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Carnegie DR, Hirsch SM, Howarth SJ, Beach TAC. Can we enable individuals to reach further down without rounding their backs before beginning a lift? Examining the influence of starting foot and trunk position on reach depth. ERGONOMICS 2024; 67:1097-1107. [PMID: 37955653 DOI: 10.1080/00140139.2023.2282953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
There is disagreement regarding the efficacy of 'safe' lifting recommendations for reducing low back disorder risk. These recommendations commonly focus on minimising lumbar spine flexion, which limits the range of allowable starting lift positions for that person. This study evaluated whether starting postural adaptations could allow a person to reach down further without rounding their lumbar spine before beginning a lift. Reach displacement was measured as participants performed a series of maximal reach tasks under different combinations of stance width, foot orientation and trunk inclination, with their lumbar spine motion restricted. There were no interactions between any of the three postural adaptations or any effect of stance width or trunk inclination. Seventy-nine percent of participants achieved their greatest reach displacement with their feet externally rotated, which contributed to a 4 cm greater reach displacement compared to a neutral foot orientation (p < 0.001).Practitioner summary: This study examined whether aspects of initial posture could influence the ability to adhere to 'safe' lifting recommendations across a range of lift heights. As a component of lifting (re)training interventions, practitioners should consider starting lift posture adaptations (e.g. manipulating foot external rotation) to improve capacity to adhere to recommendations.
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Affiliation(s)
- Danielle R Carnegie
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada
| | - Steven M Hirsch
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada
| | - Samuel J Howarth
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Tyson A C Beach
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
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2
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Asimakidis ND, Mukandi IN, Beato M, Bishop C, Turner AN. Assessment of Strength and Power Capacities in Elite Male Soccer: A Systematic Review of Test Protocols Used in Practice and Research. Sports Med 2024:10.1007/s40279-024-02071-8. [PMID: 39026085 DOI: 10.1007/s40279-024-02071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Strength and power represent two crucial physical qualities for the attainment of a high level of performance considering the frequency and the importance of explosive actions occurring during elite soccer match-play. Evaluation of strength and power is a multifaceted concept involving a vast array of tests and outcome variables. Nevertheless, a comprehensive and systematic search of strength and power assessment procedures in elite soccer has yet to be undertaken. OBJECTIVES The aims of this systematic review were to: (1) identify the tests and outcome variables used to assess strength and power of elite male soccer players; (2) provide normative values for the most common tests of strength and power across different playing levels; and (3) report the reliability values of these strength and power tests. METHODS A systematic review of the academic databases MEDLINE, CINAHL, SPORTDiscus, Web of Science and OVID for studies published until August 2023 was conducted, following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were eligible for inclusion if they: (1) were original research studies, published in a peer-reviewed journal, and written in English language; (2) had the primary aim to assess strength and/or power; (3) players were male and older than 17 years of age (i.e., mean age of the group); and (4) their playing level was defined as "professional", "international" or "elite". RESULTS Regarding strength testing, 115 studies and 29 different tests were identified. The three most frequent strength tests were the knee extensor isokinetic strength test (58 studies), the knee flexor isokinetic strength test (55 studies) and the Nordic hamstring strength test (13 studies). In terms of power testing, 127 studies with 31 different tests were included. The three most frequent power tests were the countermovement jump with hands fixed on hips (99 studies), the squat jump (48 studies) and the vertical jump with arm swing (29 studies). CONCLUSIONS The wide range of different tests and outcome variables identified in this systematic review highlights the large diversity in the employed testing procedures. The establishment of a hybrid testing approach, combining standardised and widely accepted tests for establishing normative standards and enabling comparisons across different contexts, with flexible context-specific testing batteries, has the potential to maximise the impact of testing information for practitioners. In addition, the limited reporting of reliability data across studies highlights the need for practitioners to establish their own reliability measure within their specific contexts, informing the selection of certain tests and outcome variables.
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Affiliation(s)
- Nikolaos D Asimakidis
- Faculty of Science and Technology, London Sport Institute, Middlesex University, The Burroughs, London, NW4 4BT, UK.
- Performance Department, Ipswich Town Football Club, Ipswich, UK.
| | - Irvin N Mukandi
- Faculty of Science and Technology, London Sport Institute, Middlesex University, The Burroughs, London, NW4 4BT, UK
- Performance Department, Ipswich Town Football Club, Ipswich, UK
| | - Marco Beato
- School of Health and Sports Sciences, University of Suffolk, Ipswich, UK
| | - Chris Bishop
- Faculty of Science and Technology, London Sport Institute, Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Anthony N Turner
- Faculty of Science and Technology, London Sport Institute, Middlesex University, The Burroughs, London, NW4 4BT, UK
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Suits WH, O’Neil MM, Fogarty KJ. Acute Effects of Ice Hockey on Hip Range of Motion, Strength, and Pelvic Tilt in Competitive Male Players. Sports Health 2024; 16:616-621. [PMID: 37565469 PMCID: PMC11195869 DOI: 10.1177/19417381231190649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
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.
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Affiliation(s)
- William H. Suits
- Department of Physical Therapy, University of Michigan-Flint, Flint, Michigan
- College of Health and Human Services, Western Michigan University, Kalamazoo, Michigan
| | - Margaret M. O’Neil
- Department of Physical Therapy, University of Michigan-Flint, Flint, Michigan
| | - Kieran J. Fogarty
- College of Health and Human Services, Western Michigan University, Kalamazoo, Michigan
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Retchford TH, Tucker KJ, Hart HF, Semciw AI, Weinrauch P, Grimaldi A, Cowan SM, Crossley KM, Kemp JL. No Difference in Hip Muscle Volumes and Fatty Infiltration in Those With Hip-Related Pain Compared to Controls. Int J Sports Phys Ther 2022; 17:851-862. [PMID: 35949368 PMCID: PMC9340835 DOI: 10.26603/001c.36528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about muscle morphology in people with hip-related pain, without signs of femoro-acetabular impingement syndrome (FAIS). Identifying changes in hip muscle volume, fatty infiltrate and establishing relationships between muscle volume and strength, may provide insight into potential early treatment strategies. Purposes To: (i) compare the volumes and fatty infiltrate of gluteus maximus, gluteus medius, gluteus minimis, tensor fascia latae and quadratus femoris between symptomatic and less-symptomatic sides of participants with hip-related pain; (ii) compare the volumes and fatty infiltrate of hip muscles between healthy controls and symptomatic participants; and (iii) explore relationships of hip muscle volumes to muscle strength and patient-reported outcome measures in people with hip-related pain. Study Design Cross-sectional study. Methods Muscle volume and fatty infiltrate (from magnetic resonance imaging), hip muscle strength, patient-reported symptoms, function and quality of life (QOL) were determined for 16 participants with hip-related pain (no clinical signs of FAIS; 37±9 years) and 15 controls (31±9 years). Using One Way Analysis of Co-Variance tests, muscle volume and fatty infiltrate was compared between the symptomatic and less-symptomatic sides in participants with hip-related pain as well as between healthy controls and symptomatic participants. In addition, hip muscle volume was correlated with hip muscle strength, hip-reported symptoms, function and QOL. Results No differences in all the studied muscle volumes or fatty infiltrate were identified between the symptomatic and less-symptomatic hips of people with hip-related pain; or between people with and without hip-related pain. Greater GMED volume on the symptomatic side was associated with less symptoms and better function and QOL (ρ=0.522-0.617) for those with hip-related pain. Larger GMAX volume was associated with greater hip abduction and internal rotation strength, larger GMED volume was associated with greater hip extension strength, and larger QF volume was associated with greater hip abduction strength (rho=0.507-0.638). Conclusion People with hip-related pain and no clinical signs of FAIS have hip muscle volumes that are not significantly different than those of matched pain-free controls or their less-symptomatic hip. Larger GMED muscle volume was associated with fewer symptoms and greater strength. Level of evidence Level 3a.
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Affiliation(s)
| | | | - Harvi F Hart
- La Trobe University; Bone and Joint Institute, Western University
| | - Adam I Semciw
- La Trobe University; Northern Centre for Health, Education and Research- The Northern Hospital
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Risk Factors for Groin Pain in Male High School Soccer Players Undergoing an Injury Prevention Program: A Cluster Randomized Controlled Trial. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Little is known about the risk factors for developing groin pain in high school soccer players. Therefore, the purpose of the study is to investigate the risk factors for developing inguinal pain in high school soccer players who are undergoing an injury prevention program. A cluster randomized controlled trial was conducted on 202 high school soccer players. Players were allocated to either group A (3 schools, 66 players) receiving the Copenhagen adduction exercise (CAE) alone, or group B (2 schools, 73 players) receiving the CAE and Nordic hamstrings exercise, or group C, the control group without any intervention (2 schools, 63 players). Hip range of motion (ROM) and strength measures were assessed prior to a groin injury prevention program and used in univariate and multivariate analysis to predict development of groin pain. Logistic regression analysis identified that hip abduction ROM and eccentric adductor strength of the dominant leg were factors in the development of groin pain. Increased abduction ROM and decreased eccentric adductor muscle strength of the dominant leg were risk factors for the development of groin pain.
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Filan D, Mullins K, Carton P. Hip Range of Motion Is Increased After Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e797-e822. [PMID: 35494261 PMCID: PMC9042900 DOI: 10.1016/j.asmr.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/08/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To investigate the impact of arthroscopic correction of symptomatic femoroacetabular impingement on postoperative hip range of motion (ROM), as an objectively measured postoperative clinically reported outcome. Methods A systematic review of the current literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, OVID/MEDLINE, EMBASE, and Cochrane databases were queried in November 2020. Studies not reporting pre- to postoperative ROM measurements were excluded. Methodologic quality was assessed using the MINORS assessment, and certainty of evidence was assessed using the GRADE approach. Effect size using standardized mean differences assessed magnitude of change between pre- and postoperative ROM. Results In total, 23 studies were included evaluating 2,332 patients. Mean age ranged from 18 to 44.2 years. Flexion, internal rotation (IR), and external rotation (ER) were the predominantly measured ROMs reported in 91%, 100% and 65% of studies, respectively. Observed change following hip arthroscopy was considered significant in 57.1% (flexion), 74% (IR), and 20% (ER). Effect size of change in significantly improved ROMs were weak (16.7% flexion, 33.3% ER), moderate (58.3% flexion, 29.4% IR), and large (25% flexion, 64.7% IR, 66.7% ER). For goniometric assessment mean observed changes ranged as follows: flexion: 0.1° to 12.2°; IR: 3.6° to 21.9°; ER: –2.6° to 12.8°. For computed tomography–simulated assessment, the mean observed change ranged as follows: flexion: 3.0° to 8.0°; IR 9.3° to 14.0°. Conclusions Outcome studies demonstrate overall increased range of flexion and IR post-hip arthroscopy, with a moderate and large effect respectively. Change in ER is less impacted following hip arthroscopy. Certainty of evidence to support this observation is low. Current research evaluating changes in this functional ability is limited by a lack of prospective studies and non-standardized measurement evaluation techniques. Level of Evidence Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- David Filan
- UPMC Whitfield, Waterford, Ireland
- Address correspondence to David Filan, Suite 5, UPMC Whitfield, Butlerstown North, Cork Road, Waterford, Ireland.
| | | | - Patrick Carton
- Hip and Groin Clinic, Waterford, Ireland
- UPMC Whitfield, Waterford, Ireland
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Serner A, Lichau O, Reboul G. Evaluation of the bent knee fall out test pre- and post- an adductor longus tenotomy. Phys Ther Sport 2021; 48:196-200. [PMID: 33508695 DOI: 10.1016/j.ptsp.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the immediate effect of an adductor longus tenotomy on the results of the bent knee fall out test, and whether there was a correlation between pre-tenotomy measures and the magnitude of change. DESIGN Observational study. METHODS We included recreational to elite athletes with longstanding adductor-related groin pain (specifically adductor longus insertion pain) undergoing unilateral or bilateral full adductor longus tenotomy. The bent knee fall out test was performed immediately prior and immediately after the surgical procedure. We used Wilcoxon signed-rank test to compare test results pre- and post-tenotomy, and Spearman's rho (rs) to analyse correlation between pre-tenotomy values and the magnitude of change in the bent knee fall out test. RESULTS We consecutively included 60 male adult athletes. There was a statistically significant difference (p < 0.001) in the bent knee fall out result from pre-surgery (median 11.5 cm [IQR 9-15], range 5-25 cm) to post-surgery (median 8 cm [IQR 6-10], range 3-15 cm). The mean difference was 3.9 ± 2 cm, range 0-11 cm, corresponding to a large effect size, d = 1.92. There was a moderate correlation between the bent knee fall out measurement pre-tenotomy and the difference from pre-to-post, rs = 0.75, p < 0.001. CONCLUSION The bent knee fall out measurements changed considerably immediately after an adductor longus tenotomy, showing that the test is assessing adductor longus flexibility in male athletes with longstanding adductor-related groin pain. There was a moderate correlation between the bent knee fall out measure pre-tenotomy and the magnitude of change.
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Affiliation(s)
- Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Sport City Street, PO Box, 29222, Doha, Qatar.
| | - Olivier Lichau
- Hôpital Pellegrin, Centre Hospitalier Universitaire, Place Amélie Raba Léon, 33000, Bordeaux, France; Hernia Center, Clinique du sport, Bordeaux-Mérignac, 4 Rue Georges Negrevergne, 33700, Mérignac, France
| | - Gilles Reboul
- Hernia Center, Clinique du sport, Bordeaux-Mérignac, 4 Rue Georges Negrevergne, 33700, Mérignac, France
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Estberger A, Pålsson A, Kostogiannis I, Ageberg E. Less hip range of motion is associated with a greater alpha angle in people with longstanding hip and groin pain. Knee Surg Sports Traumatol Arthrosc 2021; 29:4091-4099. [PMID: 34510222 PMCID: PMC8595235 DOI: 10.1007/s00167-021-06733-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE A higher alpha angle has been proposed to correlate with lower hip range of motion, but the association in people with longstanding hip and groin pain is currently unclear. The aims were to: (1) assess the association between range of motion and alpha angle in patients with longstanding hip and groin pain; (2) examine if a cut-off value in range of motion variables could identify patients with an alpha angle above or below 60°. METHODS Seventy-two participants were consecutively recruited from an orthopaedic department after referral for hip- and groin-related pain. Passive hip range of motion was measured in flexion, internal rotation with 90° hip flexion, internal rotation in neutral hip position, external rotation with 90° hip flexion, and abduction. The alpha angle was calculated from a frog-leg lateral radiograph. Linear regression examined the association between range of motion and alpha angle, and an ROC-curve analysis was performed to identify the sensitivity and specificity of range of motion cut-offs. RESULTS Lower range of motion in internal rotation in flexion, external rotation, and abduction were associated with higher alpha angle. Internal rotation of 27° or less displayed good sensitivity (81%) and specificity (85%) to detect an alpha angle above 60°, while a cut-off of 41° in external rotation and 27° in abduction showed a sensitivity of 72% and specificity of 50% and 60%, respectively. CONCLUSION Less internal rotation in flexion, external rotation, and abduction are associated with a greater alpha angle in a cohort of people with longstanding hip and groin pain. A cut-off of 27° in internal rotation has good sensitivity and specificity to identify people with an alpha angle above or below 60° and have the potential to be used in the clinical setting to identify patients that require further imaging, or that are unlikely to have cam morphology. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Anders Pålsson
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Lund University, Lund, Sweden
| | - Ioannis Kostogiannis
- grid.4514.40000 0001 0930 2361Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
| | - Eva Ageberg
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Lund University, Lund, Sweden
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Clinical and radiological hip parameters do not precede, but develop simultaneously with cam morphology: a 5-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2021; 29:1401-1410. [PMID: 33001216 PMCID: PMC8038954 DOI: 10.1007/s00167-020-06282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE The aim of this study was to (1) investigate whether radiographic and clinical parameters, which influence how stresses during sporting activities act on the proximal femur, are associated with cam morphology or (2) precede cam morphology development. METHODS Young male football players participated at baseline (n = 89, 12-19 years of age), 2.5-year (n = 63) and 5-year follow-up (n = 49). Standardized anteroposterior pelvic and frog-leg lateral radiographs were obtained at each time-point. Cam morphology was quantified by an alpha angle ≥ 60°, and large cam morphology ≥ 78°. The neck-shaft angle (NSA), epiphyseal extension (EE), lateral center-edge angle (LCEA) and hip internal rotation (IR) were also measured. Cross-sectional associations between NSA, EE, LCEA and IR and (large) cam morphology were studied at all time-points. To study whether these variables preceded cam morphology development, hips without cam morphology at baseline were studied prospectively. RESULTS A lower NSA, a higher EE and limited IR were consistently associated with cam morphology at all three time-points. These differences were more pronounced in hips with large cam morphology. No association between cam morphology and the LCEA was found. None of the parameters studied preceded cam morphology development. CONCLUSION Cam morphology developed simultaneously with a varus orientation, growth plate extension towards the femoral neck and limited hip internal rotation. These parameters did not precede cam morphology development. The hip parameters studied cannot be used to identify individuals at risk of developing cam morphology. LEVEL OF EVIDENCE Level II.
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van Klij P, Reiman MP, Waarsing JH, Reijman M, Bramer WM, Verhaar JAN, Agricola R. Classifying Cam Morphology by the Alpha Angle: A Systematic Review on Threshold Values. Orthop J Sports Med 2020; 8:2325967120938312. [PMID: 32844100 PMCID: PMC7418265 DOI: 10.1177/2325967120938312] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The alpha angle is the most often used measure to classify cam morphology. There is currently no agreement on which alpha angle threshold value to use. Purpose To systematically investigate the different alpha angle threshold values used for defining cam morphology in studies aiming to identify this threshold and to determine whether data are consistent enough to suggest an alpha angle threshold to classify cam morphology. Study Design Systematic review; Level of evidence, 3. Methods The Embase, Medline (Ovid), Web of Science, Cochrane Central, and Google Scholar databases were searched from database inception to February 28, 2019. Studies aiming at identifying an alpha angle threshold to classify cam morphology were eligible for inclusion. Results We included 4 case-control studies, 10 cohort studies, and 1 finite-element study from 2437 identified publications. Studies (n = 3) using receiver operating characteristic (ROC) curve analysis to distinguish asymptomatic people from patients with femoroacetabular impingement syndrome consistently observed alpha angle thresholds between 57° and 60°. A 60° threshold was also found to best discriminate between hips with and without cam morphology in a large cohort study based on a bimodal distribution of the alpha angle. Studies (n = 8) using the upper limit of the 95% reference interval as threshold proposed a wide overall threshold range between 58° and 93°. When stratified by sex, thresholds between 63° and 93° in male patients and between 58° and 94° in female patients were reported. Conclusion Based on the available evidence, mostly based on studies using ROC curve analysis, an alpha angle threshold of ≥60° is currently the most appropriate to classify cam morphology. Further research is required to fully validate this threshold.
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Affiliation(s)
- Pim van Klij
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Michael P Reiman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jan H Waarsing
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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van Klij P, Ginai AZ, Heijboer MP, Verhaar JAN, Waarsing JH, Agricola R. The relationship between cam morphology and hip and groin symptoms and signs in young male football players. Scand J Med Sci Sports 2020; 30:1221-1231. [PMID: 32201993 PMCID: PMC7317829 DOI: 10.1111/sms.13660] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
Background Conflicting and limited high‐quality prospective data are available on the associations between cam morphology and hip and groin symptoms and range of motion (ROM). Objectives This cross‐sectional cohort study investigated associations between cam morphology presence, size and duration and symptoms and ROM. Methods Academy male football players (n = 49, 17‐24 years) were included. Standardized antero‐posterior pelvic and frog‐leg lateral radiographs were obtained at baseline, 2.5‐ and 5‐year follow‐up. The femoral head‐neck junction was quantified by:
Visual score. Cam morphology (flattening or prominence), large cam (prominence). Alpha angle. Cam morphology (≥60°), large cam (≥78°).
Cam morphology duration was defined as long (first present at baseline) or short (only from 2.5‐ to 5‐year follow‐up). Current symptoms at 5‐year follow‐up were assessed using a hip and groin pain question and by the “Hip and Groin Outcome Score” (HAGOS). HAGOS scores were categorized into: most symptoms (≥2 domains in lowest interquartile range [IQR]), least symptoms (≥2 domains in highest IQR). Hip ROM was measured by goniometry at 5‐year follow‐up. Results Large cam morphology based on visual score was associated with hip and groin pain (23.8% vs. 7.1%, OR: 3.17, CI: [1.15‐8.70], P = .026), but not with HAGOS scores. Cam morphology presence, size, and duration were associated with limited flexion of around 6° and/or 3° to 6° for internal rotation. Conclusion Cam morphology presence, size, and duration were associated with limited hip flexion and/or internal rotation, but differences might not exceed the minimal clinical important difference. Whether cam morphology results in symptoms is uncertain.
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Affiliation(s)
- Pim van Klij
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Abida Z Ginai
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marinus P Heijboer
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jan H Waarsing
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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12
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Combining results from hip impingement and range of motion tests can increase diagnostic accuracy in patients with FAI syndrome. Knee Surg Sports Traumatol Arthrosc 2020; 28:3382-3392. [PMID: 32335699 PMCID: PMC7511272 DOI: 10.1007/s00167-020-06005-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/16/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Clinical examination is an important part in the diagnosis of femoroacetabular impingement (FAI) syndrome. However, knowledge on reliability and validity of clinical diagnostic tests is scarce. The aims were to evaluate the inter-rater agreement and diagnostic accuracy of clinical tests to detect patients with FAI syndrome. METHODS Eighty-one patients (49% women) were recruited. Two experienced raters performed impingement and range of motion (ROM) tests. Three criteria had to be fulfilled for the diagnosis of FAI syndrome: (1) symptoms; (2) CAM and/or Pincer morphology; and (3) being responder to intra-articular block injection. For inter-rater agreement, the Cohen's kappa statistics were used (0.41-0.60 = moderate, 0.61-0.80 = substantial agreement). For diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were calculated. RESULTS Anterior impingement test (AIMT), FADIR test and FABER test showed kappa values above 0.6. All passive hip ROM, except extension, had kappa values above 0.4. AIMT and FADIR showed the highest sensitivity, i.e., 80%, with a specificity of 26% and 25%, respectively. Passive hip ROM in internal rotation with neutral hip position had a sensitivity of 29% and a specificity of 94%. CONCLUSION The AIMT, FADIR and FABER tests were reliable between two experienced raters, while results from different raters for hip ROM should be interpreted with caution. The AIMT and FADIR test can only be used to rule out patients with FAI syndrome, while evaluation of ROM in internal rotation with neutral position may be more suitable to rule in patients with FAI syndrome. LEVEL OF EVIDENCE II.
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Harris JD, Mather RC, Nho SJ, Salvo JP, Stubbs AJ, Van Thiel GS, Wolff AB, Christoforetti JJ, Ellis TJ, Matsuda DK, Kivlan BR, Carreira DS. Reliability of hip range of motion measurement among experienced arthroscopic hip preservation surgeons. J Hip Preserv Surg 2019; 7:77-84. [PMID: 32382433 PMCID: PMC7195937 DOI: 10.1093/jhps/hnz062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/10/2019] [Accepted: 10/13/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine (i) the reliability of hip range of motion measurement among experienced arthroscopic hip preservation surgeons and (ii) the magnitude of hip flexion change with posterior pelvic tilt. Five experienced arthroscopic hip preservation surgeons (5–18 years of hip surgery experience) performed passive hip range of motion (internal and external rotation), flexion (contralateral hip extended) and flexion with posterior pelvic tilt (contralateral hip maximally flexed) on five young healthy asymptomatic volunteers (three males, two females; 34.4 ± 10.7 years of age). Motion was measured via digital photography and goniometry. Inter-observer reliability was calculated via two-way mixed, single measures, intra-class correlation coefficient. Paired t-test was utilized to compare hip flexion (with contralateral hip extended) to hip flexion with posterior pelvic tilt (with contralateral hip in forced flexion). The reliabilities of measurements of hip flexion with posterior pelvic tilt and external rotation were excellent, that of hip flexion was fair, and that of hip internal rotation was poor. The magnitude of hip flexion increase with posterior pelvic tilt was 17.0° ± 3.0° (P < 0.001). The reliability of hip range of motion measurement by five experienced arthroscopic hip preservation surgeons was excellent for measures of hip flexion with posterior pelvic tilt and external rotation. Contralateral maximal hip flexion significantly increased ipsilateral hip flexion (approximately 17°). Level of Evidence: Diagnostic, level III (without consistently applied reference standard)
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Affiliation(s)
- Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center Suite 2500, Houston, TX 77030, USA
| | - Richard C Mather
- Duke University, DukeHealth, James R. Urbaniak, MD Sports Sciences Institute, 3475 Erwin Rd, Durham, NC 27705, USA
| | - Shane J Nho
- Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA
| | - John P Salvo
- Rothman Orthopaedic Institute, 999 Route 73 North, Marlton, NJ 08053, USA
| | - Allston J Stubbs
- Wake Forest University, 1901 Mooney Street, Winston-Salem, NC 27103, USA
| | | | - Andrew B Wolff
- Washington Orthopaedics & Sports Medicine, 2021 K Street, NW, Suite 516, Washington, DC 20006, USA
| | - John J Christoforetti
- Allen Orthopedics & Sports Medicine, 1120 Raintree Circle, Suite 280, Allen, TX 75013, USA
| | - Thomas J Ellis
- Orthopedic ONE, 4605 Sawmill Road, Columbus, OH 43220, USA
| | - Dean K Matsuda
- Premier Hip Arthroscopy, 13160 Mindanao Way, Suite 300, Marina Del Ray, CA 90292, USA
| | | | - Dominic S Carreira
- Peachtree Orthopedics, 11800 Amber Park Drive Parkway, 400 Building One Suite 200, Alpharetta, GA 30009, USA
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Landgraeber S, Dienst M. [Footballer's hip]. DER ORTHOPADE 2019; 48:1013-1018. [PMID: 31729559 DOI: 10.1007/s00132-019-03844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although complaints and injuries in the knee and ankle joints are very prevalent in football, the hip has so far been given very little attention. Complaints in this area are often attributed to pathological changes in the inguinal region. However, intraarticular differential diagnoses are often not taken into consideration. This article gives an overview of possible hip pathology in footballers, as well as its diagnosis and treatment.
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Affiliation(s)
- S Landgraeber
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg, Deutschland.
| | - M Dienst
- Orthopädische Chirurgie München, OCM Gemeinschaftspraxis GbR, OCM Klinik GmbH, Steinerstraße 6, 81369, München, Deutschland
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Buckley PS, Bolia IK, Briggs KK, Philippon MJ. The Evolution of Treated Versus Untreated Femoroacetabular Impingement in a Professional Hockey Player with a 10-Year Follow-up: A Case Report. JBJS Case Connect 2019; 9:e15. [PMID: 30882515 DOI: 10.2106/jbjs.cc.18.00178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe the diagnosis, treatment, rehabilitation, and 10-year outcome of a National Hockey League (NHL) player who was treated successfully with hip arthroscopy for symptomatic femoroacetabular impingement (FAI) of the right hip. At the 10-year follow-up, the patient presented with contralateral hip symptoms consistent with FAI and radiographic progression of degenerative changes that were not present at the initial presentation. CONCLUSION Untreated FAI may result in the progression of degenerative changes in the hip.
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Femoroazetabuläres Impingement. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-018-0229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Significant Knowledge Gaps Between Clinical Practice and Research on Femoroacetabular Impingement: Are We on the Same Path? J Orthop Sports Phys Ther 2018; 48:228-229. [PMID: 29607765 DOI: 10.2519/jospt.2018.0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Femoroacetabular impingement (FAI) is the abnormal osseous contact between the femur (cam impingement) and/or acetabular rim (pincer impingement) during end-range hip motions. This special issue on FAI aims at closing some of the gaps between clinical practice and research findings, important for all health professions treating patients with hip pain. This special issue will explore several aspects of FAI syndrome. Specifically, it will provide clinicians with a greater understanding of the etiology and prevalence of hip morphology seen in FAI syndrome, and its relationship with hip range of motion, muscle strength, and hip osteoarthritis (OA). J Orthop Sports Phys Ther 2018;48(4):228-229. doi:10.2519/jospt.2018.0103.
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