The association between hip/groin pain and hip strength in football players: An exploratory analysis of the FORCe cohort.

OBJECTIVES: Explore associations between peak hip strength in football players with hip/groin pain and healthy controls. DESIGN: Cross-sectional study. METHODS: Male and female sub-elite football players (soccer and Australian football) with hip/groin pain >6-month duration and players without hip/groin pain were recruited across Melbourne and Brisbane, Australia. Demographic information and two questionnaires; the Copenhagen Hip and Groin Outcome Score and the International Hip Outcome Tool 33 were collected. Hand-held dynamometry was used to measure isometric hip strength for flexion, extension, abduction, adduction, internal rotation, and external rotation. Linear mixed effects models were used to compare strength measures between groups. RESULTS: 190 football players with hip/groin pain (mean ±â€¯standard deviation age, 27.8 ±â€¯6.3 years) and 64 controls (age, 27.3 ±â€¯5.6 years) were included in this study. Of these, 291 symptomatic limbs and 128 control limbs were used for analyses. Symptomatic players had lower peak hip adduction (adjusted mean difference = -0.18: 95 % confidence interval -0.27 to -0.08, P : 0.001), external rotation (-0.06: 95 % confidence interval -0.09 to -0.02, P : 0.003), and internal rotation strength (-0.06: 95 % confidence interval -0.10 to -0.03, P : 0.001) compared to controls. A sport-specific interaction was observed for hip abduction strength. When separated by football code, abduction strength was lower in symptomatic Australian football players compared to their same sport peers (-0.20: 95 % confidence interval -0.33 to -0.06, P : 0.004), but not in symptomatic soccer players (-0.05: 95 % confidence interval -0.15 to 0.06, P : 0.382). CONCLUSIONS: Hip adduction, internal rotation, and external rotation strength appears lower in football players with hip/groin pain independent of sex and football code. Hip abduction strength was lower in symptomatic Australian football players but not in soccer players.

Descriptive Analysis of a Telephone Based Community Monitoring Service for COVID-19.

The coronavirus disease (COVID-19) pandemic has required health services to rapidly respond to the needs of people diagnosed with the virus. Over 80% of people diagnosed with COVID-19 experience a mild illness and there is a need for community management to support these people in their home. In this paper we present, a telephone based COVID-19 community monitoring service developed in an Australian public health network, and we describe the rapid implementation of the service and the demographic and clinical characteristics of those enrolled. A retrospective mixed methods evaluation of the COVID-19 community monitoring service using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Eight hundred and fifty COVID-19 positive patients were enrolled, 54% female, 45% male, mean age 34 years SD 17. Four hundred and nine (48%) patients were born outside Australia. Among the 850 patients, 305 (36%) were classified as having a high risk of serious illness from COVID-19. The most prevalent risk factors were cardiovascular disease (37%), lung disease (30%) and age over 60 years (26%). The most common reported ongoing symptoms were fatigue (55%), breathing issues (26%) and mental health issues such as low mood (19%). There were no deaths in patients that participated in the service. The process of risk stratification undertaken with telephone triage was effective in determining risk of prolonged illness from COVID-19. Telephone monitoring by trained health professionals has a strong potential in the effective management of patients with a mild COVID-19 illness.

Between session reliability of intramuscular electromyography for segments of gluteus medius and minimus during gait and stepping tasks.

Between-session reliability of electromyographic data is important for confidence in interpreting the role of muscles in functional tasks but critical if these data are to be compared before and after an intervention that seeks to change pathological patterns of muscle activity. The gluteus medius (GMed) and minimus (GMin) are known to have functionally discrete segments that are highly active during stance phase of gait and stepping tasks. This study measured the between-session reliability of activity patterns, mean amplitudes and time to peak (TTP) activity of these muscle segments. Intramuscular electrodes were placed in 3 segments of GMed and 2 segments of GMin in 10 healthy young adults for each of two testing sessions held two weeks apart. Participants completed six repetitions of comfortable speed walking trials, step-up and step-down tasks with activity patterns for each muscle segment time- and amplitude-normalized and averaged across trials. Re-test reliability for was high for activity patterns (coefficient of mean correlation ranging from 0.890 to 0.998) across all tasks and muscle segments and only two pairwise comparisons showing differences in amplitude between sessions. With standardized data collection and analysis procedures, GMed and GMin muscle segment activity patterns show good between-session reliability for weightbearing tasks.

Muscle size and composition in people with articular hip pathology: a systematic review with meta-analysis.

OBJECTIVE: To synthesise and evaluate the current evidence investigating muscle size and composition in non-inflammatory articular hip pathology. METHODS: A systematic review of five electronic databases, using three concepts; articular hip pathology (e.g., osteoarthritis (OA)); hip muscles; and outcomes (e.g., muscle size and adiposity) was undertaken. Studies addressing non-inflammatory or non-traumatic articular hip pain, using measures of muscle size and adiposity were included and appraised for risk of bias. Data was extracted to calculate standardised mean differences (SMD) and pooled where possible for meta-analysis. RESULTS: Thirteen cross-sectional studies were included; all studies measured muscle size and 5/13 measured adiposity. In OA, there was low to very low quality evidence of no difference in hip muscle size, compared with matched controls. In unilateral OA, there was low to very low quality evidence of smaller size in gluteus minimus (SMD -0.38; 95% confidence interval (CI) -0.74, -0.01), gluteus medius (-0.44; 95% CI: -0.83, -0.05) and gluteus maximus (-0.39; 95% CI: -0.75, -0.02) muscles in the symptomatic limb. Individual studies demonstrated non-uniform changes in muscle size in OA. No significant difference was observed in muscle size in other pathologies or in adiposity for any group. CONCLUSION: There is some low quality evidence that specific hip muscles are smaller in unilateral hip OA. Variation in the magnitude of differences indicate changes in size are not uniform across all muscles or stage of pathology. Studies in larger cohorts investigating muscle size and composition across the spectrum of articular pathologies are required to clarify these findings.

Efficacy of rehabilitation programs for improving muscle strength in people with hip or knee osteoarthritis: a systematic review with meta-analysis.

To analyse the effect of exercise-based rehabilitation programs for improving lower limb muscle strength in individuals with hip or knee osteoarthritis (OA). A systematic search utilizing seven databases identified randomized controlled trials (RCTs) evaluating lower limb strength outcomes of exercise-based interventions for participants with hip or knee OA. All studies were screened for eligibility and methodological quality. Quality of evidence was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Data were pooled and meta-analyses performed where appropriate. Forty RCTs were included and the majority (77%) involved resistance based exercise programs. For knee OA populations, there was high quality evidence for improved knee extension (standardized mean difference (SMD) = 0.47, 95% confidence intervals (CI) 0.29, 0.66) and flexion strength (SMD = 0.74, 95% CI 0.56, 0.92) with low-intensity resistance program when compared to a control at short term (ST) follow-up. There was moderate quality evidence for a large effect favouring high-intensity resistance programs (SMD = 0.76, 95% CI 0.47, 1.06) when compared to a control. This effect was sustained at intermediate term (IT) follow-up (SMD = 0.80, 95% CI 0.44, 1.17). Few studies reported on outcomes at long term (LT) follow-up. Only one study reported on a population with hip OA. When compared to a control group, high-intensity resistance exercise demonstrated moderate quality of evidence for large and sustained improvements for knee muscle strength in knee OA patients. Further work is needed to compare different modes of exercise at a LT follow-up for knee OA patients and to address the dearth of literature evaluating exercise interventions in people with hip OA.

Verification of a standardized method for inserting intramuscular EMG electrodes into uniquely oriented segments of gluteus minimus and gluteus medius.

Guidelines for assessing the function of gluteus minimus and gluteus medius with electromyography (EMG) traditionally offer one electrode placement site per muscle. However, anatomical studies suggest that there are two uniquely oriented segments within gluteus minimus (anterior and posterior), and three within gluteus medius (anterior, middle, and posterior) with potential for independent function. Assessment of these muscles with one electrode may therefore provide only a limited account of their role. Thus, the aim of this cadaveric study was to verify guidelines for placing intramuscular electrodes into two uniquely oriented segments of gluteus minimus, and three segments of gluteus medius. The guidelines were developed with reference to anatomical reports, cadaveric observation and real-time ultrasound imaging in vivo. Five cadaveric gluteal regions were marked for intramuscular electrode insertions based on these guidelines. Intramuscular electrodes were inserted into the marked regions of gluteus minimus (2×) and gluteus medius (3×) with the aid of a 15 cm biopsy needle. Systematic dissection revealed that electrodes were successfully inserted into uniquely oriented segments of gluteus minimus and medius. The orientation of fascicles surrounding each electrode was also consistent with segmental descriptions in past anatomical research. The findings of this research suggest that the guidelines described may be used to assess the functional role of segments within gluteus minimus and medius in health and dysfunction using EMG. Finally, electromyographers intent on investigating the role of posterior gluteus minimus must be cautious of the superior gluteal neurovascular bundle.