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Chaari F, Rahmani A, Rebai H, Fendri T, Sahli S, Boyas S. Core stability is associated with dynamic postural balance in soccer players experiencing groin pain without time-loss. J Orthop 2024; 53:1-6. [PMID: 38450062 PMCID: PMC10911967 DOI: 10.1016/j.jor.2024.02.038] [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: 02/11/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024] Open
Abstract
Objectives The study sought to evaluate possible relationships between dynamic postural balance and pain, core stability, and hip range of motion in soccer players who were experiencing groin pain (GP). Furthermore, the study aimed to compare these measurements in symptomatic and asymptomatic players. Methods The study included 42 male soccer players experiencing GP and an equal number of asymptomatic players. Dynamic postural balance, pain, hip range of motion and trunk endurance were measured. Results The GP group revealed reduced dynamic balance performance (p < 0.01-0.001) in injured and non-injured limbs compared to control group. Further, players experiencing GP demonstrated lower hip range of motion in internal (p < 0.05) and total rotations (p < 0.01) in the injured limb, and lower trunk endurance (p < 0.001) compared to their asymptomatic peers. In general, core stability was associated (r = 0.13-0.61, p < 0.05-0.001) with the poor dynamic balance performance in the GP group while standing on injured and non-injured limbs. No significant correlations between dynamic postural balance, pain and hip range of motion were observed. Conclusion Poor core endurance was found to be associated with dynamic balance disorders in soccer players experiencing GP. This information can aid in the development of targeted strategies to enhance dynamic postural balance in these players.
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Affiliation(s)
- Fatma Chaari
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia
- Research Laboratory, Movement - Interactions, Performance, MIP, UR4334, Faculty of Sciences and Technologies, Le Mans, France
| | - Abderrahmane Rahmani
- Research Laboratory, Movement - Interactions, Performance, MIP, UR4334, Faculty of Sciences and Technologies, Le Mans, France
| | - Haithem Rebai
- Tunisian Research Laboratory ‘Sports Performance Optimization (LR09SEP01), National Center of Medicine and Science in Sports (CNMSS), Tunis, Tunisia
| | - Thouraya Fendri
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia
- Research Laboratory, Movement - Interactions, Performance, MIP, UR4334, Faculty of Sciences and Technologies, Le Mans, France
| | - Sonia Sahli
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia
| | - Sébastien Boyas
- Research Laboratory, Movement - Interactions, Performance, MIP, UR4334, Faculty of Sciences and Technologies, Le Mans, France
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Cotellessa F, Puce L, Formica M, May MC, Trompetto C, Perrone M, Bertulessi A, Anfossi V, Modenesi R, Marinelli L, Bragazzi NL, Mori L. Effectiveness of a Preventative Program for Groin Pain Syndrome in Elite Youth Soccer Players: A Prospective, Randomized, Controlled, Single-Blind Study. Healthcare (Basel) 2023; 11:2367. [PMID: 37685401 PMCID: PMC10486402 DOI: 10.3390/healthcare11172367] [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: 06/30/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
Groin pain syndrome (GPS) is a prevalent issue in soccer. This study assessed the effectiveness of a new preventive protocol on GPS for youth soccer players. The protocol included targeted stretching and strengthening exercises for the adductor and core muscles from preseason to midseason. A questionnaire and two pain provocation tests were used for the evaluation. Mild GPS required positive results in at least two evaluations, while severe GPS was associated with pain incompatible with engagement in any activity confirmed by diagnostic ultrasound. Forty-two elite male athletes (aged 16.9 ± 0.7 years) participated in the study, with half of them assigned to the usual training (control group) and the remaining athletes undergoing the preventive protocol (treatment group) for 24 weeks. GPS rates were 14.3% (three diagnoses: two mild, one severe) in the treatment group and 28.6% (six diagnoses: three mild, three severe) in the control group. Toward the end of the season, three players, one from the treatment group and two from the control group had to stop playing due to severe GPS problems. In addition, one player in the control group stopped midseason. Even though the reduction in the risk of developing GPS was not significant (relative risk of 0.50 ([95%CI 0.14 to 1.74], p = 0.2759), the halved incidence of severe GPS and the increased muscle strength related to the treatment (p = 0.0277) are encouraging data for future studies.
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Affiliation(s)
- Filippo Cotellessa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
| | - Matteo Formica
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
- Orthopedic Clinic, Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Maria Cesarina May
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Marco Perrone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
| | - Andrea Bertulessi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Vittorio Anfossi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Roberto Modenesi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (F.C.); (C.T.); (M.P.); (A.B.); (V.A.); (R.M.); (L.M.); (L.M.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.F.); (M.C.M.)
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Chaari F, Boyas S, Sahli S, Fendri T, Harrabi MA, Rebai H, Rahmani A. Postural balance asymmetry and subsequent noncontact lower extremity musculoskeletal injuries among Tunisian soccer players with groin pain: A prospective case control study. Gait Posture 2022; 98:134-140. [PMID: 36115130 DOI: 10.1016/j.gaitpost.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 08/08/2022] [Accepted: 09/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent studies reported postural balance disorders in patients and soccer players with groin pain (GP) compared to controls. Since postural balance asymmetry identified after an initial injury contributes for subsequent injuries, identification of this asymmetry in soccer players with GP may highlight the risk of sustaining subsequent noncontact lower extremity musculoskeletal injuries in these players. Therefore, the aims of this study were to (i) examine static and dynamic unipedal postural balance asymmetry in soccer players with GP compared to healthy ones, and (ii) quantify the risk of subsequent noncontact lower extremity injuries in these players. RESEARCH QUESTION Do soccer players with GP exhibit higher static and dynamic unipedal postural balance asymmetry, and higher risk of sustaining subsequent injuries compared to controls? METHODS In this prospective case control study, 27 soccer players with non-time loss GP (GP group: GPG), and 27 healthy ones (control group: CG) were enrolled. Static and dynamic unipedal postural balance asymmetry were evaluated with a force platform using symmetry index (SI), and Y-balance test (Y-BT), respectively. Additionally, subsequent noncontact lower extremity musculoskeletal injuries were tracked for 10 months. RESULTS The GPG revealed higher (p < 0.01) SI in eyes closed condition, higher (p < 0.001) side-to-side asymmetry in anterior, posteromedial and posterolateral reach distances and in composite Y-BT score compared to CG. They showed lower (p < 0.001) composite score for injured limb and higher (p < 0.001) side-to-side asymmetry in posteromedial reach distance compared to the cut-off values of 89.6 % and 4 cm, respectively. Moreover, GPG exhibited higher odds (OR= 7.48; 95 % CI = 2.15, 26.00; p < 0.01) of sustaining subsequent injuries compared to CG. SIGNIFICANCE The Y-BT should be instituted into existing pre-participation physical examinations to screen for soccer players with non-time loss GP at an elevated risk of sustaining subsequent injuries. This could help coaches and clinicians make valid return to play decisions.
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Affiliation(s)
- Fatma Chaari
- Research laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Sébastien Boyas
- Le Mans University, Movement - Interactions, Performance, MIP, EA 4334, France Faculty of Sciences and Technologies, Avenue Olivier Messiaen, 72000 Le Mans, France.
| | - Sonia Sahli
- Research laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Thouraya Fendri
- Research laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Mohammed A Harrabi
- Research laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Haithem Rebai
- Research laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Abderrahmane Rahmani
- Le Mans University, Movement - Interactions, Performance, MIP, EA 4334, France Faculty of Sciences and Technologies, Avenue Olivier Messiaen, 72000 Le Mans, France.
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Tateuchi H, Yamagata M, Asayama A, Ichihashi N. Influence of simulated hip muscle weakness on hip joint forces during deep squatting. J Sports Sci 2021; 39:2289-2297. [PMID: 34006185 DOI: 10.1080/02640414.2021.1929009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to determine the effects of simulated hip muscle weakness on changes in hip joint forces during deep squat motion. Ten healthy individuals performed squat motion at three different positions (0° foot angle [N-squat], 10° toe-in [IN-squat], and 30° toe-out [OUT-squat]). A scaled musculoskeletal model for each participant was used to calculate the muscle and hip joint forces. For each hip muscle, models of full strength, mild muscle weakness (15% decrease), and severe muscle weakness (30% decrease) were created. The muscles affecting the hip joint forces were identified, and the rate of change in the joint forces was compared among the three squat conditions. The anterior hip joint force was increased in the muscle weakness models of the inferior gluteus maximus (iGlutMax) and iGlutMax+deep external rotator (ExtRot) muscles. With 30% muscle weakness of these muscles, statistically significant differences in the rate of increase in the anterior joint force were observed in the following order: IN-squat (iGlutMax, 29.5%; iGlutMax+ExtRot, 41.4%), N-squat (iGlutMax, 18.3%; iGlutMax+ExtRot, 27.8%), and OUT-squat (iGlutMax, 5.6%; iGlutMax+ExtRot, 9.3%). OUT-squat may be recommended to minimize the increase in hip joint forces if accompanied by hip muscle weakness.
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Affiliation(s)
- Hiroshige Tateuchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Momoko Yamagata
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Graduate School of Human Development and Environment, Kobe University, Hyogo, Japan.,Japan Society for the Promotion of Science, Japan
| | - Akihiro Asayama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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AlAbdulwahab SS, Kachanathu SJ, AlSunaidi ASN. A cross-sectional study on fear-avoidance beliefs and chronic low back pain in fighter pilots. Int J Crit Illn Inj Sci 2021; 11:29-32. [PMID: 34159134 PMCID: PMC8183371 DOI: 10.4103/ijciis.ijciis_95_19] [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: 11/19/2019] [Revised: 01/21/2020] [Accepted: 06/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background Chronic low back pain (CLBP) is considered a serious complaint among fighter pilots because the vertebrae of these pilots are exposed to high compression forces from prolonged sitting on a hard ejection seat and frequent sudden fighter aircraft maneuvers. It is yet unknown whether a correlation exists between CLBP and psychosocial/behavioral performance of fighter pilots. Methods This was a cross-sectional study of 66 fighter pilots with nonspecific CLBP voluntarily participated in this study. Self-efficacy was measured based on the degree of physical activity and work performance using the fear-avoidance beliefs questionnaire (FABQ). Results A significant inverse correlation was found between the work subscale of the FABQ (FABQw) (mean score: 27.4 ± 8.4) and both age (mean: 35 ± 4.9 years) and flying experience (mean: 13.2 ± 4.4 years) among fighter pilots with nonspecific CLBP. In contrast, there was no significant correlation between physical activity subscale of the FABQ (mean score: 12.3 ± 6.4) and both age and flying experience. Conclusions An inverse correlation was observed between FABQw and both age and flying experience among fighter pilots with nonspecific CLBP. It is important for rehabilitation specialists to understand the role of cognitive/affective components of a pain from tissue injury and nociception to prevent occupational disability and enhance occupational performance.
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Affiliation(s)
- Sami S AlAbdulwahab
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Shaji John Kachanathu
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali S N AlSunaidi
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Daniels KAJ, King E, Richter C, Falvey É, Franklyn-Miller A. Changes in the kinetics and kinematics of a reactive cut maneuver after successful athletic groin pain rehabilitation. Scand J Med Sci Sports 2020; 31:839-847. [PMID: 33098142 DOI: 10.1111/sms.13860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/19/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
Athletic groin pain (AGP) is a chronic, painful condition which is prevalent in players of field sports that require rapid changes of direction. Following successful rehabilitation, systematic changes have been observed in the kinetics and kinematics of pre-planned change of direction maneuvers, providing insight into potential foci for rehabilitation monitoring and for the assessment of interventions. However, changing direction in field sports is often reactive rather than pre-planned, and it is not known whether such post-rehabilitation changes are seen in reactive maneuvers. We analyzed the stance phase kinetics and kinematics of a 90° reactive cutting maneuver in 35 AGP patients before and after a successful exercise intervention program. Following the intervention, transverse plane rotation of the pelvis toward the intended direction of travel increased, and the body center of mass was positioned more anteriorly relative to the center of pressure. Ankle dorsiflexion also increased, and participants demonstrated greater ankle plantar flexor internal moment and power during the second half of stance. These findings provide insight into mechanical variables of potential importance in AGP, as identified during a maneuver based on a common sporting task.
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Affiliation(s)
- Katherine A J Daniels
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Queen's School of Engineering, University of Bristol, Bristol, UK.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Life Sciences, University of Roehampton, London, UK
| | - Chris Richter
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Life Sciences, University of Roehampton, London, UK
| | - Éanna Falvey
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Andy Franklyn-Miller
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.,Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
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Combining results from hip impingement and range of motion tests can increase diagnostic accuracy in patients with FAI syndrome. Knee Surg Sports Traumatol Arthrosc 2020; 28:3382-3392. [PMID: 32335699 PMCID: PMC7511272 DOI: 10.1007/s00167-020-06005-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/16/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Clinical examination is an important part in the diagnosis of femoroacetabular impingement (FAI) syndrome. However, knowledge on reliability and validity of clinical diagnostic tests is scarce. The aims were to evaluate the inter-rater agreement and diagnostic accuracy of clinical tests to detect patients with FAI syndrome. METHODS Eighty-one patients (49% women) were recruited. Two experienced raters performed impingement and range of motion (ROM) tests. Three criteria had to be fulfilled for the diagnosis of FAI syndrome: (1) symptoms; (2) CAM and/or Pincer morphology; and (3) being responder to intra-articular block injection. For inter-rater agreement, the Cohen's kappa statistics were used (0.41-0.60 = moderate, 0.61-0.80 = substantial agreement). For diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were calculated. RESULTS Anterior impingement test (AIMT), FADIR test and FABER test showed kappa values above 0.6. All passive hip ROM, except extension, had kappa values above 0.4. AIMT and FADIR showed the highest sensitivity, i.e., 80%, with a specificity of 26% and 25%, respectively. Passive hip ROM in internal rotation with neutral hip position had a sensitivity of 29% and a specificity of 94%. CONCLUSION The AIMT, FADIR and FABER tests were reliable between two experienced raters, while results from different raters for hip ROM should be interpreted with caution. The AIMT and FADIR test can only be used to rule out patients with FAI syndrome, while evaluation of ROM in internal rotation with neutral position may be more suitable to rule in patients with FAI syndrome. LEVEL OF EVIDENCE II.
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Measuring the Hip Adductor to Abductor Strength Ratio in Ice Hockey and Soccer Players: A Critically Appraised Topic. J Sport Rehabil 2020; 29:116-121. [PMID: 30676199 DOI: 10.1123/jsr.2018-0250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/12/2018] [Accepted: 12/28/2018] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Ice hockey and soccer are both dynamic sports that involve continuous, unpredictable play. These athletes consistently demonstrate higher rates of groin strains compared with other contact sports. Measuring the hip adductor/abductor ratio has the potential to expose at-risk players, reduce injury rates, and preserve groin health in players with chronic strains. Focused Clinical Question: What is the clinical utility of measuring the hip adductor/abductor ratio for preseason and in-season ice hockey and soccer players? Summary of Key Findings: Three studies, all of which were prospective cohort designs, were included. One study involved assessing preseason strength and flexibility as a risk factor for adductor strains in professional ice hockey players. Another study performed with the same professional hockey team used preseason hip adductor/abductor strength ratios to screen for those players who would benefit from a strengthening intervention aimed at reducing the incidence of adductor strains. The final study, which was performed in elite U17 soccer players, assessed the effectiveness of monthly in-season strength monitoring as a guide to trigger in-season interventions to decrease injury incidence. Clinical Bottom Line: Measuring the hip adductor/abductor strength ratio in hockey and soccer players can be a beneficial preseason and in-season tool to predict future groin strain risk and screen for athletes who might benefit from a strengthening intervention. Strength of Recommendation: Level 3 evidence exists to support monitoring the hip adductor/abductor strength ratio to assess and reduce the risk of adductor strains in ice hockey and soccer players.
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Moreno-Pérez V, Nakamura FY, Sánchez-Migallón V, Domínguez R, Fernández-Elías VE, Fernández-Fernández J, Pérez-López A, López-Samanes A. The acute effect of match-play on hip range of motion and isometric strength in elite tennis players. PeerJ 2019; 7:e7940. [PMID: 31737442 PMCID: PMC6855201 DOI: 10.7717/peerj.7940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022] Open
Abstract
Background Groin injuries are some of the most common injuries tennis players suffer. Several factors (e.g., post-match decrease in hip adductor (ADD) strength) have been proposed as possible mechanisms for increasing the incidence of this type of injury. However, the risk factors of developing groin injuries after a tennis match have not yet been delineated. Objective The aim of this study was to determine the effect of tennis match-play on isometric ADD and abductor (ABD) strength and passive hip range of motion (ROM). Methods Twenty-six male tennis players (20.30 ± 4.98 years) took part in this study. Participants completed an evaluation of strength and flexibility hip measurements before and after a simulated tennis match. Dominant and non-dominant passive hip ROM, ADD and ABD isometric strength, and the ADD/ABD strength ratio were measured before and immediately post-match. A global positioning system (GPS) and a session rating of perceived exertion (RPE) were used to assess the locomotive demands and internal match load. Results Isometric dominant ADD strength (17.8%, p ≤ 0.01) and ADD/ABD strength ratio (11.6%, p = 0.04) were lower post-match compared to the pre-match values. No between-limbs differences were observed for isometric ADD strength, ABD strength, and passive hip ROM tests. RPE showed an expected increase between pre- vs. post-match (pre- vs. post-warming-up, 3.42 ± 2.08 vs. 5.62 ± 2.29, p < 0.01). In addition, a significant relationship between ADD strength and the volume of tennis practice per week was found, stablishing that tennis players with lower volume of training per week suffered a reduction in ADD strength in their dominant limb after match-play (r = 0.420, p = 0.04). Conclusion The assessment of ADD strength and the ADD/ABD strength ratio in the dominant limb may be considered a post-match tool that can be used to identify players who require rest and additional recovery strategies before competing again.
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Affiliation(s)
- Victor Moreno-Pérez
- Center for Translational Research in Physiotherapy, Department of Pathology and Surgery. Universidad Miguel Hernández, Elche, San Juan, Spain
| | - Fabio Yuzo Nakamura
- Associate Graduate Program in Physical Education UPE/UFPB, Joao Pessoa University, Joao Pessoa, Brazil.,The College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Violeta Sánchez-Migallón
- School of Physiotherapy, School of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Raul Domínguez
- College of Health Sciences, Isabel I University, Burgos, Spain
| | | | - Jaime Fernández-Fernández
- Department of Physical Activity and Sports Sciences, Universidad del León, Spain, University of Leon, Leon, Spain
| | - Alberto Pérez-López
- Department of Biomedical Sciences (Area of Sport and Physical Education), Faculty of Medicine and Health Sciences, University of Alcala, Madrid, Spain
| | - Alvaro López-Samanes
- School of Physiotherapy, School of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
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Pålsson A, Kostogiannis I, Lindvall H, Ageberg E. Hip-related groin pain, patient characteristics and patient-reported outcomes in patients referred to tertiary care due to longstanding hip and groin pain: a cross-sectional study. BMC Musculoskelet Disord 2019; 20:432. [PMID: 31521142 PMCID: PMC6745069 DOI: 10.1186/s12891-019-2794-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 08/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to advances in hip arthroscopy, the number of surgical procedures has increased dramatically. The diagnostic challenge in patients with longstanding hip and groin pain, as well as the increasing number of hip arthroscopies, may lead to a higher number of patients referred to tertiary care for consideration for surgery. Therefore, the aims were: 1) to describe the prevalence of hip-related groin pain in patients referred to tertiary care due to longstanding hip and groin pain; and 2) to compare patient characteristics and patient-reported outcomes for patients categorized as having hip-related groin pain and those with non-hip-related groin pain. METHODS Eighty-one patients referred to the Department of Orthopedics at Skåne University Hospital for longstanding hip and groin pain were consecutively included and categorized into hip-related groin pain or non-hip-related groin pain using diagnostic criteria based on current best evidence (clinical examination, radiological examination and intra-articular block injection). Patient characteristics (gender (%), age (years), BMI (kg/m2)), results from the Hip Sports Activity Scale (HSAS), the SF-36, the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain distribution (pain manikin) were collected. Parametric and non-parametric statistics were used as appropriate for between-group analysis. RESULTS Thirty-three (47%) patients, (30% women, 70% men, p < 0.01), were categorized as having hip-related groin pain. The hip-related groin pain group had a higher activity level during adolescence (p = 0.013), and a higher pre-injury activity level (p = 0.034), compared to the non-hip-related groin pain group. No differences (mean difference (95% CI)) between hip-related groin pain and non-hip-related groin pain were observed for age (0 (- 4; 4)), BMI (- 1.75 (- 3.61; 0.12)), any HAGOS subscales (p ≥ 0.318), any SF-36 subscales (p ≥ 0.142) or pain distribution (p ≥ 0.201). CONCLUSIONS Only half of the patients referred to tertiary care for long-standing hip and groin pain, who were predominantly men with a high activity level, had hip-related groin pain. Self-reported pain localization and distribution did not differ between patients with hip-related groin pain and those with non-hip-related groin pain, and both patient groups had poor perceived general health, and hip-related symptoms and function.
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Affiliation(s)
- Anders Pålsson
- Department of Health Sciences, Lund University, PO Box 157, 22100, Lund, Sweden.
| | - Ioannis Kostogiannis
- Department of Health Sciences, Lund University, PO Box 157, 22100, Lund, Sweden.,Department of Orthopaedics, Clinical Sciences, Lund University, Malmö, Sweden
| | - Håkan Lindvall
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Malmö, Sweden.,Department of Imaging and Functional Medicine, Skåne University Hospital Malmö, Malmö, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, PO Box 157, 22100, Lund, Sweden
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11
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Ramazzina I, Bernazzoli B, Braghieri V, Costantino C. Groin pain in athletes and non-interventional rehabilitative treatment: a systematic review. J Sports Med Phys Fitness 2018; 59:1001-1010. [PMID: 30160087 DOI: 10.23736/s0022-4707.18.08879-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Groin pain is a common complaint both in high-performance and recreational athletes. Diagnosis is based on the patient's history and physical examination. Imaging assessments are often considered to exclude other pathologies. To date there is no strong evidence to support conservative or surgical treatment options. The purpose of this study is to shed light on the more effective non-interventional rehabilitative treatments for the management of groin pain in athletes and, if possible, provide guidelines useful for clinical practice. EVIDENCE ACQUISITION The following electronic databases were searched: PubMed, Physiotherapy Evidence Database (PEDro), Scopus, Web of Science, Google and Google Scholar. Databases were investigated from January 1997 until March 2017. EVIDENCE SYNTHESIS The results reported in the randomized clinical trial studies highlight that active treatment is better than passive treatment to improve clinical signs of groin pain. Comparing the active strategy with multi-modal treatment the latter allows a faster return to sport activity. Although the evidence remains poor, all the included literature highlights that an integrated strategy which combines active and passive treatment, the assessment of perceived pain, a return to running program and specific-sport exercises is an effective strategy for management of groin pain in athletes. CONCLUSIONS Although we shed some light on common key aspects able to improve the typical signs of groin pain, on the basis of available data we were unable to provide practice guidelines. Further studies are necessary to set the best treatment algorithm for the management of groin pain in athletes.
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Affiliation(s)
- Ileana Ramazzina
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Benedetta Bernazzoli
- Graduate School of Physical Medicine and Rehabilitation, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy - .,Graduate School of Physical Medicine and Rehabilitation, Department of Medicine and Surgery, University of Parma, Parma, Italy
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12
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Krüger S, Khayat D, Hoffmeister M, Hilberg T. Pain thresholds following maximal endurance exercise. Eur J Appl Physiol 2015; 116:535-40. [PMID: 26700745 DOI: 10.1007/s00421-015-3307-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Physical exercise causes alterations in pain sensitivity. Many studies verified so-called exercise-induced analgesia caused by submaximal aerobic intensity. This study aimed to determine the effect of an endurance exercise to exhaustion on pain sensitivity of healthy young men. METHOD Pressure pain thresholds (PPTs) [in Newton, (N)] of 50 healthy males (mean age 26 ± 4 years) were applied to knee, ankle and elbow joints as well as to the sternum and forehead. This was followed by a bout of cycling ergometer exercise to exhaustion. The whole process was repeated after 20 and 60 min respectively. RESULTS Endurance exercise to exhaustion decreased PPTs at sternum and forehead significantly, while thresholds at the joints were not affected. Pain thresholds at forehead and sternum declined 20 min after exercise with the forehead's threshold being more reduced. PPTs remain decreased until 60 min after exercise (forehead: from 43.6 ± 15.2 N to 36.6 ± 19.8 N to 37.2 ± 13.4 N; sternum: from 46.8 ± 21.0 N to 42.5 ± 17.1 N to 44.8 ± 18.2 N). Modulation of pain sensitivity showed large effect sizes over time for both landmarks (forehead w = 0.65; sternum w = 0.50). CONCLUSION Exhaustive endurance exercise is followed by a hyperalgetic condition at forehead and sternum. This may be due to either a reduction in pain inhibiting or an activation in pain stimulating pathways.
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Affiliation(s)
- Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Pauluskirchstraße 7, 42285, Wuppertal, Germany.
| | - Dominik Khayat
- Department of Sports Medicine, University of Wuppertal, Pauluskirchstraße 7, 42285, Wuppertal, Germany.
| | - Meike Hoffmeister
- Department of Sports Medicine, University of Wuppertal, Pauluskirchstraße 7, 42285, Wuppertal, Germany.
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Pauluskirchstraße 7, 42285, Wuppertal, Germany.
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13
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Tansey RJ, Benjamin-Laing H, Jassim S, Liekens K, Shankar A, Haddad FS. Successful return to high-level sports following early surgical repair of combined adductor complex and rectus abdominis avulsion. Bone Joint J 2015; 97-B:1488-92. [DOI: 10.1302/0301-620x.97b11.32924] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hip and groin injuries are common in athletes who take part in high level sports. Adductor muscle tendon injuries represent a small but important number of these injuries. Avulsion of the tendons attached to the symphysis pubis has previously been described: these can be managed both operatively and non-operatively. We describe an uncommon variant of this injury, namely complete avulsion of the adductor sleeve complex: this includes adductor longus, pectineus and rectus abdominis. We go on to describe a surgical technique which promotes a full return to the pre-injury level of sporting activity. Over a period of ten years, 15 high-level athletes with an MRI-confirmed acute adductor complex avulsion injury (six to 34 days old) underwent surgical repair. The operative procedure consisted of anatomical re-attachment of the avulsed tissues in each case and mesh reinforcement of the posterior inguinal wall in seven patients. All underwent a standardised rehabilitation programme, which was then individualised to be sport-specific. One patient developed a superficial wound infection, which was successfully treated with antibiotics. Of the 15 patients, four complained of transient local numbness which resolved in all cases. All patients (including seven elite athletes) returned to their previous level of participation in sport. Cite this article: Bone Joint J 2015;97-B:1488–92.
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Affiliation(s)
- R. J. Tansey
- University College London Hospitals, 235
Euston Rd, London, NW1
2BU, UK
| | - H. Benjamin-Laing
- University College London Hospitals, 235
Euston Rd, London, NW1
2BU, UK
| | - S. Jassim
- University College London Hospitals, 235
Euston Rd, London, NW1
2BU, UK
| | | | - A. Shankar
- University College London Hospitals, 235
Euston Rd, London, NW1
2BU, UK
| | - F. S. Haddad
- University College London Hospitals, 235
Euston Rd, London, NW1
2BU, UK
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14
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Cheatham SW, Hanney WJ, Kolber MJ, Salamh PA. Adductor-related groin pain in the athlete. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x14y.0000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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