Core Stability Training for Young Gymnasts With Adductor Strain (CST - ADD:ABD)

Effect of Core Stability Training on Hip Adduction Abduction Strength Ratio in Young Gymnasts With Adductor Strain: A Randomized Controlled Trial

Adductor muscle strain is a common cause of groin pain in young athletes, particularly in gymnasts who frequently perform movements that require extreme hip flexibility and strength. Muscle imbalance around the hip joint and reduced core stability may increase the risk of adductor injuries.

This randomized clinical trial aims to investigate the effect of adding core stability training to a traditional physiotherapy rehabilitation program on the hip adduction-abduction strength ratio in young gymnasts with adductor muscle strain.

Thirty-six young gymnasts aged 7-10 years with Grade I or II adductor strain will be randomly assigned to two groups. Both groups will receive a traditional physiotherapy rehabilitation program for eight weeks, while the study group will also perform additional core stability exercises.

Outcomes will include hip adductor and abductor strength measured using a hand-held dynamometer, pain intensity assessed using the Visual Analog Scale (VAS), and hip and groin function evaluated using the Copenhagen Hip and Groin Outcome Score (HAGOS).

The findings of this study may help determine whether adding core stability training improves rehabilitation outcomes in young gymnasts with adductor muscle strain.

Study Overview

• Status: Completed
• Conditions: Groin Pain; Adductor Muscle Strain
• Intervention / Treatment: Other: core stability training + traditional physio therapy for study group; Other: traditional physiotherapy for control group

Detailed Description

Adductor muscle strain is one of the most common causes of groin pain in athletes and is frequently reported in sports that involve rapid directional changes, high-impact landings, and extreme hip ranges of motion. Young gymnasts are particularly vulnerable to such injuries due to the repetitive mechanical loading placed on the hip and groin region during training and performance. Muscle imbalance around the hip joint, particularly an altered hip adduction to abduction (ADD:ABD) strength ratio, has been identified as a key intrinsic risk factor associated with groin injuries.

Core stability plays an essential role in maintaining lumbopelvic control and providing proximal stability for efficient movement of the lower extremities. Deficits in core stability may increase compensatory movements at the hip joint and contribute to excessive loading on the adductor muscles. Consequently, incorporating core stability exercises into rehabilitation programs may improve neuromuscular control and optimize hip muscle function.

The aim of this randomized clinical trial is to investigate the effect of adding core stability training to a traditional physiotherapy rehabilitation program on hip adduction-abduction strength ratio, pain intensity, and hip and groin function in young gymnasts diagnosed with adductor muscle strain.

Thirty-six young gymnasts aged 7-10 years with Grade I or Grade II adductor muscle strain will be randomly assigned to either a study group or a control group. Both groups will receive a traditional physiotherapy program three times per week for eight weeks. The study group will additionally perform a structured core stability training program.

Outcome measures will include hip adductor and abductor muscle strength assessed using a hand-held dynamometer, pain intensity measured using the Visual Analog Scale (VAS), and functional outcomes evaluated using the Copenhagen Hip and Groin Outcome Score (HAGOS). Assessments will be conducted before and after the intervention period.

The results of this study may contribute to improving rehabilitation strategies for young athletes with adductor-related groin injuries and may help determine whether core stability training provides additional benefits beyond traditional physiotherapy.

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt, 1151
    • the Faculty of Physical Therapy, Cairo University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Young gymnastic athletes aged 7-10 years.

  • Male or female participants who are actively practicing gymnastics.
  • Clinically diagnosed with Grade I or Grade II adductor muscle strain by an orthopedic physician.
  • Presence of groin pain reproduced during resisted hip adduction test.
  • Positive adductor squeeze test indicating adductor-related groin pain.

Exclusion Criteria:

• Presence of radiological evidence of hip joint pathology or fracture.

  • Neurological disorders affecting motor control or balance.
  • History of previous hip or pelvic surgery.
  • Presence of spinal pain involving the thoracolumbar region.
  • Any medical condition that could interfere with participation in the rehabilitation program or outcome assessments.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Active Comparator: Arm1(study group) , Arm2 (control group); Arm 1 - Study Group (Intervention Arm) Arm Description: Participants in this arm received a core stability training (CST) program in addition to the traditional physiotherapy program for the rehabilitation of adductor muscle strain. The intervention was performed three times per week for eight weeks. Each session consisted of 30 minutes of core stability exercises combined with 40 minutes of traditional physiotherapy. The CST program included exercises targeting trunk and lumbopelvic stability such as abdominal hollowing, abdominal bracing, dissociation of the shoulder and pelvic girdles, cat-camel exercise, quadruped stance, front bridge, side bridge, and supine bridge, applied in progressive phases. - Arm 2 - Control Group Arm Description: Participants in this arm received a traditional physiotherapy program alone for the rehabilitation of adductor muscle strain. The treatment was conducted three times per week for eight weeks, with each session lasting approximately 70 minutes.

Other: core stability training + traditional physio therapy for study group; Core stability training (CST) was implemented to improve trunk control and lumbopelvic stability in young gymnasts with adductor muscle strain. The program was performed three times per week for eight consecutive weeks and was provided in addition to the traditional physiotherapy program. Each session included approximately 30 minutes of CST exercises focusing on neuromuscular control of the trunk and pelvis. The training protocol consisted of progressive exercises including abdominal hollowing, abdominal bracing, dissociation of the shoulder and pelvic girdles, cat-camel exercise, quadruped stance, front bridge, side bridge (both sides), and supine bridge. The program was delivered in three progressive phases with gradual increases in training difficulty to enhance trunk muscle activation, improve lumbopelvic stability, and optimize force transmission through the kinetic chain during lower limb movements.; Other Names: core stability exercises; Other: traditional physiotherapy for control group; The traditional physiotherapy program was designed for the rehabilitation of adductor muscle strain and was conducted three times per week for eight weeks, with each session lasting approximately 70 minutes. The program included a 10-minute warm-up using a cycle ergometer followed by pain-free strengthening exercises targeting hip flexion, extension, abduction, and adduction performed in side-lying and standing positions. Isometric adductor strengthening exercises were performed in the supine position using a small roll placed between the knees or feet. Balance and proprioceptive training were incorporated using balance boards and functional tasks. Stretching exercises for the hamstrings, gluteal muscles, hip flexors, and iliotibial band were performed during the cool-down period. In addition, low-level laser therapy was applied for 10 minutes over the symptomatic adductor tendon insertion sites to reduce pain and local tenderness.; Other Names: conventional physiotherapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hip Adduction-Abduction Strength Ratio (ADD:ABD ratio)	Hip adduction and abduction muscle strength were measured using a hand-held dynamometer, and the ratio between adduction and abduction strength was calculated to evaluate hip muscle balance.	Baseline and after 8 weeks of intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain intensity	Pain intensity related to adductor strain was assessed using the Visual Analog Scale (VAS), where higher scores indicate greater pain.	Baseline and after 8 weeks of intervention.
hip and groin function	Functional status was evaluated using the Hip and Groin Outcome Score (HAGOS), a questionnaire assessing symptoms, pain, daily activities, sport and recreation, participation in physical activities, and quality of life.	Baseline and after 8 weeks of intervention.

Collaborators and Investigators

• Sponsor: Aya Mohamed Elsheikh
• Collaborators: Faculty of Physical Therapy, Cairo University, Egypt is not a recognized organization name.
• Investigators: Study Director: Nanees Essam Mohamed, physiotherapy Professor, Institutional Review Board of the Faculty of Physical Therapy, Cairo University, Egypt

Publications and helpful links

General Publications

• 29.Rodríguez-Perea Á, Reyes-Ferrada W, Jerez-Mayorga D, Chirosa Ríos L, Van den Tillar R, Chirosa Ríos I, et al. Core training and performance: a systematic review with meta-analysis. Biol Sport. 2023;40(4):975-992.
• 28.McGill S. (2016). Ultimate back fitness and performance (7th ed.). Backfitpro.
• 27.Cabrejas C, Solana-Tramunt M, Morales J, Campos-Rius J, Ortegón A, Nieto-Guisado A, et al. The effect of eight-week functional core training on core stability in young rhythmic gymnasts: A randomized clinical trial. Int J Environ Res Public Health. 2022;19(6):3509.
• 21.Mahmoud WS, Ibrahim MM, Radwan NL. Efficacy of modified active physical therapy program on pain, muscle strength, and function in adolescent football players with osteitis pubis. Bull Fac Phys Ther. 2024;29:2. https://doi.org/10.1186/s43161-023-00170-7.
• 20.Maestroni L, Read PJ, Bishop C, Turner AN. Strength and power training in rehabilitation: Underpinning principles and practical strategies to return athletes to high performance. Sports Medicine. 2019;50:239-252.
• 19.Abdelwakel IAZ. Impact of rehabilitation exercises program on adductor muscle strain. Assiut Journal For Sport Science Arts. 2016;216(2):1-13.
• 18.Harøy J, Bache-Mathiesen LK, Andersen TE. Lower HAGOS subscale scores associated with a longer duration of groin problems in football players in the subsequent season. BMJ Open Sport Exerc Med. 2024;10(2):e001812.
• 16.Thorborg K, Hölmich P, Christensen R, Petersen J, Roos EM. The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med. 2011;45(6):478-491. Johnson EW. Visual analog scale (VAS). Am J Phys Med Rehabil. 2001;80(10):717.
• 15.Thorborg K, Petersen J, Magnusson SP, Hölmich P. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports. 2010;20(3):493-501.
• 13.Beard MQ, Boland SA, Gribble PA. Reliability of the Hand-Held Dynamometer During Hip Isometric Strength Testing Both With and Without a Stabilization Strap. International Journal of Athletic Therapy and Training. 2020;25(1):37-42.
• 12.Heijboer WMP, Weir A, Vuckovic Z, Tol JL, Hölmich P, Serner A. Clinical examination tests for adductor- and pubic-related groin pain in athletes with longstanding groin pain: Inter-examiner reliability and prevalence of positive tests. Phys Ther Sport. 2024;66: 9-16.
• 11.Verrall GM, Slavotinek JP, Barnes PG, Fon GT. Description of pain provocation tests used for the diagnosis of sports-related chronic groin pain: relationship of tests to defined clinical (pain and tenderness) and MRI (pubic bone marrow oedema) criteria. Scand J Med Sci Sports. 2005;15(1):36-42.
• Opara K, Pinkerman S, Kaiser K. Adductor Strain. [Updated 2025 Dec 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493166/

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2024
• Primary Completion (Actual): April 20, 2025
• Study Completion (Actual): August 1, 2025

Study Registration Dates

• First Submitted: March 7, 2026
• First Submitted That Met QC Criteria: March 7, 2026
• First Posted (Actual): March 12, 2026

Study Record Updates

• Last Update Posted (Actual): March 12, 2026
• Last Update Submitted That Met QC Criteria: March 7, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Core Stability Training; Adductor Muscle Strain; Hip Adduction Abduction Ratio; Gymnastics Injuries
• Additional Relevant MeSH Terms: Investigative Techniques; Epidemiologic Research Design; Epidemiologic Methods; Research Design; Methods; Control Groups
• Other Study ID Numbers: P.T.REC/012/005528

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: "Individual Participant Data (IPD) from this study will not be shared due to privacy and ethical considerations. The dataset contains sensitive information about study participants, and sharing it publicly could risk violating confidentiality agreements and data protection regulations. Additionally, data sharing may be restricted by institutional policies, participant consent forms, and legal requirements governing the use of clinical trial data."

Drug and device information, study documents

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