Inter-examiner reliability of the Doha agreement meeting classification system of groin pain in male athletes.

The Doha agreement classification is used to classify groin pain in athletes. We evaluated the inter-examiner reliability of this classification system. We prospectively recruited 48 male athletes (66 symptomatic sides) with groin pain between 10-2017 and 03-2020 at a sports medicine hospital in Qatar. Two examiners (23 and 10 years of clinical experience) performed history taking, and a standardized clinical examination blinded to each other's findings. Examiners classified groin pain using the Doha agreement terminology (adductor-, inguinal-, iliopsoas-, pubic-, hip-related groin pain, or other causes of groin pain). Multiple entities were ranked in order of perceived clinical importance. Each side was classified separately for bilateral groin pain. Inter-examiner reliability was calculated using Cohen's Kappa statistic (κ). Inter-examiner reliability was slight to moderate for adductor- (κ = 0.40), inguinal- (κ = 0.44), iliopsoas- (κ = 0.57), and pubic-related groin pain (κ = 0.12), substantial for hip-related groin pain (κ = 0.62), and slight for "other causes of groin pain" (κ = 0.13). Ranking entities in order of perceived clinical importance improved inter-examiner reliability for adductor-, inguinal-, and iliopsoas-related groin pain (κ = 0.52-0.65), but not for pubic (κ = 0.12), hip (κ = 0.51), and "other causes of groin pain" (κ = 0.03). For participants with unilateral groin pain classified with a single entity (n = 7), there was 100% agreement between the two examiners. Inter-examiner reliability of the Doha agreement meeting classification system varied from slight to substantial, depending on the clinical entity. Agreement between examiners was perfect when athletes were classified with a single clinical entity of groin pain, but lower when athletes were classified with multiple clinical entities.

The Effect of Cryotherapy Application to the Knee Joint on Dynamic Postural Stability.

CONTEXT: Decreased postural balance is a primary risk factor for lower-limb injuries. Cryotherapy is commonly utilized by clinicians to provide local analgesia for minor acute knee joint musculoskeletal injuries during breaks in play or at halftime. Its effect on dynamic postural balance remains unclear. OBJECTIVE: To investigate the acute effects of a 15-minute knee joint cryotherapy application on dynamic postural balance, as assessed primarily via a clinically oriented outcome measure. DESIGN: Experimental study. SETTING: University biomechanics laboratory. PATIENTS OR PARTICIPANTS: A total of 28 elite-level college male field-sport athletes. INTERVENTION: Participants were tested on the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test both before and after a 15-minute knee joint cryotherapy application. MAIN OUTCOME MEASURE(S): Normalized reach distances, 3-dimensional knee joint kinematics, sagittal plane hip and ankle joint kinematics, as well as fractal dimension of the center-of-pressure path during the performance of the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test. RESULTS: There was a statistically significant decrease in reach distance scores achieved on anterior, posteromedial, and posterolateral directions of the Star Excursion Balance Test from precryotherapy to postcryotherapy (P < .05). None of the decreases in reach distance scores exceeded the reported smallest detectable difference values. No significant differences were observed in hip, knee, or ankle joint kinematics (P > .05). No significant change in fractal dimension was observed for any reach direction following cryotherapy application (P > .05). CONCLUSIONS: The results of the present study indicate that dynamic postural balance is unlikely to be adversely affected immediately following cryotherapy application to the knee joint.

Dynamic Postural-Stability Deficits After Cryotherapy to the Ankle Joint.

CONTEXT: Decreased postural stability is a primary risk factor for lower limb musculoskeletal injuries. During athletic competitions, cryotherapy may be applied during short breaks in play or during half-time; however, its effects on postural stability remain unclear. OBJECTIVE: To investigate the acute effects of a 15-minute ankle-joint cryotherapy application on dynamic postural stability. DESIGN: Controlled laboratory study. SETTING: University biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 29 elite-level collegiate male field-sport athletes (age = 20.8 ± 1.12 years, height = 1.80 ± 0.06 m, mass = 81.89 ± 8.59 kg) participated. INTERVENTION(S): Participants were tested on the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the Star Excursion Balance Test before and after a 15-minute ankle-joint cryotherapy application. MAIN OUTCOME MEASURE(S): Normalized reach distances; sagittal-plane kinematics of the hip, knee, and ankle joints; and associated mean velocity of the center-of-pressure path during performance of the ANT, PL, and PM reach directions of the Star Excursion Balance Test. RESULTS: We observed a decrease in reach-distance scores for the ANT, PL, and PM reach directions from precryotherapy to postcryotherapy (P < .05). No differences were observed in hip-, knee-, or ankle-joint sagittal-plane kinematics (P > .05). We noted a decrease in mean velocity of the center-of-pressure path from precryotherapy to postcryotherapy (P < .05) in all reach directions. CONCLUSIONS: Dynamic postural stability was adversely affected immediately after cryotherapy to the ankle joint.

Star Excursion Balance Test performance and application in elite junior rugby union players.

OBJECTIVES: To evaluate performance on selected reach directions of the Start Excursion Balance Test (SEBT) in an elite underage rugby union population, and determine if differences exist between the forward and back position units. This information may have implications for the application of this test in player injury prevention and management. DESIGN: Descriptive study. SETTING: Gymnasium at an elite junior rugby union screening camp. PARTICIPANTS: 102 healthy male elite rugby union players (age = 17.9 ± 1.1 years, height = 1.83 ± 0.07 m, body mass = 90.5 ± 11.3 kg). MAIN OUTCOME MEASURES: Participants were assessed on the Anterior (A), Posterior-medial (PM), and Posterior-lateral (PL) reach directions of the SEBT. RESULTS: Normative data for SEBT performance in the A, PM and PL reach directions were established for an elite junior rugby union population. No significant differences in dynamic postural stability were observed between the forward and back position units. CONCLUSIONS: This study provides normative SEBT data on an elite junior rugby union population, which enables clinicians to compare player dynamic postural stability and has implications for use in the prevention and management of player injuries.

Kinematic analysis of selected reach directions of the Star Excursion Balance Test compared with the Y-Balance Test.

CONTEXT: The Star Excursion Balance Test (SEBT) and the Y-Balance Test (YBT) have 3 common reach directions: anterior (ANT), posteromedial (PM), and posterolateral (PL). Previous research has indicated that reach-distance performance on the ANT reach direction of the SEBT differs from that on the YBT. Kinematic patterns associated with the ANT reach direction of the SEBT and YBT need to be investigated to fully understand this difference, along with the PM and PL reach directions, to deduce any kinematic discrepancies between the 2 balance tests. OBJECTIVE: To compare and contrast the kinematic patterns associated with test performance on the reach directions common to the SEBT and YBT. DESIGN: Controlled laboratory study. SETTING: University laboratory. PARTICIPANTS: 15 healthy male (age 23.33 ± 2.02 y, height 1.77 ± 0.04 m, body mass 80.00 ± 9.03 kg) and 14 healthy female (age 21.14 ± 1.66 y, height 1.63 ± 0.06 m, body mass 59.58 ± 7.61 kg) volunteers. INTERVENTION: Each participant performed 3 trials of the ANT, PM, and PL reach directions of the SEBT and YBT on their dominant leg. MAIN OUTCOME MEASURES: Sagittal-plane lower-limb kinematic profiles were recorded using a 3-D motion-analysis system. Reach distances were also recorded for each reach direction. RESULTS: A significant main effect (P < .05) was observed for test condition with participants reaching farther on the ANT reach direction of the SEBT compared with the YBT. While reaching in the ANT direction participants were characterized by a more flexed position of the hip joint at the point of maximum reach on the YBT (27.94° ± 13.84°) compared with the SEBT (20.37° ± 18.64°). CONCLUSIONS: Based on these observed results, the authors conclude that test performance on the SEBT and YBT differ in terms of dynamic neuro-muscular demands, as evidenced by differences in reach distances achieved in the ANT reach direction and associated test kinematic profile.

A comparison between performance on selected directions of the star excursion balance test and the Y balance test.

CONTEXT: The Star Excursion Balance Test (SEBT) is a widely accepted method of assessing dynamic postural stability. The Y Balance Test (YBT) is a commercially available device for measuring balance that uses 3 (anterior, posteromedial, and posterolateral) of the 8 SEBT directions and has been advocated as a method for assessing dynamic balance. To date, no studies have compared reach performance in these tests in a healthy population. OBJECTIVE: To determine whether any differences exist between reach distance performance for the anterior, posteromedial, and posterolateral directions of the SEBT and the YBT. DESIGN: Descriptive laboratory study. SETTING: University motion analysis laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 20 healthy active male participants (age = 22.50 ± 3.05 years, height = 1.78 ± 0.82 m, weight = 79.48 ± 11.32 kg, body mass index = 24.96 ± 2.56 kg/m²). INTERVENTION(S): Participants carried out 3 trials in each reach direction on each leg on the SEBT and the YBT a minimum of 1 week apart. MAIN OUTCOME MEASURE(S): The means of the 3 trials in each direction on each leg on both tests were calculated. Data were collected after 4 practice trials in each direction. Paired t tests and Bland-Altman plots were used to compare reach distances between the SEBT and the YBT. RESULTS: Participants reached farther in the anterior direction on the SEBT than on the YBT. No differences were observed in the posteromedial and posterolateral directions. CONCLUSIONS: Differing postural-control strategies may be used to complete these tasks. This finding has implications for the implementation and interpretation of these dynamic balance tests.