Hip and groin pain in male field hockey players: Prevalence, incidence and associations with patient reported outcome scores and hip muscle strength.

OBJECTIVES: Investigate point prevalence (second half season 2018-2019) and incidence (season 2017-2018 and first half season 2018-2019) of non-time-loss and time-loss hip/groin pain in male field hockey players. Secondary aims were to study associations between: current/previous hip/groin pain and hip muscle strength, patient reported outcome measures (PROM) and hip muscle strength, and previous hip/groin pain and PROMs. Additionally we studied normal values for the PROMs (Hip and Groin Outcome Score (HAGOS)). DESIGN: Cross-sectional study. SETTING: Testing at field hockey clubs. PARTICIPANTS: 100 male field hockey players (elite, sub-elite and amateur). MAIN OUTCOME MEASURES: Point prevalence and incidence of hip/groin pain, strength: eccentric adduction and abduction, adductor squeeze, HAGOS. RESULTS: Hip/groin pain point prevalence was 17% (time-loss: 6%) and incidence was 36% (time-loss: 12%). Presence of current or previous hip/groin and lower HAGOS-values were not associated with lower hip muscle strength. Previous hip/groin pain was associated with a significant lower HAGOS-values in all domains, except for the 'participation in physical activities' domain. CONCLUSIONS: Hip/groin pain is common in field hockey. One fifth of players have hip/groin pain and one third had pain in the previous season. Previous hip/groin pain was associated with worse ongoing patient reported outcomes in most domains.

Judokas with low back pain have lower flexibility of the hip-spine complex: A case-control study.

OBJECTIVE: Study whether male adult judokas with and without low back pain (LBP) have different hip-spine flexibility. DESIGN: Cross-sectional. SETTING: Judo training centres. PARTICIPANTS: Judokas with (n = 29) and without (n = 33) LBP. MAIN OUTCOME MEASURES: Range of motion (ROM) (passive and active rotations) of hips, lumbar spine (flexion-extension) and fingertip-to-floor distance (FTFD). RESULTS: The non-dominant hips of judokas with LBP had 6.8 ± 1.2° (ES:1.45, p < 0.001) lower passive and 8.0 ± 1.3° (ES:1.55, p < 0.001) lower active internal rotation. Dominant hips of judokas with LBP had 5.1 ± 1.6° (ES: 0.81, p = 0.002) lower active internal rotation and 8.8 ± 2.9° (ES:0.79, p = 0.003) lower active total rotation. The LBP group showed 8.0 ± 2.8° (ES: 0.73, p = 0.006) lower flexion and 6.0 ± 2.2° (ES: 0.69, p = 0.009) lower extension of the lumbar spine. The FTFD in the LBP group was 7.3 ± 2.6 cm (ES: 0.72, p = 0.007) lower. The multi-level regression analyses showed passive (OR 1.54, 95%CI 1.18-2.00, p = 0.001) and active (OR 1.47, 95%CI 1.16-1.87, p = 0.001) hip internal rotation of the non-dominant leg and lumbar spinal flexion (OR 1.11, 95%CI 1.03-1.20, p = 0.006) and extension (OR 1.16, 95%CI 1.01-1.33, p = 0.035) were related to LBP. CONCLUSION: Lower hip internal rotation of the non-dominant leg (passive and active) and lower lumbar flexibility are significantly related to LBP in male adult judokas.

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.