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Is lower hip range of motion a risk factor for groin pain in athletes? A systematic review with clinical applications
  1. Igor Tak1,2,
  2. Leonie Engelaar3,
  3. Vincent Gouttebarge4,
  4. Maarten Barendrecht5,6,
  5. Sylvia Van den Heuvel5,
  6. Gino Kerkhoffs7,
  7. Rob Langhout8,
  8. Janine Stubbe9,10,
  9. Adam Weir11
  1. 1Manual Therapy and Sports Rehabilitation, Physiotherapy Utrecht Oost, Utrecht, The Netherlands
  2. 2Academic Center for Evidence based Sports Medicine (ACES), AMC, Amsterdam, The Netherlands
  3. 3Engelaar Sports Physiotherapy, Doetinchem, The Netherlands
  4. 4Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
  5. 5Dutch Center for Allied Health Care, Amersfoort, The Netherlands
  6. 6Master Physical Therapy in Sports, Avans+ Improving Professionals, Breda, The Netherlands
  7. 7Department of Orthopedic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
  8. 8Manual Therapy and Sports Rehabilitation, Physiotherapy Dukenburg Nijmegen, Nijmegen, The Netherlands
  9. 9School of Sports & Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
  10. 10Codarts University of the arts, Rotterdam, The Netherlands
  11. 11Department of Sports Medicine, Aspetar hospital, Doha, Qatar
  1. Correspondence to Igor Tak, Manual Therapy and Sports Rehabilitation, Physiotherapy Utrecht Oost, Bloemstraat 65 D, Utrecht 3581 WD, The Netherlands; igor.tak{at}gmail.com

Abstract

Background Whether hip range of motion (ROM) is a risk factor for groin pain in athletes is not known.

Objectives To systematically review the relationship between hip ROM and groin pain in athletes in cross-sectional/case–control and prospective studies.

Study design Systematic review, prospectively registered (PROSPERO) according to PRISMA guidelines.

Methods Pubmed, Embase, CINAHL and SPORTDiscus were systematically searched up to December 2015. Two authors performed study selection, data extraction/analysis, quality assessment (Critical Appraisal Skills Programme) and strength of evidence synthesis.

Results We identified seven prospective and four case–control studies. The total quality score ranged from 29% to 92%. Heterogeneity in groin pain classification, injury definitions and physical assessment precluded data pooling. There was strong evidence that total rotation of both hips below 85° measured at the pre-season screening was a risk factor for groin pain development. Strong evidence suggested that internal rotation, abduction and extension were not associated with the risk or presence of groin pain.

Conclusion Total hip ROM is the factor most consistently related to groin pain in athletes. Screening for hip ROM is unlikely to correctly identify an athlete at risk of developing groin pain because of the small ROM differences found and poor ROM measurement properties.

  • Groin pain
  • Athletes
  • Hip
  • Range of motion
  • Flexibility
  • Risk factor

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors IT: Conception and design. Data acquisition, analysis and interpretation of data. Drafting the article. Revising it critically for important intellectual content and final approval of the version to be published.

    LE: Conception and design. Data acquisition, analysis and interpretation of data. Drafting the article. Final approval of the version to be published.

    VG: Conception and design. Critically assisting in interpretation of data. Revising the article critically for important intellectual content and final approval of the version to be published.

    MB: Conception and design. Critically assisting in interpretation of data. Revising the article critically for important intellectual content and final approval of the version to be published.

    SVDH: Data acquisition. Revising the article critically and final approval of the version to be published.

    RL: Revising the article critically and final approval of the version to be published.

    GK: Revising the article critically for important intellectual content and final approval of the version to be published.

    JS: Revising the article critically for important intellectual content and final approval of the version to be published.

    AW: Help in preparation of the manuscript. Revising the article for critical intellectual content. Interpretation of data and final approval of the version to be published.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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