Pre-season adductor squeeze test and HAGOS function sport and recreation subscale scores predict groin injury in Gaelic football players

ObjectiveTo determine if pre-season adductor squeeze test and HAGOS function, sport and recreation subscale scores can identify Gaelic football players at risk of developing groin injury.DesignProspective study.SettingSenior inter-county Gaelic football team.ParticipantsFifty-five male elite Gaelic football players (age = 24.0 ± 2.8 years, body mass = 84.48 ± 7.67 kg, height = 1.85 ± 0.06 m, BMI = 24.70 ± 1.77 kg/m²) from a single senior inter-county Gaelic football team.Main outcome measuresOccurrence of groin injury during the season.ResultsTen time-loss groin injuries were registered representing 13% of all injuries. The odds ratio for sustaining a groin injury if pre-season adductor squeeze test score was below 225 mmHg, was 7.78. The odds ratio for sustaining a groin injury if pre-season HAGOS function, sport and recreation subscale score was < 87.5 was 8.94. Furthermore, for each additional point on the numerical rating scale pain rating during performance of the adductor squeeze test, the odds of groin injury increased by 2.16.ConclusionThis study provides preliminary evidence that pre-season adductor squeeze test and HAGOS function, sport and recreation subscale scores can be used to identify Gaelic football players at risk of developing groin injury.     

Postural balance impairment in Tunisian second division soccer players with groin pain: A case-control study

ObjectiveTo compare postural balance outcomes between soccer players with and without groin pain (GP).DesignCase-control study.SettingLaboratory.ParticipantsFifty-four soccer players, 27 with GP (GP group: GPG) and 27 healthy ones (control group: CG).Main outcome measuresStatic and dynamic postural balance were assessed with a force platform and Y-balance test (Y-BT), respectively. Hip abduction, internal rotation (IR), external rotation (ER) and total rotation (TR) of both limbs were evaluated.ResultsThe GPG exhibited significant higher centre of pressure values in the bipedal posture only on the foam surface in eyes opened and closed compared to controls. Besides, they had lower anterior, posteromedial and posterolateral reach distances and composite Y-BT score on the injured limb (IL) compared to non-injured limb (NIL) and dominant-limb (DL) of the CG. Moreover, they showed lower abduction, IR, ER, and TR on the IL compared to NIL and DL.ConclusionsDynamic unipedal postural balance disorder could be one of the limiting factors of performance in soccer players with non-time loss GP. Hence, postural balance data in these players could enable sport coaches and physical therapists to better understand the mechanisms contributing for performance decrease.     

Postural balance asymmetry and subsequent noncontact lower extremity musculoskeletal injuries among Tunisian soccer players with groin pain: A prospective case control study

BackgroundRecent 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 questionDo soccer players with GP exhibit higher static and dynamic unipedal postural balance asymmetry, and higher risk of sustaining subsequent injuries compared to controls?MethodsIn 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.ResultsThe 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.SignificanceThe 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.     

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

ObjectiveExamine whether football players with hip and/or groin (hip/groin) pain have impaired running biomechanics when compared to pain-free players, analysing men and women independently.DesignCross-sectional.SettingBiomechanics laboratory.ParticipantsSeventy-eight (62 men, 16 women) football players with >6months of hip/groin pain and a positive flexion-adduction-internal rotation test and 38 (25 men, 13 women) asymptomatic players.Main outcome measuresPelvis angles and hip, knee, and ankle joint angles and moments were analysed during the stance phase of overground running at 3–3.5 m⋅s⁻¹. Continuous joint angle and moment data were compared between symptomatic and asymptomatic football players of the same sex using statistical parametric mapping. Joint moment impulses (area under the curve) were compared between groups using linear regression models.ResultsSymptomatic football players did not display significant differences in pelvis angles or lower-limb joint angles, moments, or moment impulses during the stance phase of running, when compared to asymptomatic players of the same sex.ConclusionOur large sample of football players with hip/groin pain who were still participating in competitive sport displayed similar running biomechanics to asymptomatic players. Impaired running biomechanics might exist in people with worse hip/groin pain, warranting future investigation.     

Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players

Groin pain is a condition with a high prevalence in young Australian football players. It is considered that early identification of this condition allows for optimal management. Eighty-six players from two elite under-age Australian football sides were screened weekly for hip adductor muscle strength, using a hand-held dynamometer and for the onset of groin pain. The maximum variation in the average hip adductor muscle strength values of the sample was a 2.6% decrease from baseline in week 7 of the study. Twelve players (14% of the sample studied) reported groin pain for two consecutive weeks and were considered to have an onset of groin injury. The mean hip adductor muscle strength of these players was decreased significantly from baseline by an average of 11.75 ± 2.50% at the week of pain onset (F = 264.76 (1,11), p < 0.001), and 5.82 ± 5.16% in the week preceding the onset of pain (F = 14.03 (1,10), p = 0.004). These results confirm that hip adductor muscle strength is decreased both preceding and during the onset of groin injury in elite under-age Australian footballers.     

A new clinical test for measurement of lower limb specific range of motion in football players: Design,reliability and reference findings in non-injured players and those with long-standing adductor-related groin pain

ObjectiveThe association between groin pain and range of motion is poorly understood. The aim of this study was to develop a test to measure sport specific range of motion (SSROM) of the lower limb, to evaluate its reliability and describe findings in non-injured (NI) and injured football players.DesignCase-controlled.Setting6 Dutch elite clubs, 6 amateur clubs and a sports medicine practice.Participants103 NI elite and 83 NI amateurs and 57 football players with unilateral adductor-related groin pain.Main outcome measuresSport specific hip extension, adduction, abduction, internal and external rotation of both legs were examined with inclinometers. Test-retest reliability (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. Non-injured players were compared with the injured group.ResultsIntra and inter tester ICCs were acceptable and ranged from 0.90 to 0.98 and 0.50–0.88. SEM ranged from 1.3 to 9.2° and MDC from 3.7 to 25.6° for single directions and total SSROM. Both non-injured elite and amateur players had very similar total SSROM in non-dominant and dominant legs (188–190, SD ± 25). Injured players had significant (p < 0.05) total SSROM deficits with 187(SD ± 31)° on the healthy and 135(SD ± 29)° on the injured side.ConclusionThe SSROM test shows acceptable reliability. Loss of SSROM is found on the injured side in football players with unilateral adductor-related groin pain. Whether this is the cause or effect of groin pain cannot be stated due to the study design. Whether restoration of SSROM in injured players leads to improved outcomes should be investigated in new studies.     

Pre-season screening of the upper body and trunk in Australian football players: A prospective study

ObjectiveTo determine whether screening tests of upper body, trunk region, and of whole-body function could prospectively identify community AFL players who sustain in-season shoulder/head/neck injuries. Additionally, to present screening test reference values.DesignProspective cohort;SettingCommunity sport;Participants142 male community AFL players (range 15–37 years).Main outcome measures(i) isometric shoulder external and internal rotation (ER/IR) strength; (ii) upper body combined elevation functional ROM; (iii/iv) whole-body functional jump ROM; (v) static thoracic spine angle; (vi) cervical joint proprioception, and (vii) trunk muscle size and function. Results were compared among players with (n = 21) and without (n = 121) an in-season shoulder, head, or neck injury. ROC analysis and odds ratios were used to determine the predictive values.ResultsTwo screening tests predicted an in-season shoulder, head, or neck injury; dominant and non-dominant isometric ER strength (AUC 0.629, 95%CI 0.51–0.74; optimal cut point 182 N and AUC 0.619, 95%CI 0.50–0.74; optimal cut point 184 N, respectively). The adjusted odds ratio for the strongest predictor: dominant ER muscle strength was 6.02 (95%CI 1.8–19.9).ConclusionGreater ER strength was associated with in-season shoulder/head/neck injuries in community AFL players; however, further research is required to determine the clinical significance of this finding.     

Imaging and clinical tests for the diagnosis of long-standing groin pain in athletes. A systematic review

Objectives: To examine the validity of clinical tests available for the diagnosis of longstanding groin pain in athletes. Design: Systematic review. Method: A published search strategy of MeSH terms in MEDLINE, CINAHL, EMBASE, and SportDiscuss. Inclusion criteria: diagnostic studies relating to athletic groin pain, professional or semi-professional athletes, symptoms lasting for more than six weeks, and not limited by age or gender. A priori exclusion criteria were utilised. Outcome measures: QUADAS tool, sensitivity and specificity, likelihood ratios and predictive values of the reported tests and investigations. Results: 577 Journal articles were identified. Five studies met all requirements. Sensitivity and specificity of clinical tests ranged between 30 and 100% and 88 and 95% respectively with negative likelihood ratio of 0.15–0.78 and positive likelihood ratios of 1.0–11.0. Sensitivity and specificity of investigations (MRI, herniography, and dynamic ultrasound) ranged between 68% and 100% as well as 33% and 100% respectively with negative likelihood ratios between 0 and 0.32 and positive likelihood ratios between 1.5 and 8.1. Conclusion: There is a lack of validated diagnostic clinical tests available for clinicians and a lack of symptomology being evaluated. It is recommended that a reference standard should be applied and data should be reported in sufficient detail to calculate diagnostic statistics that is useful to the clinician.     

Male basketball players who report hip and groin pain perceive its negative impact both on- and off-court: A cross-sectional study

ObjectivesTo identify if basketball players aged <20 years (U20) self-report hip and/or groin pain and if they perceive this as a problem. To determine potential differences in self-reported playing (training and match play) loads and Copenhagen Hip and Groin Outcome Score (HAGOS) between those with and without hip/groin pain.DesignCross-sectional.MethodsFifty-one pre-elite (state/national representative level) male U20 basketball players (Australian n = 38; Italian n = 13) self-reported current/historical hip/groin ‘discomfort/pain’ and ‘problems’, and playing loads. A two-factor regression model was fitted including main effects for hip/groin pain and Cohort and their interaction, with outcome variables playing loads and HAGOS subscale scores and dependent variable hip/groin pain.ResultsTwenty-one players (41%) self-reported hip/groin ‘discomfort/pain’, of which nine perceived no ‘problems’. Two of these nine players reported training/playing time loss due to pain. Those self-reporting hip/groin discomfort/pain scored lower than those without in HAGOS subscales Symptoms (mean difference in score 8.94; 95%CI ?25.24, ?5.97), Pain (5.00; ?16.42, ?2.81), Function in daily living (0.00; ?26.72 to ?5.59), Function in sport and recreation (6.25; ?21.24, ?5.33), and hip and/or groin Quality of Life (5.00; ?28.63, ?8.10), indicating worse hip/groin problems. Participation subscale scores were different only for Italian players (36.25; ?51.25, ?20.00), with players self-reporting hip/groin discomfort/pain scoring lower.ConclusionMost players who perceive both hip/groin ‘discomfort/pain’ and ‘problems’ also report training/playing time loss, suggesting players’ perceptions of problematic symptoms and time-loss are associated. Adolescent basketball players perceive hip/groin pain to negatively impact their daily lives and sporting function.     

Hip adduction strength and provoked groin pain: A comparison of long-lever squeeze testing using the ForceFrame and the Copenhagen 5-Second-Squeeze test

ObjectivesTo compare long-lever squeeze testing using the ForceFrame and the Copenhagen 5-Second-Squeeze test (5SST) for assessment of hip adduction strength and provoked groin pain in elite male soccer players.DesignCross-sectional study.SettingPre-season testing at facilities of a Danish professional 1^st tier soccer club and academy.ParticipantsElite male soccer players (n = 83, mean age; 16 ± 2.7 years) from U13, U14, U15, U17, U19 and senior teams cleared for full training and match participation.Main outcome measuresMaximum isometric hip adduction strength (Nm/kg) and provoked groin pain (NRS 0–10).ResultsHip adduction strength was 16% lower in the ForceFrame. A Bland-Altman plot showed a systematic bias (−0.47 Nm/kg, 95% CI [-0.57; −0.38]) and lack of agreement (95% limits of agreement: -1.31; 0.39 Nm/kg). In the ForceFrame, provoked groin pain was less intense (median NRS 0 [IQR: 0–1] vs. 5SST: 1 [IQR: 0–3], p < 0.001) and reported by fewer players (NRS >0) (27% [n = 22] vs. 5SST: 61.4% [n = 51], p < 0.001).ConclusionsThe ForceFrame and the 5SST lack agreement and are not interchangeable methods. This may have implications when selecting a method for screening and detecting early groin problems in male soccer players.     

Prevalence and severity of groin problems in Spanish football: A prospective study beyond the time-loss approach

The time-loss definition of injury is commonly adopted in epidemiological groin-injury studies in football, with a significant risk of underestimating the impact of these injuries. This study investigated the extent of groin problems, beyond the time-loss approach, over a full Spanish football season. Players from 17 amateur male teams were followed over 39 consecutive weeks. Groin-injury time loss and self-reported groin pain, irrespective of time loss, were combined to calculate the average weekly prevalence of all groin problems with or without time loss. A subscale measuring hip- and groin-related sporting function from the Copenhagen Hip and Groin Outcome Score questionnaire (HAGOS, Sport/Rec) was registered every 4 weeks. In total, 407 players participated in the study. The average (range) weekly prevalence of all groin problems was 11.7% (7.2%-20.8%); 1.3% with time loss (0.0%-3.2%) and 10.4% without time loss (6.3%-17.6%). Players with groin problems reported lower scores (mean difference) on the HAGOS, Sport/Rec subscale compared with players without (−19.5 [95% CI: −20.7 to −18.4]), while there was no difference between players reporting groin problems with and without time loss (4.0 [95% CI: −1.1 to 9.1]). The traditional time-loss measure only captured 10% of all groin problems. Hip- and groin-related sporting function was not different between players reporting groin problems with or without time loss, suggesting the reason for continuing to play is not only related to the severity of symptoms. These findings question the judicious use of the time-loss approach in overuse conditions, such as groin pain in footballers.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Incidence,costs, and temporal trends of sports injury-related hospitalisations in Australian children over a 10-year period: A nationwide population-based cohort study

Objectives

To quantify and describe the incidence, cost, and temporal trends of sports injury-related hospitalisations in Australian children over a 10-year period.

Hamstring and ACL injuries impacts on hamstring-to-quadriceps ratio of the elite soccer players: A retrospective study

This study aimed to compare the angle-specific (AS) and non-angle-specific (NAS) hamstring to quadriceps conventional and functional ratios between healthy, hamstring- and ACL-injured elite soccer players. One hundred and eleven players (27.42 ± 8.01 years, 182.11 ± 6.79 cm, 75.93 ± 7.25 kg) completed a series of concentric knee flexor and extensor strength in addition to eccentric knee flexor strength was measured at an angular velocity of 60°.s⁻¹. Normalized and raw peak torque values, and the torque-angle profiles were extracted for analysis. Conventional and functional NAS (peak values) and AS (waveform ratios) hamstring to quadriceps ratios were calculated and compared between the groups. Healthy players produced greater functional and conventional ratios compared to players with either ACL or hamstring injury. Players with hamstring injury produced a lower AS functional ratios between 46° and 54° of knee flexion. Players suffering from ACL injury depicted a lower value for the AS functional ratio between 33° and 56° of knee flexion. Although NAS can identify soccer players with previous hamstring or ACL injury, the range where there is a strength deficiency is eluded. With the use of AS the range where the deficiency is present can be identified, and clinicians can benefit from this analysis to design robust rehabilitation protocols.     

Low back pain in young female gymnasts and the effect of specific segmental muscle control exercises of the lumbar spine: a prospective controlled intervention study

Prospective controlled intervention study. To evaluate a specific segmental muscle training program of the lumbar spine in order to prevent and reduce low back pain in young female teamgym gymnasts. Teamgym is a team sport comprising three events: trampette, tumbling and floor programme. In a recent study, it was found that teamgym gymnasts practice and compete despite suffering from back pain. Specific muscle control exercises of the lumbar spine have shown good results in reducing pain intensity and functional disability levels in patients with low back pain. To our knowledge, this type of training has not been studied in an adolescent athletic population before. Fifty-one gymnasts, with and without LBP, 11–16 years old, from three top-level gymnastics team participated in the study comprising 12 weeks. Every day the gymnasts answered a questionnaire regarding low back pain. After baseline (4 weeks) the intervention group performed a specific segmental muscle training program. Twenty-four gymnasts (47%) reported low back pain during baseline. Nine gymnasts failed to answer the questionnaire every day and the following results are based on 42 gymnasts (intervention group, n = 30, and control group, n = 12). Gymnasts in the intervention group reported significantly less number of days with low back pain at completion compared to baseline (P = 0.02). Gymnasts in the control group showed no difference in terms of days with low back pain or intensity of low back pain between baseline and completion. Eight gymnasts (out of 15) with LBP in the intervention group became pain free. Specific segmental muscle control exercises of the lumbar spine may be of value in preventing and reducing low back pain in young teamgym gymnasts.     

The incidence,prevalence, severity,mechanism and body region of injury in elite junior Australian football players: A prospective cohort study over one season

Objectives

To describe the incidence, prevalence, severity, mechanism and body region of injuries in elite junior Australian football (AF) players over one competitive season in order to help inform injury prevention interventions.

A heel cup improves the function of the heel pad in Sever's injury: effects on heel pad thickness, peak pressure and pain

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. Treating Sever's injury with insoles is often proposed as a part of a traditional mix of recommendations. Using a custom-molded rigid heel cup with a brim enclosing the heel pad resulted in effective pain relief without reducing the physical activity level in our previous two studies. The purpose of this study was to assess the effect of the heel cup on heel pad thickness and heel peak pressure (n=50). The difference in heel pad thickness and in heel peak pressure using a sports shoe without and with a heel cup was compared. With the heel cup the heel pad thickness improved significantly and the heel peak pressure was significantly reduced. These effects correlated with a significant reduction in pain when using the heel cup in a sports shoe, compared with using a sports shoe without the heel cup. A heel cup, providing an effective heel pad support in the sports shoe, improved the heel pad thickness and reduced heel peak pressure in Sever's injury with corresponding pain relief.