Anatomical, Radiological and Biomechanical Examination of Athletic Groin Pain Patients and Physical Therapy Intervention

NCT02437942 | Completed

• 1 other identifier: SSC-Groin-001
• Study Type: interventional
• Target: 205
• Locations: 1 country
• Sites: 1

Brief Summary

Athletic groin pain (AGP) is a chronic condition common in multi-directional sports (Walden et al. 2007, Robinson et al. 2004, Murphy et al. 2012). It is a complex injury with a challenging diagnosis. Dramatic differences in the anatomical diagnoses of AGP cohorts exist in the literature (Renstrom et al. 1980, Lovell et al. 1995, Holmich et al. 2007, Bradshaw et al. 2008). This may be due to the complexity of the anatomy in the region and the absence of magnetic resonance imaging (MAGNETIC RESONANCE IMAGE) to confirm clinical examination. Dynamic actions undertaken in field sports (including change of direction cutting) are particularly associated with the development of athletic groin pain (Holmich et al. 2014). Dynamic multi-plane, multi-joint actions can overload musculoskeletal and fascial structures in the hip and groin. Despite this, traditional groin pain assessments do not involve an examination of sport specific actions. An examination of jumping, hopping and cutting mechanics, which is possible with the use of three dimensional motion capture techniques, will provide additional information with which to diagnosis and rehabilitate athletes. While the majority of published studies on AGP have focused on surgical management (Serner et al. 2015), exercise therapy has been found to be an effective treatment (Holmich et al. 1995). In exercise therapy studies the best results were shown by Holmich et al (1995) where subjects suffered for an average of 9.9 months with symptoms and a strength and stability program focused on adductor strength returned them to sport in 18.5 weeks. The latest paper on rehabilitation by Jardi et al. demonstrates little improvement with a mean time to return to training of 86 days +/-15. The focus remains on improving strength of isolated muscle groups and not attempting to address underlying biomechanical abnormalities that may be leading to overload. Accurate biomechanical assessment and individualized rehabilitation based on the high speed multiplanar movements that drive the athlete's symptoms may enhance the efficiency of rehabilitation. Moreover post-rehabilitation changes in biomechanical factors may provide a further insight into the biomechanical factors associated with AGP. The purpose of this study was to:

1. 1.Describe clinical presentation (physical examination and magnetic resonance imaging findings) for a group of athletes presenting with AGP
2. 2.To describe the different biomechanical diagnoses that exist in AGP patients
3. 3.To examine the effects of a biomechanics led exercise intervention to rehabilitate chronic groin pain

Conditions

Groin Pain

Keywords

Athletic injuries; chronic; rehabilitation; diagnosis; biomechanics

Outcome Measures

Primary Outcomes (1)

• Hip and groin outcome score (HAGOS)

  The HAGOS questionnaire is a validated tool (Thorborg et al. 2014; Thorborg et al. 2011) used to examine the impact of injury on physical function and to track symptoms at the time of diagnosis and as rehabilitation progresses.

  Over the course of the rehabilitation time frame and one year and two years post initial consultation

Secondary Outcomes (1)

• Kinetic and kinematic composite score

  Following rehabilitation, an expected average of 10 weeks

Other Outcomes (4)

• Hip range of movement

  Following rehabilitation, an expected average of 10 weeks

• Hip strength

  Following rehabilitation, an expected average of 10 weeks

• Squeeze test

  Following rehabilitation, an expected average of 10 weeks

Study Arms (1)

Biomechanics led physical therapy rehabilitation

EXPERIMENTAL

Physical therapy exercise rehabilitation

Other: Biomechanics led physical therapy rehabilitation

Interventions

Biomechanics led physical therapy rehabilitation OTHER

Rehabilitation intervention will consist of movement control (3 days per week), whole body strength and power (2 days per week), linear running mechanics (3 days per week), multi-directional mechanics (3 days per week), conditioning sessions (2 days per week). Rehabilitation will continue until physical therapist deems the athlete ready to return to sport.

Biomechanics led physical therapy rehabilitation

Eligibility Criteria

• Age: 14 Years - 40 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Diagnosis of athletic groin pain
• Professional athlete in full time training with groin pain diagnosis

You may not qualify if:

• Post infective osteitis
• Bone tumour
• Acute injury

Sponsors & Collaborators

• Sports Surgery Clinic, Santry, Dublin: lead
• Insight Centre for Data Analytics: collaborator
• Science Foundation Ireland: collaborator

Study Sites (1)

Sports Surgery Clinic

Dublin, Leinster, Ireland

Location

Related Publications (15)

• Bradshaw CJ, Bundy M, Falvey E. The diagnosis of longstanding groin pain: a prospective clinical cohort study. Br J Sports Med. 2008 Oct;42(10):851-4. doi: 10.1136/bjsm.2007.039685. Epub 2008 Apr 1.

  PMID: 18381826 BACKGROUND

• Holmich P, Thorborg K, Dehlendorff C, Krogsgaard K, Gluud C. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med. 2014 Aug;48(16):1245-50. doi: 10.1136/bjsports-2013-092627. Epub 2013 Aug 16.

  PMID: 23956334 BACKGROUND

• Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients. Br J Sports Med. 2007 Apr;41(4):247-52; discussion 252. doi: 10.1136/bjsm.2006.033373. Epub 2007 Jan 29.

  PMID: 17261557 BACKGROUND

• Holmich P, Uhrskou P, Ulnits L, Kanstrup IL, Nielsen MB, Bjerg AM, Krogsgaard K. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet. 1999 Feb 6;353(9151):439-43. doi: 10.1016/S0140-6736(98)03340-6.

  PMID: 9989713 BACKGROUND

• Jardi J, Rodas G, Pedret C, Til L, Cusi M, Malliaropoulos N, Del Buono A, Maffulli N. Osteitis pubis: can early return to elite competition be contemplated? Transl Med UniSa. 2014 Apr 8;10:52-8. eCollection 2014 Sep.

  PMID: 25147768 BACKGROUND

• Lovell G. The diagnosis of chronic groin pain in athletes: a review of 189 cases. Aust J Sci Med Sport. 1995 Sep;27(3):76-9.

  PMID: 8599748 BACKGROUND

• Murphy JC, O'Malley E, Gissane C, Blake C. Incidence of injury in Gaelic football: a 4-year prospective study. Am J Sports Med. 2012 Sep;40(9):2113-20. doi: 10.1177/0363546512455315. Epub 2012 Aug 9.

  PMID: 22879401 BACKGROUND

• Renstrom P, Peterson L. Groin injuries in athletes. Br J Sports Med. 1980 Mar;14(1):30-6. doi: 10.1136/bjsm.14.1.30. No abstract available.

  PMID: 7378668 BACKGROUND

• Robinson P, Barron DA, Parsons W, Grainger AJ, Schilders EM, O'Connor PJ. Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal Radiol. 2004 Aug;33(8):451-7. doi: 10.1007/s00256-004-0753-2. Epub 2004 Jun 29.

  PMID: 15224172 BACKGROUND

• Serner A, van Eijck CH, Beumer BR, Holmich P, Weir A, de Vos RJ. Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes. Br J Sports Med. 2015 Jun;49(12):813. doi: 10.1136/bjsports-2014-094256. Epub 2015 Jan 29.

  PMID: 25633830 BACKGROUND

• Thorborg K, Branci S, Stensbirk F, Jensen J, Holmich P. Copenhagen hip and groin outcome score (HAGOS) in male soccer: reference values for hip and groin injury-free players. Br J Sports Med. 2014 Apr;48(7):557-9. doi: 10.1136/bjsports-2013-092607. Epub 2013 Jul 12.

  PMID: 23850734 BACKGROUND

• Thorborg K, Bandholm T, Schick M, Jensen J, Holmich P. Hip strength assessment using handheld dynamometry is subject to intertester bias when testers are of different sex and strength. Scand J Med Sci Sports. 2013 Aug;23(4):487-93. doi: 10.1111/j.1600-0838.2011.01405.x. Epub 2011 Oct 28.

  PMID: 22092308 BACKGROUND

• Walden M, Hagglund M, Ekstrand J. Football injuries during European Championships 2004-2005. Knee Surg Sports Traumatol Arthrosc. 2007 Sep;15(9):1155-62. doi: 10.1007/s00167-007-0290-3. Epub 2007 Mar 21.

  PMID: 17375283 BACKGROUND

• Franklyn-Miller A, Richter C, King E, Gore S, Moran K, Strike S, Falvey EC. Athletic groin pain (part 2): a prospective cohort study on the biomechanical evaluation of change of direction identifies three clusters of movement patterns. Br J Sports Med. 2017 Mar;51(5):460-468. doi: 10.1136/bjsports-2016-096050. Epub 2016 Oct 6.

  PMID: 28209597 DERIVED

• Falvey EC, King E, Kinsella S, Franklyn-Miller A. Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients--clinical findings, MRI findings and patient-reported outcome measures at baseline. Br J Sports Med. 2016 Apr;50(7):423-30. doi: 10.1136/bjsports-2015-094912. Epub 2015 Nov 30.

  PMID: 26626272 DERIVED

MeSH Terms

Conditions

Athletic Injuries; Bronchiolitis Obliterans Syndrome; Disease

Condition Hierarchy (Ancestors)

Wounds and Injuries; Organizing Pneumonia; Bronchiolitis Obliterans; Bronchiolitis; Bronchitis; Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Graft vs Host Disease; Immune System Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Andy D Franklyn-Miller, MBBS

  Sports Surgery Clinic

  STUDY DIRECTOR

• Éanna C Falvey, MB, BCh, PhD

  Sports Surgery Clinic

  STUDY DIRECTOR

• Enda A King, BSc, MSc

  Sports Surgery Clinic

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 29, 2015
• First Posted: May 8, 2015
• Study Start: April 1, 2015
• Primary Completion: September 1, 2022
• Study Completion: December 1, 2023
• Last Updated: April 22, 2024

Record last verified: 2024-04

Locations

IE (1)