Summary of significant and non-significant groin injury risk factors by quantity, quality and level of evidence
| Level of evidence* | 1 | 2 | 3 | 4 | 5 | Total studies | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| a | b: High-quality RCT | c | a | b: True or quasi experimental | b: Prospective cohort | b: Retrospective cohort | c | a | b: Case–control | Pilot cohort cross-sectional | ||||||||||
| Risk factor | Risk factor | SIG | NOT | SIG | NOT | SIG | NOT | SIG | NOT | SIG | NOT | SIG | NOT | |||||||
| Modifiable | Weight | 1 (11) | 4 (13–19) | 1 (9) | 1 (12) | 7 | ||||||||||||||
| BMI | 5 (13–18) | 1 (9) | 6 | |||||||||||||||||
| Body fat | 3 (11–18) | 3 | ||||||||||||||||||
| Hip ROM | 1 (10) | 5 (9–18) | 1 (7) | 1 (11) | 1 (12) | 9 | ||||||||||||||
| Hip Add strength | 1 (12) | 3 (9–18) | 2 (11–15) | 2 (7–11) | 1 (9) | 9 | ||||||||||||||
| Hip Abd strength | 1 (12) | 1 (11) | 1 (9) | 1 (11) | 4 | |||||||||||||||
| GMd activation | 1 (7) | 1 | ||||||||||||||||||
| TrA thickness/activation | 2 (9–11) | 2 | ||||||||||||||||||
| Knee muscle strength | 1 (11) | 1 | ||||||||||||||||||
| Knee ROM | 1 (9) | 1 | ||||||||||||||||||
| Calf flexibility | 1 (9) | 1 | ||||||||||||||||||
| Clinical tests† | 1 (18) | 1 (11) | 1 (11) | 3 | ||||||||||||||||
| Fitness tests‡ | 1 (18) | 4 (11–18) | 5 | |||||||||||||||||
| GrOS/function | 2 (16–18) | 1 (11) | 3 | |||||||||||||||||
| Exposure§ | 3 (16–18) | 1 (10) | 4 | |||||||||||||||||
| Stretching and cross-training | 1 (10) | 1 | ||||||||||||||||||
| Sport specific training | 1 (15) | 1 | ||||||||||||||||||
| Non-modifiable | Age | 1 (20) | 2 (10–13) | 6 (13–18) | 1 (9) | 2 (10–12) | 12 | |||||||||||||
| Sex | 1 (18) | 1 (16) | 1 (9) | 1 (10) | 4 | |||||||||||||||
| Height | 6 (11–18) | 1 (9) | 1 (12) | 8 | ||||||||||||||||
| Previous injury | 1 (20) | 4 (15–18) | 5 | |||||||||||||||||
| Game play | 1 (13) | 1 (18) | 2 | |||||||||||||||||
| Level of play | 1 (20) | 2 (11–18) | 3 | |||||||||||||||||
| Player position | 1 (20) | 1 (11) | 2 (11–18) | 1 (9) | 5 | |||||||||||||||
| Years of sport experience | 1 (15) | 2 (11–16) | 1 (9) | 4 | ||||||||||||||||
| Occupational demands | 1 (20) | 1 | ||||||||||||||||||
| Skeletal maturation | 1 (10) | 1 | ||||||||||||||||||
| Leg morphology | 1 (11) | 1 | ||||||||||||||||||
Cell values represent number of studies (range of Downs and Black quality assessment tool scores/23 for cohort studies and/32 for RCT's). As per exclusion criteria, systematic reviews (1a, 2a and 3a), case series (4) and opinion-based papers (5) were not included (shown in dark grey).
*Level of evidence is based on the modified Oxford Centre for Evidence-Based Medicine Model.
†Including tenderness on palpation, pain, joint stability (knee and ankle) and positive active straight leg raise test.
‡Includes jump height, leg power (squat), 40 m sprint, sidestepping, kicking and VO2max estimated from a shuttle run.
§Includes measures of training and match exposure as well as weekly sports participation.
Abd, abduction; Add, adduction; ASLR, active straight leg raise test; BMI, body mass index; GMd, glutaeus medius; GrOS, groin outcome score; IO, internal oblique; LE, lower extremity (knee and ankle); NOT, not significant finding; RA, rectus abdominins; RCT, randomised control trial; ROM, range of motion; SIG, significant finding; TrA, transversus abdominis.