Groin Pain Clinical Trial
Official title:
An Examination of the Anatomical and Biomechanical Diagnoses That Exist in Athletic Groin Pain Patients and the Effects of a Biomechanics Led Rehabilitation Intervention in These Same Patients
NCT number | NCT02437942 |
Other study ID # | SSC-Groin-001 |
Secondary ID | |
Status | Completed |
Phase | N/A |
First received | |
Last updated | |
Start date | April 2015 |
Est. completion date | December 2023 |
Verified date | April 2024 |
Source | Sports Surgery Clinic, Santry, Dublin |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Athletic groin pain (AGP) is a chronic condition common in multi-directional sports (Walden et al. 2007, Robinson et al. 2004, Murphy et al. 2012). It is a complex injury with a challenging diagnosis. Dramatic differences in the anatomical diagnoses of AGP cohorts exist in the literature (Renstrom et al. 1980, Lovell et al. 1995, Holmich et al. 2007, Bradshaw et al. 2008). This may be due to the complexity of the anatomy in the region and the absence of magnetic resonance imaging (MAGNETIC RESONANCE IMAGE) to confirm clinical examination. Dynamic actions undertaken in field sports (including change of direction cutting) are particularly associated with the development of athletic groin pain (Holmich et al. 2014). Dynamic multi-plane, multi-joint actions can overload musculoskeletal and fascial structures in the hip and groin. Despite this, traditional groin pain assessments do not involve an examination of sport specific actions. An examination of jumping, hopping and cutting mechanics, which is possible with the use of three dimensional motion capture techniques, will provide additional information with which to diagnosis and rehabilitate athletes. While the majority of published studies on AGP have focused on surgical management (Serner et al. 2015), exercise therapy has been found to be an effective treatment (Holmich et al. 1995). In exercise therapy studies the best results were shown by Holmich et al (1995) where subjects suffered for an average of 9.9 months with symptoms and a strength and stability program focused on adductor strength returned them to sport in 18.5 weeks. The latest paper on rehabilitation by Jardi et al. demonstrates little improvement with a mean time to return to training of 86 days +/-15. The focus remains on improving strength of isolated muscle groups and not attempting to address underlying biomechanical abnormalities that may be leading to overload. Accurate biomechanical assessment and individualized rehabilitation based on the high speed multiplanar movements that drive the athlete's symptoms may enhance the efficiency of rehabilitation. Moreover post-rehabilitation changes in biomechanical factors may provide a further insight into the biomechanical factors associated with AGP. The purpose of this study was to: 1. Describe clinical presentation (physical examination and magnetic resonance imaging findings) for a group of athletes presenting with AGP 2. To describe the different biomechanical diagnoses that exist in AGP patients 3. To examine the effects of a biomechanics led exercise intervention to rehabilitate chronic groin pain It is hypothesised that standardised magnetic resonance imaging will aid in the anatomical diagnosis of athletic groin pain patients. From a biomechanics perspective, distinct subgroups/clusters will exist that differ from each other in how they undertake dynamic sport specific actions. These distinct clusters will describe potential biomechanical diagnoses that exist in groin pain patients. A biomechanics led rehabilitation program will return groin pain patients back to sport more quickly than previous rehabilitation programs without biomechanical diagnostic information. Brief protocol Participants will be recruited from patients with chronic athletic groin pain who present for investigation and rehabilitation at Sports Surgery Clinic, Ireland. A standardised clinical examination will be undertaken including range of motion assessment, pain provocation and load tolerance tests, and palpation. A Magnetic Resonance Image of the hip and groin region will then be undertaken and read by a consultant sports physician. Biomechanical assessment will include capturing of jumping, hopping and cutting mechanics through the use of three dimensional motion capture technology and force plates. Here reflective markers are placed on the skin at anatomical landmarks. These markers are picked up by the cameras and tracked at 200 frames per second. Participants will contact the force plate with their foot on undertaking the movements. Force and marker data will be combined to calculate joint angles and moments. Physical therapy assessment will include an assessment of functional movement, range of motion testing, adductor squeeze tests, strength assessment of hip and trunk. Physiotherapists will utilise three dimensional biomechanical data during cutting and landing to inform individualised rehabilitation. Rehabilitation will consist of movement control, whole body strength and power, linear running mechanics, multi-directional mechanics and conditioning sessions. Participants will have follow up physical therapy appointments approximately every two weeks. A hip and groin outcome score (HAGOS) will be used to monitor the morbidity and severity of the injury throughout the rehabilitation process. Once the physiotherapist determines that the patient is ready to return to play a biomechanical re-test will be undertaken.
Status | Completed |
Enrollment | 205 |
Est. completion date | December 2023 |
Est. primary completion date | September 2022 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 14 Years to 40 Years |
Eligibility | Inclusion Criteria: - Diagnosis of athletic groin pain - Professional athlete in full time training with groin pain diagnosis Exclusion Criteria: - Post infective osteitis - Bone tumour - Acute injury |
Country | Name | City | State |
---|---|---|---|
Ireland | Sports Surgery Clinic | Dublin | Leinster |
Lead Sponsor | Collaborator |
---|---|
Sports Surgery Clinic, Santry, Dublin | Insight Centre for Data Analytics, Science Foundation Ireland |
Ireland,
Bradshaw CJ, Bundy M, Falvey E. The diagnosis of longstanding groin pain: a prospective clinical cohort study. Br J Sports Med. 2008 Oct;42(10):851-4. doi: 10.1136/bjsm.2007.039685. Epub 2008 Apr 1. Erratum In: Br J Sports Med. 2009 Apr;43(4):310-1. — View Citation
Holmich P, Thorborg K, Dehlendorff C, Krogsgaard K, Gluud C. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med. 2014 Aug;48(16):1245-50. doi: 10.1136/bjsports-2013-092627. Epub 2013 Aug 16. — View Citation
Holmich P, Uhrskou P, Ulnits L, Kanstrup IL, Nielsen MB, Bjerg AM, Krogsgaard K. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet. 1999 Feb 6;353(9151):439-43. doi: 10.1016/S0140-6736(98)03340-6. — View Citation
Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients. Br J Sports Med. 2007 Apr;41(4):247-52; discussion 252. doi: 10.1136/bjsm.2006.033373. Epub 2007 Jan 29. — View Citation
Jardi J, Rodas G, Pedret C, Til L, Cusi M, Malliaropoulos N, Del Buono A, Maffulli N. Osteitis pubis: can early return to elite competition be contemplated? Transl Med UniSa. 2014 Apr 8;10:52-8. eCollection 2014 Sep. — View Citation
Lovell G. The diagnosis of chronic groin pain in athletes: a review of 189 cases. Aust J Sci Med Sport. 1995 Sep;27(3):76-9. — View Citation
Murphy JC, O'Malley E, Gissane C, Blake C. Incidence of injury in Gaelic football: a 4-year prospective study. Am J Sports Med. 2012 Sep;40(9):2113-20. doi: 10.1177/0363546512455315. Epub 2012 Aug 9. — View Citation
Renstrom P, Peterson L. Groin injuries in athletes. Br J Sports Med. 1980 Mar;14(1):30-6. doi: 10.1136/bjsm.14.1.30. No abstract available. — View Citation
Robinson P, Barron DA, Parsons W, Grainger AJ, Schilders EM, O'Connor PJ. Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal Radiol. 2004 Aug;33(8):451-7. doi: 10.1007/s00256-004-0753-2. Epub 2004 Jun 29. — View Citation
Serner A, van Eijck CH, Beumer BR, Holmich P, Weir A, de Vos RJ. Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes. Br J Sports Med. 2015 Jun;49(12):813. doi: 10.1136/bjsports-2014-094256. Epub 2015 Jan 29. — View Citation
Thorborg K, Bandholm T, Schick M, Jensen J, Holmich P. Hip strength assessment using handheld dynamometry is subject to intertester bias when testers are of different sex and strength. Scand J Med Sci Sports. 2013 Aug;23(4):487-93. doi: 10.1111/j.1600-0838.2011.01405.x. Epub 2011 Oct 28. — View Citation
Thorborg K, Branci S, Stensbirk F, Jensen J, Holmich 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 Apr;48(7):557-9. doi: 10.1136/bjsports-2013-092607. Epub 2013 Jul 12. — View Citation
Walden M, Hagglund M, Ekstrand J. Football injuries during European Championships 2004-2005. Knee Surg Sports Traumatol Arthrosc. 2007 Sep;15(9):1155-62. doi: 10.1007/s00167-007-0290-3. Epub 2007 Mar 21. — View Citation
* Note: There are 13 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Hip range of movement | Post rehabilitation change in hip range as assessed by the physical therapist | Following rehabilitation, an expected average of 10 weeks | |
Other | Hip strength | Post rehabilitation change in hip strength as assessed by the physical therapist | Following rehabilitation, an expected average of 10 weeks | |
Other | Squeeze test | Using a pressure cuff, measure the pressure at which pain is felt | Following rehabilitation, an expected average of 10 weeks | |
Other | Cross-over test | Pain provocation test undertaken by physical therapist | Following rehabilitation, an expected average of 10 weeks | |
Primary | Hip and groin outcome score (HAGOS) | The HAGOS questionnaire is a validated tool (Thorborg et al. 2014; Thorborg et al. 2011) used to examine the impact of injury on physical function and to track symptoms at the time of diagnosis and as rehabilitation progresses. | Over the course of the rehabilitation time frame and one year and two years post initial consultation | |
Secondary | Kinetic and kinematic composite score | The post-training change in biomechanical measures following the intervention | Following rehabilitation, an expected average of 10 weeks |
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