Do hip and groin muscle strength and symptoms change throughout a football season in professional male football players? A prospective cohort study with repeated measures.

OBJECTIVES: Groin injuries are common in professional male football and result in significant complaints, time-loss and cost. We aimed to study: 1. Normal values of hip muscle strength and self-reported hip and groin function (Hip And Groin Outcome Score (HAGOS)). 2. Changes in these values throughout the season. 3. If previous (groin) injuries, leg dominance or league were associated with these outcome measures. DESIGN: Prospective cohort study. METHODS: 313 professional male football players (11 clubs) participated. Player characteristics and previous injuries were registered. Hip muscle strength (hand-held dynamometer) and HAGOS measurements were done at the start, middle and end of the season. RESULTS: Data from 217 players were analysed. Adduction strength (mean±standard deviation, Nm/Kg) was 3.40±0.72 (start), 3.30±0.65 (mid) and 3.39±0.74 (end) (p=0.186). Abduction strength was 3.45±0.67, 3.14±0.57 and 3.28±0.61 (p<0.001). Adduction/abduction ratio was 1.00±0.21, 1.07±0.22 and 1.05±0.23 (p<0.001). Statistically, the HAGOS-subscale 'Pain' (median [interquartile range]) deteriorated slightly during the season (p=0.005), especially from mid-season (97.5 [90.6-100.0]) to end-of-season (95.0 [87.5-100.0]) (p=0.003). Other subscale scores remained unchanged between time points; 85.7 (symptoms), 100.0 (daily living), 96.9 (sports and recreation) 100.0, (physical activities) and 90.0 (quality of life). Previous injuries were associated with lower HAGOS-scores. Dominant legs had higher abduction strength (p<0.001) and lower adduction/abduction ratio (p<0.001). No differences between leagues were found for hip muscle strength and HAGOS-scores. CONCLUSIONS: In Dutch male professional football players, hip muscle strength and HAGOS-scores remained relatively stable throughout the season. Pain increased slightly, which while statistically significant, was not clinically relevant.

Active pelvic tilt is reduced in athletes with groin injury; a case-controlled study.

OBJECTIVE: To study if athletes with groin injury had less active pelvic tilt (APT) than non-injured controls. DESIGN: Case-control. SETTING: Sports physiotherapy clinics and sports clubs. PARTICIPANTS: 17 athletes (Tegner>5, age 25.1(5.2) with groin injury and 27 healthy controls (Tenger>5, age 24.4(3.6)). MAIN OUTCOME MEASURES: Active pelvic tilt, defining the ability of an individual to actively tilt the pelvis anteriorly and posteriorly over a frontal axis, and hip range of motion (HROM) parameters. RESULTS: Linear regression model associations with generalized estimated equations revealed that APT was lower on injured sides compared to non-injured for total (21.1(7.1) vs. 27.2(8.0), P = .003, effect size (ES) = 0.8) and anterior (10.2(5.9) vs. 13.7(4.8), P = .004, ES = 0.65) APT. Posterior APT (-10.9(3.6) vs. -13.4(5.2), P = .06, ES = 0.56) showed a trend towards being lower in those with groin injury. HROM parameters were not found associated. CONCLUSIONS: Total active and anterior pelvic tilt were lower on the injured side in athletes with groin injury when compared to non-injured sides and healthy controls. This may be a relevant factor to consider in rehabilitation. Whether this is a cause or effect cannot be ascertained due to the cross sectional study design.

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.

OBJECTIVE: The 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. DESIGN: Case-controlled. SETTING: 6 Dutch elite clubs, 6 amateur clubs and a sports medicine practice. PARTICIPANTS: 103 NI elite and 83 NI amateurs and 57 football players with unilateral adductor-related groin pain. MAIN OUTCOME MEASURES: Sport 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. RESULTS: Intra 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. CONCLUSION: The 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.

Incivility in the workplace: incidence and impact.

This study extends the literature on interpersonal mistreatment in the workplace by examining the incidence, targets, instigators, and impact of incivility (e.g., disrespect, condescension, degradation). Data were collected from 1,180 public-sector employees, 71% of whom reported some experience of workplace incivility in the previous 5 years. As many as one third of the most powerful individuals within the organization instigated these uncivil acts. Although women endured greater frequencies of incivility than did men, both genders experienced similarly negative effects on job satisfaction, job withdrawal, and career salience. Uncivil workplace experiences were also associated with greater psychological distress; however, indices of psychological and physical health were relatively unaffected. The authors discuss these findings in the context of organizational and cognitive stress theories.