Falvey, Eanna

Franklyn-Miller, Andrew

Gore, Shane

King, Enda

Moran, Kieran

Richter, Chris

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							2017	OFFICIAL	ABSTRACT	FORM	XXVI	International	Conference	of	Sport	Rehabilitation	and	Traumatology	Football	Medicine	Strategies	–	The	future	of	football	medicine	Barcelona,	Spain	May	2017			All	named	Authors	have	read,	understood	and	agreed	the	submission	rules	and	guidelines	 	 R	(please	tick)		All	 named	 Authors	 confirm	 that	 they	 have	 given	 due	 consideration	 to	 the	 protection	 of	intellectual	 property	 associated	 with	 this	 work	 and	 that	 there	 are	 no	 impediments	 to	publication	in	the	abstract	book	of	the	Conference.	In	so	doing	they	confirm	that	they	have	followed	the	regulations	of	their	institutions	concerning	intellectual	property.		 R	(please	tick)			The	Presenting	Author	commits	himself	to	attend	the	conference.	The	Presenting	Author	will	be	Mr	Shane	Gore			TITLE	Stiffness	as	an	outcome	measure	of	rehabilitation	in	athletic	groin	pain	patients		AUTHORS	 Gore S. 1,2,3, A. Franklyn-Miller1,4 , Richter C. 1, Falvey E1,4 ,King E. 1 & K. Moran2,3	AFFILIATIONS	1Sports	Medicine	Department,	Sports	Surgery	Clinic,	Santry	Demesne,	Dublin,	Ireland	2School	of	Health	and	Human	Performance,	Dublin	City	University,	Dublin,	Ireland	3Insight	Centre	for	Data	Analytics,	Dublin	City	University,	Dublin,	Ireland	4Centre	for	Health,	Exercise	and	Sports	Medicine,	University	of	Melbourne,	Melbourne,	Australia 	PRESENTATION	PREFERENCE	 ORAL						R	(please	tick)	 POSTER						£	(please	tick)	 CONTEST						£	(please	tick)	Topic:	Functional	Assessment		Introduction: Athletic groin pain (AGP) is a chronic condition, prevalent in field sports including football. Current outcome measures following rehabilitation in AGP include radiological and clinical measures [1], however these provide little insight into potential propagative movements associate with AGP. A detailed biomechanical assessment may be used to identify other potential outcome measures in AGP. One biomechanical measure, which may be of particular importance for injury risk, is stiffness. Previous research has associated greater stiffness with for example stress fracture [2], and contrastingly lesser stiffness with achilles tendinopathy [3].  To date however, stiffness has not been examined in AGP. The purpose of this investigation was to examine if sagittal plane joint stiffness of the hip, knee and ankle are potential outcome measures of successful rehabilitation in AGP.  Methods: Sixty-five male patients presenting with AGP and fifty male controls were recruited to this study. Assessment included patient report outcome measures, adductor squeeze scores and a biomechanical examination of stiffness during a lateral hurdle hop test. Subjects with AGP were tested pre and post rehabilitation, while controls were tested once. The biomechanical assessment involved three trials of a lateral hurdle hop test. Reflective markers (14mm diameter) were placed at bony landmarks on the lower limbs, pelvis and trunk as per the Vicon Plug in Gait model (Vicon, Oxford, UK). Eight infrared cameras (200Hz; Vicon, Bonita B10, UK), synchronized with two force platforms (1000Hz, AMTI, BP400600, USA) collected marker motion and force data respectively. Marker and force data were filtered using a fourth order low pass Butterworth filter at 15 Hz to avoid impact artifacts. The data was subsequently exported to Matlab 2013b (Mathworks, USA), where stiffness was calculated and the statistical analysis conducted. Stiffness was examined during the eccentric phase of the hurdle hop action. During this phase, normalized joint stiffness was calculated as the ratio of change in joint moment to the change in joint angle (Eq. 1):     Where ΔM is the change in joint moment and Δθ is the range of motion of the joint. Given the observation of fluctuating joint moment signs (e.g. between eccentric and concentric hip extensor moments), a novel weighted mean stiffness calculation was proposed to adequately represent the mean stiffness of a joint. The mean weighted net joint stiffness was calculated from the net joint stiffness of each phase i where the joint was acting eccentrically (Eq. 2):    All results are presented as mean ± SD.  Cohen’s effect size was reported as small (0.2 – 0.5), medium (0.5 – 0.8), and large (> 0.8).  Results: Using the HAGOS questionnaire, adductor squeeze tests and return to pain free sport as outcome measures, sixty-five athletes presenting with AGP were returned to play in a median time of 9.1 weeks with no return of symptoms. Stiffness was significantly less in the AGP pre rehabilitation in comparison to the control group at the ankle and knee but not at the hip. From pre to post rehabilitation, neither ankle nor knee stiffness changed significantly (Table 1).   Table	1:	Sagittal	Plane	Stiffness	Results	D	=	Cohen’s	D	effect	size,	Sig	=	significance	(p).  Conclusion:  Despite a successful return to pain-free participation in sport in 65 players with AGP after rehabilitation, none of the variables that differed significantly to the control group pre rehabilitation, changed significantly from pre to post rehabilitation. This would suggest, based on current return to play standards, that stiffness in general is not a sufficiently sensitive measure alone to determine rehabilitation success in patients with AGP. Future research should examine joint stiffness in AGP patients in all three planes of the lower limb.  References: 1		 Falvey	ÉC,	King	E,	Kinsella	S.	Athletic	groin	pain	(	part	1	):	a	prospective	anatomical	diagnosis	of	382	patients	—	clinical	findings	,	MRI	findings	and	patient-reported	outcome	measures	at	baseline.	2015;:1–9.		2		 Milner	CE,	Hamill	J,	Davis	I.	Are	knee	mechanics	during	early	stance	related	to	tibial	stress	fracture	in	runners?	Clin	Biomech	2007;22:697–703.		3		 Maquirriain	J.	Leg	Stiff	ness	Changes	in	Athletes	with	Achilles	Tendinopathy.	Int	J	Sports	Med	2012;33:567–71.		Stiffness	(k)	 AGP	Pre	 AGP	Post	 Control	 AGP	Pre	vs.	Control	 AGP	Pre	vs.	AGP	Post	Variable	 Mean	±	SD	 Mean	±	SD	 Mean	±	SD	 D	 Sig	 D	 Sig		Ankle	plantarflexor	 1.06	±	0.31	 1.07	±	0.32	 1.25	±	0.38	 0.55	 0.00	 0.00	 0.98	Knee	extensor	 3.14	±	1.65	 2.93	±	1.44	 4.05	±	3.32	 0.36	 0.05	 0.13	 0.35	Hip	extensor	 1.01	±	43.05	 7.45	±	24.77	 6.42	±	148.45	 0.05	 0.79	 0.15	 0.31	

Stiffness as an outcome measure of rehabilitation in athletic groin pain patients

http://doras.dcu.ie/21763/1/Isokinetic_GoreS_Stiffness_2017.pdf

Stiffness as an outcome measure of rehabilitation in athletic groin pain patients

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