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Past-season, pre-season and in-season risk assessment of groin problems in male football players: a prospective full-season study
  1. Ernest Esteve1,
  2. Marti Casals2,3,
  3. Marc Saez4,5,
  4. Michael Skovdal Rathleff6,7,
  5. Mikkel Bek Clausen8,9,
  6. Jordi Vicens-Bordas2,10,
  7. Per Hölmich8,
  8. Tania Pizzari11,
  9. Kristian Thorborg8,12
  1. 1 Universtiy School of Health and Sport (EUSES), University of Girona, Girona, Catalunya, Spain
  2. 2 Sport and Physical Activity Studies Centre (CEEAF), Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Catalunya, Spain
  3. 3 Servicios Médicos, Futbol Club Barcelona, Barcelona, Catalunya, Spain
  4. 4 Research Group on Statistics, Econometrics and Health, GRECS, University of Girona, Girona, Catalunya, Spain
  5. 5 CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Comunidad de Madrid, Spain
  6. 6 SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
  7. 7 Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
  8. 8 Sports Orthopaedic Research Center–Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hovedstaden, Denmark
  9. 9 Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Kobenhavn, Hovedstaden, Denmark
  10. 10 NEOMA Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Catalunya, Spain
  11. 11 La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
  12. 12 Physical Medicine and Rehabilitation–Copenhagen (PMR-C), Amager-Hvidovre Hospital, Copenhagen University, Hvidovre, Denmark
  1. Correspondence to Dr Ernest Esteve, School of Health and Sport Sciences (EUSES), University of Girona, Salt (Girona), Catalunya, Spain; ernestesteve{at}


Objective We assessed past-season, pre-season and in-season risk factors to investigate their association with an in-season groin problem in male amateur football players.

Methods Past-season groin-pain information and pre-season short-lever and long-lever adductor squeeze strength were obtained at baseline, together with anthropometrics (weight, lower limb lever length) and player age. In-season hip-related and groin-related sporting function was monitored every 4 weeks using the Sports and Recreation (Sport) subscale from the Hip And Groin Outcome Score questionnaire (HAGOS (Sport)). Groin problems, including time-loss groin injuries and groin pain irrespective of time loss, were collected over a 39-week competitive in-season. We estimated relative risk (RR), and 95% credibility interval (ICr) from logistic regressions fitted in a Bayesian framework.

Results Players (n=245) suffering from groin pain during the past-season had 2.4 times higher risk of experiencing a groin problem in the new season (2.40 RR; 95% ICr 1.5 to 3.7). This risk was reduced by 35% (0.65 RR; 95% ICr 0.42 to 0.99) per unit (N·m/kg) increase in the long-lever adductor squeeze test. Player age, short-lever squeeze test and the HAGOS (Sport) scores were not associated with the risk of a groin problem.

Conclusions Past-season groin pain increased the risk of a groin problem in the new in-season. This risk was reduced by higher pre-season long-lever adductor squeeze strength. Past-season groin-pain information and long-lever adductor squeeze strength can be quickly obtained during pre-season to identify players with an elevated risk of in-season groin problems. This may be key to reduce these problems in the new season.

  • groin injuries
  • groin pain
  • hip strength
  • Bayesian inference

Data availability statement

Authors are happy to share the data upon reasonable request.

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Data availability statement

Authors are happy to share the data upon reasonable request.

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  • Twitter @CasalsTMarti, @MichaelRathleff, @mikkelbek, @jordivicensb, @PerHölmich, @DrTaniaPizzari, @KThorborg

  • Contributors EE, KT, MSR, MBC and PH have contributed to the original idea of this work, design, analyses and interpretation of the data. JV-B has contributed together with EE in data collection, as well as interpretation of the data. MC and MS contributed in analyses, and visualisation and interpretation of the data. TP has contributed in interpretation of the results, writing and reviewing the manuscript. All authors have participated in writing the paper and revising it critically for important intellectual content, as well as the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.