Fuel tank injury in a fatal motorcycle accident.

Vehicular trauma is the most common cause of pelvic fractures. In motorcycle collisions, the driver strikes or is struck by a fixed object, and is subjected to blunt trauma and deceleration forces. Injuries around the scrotum and perineum of victims in motorcycle accidents are known as a fuel tank injuries (FTI). We report the case of a 26-year-old male motorcyclist involved in a fatal high-speed head-on collision with a car. At autopsy, purple bruising distributed symmetrically over both hips with scrotal lacerations were found. Partial bowel evisceration through an abdominal lacerated wound, extensive abdominal organ injuries and multiple fractures were also found. Considering the dynamics of the accident and the type of motorcycle he had been riding, the pelvic bruising and the scrotal injury were related to violent deceleration following the impact, leading the driver to slide forward against the fuel tank of the motorcycle.FTI is comparatively rare in motorcycle accidents because it only occurs in cases involving a head-on collision, and most drivers try to swerve or correct their direction just prior to the collision. Nevertheless, the most frequent cause of pelvic injuries in motorcyclists is caused by contact with the vehicles fuel tank during the crash. Forensic pathologists should have a better knowledge of FTIs as they are helpful in understand the dynamics of the accident and in distinguishing the driver from the passenger in two-rider motorcycle crashes.

Intra and inter-tester reliability of a novel device to assess gluteal muscle strength in professional football players.

The aim of this study is to investigate inter-tester and intra-tester reliability of a novel clam test (CLAMT) for the measurement of gluteal muscle strength and to detect possible differences between CLAMT values in football players with and without a history of groin injuries. Twenty male football players participated in the test-retest and sixty-two male professional football players participated in the case-control study. Hip abductor maximal muscle strength was evaluated either using CLAMT or in a supine position with the hip in a neutral pose. For CLAMT, intraclass correlation coefficient (ICC) for inter-tester-intra-day reliability was 0.80 (95% CI: 0.60-0.90), with a standard error of measurement of 34.2 N. The intra-tester-intra-day ICC was 0.92 (95% CI: 0.87-0.95), with a standard error of measurement of 23.6 N. The inter-week ICC was 0.96 (95% CI: 0.92-0.98), with a standard error of measurement of 18.9 N. CLAMT showed lower (but not significant) strength values in football players with a history of groin injuries to non-injured players. CLAMT showed good to excellent levels of reliability, intraday and inter-week, with low standard errors of measurement while it was effective (possible) to identify residual weakness in players with previous groin injuries.

A prospective study of risk factors for hamstring injury in Australian football league players.

This study aimed to explore the association between hamstring strength, age and lower limb soft tissue injury history and subsequent hamstring injury among Australian Football League (AFL) players. This prospective cohort study recruited 125 players from three professional AFL teams. Eccentric knee flexor strength was assessed while performing the Nordic hamstring exercise in pre-season, and injury data were collected retrospectively (hamstring, groin, calf, quadriceps and knee), and prospectively (hamstring injuries) for one AFL playing season. Fourteen players (11%) sustained a hamstring injury in the subsequent playing season. Nordic strength was not significantly associated with future hamstring injury (Odds Ratio (OR) 1.9, p = 0.36), whereas player age greater than 25 years (OR = 2.9, p < 0.05), report of a hamstring injury within the previous year (OR = 3.7, p = 0.01), or greater than 1-year (OR = 3.6, p = 0.01), a previous groin (OR = 8.6, p < 0.01) or calf injury (OR = 4.6, p = 0.01) were factors significantly associated with subsequent hamstring injury. Based on these findings, increasing age and previous hamstring, groin and calf injury are all associated with an elevated risk of subsequent hamstring injury in AFL players.

Prevalence and severity of groin problems in Spanish football: A prospective study beyond the time-loss approach.

The time-loss definition of injury is commonly adopted in epidemiological groin-injury studies in football, with a significant risk of underestimating the impact of these injuries. This study investigated the extent of groin problems, beyond the time-loss approach, over a full Spanish football season. Players from 17 amateur male teams were followed over 39 consecutive weeks. Groin-injury time loss and self-reported groin pain, irrespective of time loss, were combined to calculate the average weekly prevalence of all groin problems with or without time loss. A subscale measuring hip- and groin-related sporting function from the Copenhagen Hip and Groin Outcome Score questionnaire (HAGOS, Sport/Rec) was registered every 4 weeks. In total, 407 players participated in the study. The average (range) weekly prevalence of all groin problems was 11.7% (7.2%-20.8%); 1.3% with time loss (0.0%-3.2%) and 10.4% without time loss (6.3%-17.6%). Players with groin problems reported lower scores (mean difference) on the HAGOS, Sport/Rec subscale compared with players without (-19.5 [95% CI: -20.7 to -18.4]), while there was no difference between players reporting groin problems with and without time loss (4.0 [95% CI: -1.1 to 9.1]). The traditional time-loss measure only captured 10% of all groin problems. Hip- and groin-related sporting function was not different between players reporting groin problems with or without time loss, suggesting the reason for continuing to play is not only related to the severity of symptoms. These findings question the judicious use of the time-loss approach in overuse conditions, such as groin pain in footballers.

Implementation of the Adductor Strengthening Programme: Players primed for adoption but reluctant to maintain - A cross-sectional study.

Groin injuries represent a considerable problem in male football, accounting for 4%-19% of all time-loss injuries. The Adductor Strengthening Programme is the first groin-specific prevention program shown to reduce the risk of groin problems. We aimed to use the RE-AIM framework to examine the players' experiences with the implementation of the program and player attitude toward groin injury prevention in football. Of the 632 players involved in the trial examining the effect of the Adductor Strengthening Programme, 501 agreed to participate in a survey at the end of the season. Most players thought that footballers are at moderate to high risk for groin injuries (87%) and that there is a need for preventive measures (96%). They also believed that a preventive program with strengthening exercises would reduce the risk of groin injuries (91%). Majority of the players reported using <5 minutes to complete the program (73%), and only 11% wanted additional exercises. However, only 46% reported to have performed the program as recommended, and an even smaller proportion (31%) planned to continue using it as recommended the next season. Our results suggest that footballers believe that prevention of groin injuries is needed. Attitude toward implementation of the Adductor Strengthening Programme was positive, and the single-exercise approach was considered an important facilitator. However, in future dissemination of the program, the players' reluctance to maintain the exercise protocol may be a potential barrier to implementation that should be addressed.

Hip and groin injury is the most common non-time-loss injury in female amateur football.

PURPOSE: Hip and groin injuries in football are problematic due to their high incidence and risk of chronicity and recurrence. The use of only time-loss injury definitions may underestimate the burden of hip and groin injuries. Little is known about hip and groin injury epidemiology in female football. The first aim of this study was to examine the within-season (2014-2015) prevalence of total injury with and without time-loss in female amateur football players. The second aim was to study the within-season and preseason (2015-2016) prevalence of hip/groin injuries with and without time-loss. The third aim was to study the association between the duration of hip and groin injury in the 2014-2015 season and the severity of hip/groin problems during the 2015-2016 preseason. METHODS: During the preseason, 434 Dutch female amateur football players completed an online questionnaire based on the previous season and current preseason. The hip and groin outcome score (HAGOS) was used to assess the severity of hip and groin injuries. RESULTS: The hip/groin (17%), knee (14%), and ankle (12%) were the most frequent non-time-loss injury locations. The ankle (22%), knee (18%), hamstring (11%), thigh (10%), and hip/groin (9%) were the most common time-loss injury locations. The previous season prevalence of total injury was 93%, of which non-time-loss injury was 63% and time-loss injury was 37%. The prevalence of hip/groin injury was 40%, non-time-loss hip/groin injury was 36% and time-loss hip/groin injury was 11%. The preseason prevalence of hip/groin injury was 27%, non-time-loss hip/groin injury was 25%, and time-loss hip/groin injury was 4%. Players with longstanding hip/groin injury (> 28 days) in the previous season had lower HAGOS scores at the next preseason than players with short-term (1-7 days) or no hip/groin injury (p < 0.001). From all players with hip/groin injury from the previous season, 52% also sustained hip/groin injury in the following preseason, of which 73% were recurrent and 27% were chronic hip/groin injuries. CONCLUSION: Injury risk, and especially non-time-loss hip and groin injury risk, is high in female amateur football. Three-quarters of the players with longstanding hip and groin injuries in the previous season have residual problems at the start of the following season. LEVEL OF EVIDENCE: II.

Core stability is associated with dynamic postural balance in soccer players experiencing groin pain without time-loss.

Objectives: The study sought to evaluate possible relationships between dynamic postural balance and pain, core stability, and hip range of motion in soccer players who were experiencing groin pain (GP). Furthermore, the study aimed to compare these measurements in symptomatic and asymptomatic players. Methods: The study included 42 male soccer players experiencing GP and an equal number of asymptomatic players. Dynamic postural balance, pain, hip range of motion and trunk endurance were measured. Results: The GP group revealed reduced dynamic balance performance (p < 0.01-0.001) in injured and non-injured limbs compared to control group. Further, players experiencing GP demonstrated lower hip range of motion in internal (p < 0.05) and total rotations (p < 0.01) in the injured limb, and lower trunk endurance (p < 0.001) compared to their asymptomatic peers. In general, core stability was associated (r = 0.13-0.61, p < 0.05-0.001) with the poor dynamic balance performance in the GP group while standing on injured and non-injured limbs. No significant correlations between dynamic postural balance, pain and hip range of motion were observed. Conclusion: Poor core endurance was found to be associated with dynamic balance disorders in soccer players experiencing GP. This information can aid in the development of targeted strategies to enhance dynamic postural balance in these players.

Acute Effects of Ice Hockey on Hip Range of Motion, Strength, and Pelvic Tilt in Competitive Male Players.

BACKGROUND: Ice hockey players are at high risk for hip and groin injury. Several risk factors have been identified or proposed, including lower hip rotation range of motion (ROM), lower hip adductor strength, lower ratio of hip adductor to abductor strength, and lower pelvic tilt angle. It is not known how these risk factors change acutely with ice hockey participation. HYPOTHESIS: Acute exposure to ice hockey will result in a reduction in ROM, strength, and pelvic tilt angle in competitive male players. STUDY DESIGN: Controlled cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Risk factors for hip and groin injury, including isometric hip adductor strength at 0° of flexion, the ratio of hip adductor to abductor strength, total hip rotation passive ROM in supine, and the resting pelvic tilt angle, were assessed immediately before, immediately after, and 24 hours after an ice hockey exposure in 42 competitive male ice hockey players. Rating of perceived exertion (RPE) was collected to identify the intensity of the exposure. RESULTS: There was a significant decrease in total hip rotation ROM (-7.32°, P < 0.01 (-3.91, -10.70)) and hip adductor strength (-4.41 kg, P < 0.01 (-2.81, -6.00) immediately after the exposure, and a significant decrease in total hip rotation ROM (-18.54°, P < 0.01 (-14.35, -22.73)), hip adductor strength (-6.56 kg, P < 0.01 (-4.58, -8.61)), and the ratio of hip adductor to abductor strength (-0.12, P < 0.01 (-0.21, -0.45)) 24 hours after. There was no significant change in pelvic tilt found in this study immediately after or 24 hours after. There was a moderate relationship between changes in hip adductor strength and changes in the ratio of hip adductor to abductor strength (r = 0.433, P < 0.01). RPE was not significantly correlated to any of the changes observed. CONCLUSION: Risk factors for hip and groin injury in ice hockey players are modifiable after a single ice hockey exposure. CLINICAL RELEVANCE: The identified fluctuation of injury risk factors for hip and groin injury in ice hockey players has implications for injury risk profiling, rehabilitation, and return-to-competition decision-making.

The Prevalence of Inguinal Hernia Among Athletes in Saudi Arabia: A Cross-Sectional Study.

Introduction An inguinal hernia is the most common type of hernia. It might manifest as a groin bulge, lump, or enlarged scrotum. Swelling may be uncomfortable and painful and even cause intestinal obstruction. This study aimed to measure the prevalence of inguinal hernia among athletes in Saudi Arabia. Subject and methods This is a cross-sectional study conducted among Saudi Arabian athletes. A self-administered questionnaire was distributed among athletes using an online survey through different Saudi Olympic Training and Fitness Centers throughout the kingdom. The questionnaire includes sociodemographic characteristics (i.e. age, gender, etc.), risk factors, and complications of inguinal hernia. Results Of the 594 athletes, 55.6% were females and 57.6% were aged between 18 and 24 years. The most common type of sport was running (31%). The most common risk factor for inguinal hernia was previous abdominal surgery (57.5%). The prevalence of inguinal hernia among Saudi athletes was 12.3%. Being older in age and being male were the independent significant predictors associated with increased risk for inguinal hernia, whereas weightlifting was the independent significant factor of decreased risk for inguinal hernia. Conclusion The prevalence of inguinal hernia among athletes was 12.3%. Older male athletes were most likely at a greater risk to suffer from inguinal hernia as compared to the rest of the athletes. Further research is needed to extract more data about the prevalence of inguinal hernia among Saudi Arabian athletes and determine its risk factors.

Roller Speed Skating Kinematics and Electromyographic Analysis: A Methodological Approach.

Roller speed skating is a discipline similar to hockey and ice skating from a biomechanical point of view, but there are no specific functional protocols for rehabilitation and performance improvement for these athletes. The aim of the study is to create a dedicated functional, kinematic and electromyographic protocol to be used as a tool for future studies on the subject. The protocol was created, starting from a correct and repeatable movement as a case study, on a world speed skating champion, using an inertial sensor positioned at the level of the first sacral vertebra, eight electromyographic probes positioned on one or the other lower limb, and a high-definition camera at 50 Hz. The results show the electromyographic activity of the muscles investigated, the degree of absolute muscle activation and compared to their maximum voluntary isometric contraction (MVIC), the level of co-activation of the agonist/antagonist muscles, and the accelerations of the body on the three axes of space. The results will represent the basis for physiotherapy and specific training use. Future developments will include the analysis of a sample of elite athletes to be able to build a normal range on the parameters investigated, and the possibility of treating in the most appropriate way possible muscle injuries (which mostly occur in the groin in such athletes) once they have occurred, even with oriented MVIC or co-activation oriented exercises.

Frontal plane lower extremity alignment in adolescent athletes with chronic hip adductor-related groin injury symptoms: A case-control study.

OBJECTIVE: To compare trunk and lower extremity frontal plane projection angles (FPPA) during single leg squat (SLS) performance, perceived hip and groin function and symptoms, and isometric hip strength of adolescent athletes with chronic hip adductor-related groin injury (HARGI) symptoms and age, gender, and sport-matched healthy subjects. DESIGN: Case-control study. SETTING: Junior Olympic Development Training Centre. PARTICIPANTS: Twenty-six athletes at 59.1 ± 60 weeks (range = 12-208 weeks) post-index grade II HARGI injury who had continued sport training (injury group) and 26 control group subjects. MAIN OUTCOME MEASURES: SLS trunk, hip, and knee FPPA, isometric hip strength standardized to bodyweight, and Copenhagen Hip and Groin Outcome Scores (HAGOS). RESULTS: The injury group had greater bilateral knee FPPA, and greater injury side hip FPPA during maximum SLS. Injury group HAGOS subscale scores were lower than control group scores. Hip abductor, adductor, external rotator, and internal rotator strength was lower at the injury side of the injury group compared to the matched control group limb. Forward stepwise multiple regression analysis of the injury group found that 50% of injury side knee FPPA was predicted by hip internal rotator strength and time post-index HARGI; and 47% of injury side hip FPPA was predicted by other side hip flexor strength and the HAGOS function, sport and recreation subscale score (p = 0.002). CONCLUSIONS: Greater injury side hip and bilateral knee FPPA during maximum SLS, lower self-reported hip symptom and function scores, and less injury side hip abductor, adductor, external rotator and internal rotator strength suggests that adolescent athletes with chronic HARGI symptoms are at an increased risk for sustaining a non-contact knee injury. Impaired hip internal rotator strength at the side of the chronic HARGI was related to increased knee FPPA, and impaired hip flexor strength at the other side of the HARGI was related to increased hip FPPA. Findings support using SLS performance testing in this athlete group to help determine safe return to sport training readiness.

Hip adduction strength and provoked groin pain: A comparison of long-lever squeeze testing using the ForceFrame and the Copenhagen 5-Second-Squeeze test.

OBJECTIVES: To compare long-lever squeeze testing using the ForceFrame and the Copenhagen 5-Second-Squeeze test (5SST) for assessment of hip adduction strength and provoked groin pain in elite male soccer players. DESIGN: Cross-sectional study. SETTING: Pre-season testing at facilities of a Danish professional 1st tier soccer club and academy. PARTICIPANTS: Elite male soccer players (n = 83, mean age; 16 ± 2.7 years) from U13, U14, U15, U17, U19 and senior teams cleared for full training and match participation. MAIN OUTCOME MEASURES: Maximum isometric hip adduction strength (Nm/kg) and provoked groin pain (NRS 0-10). RESULTS: Hip adduction strength was 16% lower in the ForceFrame. A Bland-Altman plot showed a systematic bias (-0.47 Nm/kg, 95% CI [-0.57; -0.38]) and lack of agreement (95% limits of agreement: -1.31; 0.39 Nm/kg). In the ForceFrame, provoked groin pain was less intense (median NRS 0 [IQR: 0-1] vs. 5SST: 1 [IQR: 0-3], p < 0.001) and reported by fewer players (NRS >0) (27% [n = 22] vs. 5SST: 61.4% [n = 51], p < 0.001). CONCLUSIONS: The ForceFrame and the 5SST lack agreement and are not interchangeable methods. This may have implications when selecting a method for screening and detecting early groin problems in male soccer players.

Proximal Adductor Longus Tendon Repair With a Concomitant Distal Fascial Release for Complete Hip Adductor Tendon Tears: Surgical Technique and Outcomes in 40 Male Athletes.

BACKGROUND: The optimal treatment for complete avulsions of the proximal adductor longus (AL) is still debatable, and different operative and nonoperative treatment options have been suggested. PURPOSE: To report surgical techniques and functional outcomes of a series of athletes who were treated operatively for proximal AL tears. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective evaluation of patients who underwent surgical repair of complete proximal AL tear with concomitant distal fascial release with or without lesions of the neighboring soft tissue structures was performed. This included preinjury Tegner score, age, number of tendons involved, time interval from injury to surgery, and postoperative complications. Self-reported outcomes were defined based on the ability to regain sports activities (excellent, good, moderate, fair, or poor). Between-group comparisons were performed to identify factors associated with improved outcomes. The Mann-Whitney nonparametric test was used for comparing continuous variables, and the Fisher exact test was used for comparing nominal variables. RESULTS: A total of 40 male athletes were included in the evaluation, with an average follow-up of 11 months (range, 6 months-8 years). Self-reported outcome was excellent in 23 (57.5%), good in 13 (32.5%), and moderate in 4 (10%) patients. Comparisons between patients with excellent versus good/moderate outcomes revealed nonsignificant differences regarding age at injury and preinjury Tegner score. Athletes with excellent outcomes received surgery sooner after the injury compared with athletes with good/moderate outcomes (2.4 ± 1.8 vs 11.4 ± 11.0 weeks, respectively; P < .01). CONCLUSION: Surgical repair for complete proximal AL tears with a concomitant distal fascial release resulted in outcomes rated as good or excellent in 90% of the cases. This treatment should be considered particularly in high-level athletes with a clear tendon retraction and within the first month after the injury. Further research is nevertheless needed to compare these outcomes with other treatment alternatives to better define criteria advocating surgery.

Including performance level lowers prevalence of non-timeloss groin injury. A cross-sectional study in 383 female amateur football players.

OBJECTIVE: To study the preseason prevalence of groin injury with normal and reduced performance. DESIGN: Cross-sectional cohort. SETTINGS: Online survey. PARTICIPANTS: 383 Dutch female amateur football players (35 teams). MAIN OUTCOME MEASURES: Prevalence of groin injury per injury group (timeloss or non-timeloss) using a general questionnaire and per performance group (groin pain with normal or reduced performance) using subscales Pain and Participation in Physical Activities of the Hip And Groin Outcome Score (HAGOS). Levels and between-group differences of groin-related symptoms and problems (HAGOS) for injury and performance groups. The injury groups from which players with groin pain and normal performance originate. RESULTS: Prevalence of non-timeloss groin injury was 22% (95% confidence interval (95%CI) = 18-26) (n = 84), 7% (95%CI = 5-10) (n = 26) for timeloss groin injury, 21% (95%CI = 17-25) (n = 80) for pain + normal performance and 16% (95%CI = 12-20) (n = 61) for pain + reduced performance. HAGOS-scores differed between injury (P < .022) and performance groups (p < .043). Twenty-three players (27%) with pain + normal performance originated from the non-timeloss groin injury group (100%). CONCLUSION: As female amateur football players with groin pain and normal performance are considered non-injured, the prevalence of non-timeloss groin injury lowers by a quarter. These players have lower HAGOS scores than non-injured players without pain yet higher scores than those with non-timeloss groin injury.

Distinct cut task strategy in Australian football players with a history of groin pain.

OBJECTIVES: This study aimed to explore the differences in the magnitude of movement variability and strategies utilized during an unanticipated cut task between players with and without a history of groin pain. DESIGN: Cross-sectional design. SETTING: Biomechanics laboratory. PARTICIANTS: Male Australian football players with (HISTORY; n = 7) or without (CONTROL; n = 10) a history of groin pain. OUTCOME MEASURES: Three-dimensional ground reaction forces (GRF) and kinematics were recorded during 10 successful trials of an unanticipated cut task, and isokinetic hip adduction and abduction strength. Between-group differences were determined using independent-samples t-tests and the coefficient of variation (CV). RESULTS: Key substantial between-group differences identified were that the HISTORY group displayed decreased knee flexion and hip internal rotation, increased knee internal rotation and T12-L1 right rotation, and higher GRFs during the cut task. They also utilized three invariant systems (ankle, knee and T12-L1 joints), while being connected by a segment (hip and L5-S1 joints) that displayed increased lumbopelvic movement during the cut task, and decreased adductor muscle strength. CONCLUSION: This identifies the need for clinical management of the lower limb and thoracic segment to improve functional movement patterns in athletes with a history of a groin injury.

Underbelly injury based identification of the driver in a three-rider motorcycle accident.

This paper presents a three-rider motorcycle accident which took place in a suburb of Chongqing China. In the accident, the motorcycle impacted the terminal of a bridge footpath and led to two riders died and one rider injured. After the accident, one rider received injuries around the groin area including the underbelly area and the perineum area. Another rider suffered from injuries only on the perineum areas. In medico-legal judgments, injuries around the groin area also called groin injuries in victims of motorcycle accidents are usually regarded as "fuel tank injuries" which are commonly found in drivers. But, the injuries around the groin area are sometimes confused with the perineum injuries. Therefore, the perineum injuries are often wrongly reckoned as the "fuel tank injuries" and used to identify the drivers too. Actually, passengers can sometimes suffer from perineum injuries in many head-on impacting motorcycle accidents. It is of vital matters to understand the differences between groin injuries and perineum injuries so that the real driver who should be responsible for the accident can be recognized. In this paper, the three-rider motorcycle accident was presented and the injury information of the three riders was studied in order to distinguish the real driver from the riders. We consider that the groin injury has some differences with the perineum injury and the latter should not always be related to the driver especially in high-speed head-on impacting motorcycle accidents. In addition, the injury on underbelly areas is important to identify the driver.

RELIABILITY OF TWO METHODS OF CLINICAL EXAMINATION OF THE FLEXIBILITY OF THE HIP ADDUCTOR MUSCLES.

BACKGROUND: An inadequate level of flexibility of the adductor muscles is one of the most critical risk factors for chronic groin pain and strains. However, measurement methods of adductor muscle flexibility are not well defined. PURPOSE: To determine the inter-session reliability of the biarticular and monoarticular adductor muscle flexibility measures obtained from passive hip abduction with the knee flexed over the edge of the plinth test (PHA) and the passive hip abduction test at 90° of hip flexion (PHA90°). STUDY DESIGN: Clinical Measurement Reliability study. METHODS: Fifty healthy recreational athletes participated in this study. All participants performed the PHA and PHA90° on four different occasions, with a two-week interval between testing sessions. Reliability was examined through the change in the mean between consecutive pairs of testing sessions (ChM), standard error of measurement expressed in absolute values (SEM) and as a percentage of the mean score (%SEM), minimal detectable change at 95% confidence interval (MDC95), and intraclass correlation coefficients (ICC2,k). RESULTS: The findings showed negligible or trivial ChM values for the two adductor flexibility measures analyzed (<2°). Furthermore, the SEM and MDC95 were 2.1° and 5.9° and 2.2° and 6.2° for the measures obtained from the PHA and PHA90°, respectively, with %SEM scores lower than 5% and ICC scores higher than 0.90. CONCLUSION: The findings from this study suggest that the adductor muscle flexibility measures analyzed have good to excellent inter-session reliability in recreational athletes. Thus, clinicians can be 95% confident that an observed change between two measures larger than 5.9° and 6.2° for the flexibility measures obtained from the PHA and PHA90°, respectively, would indicate a real change in muscle flexibility. LEVEL OF EVIDENCE: 2.

Eccentric and Isometric Hip Adduction Strength in Male Soccer Players With and Without Adductor-Related Groin Pain: An Assessor-Blinded Comparison.

BACKGROUND: Adductor-related pain is the most common clinical finding in soccer players with groin pain and can be a long-standing problem affecting physical function and performance. Hip adductor weakness has been suggested to be associated with this clinical entity, although it has never been investigated. PURPOSE: To investigate whether isometric and eccentric hip strength are decreased in soccer players with adductor-related groin pain compared with asymptomatic soccer controls. The hypothesis was that players with adductor-related groin pain would have lower isometric and eccentric hip adduction strength than players without adductor-related groin pain. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Male elite and subelite players from 40 teams were contacted. In total, 28 soccer players with adductor-related groin pain and 16 soccer players without adductor-related groin pain (asymptomatic controls) were included in the study. In primary analysis, the dominant legs of 21 soccer players with adductor-related groin pain (≥4 weeks duration) were compared with the dominant legs of 16 asymptomatic controls using a cross-sectional design. The mean age of the symptomatic players was 24.5 ± 2.5 years, and the mean age of the asymptomatic controls was 22.9 ± 2.4 years. Isometric hip strength (adduction, abduction, and flexion) and eccentric hip strength (adduction) were assessed with a handheld dynamometer using reliable test procedures and a blinded assessor. RESULTS: Eccentric hip adduction strength was lower in soccer players with adductor-related groin pain in the dominant leg (n = 21) compared with asymptomatic controls (n = 16), namely 2.47 ± 0.49 versus 3.12 ± 0.43 N·m/kg, respectively (P < .001). No other hip strength differences were observed between symptomatic players and asymptomatic controls for the dominant leg (P = .35-.84). CONCLUSION: Large eccentric hip adduction strength deficits were found in soccer players with adductor-related groin pain compared with asymptomatic soccer players, while no isometric strength differences were observed between the groups.

Groin injuries in sports medicine.

CONTEXT: An in-season groin injury may be debilitating for the athlete. Proper diagnosis and identification of the pathology are paramount in providing appropriate intervention. Furthermore, an adductor strain that is treated improperly can become chronic and career threatening. Any one of the 6 muscles of the adductor muscle group can be involved. The degree of injury can range from a minor strain (grade 1), where minimal playing time is lost, to a severe strain (grade 3), in which there is complete loss of muscle function. Persistent groin pain and muscle imbalance may lead to athletic pubalgia. EVIDENCE ACQUISITION: Relevant studies were identified through a literature search of MEDLINE and the Cochrane database from 1990 to 2009, as well as a manual review of reference lists of identified sources. RESULTS: Ice hockey and soccer players seem particularly susceptible to adductor muscle strains. In professional ice hockey and soccer players throughout the world, approximately 10% to 11% of all injuries are groin strains. These injuries have been linked to hip muscle weakness, a previous injury to that area, preseason practice sessions, and level of experience. This injury may be prevented if these risk factors are addressed before each season. CONCLUSION: Despite the identification of risk factors and strengthening intervention for athletes, adductor strains continue to occur throughout sport. If groin pain persists, the possibility of athletic pubalgia needs to be explored, because of weakening or tears in the abdominal wall muscles. A diagnosis is confirmed by exclusion of other pathology.