Eccentric strengthening effect of hip-adductor training with elastic bands in soccer players: a randomised controlled trial

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.

Weekly screening of youth male football players: a 14-week longitudinal investigation of interactions between groin pain and long lever adductor squeeze strength

OBJECTIVES

To explore relationships between groin pain and adductor squeeze strength in male academy football players over a 14-week period.

DESIGN

Longitudinal cohort study.

METHODS

Weekly monitoring of youth male football players consisted of reporting groin pain and testing long lever adductor squeeze strength. Players who reported groin pain at any time during the study period were stratified into the "groin pain" group while players who did not report pain remained in the "no groin pain" group. Baseline squeeze strength was retrospectively compared between groups. Players that developed groin pain were examined via repeated measures ANOVA at four timepoints: baseline, last squeeze before pain, pain onset, and return to pain-free.

RESULTS

53 players were included (age 14.4 ± 1.6 years). Baseline squeeze strength was not different between players in the "groin pain" (n = 29, 4.35 ± 0.89 N/kg) versus "no groin pain" group (n = 24, 4.33 ± 0.90 N/kg, p = 0.83). At a group level, players with no groin pain maintained similar adductor squeeze strength throughout 14 weeks (p > 0.05). Compared to baseline (4.33 ± 0.90 N/kg), players with groin pain had decreased adductor squeeze strength at the last squeeze before pain (3.91 ± 0.85 N/kg, p = 0.003) and at pain onset (3.58 ± 0.78 N/kg, p < 0.001). Adductor squeeze strength at the point where pain subsided (4.06 ± 0.95 N/kg) was not different from baseline (p = 0.14).

CONCLUSIONS

Decreases in adductor squeeze strength manifest one-week prior to groin pain onset and further decrease at pain onset. Weekly adductor squeeze strength may be an early detector for groin pain in youth male football players.

Dynamometric Strength Profile of Hip Muscles in Youth Soccer Players

BACKGROUND

Soccer is the most widely practiced sport in the world, demanding high-speed activities such as jumps, sprints and changes of direction. Therefore, having optimal levels of muscle strength improves performance and reduces the injury rate.

OBJECTIVES

The objectives of our study were (i) to determine the dynamometric profile of hip muscle strength in young soccer players by position, evaluated at different isokinetic speeds, (ii) to describe the conventional and functional unilateral muscle strength ratios, (iii) to analyze the bilateral balance.

METHODS

Thirty-seven male soccer players (age 17.02 ± 0.92 years) participated in the study. Strength assessment was performed with a functional electromechanical dynamometer, and concentric and eccentric strength of abductors, adductors, extensors and hip flexors were measured bilaterally at 0.5 m/s and 1 m/s.

RESULTS

For eccentric right hip abduction at 0.5 m/s, defenders are significantly stronger than midfielders (p = 0.013) and stronger than forwards (p = 0.140). For eccentric right hip adduction at 0.5 m/s, defenders are significantly stronger than midfielders (p = 0.005) and stronger than forwards (p = 0.253), as for eccentric right hip adduction at 1 m/s, defenders are significantly stronger than midfielders (p = 0.014) and stronger than forwards (p = 0.084). There is a significant effect for the conventional strength ratio of left abduction/adduction at 1 m/s. The conventional strength ratio of forwards is significantly higher than that of defenders (p = 0.045) and higher than that of midfielders (p = 0.152).

CONCLUSIONS

Concentric and eccentric hip strength values differ according to playing position.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Tennis: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association (NCAA) has sponsored men's tennis programs since 1982. The popularity of tennis has grown, as has sponsorship of men's tennis within NCAA institutions.

BACKGROUND

Continued monitoring of athletic injuries is important for identifying emerging temporal patterns.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 4.41 per 1000 athlete-exposures. Lateral ligament complex tears of the ankle (8.5%) were the most reported injury. Trunk (15.1%) and shoulder (13.2%) injuries accounted for the largest proportions of all injuries. Noncontact and overuse were the most common mechanisms of injury among all reported injuries, together accounting for 69.4% of all injuries.

CONCLUSIONS

Findings of this study differed slightly from previous studies, most notably in specific injuries reported. Continued monitoring of specific injury incidence as well as greater participation in injury surveillance is needed to inform the development of nuanced injury prevention strategies for this population.

Strength Conditioning Program to Prevent Adductor Muscle Strains in Football: Does it Really Help Professional Football Players?

Coaches at the professional level are often concerned about negative side effects from testing and intensive resistance training periods, and they are not willing to base their training prescriptions on data obtained from semiprofessional or amateur football players. Consequently, the purpose of this study was to analyze the reliability and effectiveness of two adductor injury active prevention programs using the adductor/abductor ratio and deficit between legs, on the basis of adduction-abduction power output during the exercises proposed, in professional football players. Forty-eight professional football players undertook complementary strength training for the adductor and abductor muscles in their dominant and non-dominant legs, once or twice a week throughout the playing season. The volume of the session was determined by the adductor/abductor ratio and the deficit between legs in the last session training measured. The number and severity of muscle injuries per 1000 h of exposure were recorded. Both prevention programs showed a very low rate of adductor injury (0.27 and 0.07 injuries/1000 h) with mild-to-moderate severity, maintaining a balance in percentage asymmetry between dominant and non-dominant legs for adductor (10.37%) and in the adductor/abductor ratio (0.92) in top professional football players throughout the season. The strength conditioning program proposed can help to prevent adductor muscle injuries in top professional football players.

Effectiveness of Field-Based Resistance Training Protocols on Hip Muscle Strength Among Young Elite Football Players

OBJECTIVE

The objective of this study was to examine the effects of an 8-week progressive resistance training program on hip joint muscles' strength measures, using the Copenhagen adduction (CA) and the sliding hip (SH) exercises.

DESIGN

Prospective randomized controlled trial.

SETTING

Sport training and medical centers.

PARTICIPANTS

Forty-two young male football athletes (age 17.5 ± 1.1 years; height 178.3 ± 3.2 cm; body mass 66.1 ± 8.6 kg) allocated to a CA, SH, and matched control (C) group.

INTERVENTIONS

Two weekly sessions of CA and SH.

MAIN OUTCOME MEASURES

Maximal eccentric strength test for the hip adductor (EHAD) and maximal eccentric strength test for the hip abductor (EHAB) muscles, and the relative EHAD/EHAB ratio assessed through a break test in the side-lying position.

RESULTS

No significant differences between groups were found at baseline for any of the assessed variables (all P > 0.053). The CA group had a significant strength increase in the right and left leg (d = 2.11, d = 1.9, respectively). The SH group also had a significant strength increase in the right and left leg (d = 1.68 and d = 1.67, respectively). The CA group presented EHAD/EHAB improvements in the right and left leg (d = 0.84 and d = 1.14, respectively). The SH group also presented EHAD/EHAB improvements in the right and left leg (d = 1.34 and d = 1.44, respectively).

CONCLUSIONS

Both exercises' protocols were effective in inducing significant increases on EHAD, EHAB, and EHAD/EHAB ratio when compared with the control group. Practitioners should be aware of the training effectiveness of both protocols.

COVID-19 and Social Isolation: A Case for Why Home-Based Resistance Training Is Needed to Maintain Musculoskeletal and Psychosocial Health for Older Adults

The coronavirus disease outbreak in China has become the world's leading health headline and is causing major panic and public concerns. Public health guidelines in many countries are suggesting that people stay at home to avoid human-to-human transmission of the virus, which may lead to reduced physical activity and greater feelings of isolation. Such effects may be particularly problematic in older adults due to their reduced physical capacities and their potential for increased mental health issues, such as anxiety and depression. A potential way to minimize many of these side effects of stay-at-home guidelines may be progressive home-based resistance training. A simple way to provide progressive overload in home-based resistance training may involve elastic resistance, which has been demonstrated to provide similar benefits to traditional resistance training equipment typically found in gymnasiums. Recommendations on how older adults can safely and effectively perform elastic resistance training at home are provided.

The effect of targeted resistance training on bench press performance and the alternation of prime mover muscle activation patterns

Targeted muscle strengthening might improve performance or help overcome training stagnation; therefore, the aim of the present study was to investigate changes in muscle activity patterns before and after six weeks of targeted resistance training. Twenty-seven resistance-trained men were divided into three groups according to their prime mover activity, as measured by surface electromyography during a bench press (BP). Each group underwent a six-week block of targeted exercises for one of the following muscles: anterior deltoid (AD), pectoralis major (PM) or triceps brachii (TB). ANOVA showed that each group increased their 1 repetition maximum (1RM) (p < 0.05) and the activity of the exercised muscle group during an isometric bench press (p < 0.01) and during a dynamic bench press (p < 0.01) at 85% of the 1RM. During the isometric BP, the TB training group had an increase in TB activity in comparison to the other groups. Targeted muscle training is a useful method for muscle activity increase and increasing the maximum strength in complex exercise, when applied in activity-deficient muscle groups. Strengthening the TB elicits changes in all prime movers and results in TB activity domination during a bench press.

Hip and Groin Injuries in National Collegiate Athletic Association Women's Soccer Players

Background:

Hip and groin injuries are common in competitive soccer players and have been shown to be significant sources of time loss. There are few studies describing the epidemiology of hip and groin injuries in female National Collegiate Athletic Association (NCAA) soccer players.

Purpose:

To describe the epidemiology of hip and groin injuries in women’s collegiate soccer players.

Study Design:

Descriptive epidemiology study.

Methods:

The NCAA Injury Surveillance System/Program (ISS/ISP) was analyzed from 2004 through 2014 for data related to hip and groin injuries in female collegiate soccer players. Injuries and athlete-exposures (AEs) were reported by athletic trainers. Data were stratified by time of season, event type, injury type, treatment outcome, time loss, and player field position.

Results:

Between 2004 and 2014, there were 439 recorded hip or groin injuries in female soccer players and an overall rate of injury of 0.57 per 1000 AEs. Injuries were 12.0 times more likely to occur during the preseason (4.41/1000 AEs) as opposed to during the regular season (0.37/1000 AEs) (injury rate ratio [IRR], 12.01; 95% confidence interval [CI], 9.92-14.55) or postseason (0.38/1000 AEs) (IRR, 11.55; 95% CI, 7.06-18.91). Rates of injury were similar during the regular season and postseason (IRR, 0.96; 95% CI, 0.59-1.58). Rates of injury were higher during competition (0.69/1000 AEs) than during practice (0.52/1000 AEs) (IRR, 1.33; 95% CI, 1.08-1.63). Most injuries were new (87.5%; n = 384) and unlikely to recur (12.5%; n = 55).

Conclusion:

Hip and groin injuries in female NCAA soccer players are uncommon, and fortunately, most players return to play quickly without recurrence. Future prospective studies should evaluate the effectiveness of strength and conditioning programs in preventing these injuries.

Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study

Background:

Despite being one of the most common sports injuries, there are no criteria-based rehabilitation programs published for acute adductor injuries.

Purpose:

To evaluate return-to-sport (RTS) outcomes and reinjuries after criteria-based rehabilitation for athletes with acute adductor injuries.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Male adult athletes with an acute adductor injury underwent a supervised, standardized criteria-based exercise rehabilitation program. Magnetic resonance imaging (MRI) was used to grade the injury extent from 0 (negative finding) to 3 (complete tear/avulsion). There were 3 milestones used to evaluate the RTS continuum: (1) clinically pain-free, (2) completion of controlled sports training, and (3) return to full team training. Subsequent injuries were registered within the first year.

Results:

We included 81 athletes with an acute adductor injury (MRI grade 0: n = 14; grade 1: n = 20; grade 2: n = 30; grade 3: n = 17). Of these, 61 (75%) athletes achieved RTS milestone 1, 50 (62%) achieved RTS milestone 2, and 75 (93%) achieved RTS milestone 3. There were no statistical differences in the RTS duration between MRI grade 0, 1, and 2 at any RTS milestone; thus, these were grouped together as grade 0-2. The median time (interquartile range [IQR]) for athletes with grade 0-2 injuries to become clinically pain-free was 13 days (IQR, 11-21 days), to complete controlled sports training was 17 days (IQR, 15-27 days), and to return to full team training was 18 days (IQR, 14-27 days). For athletes with a grade 3 injury, median times were 55 days (IQR, 31-75 days), 68 days (IQR, 51-84 days), and 78 days (IQR, 68-98 days), respectively. The overall 1-year reinjury rate was 8%. Athletes who achieved RTS milestone 1 had a statistically significantly lower reinjury rate than athletes who did not (5% vs 21%, respectively; ϕ = –0.233; P = .048). Athletes who achieved RTS milestone 2 had a nonstatistically significantly lower reinjury rate than athletes who did not (6% vs 13%, respectively; ϕ = –0.107; P = .366).

Conclusion:

We analyzed the results of a criteria-based rehabilitation protocol for athletes with acute adductor injuries. Athletes with an MRI grade 0-2 adductor injury were clinically pain-free after approximately 2 weeks and returned to full team training after approximately 3 weeks. Most athletes with an MRI grade 3 adductor injury were pain-free and returned to full team training within 3 months. Meeting the clinically pain-free criteria resulted in fewer reinjuries compared with not meeting the criteria.

Practical Use of the Navigate Pain Application for the Assessment of the Area, Location, and Frequency of the Pain Location in Young Soccer Goalkeepers

Next to winning, minimizing injuries during training and matches is one of the primary goals of professional team sports games. Soreness and pain can be early indicators and risk factors for acute or long‐term injuries. Monitoring pain intensity and duration, as well as potential sources, are useful for planning practices and can be effective means for preventing injury. The aim of this study was to assess the areas and locations of pain in young soccer goalkeepers during a training camp, and to differentiate the area and frequency between pain arising from the muscles (MP), joints (JP), or as a result of an impact (IP). Recordings of the MP, JP, and IP location along with the area were performed using digital body mapping software (Navigate Pain Android app, Aalborg University, Denmark) installed on a tablet personal computer at the end of each training day across a 5‐day training camp. There was a significant difference in the area between the three types of pain (p < 0.001). The post hoc analysis revealed statistically significant differences between the pixel areas of IP versus JP (p < 0.001), IP versus MP (p < 0.001), and JP versus MP (p < 0.001). There was no significant time‐effect for the IP area between 1‐5 days of training (p = 0.610), neither for MP (p = 0.118) or JP (p = 0.797) and no significant difference for all three pain areas between the front and the back side of the body. The body regions most often reported for MP were thighs, while for JP they were groin and hips, and for IP the hips, shoulders, and forearms were most frequently indicated. This is the first study to map and report the pain distribution associated with training across a 5‐day training camp in soccer goalkeepers, and these findings emphasize the value of using digital pain drawings clinically as well as for monitoring the health status of soccer players.

Impact of a modified progressive Copenhagen adduction exercise programme on hip adduction strength and postexercise muscle soreness in professional footballers

Background

Reduced hip adduction strength has been identified as a key predisposing factor in developing hip and groin injuries. The Copenhagen adduction programme has been shown to increase hip adduction strength in semiprofessional footballers but can cause muscle soreness. Therefore, a modified progressive Copenhagen adduction (MPCA) programme has been designed to increase hip adduction strength while limiting muscle soreness.

Objective

To investigate the effect of an 8-week MPCA exercise on eccentric hip adduction and abduction strength in senior professional footballers.

Methods

25 senior professional footballers completed an 8-week MPCA strengthening programme. Eccentric hip adduction (EHAD) and eccentric hip abduction (EHAB) strengths were measured. Changes in preintervention and postintervention strengths and EHAD:EHAB ratios were calculated. The statistical significance between strength changes was assessed with dependent t-tests and Wilcoxon signed-rank tests due to the distribution of the data (p<0.05). Delayed onset of muscle soreness (DOMS) and rate of perceived exertion were measured throughout the programme.

Results

There were statistically significant increases in EHAD strength (24% and 25%, left and right), EHAB strength (10% and 13%, left and right) and the EHAD:EHAB ratio (12% and 10%, left and right) (p<0.01).

Professional footballers were able to complete the MPCA exercise with low levels of DOMS.

Conclusion

An 8-week MPCA exercise elicited significant EHAD and EHAB strength increases with reduced levels of muscle soreness in senior professional footballers.

Test-retest reliability of knee extensors endurance test with elastic resistance

Background

Reliable clinical tests capable of measuring resistance are important tools for rehabilitation. One alternative that has recently increased in popularity is the use of elastic tubes, which stand out for being easy to handle, low cost, practical, and feasible.

Objective

Analyze the test-retest reliability of the knee extensors muscle fatigue resistance test (FRT) with elastic tubes.

Methods

A total of 116 healthy young males, aged between 18 and 30 years old, participated in the study. Participants performed three pre-test stages: orientation, load presentation, and familiarization with equipment, lasting two weeks. Subsequently, they performed the FRT on two occasions (test and retest), with an interval of seven days. The reliability analyzes were performed using the intraclass correlation coefficient (ICC) with 95% confidence interval and typical measurement error (TME), also expressed as coefficient of variation (CV%).

Results

The findings regarding the reliability of the test demonstrated satisfactory values (time: ICC = 0.66; 95%CI [0.50; 0.76]; CV(%) = 9.34; repetition: ICC = 0.61; 95%CI [0.46; 0.73], CV(%) = 13.66; rhythm: ICC = 0.52; 95%CI [0.35; 0.67], CV(%) = 10.29.

Conclusion

From the findings presented, it is concluded that the proposed clinical test with elastic tubes demonstrates evidence of acceptable values.

Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis

BACKGROUND

Change of direction and kicking have been described as the main actions resulting in adductor longus injury. Video descriptions of inciting events are lacking.

OBJECTIVE

Perform a standardised visual video analysis of a series of acute adductor longus injuries in football.

STUDY DESIGN

Cross-sectional.

METHODS

Video footage was reviewed by players, and assessed independently by five sports medicine professionals. Inciting events were described and categorised using standardised scoring, including playing situation, player/opponent behaviour, movement and body positions.

RESULTS

Videos of acute adductor longus injuries in 17 professional male football players were analysed. Most injuries occurred in non-contact situations (71%), following a quick reaction to a change in play (53%). Injury actions were: change of direction (35%), kicking (29%), reaching (24%) and jumping (12%). Change of direction and reaching injuries were categorised as closed chain movements (59%), characterised by hip extension and abduction with external rotation. Kicking and jumping injuries were categorised as open chain (41%), characterised by a change from hip extension to hip flexion, and hip abduction to adduction, with external rotation.

CONCLUSION

Acute adductor longus injuries in football occur in a variety of situations. Player actions can be categorised into closed (change of direction and reaching) and open (kicking and jumping) chain movements involving triplanar hip motion. A rapid muscle activation during a rapid muscle lengthening appears to be the fundamental injury mechanism for acute adductor longus injuries.

Effect of Holmich protocol exercise therapy on long-standing adductor-related groin pain in athletes: an objective evaluation

Aim

To objectively evaluate the effect of Holmich protocol-based exercise therapy on long-standing adductor-related groin pain (LSAGP).

Methods

We reproduced the Holmich protocol of exercise therapy and objectively evaluated its effect on 17 male athletes (mean age, 25.07±4.96 years) suffering from LSAGP, of whom 14 participants completed the 10 weeks treatment period. The study was designed as a single-blinded, before-and-after clinical trial. Main outcome measures included pain, functional ability, hip range of motion (ROM), hip abductor and adductor muscle strength, and successful return to sports activity.

Results

Eleven athletes (78.57%) returned to their sports activities in a mean time of 14.2 weeks (range, 10-20 weeks). Visual analogue scale pain score, hip abductor and adductor muscles strength, and function scores improved significantly. Although hip abduction ROM did not show any significant changes (p = 0.609), the extent of progress in the hip internal rotation ROM was significant (p = 0.001). The ratio of hip adduction to abduction strength did not change significantly (p = 0.309 for the isometric and p = 0.957 for the eccentric ratio).

Conclusions

Exercise therapy according to the Holmich programme may be an effective treatment for LSAGP. However, more emphasis should be paid to the hip adductor muscles' eccentric strength.

Trial registration number

IRCT2016080829269N1.

Impairment-Based Rehabilitation Following Hip Arthroscopy: Postoperative Protocol for the HIP ARThroscopy International Randomized Controlled Trial

Synopsis The number of hip arthroscopies for the management of femoroacetabular impingement syndrome and other hip intra-articular conditions has grown exponentially in the last decade. Postoperative rehabilitation is part of the treatment algorithm, although there is a lack of high-quality studies on the efficacy of both surgery and postoperative rehabilitation programs. It is known that impairments can be present up to 2 years after hip arthroscopy, with individuals exhibiting reduced function and quality of life when compared to those of similar age, highlighting a need to improve postoperative care. Postoperative rehabilitation programs aim to improve hip function; however, the description of interventions as well as criteria for progression are lacking in the literature. The aim of this clinical commentary was to present a targeted clinical rehabilitation approach for individuals undergoing hip arthroscopy. J Orthop Sports Phys Ther 2018;48(4):336-342. doi:10.2519/jospt.2018.8002.

The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol

Objective

The Hölmich protocol in therapeutic exercise is the most appropriate method for the treatment of long-standing adductor-related groin pain (LSAGP). Herein, we evaluated a modified Hölmich protocol to resolve the possible limitations intrinsic to the Hölmich protocol in terms of the rate of return to sport and the recovery period for athletes with LSAGP.

Design

The study followed a single-blind, before/after study design, where 15 athletes with LSAGP (mean age = 26.13 years; SD = 4.48) performed a 10-week modified Hölmich therapeutic exercise protocol.

Results

Outcome scores related to pain, hip adductor and abductor muscle strengths, and the ratio of maximum isometric and eccentric hip adduction to abduction strength increased significantly. Likewise, hip abduction and internal rotation ROM improved significantly compared to that at baseline. Furthermore, functional records (t-test, Edgren Side Step Test, and Triple Hop Test) showed significant improvement after treatment. Finally, 13 athletes (86.6% of the participants) successfully returned to sports activity in a mean time of 12.06 weeks (SD = 3.41).

Conclusion

The findings of this study objectively show that the modified Hölmich protocol may be safer and more effective than the Hölmich protocol in athletes with LSAGP in promoting their return to sports activity. This trial is registered with  IRCT2016080829269N1.

Professional football players at risk for non-acute groin injuries during the first half of the season: A prospective cohort study in The Netherlands

OBJECTIVES

To study the incidence, diagnostics, treatment, anatomical region and return to play of non-acute groin injuries among professional footballers in the Netherlands.

DESIGN

Prospective cohort study.

METHODS

Medical staff members of all Dutch professional football clubs, recording prospectively injury occurrence of all professional footballers in their clubs, were asked to fill in an injury form about time-loss (⩾ 8 days) non-acute groin injury over the 2012-2013 season.

RESULTS

A cohort of 410 players from 12 professional football clubs were included (response rate = 44%). The season incidence of non-acute groin injuries was nearly 7% (29 non-acute groin injuries). In 82% of all cases, the player suffered from non-acute groin injury in the first half of the season. The average time to return to play was 35 days, ranging from 8 to 84 days. The adductors were the most affected anatomical regions (82%), with the most frequent diagnosis being overuse of the adductors (36%), followed by adductor tendinopathy (18%). In addition to medical history and physical examination, ultrasound (50%) and MRI (32%) were the diagnostic methods most frequently mentioned. As well as physical therapy, treatment consisted mostly of manual therapy (96%) and dry needling (61%).

CONCLUSIONS

A professional club with a squad of 25 players can expect on average two non-acute groin injuries per season with an average time-loss of 35 days. Players are more at risk in the first half of the season. In Dutch professional football, ultrasound is commonly used to diagnose non-acute groin injury, while manual therapy is the most commonly applied treatment.

Preseason Adductor Squeeze Strength in 303 Spanish Male Soccer Athletes: A Cross-sectional Study

Background:

Hip adductor muscle weakness and a history of groin injury both have been identified as strong risk factors for sustaining a new groin injury. Current groin pain and age have been associated with hip adductor strength. These factors could be related, but this has never been investigated.

Purpose:

To investigate whether soccer athletes with past-season groin pain and with different durations of past-season groin pain had lower preseason hip adductor squeeze strength compared with those without past-season groin pain. We also investigated whether differences in preseason hip adductor squeeze strength in relation to past-season groin pain and duration were influenced by current groin pain and age.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

In total, 303 male soccer athletes (mean age, 23 ± 4 years; mean weight, 74.0 ± 7.9 kg; mean height, 178.1 ± 6.3 cm) were included in this study. Self-reported data regarding current groin pain, past-season groin pain, and duration were collected. Hip adductor squeeze strength was obtained using 2 different reliable testing procedures: (1) the short-lever (resistance placed between the knees, feet at the examination bed, and 45° of hip flexion) and (2) the long-lever (resistance placed between the ankles and 0° of hip flexion) squeeze tests.

Results:

There was no difference between those with (n = 123) and without (n = 180) past-season groin pain for hip adductor squeeze strength when adjusting for current groin pain and age. However, athletes with past-season groin pain lasting longer than 6 weeks (n = 27) showed 11.5% and 15.3% lower values on the short-lever (P = .006) and long-lever (P < .001) hip adductor squeeze strength tests, respectively, compared with those without past-season groin pain.

Conclusion:

Male soccer athletes with past-season groin pain lasting longer than 6 weeks are likely to begin the next season with a high-risk groin injury profile, including a history of groin pain and hip adduction weakness.

Including the Copenhagen Adduction Exercise in the FIFA 11+ Provides Missing Eccentric Hip Adduction Strength Effect in Male Soccer Players: A Randomized Controlled Trial

BACKGROUND

The FIFA 11+ was developed as a complete warm-up program to prevent injuries in soccer players. Although reduced hip adduction strength is associated with groin injuries, none of the exercises included in the FIFA 11+ seem to specifically target hip adduction strength.

PURPOSE

To investigate the effect on eccentric hip adduction strength of the FIFA 11+ warm-up program with or without the Copenhagen adduction exercise.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

We recruited 45 eligible players from 2 U19 elite male soccer teams. Players were randomized into 2 groups; 1 group carried out the standard FIFA 11+ program, while the other carried out the FIFA 11+ but replaced the Nordic hamstring exercise with the Copenhagen adduction exercise. Both groups performed the intervention 3 times weekly for 8 weeks. Players completed eccentric strength and sprint testing before and after the intervention. Per-protocol analyses were performed, and 12 players were excluded due to low compliance (<67% of sessions completed). The main outcome was eccentric hip adduction strength (N·m/kg).

RESULTS

Between-group analyses revealed a significantly greater increase in eccentric hip adduction strength of 0.29 Nm/kg (8.9%; P = .01) in favor of the group performing the Copenhagen adduction exercise, whereas no within-group change was noted in the group that used the standard FIFA 11+ program (-0.02 N·m/kg [-0.7%]; P = .69).

CONCLUSION

Including the Copenhagen adduction exercise in the FIFA 11+ program increases eccentric hip adduction strength, while the standard FIFA 11+ program does not. Registration: Registration: ISRCTN13731446 (International Standard Randomised Controlled Trial Number registry).

Elastic Resistance Effectiveness on Increasing Strength of Shoulders and Hips

Picha, KJ, Almaddah, MR, Barker, J, Ciochetty, T, Black, WS, and Uhl, TL. Elastic resistance effectiveness on increasing strength of shoulders and hips. J Strength Cond Res 33(4): 931-943, 2019-Elastic resistance is a common training method used to gain strength. Currently, progression with elastic resistance is based on the perceived exertion of the exercise or completion of targeted repetitions; exact resistance is typically unknown. The objective of this study was to determine whether knowledge of load during elastic resistance exercise will increase strength gains during exercises. Participants were randomized into 2 strength training groups, elastic resistance only and elastic resistance using a load cell (LC) that displays force during exercise. The LC group used a Smart Handle (Patterson Medical Supply, Chicago, IL, USA) to complete all exercises. Each participant completed the same exercises 3 times weekly for 8 weeks. The LC group was provided with a set load for exercises, whereas the elastic resistance only group was not. The participant's strength was tested at baseline and program completion, measuring isometric strength for shoulder abduction (SAb), shoulder external rotation (SER), hip abduction (HAb), and hip extension (HEx). Independent t-tests were used to compare the normalized torques between groups. No significant differences were found between groups. Shoulder strength gains did not differ between groups (SAb p > 0.05; SER p > 0.05). Hip strength gains did not differ between groups (HAb p > 0.05; HEx p > 0.05). Both groups increased strength because of individual supervision, constantly evaluating degree of difficulty associated with exercise and providing feedback while using elastic resistance. Using an LC is as effective as supervised training and could provide value in a clinical setting when patients are working unsupervised.

Large strengthening effect of a hip-flexor training programme: a randomized controlled trial

PURPOSE

To investigate the effect on hip-flexion strength of a 6-week hip-flexor training programme using elastic bands as resistance. We hypothesized that the training group, compared to a control group, would increase their hip-flexion strength more.

METHODS

Thirty-three healthy subjects (45 % females), 24(5) years of age, were included in a randomized controlled trial and allocated to heavy strength training of the hip-flexor muscles or to control (no strength training). Strength training of the hip-flexors (dominant leg) was performed three times 10 min per week for 6 weeks. The strength training group progressed from 15 repetition maximum (RM) (week 1) to 8 RM (week 6). Isometric hip-flexion strength (primary outcome) was measured by a blinded assessor using a reliable test procedure.

RESULTS

In the strength training group, the isometric hip-flexion strength of the trained leg increased by 17 %, (p < 0.001). The between-group difference in hip-flexion strength change in the trained leg (dominant leg, training group) versus the non-trained leg (dominant leg, control group) was significantly different from baseline to follow-up, corresponding to a mean change of 0.34 (95 % CI 0.17-0.52) Nm/kg, in favour of the strength training group (p < 0.001).

CONCLUSION

Simple hip-flexor strength training using elastic bands as external loading, for only 6 weeks, substantially improves hip-flexor muscle strength. This simple exercise programme seems promising for future prevention and treatment of acute and longstanding hip-flexor injuries, such as acute rectus femoris injuries and longstanding iliopsoas-related pain and impingement.

LEVEL OF EVIDENCE

I.

Hip Strength Testing of Soccer Players With Long-Standing Hip and Groin Pain: What are the Clinical Implications of Pain During Testing?

OBJECTIVE

To investigate whether self-reported pain during hip strength testing correlates to a large degree with hip muscle strength in soccer players with long-standing unilateral hip and groin pain.

DESIGN

Cross-sectional study.

SETTING

Clinical assessments at Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Denmark.

PARTICIPANTS

Twenty-four male soccer players with unilateral long-standing hip and groin pain.

INTERVENTIONS

The soccer players performed 5 reliable hip muscle strength tests (isometric hip flexion, adduction, abduction, isometric hip flexion-modified Thomas test, and eccentric hip adduction).

MAIN OUTCOME MEASURES

Muscle strength was measured with a hand-held dynamometer, and the players rated the pain during testing on a numerical rating scale (0-10).

RESULTS

In 4 tests (isometric hip adduction, abduction, flexion, and eccentric adduction), no significant correlations were found between pain during testing and hip muscle strength (Spearman rho = -0.28 to 0.06, P = 0.09-0.39). Isometric hip flexion (modified Thomas test position) showed a moderate negative correlation between pain and hip muscle strength (Spearman rho = -0.44, P = 0.016).

CONCLUSIONS

Self-reported pain during testing does not seem to correlate with the majority of hip muscle strength tests used in soccer players with long-standing hip and groin pain.

Large eccentric strength increase using the Copenhagen Adduction exercise in football: A randomized controlled trial

Hip adductor injuries are frequent in football, and players with low adductor strength appear to be at increased risk of injury. High adductor muscle activity has been shown in the Copenhagen Adduction exercise (CA); however, an associated strength gain has not been investigated. This study aims to examine the eccentric hip adduction strength (EHAD) gain using the CA in-season. Two U-19 sub-elite football teams, including 24 football players, were randomized to either an 8-week supervised progressive training program in addition to the usual training (intervention) or to continue training as usual (control). EHAD, eccentric hip abduction strength (EHAB), and side-bridge endurance were measured using reliable test procedures at baseline and follow-up by a blinded tester. There was a significant interaction between group and time on EHAD, EHAB, and EHAD/EHAB ratio (P < 0.025). The intervention group demonstrated a 35.7% increase in EHAD (P < 0.001); a 20.3% increase in EHAB (P = 0.003), and 12.3% increase in EHAD/EHAB ratio (P = 0.019). No significant within-group differences were found in the control group (P > 0.335). Compliance was 91.25%, and median muscle soreness ranged from 0 to 2. The CA implemented in-season with an 8-week progressive training program elicited a large significant increase in EHAD, EHAB, and EHAD/EHAB ratio.

Diagnosis of Acute Groin Injuries: A Prospective Study of 110 Athletes

BACKGROUND

Acute groin injuries are common in high-intensity sports, but there are insufficient data on injury characteristics such as injury mechanisms and clinical and radiological findings.

PURPOSE

To describe these characteristics in a cohort of athletes.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A total of 110 male athletes (mean age, 25.6 ± 4.7 years) with sports-related acute groin pain were prospectively included within 7 days of injury from August 2012 to April 2014. Standardized history taking, a clinical examination, magnetic resonance imaging (MRI), and/or ultrasound (US) were performed.

RESULTS

The most frequent injury mechanism in soccer was kicking (40%), and change of direction was most frequent in other sports (31%). Clinically, adductor injuries accounted for 66% of all injuries and primarily involved the adductor longus on imaging (91% US, 93% MRI). The iliopsoas and proximal rectus femoris were also frequently injured according to all examination modalities (15%-25%). Acute injury findings were negative in 22% of the MRI and 25% of the US examinations. Of the clinically diagnosed adductor injuries, 3% (US) and 6% (MRI) showed a radiological injury in a different location compared with 35% to 46% for clinically diagnosed iliopsoas and proximal rectus femoris injuries.

CONCLUSION

Adductor injuries account for the majority of acute groin injuries. Iliopsoas and proximal rectus femoris injuries are also common. More than 1 in 5 injuries showed no imaging signs of an acute injury. Clinically diagnosed adductor injuries were often confirmed on imaging, whereas iliopsoas and rectus femoris injuries showed a different radiological injury location in more than one-third of the cases. The discrepancy between clinical and radiological findings should be considered when diagnosing acute groin injuries.

The majority are not performing home-exercises correctly two weeks after their initial instruction-an assessor-blinded study

Introduction. Time-under-tension (TUT) reflects time under load during strength training and is a proxy of the total exercise dose during strength training. The purpose of this study was to investigate if young participants are able to reproduce TUT and exercise form after two weeks of unsupervised exercises. Material and Methods. The study was an assessor-blinded intervention study with 29 participants. After an initial instruction, all participants were instructed to perform two weeks of home-based unsupervised shoulder abduction exercises three times per week with an elastic exercise band. The participants were instructed in performing an exercise with a predefined TUT (3 s concentric; 2 s isometric; 3 s eccentric; 2 s break) corresponding to a total of 240 s of TUT during three sets of 10 repetitions. After completing two weeks of unsupervised home exercises, they returned for a follow-up assessment of TUT and exercise form while performing the shoulder abduction exercise. A stretch sensor attached to the elastic band was used to measure TUT at baseline and follow-up. A physiotherapist used a pre-defined clinical observation protocol to determine if participants used the correct exercise form. Results. Fourteen of the 29 participants trained with the instructed TUT at follow-up (predefined target: 240 s ±8%). Thirteen of the 29 participants performed the shoulder abduction exercise with a correct exercise form. Seven of the 29 participants trained with the instructed TUT and exercise form at follow-up. Conclusion. The majority of participants did not use the instructed TUT and exercise form at follow-up after two weeks of unsupervised exercises. These findings emphasize the importance of clear and specific home exercise instructions if participants are to follow the given exercise prescription regarding TUT and exercise form as too many or too few exercise stimuli in relation to the initially prescribed amount of exercise most likely will provide a misinterpretation of the actual effect of any given specific home exercise intervention.

Successful treatment of athletic pubalgia in a lacrosse player with ultrasound-guided needle tenotomy and platelet-rich plasma injection: a case report

Athletic pubalgia is a syndrome of persistent groin pain due to chronic repetitive trauma or stress involving the pelvic joints and many musculotendinous structures that cross the anterior pelvis. As a result, the differential diagnosis can be complex, but insertional tendinopathies are the most common. This case report describes a novel approach to the treatment of distal rectus abdominis tendinopathies with ultrasound-guided needle tenotomy and platelet-rich plasma (PRP) injection. After injection, the patient returned to pain-free play at his previous level of intensity. This suggests that PRP may be a useful treatment for this diagnosis.

The role of eccentric exercise in sport injuries rehabilitation

INTRODUCTION

Sports injuries frequently involve tendons, muscles and ligaments. The variable outcome of surgery and medical treatment support early functional treatments. Eccentric exercise (EE) showed effectiveness in the management of Achilles tendinopathy (AT), patellar tendinopathy (PT) and lateral epicondyle tendinopathy (LET). Preliminary results of EE in other tendinopathies and sports injuries suggest its wide prescription in the sport rehabilitation field.

SOURCES OF DATA

A comprehensive search of PubMed, Web of Science, the Cochrane Collaboration Database, Physiotherapy Evidence Database (PEDro), Evidence Based Medicine (EBM) Search review, National Guidelines, Scopus and Google Scholar was performed using keywords such as 'eccentric exercise', 'sports injuries rehabilitation', 'tendinopathy', 'hamstrings strain' 'adductor injuries' and 'ACL reconstruction rehabilitation'.

AREAS OF AGREEMENT

EE, alone or associated with other therapies, represents a feasible, cost-effective and successful tool in the treatment of well-known targets and might be promising in shoulder tendinopathy, adductor-related groin pain, hamstring strains, and ACL rehabilitation.

AREA OF CONTROVERSY

The lack of standardization of protocols, the variable amount, quality and follow-up of studies, the different anatomy and pathophysiology of the therapeutic targets limit the evidence of applicability of EE to sports injuries.

GROWING POINTS

The role of pathology and biomechanics in the response to EE should be further investigated.

AREAS TIMELY FOR DEVELOPING RESEARCH

New randomized controlled trials should test the effectiveness of standardized EE regimens to various sites of sports injuries.

Eccentric and Isometric Hip Adduction Strength in Male Soccer Players With and Without Adductor-Related Groin Pain: An Assessor-Blinded Comparison

BACKGROUND

Adductor-related pain is the most common clinical finding in soccer players with groin pain and can be a long-standing problem affecting physical function and performance. Hip adductor weakness has been suggested to be associated with this clinical entity, although it has never been investigated.

PURPOSE

To investigate whether isometric and eccentric hip strength are decreased in soccer players with adductor-related groin pain compared with asymptomatic soccer controls. The hypothesis was that players with adductor-related groin pain would have lower isometric and eccentric hip adduction strength than players without adductor-related groin pain.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Male elite and subelite players from 40 teams were contacted. In total, 28 soccer players with adductor-related groin pain and 16 soccer players without adductor-related groin pain (asymptomatic controls) were included in the study. In primary analysis, the dominant legs of 21 soccer players with adductor-related groin pain (≥4 weeks duration) were compared with the dominant legs of 16 asymptomatic controls using a cross-sectional design. The mean age of the symptomatic players was 24.5 ± 2.5 years, and the mean age of the asymptomatic controls was 22.9 ± 2.4 years. Isometric hip strength (adduction, abduction, and flexion) and eccentric hip strength (adduction) were assessed with a handheld dynamometer using reliable test procedures and a blinded assessor.

RESULTS

Eccentric hip adduction strength was lower in soccer players with adductor-related groin pain in the dominant leg (n = 21) compared with asymptomatic controls (n = 16), namely 2.47 ± 0.49 versus 3.12 ± 0.43 N·m/kg, respectively (P < .001). No other hip strength differences were observed between symptomatic players and asymptomatic controls for the dominant leg (P = .35-.84).

CONCLUSION

Large eccentric hip adduction strength deficits were found in soccer players with adductor-related groin pain compared with asymptomatic soccer players, while no isometric strength differences were observed between the groups.

The health profile of football/soccer players in Northern Ireland - a review of the uefa pre-participation medical screening procedure

Background

It is compulsory that domestic football/soccer teams in UEFA competitions organise players’ pre-participation medicals. Although screening guidelines have been established, these remain controversial. The findings of medical examinations can have lasting consequences for athletes and doctors. No previous studies have reported UEFA pre-participation screening results in semi-professional footballers. This study aims to further knowledge regarding ‘normal’ data in this population.

Method

Retrospective audit and analysis of records of pre-season medicals for all male first-team players at one semi-professional Northern Ireland Premiership team between 2009-2012. Medicals were conducted by the club doctor following the UEFA proforma. Height, weight, blood pressure (BP), full blood count (FBC), dipstick urinalysis and resting electrocardiogram (ECG) were conducted by an independent nurse. Only one ECG must be documented during a player’s career; other tests are repeated yearly.

Results

89 medicals from 47 players (6 goalkeepers, 11 defenders, 22 midfielders and 8 attackers; mean age 25.0 years (SD 4.86)) were reviewed. Mean height of the players was 179.3 cm (SD 5.90) with a mean weight of 77.6 kg (SD 10.5). Of 89 urine dipsticks, 7 were positive for protein; all 7 were normal on repeat testing following 48 hours of rest. Of 40 ECGs (mean ventricular rate 61.2 bpm (SD 11.6)), one was referred to cardiology (right bundle branch block; prolonged Q-T interval). No players were excluded from participation.

Conclusions

This study provides important information about ‘normal’ values in a population of semi-professional footballers. Urinalysis showing protein is not uncommon but is likely to be normal on repeat testing.

Incidence and clinical presentation of groin injuries in sub-elite male soccer

BACKGROUND

Groin injuries cause major problems in the football codes, as they are prevalent and lead to prolonged symptoms and high recurrence. The aim of the present study was to describe the occurrence and clinical presentation of groin injuries in a large cohort of sub-elite soccer players during a season.

METHODS

Physiotherapists allocated to each of the participating 44 soccer clubs recorded baseline characteristics and groin injuries sustained by a cohort of 998 sub-elite male soccer players during a full 10-month season. All players with groin injuries were examined using the clinical entity approach, which utilises standardised reproducible examination techniques to identify the injured anatomical structures. The exposure time and the injury time were also recorded. Injury time was analysed using multiple regression on the log of the injury times as the data were highly skewed. Effects are thus reported at relative injury time (RIT).

RESULTS

Adductor-related groin injury was the most common entity found followed by iliopsoas-related and abdominal-related injuries. The dominant leg was significantly more often injured. Age and previous groin injury were significant risk factors for sustaining a groin injury. Groin injuries were generally located on the same side as previously reported groin injuries. Adductor-related injuries with no abdominal pain had significantly longer injury times compared to injuries with no adductor and no abdominal pain (RIT 2.28, 95% CI 1.22 to 4.25, p=0.0096). Having both adductor and abdominal pain also increased the injury time significantly when compared to injuries with no adductor and no abdominal pain (RIT=4.56, 95% CI 1.91 to 10.91, p=0.001).

CONCLUSION

Adductor-related groin injury was the most common clinical presentation of groin injuries in male soccer players and the cause of long injury time, especially when combined with abdominal-related injury.

EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries

INTRODUCTION

Exercise programmes are used in the prevention and treatment of adductor-related groin injuries in soccer; however, there is a lack of knowledge concerning the intensity of frequently used exercises.

OBJECTIVE

Primarily to investigate muscle activity of adductor longus during six traditional and two new hip adduction exercises. Additionally, to analyse muscle activation of gluteals and abdominals.

MATERIALS AND METHODS

40 healthy male elite soccer players, training >5 h a week, participated in the study. Muscle activity using surface electromyography (sEMG) was measured bilaterally for the adductor longus during eight hip adduction strengthening exercises and peak EMG was normalised (nEMG) using an isometric maximal voluntary contraction (MVC) as reference. Furthermore, muscle activation of the gluteus medius, rectus abdominis and the external abdominal obliques was analysed during the exercises.

RESULTS

There were large differences in peak nEMG of the adductor longus between the exercises, with values ranging from 14% to 108% nEMG (p<0.0001). There was a significant difference between legs in three of the eight exercises (35-48%, p<0.0001). The peak nEMG results for the gluteals and the abdominals showed relatively low values (5-48% nEMG, p<0.001).

CONCLUSIONS

Specific hip adduction exercises can be graded by exercise intensity providing athletes and therapists with the knowledge to select appropriate exercises during different phases of prevention and treatment of groin injuries. The Copenhagen Adduction and the hip adduction with an elastic band are dynamic high-intensity exercises, which can easily be performed at any training facility and could therefore be relevant to include in future prevention and treatment programmes.