Eccentric and Isometric Hip Adduction Strength in Male Soccer Players With and Without Adductor-Related Groin Pain

Abstract

Background:Adductor-related pain is the most common clinical finding in soccer players with groin pain and can be a long-standing problem affecting physical function and performance. Hip adductor weakness has been suggested to be associated with this clinical entity, although it has never been investigated.Purpose:To investigate whether isometric and eccentric hip strength are decreased in soccer players with adductor-related groin pain compared with asymptomatic soccer controls. The hypothesis was that players with adductor-related groin pain would have lower isometric and eccentric hip adduction strength than players without adductor-related groin pain.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Male elite and subelite players from 40 teams were contacted. In total, 28 soccer players with adductor-related groin pain and 16 soccer players without adductor-related groin pain (asymptomatic controls) were included in the study. In primary analysis, the dominant legs of 21 soccer players with adductor-related groin pain (≥4 weeks duration) were compared with the dominant legs of 16 asymptomatic controls using a cross-sectional design. The mean age of the symptomatic players was 24.5 ± 2.5 years, and the mean age of the asymptomatic controls was 22.9 ± 2.4 years. Isometric hip strength (adduction, abduction, and flexion) and eccentric hip strength (adduction) were assessed with a handheld dynamometer using reliable test procedures and a blinded assessor.Results:Eccentric hip adduction strength was lower in soccer players with adductor-related groin pain in the dominant leg (n = 21) compared with asymptomatic controls (n = 16), namely 2.47 ± 0.49 versus 3.12 ± 0.43 N·m/kg, respectively (P < .001). No other hip strength differences were observed between symptomatic players and asymptomatic controls for the dominant leg (P = .35-.84).Conclusion:Large eccentric hip adduction strength deficits were found in soccer players with adductor-related groin pain compared with asymptomatic soccer players, while no isometric strength differences were observed between the groups.

A Combined Treatment Approach Emphasizing Impairment-Based Manual Therapy and Exercise for Hip-Related Compensatory Injury in Elite Athletes: A Case Series

“…Once symptoms are improved, continuing an individualized program may be beneficial in further reducing this risk. 23,24,43 Additional treatment sessions including manual therapy and exercise, like those implemented in this case series, may be beneficial in the long-term management of athletes, as they continue to address any potential long-term impairments 14,22,32,36,63 and may improve outcomes. 57 For comparison, it is common practice for baseball pitchers to perform an individualized arm-care program in the presence of sportspecific morphological adaptations.…”

“…The regional synergy required to athletically move about and stabilize the pelvis place an importance on addressing muscle imbalances, 18,31,32 motor control, 37 strength, power and work capacity abilities via an appropriately loaded training program 60 in order to allow the athlete to develop a resistance to risk factors while preparing for sport. 61 The exercise programs that were prescribed in these cases potentially served to dynamically stabilize the lumbopelvic region and may have improved force distribution and load tolerance, 63 while unloading irritated structures and building a tolerance to repeated bouts of sporting activity.…”

“…13,18,29,30 In addition to limited hip ROM, other risk factors include impaired regional strength and motor control. Inadequate strength profiles of the hip musculature have been identified in those who have sustained groin and lower extremity injury, 31,32,33,34 while individuals with groin pain and LBP have been found to demonstrate motor control deficits of the lumbopelvic region and lower quarter. 14,23,24,35 Those with FAI have been reported to demonstrate altered lower body kinetics and force attenuation, potentially resulting in excessive impulse to the joint.…”

“…36 Motor control deficits have been linked to reports of impaired sport performance and pain. 35,37 Uneven distribution of forces across the pelvis, in part due to limited regional mobility 22 and impaired strength 31,32,33 and neuromuscular control 15,35 may result in mechanical overload and subsequent acute or chronic injury, 1,4 ultimately impacting the movement system. These previously noted findings about the hip and lumbopelvis have been proposed to be related irrespective of any individual pathoanatomical diagnosis.…”

Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management

“…93 Continuing to train and play with groin pain can result in movement compensation strategies, resulting in decreased function and performance. 24,27,41,56,57,93 Therefore, in addition to the use of pain-provocation tests, 69,92 joint ROM, muscle strength, function, and performance must be systematically assessed (FIGURE 4) 69 and the appropriate patientreported outcome measures must be completed (FIGURE 5).…”