The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial

Perceptions of Elite Young Male Football Players Regarding Injury Risk Factors and Prevention Strategies

CONTEXT

Football players aged 15-20 years experience injury incidence rates similar to those of professionals, with players injured in this age group being significantly less likely to reach the professional level. Understanding the factors that influence young footballers' acceptance, adoption, and compliance with injury prevention programs is crucial. Therefore, this study aimed to describe the perceptions of male football players from premier league academies regarding injury risk factors and prevention strategies.

DESIGN

Cross-sectional observational study.

METHODS

An online survey was used to explore perceptions of injury risk factors and prevention strategies among young football players (under-17 and under-20 teams) from premier league academies.

RESULTS

A total of 504 footballers (mean age: 18 [2] y) across 9 academies in 8 different cities participated in this study. No risk factor was elected as very important by at least half of participants. The top 5 injury risk factors elected by players were "poor hydration," "inadequate warm-up," "poor rest/sleep," "inadequate diet," and "poor strength/power." At least 1 quarter of participants considered "genetics," "advanced age," "attention level," "wheatear conditions," and "alcohol consumption" as irrelevant factors for injury. There was no consensus for any prevention strategy. Fourteen strategies were ranked as efficient by at least 3 quarters of participants. The top 5 prevention strategies elected by players were "warm-up before training/matches," "functional training," "hydration before and during training/matches," "flexibility training," and "workload monitoring." Lower than a half of participants endorsed "ankle braces" and "thermal shorts" for injury prevention.

CONCLUSIONS

The results of this study offer valuable insights into the perceptions of elite young football players regarding injury risk factors and the effectiveness of preventive strategies. These perceptions are essential for understanding how athletes view injury prevention approaches in their daily routines.

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

OBJECTIVE

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

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

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

ELIGIBILITY CRITERIA

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

RESULTS

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

CONCLUSION

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

PROSPERO REGISTRATION NUMBER

CRD42024548630.

Measuring eccentric hip adductor strength during the Copenhagen adduction exercise: A proof-of-concept and test re-test reliability study

OBJECTIVES

To describe a novel method for measuring eccentric hip adductor (EHAD) strength during the Copenhagen adduction exercise (CAE) and investigate the test re-test reliability of this measure.

DESIGN

Test re-test reliability study.

PARTICIPANTS

Twenty male athletes aged 24 ± 6 years participated in two data collection sessions 7 ± 2 days apart.

MAIN OUTCOME MEASURES

During each data collection session, participants performed three maximal effort repetitions of the CAE with their leg supported by an ankle strap hung from a fixed barbell. We attached a commercially available load cell in-series with the ankle strap to measure peak force in Newtons (N) during the eccentric lowering phase of the CAE. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), SEM as a percentage of the mean (SEM%) and minimal detectable change at a 95% confidence interval (MDC95) were calculated for this measure of EHAD strength.

RESULTS

Test re-test reliability was good for EHAD strength measured during the CAE on dominant (ICC = 0.84; SEM% = 3.6%; MDC95 = 33 N) and non-dominant (ICC = 0.87; SEM% = 3.3%; MDC95 = 29 N) legs.

CONCLUSIONS

This study provides proof-of-concept that EHAD strength can be measured during the CAE with good test re-test reliability.

A Critical Review of Trunk and Hip Exercise Prescription: Applying Evidence for a Modern Approach

Exercise targeting the trunk and hip (core) musculature is common practice in rehabilitation and performance training. Historical underpinnings of core exercise focus on providing stability to the spine, thus improving the function of the spine and extremities, while instability has been postulated to result in pathology and impaired performance. Mechanistic studies on the topic are often conflicting and indeterminate, suggesting the theoretical underpinnings of targeted core exercise may be over assumed in common practice. The best modes of intervention also remain undefined, with combined methods having potential to optimize outcomes. This includes moving beyond isolated exercise camps and being inclusive of both targeted exercise and progressive multi-joint movements. The purpose of this clinical commentary is to describe the historical mechanisms of the stability-instability continuum and the role of exercise intervention. A spectrum of ideologies related to core exercise are examined, while appreciating positive outcomes of exercise interventions across healthy and pathological populations. Finally, exercise summaries were compiled to improve critical reasoning within current practice and inspire future investigations.

Level of Evidence

5.

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

OBJECTIVES

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

DESIGN

Cross-sectional study.

SETTING

Club training facility.

PARTICIPANTS

Forty-four male, rugby union players.

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Injury and illness prevention practices in Qatar's professional football clubs-implementation of the IP2 NetWork

Background

The Aspetar Sports Injury and Illness Prevention Programme introduced the Aspetar IP2 NetWork, a customizable injury prevention programme for professional football clubs in Qatar during the 2020/2021 season. It includes 23 focus areas selected by stakeholders to prevent sports-related health issues.

Objective

To assess the real world implementation of the IP2 NetWork preventive focus areas during the first season after introduction, focusing on team adoption and player compliance.

Methods

A survey was conducted among team physicians, physiotherapists and fitness coaches from the 18 professional football clubs in Qatar. The survey examined the implementation of the IP2 NetWork focus areas and the roles of the different professionals in managing these areas.

Results

17 out of 18 clubs reported using IP2 focus areas, applying an average of 11.4 areas (range 4-21). The most commonly used strategies were the Nordic hamstring exercise, cold water immersion, taping and concussion prevention. Team physicians led 38% of the focus areas, followed by physiotherapists (25%) and fitness coaches (24%), with 11% managed collaboratively. Fitness coaches primarily handled exercise-based areas like warm-ups and load monitoring. Preventive measures were applied to the full squad in 81% of cases, with 19% targeting at-risk players. Player compliance was high, with 86% of focus areas adopted by all or most players, rising to 97% for players identified to be at greater risk of injury or illness.

Conclusion

Implementing the IP2 focus areas was widespread among teams in Qatar, with strong collaboration between medical staff. Player compliance, especially among at-risk players, was excellent, demonstrating the programme's feasibility and effectiveness in real-world settings.

Effect of an unsupervised multidomain intervention integrating education, exercises, psychological techniques and machine learning feedback, on injury risk reduction in athletics (track and field): protocol of a randomised controlled trial (I-ReductAI)

The primary aim is to assess the impact of a multidomain intervention that integrates education, exercise, psychological techniques and machine learning feedback on the duration athletes remain free from injury complaints leading to participation restriction (ICPR) during a 20-week summer competitive athletics season. The secondary aims are to assess the intervention's effect on reducing (i) the incidence, (ii) the burden, (iii) the period prevalence and (iv) the weekly prevalence of ICPR during the same timeframe. We will perform a two-arm randomised controlled trial. This study will involve an intervention group and a control group of competitive athletes licensed with the French Federation of Athletics, aged between 18 and 45, over an outdoor athletics competitive season lasting 20 weeks (March to July 2025). Data will be collected before the start (demographic, training and injury history) and one time per day (training and competition volume/intensity, perceived physical and psychological state, and illness and injury incidents) for both groups. The intervention group will be required to (i) view a series of 12 educational videos on injury prevention, (ii) engage in discipline-specific exercise programmes, (iii) implement stress and anxiety management techniques and (iv) view daily the injury prognostic feedback generated by the athlete's collected data based on machine learning. Outcomes will be analysed over the final 14 weeks of follow-up to allow time for the intervention to establish any potential efficacy. The primary outcome will be the time-to-event for each ICPR. Secondary outcomes will include (i) incidence, (ii) burden, (iii) period prevalence and (iv) weekly prevalence of ICPR. The primary outcome will be analysed using a Prentice-Williams-Peterson gap-time model. In contrast, the secondary outcomes will employ Poisson (i, ii), logistic (iii) and generalised estimating equations (iv) regression models, respectively.

Video Analysis of Acute Lower Extremity Injury Mechanisms in Soccer Demonstrates Most Anterior Cruciate Ligament, Achilles, and Muscle Injuries Occur Without Direct Contact: A Systematic Review and Meta-analysis

PURPOSE

To systematically review the literature for studies using video analysis to evaluate acute lower extremity injury mechanisms in soccer players.

METHODS

The study was preregistered on PROSPERO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Three databases were searched for Level I to IV studies that quantified lower extremity injury mechanisms in soccer players using video analysis. Data recorded included study demographics, injury type, mechanisms, contact, phase of play, timing, and sagittal plane kinematics. Study methodological quality was analyzed using the Quality Appraisal for Sports Injury Video Analysis Studies scale. Forest plots of proportions were generated for injuries occurring in the first versus second half, defensive versus offensive phase, and contact versus noncontact injury.

RESULTS

Nineteen articles (mean Quality Appraisal for Sports Injury Video Analysis Studies score 14.3 ± 1.9; all Level IV evidence, 1,652 videos, 17 professional males, 1 professional female, 1 both male/female) were included. Anterior cruciate ligament (ACL) tears (49% [42%-55%]), muscle strains (hamstring: 71% [47%-87%]), and Achilles tears (80%-83%) had a high percentage of noncontact (NC) injury mechanisms. Direct and indirect contact-predominant injuries include medial collateral ligament sprains (14% NC) and foot/ankle sprains (6% [4%-10%] NC). Most ACL injuries (68% [61%-75%]) occurred while defending, and quadriceps strains (81%-89%) occurred while attacking.

CONCLUSIONS

In soccer, video analysis shows that a high proportion of acute ACL, Achilles, and muscle injuries occur through noncontact mechanisms, while medial collateral ligament and foot/ankle injuries usually happen with direct contact. ACL injuries are more likely to be sustained when defending, specifically when pressing/tackling, and muscle injuries result from sprinting, kicking, and lunging. Most noncontact-predominant injuries occurred at a higher percentage in the first half, whereas contact-predominant injuries occurred at a higher percentage in the second half.

LEVEL OF EVIDENCE

Level IV, systematic review and meta-analysis of Level IV studies.

Incidence, Prevalence, and Burden of Health Problems in Elite Female Ice Hockey Players-A One-Season Prospective Study

Introduction: Epidemiological studies on elite female ice hockey players are lacking but needed to tailor preventive efforts in this growing group of athletes. Therefore, the aim of this study was to describe the incidence, prevalence, and burden of health problems in elite female ice hockey players. Methods: In this prospective cohort study, we asked all Swedish Women's Hockey League (SWHL) players (N = 207) to report their health status on the OSTRC-H2 weekly throughout the 2022/2023 season (28 weeks). Reported problems were categorized as injuries (acute or overuse) or illnesses and presented as incidence per player season and mean weekly prevalence. Results: A total of 129 players (62% of all SWHL players) provided 2286 health reports with a mean weekly response rate of 67%. Mean weekly prevalence of health problems was 21% (95% confidence interval [CI]: 19-23) (injuries: 15% [95% CI: 14-17] and illnesses: 6% [95% CI: 5-8]). Injury incidence was 2.1 (95% CI: 1.8-2.4) per player season (acute: 1.2 [95% CI: 1.0-1.5] and overuse: 0.8 [95% CI: 0.7-1.1]). Illness incidence was 1.3 per player season (95% CI: 1.1-1.6). Most reported health problems were acute injuries (59.4% of reported injuries). Most common among acute injuries where to the shoulder (15%), head (13%), and knee (11%). The hip/groin was the most reported (35%) and burdensome (49% of severity score) region among overuse injuries. Reported illnesses were mostly represented by respiratory infections (75%). Conclusions: In average, one in five elite ice hockey players reported a health problem at any given time during the season. Results of this study highlight the need to develop and test primary prevention strategies for shoulder, head, and knee injuries and secondary prevention strategies for hip and groin problems.

Injury prevention in youth football (soccer): a comprehensive description of the development process of the 'FUNBALL' programme

Many football injury prevention programmes (IPPs) have been developed to target various injuries and populations. There was no specific IPP for youth players in place before. However, several existing IPPs designed for adults were also assessed in the youth population. All the existing ones face the challenge of long-term adherence even though efficacy has been demonstrated for many weeks to seasons. The main barriers to a successful long-term implementation of IPPs are time constraints and the lack of attractiveness for the players as they do not contain football-specific and motivating exercises. Increasing its attractiveness was the main aspect of designing the programme. To achieve this, a new approach was used. The 'FUNBALL' programme includes competitive, pair-based exercises and frequent ball use. It offers more flexibility as there is a choice between two different exercises for each category. It was developed through close collaboration between the research community, closely involved in real-life football, and the end-users. Tailoring IPPs to the preferences of end-users could mean a significant advancement on long-term adherence compared with previous programmes. However, further research is needed to assess this assumption.

Strength effects of the Copenhagen adduction exercise vs an adductor squeeze exercise in male football players - A randomized controlled trial

To examine the effect of assigning male football players to an 8-week Copenhagen Adduction (CA) and Adductor Squeeze (SQ) Pragmatic randomized controlled trial, 57 participants (16.7 ± 0.9 years, 175.9 ± 7.3 height and 66 ± 8.4 weight) were individually randomized to an 8-week progressive dynamic training protocol with the CA or an isometric training protocol with the SQ twice per week. Maximal eccentric (EHAD) and isometric (IHAD) hip adductor torque was tested with a handheld dynamometer. Perceived exertion and delayed onset muscle soreness (DOMS) were recorded throughout the intervention period. In the intention-to-treat analysis, no significant between-group difference was observed for EHAD (p = 0.478-0.833) nor IHAD (p = 0.084-0.118). There was a significant difference in DOMS between groups in the third to sixteenth exercise session, with the CA group reporting higher values (median varying between 0-3 vs 0-1, p = 0.000-0.009). Perceived exertion was greater for the CA group only in the fifteenth exercise session of the protocol (median of 4 vs 3, p = 0.031). No other significant differences between the groups were observed for DOMS nor perceived exertion. An 8-week adductor training program with either the Copenhagen Adduction or Adductor Squeeze exercise performed with two sets twice a week and adjusted for total volume did not result in significant differences in eccentric nor isometric adduction torque between the groups.

Developing a data-driven multimodal injury and illness prevention programme in male professional football based on a risk management model: the IP2 NetWork

Background

Current injury prevention programmes in football are limited by a one-size-fits-all approach, which predominantly focuses on preventive exercise programmes while ignoring differences in risk profiles between individuals and teams.

Objective

To address this gap, we developed a new data-driven, customisable approach based on the principles of risk management. We collaborated with key stakeholders to identify focus areas for injury and illness prevention and determine their priorities.

Setting

The team medical and coaching staff included members from 17 professional football clubs, the national team and a youth football academy in Qatar.

Methods

In 2015, we launched a series of annual workshops under the Aspetar Sports Injury and Illness Prevention Programme. The workshops included club medical personnel and fitness coaches in a process to develop team-specific programmes for injury and illness prevention based on the principle of risk management. Over 2 years, workshops refined focus areas through discussions, surveys and small-group presentations, culminating in the creation a novel programme for football injury prevention.

Results

Out of 44 focus areas first identified, 23 were selected as priorities for inclusion in multimodal injury and illness prevention programmes. The identified focus areas represent a variety of aspects, including social/behavioural/lifestyle, exercise programmes/training, load management, recovery and equipment. The top priorities included communication, the Nordic hamstring exercise, training load, recovery strategies, nutrition, sleep, warm-up, the Copenhagen adduction exercise and core and dynamic stability.

Conclusion

We have developed a comprehensive framework for preventing injuries and illnesses in football grounded in the general principles of risk management. This framework has proven feasible and led to the creation of a new multicomponent programme, The Aspetar IP2 (Injury and Illness Prevention for Performance) NetWork, focusing on a range of areas beyond preventive exercise programmes only.

Implementing the Copenhagen Adductor Exercise and Nordic Hamstring Exercise in West African Academy Soccer Players: An Intervention Study

BACKGROUND

This study implemented the Copenhagen Adductor Exercise (CAE) and Nordic Hamstring Exercise (NHE) to examine 1) whether CAE and NHE interventions are associated with adductor and hamstring strength gains in youth African male soccer players and 2) whether strength changes after a rest period and secondary intervention.

STUDY DESIGN

Pre-post intervention study.

METHODS

Forty-four African elite male academy players (age 14.7±1.5 [12-18] years) participated in twice weekly CAE and NHE interventions for 8- and 10-week periods separated by a 4-week rest. Long lever adductor squeeze strength and prone isometric hamstring strength were measured with mixed-effects linear regression models to observe strength changes over time.

RESULTS

Ninety-six and 95% of CAE and NHE sessions were completed in each intervention, with no adverse events related to the execution of the exercises. Adductor squeeze strength increased during the first intervention (baseline 3.23 [2.99-3.47] N/kg, post-intervention 3.53 [3.30-3.76] N/kg, p=0.911) and was maintained following the rest period (3.52 [3.27-3.76] N/kg, p=0.999) and second intervention (3.60 [3.35-3.84] N/kg, p=0.002). Hamstring strength improved during the first intervention (baseline 4.95 [4.42-5.49] N/kg, post-intervention 5.48 [4.95-6.02] N/kg, p<0.001), decreased to baseline during the rest period (4.98 [4.44-5.53] N/kg, p=0.996), and did not improve during the second intervention (5.01 [4.46-5.55] N/kg, p=0.978).

CONCLUSION

CAE and NHE interventions can be implemented at an elite African academy with high compliance. Adductor and hamstring strength improved in the first intervention, with no further improvements in the second intervention. Secondary interventions therefore should include higher exercise volume or load to improve longitudinal adductor and hamstring strength.

Level of Evidence

Level III (Cohort Study).

The effectiveness of the Copenhagen adduction exercise on improving eccentric hip adduction strength among soccer players with groin injury: a randomized controlled trial

INTRODUCTION

Groin injuries are common in soccer players and often involve adductor muscle strains. The Copenhagen Adduction Exercise (CAE) is a targeted intervention whose effectiveness in rehabilitation for these injuries warrants investigation.

OBJECTIVE

To investigate the impact of a rehabilitation program, which includes the CAE, on eccentric hip adduction (EHAD) strength, hip joint range of motion (ROM), self-reported disability, and pain among soccer players with adductor-related groin pain. It was hypothesized that the addition of CAE to the rehabilitation program would yield greater improvements.

METHODS

Employing a randomized controlled trial with a two-group parallel design, thirty male soccer players with a mean age of 26.4 ± 3.9 years were randomized into an intervention group (IG) including CAE (n = 15) and a control group (CG) without CAE (n = 15), based on a power analysis to ensure 80% power to detect significant differences. Both groups engaged in their respective rehabilitation programs twice a week for eight weeks. The primary outcome measured was EHAD strength, while secondary outcomes included hip joint ROM, self-reported disability measured by the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain levels.

RESULTS

Significant improvements within groups were observed across all measures (p < 0.001). The IG demonstrated a greater increase in EHAD strength (Mean Difference [MD] = 0.49 Nm/kg, 95% Confidence Interval [CI] [0.31, 0.66]), a more pronounced reduction in pain (MD = -1.60, 95% CI [-2.18, -1.02]), and betterment in all HAGOS subscale scores compared to the CG. There were no significant between-group differences in hip joint ROM.

CONCLUSION

Incorporating the CAE into rehabilitation programs significantly improves EHAD strength, decreases pain scores, and reduces self-reported disability in soccer players with adductor-related groin pain.

REGISTRATION

ClinicalTrials.gov identifier: NCT05589623.

Changes in injury type among NBA athletes in response to the COVID-19 pandemic

CONTEXT

The 2019-2020 NBA season was altered significantly by the COVID-19 pandemic with a midseason suspension of games, the NBA 'bubble' tournament, and a shortened offseason. Concerns were raised regarding player conditioning and the potential increased risk of injury due to the schedule changes. The purpose of this study was to determine the impact of the COVID-19 pandemic and associated schedule changes on NBA injuries. It was hypothesized that injury rates would be higher in the year following the pandemic and teams who participated in the bubble would have higher injury rates in the following season than non-bubble teams. Furthermore, the types of injuries would shift toward more severe injuries in the condensed 2019-20 season and the following 2020-21 season.

DESIGN

Retrospective Cohort Study.

METHODS

The NBA's public injury reports were queried to identify players listed on an injury report. Standardized injury events were calculated for four pre-COVID-19 seasons (2015-2019), the COVID-19 season (2019-2020), and the post-COVID-19 season (2020-2021). Injury characteristics including type and location were extracted for each year and differences within each period were calculated.

RESULTS

When excluding injury events related to COVID-19 health and safety protocols, the overall injury events per 1000 exposures were not significantly different between time periods of pre-COVID-19, COVID-19, and post-COVID-19 seasons; (p = 0.199), and no difference was found in the rates of teams who participated in the bubble. Injuries, including soreness and strains, significantly decreased while fracture injuries significantly increased in the COVID-19 year.

CONCLUSIONS

The COVID-19 pandemic led to an increased number of games missed, but no increase in injury rates when accounting for health and safety protocols. Additionally, bubble participation had no impact on injury rates. However, despite no changes in injury rates, the types of injuries changed with an increased proportion of severe injuries and decreased proportion of minor injuries.

Association between Hip/Groin Pain and Hip ROM and Strength in Elite Female Soccer Players

Background/Objectives: Hip strength and range of motion have been compared in soccer players with and without hip and groin pain but only in male footballers or gender-combined samples. In female soccer players, the biomechanics contributing to this injury remain poorly understood compared to other sporting injuries. The aim of the present study is to investigate whether differences exist in adductor and abductor isometric test values and hip joint range of motion between elite female soccer players with longstanding groin pain and injury-free controls. Methods: Ten female elite soccer players with current longstanding hip and groin pain and twenty-five injury-free controls from the same teams were included in the study. Hip adductor and abductor isometric strength were evaluated with a hand-held dynamometer. A bent knee fall-out test was also utilized to examine the hip joint range of motion. Results: A significant difference in abductor isometric test values was observed between the control group (2.29 ± 0.53 N/Kg) and the hip and groin pain group (2.77 ± 0.48 N/Kg; p = 0.018). Furthermore, the injured group showed a decreased adductor/abductor ratio compared to the control group (1.00 ± 0.33 vs. 1.27 ± 0.26; p = 0.013). No differences were observed in the bent knee fall-out test (p = 0.285). Conclusions: Female elite soccer players with current longstanding hip and groin pain exhibited higher abductor isometric strength and lower adductor/abductor ratio compared to non-injured women players. There were no differences in the BKFO test between groups.

Athletes With Adductor-Related Groin Pain: A Narrative Review

Adductor-related groin pain is extremely common among athletes, and despite its high prevalence and impact, there is no consensus regarding taxonomy, anatomy, physiopathology, or treatment. We performed a comprehensive literature review and tried to demystify this pathology and its treatment. The Doha agreement classification and its impact are scrutinized as well as the complexity of the proximal adductor longus (AL) insertion and its relationship with the pyramidalis-anterior pubic ligament-AL complex. The stress-shielding and compression theories for the origin of AL tendon pathology are exploited along with how this knowledge translates into injury prevention protocols and surgical techniques. The importance of active rehabilitation protocols and intersegmental control-focused programs is highlighted. The role of an enthesis injection in the treatment algorithm is discussed along with when to perform a tenotomy. The differences between selective and complete tenotomy are highlighted.

Real-world implementation of the Copenhagen Adduction Exercise: what do football teams modify and why?

Objectives

To evaluate the use and modification of the Copenhagen Adduction Exercise in football (soccer) teams, including the reasons for modification and alternate injury-prevention strategies.

Methods

In this cross-sectional study, staff members from a convenience sample of 50 male elite, academy and amateur football teams in Norway, Germany and Austria completed an online questionnaire focussing on the implementation of the Copenhagen Adduction Exercise. Fourteen of the staff members also completed an interview.

Results

Forty-two teams (84%) reported using the Copenhagen Adduction Exercise, but the majority (65%) had modified the original programme. Modifications included changes to sets, repetitions, progressions and frequency and were particularly common among elite teams. The main reasons for modifications were managing overall player load, experiences and beliefs and individualisation. Despite modifications, all teams followed the basic principles of the original programme.

Conclusion

The adoption of the Copenhagen Adduction Exercise by football teams is high, but the vast majority of teams modify the programme. Despite these modifications, the basic principles of the programme are maintained.

Predicting the occurrence of in-season groin pain in male high school soccer players: a cohort study

[Purpose] This study investigated whether pre-season HAGOS (Japanese Copenhagen Hip and Groin Outcome Scores) and eccentric muscle strength of the hip muscles predict in-season groin pain incidences in high school soccer players. [Participants and Methods] This study had a cohort design. The participants were male high school players under 18 years playing in the Japan Soccer League, which is an elite-level soccer league of that age category in Japan. The HAGOS and the strength of hip abductor and adductor muscles in eccentric contraction were measured before the season, and hip and groin pain incidences were recorded during the season. Multiple logistic regression analysis was performed to investigate the factors derived from the pre-season HAGOS and hip muscle strength tests, presumably pertaining to the development of in-season groin pain. [Results] The eccentric adductor muscle strength of the dominant leg and the HAGOS were selected as factors associated with groin pain during the season. [Conclusion] Low pre-season HAGOS and weak dominant-leg eccentric adductor muscle strength were suggested as factors to predict in-season groin pain occurrence in male high school soccer players.

Injury Prevention Training in Girls' and Women's Elite Football in Denmark: A Survey of Practices and Perceptions

Through a national cross-sectional survey, the present study investigated the use and content of injury prevention training (IPT), and associated attitudes and beliefs, involving stakeholders in Danish girls' and women's elite football (U14, U16, U18, and Danish Women's League teams). A total of 168 stakeholders (coaches, physical performance coaches, physiotherapists, medical doctors, and club management) from 18 Danish elite clubs were invited to participate. Of these, 158 were eligible to participate, and 110 participants (69.6% response rate) provided 191 valid survey responses, as some provided more than one response due to multiple affiliations within the same club. The use of IPT ranged from 91.1% to 100% across team levels, with approximately 50% reporting up to 1-2 h/week. Interestingly, only 52.9%-72.7% of the responses indicated use of an evidence-based IPT program, with lowest adoption at the U14 and Danish Women's League teams. The FIFA 11+ was the most used evidence-based IPT program. The majority of the participants (>72%) had positive perceptions regarding IPT impact on injury reduction. These findings indicate that, while IPT is broadly used across Danish girls' and women's elite football teams, the implementation of evidence-based IPT programs varies, with lower adoption of these programs among the youngest and senior elite teams. Hence, there is a need to enhance integration of IPT programs proven effective in girls' and women's elite football. Notably, stakeholders expressed positive perceptions regarding the impact of IPT on injury reduction, which provides valuable support for future efforts to strengthen IPT in football practice.

Effectiveness of the Copenhagen adduction modified position stage 1: EMG measurements and hand-held dynamometer analysis in young and healthy men

OBJECTIVES

To verify the effectiveness of the use of a modified position of the Copenhagen Adduction (CA) stage 1 compared to the original position.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PARTICIPANTS

31 healthy men aged 23.7 ± 1.9 years with no recent or chronic general pathology.

MAIN OUTCOME MEASURES

Differences between EMG amplitudes for the adductor longus (AL), rectus femoris (RF) and semi tendinous (ST) during dynamic contractions and adductor maximal isometric voluntary contraction (MIVC) force values between CA stage 1 standard and modified positions were assessed with either Wilcoxon or paired t-test.

RESULTS

No significant differences were observed for EMG amplitudes of the AL (p-value = 0.724) and for the RF muscle (p-value = 0.337) and for the adductor force (p-value = 0.361) between the two positions. A significant difference was obtained for the ST (p-value<0.001) mainly explained by the adapted position of the non-dominant leg which unlocked the hip joint and generated less muscle activity in the hamstrings.

CONCLUSIONS

Muscle activity of the AL muscle and adductor force being similar in both positions, the CA stage 1 modified position could be of interest for rehabilitation after adductor injury or strengthening of the adductors in elite athletes.

Acute Effects of Ice Hockey on Hip Range of Motion, Strength, and Pelvic Tilt in Competitive Male Players

BACKGROUND

Ice hockey players are at high risk for hip and groin injury. Several risk factors have been identified or proposed, including lower hip rotation range of motion (ROM), lower hip adductor strength, lower ratio of hip adductor to abductor strength, and lower pelvic tilt angle. It is not known how these risk factors change acutely with ice hockey participation.

HYPOTHESIS

Acute exposure to ice hockey will result in a reduction in ROM, strength, and pelvic tilt angle in competitive male players.

STUDY DESIGN

Controlled cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Risk factors for hip and groin injury, including isometric hip adductor strength at 0° of flexion, the ratio of hip adductor to abductor strength, total hip rotation passive ROM in supine, and the resting pelvic tilt angle, were assessed immediately before, immediately after, and 24 hours after an ice hockey exposure in 42 competitive male ice hockey players. Rating of perceived exertion (RPE) was collected to identify the intensity of the exposure.

RESULTS

There was a significant decrease in total hip rotation ROM (-7.32°, P < 0.01 (-3.91, -10.70)) and hip adductor strength (-4.41 kg, P < 0.01 (-2.81, -6.00) immediately after the exposure, and a significant decrease in total hip rotation ROM (-18.54°, P < 0.01 (-14.35, -22.73)), hip adductor strength (-6.56 kg, P < 0.01 (-4.58, -8.61)), and the ratio of hip adductor to abductor strength (-0.12, P < 0.01 (-0.21, -0.45)) 24 hours after. There was no significant change in pelvic tilt found in this study immediately after or 24 hours after. There was a moderate relationship between changes in hip adductor strength and changes in the ratio of hip adductor to abductor strength (r = 0.433, P < 0.01). RPE was not significantly correlated to any of the changes observed.

CONCLUSION

Risk factors for hip and groin injury in ice hockey players are modifiable after a single ice hockey exposure.

CLINICAL RELEVANCE

The identified fluctuation of injury risk factors for hip and groin injury in ice hockey players has implications for injury risk profiling, rehabilitation, and return-to-competition decision-making.

Players are positive regarding injury prevention exercise programmes, but coaches need ongoing support: a survey-based evaluation using the Health Action Process Approach model across one season in amateur and youth football

Objectives

Implementation of injury prevention exercise programmes (IPEPs) in sports is challenging, and behaviour change among players and coaches is essential for success. The aim was to describe players' and coaches' motivation and coaches' goal pursuit when using IPEPs in amateur and youth football across a season. A secondary aim was to describe players' motivation to engage in IPEP use in relation to presence or absence of injury.

Methods

The study was based on questionnaires to amateur and youth, male and female football players and coaches at baseline, mid-season and post-season in a three-armed randomised trial in 2020 in Sweden. Questionnaires were based on the Health Action Process Approach (HAPA) model with questions about the motivational phase when intention for change is created (players and coaches) and a goal-pursuit phase when intention is translated into action (coaches).

Results

In total, 455 players (126 male), mean age 20.1 years (SD±5.8, range 14-46) and 59 (52 male) coaches took part. Players generally gave positive answers in the HAPA motivational phase (Likert 6-7 on a 1-7 Likert scale). Differences in ratings between injured and uninjured players were minor. Coaches had positive or neutral ratings (Likert 4-6) in the motivational and goal-pursuit phases. Ratings deteriorated across the season, with less positive responses from 40% of players and 38-46% of coaches post-season.

Conclusion

Positive ratings in the HAPA motivational phase indicated fertile ground for IPEP use. Neutral ratings by coaches and deterioration across the season in players and coaches suggest a need for ongoing support for IPEP use.

Trial registration number

NCT04272047.

Hip and core exercise programme prevents running-related overuse injuries in adult novice recreational runners: a three-arm randomised controlled trial (Run RCT)

OBJECTIVE

This study aims to investigate the efficacy of two exercise interventions in reducing lower extremity (LE) injuries in novice recreational runners.

METHODS

Novice runners (245 female, 80 male) were randomised into hip and core (n=108), ankle and foot (n=111) or control (n=106) groups. Interventions were completed before running and included exercise programmes focusing on either (1) hip and core or (2) ankle and foot muscles. The control group performed static stretching exercises. All groups were supervised by a physiotherapist and performed the same running programme. Injuries and running exposure were registered using weekly questionnaires during the 24-week study. Primary outcome was running-related LE injury.

RESULTS

The incidence of LE injuries was lower in the hip and core group compared with the control group (HR 0.66; 95% CI 0.45 to 0.97). The average weekly prevalence of overuse injuries was 39% lower (prevalence rate ratio, PRR 0.61, 95% CI 0.39 to 0.96), and the prevalence of substantial overuse injuries was 52% lower (PRR 0.48, 95% CI 0.27 to 0.90) in the hip and core group compared with the control group. No significant difference was observed between the ankle and foot group and control group in the prevalence of overuse injuries. A higher incidence of acute injuries was observed in the ankle and foot group compared with the control group (HR 3.60, 95% CI 1.20 to 10.86).

CONCLUSION

A physiotherapist-guided hip and core-focused exercise programme was effective in preventing LE injuries in novice recreational runners. The ankle and foot programme did not reduce LE injuries and did not protect against acute LE injuries when compared with static stretching.

Platelet-Poor versus Platelet-Rich Plasma for the Treatment of Muscle Injuries

ABSTRACT

Muscle injury in sport results in significant lost time and potential for reinjury for athletes. Autologous blood product, namely, platelet-rich plasma (PRP), has been investigated for possible augmentation of the treatment timeline with prevention of reinjury; however, conflicting results have been identified. A growing body of basic science and clinical literature is forming that supports the use of platelet-poor plasma (PPP) for muscle injury. The purpose of this study was to provide a background of the basic science of PRP versus PPP for muscle injury and to identify and review the clinical evidence for both autologous blood products, including the author's clinical experience utilizing the blood products. At the tissue level, PRP causes myoblast proliferation while PPP has led to myoblast induction, potentially identifying improved native muscle healing. Conflicting studies have been identified for the use of PRP for muscle injury. A growing body of positive results for PPP was identified, but high-quality comparative studies are needed.

Efficacy of a new injury prevention programme (FUNBALL) in young male football (soccer) players: a cluster-randomised controlled trial

OBJECTIVES

To evaluate the efficacy of a new multicomponent, exercise-based injury prevention programme in football players 13-19 years old.

METHODS

Two-arm cluster-randomised controlled trial with clubs as the unit of randomisation. 55 football teams from Kosovo of the under 15, under 17 and under 19 age groups were randomly assigned to the intervention (INT; 28 teams) or the control group (CON; 27 teams) and were followed for one football season (August 2021-May 2022). The INT group performed the 'FUNBALL' programme after their usual warm-up at least twice per week, while the CON group followed their usual training routine. The primary outcome measure was the overall number of football-related injuries. Secondary outcomes were region-specific injuries of the lower limbs (hip/groin, thigh, knee, lower leg, ankle and foot) and injury severity.

RESULTS

319 injuries occurred, 132 in the INT and 187 in the CON group. The INT group used the 'FUNBALL' programme in 72.2% of all training sessions, on average 2.2 times per week. There was a significantly lower incidence in the INT group regarding the overall number of injuries (incidence rate ratio (IRR) 0.69, 95% CI 0.55 to 0.87), the number of thigh injuries (IRR 0.62, 95% CI 0.39 to 0.98), of moderate (time loss between 7 and 28 days) (IRR 0.65, 95% CI 0.44 to 0.97) and of severe injuries (time loss >28 days) (IRR 0.51, 95% CI 0.28 to 0.91).

CONCLUSION

The 'FUNBALL' programme reduced the incidence of football-related injuries among male adolescent football players, and its regular use for injury prevention in this population is recommended.

TRIAL REGISTRATION NUMBER

NCT05137015.

Identification of potential risk factors for lower limb injuries in female team-sport athletes: a prospective cohort study

OBJECTIVES

The purpose of this prospective cohort study was to assess the associations between lower limb injuries in female team-sport athletes and a number of factors. The potential risk factors explored included (1) lower limb strength, (2) history of life-event stress, (3) family history of ACL injuries, (4) menstrual history, and (5) history of oral contraception use.

METHODS

One hundred and thirty-five female athletes aged between 14 and 31 years (mean: 18.8 ± 3.6 years) from rugby union (n = 47), soccer (n = 72), and netball (n = 16) volunteered to participate in this study. Demographics, history of life-event stress, injury history and baseline data were obtained prior to the competitive season. The following strength measures were collected: isometric hip adductor and abductor strength, eccentric knee flexor strength and single leg jumping kinetics. Athletes were then followed for 12 months, and all lower limb injuries sustained were recorded.

RESULTS

One hundred and nine athletes provided one-year follow-up injury data, of whom, 44 suffered at least one lower limb injury. All athletes who reported high scores for negative life-event stress sustained lower limb injuries. Non-contact lower limb injury was positively associated with weak hip adductor strength (OR: 0.88; 95%CI: 0.78-0.98; p = 0.017), and between-limb adductor (OR: 5.65; 95%CI: 1.61-19.7.; p = 0.007) and abductor (OR: 1.95; 95%CI: 1.03-3.71; p = 0.039) strength asymmetries.

CONCLUSION

History of life event stress, hip adductor strength, and between-limb adductor and abductor strength asymmetries offer potential novel avenues for investigating injury risk factors in female athletes.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Groin injuries in women's premier league football in Norway: A two-season prospective cohort study describing clinical and imaging characteristics

OBJECTIVE

To describe the prevalence, incidence, and burden of groin injuries in the Norwegian women's premier football league and to describe their clinical and imaging characteristics.

METHODS

During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported groin injuries weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2). We calculated weekly prevalence, incidence, and burden of groin injuries. The team physical therapists classified the player-reported injuries based on the Doha classification system. Injuries with more than 3 days' time loss or reported in 2 consecutive weeks were eligible for magnetic resonance imaging (MRI).

RESULTS

On average, 3.9% (95% CI: 3.4-4.4) of players reported a groin injury at any time; of which 78% caused time loss. The incidence rate was 1.6 injuries/1000 h (95% CI: 1.3-2.0) and their burden was 11 days lost/1000 h. The physical therapists examined 67 of 124 player-reported groin injuries (53%). Adductor-related injury was most common (55%) followed by iliopsoas (15%) and rectus femoris-related (12%). Pubic-related injuries caused most time loss (median: 24 days, IQR: 5-133). In this study, 42 injuries were investigated with MRI; 8 (19%) showed no changes, 6 (14%) an acute musculotendinous lesion, and 32 (76%) a nonacute finding (e.g., central symphyseal disc protrusion, tendinopathies).

CONCLUSION

The incidence rate and burden of groin injuries were high. Adductor-related injuries were most common, but pubic-related injuries caused most time loss. Most MRI examinations demonstrated nonacute findings.

Reliability of Measures of Lower-Body Strength and Speed in Academy Male Adolescent Soccer Players

ABSTRACT

Ferguson, J, Gibson, NV, Weston, M, and McCunn, R. Reliability of measures of lower body strength and speed in academy male adolescent soccer players. J Strength Cond Res 38(3): e96-e103, 2024-The Nordbord and ForceFrame represent a practical and time efficient means of assessing eccentric hamstring and isometric adductor strength in the large number of squads and players associated with youth soccer academies, yet measurement reliability in this population is unexamined. Therefore, over a period of 4 days, with no less than 24 hours and no more than 48 hours between trials, 37 players (age: 14.7 ± 0.8 years, stature: 168.7 ± 7.8 cm, mass: 57.7 ± 9.1 kg, and maturity offset: 0.8 ± 0.9 years) were assessed for eccentric hamstring strength (force, torque), isometric adductor strength (long and short lever positions), and 30-m sprint (5, 10, and 20-m splits), using the Nordbord, ForceFrame, and electronic timing gates, respectively, on 3 separate occasions. Relative reliability (intraclass correlation coefficient) was rated as good for all Nordbord (range: 0.86-0.89) and ForceFrame (0.78-0.85) measures and ranged from moderate (0.53) to excellent (0.93) for the speed measures, improving with increased distance. Absolute reliability (standard error of the measurement [%SEM]) ranged from 7 to 8% (Nordbord), 3 to 11% (ForceFrame), and 1 to 4% (sprints). Our data provide the first Nordbord and ForceFrame reliability estimates in adolescent soccer academy players. To interpret test sensitivity, practitioners are encouraged to interpret our estimates of absolute reliability against meaningful change values derived from personal experience and evidence-based knowledge and not against absolute or standardized thresholds.

Effectiveness of cryo plus ultrasound therapy versus diathermy in combination with high-intensity laser therapy for pain relief in footballers with muscle injuries: A prospective study

BACKGROUND

Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes.

OBJECTIVE

The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries.

METHODS

A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury.

RESULTS

Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p< 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier.

CONCLUSION

HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers.

Can the Copenhagen Adduction Exercise Prevent Groin Injuries in Soccer Players? A Critically Appraised Topic

CLINICAL SCENARIO

Injuries that affect the groin region are among the most common in football players. To prevent this condition, studies have focused on strengthening the adductors, hip flexors, or abdominal muscles. Recent investigations have used an eccentric-biased exercise (Copenhagen Adduction Exercise [CAE]) that promotes functional and architectural adaptations in the muscle tissue, though its effect on injury risk reduction is unknown.

CLINICAL QUESTION

Can the Copenhagen Adduction Exercise prevent groin injuries in soccer players?

SUMMARY OF KEY FINDINGS

The literature was searched for studies investigating the potential groin injury risk reduction effect of the CAE. (1) Three studies met the inclusion criteria and were used for this appraisal; (2) one study observed a significantly lower injury rate ratio favoring the group that used the CAE program; and (3) 2 studies found similar or higher injury rates in the intervention groups, not supporting the inclusion of the CAE as a preventative tool.

CLINICAL BOTTOM LINE

There is conflicting evidence that usage of the CAE is superior to not performing adductor strengthening exercises in mitigating the risk of sustaining groin injuries. Given the evidence supporting these findings, it is advisable to exercise caution when contemplating the incorporation of the CAE into training regimens aimed at preventing groin injuries.

STRENGTH OF RECOMMENDATION

There is Grade B evidence to suggest that inclusion of the CAE may not be associated with reduced injury rates.

Managing Lower Limb Muscle Reinjuries in Athletes: From Risk Factors to Return-to-Play Strategies

Muscle injuries and subsequent reinjuries significantly impact athletes, especially in football. These injuries lead to time loss, performance impairment, and long-term health concerns. This review aims to provide a comprehensive overview of the current understanding of muscle reinjuries, delving into their epidemiology, risk factors, clinical management, and prevention strategies. Despite advancements in rehabilitation programs and return-to-play criteria, reinjury rates remain alarmingly high. Age and previous muscle injuries are nonmodifiable risk factors contributing to a high reinjury rate. Clinical management, which involves accurate diagnosis, individualized rehabilitation plans, and the establishment of return-to-training and return-to-play criteria, plays a pivotal role during the sports season. Eccentric exercises, optimal loading, and training load monitoring are key elements in preventing reinjuries. The potential of artificial intelligence (AI) in predicting and preventing reinjuries offers a promising avenue, emphasizing the need for a multidisciplinary approach to managing these injuries. While current strategies offer some mitigation, there is a pressing need for innovative solutions, possibly leveraging AI, to reduce the incidence of muscle reinjuries in football players. Future research should focus on this direction, aiming to enhance athletes' well-being and performance.

Time-loss Injuries among Female and Male Spanish Rink Hockey Players

The present study describes the time-loss injuries among female and male athletes of the Spanish rink hockey league during the 2021/22 season.We performed a retrospective cohort study on time-loss injuries, whereby the athlete is prevented from participating in a training session or game because of the injury.A total of 463 athletes were included, with 326 (70.4%) senior male and 137 (29.6%) female. Two hundred and eighty-two time-loss injuries were recorded, the most common form being muscle injuries (112 episodes, 39.7%), especially those affecting the hip adductor muscles (52 episodes, 46.4% of muscle injuries). Most injuries were classified as mild (1-7 days of time-loss) and the median return-to-play was 9.5 days (range 1-180).Injury patterns were compared according to gender, position and moment: the results showed significant differences between senior males and females, between field players and goalkeepers, as well as between training and game, in terms of injury nature and type. The injury incidence proportion was significantly higher for field players compared to goalkeepers), and senior males had a significantly higher risk than senior females.The present study provides a starting point for studying and preventing injuries in rink hockey athletes.

Acute Adductor Muscle Injury: A Systematic Review on Diagnostic Imaging, Treatment, and Prevention

BACKGROUND

Controversies remain regarding the diagnosis, imaging, and treatment of acute adductor injuries in athletes.

PURPOSE

To investigate the diagnostic imaging, treatment, and prevention of acute adductor injuries based on the most recent and relevant scientific evidence.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

The PubMed and Web of Science databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify articles studying acute adductor injury in athletes. Inclusion criteria were original publication on acute adductor injury in amateur or professional athletes, level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or the methodological index for non-randomized studies criteria. Articles were grouped as imaging, treatment, prevention focused, or mixed.

RESULTS

A total of 30 studies published between 2001 and 2021 were selected, involving 594 male patients with a mean age 26.2 years (range, 16-68 years). The most frequent sports were soccer (62%), basketball (14%), futsal (6%), American football (3%), and ice hockey and handball (2%). Risk factors for acute adductor injury were previous acute groin injury, adductor weakness compared with the uninjured side, any injury in the previous season, and reduced rotational hip range of motion. The frequency of complete adductor muscle tears on magnetic resonance imaging was 21% to 25%. For complete adductor tears, the average time to return to play was 8.9 weeks in patients treated nonoperatively and 14.2 weeks for patients treated surgically. Greater stump retraction was observed in individuals treated surgically. Partial acute adductor tears were treated nonoperatively with physical therapy in all studies in the present systematic review. The average time to return to play was 1 to 6.9 weeks depending on the injury grade. The efficacy of adductor strengthening on preventing acute adductor tears has controversial results in the literature.

CONCLUSION

Athletes with partial adductor injuries returned to play 1 to 7 weeks after injury with physical therapy treatment. Nonoperative or surgical treatment is an acceptable option for complete adductor longus tendon tear.

Contemporary practices of physical trainers in professional soccer: A qualitative study

Introduction

Physical trainers (PTs) are integral for managing load, reducing injury and optimizing performance in professional soccer. However, little is known about how this practitioners operate in the applied setting and how some of the nuances experienced influence practice.

Methods

This study explored the contemporary practices of PTs in professional soccer. Semi-structured interviews were undertaken with eight PTs from different professional teams in European and South American leagues. Interview questions were designed to extract information on the evaluation of physical abilities, monitoring and control of training and injury prevention. Subsequently, the interviews were video-recorded, transcribed, translated and analyzed using a content analysis approach.

Results

The results suggest that the evaluation of physical capacities is carried out by PTs at the beginning of the preseason. It also appears that it is attempted that this process of regular testing is applied during the competitive period, with most participants conducting partial physiological and physical evaluations at different stages throughout the competitive season. In relation to the monitoring and control of training, subjective feedback scales are used to estimate the internal load, and the use of GPS devices is common to quantify external loads. Injury prevention programmes were implemented by all participants and were generally in a multi-component format focused on preventing or optimizing physical capabilities.

Discussion

These insights can be used as a scientific reference point to inform applied practice in professional soccer, especially for practitioners that are inexperienced and aspiring to enhance how they operate in the field. Future investigations should explore the practices of PTs in detail and across a wider network in order to gain deeper and comprehensive insights into the applied soccer environment.

The association between hip/groin pain and hip strength in football players: An exploratory analysis of the FORCe cohort

OBJECTIVES

Explore associations between peak hip strength in football players with hip/groin pain and healthy controls.

DESIGN

Cross-sectional study.

METHODS

Male and female sub-elite football players (soccer and Australian football) with hip/groin pain >6-month duration and players without hip/groin pain were recruited across Melbourne and Brisbane, Australia. Demographic information and two questionnaires; the Copenhagen Hip and Groin Outcome Score and the International Hip Outcome Tool 33 were collected. Hand-held dynamometry was used to measure isometric hip strength for flexion, extension, abduction, adduction, internal rotation, and external rotation. Linear mixed effects models were used to compare strength measures between groups.

RESULTS

190 football players with hip/groin pain (mean ± standard deviation age, 27.8 ± 6.3 years) and 64 controls (age, 27.3 ± 5.6 years) were included in this study. Of these, 291 symptomatic limbs and 128 control limbs were used for analyses. Symptomatic players had lower peak hip adduction (adjusted mean difference = -0.18: 95 % confidence interval -0.27 to -0.08, P : 0.001), external rotation (-0.06: 95 % confidence interval -0.09 to -0.02, P : 0.003), and internal rotation strength (-0.06: 95 % confidence interval -0.10 to -0.03, P : 0.001) compared to controls. A sport-specific interaction was observed for hip abduction strength. When separated by football code, abduction strength was lower in symptomatic Australian football players compared to their same sport peers (-0.20: 95 % confidence interval -0.33 to -0.06, P : 0.004), but not in symptomatic soccer players (-0.05: 95 % confidence interval -0.15 to 0.06, P : 0.382).

CONCLUSIONS

Hip adduction, internal rotation, and external rotation strength appears lower in football players with hip/groin pain independent of sex and football code. Hip abduction strength was lower in symptomatic Australian football players but not in soccer players.

Effectiveness of a Preventative Program for Groin Pain Syndrome in Elite Youth Soccer Players: A Prospective, Randomized, Controlled, Single-Blind Study

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.

Comprehensive Approach to Core Training in Sports Physical Therapy: Optimizing Performance and Minimizing Injuries

This clinical commentary explores the significance of a comprehensive approach to core training in sports physical therapy, focusing on optimizing performance and minimizing injuries. The core, encompassing multiple regions from the scapula to the glutes and beyond, plays a vital role in athletic performance and injury prevention. The commentary provides a thorough understanding of the various "cores" in the body, highlighting their primary functions and the importance of core stability. The commentary delves into the anatomy of the core, its primary functions, common injuries, and clinical evaluation techniques. It aims to define the role of core stability in athletic activities and discusses the prevalence and characteristics of core injuries in various sports such as baseball, basketball, football, hockey, and soccer. Furthermore, the clinical evaluation section describes subjective and objective assessments, functional testing, and special tests used to identify core injuries and determine their root causes. The author introduces a personalized dynamic core assessment to evaluate multiplanar stabilization and proposes a four-phase intervention program called the "Core Four Pyramid Principles." This program includes activation, stabilization, integration, and perturbation phases, each with specific entry criteria, goals, and targeted exercises. This commentary contributes to the body of literature by providing a comprehensive overview of core training in sports physical therapy, highlighting the significance of a systematic and evidence-based approach, and introducing the "Core Four Pyramid Principles" as a guideline for designing effective core training programs for sports therapists to optimize core function, stability and overall athletic performance while reducing the risk of injuries amongst their athletes.

Adherence to Injury Prevention Exercise Programmes in Amateur Adolescent and Adult Football: A Detailed Description of Programme Use from a Randomised Study

BACKGROUND

Injury prevention exercise programmes (IPEPs) efficaciously reduce injuries. However, it is challenging to achieve sufficient adherence across a season. The main aim was to describe adherence to IPEPs in three groups of coaches and players partaking in a cluster randomised trial. Secondary aims were to describe perceptions of IPEPs, use of programme material, and overall preventive strategies.

METHODS

This is a sub-study analysing data from a three-armed randomised trial with teams randomised to use either a comprehensive IPEP (extended Knee Control) or an adductor strength programme, and non-randomised teams that already used a self-chosen IPEP regularly at study start (comparison group). Teams were instructed to use their respective intervention across the 2020 football season. Male and female, adolescent (≥ 14 years of age), and adult amateur players took part. Coaches and players responded to weekly and end-of-season questionnaires. Data were presented descriptively.

RESULTS

Weekly player data were reported by 502 players (weekly response rate 65%), 289 (58%) responded to end-of-season questionnaires. Teams in the extended Knee Control and comparison group used their respective IPEP in 483/529 (91%) and 585/641 (91%) of training sessions, and teams in the adductor group in in 199/315 (63%) sessions. Regarding utilisation fidelity, 42-52% of players in each group used 1-10 repetitions per exercise. Seven out of 17 teams in the adductor group had progressed as recommended in terms of number of repetitions. Two teams (10%) in the extended Knee Control group, and 7/24 of comparison teams used the same exercises across the season. Coaches accessed the IPEPs by different means (printed material, films, workshops, etc.), but half did not use the provided digital material. The players appreciated that the IPEPs could reduce injury risk and that they improved their exercise performance, but disliked that they had less time for football and that the exercises were boring. Forty-nine players had experienced pain during IPEP performance.

CONCLUSIONS

Adherence with the IPEPs was generally high. To meet different coach needs, programme material should be available via different digital and printed resources. The number of players reporting pain during IPEP performance is a noteworthy finding.

TRIAL REGISTRATION

Clinical Trials gov identifier: NCT04272047. Registered February 17, 2020. https://clinicaltrials.gov/ct2/show/NCT04272047 .

Current Clinical Concepts: Exercise and Load Management of Adductor Strains, Adductor Ruptures, and Long-Standing Adductor-Related Groin Pain

Adductor-related groin pain is a common problem in sports. Evidence-based management of athletes with adductor strains, adductor ruptures, and long-standing adductor-related groin pain can be approached in a simple yet effective and individualized manner. In most cases, managing adductor-related pain in athletes should be based on specific exercises and loading strategies. In this article, I provide an overview of the different types of adductor injuries, from acute to overuse, including their underlying pathology, functional anatomy, diagnosis, prognosis, mechanisms, and risk factors. This information leads to optimal assessment and management of acute to long-standing adductor-related problems and includes primary, secondary, and tertiary prevention strategies that focus on exercise and load-based strategies. In addition, information on different options and contexts for exercise selection and execution for athletes, athletic trainers, and sports physical therapists in adductor injury rehabilitation is provided.

Development and Predictive Validation of the Brazilian Adductor Performance Test for Estimating the Chance of Hip Adductor Injuries in Elite Soccer Athletes

PURPOSE

To develop and validate the Brazilian Adductor Performance Test (BAPT) for predicting hip adductor muscle injuries in elite soccer athletes.

METHODS

A total of 108 soccer athletes were assessed, followed up for 3 months, and evaluated for a history of adductor injury 6 months before BAPT evaluation. The Shapiro-Wilk test was used as the normality test. The Mann-Whitney U test was used to compare BAPT scores between injured and uninjured athletes. Binary logistic regression was performed to identify the athletes' chances of injury based on their BAPT scores. A receiver operating characteristic curve was used to determine the cutoff point for the number of repetitions in the BAPT and Spearman bivariate correlation and identify factors potentially related to the test score. Furthermore, the intraclass correlation coefficient was used to determine interexaminer agreement. The level of significance was set at 95%.

RESULTS

The BAPT scores for hip adductor injury history did not differ significantly (P = .08). A significant deficit was identified in the BAPT scores of the injured athletes at the 3-month follow-up (P = .001). The cutoff point identified was 33 repetitions. Low BAPT scores increased the chance of injury by 20% (odds ratio, 1.20%; P = .001). The interexaminer agreement was .96 (P = .001).

CONCLUSION

BAPT can be used to identify athletes most likely to sustain hip adductor muscle injuries, indirectly reducing the rate of this injury in soccer clubs.

[Groin pain in sports games: a systematic review]

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Injury rates in the National Football League during the 2020 COVID-19 season

OBJECTIVES

The National Football League (NFL) altered the 2020 season due to the COVID-19 pandemic, which resulted in canceled preseason games and a dynamic regular season schedule to accommodate for canceled games. The purpose of this study was to evaluate if the disrupted training and preseason schedule lead to increased injury rates as seen in other professional sports. We hypothesized that the overall injury rate would be higher in the 2020 season compared to the 2018-2019 seasons and that this increase will affect all body regions equally.

METHODS

Publicly released NFL weekly injury reports were queried to identify players listed as out or placed on the injured reserve for at least one game in the 2018-2020 seasons. Injuries were categorized into upper extremity, lower extremity, spine/core, head, illness, not injury related and undisclosed injuries. Incidents per 1000 athlete exposures were calculated for the prior two seasons (2018-2019) and for the 2020 season separately. Percentage of injuries occurring in each position was calculated separately for the pre-COVID-19 (2018 and 2019) and post-COVID-19 (2020) cohorts. Incidence rate ratios (IRR) and confidence intervals were used to compare injury rates in 2018-2019 versus 2020. The z-test for proportions was used to determine significant differences between injury incidences.

RESULTS

The overall incidence rate per 1000 athlete exposures in 2020 was not significantly different compared to pre-COVID-19 seasons (21.6 versus 23.1, IRR 0.94, 95% CI: 0.9-1.0 p > 0.999). The proportion of injuries by position did not change before and after COVID-19 either (p > 0.999). Out listings due to illness were significantly increased during the 2020 season (0.8 versus 0.3, IRR 2.8, 95% CI: 1.4-5.2, p = 0.004).

CONCLUSION

The incidence of NFL injuries did not significantly change in 2020. The distribution of injuries did not change with respect to position.

Extended Knee Control programme lowers weekly hamstring, knee and ankle injury prevalence compared with an adductor strength programme or self-selected injury prevention exercises in adolescent and adult amateur football players: a two-armed cluster-randomised trial with an additional comparison arm

OBJECTIVE

To evaluate the preventive efficacy of an extended version of the Knee Control injury prevention exercise programme (IPEP) compared with an adductor strength programme and to a comparison group using a self-selected IPEP in amateur adolescent and adult male and female football players.

METHODS

Two-armed cluster-randomised trial with an additional non-randomised arm. All 251 amateur teams (players 14-46 years) in one regional football district were approached. Teams meeting inclusion criteria were randomised to (1) extended Knee Control or (2) an adductor strength programme. Teams already using an IPEP were allocated to a comparison group and received no new intervention. Players responded to weekly questionnaires about football exposures and injuries during a 7-month season.

RESULTS

Seventeen teams in the extended Knee Control, 12 in the adductor and 17 in the comparison group participated, with 502 players. For the primary outcomes, no difference in injury incidence in three lower-limb injury locations combined (hamstring, knee and ankle) was seen between extended Knee Control and the adductor group, whereas extended Knee Control had 29% lower incidence than the comparison group (incidence rate ratio 0.71, 95% CI 0.52 to 0.98). No between-group differences in groin injury incidence were seen. The weekly injury prevalence rates in the three lower limb locations combined (hamstring, knee and ankle) were 17% lower (prevalence rate ratio (PRR) 0.83, 95% CI 0.69 to 1.00) and 26% lower (PRR 0.74, 95% CI 0.63 to 0.87) in extended Knee Control compared with the adductor and comparison groups, respectively.

CONCLUSION

No difference in injury incidence was seen between the extended Knee Control and the adductor programme whereas extended Knee Control reduced injury incidence by nearly one-third compared with a self-selected IPEP. Players in extended Knee Control had lower injury prevalence compared with an adductor or self-selected IPEP.

TRIAL REGISTRATION NUMBER

NCT04272047; Clinical trials.

Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts

Background

Groin pain is a very common injury in multidirectional sports such as soccer, ice hockey, rugby and Australian football. Long-standing adductor-related groin pain is a persistent clinical condition and a frequent complaint in athletes involved in sports that require multiplanar movement patterns (change of direction, high-speed sprinting and kicking). To date, the lack of rehabilitation guidelines and return-to-play criteria makes this clinical entity difficult to manage. The aim of the present Delphi was to suggest, based on opinion and practical experience of a panel of experts, potential criteria that could be taken into consideration by clinicians in the RTP decision-making process in athletes suffering from long-standing adductor-related groin pain.

Methods

Thirty two out of 40 experts participated to a 3-Round Delphi questionnaire. In round 1, open-ended and closed questions about 9 different sections (palpation, flexibility, strength, patient-reported outcome measures, imaging, intersegmental control, performance tests, sport-specific skills, training load) were proposed to investigate return to play evaluation criteria used by each expert. Responses were analysed and coded to produce round 2 questionnaire that investigated only the sections and the items that reached the cut-off value (≥ 70%). Round 3 questionnaire was based on sections and items that reached cut-off value in previous rounds and experts rated their agreement for return to play criteria with a 5-point Likert Scale. Descriptive statistics enabled interpretation of consensus.

Results

High participation rate (80%) and response rate across the 3 rounds (100%) were recorded. 6 sections reached positive consensus in round 1, 1 section reached negative consensus. In round 2 positive consensus was confirmed only for 3 sections and negative consensus for 1 section. In round 3, positive agreement was established for strength (3 items), performance tests (3 items) and sport-specific skills (2 items) sections. Negative consensus was confirmed for imaging section.

Conclusion

Experts agreed that strength, performance tests and sport-specific skills can be used to support RTP decision, while imaging cannot be used. These findings could be useful in assisting clinicians in the RTP decision making.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-021-00400-z.

Adductor Strengthening Programme is successfully adopted but frequently modified in Norwegian male professional football teams: a cross-sectional study

OBJECTIVES

Groin injuries represent a substantial problem in male football, with the Adductor Strengthening Programme (ASP) being the only exercise programme demonstrated to significantly reduce the risk of groin problems. We aimed first, to use the Reach Adoption Effectiveness Implementation Maintenance (RE-AIM) framework to investigate attitudes, beliefs and behaviour to the ASP among primary delivery agents of injury prevention exercises in Norwegian male professional football teams. Second, we aimed to identify a real-world application of the ASP protocol used in a professional team setting.

DESIGN

A descriptive cross-sectional survey, using a questionnaire designed to cover all five dimensions of the RE-AIM framework.

SETTING

The top two divisions of Norwegian male professional football.

PARTICIPANTS

32 primary injury prevention delivery agents.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primarily, the proportion of respondents being aware of the ASP and its effect; having adopted it; having implemented it as intended; and considering maintaining using it. Secondary, the most often used ASP modifications.

RESULTS

Twenty-nine (91%) participants responded. All (100%) respondents were aware of the ASP and its injury preventive effect. The two most stated reasons for using the ASP were its injury preventive effect and that it does not require equipment. The ASP was adopted by all (100%) delivery agents, but only 10% used it in accordance with the original protocol. The main modifications were that the players in 72% of the teams were instructed to perform a non-progressive number of repetitions during pre-season, and in 86% of the teams instructed to perform more sets, but fewer repetitions per set, during in season. In total, 97% of the delivery agents planned to continue using the ASP.

CONCLUSION

The delivery agents have positive attitudes and beliefs to the ASP, but they frequently modify it. We identified and reported a real-world application of the ASP protocol.

Midseason Screening for Groin Pain, Severity, and Disability in 101 Elite American Youth Soccer Players: A Cross-Sectional Study

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.