Effect of Holmich protocol exercise therapy on long-standing adductor-related groin pain in athletes: an objective evaluation

Abbas Yousefzadeh, Azadeh Shadmehr, Gholam Reza Olyaei, Nasrin Naseri, Zahra Khazaeipour, Abbas Yousefzadeh, Azadeh Shadmehr, Gholam Reza Olyaei, Nasrin Naseri, Zahra Khazaeipour

Abstract

Aim: To objectively evaluate the effect of Holmich protocol-based exercise therapy on long-standing adductor-related groin pain (LSAGP).

Methods: We reproduced the Holmich protocol of exercise therapy and objectively evaluated its effect on 17 male athletes (mean age, 25.07±4.96 years) suffering from LSAGP, of whom 14 participants completed the 10 weeks treatment period. The study was designed as a single-blinded, before-and-after clinical trial. Main outcome measures included pain, functional ability, hip range of motion (ROM), hip abductor and adductor muscle strength, and successful return to sports activity.

Results: Eleven athletes (78.57%) returned to their sports activities in a mean time of 14.2 weeks (range, 10-20 weeks). Visual analogue scale pain score, hip abductor and adductor muscles strength, and function scores improved significantly. Although hip abduction ROM did not show any significant changes (p = 0.609), the extent of progress in the hip internal rotation ROM was significant (p = 0.001). The ratio of hip adduction to abduction strength did not change significantly (p = 0.309 for the isometric and p = 0.957 for the eccentric ratio).

Conclusions: Exercise therapy according to the Holmich programme may be an effective treatment for LSAGP. However, more emphasis should be paid to the hip adductor muscles' eccentric strength.

Trial registration number: IRCT2016080829269N1.

Keywords: eccentric; exercise; groin.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Training in sideways motion on a ‘Fitter’.

References

    1. Caudill P, Nyland J, Smith C, et al. . Sports hernias: a systematic literature review. Br J Sports Med 2008;42:954–64. 10.1136/bjsm.2008.047373
    1. Hawkins RD, Hulse MA, Wilkinson C, et al. . The association football medical research programme: an audit of injuries in professional football. Br J Sports Med 2001;35:43–7. 10.1136/bjsm.35.1.43
    1. Waldén M, Hägglund M, Werner J, et al. . The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective. Knee Surg Sports Traumatol Arthrosc 2011;19:3–10. 10.1007/s00167-010-1172-7
    1. Hölmich P, Thorborg K, Dehlendorff C, et al. . Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med 2014;48:1245–50. 10.1136/bjsports-2013-092627
    1. Weir A, Jansen JA, van de Port IG, et al. . Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial. Man Ther 2011;16:148-54–154. 10.1016/j.math.2010.09.001
    1. Almeida MO, Silva BN, Andriolo RB, et al. . Conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain. Cochrane Database Syst Rev 2013;6:CD009565 10.1002/14651858.CD009565.pub2
    1. Hölmich P, Uhrskou P, Ulnits L, et al. . Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet 1999;353:439–43. 10.1016/S0140-6736(98)03340-6
    1. Hölmich 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;41:247–52. 10.1136/bjsm.2006.033373
    1. Machotka Z, Kumar S, Perraton LG. A systematic review of the literature on the effectiveness of exercise therapy for groin pain in athletes. Sports Med Arthrosc Rehabil Ther Technol 2009;1:5 10.1186/1758-2555-1-5
    1. Tyler TF, Nicholas SJ, Campbell RJ, et al. . The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med 2001;29:124–8. 10.1177/03635465010290020301
    1. Thorborg K. Clinical outcome measures for physically active individuals with hip and groin pain. Copenhagen: Copenhagen University, 2011.
    1. Whittaker JL, Small C, Maffey L, et al. . Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med 2015;49:803–809. 10.1136/bjsports-2014-094287
    1. Jensen J, Hölmich P, Bandholm T, et al. . Eccentric strengthening effect of hip-adductor training with elastic bands in soccer players: a randomised controlled trial. Br J Sports Med 2014;48:332–8. 10.1136/bjsports-2012-091095
    1. Thorborg K, Couppé C, Petersen J, et al. . Eccentric hip adduction and abduction strength in elite soccer players and matched controls: a cross-sectional study. Br J Sports Med 2011;45:10–13. 10.1136/bjsm.2009.061762
    1. Thorborg K, Petersen J, Magnusson SP, et al. . Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports 2010;20:493–501. 10.1111/j.1600-0838.2009.00958.x
    1. Thorborg K, Serner A, Petersen J, Madsen TM, et al. . Hip adduction and abduction strength profiles in elite soccer players: implications for clinical evaluation of hip adductor muscle recovery after injury. Am J Sports Med 2011;39:121–6. 10.1177/0363546510378081
    1. Taylor CJ, Pizzari T, Ames N, Orchard JW, et al. . Groin pain and hip range of motion is different in Indigenous compared to non-indigenous young Australian football players. J Sci Med Sport 2011;14:283–6. 10.1016/j.jsams.2011.02.002
    1. Miller MG, Herniman JJ, Ricard MD, Cheathm CC, et al. . The effects of a 6-week plyometric training program on agility. J Sports Sci Med 2006;5:459–65.
    1. Raya MA, Gailey RS, Gaunaurd IA, Jayne DM, et al. . Comparison of three agility tests with male servicemembers: Edgren Side Step Test, T-Test, and Illinois Agility Test. J Rehabil Res Dev 2013;50:951–60. 10.1682/JRRD.2012.05.0096
    1. Hamilton RT, Shultz SJ, Schmitz RJ, Perrin DH, et al. . Triple-hop distance as a valid predictor of lower limb strength and power. J Athl Train 2008;43:144–51. 10.4085/1062-6050-43.2.144
    1. Williams D, Heidloff D, Haglage E, Schumacher K, et al. . Anterior Cruciate Ligament Functional Sports Asssessment. Oper Tech Sports Med 2016;24:59–64. 10.1053/j.otsm.2015.10.002
    1. Pauole K, Madole K, Garhammer J, et al. . Reliability and validity ot the T-Test as a measure of agility, leg power and leg speed in college-aged men and women. J Strength Cond Res 2000;14.
    1. Bolgla LA, Keskula DR. Reliability of lower extremity functional performance tests. J Orthop Sports Phys Ther 1997;26:138–42. 10.2519/jospt.1997.26.3.138

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