The biomechanical determinants of sports related groin pain in athletes.

PhDIntroduction Sports related groin pain (SRGP) is common, debilitating and often recurrent. Rehabilitation that addresses strength and flexibility deficits has only moderate effects. Recurrence of SRGP remains high, suggesting that deficits remain after apparently successful rehabilitation. The aims of this thesis were to inform best practice by (i) systematically reviewing the literature on biomechanical factors associated with SRGP (ii) investigating muscle activation and movement patterns associated with SRGP in both professional and amateur athletes; (iii) investigating muscle activation and movement patterns immediately after groin injury alongside their response to standard rehabilitation. Methods A systematic review with meta-analysis was completed. 84 athletes from four sports (56 professional and 28 amateur) were recruited and clinically assessed. Hip joint kinematics and surface electromyography of gluteus medius (GM) and adductor longus (AL) muscles were measured while performing selected manoeuvres. A further 5 athletes had serial measures during traditional rehabilitation from acute injury. Results The review found strong evidence for decreased adductor flexibility as a risk factor; and decreased adductor strength and external rotation range of movement being associated with SRGP. The GM:AL ratio in injured professionals was increased due to reduced AL activation, a decreased GM:AL ratio was found in amateurs due to a decrease of GM activation. In injured professionals hip kinematic change matched the sEMG findings (increased abduction), whereas no consistent pattern was observed in amateurs. Longitudinal study participants 7 improved clinically after groin injury, but the muscle activation and movement patterns did not alter. Conclusion These studies identified clear muscle activation differences that extend existing the literature while the kinematic changes are novel. Further, participation level and sports-specific subgroups had not previously been identified but are clearly evident. Published guidelines require amendment, while clinical innovation that addresses sub-group specific biomechanical factors in rehabilitation programmes may inform prevention, improve outcome and certainly warrant further research

Movement Patterns and Muscular Function Before and After Onset of Sports-Related Groin Pain: A Systematic Review with Meta-analysis

BACKGROUND: Sports-related groin pain (SRGP) is a common entity in rotational sports such as football, rugby and hockey, accounting for 12-18 % of injuries each year, with high recurrence rates and often prolonged time away from sport. OBJECTIVE: This systematic review synthesises movement and muscle function findings to better understand deficits and guide rehabilitation. STUDY SELECTION: Prospective and retrospective cross-sectional studies investigating muscle strength, flexibility, cross-sectional area, electromyographic activation onset and magnitude in patients with SRGP were included. SEARCH METHODS: Four databases (MEDLINE, Web of Knowledge, EBSCOhost and EMBASE) were searched in June 2014. Studies were critiqued using a modified version of the Downs and Black Quality Index, and a meta-analysis was performed. RESULTS: Seventeen studies (14 high quality, 3 low quality; 8 prospective and 9 retrospective) were identified. Prospective findings: moderate evidence indicated decreased hip abduction flexibility as a risk factor for SRGP. Limited or very limited evidence suggested that decreased hip adduction strength during isokinetic testing at ~119°/s was a risk factor for SRGP, but no associations were found at ~30°/s or ~210°/s, or with peak torque angle. Decreased hip abductor strength in angular velocity in ~30°/s but not in ~119°/s and ~210°/s was found as a risk factor for SRGP. No relationships were found with hip internal or external rotation range of movement, nor isokinetic knee extension strength. Decreased isokinetic knee flexion strength also was a potential risk factor for SRGP, at a speed ~60°/s. Retrospective findings: there was strong evidence of decreased hip adductor muscle strength during a squeeze test at 45°, and decreased total hip external rotation range of movement (sum of both legs) being associated with SRGP. There was strong evidence of no relationship to abductor muscle strength nor unilateral hip internal and external rotation range of movement. Moderate evidence suggested that increased abduction flexibility and no change in total hip internal rotation range of movement (sum of both legs) were retrospectively associated with SRGP. Limited or very limited evidence (significant findings only) indicated decreased hip adductor muscle strength during 0° and 30° squeeze tests and during an eccentric hip adduction test, but a decrease in the isometric adductors-to-abductors strength ratio at speed 120°/s; decreased abductors-to-adductors activation ratio in the early phase in the moving leg as well as in all three phases in the weight-bearing leg during standing hip flexion; and increased hip flexors strength during isokinetic and decrease in transversus abdominis muscle resting thickness associated with SRGP. CONCLUSIONS: There were a number of significant movement and muscle function associations observed in athletes both prior to and following the onset of SRGP. The strength of findings was hampered by the lack of consistent terminology and diagnostic criteria, with there being clear guides for future research. Nonetheless, these findings should be considered in rehabilitation and prevention planning

An investigation of the wants and needs for Pregnancy in Athletes and their postpartum return to sport in relation to Nutrition (The PAN project)

The study will aim to generate preliminary quantitative evidence to assess nutrition requirements and support female athletes from the United Kingdom and Republic of Ireland during pregnancy and postpartum. This exploratory cross-sectional survey will follow on the research and topic area that was previously explored in a 2023 UK-based qualitative study