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  • Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients

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Original article
Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients
  1. Enda King1,2,
  2. Andrew Franklyn-Miller1,3,
  3. Chris Richter1,
  4. Eamon O’Reilly1,
  5. Mark Doolan1,
  6. Kieran Moran4,5,
  7. Siobhan Strike2,
  8. Éanna Falvey1,6
  1. 1 Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland
  2. 2 Department of Life Sciences, University of Roehampton, Roehampton, UK
  3. 3 Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
  4. 4 School of Health and Human Performance, Dublin City University, Dublin, Ireland
  5. 5 Insight Research Centre, Dublin City University, Dublin, Ireland
  6. 6 Department of Medicine, University College Cork, Cork, Ireland
  1. Correspondence to Mr Enda King, Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin 9, Republic of Ireland; endaking{at}hotmail.com

Abstract

Background Clinical assessments and rehabilitation in athletic groin pain (AGP) have focused on specific anatomical structures and uniplanar impairments rather than whole body movement.

Objective To examine the effectiveness of rehabilitation that targeted intersegmental control in patients with AGP and to investigate post rehabilitation changes in cutting biomechanics.

Methods Two hundred and five patients with AGP were rehabilitated focusing on clinical assessment of intersegmental control, linear running and change of direction mechanics in this prospective case series. Hip and Groin Outcome Score (HAGOS) was the primary outcome measure. Secondary measures included pain-free return to play rates and times, pain provocation on squeeze tests and three-dimensional (3D) biomechanical analysis during a 110° cutting manoeuvre.

Results Following rehabilitation, patients demonstrated clinically relevant improvements in HAGOS scores (effect size (ES): 0.6–1.7). 73% of patients returned to play pain-free at a mean of 9.9 weeks (±3.5). Squeeze test values also improved (ES: 0.49–0.68). Repeat 3D analysis of the cutting movement demonstrated reductions in ipsilateral trunk side flexion (ES: 0.79) and increased pelvic rotation in the direction of travel (ES: 0.76). Changes to variables associated with improved cutting performance: greater centre of mass translation in the direction of travel relative to centre of pressure (ES: 0.4), reduced knee flexion angle (ES: 0.3) and increased ankle plantar flexor moment (ES: 0.48) were also noted.

Conclusions Rehabilitation focused on intersegmental control was associated with improved HAGOS scores, high rates of pain-free return to sporting participation and biomechanical changes associated with improved cutting performance across a range of anatomical diagnoses seen in AGP.

  • groin
  • biomechanics
  • rehabilitation
  • injury
  • performance

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/

https://doi.org/10.1136/bjsports-2016-097089

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    Footnotes

    • Contributors EK was involved in the creation of study design and hypothesis, data collection, carrying out rehabilitation intervention, data analysis, and drafting and revising submission. AFM was involved in the creation of study design and hypothesis, data collection, and drafting and revising submission. CR was involved in the creation of study design, data collection, data analysis and drafting submission. EOR was involved in the creation of study design, data collection and carrying out rehabilitation intervention, and revision of submission. MD was involved in study design, data collection, data analysis and revision of submission. KM was involved in study design, data interpretation and revision of submission. SS was involved in study design, data interpretation and revision of submission. EF was involved in the creation of study design and hypothesis, data collection, and drafting and revising submission.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Sports Surgery Clinic is a private orthopaedic and sports medicine clinic and operates an athletic groin pain programme.

    • Patient consent Obtained.

    • Ethics approval The Sports Surgery Clinic Hospital Ethics Committee approved the study (Ref 25EF011), which was registered at ClinicalTrials.gov (NCT02437942).

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