Comparative Effects of Copenhagen and Holmich Exercises in Hip Adductor

Comparative Effects of Copenhagen and Holmich Exercises in Hip Adductor Related Groin Pain, Strength and Lower Extremity Function in Soccer Players

Groin pain that relates to the adductor muscle usually represents in the groin region specifically in superior internal thigh. Tears or strains may happen within the muscles itself, tears or strains mainly occurs at musculotendinous junctions or within the tendons. Adductor strain is a familiar but mostly ignored cause of groin injury and pain among athletes. Risk factors include past hip or groin injury, age, weak adductors, muscle fatigue, lessen range of motion, and deficient stretching of the adductor muscle complex.

Study Overview

• Status: Recruiting
• Conditions: Groin Strain
• Intervention / Treatment: Other: Copenhagen exercises; Other: Holmich exercises

Detailed Description

This study will be a randomized clinical trial and will be conducted in Pakistan sports board and coaching center. Non-probability consecutive sampling will be used to collect the data. Sample size of this research is 46 subjects with age group between 18-30 years will be taken. Data will be collected from the patients of adductor strain that causes groin pain by using tools Numeric Pain Rating Scale for pain, Adductor Muscle Strength Test by Hand Held Dynamometer, The Copenhagen Hip and Groin Outcome Score (HAGO's) questionnaire and Lower Extremity Functional Scale (LEFS). An informed consent will be taken. Squeeze test will be performed to evaluate the adductor related groin pain. The subjects will be divided into two groups i.e. Group A and Group B. Group A will receive the Copenhagen exercise, also known as the adductor strengthening protocol, is a dynamic and high-intensity exercise. It doesn't require any special equipment and can be done in any training center. Group B will receive Holmich continues to provide the strongest evidence for the efficacy of exercise as an ARGP treatment. Both groups will perform their routine warm ups and cool downs the total duration of the protocol is 6 weeks, 3 times a week the duration of each session 3 sets of 10 repetitions with 15 sec recovery period Keywords groin pain, Holmich protocol, Copenhagen exercise, adductor strain.

• Study Type: Interventional
• Enrollment (Estimated): 46
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Samrood Akram, Mphil; Phone Number: 923324806143; Email: samrood.akram@gmail.com
• Study Contact Backup: Name: Samrood Akram, Mphil; Phone Number: 923324806143; Email: samrood.akram@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab
    • Lahore, Punjab, Pakistan, 54000
      • Recruiting
      • Pakistan Sports Board
      • Contact: Samrood Akram, Mphil; Phone Number: 923324806143; Email: samrood.akram@riphah.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• • Male soccer player age group 18-30 years

  • Groin pain during or after game
  • Persistent groin pain over 2-3 weeks
  • Pain at palpation of groin
  • Positive pain with Adductor squeeze test

Exclusion Criteria:

• • Low back pain

  • Infection (UTI)
  • Malignancy
  • Recent fractures or injuries
  • Hip osteoarthritis
  • Inguinal hernia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group A: Copenhagen exercise; Group A will receive the Copenhagen exercise, also known as the adductor strengthening protocol, is a dynamic and high-intensity exercise. It doesn't require any special equipment and can be done in any training center. There are 3 different levels of exercise were performed by players.; Level 1: Side-lying hip adduction exercise.; Level 2: Copenhagen adduction exercises while both arms support at the knee.; Level 3: Copenhagen adduction exercise - primary support at the ankle and minor support at the knee.	Other: Copenhagen exercises; Group A performs copenhagen exercises Both groups will perform their routine warm ups and cool downs the total duration of the protocol is 6 weeks, 3 times a week the duration of each session 3 sets of 10 repetitions with 15 sec recovery period. Hip extensor and flexor stretching and strengthening.
Active Comparator: Group B : Holmich Exercises; Group B will receive Holmich continues to provide the strongest evidence for the efficacy of exercise as an ARGP treatment. The Holmich treatment protocol exercise includes static and dynamic and/or isometric and isotonic strengthening exercises for hip adductors and abductors and also for abdominal muscles. There are 6 Different types of exercises were performed by players who were a participant with 3 sets of 10 repetitions with 15 sec recovery period.	Other: Holmich exercises; The Holmich treatment protocol exercise includes static and dynamic and/or isometric and isotonic strengthening exercises for hip adductors and abductors and also for abdominal muscles. There are 6 Different types of exercises were performed by players who were a participant with 3 sets of 10 repetitions with 15 sec recovery period. Both groups will perform their routine warm ups and cool downs the total duration of the protocol is 6 weeks, 3 times a week the duration of each session 3 sets of 10 repetitions with 15 sec recovery period. Hip extensor and flexor stretching and strengthening.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numerical pain rating scale (NPRS)	Numeric Pain Rating Scale for Pain In a Numerical Rating Scale (NRS), patients are asked to circle the number between 0 and 10, 0 and 20 or 0 and 100 that fits best to their pain intensity. Zero usually represents 'no pain at all' whereas the upper limit represents 'the worst pain ever possible.	upto 4th weeks
Lower Extremity Functional Scale (LEFS)	Lower Extremity Functional Scale (LEFS) The Lower Extremity Functional Scale (LEFS) is a questionnaire containing 20 questions about a person's ability to perform everyday tasks. The LEFS can be used by clinicians as a measure of patients' initial function, ongoing progress and outcome, as well as to set functional goals. The LEFS can be used to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It can be used to monitor the patient over time and to evaluate the effectiveness of an intervention. The final version of the LEFS consists 20 items, each with a maximum score of 4. The total possible score of 80 indicates a high functional level (Appendix). The scale is one page, can be filled out by most patients in less than 2 minutes, and is scored by tallying the responses for all of the items. Scoring is performed without the use of a calculator or computer and requires approximately 20 seconds	upto 4th weeks
Manual Muscle Testing	MMT grades are usually labelled with the following terms: "zero," "trace," "poor," "fair," "good," and "normal." In addition, manual muscle testing grades can be further described using a numerical scale from 0 through 5.	upto 4th weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Samrood Akram, Mphil, Riphah International University,Lahore

Publications and helpful links

General Publications

• Haroy J, Clarsen B, Wiger EG, Oyen MG, Serner A, Thorborg K, Holmich P, Andersen TE, Bahr R. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 2019 Feb;53(3):150-157. doi: 10.1136/bjsports-2017-098937. Epub 2018 Jun 10.
• Mercurio M, Corona K, Galasso O, Cerciello S, Morris BJ, Guerra G, Gasparini G. Soccer players show the highest seasonal groin pain prevalence and the longest time loss from sport among 500 athletes from major team sports. Knee Surg Sports Traumatol Arthrosc. 2022 Jun;30(6):2149-2157. doi: 10.1007/s00167-022-06924-5. Epub 2022 Mar 8.
• Schaber M, Guiser Z, Brauer L, Jackson R, Banyasz J, Miletti R, Hassen-Miller A. The Neuromuscular Effects of the Copenhagen Adductor Exercise: A Systematic Review. Int J Sports Phys Ther. 2021 Oct 1;16(5):1210-1221. doi: 10.26603/001c.27975. eCollection 2021.
• Almeida MO, Silva BN, Andriolo RB, Atallah AN, Peccin MS. Conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain. Cochrane Database Syst Rev. 2013 Jun 6;2013(6):CD009565. doi: 10.1002/14651858.CD009565.pub2.

Study record dates

Study Major Dates

• Study Start (Actual): October 5, 2023
• Primary Completion (Actual): March 8, 2024
• Study Completion (Estimated): March 10, 2024

Study Registration Dates

• First Submitted: June 27, 2023
• First Submitted That Met QC Criteria: July 23, 2023
• First Posted (Actual): August 1, 2023

Study Record Updates

• Last Update Posted (Actual): March 13, 2024
• Last Update Submitted That Met QC Criteria: March 12, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: groin pain; adductor strain; Holmich protocol; Copenhagen exercises
• Additional Relevant MeSH Terms: Wounds and Injuries; Sprains and Strains
• Other Study ID Numbers: REC/RCR & AHS/23/0412

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No