Recovery of two elite footballers from adductor strain with dry needling and eccentric strengthening: Two case studies.

INTRODUCTION: Groin injuries are common in sports, almost 68% adductor strain among them, which generally more prone in football, soccer, hockey, and other games. The available literature well describes the rehabilitation phase of adductor strain but an application of dry needling on adductor injuries are not yet established. CASE DESCRIPTION: Two national-level younger football players were clinically diagnosed with the adductor strain. They had severe pain on medial aspect of the thigh, aggravated with kicking and functional activity (VAS- 8/10, LEFS 58/80, 69/80). The therapist assessed the patients and designed their rehabilitation protocol as per their findings of the examination. OUTCOME: The lower extremity functional scale (LEFS), global rating scale, and VAS were used as outcome variables. The total intervention was given for 10-12 weeks, follow up had been taken for 4 months. DISCUSSION: The application of dry needling reduced the pain, improved and relieved the symptoms. The eccentric strengthening of the adductors and core stability improved the strength as well as functional activity of the lower limb. The case study is not generalized the effect of treatment. Thus, a randomized control trial is suggested for further study.

Manual therapy and early return to sport in football players with adductor-related groin pain: A prospective case series.

OBJECTIVES: To study the clinical course including return to sport success rates of football players with adductor-related groin pain (ARGP) after manual therapy of the adductor muscles. DESIGN: Prospective case series. METHODS: Thirty-four football players with ARGP with median pre-injury Tegner scores of 9 (IQR 25-75: 9-9) were treated with manual therapy of the adductor muscles. Main outcome measures were numeric pain rating scale (NPRS), Hip and Groin Outcome Score (HAGOS) and global perceived effect (GPE) for treatment and patient satisfaction at 2, 6 and 12 weeks. Return to sport was documented. RESULTS: Pain during (NPRS 7 (6-8) and after (NPRS 8 (6-8) sports decreased to NPRS 1 (0.2-3) and 1 (0.8-3), respectively (p < 0.001). Within 2 weeks 82% of the players returned to pre-injury playing levels with improved (p < 0.001) HAGOS subscale scores. Eighty-five percent reported clinically relevant improvement, 82% reported to be satisfied. At 12 weeks, 88% had returned to pre-injury playing levels. HAGOS showed symptoms were still present. CONCLUSION: Early return to sport seems possible and safe after manual therapy of the adductor muscles in football players with ARGP in the short term. While the majority of injured football players return to sport within two weeks, caution is advised regarding effectiveness as hip and groin symptoms were still present and no control groups were available.

Professional football players at risk for non-acute groin injuries during the first half of the season: A prospective cohort study in The Netherlands.

OBJECTIVES: To study the incidence, diagnostics, treatment, anatomical region and return to play of non-acute groin injuries among professional footballers in the Netherlands. DESIGN: Prospective cohort study. METHODS: Medical staff members of all Dutch professional football clubs, recording prospectively injury occurrence of all professional footballers in their clubs, were asked to fill in an injury form about time-loss (⩾ 8 days) non-acute groin injury over the 2012-2013 season. RESULTS: A cohort of 410 players from 12 professional football clubs were included (response rate = 44%). The season incidence of non-acute groin injuries was nearly 7% (29 non-acute groin injuries). In 82% of all cases, the player suffered from non-acute groin injury in the first half of the season. The average time to return to play was 35 days, ranging from 8 to 84 days. The adductors were the most affected anatomical regions (82%), with the most frequent diagnosis being overuse of the adductors (36%), followed by adductor tendinopathy (18%). In addition to medical history and physical examination, ultrasound (50%) and MRI (32%) were the diagnostic methods most frequently mentioned. As well as physical therapy, treatment consisted mostly of manual therapy (96%) and dry needling (61%). CONCLUSIONS: A professional club with a squad of 25 players can expect on average two non-acute groin injuries per season with an average time-loss of 35 days. Players are more at risk in the first half of the season. In Dutch professional football, ultrasound is commonly used to diagnose non-acute groin injury, while manual therapy is the most commonly applied treatment.

Conservative care of sports hernias within soccer players: a case series.

OBJECTIVE: To detail the progress of 2 high-level soccer players and 1 recreational soccer player with chronic groin pain that was exacerbated by participation in sports and relieved by rest. The patients under went a conservative treatment plan featuring manual therapy, therapeutic modalities, and plyometric training. CLINICAL FEATURES: The most important examination findings were palpable tenderness over the internal oblique fascia and anterior pubic tubercle, pain with resisted hip adduction, and pain with a resisted abdominal curl-up. Conventional treatment aimed at decreasing healing time of the injury through manual therapy, including soft tissue and modality techniques; rehabilitative exercises, focusing on the pelvic muscles; and plyometric training, aiming at sport specific functional improvement. INTERVENTION: The conservative treatment approach utilized in this case series involved manual therapy, 1-2 times a week for 6-8 weeks, consisting of soft tissue, laser, microcurrent, and acupuncture; rehabilitative exercise and plyometric training, 3 times a week for 8 weeks, to help improve strength, coordination, and correct pelvic muscle imbalances. Outcome measures included visual analog scale scores and resisted muscle testing. SUMMARY: Three soccer players, of varying levels of ability, presenting with a suspected sports hernia (chronic groin pain exacerbated by sports and relieved by rest) were relieved of their pain after 8 weeks of conservative care featuring manual therapy, rehabilitative exercises, and plyometric training.

Trauma, systemic inflammatory response syndrome, dietary supplements, illicit steroid use and a questionable malignant hyperthermia reaction.

BACKGROUND: Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle calcium regulation associated primarily, but not exclusively, with mutations in the skeletal muscle ryanodine receptor. Associated environmental factors, however, may also be important for expression of the syndrome. METHODS AND RESULTS: A 24-yr-old trauma patient developed a fulminant MH crisis after a 3 minute exposure to sevoflurane. A thorough evaluation of underlying co-morbidities revealed a number of environmental factors that could have altered skeletal muscle calcium regulation, and may have potentially influenced the effects of volatile inhaled anesthetics. Since MH is a syndrome characterized by abnormal skeletal muscle calcium regulation, other factors that alter calcium homeostasis may exacerbate the impact of inhaled MH-triggering drugs. CONCLUSIONS: While a thorough history of MH episodes in a proband and family is emphasized as part of a complete preanesthetic evaluation, obtaining a history of other environmental entities that may alter calcium regulation may be equally important to knowing the family history.

Treatment of longstanding groin pain in athletes: a systematic review.

The aims of this study were to determine (1) the kinds of treatments applied for longstanding groin pain (LGP) in athletes; (2) the results; and (3) the levels of evidence for the interventions. Digital databases P were searched for articles describing the effects of interventions for LGP in athletes. Treatment of LGP in athletes can consist of conservative measures such as rest or restricted activity, active or passive physical therapy, steroid injections or dextrose prolotherapy. Studies describing surgery generally mention failure of conservative measures, although a description of these conservative measures is mostly lacking. During surgery, a reinforcement of the abdominal wall is applied in most cases, using an open or laparoscopic approach. There is level I evidence that physical therapy aiming at strengthening and coordinating the muscles stabilizing hip and pelvis has superior results compared with passive physical therapy. For patients with a positive herniography and/or positive ilioinguinal or iliohypogastric nerve block tests, there are indications (level II) that surgery results in earlier return to sport compared with exercise therapy. Possibly, laparoscopic intervention might result in an earlier return to sport compared with open approach surgery (level III). For different clinical diagnoses, the same or similar surgical interventions were performed.

Application of a zeolite hemostatic agent achieves 100% survival in a lethal model of complex groin injury in Swine.

BACKGROUND: Techniques for better hemorrhage control after injury could change outcome. We have previously shown that a zeolite mineral hemostatic agent (ZH) can control aggressive bleeding through adsorption of water, which is an exothermic process. Increasing the residual moisture content (RM) of ZH can theoretically decrease heat generation, but its effect on the hemostatic properties is unknown. We tested ZH with increasing RM against controls and other hemostatic agents in a swine model of battlefield injury. METHODS: A complex groin injury was created in 72 swine (37 +/- 0.8 kg). This included semitransection of the proximal thigh and complete division of the femoral artery and vein. After 3 minutes, the animals were randomized to 1 of 10 groups: group 1, no dressing (ND); group 2, standard dressing (SD); group 3, SD + 3.5 oz ZH with 1% RM (1% ZH); group 4, SD + 3.5 oz ZH with 4% RM (4% ZH); group 5, SD + 2 oz ZH with 1% RM (1% ZH 2oz); group 6, SD + 3.5 oz ZH with 8% RM (8% ZH); group 7, SD + chitosan-based hemostat, HemCon (HC); group 8, SD + 3.5 oz nonzeolite mineral hemostat, Quick Relief (NZH); group 9, SD + bovine clotting factors-based hemostat, Fast Act (FA); and group 10, SD + 30 g of starch-based hemostat, TraumaDex (TDex). Resuscitation (500 mL of Hespan over 30 minutes) was started 15 minutes after injury and hemodynamic monitoring was performed for 180 minutes. Primary endpoints were survival for 180 minutes and blood loss. In addition, maximum wound temperatures were recorded, and histologic damage to artery, vein, nerve, and muscle was documented. RESULTS: Use of 1% ZH decreased blood loss and reduced mortality to 0% (p < 0.05). Increasing the RM adversely affected efficacy without any significant decrease in wound temperatures. Minimal histologic tissue damage was seen with ZH independent of the percentage of RM. CONCLUSION: The use of zeolite hemostatic agent (1% residual moisture, 3.5 oz) can control hemorrhage and dramatically reduce mortality from a lethal groin wound.