Dual effect of practical blood flow restriction training on groin pain and recovery in athletes

BackgroundAthletic hip and groin pain is common in the Gaelic Athletic Association (GAA) but its prevalence at elite level is unknown. The changes in Hip and Groin Outcome Score (HAGOS)...

BackgroundAthletic hip and groin pain is common in the Gaelic Athletic Association (GAA) but its prevalence at elite level is unknown. The changes in Hip and Groin Outcome Score (HAGOS)...

BackgroundGroin pain is a common problem in athletes which results in loss of playing time. Moreover, it can be for the cause of athletic career termination. A common cause of groin pain in athletes is inguinal disruption; pain in the groin area near the pubic tubercle were no obvious other pathology exists to explain the symptoms. Aim of this study was to evaluate the effect of endoscopic totally extraperitoneal (TEP) hernia repair in athletes with inguinal disruption.MethodsThirty-one athletes with chronic groin pain due to inguinal disruption, who had undergone conservative therapy without any effect, were included in this prospective cohort study. Prior to surgery patients were assessed by clinical examination, ultrasound of the inguinal region, x-ray and a radionuclide bone scan with single photon-emission computed tomography and CT (SPECT-CT). TEP hernia repair was performed and a lightweight polypropylene mesh was placed pre-peritoneally. Additionally the athletes’ perception about their groin disability was assessed preoperatively and 6 weeks postoperatively by means of the Hip and Groin Outcome Score (HAGOS). The HAGOS consists of six subscales: Pain, Symptoms, Physical function in daily living, Physical function in Sport and Recreation, Participation in Physical Activities, and hip and/or groin-related Quality of Life.ResultsNo complications occurred during and after surgery. After six weeks patients improved in all the separate subscales of the Hip and Groin Outcome Score (HAGOS). Within 6 weeks of surgery, 26 patients (84%) returned to sports activities with no or less groin pain.ConclusionsThis study showed that endoscopic totally extraperitoneal (TEP) hernia repair is an effective surgical treatment of inguinal disruption in athletes with chronic groin pain.

BackgroundHeterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area.AimThe ‘Doha agreement meeting on terminology and definitions in groin pain in athletes’ was convened to attempt to...

The Doha agreement classification is used to classify groin pain in athletes. We evaluated the inter‐examiner reliability of this classification system. We prospectively recruited 48 male athletes (66 symptomatic sides) with groin pain between 10–2017 and 03–2020 at a sports medicine hospital in Qatar. Two examiners (23 and 10 years of clinical experience) performed history taking, and a standardized clinical examination blinded to each other's findings. Examiners classified groin pain using the Doha agreement terminology (adductor‐, inguinal‐, iliopsoas‐, pubic‐, hip‐related groin pain, or other causes of groin pain). Multiple entities were ranked in order of perceived clinical importance. Each side was classified separately for bilateral groin pain. Inter‐examiner reliability was calculated using Cohen's Kappa statistic (κ). Inter‐examiner reliability was slight to moderate for adductor‐ (κ = 0.40), inguinal‐ (κ = 0.44), iliopsoas‐ (κ = 0.57), and pubic‐related groin pain (κ = 0.12), substantial for hip‐related groin pain (κ = 0.62), and slight for “other causes of groin pain” (κ = 0.13). Ranking entities in order of perceived clinical importance improved inter‐examiner reliability for adductor‐, inguinal‐, and iliopsoas‐related groin pain (κ = 0.52–0.65), but not for pubic (κ = 0.12), hip (κ = 0.51), and “other causes of groin pain” (κ = 0.03). For participants with unilateral groin pain classified with a single entity (n = 7), there was 100% agreement between the two examiners. Inter‐examiner reliability of the Doha agreement meeting classification system varied from slight to substantial, depending on the clinical entity. Agreement between examiners was perfect when athletes were classified with a single clinical entity of groin pain, but lower when athletes were classified with multiple clinical entities.

Groin pain in athletes is a priority area for sports physiotherapy and sports medicine research. Heterogeneous studies with low methodological quality dominate research related to groin pain in athletes. Low-quality...

BkgroundNo studies have tested the validity of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory, across different cultures and languages.ObjectiveTo validate the Danish, English and Norwegian...

Blood flow restriction (BFR) training is an increasingly applied tool with potential benefits in muscular hypertrophy, strength, and endurance. This study investigates the effectiveness of BFR training relative to other forms of training on muscle strength, hypertrophy, and endurance. We performed systematic searches of MEDLINE, Embase, and PubMed and assessed the methodological quality of included studies using the Cochrane risk of bias tool. We included 53 randomized controlled trials with 31 included in meta-analyses. For muscular strength comparing low-intensity BFR (LI-BFR) training with high-intensity resistance training (HIRT), the pooled mean difference (MD) for 1 repetition maximum was 5.34 kg (95% CI, 2.58-8.09; P < 0.01) favoring HIRT. When comparing LI-BFR training with HIRT for torque, the MD was 6.35 N·m (95% CI, 0.5-12.3; P = 0.04) also favoring HIRT. However, comparing LI-BFR with low-intensity resistance training (LIRT) for torque, there was a MD of 9.94 N·m (95% CI, 5.43-14.45; P < 0.01) favoring BFR training. Assessing muscle hypertrophy, the MD in cross-sectional area was 0.96 cm2 (95% CI, 0.21-1.7; P = 0.01) favoring pooled BFR training compared with nonocclusive training. Assessing endurance, V̇o2 maximum demonstrated a greater mean increase of 0.37 mL/kg/min (95% CI, -0.97 to 3.17; P = 0.64) in BFR endurance training compared with endurance training alone. Blood flow restriction training produced increases in muscular strength, hypertrophy, and endurance. Comparing LI-BFR training with HIRT, HIRT was a significantly better training modality for increasing muscle hypertrophy and strength. However, LI-BFR was superior when compared with a similar low-intensity protocol. Blood flow restriction training is potentially beneficial to those unable to tolerate the high loads of HIRT; however, better understanding of its risk to benefit ratio is needed before clinical application. Level 1.

BackgroundDespite hip and groin pain being commonly reported in elite youth football players, little evidence on risk factors exists. Risk factors in adult football players include reduced hip adductor strength and hip adductor/abductor strength ratios, and lower Copenhagen Hip and Groin Outcome Score (HAGOS) subscale scores. It is unknown if these factors are also predictive of pain development in youth football players.ObjectiveTo identify whether preseason hip adductor and abductor strength and HAGOS subscale scores of male and female elite youth football players are associated with in-season or historical (lifetime) hip and groin pain.MethodsPreseason hip adductor and abductor strength testing and the HAGOS were undertaken by 105 elite male (n = 58) and female (n = 47) football players aged 11–15 years. Medical staff documented both players’ self-reported historical and in-season hip and groin pain. Univariate and multivariate logistic regression models were undertaken with main outcome measures in-season hip and groin pain and historical hip and groin pain and independent variables of hip muscle strength, hip muscle torque and HAGOS subscale scores.ResultsTwenty-three players (21.9%) self-reported in-season hip and groin pain, while 19 players (18.1%) self-reported historical hip and groin pain. Pre-season hip adductor and abductor variables and HAGOS subscale scores failed to predict in-season hip and groin pain. However, a higher body mass index (odds ratio [OR] = 1.32; 95% CI 1.01, 1.73, p = .043) and being male (OR 5.71; 95% CI 1.65, 19.7) were associated with having in-season hip and groin pain (R2 = 0.211). There was also an association between historical hip and groin pain (R2 = 0.579) and both HAGOS subscale Quality of Life (odds ratio [OR] = 0.84; 95% CI 0.77, 0.91, p < .001) and mean abductor torque (OR = 11.85; 95% CI 1.52, 91.97; p = .018).ConclusionPre-season hip adductor and abductor strength and HAGOS subscale scores did not predict subsequent in-season hip and groin pain in elite youth football players. However, pre-season higher hip abductor strength and lower HAGOS scores were retrospectively associated with historical hip and groin pain.

Prevalence of early hip OA features on MRI in high-impact athletes. The femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study

BackgroundDue to advances in hip arthroscopy, the number of surgical procedures has increased dramatically. The diagnostic challenge in patients with longstanding hip and groin pain, as well as the increasing number of hip arthroscopies, may lead to a higher number of patients referred to tertiary care for consideration for surgery. Therefore, the aims were: 1) to describe the prevalence of hip-related groin pain in patients referred to tertiary care due to longstanding hip and groin pain; and 2) to compare patient characteristics and patient-reported outcomes for patients categorized as having hip-related groin pain and those with non-hip-related groin pain.MethodsEighty-one patients referred to the Department of Orthopedics at Skåne University Hospital for longstanding hip and groin pain were consecutively included and categorized into hip-related groin pain or non-hip-related groin pain using diagnostic criteria based on current best evidence (clinical examination, radiological examination and intra-articular block injection). Patient characteristics (gender (%), age (years), BMI (kg/m2)), results from the Hip Sports Activity Scale (HSAS), the SF-36, the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain distribution (pain manikin) were collected. Parametric and non-parametric statistics were used as appropriate for between-group analysis.ResultsThirty-three (47%) patients, (30% women, 70% men, p < 0.01), were categorized as having hip-related groin pain. The hip-related groin pain group had a higher activity level during adolescence (p = 0.013), and a higher pre-injury activity level (p = 0.034), compared to the non-hip-related groin pain group. No differences (mean difference (95% CI)) between hip-related groin pain and non-hip-related groin pain were observed for age (0 (− 4; 4)), BMI (− 1.75 (− 3.61; 0.12)), any HAGOS subscales (p ≥ 0.318), any SF-36 subscales (p ≥ 0.142) or pain distribution (p ≥ 0.201).ConclusionsOnly half of the patients referred to tertiary care for long-standing hip and groin pain, who were predominantly men with a high activity level, had hip-related groin pain. Self-reported pain localization and distribution did not differ between patients with hip-related groin pain and those with non-hip-related groin pain, and both patient groups had poor perceived general health, and hip-related symptoms and function.

Sports hernia

The sport function subscale of the Copenhagen Hip and Groin Outcome Score could not be an indicator of postural balance in soccer players with groin pain.

Background/aimReference values are needed in order to interpret the Copenhagen Hip and Groin Outcome Score (HAGOS) in male soccer players with hip and groin pain. The aim of this study...

Blood flow restriction (BFR) training combined with aerobic exercise (AE) is proposed to benefit elderly and high-risk cardiovascular populations due to its lower joint and cardiovascular strain. However, its safety remains unclear. This meta-analysis evaluates the efficacy and safety of BFR training in improving cardiovascular health and inflammatory markers in elderly and high-risk individuals. Following PRISMA guidelines, six databases were systematically searched for studies involving BFR training in elderly (>60 years) or high-risk cardiovascular populations. Primary outcomes included systolic and diastolic blood pressure (SBP, DBP), vascular endothelial growth factor (VEGF), insulin-like growth factor 1 (IGF-1), high-density lipoprotein (HDL), hypoxia-inducible factor 1α, nitric oxide, interleukin-6, tumor necrosis factor α (TNF-α), reactive oxygen species, and adverse events. Dichotomous outcomes were analyzed using odds ratios, and continuous outcomes using mean differences. Meta-analysis and meta-regression were conducted with RevMan 5.4 and RStudio. Thirty-six studies met inclusion criteria. BFR training significantly increased VEGF (P=0.03) and IGF-1 (P=0.02), indicating angiogenic and metabolic benefits. No significant effects were found for blood pressure, HDL, or inflammatory markers overall. Subgroup analysis revealed increased SBP among healthy elderly individuals (mean difference: 7.48 mmHg; P=0.01), suggesting possible sympathetic activation and altered vascular compliance. BFR training shows potential for cardiovascular and metabolic improvements; however, its inconsistent effects on blood pressure and inflammation warrant further safety evaluation.