Athletic groin pain (part 1): A prospective anatomical diagnosis of 382 patients - Clinical findings, MRI findings and patient-reported outcome measures at baseline

Background: Athletic groin pain remains a common field-based team sports time-loss injury. There are few reports of non-surgically managed cohorts with athletic groin pain. Aim: To describe clinical presentation/examination, MRI findings and patient-reported outcome (PRO) scores for an athletic groin pain cohort. Methods: All patients had a history including demographics, injury duration, sport played and standardised clinical examination. All patients underwent MRI and PRO score to assess recovery. A clinical diagnosis of the injured anatomical structure was made based on these findings. Statistical assessment of the reliability of accepted standard investigations undertaken in making an anatomical diagnosis was performed. Result: 382 consecutive athletic groin pain patients, all male, enrolled. Median time in pain at presentation was (IQR) 36 (16–75) weeks. Most (91%) played field-based ball-sports. Injury to the pubic aponeurosis (PA) 240 (62.8%) was the most common diagnosis. This was followed by injuries to the hip in 81 (21.2%) and adductors in 56 (14.7%) cases. The adductor squeeze test (90° hip flexion) was sensitive (85.4%) but not specific for the pubic aponeurosis and adductor pathology (negative likelihood ratio 1.95). Analysed in series, positive MRI findings and tenderness of the pubic aponeurosis had a 92.8% post-test probability. Conclusions: In this largest cohort of patients with athletic groin pain combining clinical and MRI diagnostics there was a 63% prevalence of PA injury. The adductor squeeze test was sensitive for athletic groin pain, but not specific individual pathologies. MRI improved diagnostic post-test probability. No hernia or incipient hernia was diagnosed. Clinical trial registration numberl: NCT02437942

Assessment of layperson knowledge of AED use in sports clubs

Aims: To investigate knowledge and attitudes among sports club members toward AEDs, and to examine the potential benefits of an educational programme as an intervention for increasing awareness and willingness to use an AED. Methods: A number of selected sports clubs were visited, and participants aged ≥16 were asked to complete a questionnaire relating to current awareness and attitudes toward AEDs, and their willingness to use the device. Each participant then attended a 2-hour small-group teaching session where they were educated on the role and use of an AED, with opportunity to practice AED use in a controlled environment. After receiving teaching, each individual again completed the questionnaire. Results: 142 people participated in the study. Before teaching, the average level of knowledge regarding AED use was relatively low. The most common reason identified for unwillingness to operate an AED was lack of knowledge on how to correctly use the device. Paired data analysis showed that attendance at a 2-hour educational programme led to a significant improvement in layperson awareness and understanding of AED use. After teaching, 77.5%(n=110) of participants reported that they would definitely be willing to use an AED, compared with 20.4%(n=30) before teaching. Conclusion: A structured educational programme can increase layperson awareness, confidence and willingness to operate an AE

Supervised learning techniques and their ability to classify a change of direction task strategy using kinematic and kinetic features

This study examines the ability of commonly used supervised learning techniques to classify the execution of a maximum effort change of direction task into predefined movement pattern as well as the influence of fuzzy executions and the impact of selected features (e.g. peak knee flexion) towards classification accuracy. The experiment utilized kinematic and kinetic data from 323 male subjects with chronic athletic groin pain. All subjects undertook a biomechanical assessment and had been divided previously into 3 different movement strategies in an earlier paper. Examined supervised learning techniques were: a decision tree, an ensemble of decision trees, a discriminant analysis model, a naive Bayes classifier, a k-nearest-neighbour model, a multi-class model for support vector machines, a stepwise forward regression model, a neural network and a correlation approach. Performance (measured by comparing the predefined and classified movement pattern) was highest for the correlation approach (82 % - CI 81 to 83 %) and support vector machine (80 % - CI 79 to 80 %). The percentage of fuzzy observations within the data was between 15 and 25 %. The most informative features for classification were: hip flexion angle, ankle rotation angle, a flexion moment [ankle and hip] and thorax flexion. Findings of this study support the assumption that multiple patterns are used to execute a movement task and demonstrate that classification models can predict movement patterns with a high accuracy (83 %)

The effect of exercise on baseline SCAT5 performance in male professional Rugby players

Background: Rugby Union requires annual baseline testing using the Sports Concussion Assessment Tool (SCAT5) as part of its head injury assessment protocols. Scores achieved during baseline testing are used to guide return-to-play decisions at the time of head impact events during matches, and concussion diagnosis during subsequent diagnostic screens. Baseline values must be valid, accurate representations of a playerâ s capability in the various SCAT5 sub-modes, including symptom report, cognitive function and balance. The extent to which prior exercise may affect performance is an important consideration, and the present cross-sectional study aimed to explore how SCAT5 performance differs when assessed at rest (RSCAT) compared to after 30 min of exercise (EXSCAT) in 698 male professional rugby players for whom paired exercise and rest SCAT5 data were available. Results: Symptom endorsement was greater when assessed after exercise than at rest. Fatigue/Low energy was 1.5 times more likely to be reported when assessed during EXSCAT. Orientation score was improved during SCAT5s performed after exercise, but only when rest and exercise SCAT5s were conducted on the same day, suggesting a learning effect. Concentration score was impaired during EXSCAT. No other cognitive sub-modes were affected by exercise. Total errors during Modified Balance Error Scoring System (MBESS) increased during EXSCAT, as a result of increased errors made during single leg balance, irrespective of testing sequence, with 42% of players making more errors in EXSCAT, compared to 28% making more errors in RSCAT. Conclusions: Symptoms, cognitive sub-modes and balance sub-modes are all affected by exercise. These may be the result of learning effects that improve cognitive performance, and the direct effects of exercise on sub-mode performance. The clinical implications of these changes may be assessed in the future through a study of diagnostic screens in players after head impact events, to confirm whether an exercise baseline screen is required annually, or whether specific sub-modes of the SCAT5 should be obtained at rest and after exercise

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

Background: Clinical assessments and rehabilitation in athletic groin pain (AGP) have focused on specific anatomical structures and uniplanar impairments rather than whole body movement. Objective: To examine the effectiveness of rehabilitation that targeted intersegmental control in patients with AGP and to investigate post rehabilitation changes in cutting biomechanics. Methods: 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. Results: 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. Conclusions: 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

Changes in the kinetics and kinematics of a reactive cut manoeuvre after successful athletic groin pain rehabilitation.

Athletic groin pain (AGP) is a chronic, painful condition which is prevalent in players of field sports that require rapid changes of direction. Following successful rehabilitation, systematic changes have been observed in the kinetics and kinematics of pre-planned change of direction manoeuvres, providing insight into potential foci for rehabilitation monitoring and for the assessment of interventions. However, changing direction in field sports is often reactive rather than pre-planned, and it is not known whether such post-rehabilitation changes are seen in reactive manoeuvres. We analysed the stance phase kinetics and kinematics of a 90° reactive cutting manoeuvre in 35 AGP patients before and after a successful exercise intervention programme. Following the intervention, transverse plane rotation of the pelvis towards the intended direction of travel increased, and the body centre of mass was positioned more anteriorly relative to the centre of pressure. Ankle dorsiflexion also increased, and participants demonstrated greater ankle plantar flexor internal moment and power during the second half of stance. These findings provide insight into mechanical variables of potential importance in AGP, as identified during a manoeuvre based on a common sporting task

Concussion in adolescent rugby union players: comprehensive acute assessment protocol and development of the SSC concussion passport to monitor long-term health

Introduction: Sports-related concussion (SRC) can be challenging to diagnose, assess and manage. Much of the SRC research is conducted on adults. The assessment of SRC should aim to identify deficits using a detailed multimodal assessment; however, most studies investigating the effects of SRC use diagnostic tools in isolation. It is likely that a combination of diagnostic tests will improve diagnostic accuracy. In this study, we aim to investigate how concussion affects adolescent rugby players and how a variety of diagnostic tools interact with each other as participants recover from their injury. The study will also determine the logistics of recording an individual’s concussion history on a virtual ‘Concussion Passport’ that would remain with the individual throughout their sporting career to allow monitoring of long-term health.Methods and analysis All rugby players (n=211) from the Senior Cup Teams of five schools in Dublin, Ireland will be invited to participate in the study. Baseline testing will be performed at the Sports Surgery Clinic, Dublin (SSC) before the rugby season commences. Participants will be followed up over the course of the rugby season. At baseline and at each postconcussion visit, participants will complete the following: Questionnaire, Sports Concussion Assessment Tool 3, Balance Error Scoring System, Computerised Neurocognitive Testing, Vestibulo-ocular assessment, King Devick test, Graded exercise test, Blood tests, Neck strength, FitBit.Ethics and dissemination Ethical approval was obtained from the Sports Surgery Clinic Research Ethics Committee (Approval number: SSC 0020). On completion of the study, further papers will be written and published to present the results of the various tests.Trial registration number NCT03624634

Ready for impact? A validity and feasibility study of instrumented mouthguards (iMGs)

Objectives Assess the validity and feasibility of current instrumented mouthguards (iMGs) and associated systems. Methods Phase I; four iMG systems (Biocore-Football Research Inc (FRI), HitIQ, ORB, Prevent) were compared against dummy headform laboratory criterion standards (25, 50, 75, 100 g). Phase II; four iMG systems were evaluated for on-field validity of iMG-triggered events against video-verification to determine true-positives, false-positives and false-negatives (20±9 player matches per iMG). Phase III; four iMG systems were evaluated by 18 rugby players, for perceptions of fit, comfort and function. Phase IV; three iMG systems (Biocore-FRI, HitIQ, Prevent) were evaluated for practical feasibility (System Usability Scale (SUS)) by four practitioners. Results Phase I; total concordance correlation coefficients were 0.986, 0.965, 0.525 and 0.984 for Biocore-FRI, HitIQ, ORB and Prevent. Phase II; different on-field kinematics were observed between iMGs. Positive predictive values were 0.98, 0.90, 0.53 and 0.94 for Biocore-FRI, HitIQ, ORB and Prevent. Sensitivity values were 0.51, 0.40, 0.71 and 0.75 for Biocore-FRI, HitIQ, ORB and Prevent. Phase III; player perceptions of fit, comfort and function were 77%, 6/10, 55% for Biocore-FRI, 88%, 8/10, 61% for HitIQ, 65%, 5/10, 43% for ORB and 85%, 8/10, 67% for Prevent. Phase IV; SUS (preparation-management) was 51.3-50.6/100, 71.3-78.8/100 and 83.8-80.0/100 for Biocore-FRI, HitIQ and Prevent. Conclusion This study shows differences between current iMG systems exist. Sporting organisations can use these findings when evaluating which iMG system is most appropriate to monitor head acceleration events in athletes, supporting player welfare initiatives related to concussion and head acceleration exposure.</p

The journey so far : professional sport during the COVID-19 pandemic

BACKGROUND : The COVID-19 pandemic has profoundly impacted community and professional sports. Throughout this time, sports organisations collaborated closely with the WHO, host national governments and their public health authorities. The common goals were to assess risk and to implement risk reduction measures to facilitate a stepwise return to sport, thus realising the physical and mental health benefits of sport for the participants, as well as the safe resumption of competitive events despite active SARS-CoV-2 transmission in many countries.https://bmjopensem.bmj.comSports Medicin