Original researchComparison of hip joint range of motion in professional youth and senior team footballers with age-matched controls: An indication of early degenerative change?
Introduction
Football or soccer places a high demand on the hip joint. Sprinting, jumping and kicking, subject the hip to high load, whilst twisting and turning cause torsional forces on the joint, its surrounding capsule and ligaments and associated muscles (Saw & Villar, 2004). Studies on retired professional footballers have shown they have an increased risk of developing OA in the hip compared to the general population, with an earlier onset of symptoms (Drawer and Fuller, 2001, Klunder et al., 1980, Lindberg et al., 1993, Roos, 1998, Shepherd et al., 2003, Turner et al., 1998). Top level players with longer careers appear more susceptible to developing hip OA (Roos, 1998).
Previous significant hip injury does not appear to be a necessary precursor for hip joint OA in football; uninjured players also appear to have a higher risk of developing OA than the general population (Dvorak and Junge, 2000, Shepherd et al., 2003). Shepherd et al. (2003), in a survey of 68 retired professional players with OA of the hip, found none had sustained any recognised major hip injury (nor had undergone previous hip surgery). Similarly, Drawer and Fuller (2001) found OA of the knee and ankle joints to be commonly associated with previous injuries, whereas acute injury to the hip was not. These results are consistent with reports that knee and ankle injuries in UK football account for significantly more acute injuries than hip injuries (Hawkins & Fuller, 1999). This would suggest hip OA to be the consequence of low grade repetitive trauma and it may suggest that the early stages of the degeneration process could be present in non-injured/pain-free players.
It has been demonstrated that radiographically proven hip joint OA will cause a reduction in hip ROM although there is controversy over the combination of movements most predictive of the condition (Altman et al., 1991, Arokoski et al., 2004, Bijl et al., 1998, Birrell et al., 2001, Theiler et al., 1996). Cyriax (1983) developed the concept of a capsular pattern which indicates the existence of a contraction of the joint capsule and could show the first signs of degenerative change which may pre-dispose to OA. The capsular pattern of the hip is the restriction of IR first, then flexion, abduction and extension. It has been found to exist in subjects with radiographically proven OA with hip joint symptoms of one year or less, but not in those with symptoms longer than one year (Bijl et al., 1998). This suggests that the capsular contracture is present in the early stages of symptomatic OA, and may even be present before symptoms are felt.
Other tests such as Faber's test or the hip quadrant test have been used in the assessment of hip joint ROM and may also highlight potential capsular tightening (Ross et al., 2003, Theiler et al., 1996). Both have been shown to correlate with intra-articular pathology (Kelly et al., 2003, Mitchell et al., 2003, Ross et al., 2003, Saw and Villar, 2004, Theiler et al., 1996).
Very little epidemiological data appears to exist on footballers' hip joint ROM. Junge, Dvorak, Chomiak, Peterson, and Graf-Baumann (2000) examined hip joint ROM in 588 current players from France, Germany and the Czech Republic, and found IR of the hip to be decreased in older footballers compared with younger. Whilst this was a comprehensive study which looked at many different physical and physiological parameters of footballers, hip ROM was just one of them and the authors did not suggest a reason for this finding, nor did they consider future implications. No previous research was found which has comprehensively looked at hip ROM in elite footballers of different ages and compared them to matched controls in an attempt to correlate capsular restrictions with time spent playing football.
The issue of leg dominance (the leg they would normally use to kick the ball) is also important due to the potentially different loading patterns on the hip and its capsule. Unfortunately, studies which have addressed the frequency of hip OA in retired footballers did not specify whether the arthritic hip was the dominant or non-dominant leg (Drawer and Fuller, 2001, Klunder et al., 1980, Lindberg et al., 1993, Roos, 1998, Shepherd et al., 2003, Turner et al., 1998).
The aim of this study was to examine hip ROM of youth and senior team professional footballers to see if there is any evidence of abnormal capsular patterns and whether leg dominance affects this, and then compare with age-matched controls.
Section snippets
Participants
Male professional footballers were recruited from an English League 1 club: 20 youth team footballers aged 16–18 years who currently play full-time professional football, and 20 senior team footballers aged over 19 and have been playing full-time professional football for at least 2 years. Footballers were excluded if they had any current hip, groin or buttock pain but previous hip or groin pathology did not exclude participants from taking part in this study. Control participants were
Results
Participant group characteristics are shown in Table 1. Independent t tests on demographic data revealed no significant differences (p < 0.05) between groups and therefore the participants were assumed to be well matched (for age, weight and height).
Hip ROM in dominant and non-dominant legs were compared for both senior team and youth team footballers. No significant differences (p < 0.05) between dominant and non-dominant leg were found for any individual hip movement (IR, ER, flexion, abduction,
Discussion
A similar pattern of hip ROM was found in both the senior and youth team footballers which appeared to be different from controls. This may suggest a capsular pattern is present specific to playing football, and may demonstrate the early stages of hip degeneration to which it has been shown ex-professional players are prone to (Drawer and Fuller, 2001, Klunder et al., 1980, Lindberg et al., 1993, Roos, 1998, Shepherd et al., 2003, Turner et al., 1998). No significant differences were found in
Conclusion
A specific pattern of hip ROM was demonstrated in non-injured professional footballers (both youth team and senior team), which was unaffected by leg dominance. These changes (reduced IR and increased abduction) differed from the traditional Cyriax hip capsular pattern (reduction of IR first, then flexion, abduction and extension) and appeared to worsen with age. Faber's test and the hip quadrant (both of which can be used to identify hip pathology) also showed markedly different results
Conflict of Interest
None.
Funding
No funding was obtained for this study.
Ethical Approval
Ethical approval was granted by Queen Mary University of London Research Ethics Committee (reference number QMREC2006/18).
Acknowledgements
I would like to thank Dr Zoë Hudson, Lewis Manning (Head Physiotherapist) and Ed Butler (Assistant Physiotherapist) at Leyton Orient F.C, and all the players/participants who gave up their time to participate in this study.
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