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Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients.

ABSTRACT: Clinical assessments and rehabilitation in athletic groin pain (AGP) have focused on specific anatomical structures and uniplanar impairments rather than whole body movement.To examine the effectiveness of rehabilitation that targeted intersegmental control in patients with AGP and to investigate post rehabilitation changes in cutting biomechanics.Two hundred and five patients with AGP were rehabilitated focusing on clinical assessment of intersegmental control, linear running and change of direction mechanics in this prospective case series. Hip and Groin Outcome Score (HAGOS) was the primary outcome measure. Secondary measures included pain-free return to play rates and times, pain provocation on squeeze tests and three-dimensional (3D) biomechanical analysis during a 110° cutting manoeuvre.Following rehabilitation, patients demonstrated clinically relevant improvements in HAGOS scores (effect size (ES): 0.6-1.7). 73% of patients returned to play pain-free at a mean of 9.9 weeks (±3.5). Squeeze test values also improved (ES: 0.49-0.68). Repeat 3D analysis of the cutting movement demonstrated reductions in ipsilateral trunk side flexion (ES: 0.79) and increased pelvic rotation in the direction of travel (ES: 0.76). Changes to variables associated with improved cutting performance: greater centre of mass translation in the direction of travel relative to centre of pressure (ES: 0.4), reduced knee flexion angle (ES: 0.3) and increased ankle plantar flexor moment (ES: 0.48) were also noted.Rehabilitation focused on intersegmental control was associated with improved HAGOS scores, high rates of pain-free return to sporting participation and biomechanical changes associated with improved cutting performance across a range of anatomical diagnoses seen in AGP.

SUBMITTER: King E

PROVIDER: S-EPMC6089205 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients.

King Enda E Franklyn-Miller Andrew A Richter Chris C O'Reilly Eamon E Doolan Mark M Moran Kieran K Strike Siobhan S Falvey Éanna É

British journal of sports medicine 20180317 16

<h4>Background</h4>Clinical assessments and rehabilitation in athletic groin pain (AGP) have focused on specific anatomical structures and uniplanar impairments rather than whole body movement.<h4>Objective</h4>To examine the effectiveness of rehabilitation that targeted intersegmental control in patients with AGP and to investigate post rehabilitation changes in cutting biomechanics.<h4>Methods</h4>Two hundred and five patients with AGP were rehabilitated focusing on clinical assessment of inte ...[more]

PMID: 29550754

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Project description:BackgroundExercise-based rehabilitation targeting intersegmental control has high success rates and fast recovery times in the management of athletic groin pain (AGP). The influence of this approach on hip strength and lower limb reactive strength and how these measures compare with uninjured athletes (CON) remain unknown. Additionally, the efficacy of this program after return to play (RTP) has not been examined.PurposeFirst, to examine differences in isometric hip strength, reactive strength, and the Hip and Groin Outcome Score (HAGOS) between the AGP and CON cohorts and after rehabilitation; second, to examine the relationship between the change in HAGOS and the change in strength variables after rehabilitation; last, to track HAGOS for 6 months after RTP.Study designCohort study; Level of evidence, 2.MethodsA total of 42 athletes diagnosed with AGP and 36 matched controls completed baseline testing: isometric hip strength, lower limb reactive strength, and HAGOS. After rehabilitation, athletes with AGP were retested, and HAGOS was collected at 3 and 6 months after RTP.ResultsIn total, 36 athletes with AGP completed the program with an RTP time of 9.8 ± 3.0 weeks (mean ± SD). At baseline, these athletes had significantly lower isometric hip strength (abduction, adduction, flexion, extension, external rotation: d = -0.67 to -1.20), single-leg reactive strength (d = -0.73), and HAGOS (r = -0.74 to -0.89) as compared with the CON cohort. Hip strength (d = -0.83 to -1.15) and reactive strength (d = -0.30) improved with rehabilitation and were no longer significantly different between groups at RTP. HAGOS improvements were maintained or improved in athletes with AGP up to 6 months after RTP, although some subscales remained significantly lower than the CON group (r = -0.35 to -0.51). Two linear regression features (hip abduction and external rotation) explained 11% of the variance in the HAGOS Sports and Recreation subscale.ConclusionAthletes with AGP demonstrated isometric hip strength and reactive strength deficits that resolved after an intersegmental control rehabilitation program; however, improved hip strength explained only 11% of improvement in the Sports and Recreation subscale. HAGOS improvements after pain-free RTP were maintained at 6 months.

Project description:BackgroundAthletic groin pain (AGP) is prevalent in sports involving repeated accelerations, decelerations, kicking and change-of-direction movements. Clinical and radiological examinations lack the ability to assess pathomechanics of AGP, but three-dimensional biomechanical movement analysis may be an important innovation.AimThe primary aim was to describe and analyse movements used by patients with AGP during a maximum effort change-of-direction task. The secondary aim was to determine if specific anatomical diagnoses were related to a distinct movement strategy.Methods322 athletes with a current symptom of chronic AGP participated. Structured and standardised clinical assessments and radiological examinations were performed on all participants. Additionally, each participant performed multiple repetitions of a planned maximum effort change-of-direction task during which whole body kinematics were recorded. Kinematic and kinetic data were examined using continuous waveform analysis techniques in combination with a subgroup design that used gap statistic and hierarchical clustering.ResultsThree subgroups (clusters) were identified. Kinematic and kinetic measures of the clusters differed strongly in patterns observed in thorax, pelvis, hip, knee and ankle. Cluster 1 (40%) was characterised by increased ankle eversion, external rotation and knee internal rotation and greater knee work. Cluster 2 (15%) was characterised by increased hip flexion, pelvis contralateral drop, thorax tilt and increased hip work. Cluster 3 (45%) was characterised by high ankle dorsiflexion, thorax contralateral drop, ankle work and prolonged ground contact time. No correlation was observed between movement clusters and clinically palpated location of the participant's pain.ConclusionsWe identified three distinct movement strategies among athletes with long-standing groin pain during a maximum effort change-of-direction task These movement strategies were not related to clinical assessment findings but highlighted targets for rehabilitation in response to possible propagative mechanisms.Trial registration numberNCT02437942, pre results.

Project description:BackgroundDespite being a common overuse entity in youth soccer, scientific data on risk factors, rehabilitation and return to play for long-standing pubic-related groin pain is still rare. The current prospective cohort study aims to evaluate potential risk-factors, propose a criteria-based conservative rehabilitation protocol and assess return-to-play outcomes among professional youth soccer players suffering from long-standing pubic-related groin pain.MethodsMale soccer players with long-standing (> 6 weeks) pubic-related groin pain from a professional soccer club's youth academy were analyzed for possible risk factors such as age, team (U12 - U23), younger/older age group within the team, position and preinjury Functional movement score. All injured players received a conservative, standardized, supervised, criteria-based, 6-level rehabilitation program. Outcome measures included time to return to play, recurrent groin pain in the follow-up period and clinical results at final follow-up two years after their return to play.ResultsA total of 14 out of 189 players developed long-standing pubic-related groin pain in the 2017/2018 season (incidence 7.4%). The average age of the players at the time of the injury was 16.1 ± 1.9 years. Risk factor analysis revealed a significant influence of the age group within the team (p = .007). Only players in the younger age group were affected by long-standing pubic-related groin pain, mainly in the first part of the season. Injured players successfully returned to play after an average period of 135.3 ± 83.9 days. Only one player experienced a recurrence of nonspecific symptoms (7.1%) within the follow-up period. The outcome at the 24-month follow-up was excellent for all 14 players.ConclusionsLong-standing pubic-related groin pain is an overuse entity with a markedly high prevalence in youth soccer players, resulting in a relevant loss of time in training and match play. In particular, the youngest players in each team are at an elevated risk. Applying a criteria-based rehabilitation protocol resulted in an excellent return-to-play rate, with a very low probability of recurrence.Trial registrationThe trial was retrospectively registered under DRKS00016510 in the German Clinical Trials Register on 19.04.2021.

Project description:BackgroundAthletic groin pain (AGP) can lead to altered movement patterns during rapid deceleration and acceleration. However, the effect of AGP on movement variability and loading patterns during such actions remains less clear.PurposeTo investigate, using a continuous lateral hurdle hop task, how movement variability and magnitude measures of 3-dimensional (3D) kinematic, kinetic, and vertical ground-reaction force (vGRF) variables are (1) affected by AGP (AGP vs uninjured controls [CON]) and (2) changed after successful rehabilitation (AGP prerehabilitation vs AGP postrehabilitation vs CON).Study designControlled laboratory study.MethodsA total of 36 athletes diagnosed with AGP and 36 uninjured CON athletes matched on age (18-35 years), level (subelite), and type of sports played (multidirectional field sport) performed a continuous lateral hurdle hop test that involved 10 side-to-side hops over a 15-cm hurdle. The 3D joint kinematic, kinetic, and vGRF variables (total, eccentric, and concentric; ground contact time, peak force, and impulse; and eccentric rate of force development) were examined. The AGP and CON groups were tested at baseline, and the AGP group was retested after participants successfully completed a standardized, exercise-based rehabilitation program targeting intersegmental control.ResultsThere were no differences in baseline characteristics between the AGP (mean ± SD: age, 27.5 ± 4.8 years; height, 179.8 ± 6.3 cm; mass, 80.3 ± 7.1 kg) and CON (mean ± SD: age, 24.1 ± 4.5 years; height, 181.0 ± 5.8 cm; mass, 80.4 ± 8.2 kg) groups. At baseline, athletes with AGP demonstrated altered loading patterns in the vGRF (longer ground contact times, reduced peak force, and reduced rate of force development) compared with CON athletes, while no significant difference in any movement variability variables was evident. After rehabilitation, the athletes with AGP demonstrated significant changes in transverse and coronal plane hip and trunk kinematics, with no significant differences in vGRF variables compared with the CON group.ConclusionThe differences in baseline vGRF measures between the AGP and CON groups were no longer evident after athletes with AGP underwent rehabilitation. No differences in movement variability were evident between the AGP and CON groups, either before or after rehabilitation.Clinical relevanceRehabilitation programs should consider targeting intersegmental hip and trunk movement patterns to positively influence loading patterns in athletes with AGP.

Project description:BackgroundThis study investigated the long-term effects (12?months post-rehabilitation) of a standard inpatient multidisciplinary rehabilitation program for patients with chronic low back pain (CLBP), in which a control group (CG) received pain competence training and an intervention group (IG) received combined pain competence and depression prevention training.MethodsIn this prospective control group study with cluster-block randomization, a total of n?=?583 patients were included into per protocol analyses. To examine the effects of rehabilitation on depressive symptoms, pain self-efficacy, and work ability, patients were stratified in repeated-measures analyses of variance by treatment condition (IG vs. CG), level of depressive symptoms (low vs. high), and time of assessment (pre, post, 6, and 12?months after rehabilitation). The impact of each treatment on pain-related days of sick leave (DSL; dichotomized into ? vs. >?2?weeks) was determined separately by conducting non-parametric analyses. Multiple imputations (n?=?1225) confirmed the results. Effects were interpreted if clinical significance was given.ResultsOnly patients with high levels of depressive symptoms showed long-term improvements in depressive symptoms and self-efficacy. Long-term improvements in work ability index and mental work ability item were restricted to the IG. Furthermore, long-term effects on pain-related DSL were ascertained by per protocol and multiple imputation analyses only for the IG.ConclusionsPatients with high levels of depressive symptoms showed improvements in depressive symptoms and self-efficacy, supporting the psychological effectiveness of both interventions. However, the beneficial long-term effects of rehabilitation on work ability and pain-related DSL among the IG support implementation of combined pain competence and depression prevention training.Trial registrationDRKS00015465 (German Clinical Trial Register DRKS); date of registration: 03.09.2018.

Project description:BackgroundGroin pain in athletes is frequent and many different treatment options have been proposed. The current level of evidence for the efficacy of these treatments is unknown.ObjectiveSystematically review the literature on the efficacy of treatments for groin pain in athletes.MethodsNine medical databases were searched in May 2014.Inclusion criteriatreatment studies in athletes with groin pain; randomised controlled trials, controlled clinical trials or case series; n>10; outcome measures describing number of recovered athletes, patient satisfaction, pain scores or functional outcome scores. One author screened search results, and two authors independently assessed study quality. A best evidence synthesis was performed. Relationships between quality score and outcomes were evaluated. Review registration number CRD42014010262.Results72 studies were included for quality analysis. Four studies were high quality. There is moderate evidence that, for adductor-related groin pain, active exercises compared with passive treatments improve success, multimodal treatment with a manual therapy technique shortens the time to return to sports compared with active exercises and adductor tenotomy improves treatment success over time. There is moderate evidence that for athletes with sportsman's hernia, surgery results in better treatment success then conservative treatment. There was a moderate and inverse correlation between study quality and treatment success (p<0.001, r=-0.41), but not between study quality and publication year (p=0.09, r=0.20).ConclusionsOnly 6% of publications were high quality. Low-quality studies showed significantly higher treatment success and study quality has not improved since 1985. There is moderate evidence for the efficacy of conservative treatment (active exercises and multimodal treatments) and for surgery in patients with adductor-related groin pain. There is moderate evidence for efficacy of surgical treatment in sportsman's hernia.

Project description:BackgroundMusculoskeletal (MSK) pain disproportionately affects people from different ethnic backgrounds through higher burden and less access to care. Digital care programs (DCPs) can improve access and help reduce inequities. However, the outcomes of such programs based on race and ethnicity have yet to be studied.ObjectiveWe aimed to assess the impact of race and ethnicity on engagement and outcomes in a multimodal DCP for MSK pain.MethodsThis was an ad hoc analysis of an ongoing decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were stratified by self-reported racial and ethnic group, and their engagement and outcome changes between baseline and 12 weeks were compared using latent growth curve analysis. Outcomes included program engagement (number of sessions), self-reported pain scores, likelihood of surgery, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment. A minimum clinically important difference (MCID) of 30% was calculated for pain, and multivariable logistic regression was performed to evaluate race as an independent predictor of meeting the MCID.ResultsA total of 6949 patients completed the program: 65.5% (4554/6949) of them were non-Hispanic White, 10.8% (749/6949) were Black, 9.7% (673/6949) were Asian, 9.2% (636/6949) were Hispanic, and 4.8% (337/6949) were of other racial or ethnic backgrounds. The population studied was diverse and followed the proportions of the US population. All groups reported high engagement and satisfaction, with Hispanic and Black patients ranking first among satisfaction despite lower engagement. Black patients had a higher likelihood to drop out (odds ratio [OR] 1.19, 95% CI 1.01-1.40, P=.04) than non-Hispanic White patients. Hispanic and Black patients reported the highest level of pain, surgical intent, work productivity, and impairment in activities of daily living at baseline. All race groups showed a significant improvement in all outcomes, with Black and Hispanic patients reporting the greatest improvements in clinical outcomes. Hispanic patients also had the highest response rate for pain (75.8%) and a higher OR of meeting the pain MCID (OR 1.74, 95% CI 1.24-2.45, P=.001), when compared with non-Hispanic White patients, independent of age, BMI, sex, therapy type, education level, and employment status. No differences in mental health outcomes were found between race and ethnic groups.ConclusionsThis study advocates for the utility of a DCP in improving access to MSK care and promoting health equity. Engagement and satisfaction rates were high in all the groups. Black and Hispanic patients had higher MSK burden at baseline and lower engagement but also reported higher improvements, with Hispanic patients presenting a higher likelihood of pain improvement.

Dataset Information

Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients.

Publications

Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients.

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