Movement retraining programme in young soccer and rugby football players: A feasibility and proof of concept study.

INTRODUCTION: Movement screening to identify abnormal movement patterns can inform development of effective interventions. The primary objective of this study was to evaluate the feasibility of using a movement screening tool in combination with a tailored movement control retraining programme in young soccer and rugby football players. A secondary objective was to investigate changes in movement control patterns post-intervention, to provide proof of concept (PoC) for movement retraining. METHODS: 52 male amateur players, including 34 soccer players (mean age 15 ± 2 years) and 18 rugby players (mean age 15 ± 1 years) participated. They were screened for movement control ability using a shortened version of the Hip and Lower Limb Movement Screening (Short-HLLMS) and completed an eight-week movement control retraining programme. Evaluation of feasibility included consent from players invited, adherence, attendance at the exercise sessions, drop-out and adverse events. Short-HLLMS total score and The Copenhagen Hip and Groin Outcome Score (HAGOS) were analysed to provide PoC for retraining movement control. RESULTS: feasibility outcomes were favourable. Significant statistical changes occurred post-intervention in the Short-HLLMS total score (paired-samples t-test) and in three HAGOS subscales (symptoms, physical function in daily living and in sport and recreation) (Wilcoxon-Signed Rank Test) in both groups. CONCLUSIONS: Feasibility of using the Short-HLLMS in combination with a movement control retraining programme in soccer and rugby players was promising. The data provided PoC for the potential application of a shortened version of the HLLMS to evaluate changes in movement control and to inform targeted motor control programmes.

Ultrasound Shear Modulus and Thickness of Lateral Abdominal Muscles in Different Contractile States in Relation To Self- Reported Hip/Groin Problems in Youth Soccer Players.

To date, no studies have assessed lateral abdominal muscles' (LAM) elasticity and thickness in relation to hip and groin symptoms in any population. The objectives were to a) assess the relationship between LAM ultrasound measurements (elasticity and thickness) and self-reported subscales of the Copenhagen Hip and Groin Outcome Score (HAGOS) and b) compare LAM elasticity and thickness between asymptomatic and symptomatic sides. Shear modulus and thickness of the oblique external (OE), internal (OI) and transversus abdominis (TrA) muscles in 25 young soccer players were assessed at rest and during isometric contraction using ultrasound shear wave elastography. HAGOS subscales were used to assess self-reported hip/groin problems. There was a significant (p < 0.05) moderate correlation between allometric-scaled OI resting thickness (mean of right and left) and the Activities of Daily Living (r = 0.40), Sport (r = 0.57) and Quality of Life (QOL) (r = 0.41) HAGOS subscales. Also, a moderate significant correlation was found between allometric-scaled TrA resting thickness and the QOL subscale (r = 0.47). Moderate correlations were found between resting OI shear modulus and the QOL (r = 0.44), between right TrA shear modulus during contraction and Symptoms (r = 0.57), and between the left TrA shear modulus during contraction and Physical Activity (r = 0.41) subscales. No differences were found between the symptomatic and asymptomatic side in thickness and elasticity measurements among soccer players with unilateral symptoms (p > 0.05). The relationships found between LAM and hip/groin problems in youth male soccer players indicate that muscles are thinner and more elastic (less stiff) in more symptomatic athletes.

Functional movement screen and Y balance tests in adolescent footballers with hip/groin symptoms.

OBJECTIVES: To assess the correlation between the functional movement screen (FMS) and Y balance test (Y-BT) performance, and the self-reported hip/groin problems, and to compare healthy with hip/groin pain participants. DESIGN: a cross-sectional study. SETTING: Sports hall in a football club. PARTICIPANTS: 43 elite adolescent football (soccer) players. MAIN OUTCOME: The Copenhagen Hip and Groin Outcome Score (HAGOS), Anterior, posterolateral and posteromedial distance of Y-BT, FMS score. MEASURES: Y balance and FMS test kit, HAGOS questionnaire. RESULTS: The posterolateral, posteromedial distance and composite reach score of the Y-BT were lower in participants with hip/groin problems (p < 0.05). FMS performance was similar in healthy and hip/groin groups. There was a weak correlation (r = 0.32, p= 0.03) between the HAGOS Activities of Daily Living subscale and FMSstabil. In the Y-BT the posterolateral reach was weakly correlated with Symptoms (r = 0.35-0.44, p < 0.02) and moderately correlated with Pain (r = 0.44, p < 0.01) subscales. Posteromedial direction reach with the right leg was weakly correlated with Symptoms (r = 0.32, p = 0.04) and Pain (r = 0.39, p = 0.01). The Y-BT composite score was moderately correlated with Symptoms and Pain (r = 0.42-0.44, p < 0.01). CONCLUSIONS: The Y-BT and the FMS subtests were weakly or moderately correlated with self-reported hip/groin problems. Thus, these tests should be investigated further in adolescent footballers because they may have potential to predict hip and groin problems.

Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report.

Athletes with femoroacetabular impingement syndrome (FAIS) managed arthroscopically do not always return to sport. Inability to control back/pelvis, hip and lower limb movements may contribute to the onset and recurrence of symptoms. Our hypothesis is that results from a battery of cognitive movement control tests can inform a cognitive movement control (neuromuscular) retraining programme for improving the clinical presentation and quality of life in an athlete with FAIS. This case report presents a female elite rower with persistent left-sided anterior hip pain, four years post-arthroscopic surgery for FAIS, whose symptoms failed to respond to conventional physical therapy. Hip and groin outcome score (HAGOS), passive and active hip flexion range of motion (ROM) workload (time training on water), hip and pelvic kinematics (3-D motion analysis) and electromyography during a seated hip flexion movement control test, and a movement control test battery to identify movement control impairments (The Foundation Matrix), were assessed pre-intervention (week 0) and immediately post-intervention (week 16). Impaired movement control was targeted in a tailored 16-week cognitive movement control retraining exercise program. All measures improved: HAGOS (all 6 sub-scales); symptoms (61/100 pre-training to 96/100 post-training); physical activities participation (13/100 to 75/100); and active hip flexion ROM increased (78 to 116 and 98 to 118 degrees, respectively); workload increased from 4 to 18 h/week; and movement control impairment reduced (25/50 to 9/50). Pelvic motion on kinematic analysis were altered, and delayed activation onset of tensor fascia latae and rectus femoris muscles reduced. This proof-of-concept case report supports the hypothesis that cognitive movement control tests can inform a targeted cognitive movement control retraining program to improve symptoms, function and quality of life, in an elite rower with persistent hip pain. This training offers an alternative approach to conventional physical therapy, which has failed to restore function in FAIS, and the present study illustrates how specific cognitive movement control assessment can direct individual training programmes.

Accuracy of movement quality screening to document effects of neuromuscular control retraining exercises in a young ex-footballer with hip and groin symptoms: A proof of concept case study.

Hip and groin pain is common in footballers and altering movement patterns can reduce symptoms. Observational tests of movement control are thought to identify abnormal movement patterns, but their accuracy needs yet to be confirmed by comparison with an objective measure. To assess the accuracy, using 3D motion analysis, of observational movement control tests and their ability to detect changes, and document changes in symptoms following a neuromuscular control exercise programme in an ex-footballer with hip and groin pain. A 25-year-old male with chronic bilateral hip and groin pain had their movement control ability rated and kinematic data collected using 3D motion analysis while performing Small Knee Bend (SKB) and SKB with Rotation (SKB Rot) tests pre-and post-neuromuscular control exercise training. Movement control was rated as at fault if they were unable to control specific trunk and pelvic movements during the tests. The Copenhagen Hip and Groin Outcome Score (HAGOS) was used to assess symptoms. Following the intervention, observational rating during the SKB test improved from fault to no fault for anterior pelvic tilt, which decreased by 17° and 16° during right and left leg SKB tests respectively. The HAGOS symptoms subsection improved from 36% to 61%. Observational movement screening ratings were supported by 3-D motion analysis. These findings indicate that the screening tool was accurate for detecting improvements in trunk and pelvic movement control following an exercise programme in an ex-footballer who had presented with hip and groin pain.

Predicting sport and occupational lower extremity injury risk through movement quality screening: a systematic review.

BACKGROUND: Identification of risk factors for lower extremity (LE) injury in sport and military/first-responder occupations is required to inform injury prevention strategies. OBJECTIVE: To determine if poor movement quality is associated with LE injury in sport and military/first-responder occupations. MATERIALS AND METHODS: 5 electronic databases were systematically searched. Studies selected included original data; analytic design; movement quality outcome (qualitative rating of functional compensation, asymmetry, impairment or efficiency of movement control); LE injury sustained with sport or military/first-responder occupation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. 2 independent authors assessed the quality (Downs and Black (DB) criteria) and level of evidence (Oxford Centre of Evidence-Based Medicine model). RESULTS: Of 4361 potential studies, 17 were included. The majority were low-quality cohort studies (level 4 evidence). Median DB score was 11/33 (range 3-15). Heterogeneity in methodology and injury definition precluded meta-analyses. The Functional Movement Screen was the most common outcome investigated (15/17 studies). 4 studies considered inter-relationships between risk factors, 7 reported diagnostic accuracy and none tested an intervention programme targeting individuals identified as high risk. There is inconsistent evidence that poor movement quality is associated with increased risk of LE injury in sport and military/first-responder occupations. CONCLUSIONS: Future research should focus on high-quality cohort studies to identify the most relevant movement quality outcomes for predicting injury risk followed by developing and evaluating preparticipation screening and LE injury prevention programmes through high-quality randomised controlled trials targeting individuals at greater risk of injury based on screening tests with validated test properties.