How Useful Is the Flexion-Adduction-Internal Rotation Test for Diagnosing Femoroacetabular Impingement: A Systematic Review.

OBJECTIVE: Clinicians use the flexion, adduction, and internal rotation (FADIR) test in the diagnosis of femoroacetabular impingement (FAI). However, the diagnostic utility of this test remains unclear. The purpose of this review was to determine the utility of the FADIR test in diagnosing FAI. DATA SOURCES: MEDLINE, EMBASE, and PubMed were searched using relevant key terms and study screening was performed in duplicate. Patient demographics, diagnostic imaging, and summary measures (eg sensitivity, specificity, etc.) of the FADIR test in patients with FAI were recorded. MAIN RESULTS: Eight studies of levels III (87.5%) and IV (12.5%) evidence were included. Four hundred fifty-two patients (622 hips) with a mean age of 27.0 ± 9.0 were examined. Alpha (75.1%) and/or center-edge (26.8%) angles were used to diagnose hips with FAI. X-ray (78.9%), magnetic resonance imaging (MRI) (16.2%), and computed tomography (CT) (4.8%) were used to confirm the diagnosis of FAI. The sensitivity when confirmed by x-ray, MRI, or CT was 0.08 to 1, 0.33 to 1 and 0.90, respectively. The specificity when confirmed by x-ray and MRI was 0.11 and 1, respectively. CONCLUSIONS: Although the overall utility of the FADIR test in diagnosing FAI remains unclear given its moderate sensitivity and specificity, it may be a useful screening tool for FAI because of its low risk. Clinicians should consider the variability in sensitivity and specificity values reported and the low quality of literature available. Future studies should use large sample sizes and consistent radiographic measurements to better understand the usefulness of this physical examination maneuver in diagnosing FAI. LEVEL OF EVIDENCE: Level IV, Systematic Review of Level III and IV studies.

Ice hockey skating sprints: run to glide mechanics of high calibre male and female athletes.

The skating acceleration to maximal speed transition (sprint) is an essential skill that involves substantial lower body strength and effective propulsion technique. Coaches and athletes strive to understand this optimal combination to improve performance and reduce injury risk. Hence, the purpose of this study was to compare body centre of mass and lower body kinematic profiles from static start to maximal speed of high calibre male and female ice hockey players on the ice surface. Overall, male and female skaters showed similar centre of mass trajectories, though magnitudes differed. The key performance difference was the male's greater peak forward skating speed (8.96 ± 0.44 m/s vs the females' 8.02 ± 0.36 m/s, p < 0.001), which was strongly correlated to peak leg strength (R 2 = 0.81). Males generated greater forward acceleration during the initial accelerative steps, but thereafter, both sexes had similar stride-by-stride accelerations up to maximal speed. In terms of technique, males demonstrated greater hip abduction (p = 0.006) and knee flexion (p = 0.026) from ice contact to push off throughout the trials. For coaches and athletes, these findings underscore the importance of leg strength and widely planted running steps during the initial skating technique to achieve maximal skating speed over a 30 m distance.

Skating start propulsion: three-dimensional kinematic analysis of elite male and female ice hockey players.

The forward skating start is a fundamental skill for male and female ice hockey players. However, performance differences by athlete's sex cannot be fully explained by physiological variables; hence, other factors such as skating technique warrant examination. Therefore, the purpose of this study was to evaluate the body movement kinematics of ice hockey skating starts between elite male and female ice hockey participants. Male (n = 9) and female (n = 10) elite ice hockey players performed five forward skating start accelerations. An 18-camera motion capture system placed on the arena ice surface captured full-body kinematics during the first seven skating start steps within 15 meters. Males' maximum skating speeds were greater than females. Skating technique sex differences were noted: in particular, females presented ~10° lower hip abduction throughout skating stance as well as ~10° greater knee extension at initial ice stance contact, conspicuously followed by a brief cessation in knee extension at the moment of ice contact, not evident in male skaters. Further study is warranted to explain why these skating technique differences exist in relation to factors such as differences in training, equipment, performance level, and anthropometrics.