Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients

Abstract

BackgroundClinical assessments and rehabilitation in athletic groin pain (AGP) have focused on specific anatomical structures and uniplanar impairments rather than whole body movement.ObjectiveTo examine the effectiveness of rehabilitation that targeted intersegmental control in patients with AGP and to investigate post rehabilitation changes in cutting biomechanics.MethodsTwo hundred and five patients with AGP were rehabilitated focusing on clinical assessment of intersegmental control, linear running and change of direction mechanics in this prospective case series. Hip and Groin Outcome Score (HAGOS) was the primary outcome measure. Secondary measures included pain-free return to play rates and times, pain provocation on squeeze tests and three-dimensional (3D) biomechanical analysis during a 110° cutting manoeuvre.ResultsFollowing rehabilitation, patients demonstrated clinically relevant improvements in HAGOS scores (effect size (ES): 0.6–1.7). 73% of patients returned to play pain-free at a mean of 9.9 weeks (±3.5). Squeeze test values also improved (ES: 0.49–0.68). Repeat 3D analysis of the cutting movement demonstrated reductions in ipsilateral trunk side flexion (ES: 0.79) and increased pelvic rotation in the direction of travel (ES: 0.76). Changes to variables associated with improved cutting performance: greater centre of mass translation in the direction of travel relative to centre of pressure (ES: 0.4), reduced knee flexion angle (ES: 0.3) and increased ankle plantar flexor moment (ES: 0.48) were also noted.ConclusionsRehabilitation focused on intersegmental control was associated with improved HAGOS scores, high rates of pain-free return to sporting participation and biomechanical changes associated with improved cutting performance across a range of anatomical diagnoses seen in AGP.

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

“…The rehabilitation program used in this study was based mainly on our clinical experience in managing athletes with acute groin injuries while also considering the available literature on specific elements, such as muscle activation and strength increases in different exercises 5,11,12,15,19,27 and treatment of long-standing groin pain. 10,14,22 Additionally, pilot testing of 40 patients was performed during the development of the protocol.…”

Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis

“…16 27 30 31 One large cohort included thoracic exercises as part of a rehabilitation intervention in athletes with groin pain. 32 A further study investigated intrarater and inter-rater reliability of five thoracic rotation measurement techniques. 14 All other remaining sources were either from social media (YouTube n=20 and Facebook n=2), a review or evaluated as bench or 'first principles' research 25 evaluating a movement or movement characteristic in samples of convenience.…”

“…The majority of included sources were graded as level 5 25 sources being either expert opinion (review articles or social media sources), first principles exploratory laboratory-based studies with small samples (range 8-31). More recent sources included, among others, a large cohort study (n=205) 32 and four small trials (range 22-52), 16 28 30 31 where thoracic spine exercises formed a component part of an intervention. Agreement between reviewers was 100% following discussion.…”

Finland’s sports physiotherapy conference—athlete training and loading: Helsinki 7–8 June 2019

“…Groin pain can be prevented. These studies build on two important studies from Netherlands and Ireland that help clarify the anatomy1 and biomechanics/treatment2 associated with groin injuries. Groin pain features prominently at the Annual Congress with both a session on apophyseal injuries themselves and one on managing load in adolescents—a group particularly prone to groin and hip problems.…”