ADDUCTOR SQUEEZE STRENGTH AND FUNCTIONAL LEVEL IN ADOLESCENT ATHLETES WITH ADDUCTOR RELATED GROIN PAIN

Abstract

Purpose: The aim of the present study was to compare adductor squeeze strength and functional levels of adolescent athletes having adductor related groin pain (ARGP) with asymptomatic controls. Methods: A total of 52 adolescent athletes (26 in ARGP group; 26 in healthy control group) were included in the study. Visual Analog Scale was used for pain levels. Stabilizer was used to evaluate the adductor squeeze strength. Hip Outcome Score (HOS) was used to determine functional levels. Results: Demographic characteristics were similar between groups (p> 0.05). Adductor squeeze strength were lower in ARGP group when compared to controls (p<0.001). HOS activity of daily living and sport subscales were lower in ARGP group than control group (p<0.001). Conclusion: Athletes with adductor related groin injury demonstrated lower muscle strength and functional levels when compared to healthy controls. Determination of the muscle strength and functional levels of adolescent athletes is critical to identify the athletes at risk to prevent the re-injury of the adductor muscles.

Keywords

• Adolescent
• hip
• groin pain
• adductor muscles
• muscle strength

ADDÜKTÖR KASLAR İLE İLİŞKİLİ KASIK AĞRISI OLAN ADÖLESAN SPORCULARDA ADDÜKTÖR SIKIŞTIRMA KUVVETİ VE FONKSİYONEL SEVİYE

Öz

Amaç: Çalışmamızın amacı, addüktör kaslarla ilişkili kasık ağrısı olan adölesan sporcuların addüktör sıkıştırma kuvveti ve fonksiyonel seviyelerini asemptomatik kontrolleri ile karşılaştırmaktır. Yöntem: Çalışmaya toplamda 52 adölesan sporcu (26 ARGP grubu, 26 sağlıklı control grubu) dahil edildi. Ağrı seviyesi için Görsel Analog Skala kullanıldı. Addüktör sıkıştırma kuvvetini değerlendirmek için stabilizer kullanıldı. Fonksiyonel seviyeyi belirlemek için Kalça Değerlendirme Skoru (HOS) kullanıldı. Sonuçlar: Demografik özellikler grublar arasında benzerdi (p>0,05). Sağlıklı kontrolleri ile karşılaştırıldığında addüktör sıkıştırma kuvveti ARGP grubunda daha düşüktü (p<0,001). HOS günlük yaşam aktiviteleri ve spor alt bölümleri ARGP grubunda kontrol grubuna göre daha düşüktü (p<0,001). Tartışma: Addüktör kaslarla ilişkili kasık ağrısı olan sporcular sağlıklı kontrolleri ile karşılaştırıldığında daha düşük kas kuvveti ve fonksiyonel seviyeye sahiptir. Adölesan sporcuların sezon öncesi dönemde kas gücünün ve fonksiyonel seviyelerinin belirlenmesi, addüktör kasların yeniden yaralanmasını önlemek için risk altındaki sporcuları tespit etmek için kritik öneme sahiptir.

Anahtar Kelimeler

• Adölesan
• kalça
• kasık ağrısı
• addüktör kaslar
• kas kuvveti

Kaynakça

1. 1. Thorborg K, Rathleff MS, Petersen P, Branci S, Hölmich P. Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players. Scand J Med Sci Sports. 2017;27(1):107-14.
2. 2. Waldén M, Hägglund M, Ekstrand J. The epidemiology of groin injury in senior football: a systematic review of prospective studies. Br J Sports Med. 2015;49(12):792-7.
3. 3. O'Connor DM. Groin injuries in professional rugby league players: a prospective study. J Sports Sci. 2004;22(7):629-36.
4. 4. Werner J, Hägglund M, Waldén M, Ekstrand J. UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med. 2009;43(13):1036-40.
5. 5. Hägglund M, Waldén M, Ekstrand J. Risk factors for lower extremity muscle injury in professional soccer: the UEFA Injury Study. Am J Sports Med. 2013;41(2):327-35.
6. 6. Tyler TF, Nicholas SJ, Campbell RJ, McHugh MP. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med. 2001;29(2):124-8.
7. 7. Whittaker JL, Small C, Maffey L, Emery CA. Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med. 2015;49(12):803-9.
8. 8. Tak I, Engelaar L, Gouttebarge V, Barendrecht M, Van den Heuvel S, Kerkhoffs G, et al. Is lower hip range of motion a risk factor for groin pain in athletes? A systematic review with clinical applications. Br J Sports Med. 2017;51(22):1611-21.

9. 9. Ryan J, DeBurca N, Mc Creesh K. Risk factors for groin/hip injuries in field-based sports: a systematic review. Br J Sports Med. 2014;48(14):1089-96.
10. 10. Nevin F, Delahunt E. Adductor squeeze test values and hip joint range of motion in Gaelic football athletes with longstanding groin pain. J Sci Med Sport. 2014;17(2):155-9.
11. 11. Malliaras P, Hogan A, Nawrocki A, Crossley K, Schache A. Hip flexibility and strength measures: reliability and association with athletic groin pain. Br J Sports Med 2009; 43(10): 739-44.
12. 12. Crow JF, Pearce AJ, Veale JP, VanderWesthuizen D, Coburn PT, Pizzari T. Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players. J Sci Med Sport. 2010;13(2):202-4.
13. 13. Thorborg K, Branci S, Nielsen MP, Tang L, Nielsen MB, Hölmich P. Eccentric and isometric hip adduction strength in male soccer players with and without adductor-related groin pain: an assessor-blinded comparison. Orthop J Sports Med. 2014;2(2):2325967114521778.
14. 14. Light N, Thorborg K. The precision and torque production of common hip adductor squeeze tests used in elite football. J Sci Med Sport. 2016;19(11):888-92.
15. 15. Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic risk factors for hamstring injuries among male soccer players: a prospective cohort study. Am J Sports Med. 2010;38(6):1147-53.
16. 16. Belhaj K, Meftah S, Mahir L, Lmidmani F, Elfatimi A. Isokinetic imbalance of adductor–abductor hip muscles in professional soccer players with chronic adductor-related groin pain. Eur J Sport Sci. 2016;16(8):1226-31.
17. 17. Delahunt E, Kennelly C, McEntee BL, Coughlan GF, Green BS. The thigh adductor squeeze test: 45 of hip flexion as the optimal test position for eliciting adductor muscle activity and maximum pressure values. Man. Ther. 2011;16(5):476-80.
18. 18. Coughlan GF, Delahunt E, Caulfield BM, Forde C, Green BS. Normative adductor squeeze test values in elite junior rugby union players. Clin J Sport Med. 2014;24(4):315-9.
19. 19. Delahunt E, Fitzpatrick H, Blake C. Pre-season adductor squeeze test and HAGOS function sport and recreation subscale scores predict groin injury in Gaelic football players. Phys Ther Sport. 2017;23:1-6.
20. 20. Holmich P, Holmich LR, Bjerg AM. Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med. 2004;38(4):446-51.
21. 21. Martin RL, Philippon MJ. Evidence of validity for the hip outcome score in hip arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2007;23(8):822-6.
22. 22. Martin RL, Kelly BT, Philippon MJ. Evidence of validity for the hip outcome score. Arthroscopy: Arthroscopy. 2006;22(12):1304-11.
23. 23. Hinman RS, Dobson F, Takla A, O'Donnell J, Bennell KL. Which is the most useful patient-reported outcome in femoroacetabular impingement? Test–retest reliability of six questionnaires. Br J Sports Med. 2014;48(6):458-63.
24. 24. Verrall GM, Slavotinek JP, Barnes PG, Fon GT. Description of pain provocation tests used for the diagnosis of sports-related chronic groin pain: relationship of tests to defined clinical (pain and tenderness) and MRI (pubic bone marrow oedema) criteria. Scand J Med Sci Sports. 2005;15(1):36-42.
25. 25. Farina D, Arendt-Nielsen L, Merletti R, Graven-Nielsen T. Effect of experimental muscle pain on motor unit firing rate and conduction velocity. J Neurophysiol. 2004;91(3):1250-9.
26. 26. Henriksen M, Alkjær T, Lund H, Simonsen EB, Graven-Nielsen T, Danneskiold-Samsøe B, et al. Experimental quadriceps muscle pain impairs knee joint control during walking. J Appl Physiol. 2007;103(1):132-9.
27. 27. Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152(3):S90-S8.
28. 28. Ervilha UF, Arendt-Nielsen L, Duarte M, Graven-Nielsen T. Effect of load level and muscle pain intensity on the motor control of elbow-flexion movements. Eur J Appl Physiol, 2004;92(1-2):168-75.
29. 29. Thorborg K, Branci S, Stensbirk F, Jensen J, Hölmich 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;48(7):557-9.
30. 30. Hölmich P, Larsen K, Krogsgaard K, Gluud C. Exercise program for prevention of groin pain in football players: a cluster‐randomized trial. Scand J Med Sci Sports. 2010;20(6):814-21.