Changes in the kinetics and kinematics of a reactive cut maneuver after successful athletic groin pain rehabilitation

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.

Movement Variability and Loading Characteristics in Athletes With Athletic Groin Pain: Changes After Successful Return to Play and Compared With Uninjured Athletes

Background:

Athletic groin pain (AGP) can lead to altered movement patterns during rapid deceleration and acceleration. However, the effect of AGP on movement variability and loading patterns during such actions remains less clear.

Purpose:

To investigate, using a continuous lateral hurdle hop task, how movement variability and magnitude measures of 3-dimensional (3D) kinematic, kinetic, and vertical ground-reaction force (vGRF) variables are (1) affected by AGP (AGP vs uninjured controls [CON]) and (2) changed after successful rehabilitation (AGP prerehabilitation vs AGP postrehabilitation vs CON).

Study Design:

Controlled laboratory study.

Methods:

A total of 36 athletes diagnosed with AGP and 36 uninjured CON athletes matched on age (18-35 years), level (subelite), and type of sports played (multidirectional field sport) performed a continuous lateral hurdle hop test that involved 10 side-to-side hops over a 15-cm hurdle. The 3D joint kinematic, kinetic, and vGRF variables (total, eccentric, and concentric; ground contact time, peak force, and impulse; and eccentric rate of force development) were examined. The AGP and CON groups were tested at baseline, and the AGP group was retested after participants successfully completed a standardized, exercise-based rehabilitation program targeting intersegmental control.

Results:

There were no differences in baseline characteristics between the AGP (mean ± SD: age, 27.5 ± 4.8 years; height, 179.8 ± 6.3 cm; mass, 80.3 ± 7.1 kg) and CON (mean ± SD: age, 24.1 ± 4.5 years; height, 181.0 ± 5.8 cm; mass, 80.4 ± 8.2 kg) groups. At baseline, athletes with AGP demonstrated altered loading patterns in the vGRF (longer ground contact times, reduced peak force, and reduced rate of force development) compared with CON athletes, while no significant difference in any movement variability variables was evident. After rehabilitation, the athletes with AGP demonstrated significant changes in transverse and coronal plane hip and trunk kinematics, with no significant differences in vGRF variables compared with the CON group.

Conclusion:

The differences in baseline vGRF measures between the AGP and CON groups were no longer evident after athletes with AGP underwent rehabilitation. No differences in movement variability were evident between the AGP and CON groups, either before or after rehabilitation.

Clinical Relevance:

Rehabilitation programs should consider targeting intersegmental hip and trunk movement patterns to positively influence loading patterns in athletes with AGP.

Running biomechanics in football players with and without hip and groin pain. A cross-sectional analysis of 116 sub-elite players

OBJECTIVE

Examine whether football players with hip and/or groin (hip/groin) pain have impaired running biomechanics when compared to pain-free players, analysing men and women independently.

DESIGN

Cross-sectional.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Seventy-eight (62 men, 16 women) football players with >6months of hip/groin pain and a positive flexion-adduction-internal rotation test and 38 (25 men, 13 women) asymptomatic players.

MAIN OUTCOME MEASURES

Pelvis angles and hip, knee, and ankle joint angles and moments were analysed during the stance phase of overground running at 3-3.5 m⋅s^-1. Continuous joint angle and moment data were compared between symptomatic and asymptomatic football players of the same sex using statistical parametric mapping. Joint moment impulses (area under the curve) were compared between groups using linear regression models.

RESULTS

Symptomatic football players did not display significant differences in pelvis angles or lower-limb joint angles, moments, or moment impulses during the stance phase of running, when compared to asymptomatic players of the same sex.

CONCLUSION

Our large sample of football players with hip/groin pain who were still participating in competitive sport displayed similar running biomechanics to asymptomatic players. Impaired running biomechanics might exist in people with worse hip/groin pain, warranting future investigation.

Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes

Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is needed to determine the most appropriate and optimal timing and formulations in non-steroidal anti-inflammatory drug and opioid management, particularly given the strictness of anti-doping regulations. Indeed, the role of pharmacological therapy in reducing acute traumatic pain in athletes should still be addressed to minimize the timing of return to sport. Therefore, the aim of this comprehensive review was to summarize the current evidence about pain management in the setting of acute injury in elite athletes, providing the most informed strategy for pain relief and performance recovery.

Clinical Measures of Pelvic Tilt in Physical Therapy

Pelvic tilt refers to the spatial position or motion of the pelvis about a frontal horizontal axis on the rest of the body in the sagittal plane. It is relevant for several musculoskeletal conditions commonly seen in physical therapist practice, particularly conditions affecting the hip and groin. Despite the relevance of pelvic tilt identified in biomechanical studies, and the historical precedence for assessing pelvic tilt, there is a lack of clarity regarding the utility of clinical measures that are practical in a rehabilitation setting. There are several options available to assess pelvic tilt which are discussed in detail in this commentary. All of these options come with potential benefits and considerable limitations. The purpose of this commentary is to provide an overview of the relevance of understanding pelvic tilt in the pathology and rehabilitation of conditions affecting the hip joint, with a focus applying evidence towards identifying clinical measures that may be useful in the rehabilitation setting and considerations that are needed with these measures.

LEVEL OF EVIDENCE

5.