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Calatayud Moscoso Del Prado J, Fernández-Gil MÁ, Bueno Horcajadas Á, Kassarjian A. Groin pain in soccer players: anatomy, clinical presentation, biomechanics, pathology and imaging findings. Skeletal Radiol 2024:10.1007/s00256-024-04699-z. [PMID: 38787402 DOI: 10.1007/s00256-024-04699-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 04/10/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Groin pain is extremely common in soccer players, especially male soccer players, with nearly a third experiencing groin pain over the course of their careers. Despite its high prevalence, there continues to be some confusion and controversy regarding the detailed anatomy and recommended terminology related to groin pain in athletes. This article will review the anatomy, clinical presentation, biomechanics, pathology and imaging findings most commonly associated with groin pain in soccer players.
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Affiliation(s)
| | - María Ángeles Fernández-Gil
- Olympia Medical Center, Torre Caleido, Paseo de La Castellana 259 E, 28046, Madrid, Spain
- Elite Sport Imaging, SL, Madrid, Spain
| | - Ángel Bueno Horcajadas
- Olympia Medical Center, Torre Caleido, Paseo de La Castellana 259 E, 28046, Madrid, Spain
- Elite Sport Imaging, SL, Madrid, Spain
| | - Ara Kassarjian
- Olympia Medical Center, Torre Caleido, Paseo de La Castellana 259 E, 28046, Madrid, Spain
- Elite Sport Imaging, SL, Madrid, Spain
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Jochimsen KN, Archer KR, Pollini RA, Parker RA, Enkhtsetseg N, Jacobs CA, Vranceanu AM. A Mind-Body Intervention to Improve Physical Activity for Patients with Chronic Hip-Related Pain: Protocol for a Mixed Methods Study. J Pers Med 2024; 14:499. [PMID: 38793081 PMCID: PMC11122466 DOI: 10.3390/jpm14050499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Pain and dysfunction persist for most patients following hip-related pain treatment. Additionally, individuals with hip-related pain are typically less physically active than individuals without hip pain, despite evidence that regular physical activity reduces chronic musculoskeletal pain. Poor psychological health is common in patients with hip-related pain and further reinforces low physical activity. Mind-body interventions can improve psychological health and activity levels but have yet to be integrated to provide comprehensive, psychologically informed care for patients with hip-related pain. Thus, we are using the NCCIH intervention development framework to develop Helping Improve PSychological Health (HIPS), a novel, multimodal mind-body intervention to improve physical activity for individuals with hip-related pain and poor psychological health. METHODS We will recruit physical therapists (N = 20) and patients with hip-related pain (N = 20) to participate in 60 min qualitative interviews (focus groups with therapists; one-on-one interviews with patients). Using these data, we will develop the initial HIPS intervention and provider training materials. One physical therapist will be trained to deliver the HIPS intervention to five participants in an open pilot trial. Participants will attend six 30 min HIPS intervention sessions. We will collect quantitative data on satisfaction, improvement, and physical activity, alongside qualitative exit interviews with participants and the physical therapist in order to refine the HIPS intervention and provider training materials. RESULTS This study has been approved by the MGB IRB. We aim to develop and test the initial feasibility of the HIPS intervention in an open pilot trial. The findings from this project will inform a subsequent feasibility RCT.
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Affiliation(s)
- Kate N. Jochimsen
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Kristin R. Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Robin A. Pollini
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, WV 26506, USA
- Department of Epidemiology & Biostatistics, West Virginia University, Morgantown, WV 26506, USA
| | - Robert A. Parker
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nomin Enkhtsetseg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Cale A. Jacobs
- Mass General Brigham Sports Medicine, Boston, MA 02115, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Ana Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
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Kelly M, Secomb J. Associations Between Hip Pathology, Hip and Groin Pain, and Injuries in Hockey Athletes: A Clinical Commentary. Int J Sports Phys Ther 2024; 19:625-641. [PMID: 38707850 PMCID: PMC11065768 DOI: 10.26603/001c.116580] [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: 12/12/2023] [Accepted: 03/29/2024] [Indexed: 05/07/2024] Open
Abstract
Femoroacetabular impingement (FAI), particularly cam morphology, is highly prevalent among elite hockey athletes. Moreover, hip and groin pain has become a common issue in hockey, with approximately 50% of European professional athletes reported to experience a hip or groin problem during a season. While most athletes will not miss training or competition due to this, restricted competitive performance and increased risk of reduced physical and psychological well-being are likely. Recent research suggests that the development of cam morphology is related to the repetitive shear stresses experienced at the hip joint during adolescence from skating. This condition likely increases the potential for intra-articular and extra-articular injuries in these athletes later in their careers. Research also indicates that the hip joint mechanics during forward skating substantially increase the possibility of sustaining a labral tear compared to other sports. Such an injury can increase femoral head movement within the joint, potentially causing secondary damage to the iliofemoral ligament, ligamentum teres and joint capsule. These injuries and the high density of nociceptors in the affected structures may explain the high prevalence of hip and groin pain in hockey athletes. Compensatory adaptations, such as reduced hip strength, stability, and range-of-motion (ROM) likely increase the opportunity for core muscle injuries and hip flexor and adductor injuries. Specifically, the limited hip ROM associated with cam morphology appears to exacerbate the risk of these injuries as there will be an increase in pubic symphysis stress and transverse strain during rotational movements. It is hoped that this article will assist practitioners currently working with hockey athletes to develop evidence-informed monitoring strategies and training interventions, aimed at reducing the incidence and severity of hip and groin problems, ultimately enhancing athlete performance and well-being. Therefore, the purpose of this clinical commentary was to examine current evidence on common hip pathologies in hockey athletes, exploring potential associations between hip and groin pain and the biomechanics of hockey activities. Level of Evidence 5.
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Affiliation(s)
- Matt Kelly
- Physiotherapy and BiomechanicsSport Science Rehab and Performance Centre
| | - Josh Secomb
- Applied Sports Science and Exercise Testing LaboratoryUniversity of Newcastle Australia
- Active Living Research ProgramHunter Medical Research Institute
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Thorarinsdottir S, Amundsen R, Larmo A, Pedersen R, Andersen TE, Bahr R, Møller M. Groin injuries in women's premier league football in Norway: A two-season prospective cohort study describing clinical and imaging characteristics. Scand J Med Sci Sports 2024; 34:e14611. [PMID: 38534061 DOI: 10.1111/sms.14611] [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] [Received: 06/30/2023] [Revised: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To describe the prevalence, incidence, and burden of groin injuries in the Norwegian women's premier football league and to describe their clinical and imaging characteristics. METHODS During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported groin injuries weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2). We calculated weekly prevalence, incidence, and burden of groin injuries. The team physical therapists classified the player-reported injuries based on the Doha classification system. Injuries with more than 3 days' time loss or reported in 2 consecutive weeks were eligible for magnetic resonance imaging (MRI). RESULTS On average, 3.9% (95% CI: 3.4-4.4) of players reported a groin injury at any time; of which 78% caused time loss. The incidence rate was 1.6 injuries/1000 h (95% CI: 1.3-2.0) and their burden was 11 days lost/1000 h. The physical therapists examined 67 of 124 player-reported groin injuries (53%). Adductor-related injury was most common (55%) followed by iliopsoas (15%) and rectus femoris-related (12%). Pubic-related injuries caused most time loss (median: 24 days, IQR: 5-133). In this study, 42 injuries were investigated with MRI; 8 (19%) showed no changes, 6 (14%) an acute musculotendinous lesion, and 32 (76%) a nonacute finding (e.g., central symphyseal disc protrusion, tendinopathies). CONCLUSION The incidence rate and burden of groin injuries were high. Adductor-related injuries were most common, but pubic-related injuries caused most time loss. Most MRI examinations demonstrated nonacute findings.
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Affiliation(s)
- Solveig Thorarinsdottir
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Roar Amundsen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | | | | | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- The Norwegian FA Medical Centre (Idrettens helsesenter), Oslo, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Merete Møller
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Jaenada-Carrilero E, Vicente-Mampel J, Baraja-Vegas L, Thorborg K, Valero-Merlos E, Blanco-Gímenez P, Gargallo P, Bautista IJ. Hip adduction and abduction strength profiles in elite and sub-elite female soccer players according to players level and leg limb-dominance. BMC Sports Sci Med Rehabil 2024; 16:53. [PMID: 38383450 PMCID: PMC10882891 DOI: 10.1186/s13102-024-00838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Understanding the hip adduction and abduction strength in female soccer players is crucial for performance enhancement and injury prevention. This study compares the strength profiles in these muscle groups between elite and sub-elite female soccer players and assesses the impact of leg limb-dominance. METHODS A descriptive-comparative study was employed. Eighty-two female soccer players were evaluated. Isometric hip-adduction and abduction strength were measured using a handheld dynamometer. RESULTS Female elite and sub-elite soccer players displayed a mean and standard deviation (SD) on isometric hip-adductor strength for dominant (3.19 Nm/kg ± 0.69 vs. 2.40 Nm/kg ± 0.67) and non-dominant leg (3.32 Nm/kg ± 0.76 versus 2.42 Nm/kg ± 0.70), respectively. For isometric hip-abductor strength in elite and sub-elite players, a mean and SD of dominant (2.86 Nm/kg ± 0.56 vs. 2.07 Nm/kg ± 0.50) and non-dominant (2.80 Nm/kg ± 0.59 vs. 2.04 Nm/kg ± 0.43). In essence, elite players were stronger than sub-elite players on isometric hip-adduction (mean difference [MD] = 0.82 Nm/kg, CI95% = 0.42-1.12) and abduction (MD = 0.83 Nm/kg, CI95% = 0.54- 1.12) both in dominant and non-dominant, leg, whereas no differences existed for hip adduction:abduction ratios between groups and legs. CONCLUSIONS Elite female athletes exhibited greater strength than sub-elite female players in both hip adduction and abduction, whereas adduction:abduction ratio values did not differ between the two groups or between different legs.
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Affiliation(s)
| | - Juan Vicente-Mampel
- Faculty of Science Health, Catholic University of Valencia, Physiotherapy Department., C/ Ramiro de Maetzu 14, Torrent Valencia, Spain.
| | - Luis Baraja-Vegas
- Faculty of Science Health, Catholic University of Valencia, Physiotherapy Department., C/ Ramiro de Maetzu 14, Torrent Valencia, Spain
| | - Kristian Thorborg
- Department of Sports, Department of Orthopedic Surgery, Orthopedic Research Center-Copenhagen (SORC-C), Amager-Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eloína Valero-Merlos
- Faculty of Nursing. Campus Jerónimos, Catholic University of Murcia, Murcia, Spain
| | - Paula Blanco-Gímenez
- Faculty of Science Health, Catholic University of Valencia, Physiotherapy Department., C/ Ramiro de Maetzu 14, Torrent Valencia, Spain
| | - Pedro Gargallo
- Faculty of Science Health, Catholic University of Valencia, Physiotherapy Department., C/ Ramiro de Maetzu 14, Torrent Valencia, Spain
| | - Iker J Bautista
- Faculty of Science Health, Catholic University of Valencia, Physiotherapy Department., C/ Ramiro de Maetzu 14, Torrent Valencia, Spain
- Institute of Sport, Nursing and Allied Health, University of Chichester, Chichester, UK
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Ooi MWX, Marzetti M, Rowbotham E, Bertham D, Robinson P. MRI findings in athletic groin pain: correlation of imaging with history and examination in symptomatic and asymptomatic athletes. Skeletal Radiol 2024:10.1007/s00256-024-04603-9. [PMID: 38302788 DOI: 10.1007/s00256-024-04603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To determine differences in prevalence and diagnostic accuracy of MRI findings between asymptomatic athletes and athletes with longstanding groin pain. MATERIALS AND METHODS One hundred twenty-three adult male athletes were approached with 85 consecutive athletes recruited. Group 1 (symptomatic, n = 34) athletes referred for longstanding groin pain (insidious onset, > 3 weeks duration). Group 2 (control, n = 51) athletes referred for injuries remote from the pelvis and no groin pain in the last 12 weeks. All referrers completed a clinical examination proforma documenting absence or presence of pelvis and hip abnormality. All patients completed the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire and underwent a 3T MRI groin and hip protocol. MRIs were scored independently by two musculoskeletal radiologists blinded to clinical details. Statistical analysis was performed to evaluate associations between MRI findings, inter-reader reliability, clinical examination and HAGOS scores. RESULTS Pubic body subchondral bone oedema, capsule/aponeurosis junction tear and soft tissue oedema were more prevalent in the symptomatic group (p = 0.0003, 0.0273 and 0.0005, respectively) and in athletes with clinical abnormality at symphysis pubis, adductor insertion, rectus abdominis, psoas and inguinal canal (p = 0.0002, 0.0459 and 0.00002, respectively). Pubic body and subchondral oedema and capsule/aponeurosis tear and oedema significantly correlated with lower (worse) HAGOS scores (p = 0.004, 0.00009, 0.0004 and 0.002, respectively). Inter-reader reliability was excellent, 0.87 (range 0.58-1). Symphyseal bone spurring, disc protrusion and labral tears were highly prevalent in both groups. CONCLUSION Clinical assessment and MRI findings of pubic subchondral bone oedema and capsule/aponeurosis abnormality appear to be the strongest correlators with longstanding groin pain.
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Affiliation(s)
- Michelle Wei Xin Ooi
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Matthew Marzetti
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Rowbotham
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dominic Bertham
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip Robinson
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Perraton Z, Mosler AB, Lawrenson PR, Weber Ii K, Elliott JM, Wesselink EO, Crossley KM, Kemp JL, Stewart C, Girdwood M, King MG, Heerey JJ, Scholes MJ, Mentiplay BF, Semciw AI. The association between lateral hip muscle size/intramuscular fat infiltration and hip strength in active young adults with long standing hip/groin pain. Phys Ther Sport 2024; 65:95-101. [PMID: 38101293 DOI: 10.1016/j.ptsp.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES To investigate associations between lateral hip muscle size/intramuscular fat infiltration (MFI) and hip strength in active young adults with longstanding hip/groin pain. DESIGN Cross-sectional study. SETTING University/Clinical. PARTICIPANTS Sub-elite soccer and Australian Football players (n = 180; 37 female) with long standing hip/groin pain. MAIN OUTCOME MEASURES Muscle size (volume) and MFI of gluteus maximus, medius, and minimis, and tensor fascia latae (TFL) were assessed using magnetic resonance imaging. Isometric hip strength was measured with handheld dynamometry. Associations between muscle size/MFI were assessed using linear regression models, adjusted for body mass index and age, with sex-specific interactions. RESULTS Positive associations were identified between lateral hip muscle volume and hip muscle strength, particularly for gluteus maximus and gluteus minimus volume. For all muscles, hip abduction was associated with an increase in strength by up to 0.69 N (R2 ranging from 0.29 to 0.39). These relationships were consistent across sexes with no sex interactions observed. No associations were found between MFI and strength measures. CONCLUSION Greater lateral hip muscle volumes are associated with greater hip strength in active young adults with long standing hip/groin pain, irrespective of sex. Gluteus maximus and minimus volume showed the most consistent relationships with hip strength across multiple directions.
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Affiliation(s)
- Zuzana Perraton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - Peter R Lawrenson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia; Innovation and Research Centre, Community and Oral Health Directorate, Metro North Health, Brisbane, Australia.
| | - Kenneth Weber Ii
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA.
| | - James M Elliott
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia; Faculty of Medicine and Health, Northern Sydney Local Health District & The University of Sydney, The Kolling Institute St Leonards, NSW, Australia.
| | - Evert O Wesselink
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Christopher Stewart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Michael Girdwood
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Australia.
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Mark J Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Australia.
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Adam I Semciw
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Australia; Department of Allied Health Research, Northern Health, Epping, Victoria, Australia.
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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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Martins EC, Gomes DA, de Brito Fontana H, Fernandes DA. Does response to preoperative intra-articular anesthetic injections predict outcomes of femoroacetabular impingement syndrome? Arch Orthop Trauma Surg 2023; 143:6283-6294. [PMID: 37316693 DOI: 10.1007/s00402-023-04927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Some patients with femoroacetabular impingement syndrome (FAIS) who undergo surgery do not show satisfactory outcomes. Reliable tests that can inform prognosis of FAIS surgery are needed for optimized indications and contraindications to surgery. We aimed to review and critically appraise available literature on the capability of patient response to preoperative intra-articular anesthetic injections (PIAI) to predict post-surgical outcomes in patients with FAIS. MATERIALS AND METHODS This study was conducted in accordance with the PRISMA statement. Studies that assessed the patient pain response to PIAI and post-surgical outcomes in patients with FAIS were considered eligible. Study selection and data collection were performed by three independent reviewers. Main outcomes evaluated were those measured by hip outcome scales often used in assessing postoperative pain and functional recovery, such as the modified Harris Hip Score (mHHS) and international Hip Outcome Tool (iHOT). The likelihood ratio of achieving satisfactory postoperative outcomes at the mHHS (LHR) was extracted or calculated-for patients with significant response to PIAI and for those without a significant response to PIAI. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool. RESULTS Six studies were considered eligible for analysis. Five studies indicated that patient response to PIAI are associated to surgical outcomes for patients with FAIS, with a greater reduction in pain typically indicating a better surgical outcome. Additionally, the LHR ranged from 1.15 to 1.92 for patients with significant response to PIAI (I2 = 90.6%). For patients without a significant response, the LHR ranged from 0.18 to 0.65 (I2 = 87.5). An overall high risk of bias was observed for all studies included in the analysis. Study attrition, the prognostic factor measurement and the presence of confounding factors were the main sources of bias. CONCLUSIONS Greater reductions in pain with preoperative intra-articular anesthetic injections were found to be associated to better outcomes after FAIS surgery, but all available studies contain a high risk of bias.
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Affiliation(s)
- Eduardo Campos Martins
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, CEP: 88040-900, Brazil.
- Department of Surgery, Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Trindade, Florianópolis, Santa Catarina, CEP: 88036-800, Brazil.
| | - Diogo A Gomes
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, CEP: 88040-900, Brazil
| | - Heiliane de Brito Fontana
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, CEP: 88040-900, Brazil
| | - Daniel Araujo Fernandes
- Department of Surgery, Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Trindade, Florianópolis, Santa Catarina, CEP: 88036-800, Brazil
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10
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Bonello C, King MG, Crossley KM, Heerey JJ, Scholes MJ, Lawrenson P, Girdwood MA, Kemp JL, Mosler AB, Mentiplay BF, Semciw AI. The association between hip/groin pain and hip strength in football players: An exploratory analysis of the FORCe cohort. J Sci Med Sport 2023; 26:471-475. [PMID: 37532657 DOI: 10.1016/j.jsams.2023.07.008] [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: 08/31/2022] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES Explore associations between peak hip strength in football players with hip/groin pain and healthy controls. DESIGN Cross-sectional study. METHODS Male and female sub-elite football players (soccer and Australian football) with hip/groin pain >6-month duration and players without hip/groin pain were recruited across Melbourne and Brisbane, Australia. Demographic information and two questionnaires; the Copenhagen Hip and Groin Outcome Score and the International Hip Outcome Tool 33 were collected. Hand-held dynamometry was used to measure isometric hip strength for flexion, extension, abduction, adduction, internal rotation, and external rotation. Linear mixed effects models were used to compare strength measures between groups. RESULTS 190 football players with hip/groin pain (mean ± standard deviation age, 27.8 ± 6.3 years) and 64 controls (age, 27.3 ± 5.6 years) were included in this study. Of these, 291 symptomatic limbs and 128 control limbs were used for analyses. Symptomatic players had lower peak hip adduction (adjusted mean difference = -0.18: 95 % confidence interval -0.27 to -0.08, P : 0.001), external rotation (-0.06: 95 % confidence interval -0.09 to -0.02, P : 0.003), and internal rotation strength (-0.06: 95 % confidence interval -0.10 to -0.03, P : 0.001) compared to controls. A sport-specific interaction was observed for hip abduction strength. When separated by football code, abduction strength was lower in symptomatic Australian football players compared to their same sport peers (-0.20: 95 % confidence interval -0.33 to -0.06, P : 0.004), but not in symptomatic soccer players (-0.05: 95 % confidence interval -0.15 to 0.06, P : 0.382). CONCLUSIONS Hip adduction, internal rotation, and external rotation strength appears lower in football players with hip/groin pain independent of sex and football code. Hip abduction strength was lower in symptomatic Australian football players but not in soccer players.
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Affiliation(s)
- C Bonello
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia.
| | - M G King
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - K M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - J J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - M J Scholes
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - P Lawrenson
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - M A Girdwood
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - J L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - A B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - B F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - A I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
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11
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Covey CJ, Knobloch AC, Kim AR. Hip Pain in an Athlete. Curr Sports Med Rep 2023; 22:313-319. [PMID: 37678350 DOI: 10.1249/jsr.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
ABSTRACT Hip pain is a common complaint in sports, and narrowing the differential diagnosis can be difficult. Many etiologies are secondary to overuse and respond well to nonsurgical treatment. The increased use of point-of-care ultrasound has helped provide timely and accurate diagnoses and some guided treatments. The hip is in close proximity to the abdomen and pelvis, and clinicians should be familiar with nonmusculoskeletal pain generators. This article is a comprehensive review of hip pain etiologies in athletes.
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Affiliation(s)
- Carlton J Covey
- Uniformed Services University, Family and Sports Medicine, Travis AFB, CA
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12
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Ishøi L, Thorborg K, Krohn L, Louis Andersen L, Møller Nielsen A, Bek Clausen MI. Maximal and Explosive Muscle Strength During Hip Adduction Squeeze and Hip Abduction Press Test Using A Handheld Dynamometer: An Intra- and Inter-tester Reliability Study. Int J Sports Phys Ther 2023; 18:905-916. [PMID: 37547845 PMCID: PMC10399103 DOI: 10.26603/001c.83259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/16/2023] [Indexed: 08/08/2023] Open
Abstract
Background Hip adduction and abduction muscle function plays an important role for risk of groin pain in athletes. Maximal isometric strength can be obtained clinically using a handheld dynamometer. However, in very strong athletes this is challenging, as external fixation of the dynamometer is needed for reliable measures. An alternative to unilateral testing, is the long-lever hip adduction squeeze test and a novel bilateral hip abduction press test. While promising intra-tester reliability has been found for maximal strength during the long-lever hip adduction squeeze test, inter-tester reliability may be more challenging during both maximal and explosive strength measurements. Hypothesis/purpose The aim of the present study was to assess intra- and inter-tester reliability of maximal, and explosive strength during the long lever hip adduction squeeze test and the long lever hip abduction press test in healthy adults using a hand-held dynamometer. Study design Intra- and interrater reliability study. Methods Forty-nine healthy subjects were included for intra- (n=20) and inter-tester reliability (n=29). Subjects performed the hip adduction long lever squeeze test and the bilateral hip abduction press test in a randomized order. Maximal isometric strength and early (0-100 ms) and late (0-200 ms) phase rate of force development (explosive muscle strength) was obtained using a hand-held dynamometer. Relative reliability for all tests was assessed using ICC2,1 two-way mixed model with absolute agreement, thereby taking bias between testers into account. Results Maximal isometric strength showed good intra- and inter-tester reliability for adduction (ICC: 0.93-0.97) and abduction (ICC: 0.88-0.92). For 0-200 ms rate of force development, both the squeeze and press test showed good intra-tester reliability (ICC: 0.85-0.87), whereas inter-tester reliability was good for hip adduction squeeze (ICC: 0.75) and moderate for hip abduction press (ICC: 0.71). For 0-100 ms rate of force development, the hip abduction press test showed good intra-tester reliability (ICC: 0.78). Remaining tests for intra- and inter-tester reliability showed moderate reliability (ICC: 0.50-0.71). Conclusion Assessment of maximal isometric strength in hip adduction squeeze and abduction press test showed good intra- and inter-tester reliability, whereas only 0-200 ms rate of force development demonstrated good intra-tester reliability of both tests. Therefore, rate of force development should preferably be conducted by the same tester, while the long lever squeeze and press test can reliably be used within- and between testers to measure maximal isometric strength. Level of Evidence 3©The Author(s).
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Affiliation(s)
- Lasse Ishøi
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery Copenhagen University Hospital
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery Copenhagen University Hospital
| | - Laura Krohn
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery Copenhagen University Hospital
| | | | - Asger Møller Nielsen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery Copenhagen University Hospital
| | - MIkkel Bek Clausen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery Copenhagen University Hospital
- University College Copenhagen
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13
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Lahuerta-Martín S, Robles-Pérez R, Hernando-Garijo I, Jiménez-Del-Barrio S, Hernández-Lázaro H, Mingo-Gómez MT, Ceballos-Laita L. The effectiveness of non-surgical interventions in athletes with groin pain: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:81. [PMID: 37430335 DOI: 10.1186/s13102-023-00684-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Groin pain is a common pathology among athletes, presenting pain and a reduced range of motion (ROM) as clinical characteristics. Passive physical therapy (PPT) and exercise therapy (ET) interventions are chosen firstly before surgery. The aim of this systematic review and meta-analysis was: (i) to qualitative review the effects of each non-surgical intervention; (ii) to quantitative compare the effects of PPTs plus ET intervention to ET in isolation in pain intensity, and hip ROM in athletes with groin pain. METHODS A systematic review and meta-analysis was conducted. Pubmed, PEDro, Web of science, Scopus and Cochrane library were searched. Randomized controlled trials comparing PPT plus ET to ET interventions were included. The methodological quality and risk of bias of the included studies, were assessed with the PEDro scale and the Cochrane risk-of-bias tool. To assess the certainty of evidence the GRADEpro GDT was used. Meta-analyses were conducted using RevMan 5.4 using mean difference analysis to assess the variables pain intensity and hip ROM. RESULTS A total of 175 studies was identified from the consulted databases. Five studies were included for systematic- review, from which three studies were meta-analyzed. The methodological quality of the included studies ranged from poor to high. ET compared to PPT plus ET provided statistically significant improvements in pain intensity in the short-term (MD = 2.45; 95% CI 1.11, 3.79; I2 :65%). No statistically significant differences between interventions were obtained for hip ROM in the short-term. CONCLUSIONS The qualitative review showed that PPTs plus ET and ET seem to have positive effects on pain intensity and hip ROM. The quantitative analysis found very low certainty of evidence proposing a positive effect in pain intensity for ET interventions based on hip muscles stretching, compared to PPT combined with ET, in the short-term.
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Affiliation(s)
- Silvia Lahuerta-Martín
- Department of Surgery Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, 42004, Soria, Spain
| | - Román Robles-Pérez
- Department of Surgery Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, 42004, Soria, Spain
| | - Ignacio Hernando-Garijo
- Department of Surgery Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, 42004, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004, Soria, Spain
| | - Sandra Jiménez-Del-Barrio
- Department of Surgery Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, 42004, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004, Soria, Spain
| | - Héctor Hernández-Lázaro
- Department of Surgery Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, 42004, Soria, Spain
| | - María Teresa Mingo-Gómez
- Department of Surgery Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, 42004, Soria, Spain.
- Clinical Research in Health Sciences Group, University of Valladolid, 42004, Soria, Spain.
| | - Luis Ceballos-Laita
- Department of Surgery Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, 42004, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004, Soria, Spain
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14
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Thorborg K. Current Clinical Concepts: Exercise and Load Management of Adductor Strains, Adductor Ruptures, and Long-Standing Adductor-Related Groin Pain. J Athl Train 2023; 58:589-601. [PMID: 35834724 PMCID: PMC10569248 DOI: 10.4085/1062-6050-0496.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Adductor-related groin pain is a common problem in sports. Evidence-based management of athletes with adductor strains, adductor ruptures, and long-standing adductor-related groin pain can be approached in a simple yet effective and individualized manner. In most cases, managing adductor-related pain in athletes should be based on specific exercises and loading strategies. In this article, I provide an overview of the different types of adductor injuries, from acute to overuse, including their underlying pathology, functional anatomy, diagnosis, prognosis, mechanisms, and risk factors. This information leads to optimal assessment and management of acute to long-standing adductor-related problems and includes primary, secondary, and tertiary prevention strategies that focus on exercise and load-based strategies. In addition, information on different options and contexts for exercise selection and execution for athletes, athletic trainers, and sports physical therapists in adductor injury rehabilitation is provided.
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Affiliation(s)
- Kristian Thorborg
- Department of Orthopedic Surgery, Sports Orthopedic Research Center–Copenhagen (SORC-C), Amager-Hvidovre University Hospital, Denmark
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15
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Donnelly GM, Moore IS. Sports Medicine and the Pelvic Floor. Curr Sports Med Rep 2023; 22:82-90. [PMID: 36866951 DOI: 10.1249/jsr.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT The female athlete is seen as a specialist population meaning female considerations, such as pelvic floor dysfunction, are not widely taught within sports medicine. Females have unique anatomical characteristics compared with males including a wider pelvic diameter and an additional orifice in the form of the vagina. Furthermore, symptoms of pelvic floor dysfunction are prevalent among female athletes and transitional periods in their lifespan. They also are a barrier to training and performance. Therefore, it is essential that sports medicine practitioners understand how to identify and manage pelvic floor dysfunction. This report aims to describe the anatomy and function of the pelvic floor, outline the types and rates of pelvic floor dysfunction, discuss evidence-based management, and raise awareness of perinatal bodily changes. Practical recommendations are made to aid sports organizations and sports medicine practitioners in supporting the female athlete and in using a proactive approach to manage the perinatal athlete.
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Affiliation(s)
| | - Isabel S Moore
- Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, UNITED KINGDOM
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16
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Nielsen MF, Ishøi L, Juhl C, Hölmich P, Thorborg K. Pain provocation tests and clinical entities in male football players with longstanding groin pain are associated with pain intensity and disability. Musculoskelet Sci Pract 2023; 63:102719. [PMID: 36736197 DOI: 10.1016/j.msksp.2023.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/20/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Clinical examination of male football players with longstanding groin pain can be considered difficult. Pain provocation tests are used to examine and classify longstanding groin pain into clinical entities as adductor-, iliopsoas-, inguinal-, and pubic-related. It is unknown if pain provocation tests and clinical entities are associated with pain intensity and disability. OBJECTIVES To investigate if the number of positive pain provocation tests and clinical entities are associated with pain intensity and disability, measured by the Copenhagen 5-Second Squeeze Test (5SST) and the Copenhagen Hip and Groin Outcome Score (HAGOS), respectively. DESIGN Cross-sectional. METHOD Forty male football players (age: mean 24 years [SD: 3.2]; height: mean 182 cm [SD: 5.7]; weight: mean 78 Kg [SD: 6.6]) with longstanding groin pain for a median of 8.5 months (IQR: 4-36) were included. The players underwent a bilateral groin examination with 33 pain provocation tests and were classified with clinical entities (0-7) based on the test findings. RESULTS The number of positive pain provocation tests (median 10, range 2-23) correlated with pain intensity (5SST: rs = 0.70 [95% CI: 0.50, 0.83]) and disability (HAGOS subscales Sport: rs =-0.62 [95% CI: -0.81, -0.36], Pain: rs = -0.38 [95% CI: -0.69, -0.06], Symptoms: rs = 0.52 [95% CI: -0.73, -0.24], ADL: rs = -0.48 [95% CI: -0.71, -0.18]). The number of clinical entities (median 3, range: 1-7) showed similar but weaker correlations to pain intensity and disability. CONCLUSIONS In male football players with longstanding groin pain, the number of positive pain provocation tests and clinical entities shows weak to strong correlations with pain intensity and disability. Consequently, when pain intensity and disability are severe, a higher number of pain provocation tests may be positive, and more clinical entities may be present.
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Affiliation(s)
- Mathias F Nielsen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark.
| | - Lasse Ishøi
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark
| | - Carsten Juhl
- Research Unit Musculoskeletal Function and Physiotherapy, Department of Sport Science and Clinical Biomechanics (IOB), University of Southern, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark
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17
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Diggles A. The "Mother Load" and Return to Sport: A Case Report of Returning to Professional Netball Following Cesarean Section. Int J Sports Phys Ther 2023; 18:228-239. [PMID: 36793569 PMCID: PMC9897013 DOI: 10.26603/001c.65894] [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: 03/21/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background Increasing numbers of elite female athletes are competing in professional sport, and many wish to become pregnant and return to competitive sport after childbirth. Athletes have a higher risk of pelvic floor dysfunction (PFD) than non-athletes (54% versus 7%) and there is also an increased prevalence in post-partum women compared to nulliparous women (35% versus 2.8-7.9%). Additionally, PFD has been shown to influence athletic performance. High quality evidence for elite athletes is lacking, and there are no exercise guidelines specifically for these women to prepare or effectively guide their safe return to sport (RTS). The purpose of this case report is to detail the management of an elite athlete who presented following cesarean section (CS) with the goal of RTS within 16 weeks. Case Description A 27-year-old primiparous Caucasian professional netballer presented at four weeks post- caesarean section (CS) for RTS screening and assessment of pelvic floor muscle (PFM) function. Assessment included readiness and fear of movement screening, dynamic pelvic floor muscle function, structural integrity of the CS wound, levator hiatal dimensions, bladder neck descent, and early global neuromuscular screening. Measures were collected at four weeks, eight weeks, and six months post-partum. The post-partum athlete demonstrated alterations in pelvic floor muscle function, reduced lower limb power and psychological readiness. A functionally staged dynamic and sport specific pelvic floor muscle training program was implemented and adapted to the patient for her early post-partum timeline. Results Rehabilitation strategies were effective in achieving the primary outcome of RTS at 16 weeks post-partum with no adverse events reported at 6 months follow-up. Discussion This case highlights the need for a holistic and individualised RTS management approach that includes women's and pelvic health risk factors in a professional athlete. Level of Evidence 5.
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18
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Heijboer WMP, Vuckovic Z, Weir A, Tol JL, Hölmich P, Serner A. Clinical examination for athletes with inguinal-related groin pain: interexaminer reliability and prevalence of positive tests. BMJ Open Sport Exerc Med 2023; 9:e001498. [PMID: 36643406 PMCID: PMC9835948 DOI: 10.1136/bmjsem-2022-001498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives To evaluate the interexaminer reliability of abdominal palpation and resistance tests in athletes with longstanding groin pain, and to identify the prevalence of positive clinical tests in athletes classified with inguinal-related groin pain. Methods Male athletes (18-40 years) with longstanding groin pain were prospectively recruited between March 2019 and October 2020 at a sports medicine hospital. Two examiners performed history taking and standardised clinical examination (including abdominal palpation, scrotal invagination and abdominal resistance tests) blinded to each other's findings. Interexaminer reliability was calculated using Cohen's Kappa statistic (κ). Examiners classified groin pain using the Doha agreement meeting terminology. A differentiation was made between 'defined inguinal-related groin pain' (according to recommended definition criteria) and 'likely inguinal-related groin pain' (expert-based application of the Doha agreement classification when not all recommended criteria were present). Results Overall, 44 athletes were included (61 symptomatic sides). Interexaminer reliability of inguinal palpation pain provocation tests varied from fair to moderate (κ=0.35-0.49). Reliability of posterior wall structure palpation (firm/soft) was slight (κ=0.01), and posterior wall bulging (yes/no) fair (κ=0.29). Reliability for abdominal resistance tests varied from fair to substantial (κ=0.35-0.72). In athletes classified with defined inguinal-related groin pain, recognisable injury pain on palpation during scrotal invagination when athletes performed a Valsalva manoeuvre was the most prevalent positive palpation test (79%). Abdominal resistance tests were positive in 21%-49% of these cases. Conclusion The interexaminer reliability for clinical examination tests used to classify inguinal-related groin pain in athletes varies from slight to substantial. There is no single perfect clinical examination test. Trial registration number NCT03842826.
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Affiliation(s)
- Willem M P Heijboer
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar,Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands,Musculoskeletal Health and Sports, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Zarko Vuckovic
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Adam Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar,Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar,Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands,Musculoskeletal Health and Sports, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar,FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
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19
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Wrolstad K, Mischke JJ, Elias AR. Desmoid fibromatosis presenting as lateral hip pain in an outpatient physical therapy clinic: A case report. Physiother Theory Pract 2023; 39:219-226. [PMID: 34823424 DOI: 10.1080/09593985.2021.2008566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CASE DESCRIPTION A 21-year-old healthy female presented with severe left lateral hip pain beginning suddenly two weeks prior. Physical examination revealed zero degrees of left hip external rotation passive range of motion with a firm end feel and pain severity and irritability out of proportion to an expected musculoskeletal presentation. She was referred to her physician with a recommendation for imaging to determine the source of pain and appropriateness of physical therapy. OUTCOME Magnetic resonance imaging revealed a foreign mass in her left gluteus medius muscle which biopsy revealed to be a desmoid fibromatosis. CONCLUSION This case demonstrates a thorough differential diagnostic process leading to medical imaging referral in a patient with a non-musculoskeletal source of pain. Physical therapists must be diligent in their differential diagnostic process to ensure appropriateness of their treatments or the need for referral.
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Affiliation(s)
- Kelli Wrolstad
- Physical Therapy Department, University of Montana Physical Therapy, 32 Campus Dr, Missoula, MT, USA
| | - John J Mischke
- Physical Therapy Department, University of Montana Physical Therapy, 32 Campus Dr, Missoula, MT, USA
| | - Audrey Rc Elias
- Physical Therapy Department, University of Montana Physical Therapy, 32 Campus Dr, Missoula, MT, USA
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20
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Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts. SPORTS MEDICINE - OPEN 2022; 8:11. [PMID: 35043267 PMCID: PMC8766680 DOI: 10.1186/s40798-021-00400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022]
Abstract
Background Groin pain is a very common injury in multidirectional sports such as soccer, ice hockey, rugby and Australian football. Long-standing adductor-related groin pain is a persistent clinical condition and a frequent complaint in athletes involved in sports that require multiplanar movement patterns (change of direction, high-speed sprinting and kicking). To date, the lack of rehabilitation guidelines and return-to-play criteria makes this clinical entity difficult to manage. The aim of the present Delphi was to suggest, based on opinion and practical experience of a panel of experts, potential criteria that could be taken into consideration by clinicians in the RTP decision-making process in athletes suffering from long-standing adductor-related groin pain. Methods Thirty two out of 40 experts participated to a 3-Round Delphi questionnaire. In round 1, open-ended and closed questions about 9 different sections (palpation, flexibility, strength, patient-reported outcome measures, imaging, intersegmental control, performance tests, sport-specific skills, training load) were proposed to investigate return to play evaluation criteria used by each expert. Responses were analysed and coded to produce round 2 questionnaire that investigated only the sections and the items that reached the cut-off value (≥ 70%). Round 3 questionnaire was based on sections and items that reached cut-off value in previous rounds and experts rated their agreement for return to play criteria with a 5-point Likert Scale. Descriptive statistics enabled interpretation of consensus. Results High participation rate (80%) and response rate across the 3 rounds (100%) were recorded. 6 sections reached positive consensus in round 1, 1 section reached negative consensus. In round 2 positive consensus was confirmed only for 3 sections and negative consensus for 1 section. In round 3, positive agreement was established for strength (3 items), performance tests (3 items) and sport-specific skills (2 items) sections. Negative consensus was confirmed for imaging section. Conclusion Experts agreed that strength, performance tests and sport-specific skills can be used to support RTP decision, while imaging cannot be used. These findings could be useful in assisting clinicians in the RTP decision making. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00400-z.
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21
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Fasulo SM, Dávila Castrodad IM, Kraeutler MJ, Doerr N, Talishinskiy T, Scillia AJ. Robotic Abdominal Wall Repair with Endoscopic Adductor Lengthening: A Minimally Invasive Approach for Core Muscle Injuries. Arthrosc Tech 2022; 11:e2233-e2241. [PMID: 36632407 PMCID: PMC9827066 DOI: 10.1016/j.eats.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Groin pain is a common complaint in sports medicine practices but can be a challenge to accurately diagnose given the expanse of differentials. In the athlete, groin pain may be caused by a core muscle injury, also known as sports hernia or athletic pubalgia. These injuries most frequently occur in young males who participate in explosive and rotationally demanding activities such as soccer, football, and ice hockey, which generate large forces across the trunk and hip joint. These injuries are becoming more frequently diagnosed, in part, due to the utilization of diagnostic modalities, such as dynamic ultrasound and magnetic resonance imaging (MRI) and sensitive physical examination tests, such as the cross-body sit-up and squeeze test. When conservative management fails, surgical intervention is a good option for the athletes who desire to return to play. Surgical options include both open and laparoscopic techniques to repair abdominopelvic defects with or without attention to adductor pathology. The purpose of this article is to present a technique for minimally invasive robotic abdominal wall repair with endoscopic adductor lengthening for core muscle injuries.
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Affiliation(s)
- Sydney M. Fasulo
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Iciar M. Dávila Castrodad
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Matthew J. Kraeutler
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Nikki Doerr
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Toghrul Talishinskiy
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A.,Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Anthony J. Scillia
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A.,Seton Hall University, South Orange, New Jersey, U.S.A.,Hackensack Meridian School of Medicine, Nutley, New Jersey, U.S.A.,Address correspondence to Anthony J. Scillia, M.D., St. Joseph’s University Medical Center, Department of Orthopaedic Surgery, 703 Main St., Paterson, NJ 07503, U.S.A.
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22
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Serafim TT, Oliveira ES, Migliorini F, Maffulli N, Okubo R. Return to sport after conservative versus surgical treatment for pubalgia in athletes: a systematic review. J Orthop Surg Res 2022; 17:484. [DOI: 10.1186/s13018-022-03376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/29/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To assess the time required to return to sport (RTS) after conservative versus surgical treatment in athletes for pubalgia.
Methods
The PRISMA guidelines were followed. Pubmed, SportDiscus and Web of Science were last accessed on September 2022. All the studies investigating the time to RTS after conservative versus surgical treatment in athletes for pubalgia.
Results
In total, 33 studies were selected for full text assessment, and 10 studies were included in the qualitative analysis. Seven studies reported data on conservative management, two on surgical management and one compared both. A total of 468 subjects were included for analysis. 58.7% (275 of 468) were soccer players, 5.9% (28 of 468) runners, and 3.8% (18 of 468) hockey players. Two studies did not specify the type of sport. The quality of the studies detailing the results of conservative management was higher than surgical procedures.
Conclusion
This review highlights that individuals undergoing surgery for pubalgia may return to sport earlier than those receiving conservative treatment. However, conservative management should be considered before surgical treatment is indicated.
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23
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Unuvar E, Guney-Deniz H, Akinoglu B, Kocahan T, Nyland J. Frontal plane lower extremity alignment in adolescent athletes with chronic hip adductor-related groin injury symptoms: A case-control study. Phys Ther Sport 2022; 57:53-60. [PMID: 35921782 DOI: 10.1016/j.ptsp.2022.07.008] [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: 12/27/2021] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare trunk and lower extremity frontal plane projection angles (FPPA) during single leg squat (SLS) performance, perceived hip and groin function and symptoms, and isometric hip strength of adolescent athletes with chronic hip adductor-related groin injury (HARGI) symptoms and age, gender, and sport-matched healthy subjects. DESIGN Case-control study. SETTING Junior Olympic Development Training Centre. PARTICIPANTS Twenty-six athletes at 59.1 ± 60 weeks (range = 12-208 weeks) post-index grade II HARGI injury who had continued sport training (injury group) and 26 control group subjects. MAIN OUTCOME MEASURES SLS trunk, hip, and knee FPPA, isometric hip strength standardized to bodyweight, and Copenhagen Hip and Groin Outcome Scores (HAGOS). RESULTS The injury group had greater bilateral knee FPPA, and greater injury side hip FPPA during maximum SLS. Injury group HAGOS subscale scores were lower than control group scores. Hip abductor, adductor, external rotator, and internal rotator strength was lower at the injury side of the injury group compared to the matched control group limb. Forward stepwise multiple regression analysis of the injury group found that 50% of injury side knee FPPA was predicted by hip internal rotator strength and time post-index HARGI; and 47% of injury side hip FPPA was predicted by other side hip flexor strength and the HAGOS function, sport and recreation subscale score (p = 0.002). CONCLUSIONS Greater injury side hip and bilateral knee FPPA during maximum SLS, lower self-reported hip symptom and function scores, and less injury side hip abductor, adductor, external rotator and internal rotator strength suggests that adolescent athletes with chronic HARGI symptoms are at an increased risk for sustaining a non-contact knee injury. Impaired hip internal rotator strength at the side of the chronic HARGI was related to increased knee FPPA, and impaired hip flexor strength at the other side of the HARGI was related to increased hip FPPA. Findings support using SLS performance testing in this athlete group to help determine safe return to sport training readiness.
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Affiliation(s)
- Ezgi Unuvar
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Musculoskeletal Physiotherapy and Rehabilitation, 06100, Ankara, Turkey
| | - Hande Guney-Deniz
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Musculoskeletal Physiotherapy and Rehabilitation, 06100, Ankara, Turkey
| | - Bihter Akinoglu
- Ankara Yıldırım Beyazıt University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Etlik, Ankara, Turkey
| | - Tugba Kocahan
- University of Health Sciences, Gulhane Faculty of Medicine, Sports Medicine Department, Ankara, Turkey
| | - John Nyland
- Spalding University, Kosair Charities College of Health and Natural Sciences, Louisville, KY, USA.
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24
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Groin Pain in Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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25
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Thomas RJ, Timmins RG, Tofari PJ, Williams MD, Opar DA. Assessing isometric kicking force and post-match responses using the Kicker test. J Sports Sci 2022; 40:1275-1281. [PMID: 35502468 DOI: 10.1080/02640414.2022.2065772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined the inter-session reliability of force output from a novel isometric strength assessment protocol (the Kicker); and its suitability to monitor soccer player's combined hip flexion and knee extension force capacity over 72-h post-competitive matches. Reliability (Part-A) testing was completed over three sessions on 20 individuals participating in various sports at a recreational level or higher. Post-match strength response (Part-B) data were collected for 72-h after a game (24-h (+24), 48-h (+48) and 72-h (+72) post-match) in 17 male academy soccer players. After familiarisation, Kicker force for each limb showed high inter-session reliability (ICC >0.95; typical error <14 N, CV <6%); minimum detectable change at a 95% confidence interval <40 N). Across the 72-h post-match period, Kicker force for each limb was suppressed compared to baseline (force loss range = -5.8% to -12.5%; effect sizes range = -0.26 to -0.43) at all time points. The Kicker assessment protocol measures combined isometric hip flexor and knee extensor force capacity with high inter-session reliability. The proof of concept that the protocol can be used as a monitoring tool was evidenced by sustained suppression of baseline force capacity in both kicking limbs for 72-h post soccer matches.
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Affiliation(s)
- Rees J Thomas
- Melbourne Victory Football Club, Melbourne, Vic, Australia.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Vic, Australia.,College of Health and Biomedicine, Victoria University, Melbourne, Vic, Australia
| | - Ryan G Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Vic, Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Vic, Australia
| | - Paul J Tofari
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Vic, Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Vic, Australia
| | - Morgan D Williams
- School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University of South Wales, Treforest, UK
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Vic, Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Vic, Australia
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26
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Abstract
Hamstring strain injuries are common among athletes and often require rehabilitation to prepare players for a timely return to sport performance while also minimizing reinjury risk. Return to sport is typically achieved within weeks of the injury; however, subsequent athlete performance may be impaired, and reinjury rates are high. Improving these outcomes requires rehabilitation practitioners (eg, athletic trainers and physical therapists) to understand the causes and mechanisms of hamstring strain injury, know how to perform a thorough clinical examination, and progress loading to the site of injury safely and effectively. This narrative review discusses current clinical concepts related to these aspects of rehabilitation for hamstring strain injury, with the aim of helping practitioners improve athletes' outcomes. Collectively, this knowledge will inform the implementation of evidence-based rehabilitation interventions.
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Affiliation(s)
- Jack T. Hickey
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne
,Sports Performance, Recovery, Injury and New Technologies Research Centre, Australian Catholic University, Melbourne
| | - David A. Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne
,Sports Performance, Recovery, Injury and New Technologies Research Centre, Australian Catholic University, Melbourne
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27
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Roughead EA, King MG, Crossley KM, Heerey JJ, Lawrenson PR, Scholes MJ, Semciw AI, Mentiplay BF, Kemp JL. Football players with long standing hip and groin pain display deficits in functional task performance. Phys Ther Sport 2022; 55:46-54. [DOI: 10.1016/j.ptsp.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
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28
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Mendonça LDM, Camelo PRP, Trevisan GCC, Bryk FF, Thorborg K, Oliveira RR. The Brazilian hip and groin outcome score (HAGOS-Br): cross-cultural adaptation and measurement properties. Braz J Phys Ther 2021; 25:874-882. [PMID: 34802916 DOI: 10.1016/j.bjpt.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/31/2021] [Accepted: 10/04/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Hip and groin pain or symptoms is a recurrent musculoskeletal complaint among young and active individuals. It is important to objectively measure functional limitations using patient-related outcomes that have been validated in the language of the target population. OBJECTIVES To perform a cross-cultural adaptation and to evaluate the measurement properties of the Hip and Groin Outcome Score (HAGOS) for the Brazilian population. METHODS We adapted the HAGOS to Brazilian Portuguese and evaluated the following measurement properties: internal consistency, test-retest reliability, measurement error, and structural and construct validity. The sample recruited consisted of active individuals between 18 and 55 years of age with long standing hip and groin pain and individuals who participated in sports with high physical demand of the hip and groin region. RESULTS A total of 103 athletes and physically active individuals of both sexes participated in this study. The HAGOS was successfully translated and culturally adapted to the Brazilian population. Factor analysis confirmed that the HAGOS consists of six subscales. The HAGOS-Br showed good internal consistency. The CFA revealed a Cronbach's alpha for the HAGOS subscales ranging from 0.86 to 0.96, test-retest reliability was substantial, with intraclass correlation coefficients ranging from 0.81 to 0.94 for the six subscales and an acceptable measurement error (standard error of measurement [SEM]=5.43-11.15 points; and smallest detectable chance [SDC]= 16.71-30.9 points). Good construct validity existed with more than 75% of the pre-defined hypotheses being confirmed. No ceiling or floor effects were observed. CONCLUSION The HAGOS-Br showed to be equivalent to the original version with adequate validity and reliability properties.
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Affiliation(s)
- Luciana De Michelis Mendonça
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal do Vales do Jequitinhonha e Mucur, Diamantina, Minas Gerais, Brazil; Physical Therapy Department, Faculty of Biological and Health Sciences, Universidade Federal do Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
| | - Paulo Ricardo Pinto Camelo
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal do Vales do Jequitinhonha e Mucur, Diamantina, Minas Gerais, Brazil
| | | | - Flávio Fernandes Bryk
- Staff Physical Therapist, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), Physical Therapy Department, São Paulo, São Paulo, Brazil
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Rodrigo Ribeiro Oliveira
- Brazilian National Society of Sports Physical Therapy (SONAFE), São Paulo, São Paulo, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
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29
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Brancaccio M, Mennitti C, Cesaro A, Monda E, D’Argenio V, Casaburi G, Mazzaccara C, Ranieri A, Fimiani F, Barretta F, Uomo F, Caiazza M, Lioncino M, D’Alicandro G, Limongelli G, Calabrò P, Terracciano D, Lombardo B, Frisso G, Scudiero O. Multidisciplinary In-Depth Investigation in a Young Athlete Suffering from Syncope Caused by Myocardial Bridge. Diagnostics (Basel) 2021; 11:diagnostics11112144. [PMID: 34829491 PMCID: PMC8618222 DOI: 10.3390/diagnostics11112144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022] Open
Abstract
Laboratory medicine, along with genetic investigations in sports medicine, is taking on an increasingly important role in monitoring athletes’ health conditions. Acute or intense exercise can result in metabolic imbalances, muscle injuries or reveal cardiovascular disorders. This study aimed to monitor the health status of a basketball player with an integrated approach, including biochemical and genetic investigations and advanced imaging techniques, to shed light on the causes of recurrent syncope he experienced during exercise. Biochemical analyses showed that the athlete had abnormal iron, ferritin and bilirubin levels. Coronary Computed Tomographic Angiography highlighted the presence of an intramyocardial bridge, suggesting this may be the cause of the observed syncopes. The athlete was excluded from competitive activity. In order to understand if this cardiac malformation could be caused by an inherited genetic condition, both array-CGH and whole exome sequencing were performed. Array-CGH showed two intronic deletions involving MACROD2 and COMMD10 genes, which could be related to a congenital heart defect; whole exome sequencing highlighted the genotype compatible with Gilbert syndrome. However, no clear pathogenic mutations related to the patient’s cardiological phenotype were detected, even after applying machine learning methods. This case report highlights the importance and the need to provide exhaustive personalized diagnostic work up for the athletes in order to cover the cause of their malaise and for safeguarding their health. This multidisciplinary approach can be useful to create ad personam training and treatments, thus avoiding the appearance of diseases and injuries which, if underestimated, can become irreversible disorders and sometimes can result in the death of the athlete.
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Affiliation(s)
- Mariarita Brancaccio
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
| | - Cristina Mennitti
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
| | - Arturo Cesaro
- Department of Translational Medical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (E.M.); (M.L.); (G.L.); (P.C.)
- Division of Clinical Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, 81100 Caserta, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (E.M.); (M.L.); (G.L.); (P.C.)
| | - Valeria D’Argenio
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, Via di val Cannuta 247, 00166 Roma, Italy
| | - Giorgio Casaburi
- Prescient Metabiomics, 1600 Faraday Ave, Carlsbad, CA 9200, USA;
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
| | - Annaluisa Ranieri
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
| | - Fabio Fimiani
- Unit of Inherited and Rare Cardiovascular Diseases, Azienda Ospedaliera di Rilievo Nazionale AORN Dei Colli, “V. Monaldi”, 80122 Naples, Italy;
| | - Ferdinando Barretta
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
| | - Fabiana Uomo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 81100 Naples, Italy;
| | - Michele Lioncino
- Department of Translational Medical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (E.M.); (M.L.); (G.L.); (P.C.)
| | - Giovanni D’Alicandro
- Department of Neuroscience and Rehabilitation, Center of Sports Medicine and Disability, AORN, Santobono-Pausillipon, 80122 Naples, Italy;
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (E.M.); (M.L.); (G.L.); (P.C.)
| | - Paolo Calabrò
- Department of Translational Medical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (E.M.); (M.L.); (G.L.); (P.C.)
- Division of Clinical Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, 81100 Caserta, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Barbara Lombardo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
- Correspondence: (G.F.); (O.S.); Tel.: +39-3472409595 (G.F.); +39-3396139908 (O.S.)
| | - Olga Scudiero
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
- Task Force on Microbiome Studies, University of Naples Federico II, 80100 Naples, Italy
- Correspondence: (G.F.); (O.S.); Tel.: +39-3472409595 (G.F.); +39-3396139908 (O.S.)
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Wörner T, Thorborg K, Clarsen B, Eek F. Hip and groin function and strength in male ice hockey players with and without hip and groin problems in the previous season- a prospective cohort study. Phys Ther Sport 2021; 52:263-271. [PMID: 34678567 DOI: 10.1016/j.ptsp.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe and compare hip and groin strength and function of male ice hockey players over one season in players with and without hip and groin problems in the previous season. DESIGN Prospective cohort study. SETTING Swedish male ice hockey. PARTICIPANTS We followed 193 players from 10 teams during the 2017/2018 season. MAIN OUTCOME MEASURES Hip adduction and abduction strength, 5 s squeeze test (5SST), and self-reported hip and groin function (Hip and Groin Outcome Score). Changes over the season and differences between players with and without problems in the previous season were analyzed by linear mixed models. RESULTS Adduction strength decreased slightly from pre-to mid-season and abduction strength increased slightly over the full season. However, self-reported function or pain did not change. Players with hip and groin problems in the previous season had significantly worse self-reported function, and more groin pain during the 5SST compared to players without. Strength measurments did not differ between groups. CONCLUSIONS Hip muscle strength, groin pain, and self-reported function appear to remain stable throughout the season in male ice hockey players. Remaining impairments in players with problems in the previous season suggest that function does not recover by ice hockey participation alone.
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Affiliation(s)
- Tobias Wörner
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Benjamin Clarsen
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway; Center for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Frida Eek
- Department of Health Sciences, Lund University, Lund, Sweden
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31
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Ishøi L, Nielsen MF, Krommes K, Husted RS, Hölmich P, Pedersen LL, Thorborg K. Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment-a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med 2021; 55:1301-1310. [PMID: 34531185 DOI: 10.1136/bjsports-2021-104060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/03/2022]
Abstract
This statement summarises and appraises the evidence on diagnostic tests and clinical information, and non-operative treatment of femoroacetabular impingement (FAI) syndrome and labral injuries. We included studies based on the highest available level of evidence as judged by study design. We evaluated the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation framework. We found 29 studies reporting 23 clinical tests and 14 different forms of clinical information, respectively. Restricted internal hip rotation in 0° hip flexion with or without pain was best to rule in FAI syndrome (low diagnostic effectiveness; low quality of evidence; interpretation of evidence: may increase post-test probability slightly), whereas no pain in Flexion Adduction Internal Rotation test or no restricted range of motion in Flexion Abduction External Rotation test compared with the unaffected side were best to rule out (very low to high diagnostic effectiveness; very low to moderate quality of evidence; interpretation of evidence: very uncertain, but may reduce post-test probability slightly). No forms of clinical information were found useful for diagnosis. For treatment of FAI syndrome, 14 randomised controlled trials were found. Prescribed physiotherapy, consisting of hip strengthening, hip joint manual therapy techniques, functional activity-specific retraining and education showed a small to medium effect size compared with a combination of passive modalities, stretching and advice (very low to low quality of evidence; interpretation of evidence: very uncertain, but may slightly improve outcomes). Prescribed physiotherapy was, however, inferior to hip arthroscopy (small effect size; moderate quality of evidence; interpretation of evidence: hip arthroscopy probably increases outcome slightly). For both domains, the overall quality of evidence ranged from very low to moderate indicating that future research on diagnosis and treatment may alter the conclusions from this review.
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Affiliation(s)
- Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Mathias Fabricius Nielsen
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Kasper Krommes
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Rasmus Skov Husted
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Orthopedic Surgery and Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
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32
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Ghaffari R, Yang DS, Kim J, Mansour A, Wright JA, Model JB, Wright DE, Rogers JA, Ray TR. State of Sweat: Emerging Wearable Systems for Real-Time, Noninvasive Sweat Sensing and Analytics. ACS Sens 2021; 6:2787-2801. [PMID: 34351759 DOI: 10.1021/acssensors.1c01133] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Skin-interfaced wearable systems with integrated colorimetric assays, microfluidic channels, and electrochemical sensors offer powerful capabilities for noninvasive, real-time sweat analysis. This Perspective details recent progress in the development and translation of novel wearable sensors for personalized assessment of sweat dynamics and biomarkers, with precise sampling and real-time analysis. Sensor accuracy, system ruggedness, and large-scale deployment in remote environments represent key opportunity areas, enabling broad deployment in the context of field studies, clinical trials, and recent commercialization. On-body measurements in these contexts show good agreement compared to conventional laboratory-based sweat analysis approaches. These device demonstrations highlight the utility of biochemical sensing platforms for personalized assessment of performance, wellness, and health across a broad range of applications.
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Affiliation(s)
- Roozbeh Ghaffari
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois 60202, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60202, United States
- Epicore Biosystems, Inc., Cambridge, Massachusetts 02139, United States
| | - Da Som Yang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois 60202, United States
| | - Joohee Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois 60202, United States
| | - Amer Mansour
- Division of Biological Sciences, The University of Chicago, Chicago, Illinois 60637, United States
| | - John A. Wright
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois 60202, United States
- Epicore Biosystems, Inc., Cambridge, Massachusetts 02139, United States
| | - Jeffrey B. Model
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois 60202, United States
- Epicore Biosystems, Inc., Cambridge, Massachusetts 02139, United States
| | - Donald E. Wright
- Epicore Biosystems, Inc., Cambridge, Massachusetts 02139, United States
| | - John A. Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois 60202, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60202, United States
- Epicore Biosystems, Inc., Cambridge, Massachusetts 02139, United States
- Departments of Materials Science and Engineering, Mechanical Engineering, Electrical and Computer Engineering, and Chemistry, Northwestern University, Evanston, Illinois 60202, United States
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Tyler R. Ray
- Department of Mechanical Engineering, University of Hawai’i at Ma̅noa, Honolulu, Hawaii 96822, United States
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawai’i at Ma̅noa, Honolulu, Hawaii 96813, United States
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33
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Heerey J, Agricola R, Smith A, Kemp J, Pizzari T, King M, Lawrenson P, Scholes M, Crossley K. The Size and Prevalence of Bony Hip Morphology Do Not Differ Between Football Players With and Without Hip and/or Groin Pain: Findings From the FORCe Cohort. J Orthop Sports Phys Ther 2021; 51:115-125. [PMID: 33356776 DOI: 10.2519/jospt.2021.9622] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the size and prevalence of bony hip morphology in football players with and without hip and/or groin pain. DESIGN Case-control. METHODS We recruited 184 soccer and Australian football players with self-reported hip and/or groin pain of greater than 6 months in duration and a positive flexion, adduction, and internal rotation (FADIR) test (290 hips, 21% women), and 55 football players with no pain and a negative FADIR test (110 hips, 26% women) as a control group. Bony hip morphology was identified by the alpha angle and lateral center-edge angle (LCEA) on anteroposterior pelvis and Dunn 45° radiographs. The alpha angle and LCEA were analyzed as continuous measures (size) and dichotomized using threshold values to determine the presence of bony hip morphology (cam, large cam, pincer, and acetabular dysplasia). Regression analyses estimated differences in the size and prevalence of bony hip morphology between football players with and without pain. RESULTS In all football players and in men, the size and prevalence of bony hip morphology did not differ between those with and without hip and/or groin pain. Cam morphology was evident in 63% of hips in players without pain and 71% of symptomatic hips in players with hip and/or groin pain. In female football players with hip and/or groin pain compared to those without pain, larger alpha angle values were observed on the Dunn 45° view (5.9°; 95% confidence interval: 1.2°, 10.6°; P = .014). CONCLUSION The size and prevalence of bony hip morphology appear to be similar in football players with and without hip and/or groin pain. J Orthop Sports Phys Ther 2021;51(3):115-125. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9622.
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HIP AND PELVIC STABILITY AND GAIT RETRAINING IN THE MANAGEMENT OF ATHLETIC PUBALGIA AND HIP LABRAL PATHOLOGY IN A FEMALE RUNNER: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1174-1183. [PMID: 33344033 DOI: 10.26603/ijspt20201174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Athletic pubalgia is a prevalent injury in athletes who kick, pivot, and cut, however it is poorly described in the literature. Many athletes with this diagnosis fail conservative management secondary to continued pain with activity and require surgical intervention for return to sport. Purpose The purpose of this case report is to describe an intervention strategy focusing on gait retraining and hip and lumbopelvic stability for a female runner diagnosed with athletic pubalgia and a labral tear of the hip. Case Description This case report involved a 45-year-old female runner who was seen for 14 visits, from examination to return to sport, with a follow up at 12 months post discharge. Interventions included hip, pelvic, and lumbar stability exercises, and gait retraining. Outcomes measurements included: pain on the numeric pain rating scale, the Lower Extremity Functional Scale (LEFS), gait mechanics, strength, and participation in sport. Outcomes At discharge the subject demonstrated improved strength of all muscle groups and changes in lower extremity running biomechanics. Changes in running mechanics included increased cadence, decreased pelvic drop, diminished over striding, and improved knee control with less valgus movement during the stance phase of gait. The subject reported no pain with running or recreational activities at discharge and follow up at 12 months post discharge. Discussion/Conclusion Most of the literature on conservative rehabilitation for athletic pubalgia focuses on athletes whose sports require pivoting and kicking. The literature provides little information on gait analysis and retraining for runners with a diagnosis of athletic pubalgia and/or hip labrum tears. The program used in this case report including gait retraining and hip, pelvic, and lumbar stability training allowed for full return to running in a 45-year-old female with a diagnosis of hip labrum tear and athletic pubalgia. Further research is needed to discern best conservative treatment for runners with athletic pubalgia and/or hip labral tears. Level of evidence 4.
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35
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Thorborg K, Hölmich P. Use of Sports Hernia to Describe Groin Pain in Athletes. JAMA Surg 2020; 155:895. [PMID: 32520338 DOI: 10.1001/jamasurg.2020.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen, Amager-Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen, Amager-Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark
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36
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Peterson S. Physical therapy management of a patient with persistent groin pain after total hip arthroplasty and iliopsoas tenotomy: a case report. Physiother Theory Pract 2020; 38:481-491. [PMID: 32544015 DOI: 10.1080/09593985.2020.1768458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hip impingement syndrome can occur after total hip arthroplasty (THA). Nonoperative treatment is inconsistently recommended, and surgical options include iliopsoas tenotomy. The current case report describes the unique case of a patient with persistent groin pain after THA and iliopsoas tenotomy. CASE DESCRIPTION The 72-year-old male had persistent groin pain after right THA and an unsuccessful iliopsoas tenotomy. He had pain and limited right hip range of motion during active and passive hip flexion, abduction, and external rotation. Treatment consisted of high-grade joint mobilization to improve the range of motion of the right hip and an exercise program. OUTCOMES The patient was treated for six visits over 3 weeks. Clinically important improvements were noted in pain, function, and perceived level of improvement. Pain during hip flexion improved on the Numeric Pain Rating Scale, and function improved on the Lower Extremity Functional Scale. Improvements in the range of motion and strength were also observed. At 6-month follow-up, he reported maintenance of improvements. DISCUSSION Joint mobilization and exercise were effective for improving range of motion, groin pain, and function in a patient with a 4-year history of persistent groin pain after THA and subsequent iliopsoas tenotomy.
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Affiliation(s)
- Seth Peterson
- Physical Therapy, The Motive, Oro Valley, AZ, USA.,Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
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37
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Reiman MP, Agricola R, Kemp JL, Heerey JJ, Weir A, van Klij P, Kassarjian A, Mosler AB, Ageberg E, Hölmich P, Warholm KM, Griffin D, Mayes S, Khan KM, Crossley KM, Bizzini M, Bloom N, Casartelli NC, Diamond LE, Di Stasi S, Drew M, Friedman DJ, Freke M, Gojanovic B, Glyn-Jones S, Harris-Hayes M, Hunt MA, Impellizzeri FM, Ishøi L, Jones DM, King MG, Lawrenson PR, Leunig M, Lewis CL, Mathieu N, Moksnes H, Risberg MA, Scholes MJ, Semciw AI, Serner A, Thorborg K, Wörner T, Dijkstra HP. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2020; 54:631-641. [PMID: 31959678 DOI: 10.1136/bjsports-2019-101453] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2020] [Indexed: 12/31/2022]
Abstract
There is no agreement on how to classify, define or diagnose hip-related pain-a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion-adduction-internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head-neck radiographs are the initial diagnostic imaging of choice-advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.
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Affiliation(s)
- Michael P Reiman
- Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus, MC, University Medical Center, Rotterdam, Netherlands
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Weir
- Orthopaedics, Erasmus MC Center for Groin Injuries, Rotterdam, The Netherlands.,Sports Groin Pain Centre, Aspetar Hospital, Doha, Qatar
| | - Pim van Klij
- Department of Orthopaedic Surgery, Erasmus, MC, University Medical Center, Rotterdam, Netherlands
| | - Ara Kassarjian
- Elite Sports Imaging SL, Madrid, Spain.,Musculoskeletal Radiology, Corades, LLC, Brookline, MA, United States
| | - Andrea Britt Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Eva Ageberg
- Sport Sciences, Deparment of Health Sciences, Lund University, Lund, Sweden
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | | | - Damian Griffin
- Orthopaedics - Medical School, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Sue Mayes
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Karim M Khan
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Mario Bizzini
- Research, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Nancy Bloom
- Physical Therapy, Washington University, St. Louis, Missouri, USA
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland Griffith University, Schoold of Allied Health Sciences, Griffith, Queensland, Australia
| | - Stephanie Di Stasi
- School of Health and Rehabilitation Sciences, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael Drew
- Athlete Availability, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia.,Research into Sport and Exercise, University of Canberra, Canberra, Bruce, Australian Capital Territory, Australia
| | | | - Matthew Freke
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland.,Sports Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sion Glyn-Jones
- Department of Orthopaedic Surgery, University of Oxford, Institute of Musculoskeletal Sciences, Oxford, United Kingdom
| | | | - Michael A Hunt
- Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Peter R Lawrenson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
| | - Cara L Lewis
- Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Nicolas Mathieu
- Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Loeche-les-Bains, Valais, Switzerland
| | | | - May-Arna Risberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Mark James Scholes
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Andreas Serner
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Tobias Wörner
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Hendrik Paulus Dijkstra
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
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Does athletic groin pain affect the muscular co-contraction during a change of direction. Gait Posture 2019; 73:173-179. [PMID: 31344606 DOI: 10.1016/j.gaitpost.2019.07.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/04/2019] [Accepted: 07/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Groin pain is one of the common problems in multidirectional sports. It seems that abnormal muscular activity and improper movement strategy led to prolongation and high rate of this injury. Therefore, the aim of this study was to Comparing the Average amplitude of Electromyography (AEMG), co-contraction ratio (CCR) of selected thigh and thoracic muscle during turning in individuals with chronic groin pain and healthy individuals. METHODS Surface electromyography was collected from the internal oblique/transversus abdominis (IO/TrA), multifidus (MF), adductor Longus (AL) and gluteus Medius (GM) for AEMG and CCR analyzed in 16-males with LSGP and 16-controls in four motion phases during 11 cycles of gait coupled with turning. RESULTS Results revealed that in the AEMG apart from the third phase in the muscle of the IO/ Tr. A muscle and in the second phase in the MF muscle in the trunk and in the third phase in the muscle of the AL and the fourth phase in the GM foot Left There was a significant difference in other phases. There was a significant difference in the CCR, except in the second phase of the trunk and the fourth phase of the left foot in the rest of the phases. CONCLUSIONS It seems that in athletes with LSGP, have selective muscular activation and CCR have during turning, that may be resulting in compensatory strategies and movement control defects, which may be a useful tool to predict LSGP occurrence in players with a history of groin pain.
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39
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Current trends in sport and exercise hip conditions: Intra-articular and extra-articular hip pain, with detailed focus on femoroacetabular impingement (FAI) syndrome. Best Pract Res Clin Rheumatol 2019; 33:66-87. [PMID: 31431276 DOI: 10.1016/j.berh.2019.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Musculoskeletal conditions, such as hip pain are leading causes of pain and disability. Hip pain is the second most common cause of lower limb musculoskeletal pain, and is commonly seen in active individuals. Hip and groin pain may have intra-articular and extra-articular causes. Femoroacetabular impingement (FAI) syndrome and the associated pathologies are common intra-articular causes of hip and groin pain in active individuals. There are also a number of extra-articular causes of pain, which include musculotendinous conditions, extra-articular impingements and the clinical entities of groin pain described in the Doha agreement. This chapter will describe these, with a detailed focus on FAI syndrome. Specifically, it addresses: 1. What is and what causes FAI syndrome; 2. How do I diagnose FAI syndrome; and 3. What is the evidence-based approach to managing FAI syndrome?
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40
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Sheen AJ, Montgomery A, Simon T, Ilves I, Paajanen H. Randomized clinical trial of open suture repair versus totally extraperitoneal repair for treatment of sportsman's hernia. Br J Surg 2019; 106:837-844. [DOI: 10.1002/bjs.11226] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/22/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Sportsman's hernia/athletic pubalgia is a recognized cause of chronic groin pain in athletes. Both open and laparoscopic surgical repairs have been described for treatment, but there are no comparative studies. The hypothesis here was that relief of pain would be achieved earlier in patients treated with open minimal suture repair than totally extraperitoneal repair.
Methods
A randomized multicentre trial in four European countries was conducted to compare open minimal suture repair with totally extraperitoneal repair. The primary endpoint was complete relief of pain (visual analogue scale (VAS) score 20 or less on a scale from 0 to 100 mm) at 1 month. Secondary endpoints included complications, time to return to sporting activity, and number of patients returning to sport within 1 year.
Results
A total of 65 athletes (92 per cent men) with a median age of 29 years were enrolled (31 open repair, 34 totally extraperitoneal repair). By 4 weeks after surgery, median preoperative VAS scores had dropped from 70–80 to 10–20 in both groups (P < 0·001). Relief of pain (VAS score 20 or less) during sports activity 4 weeks after surgery was achieved in 14 of 31 patients after open repair and 24 of 34 after totally extraperitoneal repair (P = 0·047). Return to full sporting activity was achieved by 16 and 18 patients respectively after 1 month (P = 0·992), and by 25 versus 31 after 3 months (P = 0·408).
Conclusion
Totally extraperitoneal repair was less painful than open repair in the first month, but otherwise both procedures were similarly effective in treating chronic pain due to sportsman's hernia. Registration number: NCT02297711 ( http://www.clinical.trials.gov).
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Affiliation(s)
- A J Sheen
- Department of Surgery, Manchester University Foundation Trust, Manchester, UK
- Centre of Biomedicine Manchester Metropolitan University, Manchester, UK
- Fortius Clinic, London, UK
| | - A Montgomery
- Department of Surgery, Institution for Clinical Science, Lund University, Skåne University Hospital, Malmö, Sweden
| | - T Simon
- Department of General Surgery, GRN-Klinik Sinsheim, Heidelberg University Hospital, Heidelberg, Germany
| | - I Ilves
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
| | - H Paajanen
- Department of Gastrointestinal Surgery, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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41
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What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis. Sports Med 2019; 49:951-972. [DOI: 10.1007/s40279-019-01092-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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42
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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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