Movement Patterns and Muscular Function Before and After Onset of Sports-Related Groin Pain: A Systematic Review with Meta-analysis

Abstract

BackgroundSports-related groin pain (SRGP) is a common entity in rotational sports such as football, rugby and hockey, accounting for 12–18 % of injuries each year, with high recurrence rates and often prolonged time away from sport.ObjectiveThis systematic review synthesises movement and muscle function findings to better understand deficits and guide rehabilitation.Study SelectionProspective and retrospective cross-sectional studies investigating muscle strength, flexibility, cross-sectional area, electromyographic activation onset and magnitude in patients with SRGP were included.Search MethodsFour databases (MEDLINE, Web of Knowledge, EBSCOhost and EMBASE) were searched in June 2014. Studies were critiqued using a modified version of the Downs and Black Quality Index, and a meta-analysis was performed.ResultsSeventeen studies (14 high quality, 3 low quality; 8 prospective and 9 retrospective) were identified. Prospective findings: moderate evidence indicated decreased hip abduction flexibility as a risk factor for SRGP. Limited or very limited evidence suggested that decreased hip adduction strength during isokinetic testing at ~119°/s was a risk factor for SRGP, but no associations were found at ~30°/s or ~210°/s, or with peak torque angle. Decreased hip abductor strength in angular velocity in ~30°/s but not in ~119°/s and ~210°/s was found as a risk factor for SRGP. No relationships were found with hip internal or external rotation range of movement, nor isokinetic knee extension strength. Decreased isokinetic knee flexion strength also was a potential risk factor for SRGP, at a speed ~60°/s. Retrospective findings: there was strong evidence of decreased hip adductor muscle strength during a squeeze test at 45°, and decreased total hip external rotation range of movement (sum of both legs) being associated with SRGP. There was strong evidence of no relationship to abductor muscle strength nor unilateral hip internal and external rotation range of movement. Moderate evidence suggested that increased abduction flexibility and no change in total hip internal rotation range of movement (sum of both legs) were retrospectively associated with SRGP. Limited or very limited evidence (significant findings only) indicated decreased hip adductor muscle strength during 0° and 30° squeeze tests and during an eccentric hip adduction test, but a decrease in the isometric adductors-to-abductors strength ratio at speed 120°/s; decreased abductors-to-adductors activation ratio in the early phase in the moving leg as well as in all three phases in the weight-bearing leg during standing hip flexion; and increased hip flexors strength during isokinetic and decrease in transversus abdominis muscle resting thickness associated with SRGP.ConclusionsThere were a number of significant movement and muscle function associations observed in athletes both prior to and following the onset of SRGP. The strength of findings was hampered by the lack of consistent terminology and diagnostic criteria, with there being clear guides for futur...

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

“…All subjects continued an individualized management program 37,43,57 in the participation phase of rehabilitation that continued to focus on regional mobility, stability, strength, and power deficits. The strength and conditioning staffs primarily implemented exercise programs during this phase while the team medical staff continually monitored the athletes' status.…”

“…45,57,58 Reinforcing ROM improvements through exercise may lead to lasting ROM development. 29,30 It is hypothesized that improving ROM may alter movement patterns 24,37 and favorably modify the distribution of force about the pelvis, positively impacting dynamic movement.…”

“…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.…”

“…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.…”

“…1,8 Recently, authors have recommended assessment and intervention focusing less on painful structures and more on the resolution of comprehensive movement impairments and injury risk reduction strategies. 24,37 The purpose of this case series is to describe the conservative management of elite athletes, within the identified aforementioned sub-group, that emphasized regional manual therapy interventions, and therapeutic exercise designed to improve lumbopelvic and hip mobility, stability and motor control.…”