Estadio do Rio Ave, 4489-876, Vila do Conde, Portugal.
| | - O Gonzalo-Skok
- Faculty of Health Sciences, University of San Jorge of Zaragoza, Villanueva de Gállego, 50830, Zaragoza, Spain.
| | - J Del Coso
- Exercise Physiology Laboratory, Camilo José Cela University, Sport Sciences Institute Castillo de Alarcón, 49, Villafranca del Castillo, None, 28692, Spain.
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Langhout R, Weir A, Litjes W, Gozeling M, Stubbe JH, Kerkhoffs G, Tak I. Hip and groin injury is the most common non-time-loss injury in female amateur football. Knee Surg Sports Traumatol Arthrosc 2019; 27:3133-3141. [PMID: 29860603 PMCID: PMC6754353 DOI: 10.1007/s00167-018-4996-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/30/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Hip and groin injuries in football are problematic due to their high incidence and risk of chronicity and recurrence. The use of only time-loss injury definitions may underestimate the burden of hip and groin injuries. Little is known about hip and groin injury epidemiology in female football. The first aim of this study was to examine the within-season (2014-2015) prevalence of total injury with and without time-loss in female amateur football players. The second aim was to study the within-season and preseason (2015-2016) prevalence of hip/groin injuries with and without time-loss. The third aim was to study the association between the duration of hip and groin injury in the 2014-2015 season and the severity of hip/groin problems during the 2015-2016 preseason. METHODS During the preseason, 434 Dutch female amateur football players completed an online questionnaire based on the previous season and current preseason. The hip and groin outcome score (HAGOS) was used to assess the severity of hip and groin injuries. RESULTS The hip/groin (17%), knee (14%), and ankle (12%) were the most frequent non-time-loss injury locations. The ankle (22%), knee (18%), hamstring (11%), thigh (10%), and hip/groin (9%) were the most common time-loss injury locations. The previous season prevalence of total injury was 93%, of which non-time-loss injury was 63% and time-loss injury was 37%. The prevalence of hip/groin injury was 40%, non-time-loss hip/groin injury was 36% and time-loss hip/groin injury was 11%. The preseason prevalence of hip/groin injury was 27%, non-time-loss hip/groin injury was 25%, and time-loss hip/groin injury was 4%. Players with longstanding hip/groin injury (> 28 days) in the previous season had lower HAGOS scores at the next preseason than players with short-term (1-7 days) or no hip/groin injury (p < 0.001). From all players with hip/groin injury from the previous season, 52% also sustained hip/groin injury in the following preseason, of which 73% were recurrent and 27% were chronic hip/groin injuries. CONCLUSION Injury risk, and especially non-time-loss hip and groin injury risk, is high in female amateur football. Three-quarters of the players with longstanding hip and groin injuries in the previous season have residual problems at the start of the following season. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rob Langhout
- Department for Manual Therapy and Sports Rehabilitation, Physiotherapy Dukenburg Nijmegen, Aldenhof 7003, 6537 DZ, Nijmegen, The Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC-VUmc IOC Research Center, Amsterdam, The Netherlands.
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.
- Advanced Studies Manual Therapy, SOMT University, Amersfoort, The Netherlands.
- Dutch Center for Allied Health Care (NPi), Amersfoort, The Netherlands.
| | - Adam Weir
- Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopaedics, Erasmus MC Center for Groin Injuries, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Wendy Litjes
- Department of Sports Rehabilitation, Physiotherapy Wijchen, Wijchen, The Netherlands
| | - Maarten Gozeling
- Department of Physiotherapy, PSV Eindhoven, Eindhoven, The Netherlands
| | - Janine H Stubbe
- Codarts Rotterdam, University of the Arts, Rotterdam, The Netherlands
| | - Gino Kerkhoffs
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC-VUmc IOC Research Center, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Igor Tak
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC-VUmc IOC Research Center, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Dutch Center for Allied Health Care (NPi), Amersfoort, The Netherlands
- Department for Manual Therapy and Sports Rehabilitation, Physiotherapy Utrecht Oost, Utrecht, The Netherlands
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Klein C, Henke T, Platen P. Injuries in football (soccer)—a systematic review of epidemiology and aetiological aspects. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2018. [DOI: 10.1007/s12662-018-0530-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Feldman K, Franck C, Schauerte C. Management of a nonathlete with a traumatic groin strain and osteitis pubis using manual therapy and therapeutic exercise: A case report. Physiother Theory Pract 2018; 36:753-760. [PMID: 29979902 DOI: 10.1080/09593985.2018.1492658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Without a definitive single pathoanatomical origin for groin pain, management is difficult. The purpose of this case report is to describe the differential diagnosis and management of an individual with a traumatic groin strain. Case Description: A 47-year-old sedentary male truck driver presented to physical therapy with a 2-month history of right medial groin pain. Pushing the gas pedal and sitting were painful activities. Pain was 3-8/10 on the Numeric Pain Rating Scale (NPRS). The patient reported 46/80 on the Lower Extremity Functional Scale. Examination: Tenderness was noted along the adductor longus muscle belly, right pubic ramus and hip range of motion was limited. Special tests directed at the hip and pelvic region indicated intraarticular and pelvic dysfunction. Treatment included hip and pubic symphysis joint mobilizations, lumbopelvic manipulation, adductor longus soft-tissue mobilization, and core strengthening. Outcome: 12 sessions of physical therapy resulted in LEFS to 80/80, Global Rating of Change (GROC) + 7, and NPRS 0/10 at worst. The patient returned to full work without restriction. Discussion: Groin pain has many pathoanatomical drivers. Management of a traumatic groin injury requires a thorough evaluation and a global treatment approach, in order to improve outcomes and reduce the risk of the pathology becoming chronic.
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Affiliation(s)
- Kyle Feldman
- Physical Therapy Specialists of Winchester , Winchester, VA, USA
| | - Carla Franck
- Kepros Physical Therapy and Performance , Cedar Rapids, IA, USA
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Yousefzadeh A, Shadmehr A, Olyaei GR, Naseri N, Khazaeipour Z. Effect of Holmich protocol exercise therapy on long-standing adductor-related groin pain in athletes: an objective evaluation. BMJ Open Sport Exerc Med 2018; 4:e000343. [PMID: 30018787 PMCID: PMC6045696 DOI: 10.1136/bmjsem-2018-000343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/04/2022] Open
Abstract
Aim To objectively evaluate the effect of Holmich protocol-based exercise therapy on long-standing adductor-related groin pain (LSAGP). Methods We reproduced the Holmich protocol of exercise therapy and objectively evaluated its effect on 17 male athletes (mean age, 25.07±4.96 years) suffering from LSAGP, of whom 14 participants completed the 10 weeks treatment period. The study was designed as a single-blinded, before-and-after clinical trial. Main outcome measures included pain, functional ability, hip range of motion (ROM), hip abductor and adductor muscle strength, and successful return to sports activity. Results Eleven athletes (78.57%) returned to their sports activities in a mean time of 14.2 weeks (range, 10-20 weeks). Visual analogue scale pain score, hip abductor and adductor muscles strength, and function scores improved significantly. Although hip abduction ROM did not show any significant changes (p = 0.609), the extent of progress in the hip internal rotation ROM was significant (p = 0.001). The ratio of hip adduction to abduction strength did not change significantly (p = 0.309 for the isometric and p = 0.957 for the eccentric ratio). Conclusions Exercise therapy according to the Holmich programme may be an effective treatment for LSAGP. However, more emphasis should be paid to the hip adductor muscles' eccentric strength. Trial registration number IRCT2016080829269N1.
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Affiliation(s)
- Abbas Yousefzadeh
- Department of Physiotherapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Shadmehr
- Department of Physiotherapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholam Reza Olyaei
- Department of Physiotherapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Naseri
- Department of Physiotherapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Khazaeipour
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Harøy J, Clarsen B, Wiger EG, Øyen MG, Serner A, Thorborg K, Hölmich P, Andersen TE, Bahr R. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med 2018; 53:150-157. [DOI: 10.1136/bjsports-2017-098937] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/09/2018] [Accepted: 05/17/2018] [Indexed: 11/04/2022]
Abstract
BackgroundGroin injuries represent a considerable problem in male football. Previous groin-specific prevention programmes have not shown a significant reduction in groin injury rates. An exercise programme using the Copenhagen Adduction exercise increases hip adduction strength, a key risk factor for groin injuries. However, its preventive effect is yet to be tested.AimTo evaluate the effect of a single-exercise approach, based on the Copenhagen Adduction exercise, on the prevalence of groin problems in male football players.Methods35 semiprofessional Norwegian football teams were cluster-randomised into an intervention group (18 teams, 339 players) and a control group (17 teams, 313 players). The intervention group performed an Adductor Strengthening Programme using one exercise, with three progression levels, three times per week during the preseason (6–8 weeks), and once per week during the competitive season (28 weeks). The control group were instructed to train as normal. The prevalence of groin problems was measured weekly in both groups during the competitive season using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire.ResultsThe average prevalence of groin problems during the season was 13.5% (95% CI 12.3% to 14.7%) in the intervention group and 21.3% (95% CI 20.0% to 22.6%) in the control group. The risk of reporting groin problems was 41% lower in the intervention group (OR 0.59, 95% CI 0.40 to 0.86, p=0.008).ConclusionThe simple Adductor Strengthening Programme substantially reduced the self-reported prevalence and risk of groin problems in male football players.Trial registration numberISRCTN98514933.
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Whalan M, Lovell R, McCunn R, Sampson JA. The incidence and burden of time loss injury in Australian men's sub-elite football (soccer): A single season prospective cohort study. J Sci Med Sport 2018; 22:42-47. [PMID: 29884595 DOI: 10.1016/j.jsams.2018.05.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 05/18/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES This study aimed to conduct the first injury surveillance study in sub-elite football in Australia, using methods from the international football consensus statement. DESIGN Descriptive epidemiological study. METHODS 1049 sub-elite football players were recruited during the 2016 season. Injury and exposure data was collected by trained Primary Data Collectors (PDCs) who attended every training session and match. RESULTS There were 1041 time loss injuries recorded during 52,127h of exposure resulting in an injury incidence rate of 20 injuries/1000h (95% Confidence Interval [CI]: 15.9-23.3). The injury burden (days lost to injury relative to exposure) was 228days lost/1000h. Muscle and ligament injuries were the most prevalent (41% and 26%) and incurred the highest injury burden (83 and 80days lost/1000h, respectively). The most common injuries were observed at the thigh (22%) and ankle (17%), with hamstring (13%) the highest reported muscle injury. The profile of injury severity was: mild - 35%; minor - 29%; moderate - 28% and severe - 8%. Recurrent injuries accounted for 20% of all injuries. CONCLUSIONS By addressing issues identified with injury recording in sub-elite football, this study found that the injury incidence was twice that observed in previous research in elite and sub-elite football cohorts. Injury burden was also twice that of the elite setting, with similar injuries associated with the highest burden. The results highlight the need for investment into medical provision, facilities, coach education and injury mitigation programmes to reduce healthcare costs to sub-elite players in Australia.
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Affiliation(s)
- Matthew Whalan
- Centre for Human and Applied Physiology, School of Medicine, University of Wollongong, Australia; NSW Football Medicine Association, Australia; Figtree Physiotherapy, Australia.
| | - Ric Lovell
- School of Science and Health, Western Sydney University, Australia; NSW Football Medicine Association, Australia
| | - Robert McCunn
- Institute of Sport and Preventive Medicine, Saarland University, Germany; NSW Football Medicine Association, Australia; Oriam: Scotland's Sports Performance Centre, Heriot-Watt University, United Kingdom
| | - John A Sampson
- Centre for Human and Applied Physiology, School of Medicine, University of Wollongong, Australia; NSW Football Medicine Association, Australia
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Dimitrakopoulou A, Schilders E. Focal osteopenia of pubic parasymphyseal bone as an underlying cause of groin pain in sports: a new perspective. BMJ Case Rep 2018; 2018:bcr-2017-223698. [PMID: 29728433 DOI: 10.1136/bcr-2017-223698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Groin pain is a common problem in athletes. The diagnosis can be difficult because of the complexity of the groin anatomy, the numerous clinical entities presenting with similar symptoms, the concurrence of those entities and the confusing terminology. Thus, a dilemma in diagnosis may arise leading to long-standing symptoms, disabling groin pain, mismanagement and therefore to poor treatment. Hereby, we present such a case of a recreational athlete complaining for excruciate pubic pain after being misdiagnosed and subsequently mistreated affecting her quality of life. We report on a new interesting finding, the focal osteopenia over the pubic parasymphyseal bone, together with administration of bisphosphonates for first time, as a treatment, for this condition in this body area. Our purpose is to shed light on the pathomechanism of groin pain labelled as osteitis pubis. We also outline the importance of thorough history and physical examination combined with appropriate advanced imaging.
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Affiliation(s)
- Alexandra Dimitrakopoulou
- London Hip Arthroscopy Centre at The Wellington Hospital and Fortius Clinic, London, UK.,Carnegie Faculty of Sports, Leeds Beckett University, Leeds, UK
| | - Ernest Schilders
- London Hip Arthroscopy Centre at The Wellington Hospital and Fortius Clinic, London, UK.,Carnegie Faculty of Sports, Leeds Beckett University, Leeds, UK
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40
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Werner J, Hägglund M, Ekstrand J, Waldén M. Hip and groin time-loss injuries decreased slightly but injury burden remained constant in men's professional football: the 15-year prospective UEFA Elite Club Injury Study. Br J Sports Med 2018; 53:539-546. [PMID: 29691289 DOI: 10.1136/bjsports-2017-097796] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hip and groin injuries are common in men's professional football, but the time-trend of these injuries is not known. AIM To investigate hip and groin injury rates, especially time-trends, in men's professional football over 15 consecutive seasons. STUDY DESIGN Prospective cohort study. SETTING Men's professional football. METHODS 47 European teams were followed prospectively for a varying number of seasons between 2001/2002 and 2015/2016, totalling 268 team seasons. Time-loss injuries and individual player exposure during training and matches were recorded. Injury rate was defined as the number of injuries/1000 hours and injury burden as the number of lay-off days/1000 hours. Time-trends for total hip and groin injuries and adductor-related injury rates were analysed using Poisson regression, and injury burden was analysed using a negative binomial regression model. RESULTS Hip and groin injuries contributed 1812 out of 12 736 injuries (14%), with adductor-related injury as the most common of hip and groin injuries (n=1139, 63%). The rates of hip and groin injury and adductor-related injury were 1.0/1000 hours and 0.6/1000 hours, and these rates decreased significantly with on average 2% (Exp(b)=0.98, 95% CI 0.97 to 0.99, P=0.003) and 3% (Exp(b)=0.97, 95% CI 0.95 to 0.99, P<0.001) per season (year on year), respectively. The seasonal trend of hip and groin injury burden did not improve (Exp(b)=0.99, 95% CI 0.97 to 1.01, P=0.40). CONCLUSIONS Hip and groin injuries constitute a considerable part of all time-loss injuries in men's professional football. Although there was a promising slight decreasing trend in the rates of hip and groin injury (as a category) and adductor-related injury (as a specific diagnosis), the injury burden remained at a consistent level over the study period.
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Affiliation(s)
- Jonas Werner
- Department of Orthopaedics, Vrinnevisjukhuset, Norrköping, Sweden.,Football Research Group, Linköping, Sweden
| | - Martin Hägglund
- Football Research Group, Linköping, Sweden.,Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Ekstrand
- Football Research Group, Linköping, Sweden.,Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Markus Waldén
- Football Research Group, Linköping, Sweden.,Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Orthopaedics, Hässleholm-Kristianstad-Ystad Hospitals, Hässleholm, Sweden
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Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management. J Orthop Sports Phys Ther 2018; 48:239-249. [PMID: 29510653 DOI: 10.2519/jospt.2018.7850] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Groin pain is common in athletes who participate in multidirectional sports and has traditionally been considered a difficult problem to understand, diagnose, and manage. This may be due to sparse historical focus on this complex region in sports medicine. Until recently, there has been little agreement regarding terminology, definitions, and classification of groin pain in athletes. This has made clear communication between clinicians difficult, and the results of research difficult to interpret and implement into practice. However, during the past decade, the field has evolved rapidly, and an evidence-based understanding is now emerging. This clinical commentary discusses the clinical examination (subjective history, screening, physical examination); imaging; testing of impairments, function, and performance; and management of athletes with groin pain in an evidence-based framework. J Orthop Sports Phys Ther 2018;48(4):239-249. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7850.
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Heerey JJ, Kemp JL, Mosler AB, Jones DM, Pizzari T, Souza RB, Crossley KM. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. Br J Sports Med 2018. [PMID: 29540366 DOI: 10.1136/bjsports-2017-098264] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intra-articular hip pathologies are thought to be associated with the development of hip and groin pain. A better understanding of the relationship between symptoms and imaging findings may improve the management of individuals with intra-articular hip pathologies. OBJECTIVE To undertake a systematic review and meta-analysis to determine the prevalence of intra-articular hip pathologies in individuals with and without pain. METHODS Seven electronic databases were searched in February 2017 for studies investigating the prevalence of intra-articular hip pathologies using MRI, MRA or CT. Two independent reviewers conducted the search, study selection, quality appraisal and data extraction. Meta-analysis was performed when studies were deemed homogenous, with a strength of evidence assigned to pooled results. RESULTS In general, studies were moderate to high risk of bias, with only five studies adjudged to be low risk of bias. The 29 studies reporting on the prevalence of intra-articular hip pathologies identified limited evidence of a labral tear prevalence of 62% (95% CI 47% to 75%) in symptomatic individuals, with moderate evidence identifying a labral tear prevalence of 54% (95% CI 41% to 66%) in asymptomatic individuals. Limited evidence demonstrated a cartilage defect prevalence of 64% (95% CI 25% to 91%) in symptomatic individuals, compared with moderate evidence of a cartilage defect prevalence of 12% (95% CI 7% to 21%) in asymptomatic individuals. CONCLUSION The prevalence of intra-articular hip pathologies is highly variable in both symptomatic and asymptomatic populations. The prevalence of intra-articular hip pathologies appears to be higher in symptomatic individuals. However, imaging-defined intra-articular hip pathologies are also frequently seen in asymptomatic individuals, highlighting a potential discordant relationship between imaging pathology and pain. PROSPERO REGISTRATION NUMBER CRD42016035444.
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Affiliation(s)
- Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Andrea B Mosler
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Richard B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol. Rehabil Res Pract 2018; 2018:8146819. [PMID: 29721339 PMCID: PMC5867683 DOI: 10.1155/2018/8146819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/28/2018] [Indexed: 11/17/2022] Open
Abstract
Objective The Hölmich protocol in therapeutic exercise is the most appropriate method for the treatment of long-standing adductor-related groin pain (LSAGP). Herein, we evaluated a modified Hölmich protocol to resolve the possible limitations intrinsic to the Hölmich protocol in terms of the rate of return to sport and the recovery period for athletes with LSAGP. Design The study followed a single-blind, before/after study design, where 15 athletes with LSAGP (mean age = 26.13 years; SD = 4.48) performed a 10-week modified Hölmich therapeutic exercise protocol. Results Outcome scores related to pain, hip adductor and abductor muscle strengths, and the ratio of maximum isometric and eccentric hip adduction to abduction strength increased significantly. Likewise, hip abduction and internal rotation ROM improved significantly compared to that at baseline. Furthermore, functional records (t-test, Edgren Side Step Test, and Triple Hop Test) showed significant improvement after treatment. Finally, 13 athletes (86.6% of the participants) successfully returned to sports activity in a mean time of 12.06 weeks (SD = 3.41). Conclusion The findings of this study objectively show that the modified Hölmich protocol may be safer and more effective than the Hölmich protocol in athletes with LSAGP in promoting their return to sports activity. This trial is registered with IRCT2016080829269N1.
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Svensson K, Eckerman M, Alricsson M, Magounakis T, Werner S. Muscle injuries of the dominant or non-dominant leg in male football players at elite level. Knee Surg Sports Traumatol Arthrosc 2018; 26:933-937. [PMID: 27338959 DOI: 10.1007/s00167-016-4200-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim was to study possible differences of muscle injuries regarding type, localization and the extent of injury between the dominant and non-dominant leg in elite male football players. Another aim was to study the injury incidence of muscle injuries of the lower extremity during match and training. METHODS Data were consecutively collected between 2007 and 2013 in a prospective cohort study based on 54 football players from one team of the Swedish first league. The injury incidence was calculated for both match and training, injuries to the hip adductors, quadriceps, hamstrings and triceps surae were diagnosed and evaluated with ultrasonography, and their length, depth and width were measured to determine the extent of structural muscle injuries. RESULTS Fifty-four players suffered totally 105 of the studied muscle injuries. Out of these 105 injuries, the dominant leg was affected in 53 % (n = 56) of the cases. A significantly greater extent of the injury was found in the dominant leg when compared with the non-dominant leg with regard to structural injuries of the hamstrings. No other significant differences were found. CONCLUSIONS Structural hamstring muscle injuries were found to be of greater extent in the dominant leg when compared with the non-dominant leg. This new finding should be taken into consideration when allowing the football player to return to play after leg muscle injuries. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kjell Svensson
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Centre, Karolinska Institutet, Stockholm, Sweden. .,CIFU/Capio Artro Clinic, Sophiahemmet, Box 5605, 114 86, Stockholm, Sweden.
| | - Mattias Eckerman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Centre, Karolinska Institutet, Stockholm, Sweden
| | - Marie Alricsson
- Department of Health Sciences, Swedish Winter Sport Research Centre, Mid Sweden University, Östersund, Sweden.,Department of Sports Science, Linnaeus University, Kalmar, Sweden
| | | | - Suzanne Werner
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Centre, Karolinska Institutet, Stockholm, Sweden.,CIFU/Capio Artro Clinic, Sophiahemmet, Box 5605, 114 86, Stockholm, Sweden
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46
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Dupré T, Funken J, Müller R, Mortensen KRL, Lysdal FG, Braun M, Krahl H, Potthast W. Does inside passing contribute to the high incidence of groin injuries in soccer? A biomechanical analysis. J Sports Sci 2018; 36:1827-1835. [PMID: 29333946 DOI: 10.1080/02640414.2017.1423193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Thomas Dupré
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
| | - Johannes Funken
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
| | - Ralf Müller
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
| | | | | | - Markus Braun
- Ballspielverein Borussia 09 e.V. Dortmund, Dortmund, Germany
| | - Hartmut Krahl
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
- ARCUS Clinics Pforzheim, Pforzheim, Germany
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47
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Esteve E, Rathleff MS, Vicens-Bordas J, Clausen MB, Hölmich P, Sala L, Thorborg K. Preseason Adductor Squeeze Strength in 303 Spanish Male Soccer Athletes: A Cross-sectional Study. Orthop J Sports Med 2018; 6:2325967117747275. [PMID: 29349093 PMCID: PMC5768277 DOI: 10.1177/2325967117747275] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Hip adductor muscle weakness and a history of groin injury both have been identified as strong risk factors for sustaining a new groin injury. Current groin pain and age have been associated with hip adductor strength. These factors could be related, but this has never been investigated. Purpose: To investigate whether soccer athletes with past-season groin pain and with different durations of past-season groin pain had lower preseason hip adductor squeeze strength compared with those without past-season groin pain. We also investigated whether differences in preseason hip adductor squeeze strength in relation to past-season groin pain and duration were influenced by current groin pain and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In total, 303 male soccer athletes (mean age, 23 ± 4 years; mean weight, 74.0 ± 7.9 kg; mean height, 178.1 ± 6.3 cm) were included in this study. Self-reported data regarding current groin pain, past-season groin pain, and duration were collected. Hip adductor squeeze strength was obtained using 2 different reliable testing procedures: (1) the short-lever (resistance placed between the knees, feet at the examination bed, and 45° of hip flexion) and (2) the long-lever (resistance placed between the ankles and 0° of hip flexion) squeeze tests. Results: There was no difference between those with (n = 123) and without (n = 180) past-season groin pain for hip adductor squeeze strength when adjusting for current groin pain and age. However, athletes with past-season groin pain lasting longer than 6 weeks (n = 27) showed 11.5% and 15.3% lower values on the short-lever (P = .006) and long-lever (P < .001) hip adductor squeeze strength tests, respectively, compared with those without past-season groin pain. Conclusion: Male soccer athletes with past-season groin pain lasting longer than 6 weeks are likely to begin the next season with a high-risk groin injury profile, including a history of groin pain and hip adduction weakness.
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Affiliation(s)
- Ernest Esteve
- Sportclínic, Physiotherapy and Sports Training Centre, Girona, Spain.,School of Health and Sport Sciences (EUSES), University of Girona, Salt, Spain
| | - Michael Skovdal Rathleff
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Jordi Vicens-Bordas
- Sportclínic, Physiotherapy and Sports Training Centre, Girona, Spain.,School of Health and Sport Sciences (EUSES), University of Girona, Salt, Spain
| | - Mikkel Bek Clausen
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lluís Sala
- Sportclínic, Physiotherapy and Sports Training Centre, Girona, Spain
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark.,Physical Medicine and Rehabilitation Research-Copenhagen, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
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Harøy J, Thorborg K, Serner A, Bjørkheim A, Rolstad LE, Hölmich P, Bahr R, Andersen TE. Including the Copenhagen Adduction Exercise in the FIFA 11+ Provides Missing Eccentric Hip Adduction Strength Effect in Male Soccer Players: A Randomized Controlled Trial. Am J Sports Med 2017; 45:3052-3059. [PMID: 28806100 DOI: 10.1177/0363546517720194] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The FIFA 11+ was developed as a complete warm-up program to prevent injuries in soccer players. Although reduced hip adduction strength is associated with groin injuries, none of the exercises included in the FIFA 11+ seem to specifically target hip adduction strength. PURPOSE To investigate the effect on eccentric hip adduction strength of the FIFA 11+ warm-up program with or without the Copenhagen adduction exercise. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS We recruited 45 eligible players from 2 U19 elite male soccer teams. Players were randomized into 2 groups; 1 group carried out the standard FIFA 11+ program, while the other carried out the FIFA 11+ but replaced the Nordic hamstring exercise with the Copenhagen adduction exercise. Both groups performed the intervention 3 times weekly for 8 weeks. Players completed eccentric strength and sprint testing before and after the intervention. Per-protocol analyses were performed, and 12 players were excluded due to low compliance (<67% of sessions completed). The main outcome was eccentric hip adduction strength (N·m/kg). RESULTS Between-group analyses revealed a significantly greater increase in eccentric hip adduction strength of 0.29 Nm/kg (8.9%; P = .01) in favor of the group performing the Copenhagen adduction exercise, whereas no within-group change was noted in the group that used the standard FIFA 11+ program (-0.02 N·m/kg [-0.7%]; P = .69). CONCLUSION Including the Copenhagen adduction exercise in the FIFA 11+ program increases eccentric hip adduction strength, while the standard FIFA 11+ program does not. Registration: Registration: ISRCTN13731446 (International Standard Randomised Controlled Trial Number registry).
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Affiliation(s)
- Joar Harøy
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Andreas Serner
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark.,Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - André Bjørkheim
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Linn E Rolstad
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Per Hölmich
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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49
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Eckard TG, Padua DA, Dompier TP, Dalton SL, Thorborg K, Kerr ZY. Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes, 2009/2010-2014/2015. Am J Sports Med 2017; 45:2713-2722. [PMID: 28745561 DOI: 10.1177/0363546517716179] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little research has examined the rates and patterns of hip flexor or hip adductor strains in student-athletes in the National Collegiate Athletic Association (NCAA). PURPOSE To describe the epidemiology of hip flexor and adductor strains in NCAA athletes during the 2009/2010-2014/2015 academic years. STUDY DESIGN Descriptive epidemiology study. METHODS Rates and patterns of hip flexor and adductor strains in collegiate sports were examined in a convenience sample of NCAA varsity teams from 25 sports. Rates and distributions of strains by mechanism, recurrence, and participation restriction time were examined. Injury rate ratios (IRRs) and proportion ratios were calculated to compare rates within and between sports by event type, sex, mechanism, recurrence, and participation restriction time. RESULTS A total of 770 hip flexor and 621 hip adductor strains were reported, resulting in overall injury rates of 1.60 and 1.29 per 10,000 athlete-exposures (AEs), respectively. In men, the rate of hip flexor strains was 1.81 per 10,000 AEs, and that for hip adductor strains was 1.71 per 10,000 AEs. In women, the rate of hip flexor strains was 1.59 per 10,000 AEs, and the rate of hip adductor strains was 1.15 per 10,000 AEs. The highest rates of strains were found in men's soccer and men's ice hockey (range, 2.47-3.77 per 10,000 AEs). Most hip flexor and hip adductor strains occurred in practice, but both had higher rates in competition. In sex-comparable sports, hip flexor strain rates did not differ between the sexes (IRR = 1.14; 95% CI, 0.96-1.36), but the rate of hip adductor strains was higher in men than women (IRR = 1.49; 95% CI, 1.22-1.81). Noncontact was the most common mechanism for both types of strains (hip flexor strains, 59.4%; hip adductor strains, 62.5%); 10.1% of hip flexor strains and 11.1% of hip adductor strains were recurrent. The highest rates of recurrence of both types of strain were found in men's and women's ice hockey (range, 16.0%-30.6%). Most hip flexor and hip adductor strains resulted in <1 week of participation restriction (hip flexor strains, 83.8%; hip adductor strains, 82.9%). CONCLUSION The NCAA sports with the highest rates of hip flexor and hip adductor strains were men's soccer and men's ice hockey. In sex-comparable sports, men had a higher rate of hip adductor, but not hip flexor, strains. Recurrence rates were remarkably high in ice hockey. Male sports teams, especially soccer and ice hockey, should place an emphasis on prevention programs for hip adductor strains. Secondary prevention programs involving thorough rehabilitation and strict return-to-play criteria should be developed and implemented to curb the high recurrence rate of these injuries, particularly in ice hockey.
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Affiliation(s)
- Timothy G Eckard
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thomas P Dompier
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, Indiana, USA
| | - Sara L Dalton
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, Indiana, USA
| | - Kristian Thorborg
- Sports Orthopaedic Research Centre-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark.,Physical Medicine and Rehabilitation Research-Copenhagen, Department of Physical and Occupational Therapy, Department of Orthopedic Surgery, Clinical Research Center, Amager-Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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50
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Drew M, Palsson T, Hirata R, Izumi M, Lovell G, Welvaert M, Chiarelli P, Osmotherly P, Graven-Nielsen T. Experimental pain in the groin may refer into the lower abdomen: Implications to clinical assessments. J Sci Med Sport 2017; 20:904-909. [DOI: 10.1016/j.jsams.2017.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/14/2017] [Accepted: 04/16/2017] [Indexed: 11/27/2022]
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