Abstract
Objective The Hölmich protocol in therapeutic exercise is the most appropriate method for the treatment of long-standing adductor-related groin pain (LSAGP). Herein, we evaluated a modified Hölmich protocol to resolve the possible limitations intrinsic to the Hölmich protocol in terms of the rate of return to sport and the recovery period for athletes with LSAGP. Design The study followed a single-blind, before/after study design, where 15 athletes with LSAGP (mean age = 26.13 years; SD = 4.48) performed a 10-week modified Hölmich therapeutic exercise protocol. Results Outcome scores related to pain, hip adductor and abductor muscle strengths, and the ratio of maximum isometric and eccentric hip adduction to abduction strength increased significantly. Likewise, hip abduction and internal rotation ROM improved significantly compared to that at baseline. Furthermore, functional records (t-test, Edgren Side Step Test, and Triple Hop Test) showed significant improvement after treatment. Finally, 13 athletes (86.6% of the participants) successfully returned to sports activity in a mean time of 12.06 weeks (SD = 3.41). Conclusion The findings of this study objectively show that the modified Hölmich protocol may be safer and more effective than the Hölmich protocol in athletes with LSAGP in promoting their return to sports activity. This trial is registered with IRCT2016080829269N1.
Highlights
Despite the fact that groin injury is prevalent among soccer players, representing 9%–16% of all soccer injuries [1, 2], this injury still frequently causes sport physiotherapists trouble due to difficulties in treatment
One athlete dropped out due to educational problems, one athlete withdrew because he had to go to military service, and one athlete was lost to follow-up
Our findings suggest that this modified ten-week protocol that benefits from strengthening the muscles affecting the pelvis, core stabilization, hip adductor stretching, and high intensity eccentric exercise of the hip adductors may have a considerable effect on primary measured outcomes including pain, hip adductor and abductor muscle strength, hip range of motion (ROM), functional ability, and returning to sport
Summary
Despite the fact that groin injury is prevalent among soccer players, representing 9%–16% of all soccer injuries [1, 2], this injury still frequently causes sport physiotherapists trouble due to difficulties in treatment. A review of the studies shows that therapeutic exercise is the most appropriate method for treating long-standing groin pain [4, 5, 7,8,9]. In the study by Holmich et al (1999), the average time from the start of treatment to the return to sports activity in the group treated with therapeutic exercise was 18.5 weeks. It seems that this recovery period (18.5 weeks) is too long because, in professional sports, there is often a lot of pressure to get an athlete back to his/her sport as soon as possible [5, 8, 11]
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