Adductor Strength Research Articles

Strength Profile of Hip Abductor and Adductor Muscles in Youth Elite Soccer Players.

The main objective of this study was to provide an extensive isokinetic profile of the hip joint in youth soccer players, where the literature is limited. Additionally, this study investigated the effect of age on isokinetic peak torque values of hip abductor and adductor muscles and on reciprocal muscle group torque ratios in youth soccer players at different angular velocities (30 vs. 90o/s) and muscle actions (concentric vs. eccentric). Sixty young elite male soccer players were assigned into three equal groups (n = 20): children, young adolescents and older adolescents, and performed five maximal concentric and eccentric hip-abductions and adductions at 30o/s and 90o/s. The results showed a significant increase (p < 0.05) in peak torque values from childhood to adolescence, with the exception of young adolescents vs. older adolescents where no differences were observed. The reciprocal ratios were not affected by age, but improved with an increase in angular velocity with the exception of the CON/ECC ratio that was higher at 30o/s. The data presented in this study provide an extensive isokinetic profile of hip abductor and adductor muscle strength in youth soccer players to assist both coaches and sports medicine professionals in strength monitoring and training.

Adductor squeeze test and groin injuries in elite football players: A prospective study

ObjectiveTo examining the relationship between hip adductor strength and groin injury incidence during the competitive season of professional football teams. DesignProspective Cohort study. SettingControlled laboratory environment. ParticipantsSeventy-one players volunteered to participate. Main outcome measuresIn the pre-season, maximal hip adductor strength was measured by means of the isometric adductor squeeze test. Hip adductor strength, normalized by body mass, was compared between players who suffered a groin injury (n = 18) vs uninjured players (n = 53). Risk ratios (RR) were used to evaluate the likelihood of players to suffer this type of injury. ResultsMost of the reported groin injuries occurred during competitive matches (5.5 per 1000 match hours). Maximal isometric hip adductor strength was lower in the groin-injured group compared with their uninjured counterparts (429.8 ± 100 vs 564 ± 58.7 N, d = −1.58 and 5.40 ± 1.27 vs 7.71 ± 0.89 N/kg, d = −1.88, respectively). Results revealed that values of maximal isometric adductor strength lower than 465.33 N increased the probability to suffer a groin injury by 72%. Furthermore, values of force relative to body mass lower than 6.971 N/kg increased the probability to suffer a groin injury by 83%. ConclusionThe assessment of Hip adductor strength, in addition to other measurements, might help practitioners to determine the probability of suffering an overuse groin injuries in elite football players.

Functional Hip Characteristics and Their Relationship With Ball Velocity in College Baseball Pitchers.

Compared to shoulder and elbow functions, the hip functional characteristics of baseball pitchers have not been fully investigated. Therefore, little is known about the relationship between hip function and pitching performance. The purpose of this study was to evaluate the characteristics of hip flexibility and strength, focusing on their influences on the ball velocity in baseball pitchers. Descriptive laboratory study. Laboratory and university baseball facility. Twenty-three college baseball pitchers. Passive hip range of motion (ROM) and isometric hip muscle strength were bilaterally measured. The pitchers threw 20 fastballs at an official pitching distance. Bilateral hip ROM and strength in flexion, extension, abduction, adduction, and external and internal rotation; the maximal ball velocity. The pivot side showed smaller hip external rotation ROM (P < .01), larger hip internal rotation ROM (P = .03), and greater hip adduction strength (P = .03) than the stride side. The hip extension ROM on the stride side had a negative correlation with the maximal ball velocity (r = -.58, P < .01). The maximal ball velocity (135.3 [4.1]km/h) positively correlated with the hip extension (r = .59, P < .01), flexion (r = .57, P < .01), abduction (r = .55, P < .01), and adduction (r = .55, P < .01) strength on the pivot leg, and the hip flexion (r = .53, P = .01), abduction (r = .67, P < .01), and adduction (r = .46, P = .03) strength on the stride leg. These findings suggest that baseball pitchers do not have marked side-to-side differences in hip flexibility and strength, and that an important fitness factor for increasing ball velocity is not the hip flexibility but the hip muscle strength of both legs.

Five-Second Squeeze Testing in 333 Professional and Semiprofessional Male Ice Hockey Players: How Are Hip and Groin Symptoms, Strength, and Sporting Function Related?

Background:Hip and groin problems are just as common in ice hockey as they are in soccer. The 5-second squeeze test (5SST) is a valid indicator of hip- and groin-related sporting function (self-reported function) in soccer and is suggested to be interpreted according to a “traffic light” approach in guiding the early identification and management of affected players. It is currently unknown how the 5SST relates to self-reported function and muscle strength in ice hockey players.Purpose:To investigate correlations between the 5SST result, self-reported function, and hip muscle strength in ice hockey players. A further aim was to investigate the discriminative ability of the “traffic light” approach (numeric rating scale [NRS] score: 0-2 = green, 3-5 = yellow, 6-10 = red) regarding levels of self-reported function and strength.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Professional and semiprofessional male ice hockey players (N = 333) performed the 5SST and completed the Sport subscale of the Copenhagen Hip and Groin Outcome Score (HAGOS). Bilateral adduction and abduction strength was measured using handheld dynamometry. Associations were estimated using Spearman rank-order correlations, and groups were compared using the Kruskal-Wallis test or analysis of variance. Standardized effect sizes (ESs) for differences in strength (Hedges g) and self-reported function (r) were provided.Results:The 5SST result was significantly correlated with self-reported function (rho, –0.319; P < .01) and hip muscle strength (rho, –0.157 to –0.305; P < .01). The HAGOS Sport scores differed significantly between all 3 traffic light groups (ES, 0.23-0.33; P ≤ .005). Players with an NRS score >2 (yellow or red light) had lower adduction (ES ≥ 0.75; P < .001) and abduction strength (yellow: ES, 0.30; P = .031) (red: ES, 0.51; P = .058) than players with a green light.Conclusion:The 5SST result was significantly correlated with self-reported function as well as hip muscle strength and was able to discriminate between the traffic light levels in ice hockey players. Players with a yellow or red light had reduced adduction and abduction strength compared with players with a green light (NRS score ≤2). Routine 5SSTs may allow the early identification of affected ice hockey players and indicate yellow and red light situations, in which players may benefit from load management and appropriate hip muscle strengthening.

Effects of Game Performance on Softball Pitchers and Catchers.

Oliver, GD, Plummer, HA, Washington, JK, Weimar, WH, and Brambeck, A. Effects of game performance on softball pitchers and catchers. J Strength Cond Res 33(2): 466-473, 2019-The purpose of this study was to examine the effects of game exposure on pitchers and catchers' hip and glenohumeral range of motion (ROM), isometric strength, and vertical jump performance and power. Five college female softball pitchers (174.24 ± 7.53 cm; 82.10 ± 11.27 kg; 20 ± 1.82 years) and 4 catchers (165.10 ± 9.04 kg; 68.61 ± 3.87 cm; 20 ± 1.41 years) participated. Hip and glenohumeral rotational ROM; hip and glenohumeral rotational isometric strength; hip abduction and adduction strength; and vertical jump height were assessed pre- and postgame exposure. The catchers displayed significantly greater throwing side hip internal rotation (IR) ROM (mean difference = +6.88°, p = 0.03) postgame exposure, whereas the pitchers exhibited less IR (mean difference = -2.02%, p = 0.013) and external rotation (ER; mean difference = -1.95%, p = 0.026) strength in the nonthrowing side hip pre vs. postgame exposure. The performance demands of pitchers and catchers vary greatly, causing position-specific decreases/increases in various tests following game performance. Pitchers exhibited significant decreases in nonthrowing side hip IR and ER strength. In catchers, throwing side hip IR ROM significantly increased following game exposure. Further evaluation of ROM, strength, and power is necessary as it is unknown how these changes following a game affect sports performance or risk of injury.

Measurement Properties of an Adductor Strength-Assessment System in Professional Australian Footballers.

To examine the measurement properties of an adductor strength-assessment system in professional Australian footballers. Observational, longitudinal design. Test-retest reliability data were collected from 18 professional Australian footballers from 1 club on the same day during the 2017 Australian Football League season. Week-to-week variation data were collected on 45 professional Australian footballers from 1 club during the same season at 48, 72, and 120 h postmatch (rounds 1-23). Players lay beneath a GroinBar hip-strength testing system in supine position with their knee joints at an angle of 60°. Force (in newtons) was extracted for the left and right limbs of each player and a pain score from 0 to 10 (0 = no pain, 10 = maximum pain) was provided. Coefficient of variation (CV) and smallest worthwhile change were calculated on test-retest data. Signal-to-noise ratio was calculated for each major time point. Mean difference between force scores in a subgroup of players with and without groin pain (n = 18) was collected as evidence of construct validity for the system. Test CV was 6.3% (4.9-9.0%). CV exceeded the smallest worthwhile change on both limbs. Intraclass correlation coefficient was .94. Signal-to-noise ratio ranged from 1.6 to 2.6 on average for 48, 72, and 120 h postmatch. Groin pain had a very likely moderate negative effect on adductor strength (effect size: 0.41). The system possesses greater measurement precision than dynamometry and sphygmomanometer adductor strength-assessment methods in professional Australian footballers. Increased groin pain reduced groin squeeze force production. Practitioners may interpret changes exceeding 6.3% in adductor strength as real.

A Triple Application of Kinesio Taping Supports Rehabilitation Program for Rotator Cuff Tendinopathy: a Randomized Controlled Trial

Rotator cuff tendinopathy (RoCT) is a common pathology among adults. Kinesio-taping (KT) represents a possible rehabilitative treatment. The aim of the present study is to investigate the efficacy of a combination of three different applications of KT combined with a standardized protocol of rehabilitative exercises in reducing pain and in functional recovery in patients affected by RoCT. 21 patients were enrolled in a real group (RG) and 19 in a sham group (SG). RG received a real KT application and SG received a sham KT application. Both groups received the same rehabilitative protocol. A Numeric Rating Scale (NRS) for shoulder pain, Medical Research Council (MRC) Scales for shoulder strength assessment and Costant Murley Score (CMS) were administered before (T0) and at the end of treatment (T1). Within-group analysis for RG at T1 showed significant improvement in: NRS at-rest (p=0.002), during-movement (p&lt;0.001); CMS (p&lt;0.001); MRC shoulder flexion (p=0.003), extension (p=0.005), abduction (p=0.003), adduction (p=0.007), external rotation (p=0.011), internal rotation (p=0.002), elbow flexion (p=0.008) and extension strength (p=0.011). Within-group analysis for SG at T1 showed significant improvement in: during-movement NRS (p=0.010); CMS (p&lt;0.001). 1. KT application combined with conventional rehabilitative treatment can facilitate immediate pain reduction during rehabilitative treatment. 2. KT application combined with conventional rehabilitative treatment can increase function recovery. 3. KT application combined with conventional rehabilitative treatment can increase strength recovery. 4. Our findings however are not strong enough to recommend the application of KT during rehabilitative treatment for RoCT. 5. These results are the basis for future prospective, randomized controlled trials of larger samples of patients.

Efeitos do treino com plataforma vibratória sobre a força muscular e capacidade funcional em idosas hígidas

Avaliar efeitos da plataforma vibratória (PV) sobre a força muscular e desempenho do Teste de Caminhada de Seis Minutos (TC6) em idosas hígidas, alocadas em Grupo Plataforma Vibratória (GPV) que realizaram treino na PV e Grupo Controle (GC) não submetidos à intervenção. Avaliou-se perfil antropométrico, distância percorrida no TC6 e força muscular do membro inferior através do Teste de 1 Repetição Máxima (1-RM) pré e pós 2 meses de intervenção. 17 idosas hígidas foram avaliadas (GPV: n=7 e GC: n=10) com 65,4±6,6 anos. Houve aumento significativo da distância percorrida no GPV (p=0,0001) e aumento da força muscular dos adutores de quadril (p=0,014) do pré (66,1 ±22,8 kg) para o pós treino (72 ± 20,3 kg), bem como dos extensores de joelho do pré (46,4 ± 19,7 kg) para o pós treino (75,0 ± 16,5 kg). A VCI aumentou a capacidade funcional e força muscular de membros inferiores de idosas hígidas.

A novel device to assess hip strength: Concurrent validity and normative values in male athletes

Objectives To assess concurrent validity of the new, novel externally-fixed dynamometer (GroinBar) with hand-held dynamometry (HHD); to provide normative GroinBar scores for elite Australian rules football (AFL) and football (Soccer) players; and to evaluate preliminary predictive validity of the GroinBar and HHD in this population by comparing strength results with patient-reported outcome scores. Design Cross-sectional and reliability study Participants Total of 67 athletes, 36 AFL players and 31 football (Soccer) players Setting Elite AFL and football (Soccer) teams Main Outcome Measures The GroinBar system, HHD, The Copenhagen Hip and Groin Outcome Score (HAGOS) Questionnaire. Results Moderate to good correlations were identified between the GroinBar and HHD strength tests for hip adduction and abduction in the long lever position (rs 0.53 – 0.71). Normative values of the GroinBar and HHD for both AFL and football (Soccer) players were obtained. Neither the GroinBar or HHD strength measures differed between players with groin problems and those without. Conclusion This externally fixed strength testing device, the GroinBar, may provide a robust method of athlete monitoring and screening that does not rely on tester experience and strength. Normative values are documented for hip adduction and abduction strength in elite male athletes.

Clinical features of people with hip-related pain, but no clinical signs of femoroacetabular impingement syndrome

ObjectivesIdentifying impairments in hip range of motion (ROM) and muscle strength in people with hip-related pain, without signs of femoro-acetabular impingement syndrome (FAIS). Study aims: to determine if hip strength and ROM i) differs between the symptomatic and less-symptomatic hip of people with hip-related pain; and between people with hip-related pain and healthy controls; and ii) are associated with hip-related Quality of Life and pain. DesignCross-sectional study. SettingUniversity laboratory. ParticipantsThirty participants with hip-related pain who were awaiting hip arthroscopy (22 women; age = 37 ± 10yrs), 32 healthy controls (19 women; age = 30 ± 10yrs). Main outcome measuresHip ROM, muscle strength, pain intensity and the Hip disability and Osteoarthritis Outcome Score (HOOS) were assessed. ResultsLess hip flexion ROM (p = 0.004), and extension (p = 0.004), abduction (p = 0.001) and internal rotation (IR) (p = 0.048) strength were measured on the symptomatic compared to non-symptomatic side. Hip-related pain participants had lower hip abduction strength (p = 0.045), and less flexion (p < 0.001), IR (p = 0.027) and external rotation (ER) (p = 0.019) ROM compared to controls. Less ER ROM (p = 0.03–0.04), and greater abduction (p = 0.03–0.04) and adduction strength (p = 0.02) were associated with better patient reported outcome measures. ConclusionsSpecific impairments in hip ROM and strength were identified in people with hip-related pain but no FAIS.

Incidence and risk factors of medial tibial stress syndrome: a prospective study in Physical Education Teacher Education students

ObjectiveMedial tibial stress syndrome (MTSS) is a common lower extremity overuse injury often causing long-term reduction of sports participation. This study aimed to investigate the incidence and risk factors of...

Different neuromuscular parameters influence dynamic balance in male and female football players.

To analyse the relationship between several parameters of neuromuscular performance with unilateral dynamic balance measured through the Y-Balance test, as well as to determine the possible sex-related differences. The Y-Balance test, isokinetic (concentric and eccentric) knee flexion and extension strength, isometric hip abduction and adduction strength, lower extremity joint range of motion (ROM) (hip, knee and ankle) and core stability were assessed in male (n = 88) and female (n = 44) professional football players. A stepwise multivariate linear least square regression with backward elimination analysis was carried out to identify a group of factors that were independently associated with balance performance in both sexes. Passive hip flexion and ankle dorsiflexion with knee flexed ROM were the main factors that retained a significant association to dominant (R2 = 23.1) and non-dominant (R2 = 33.5) balance scores for males. For females, core stability, hip abduction isometric peak torque, passive hip abduction and ankle dorsiflexion with knee flexed ROM variables retained a significant association with balance scores for both, dominant (R2 = 38.2) and non-dominant (R2 = 46.9) legs. Training interventions aimed at improving or maintaining unilateral dynamic balance in male football players should include, among other things, stretching exercises for the posterior chain of the lower extremity. However, females should also include exercises for strength and mobility of the hip abductors and core stability (especially in the frontal plane). This knowledge would allow clinicians and sport practitioners to develop more effective and tailored unilateral dynamic balance training interventions in male and female football players, possibly improving performance and reducing the risk of injury. III.

Associations between adductor strength; flexibility and self-reported symptoms in elite professional footballers: a case series

ABSTRACTObjectives: Measures of adductor strength, flexibility and self-reported symptoms offer insights into footballer hip/groin health. Understanding their relationship may further determine their suitability for use. Design: Clinical case series Method: Eighteen professional footballers completed two adductor squeeze tests (short and long lever), the HAGOS (sport) and Bent Knee Fall Out (BKFO); 2 days post-match, during a period of 4 months. Results: Adductor strength reduced beyond the minimal detectable change (MDC) on 16 occasions for the long-lever squeeze (MDC = 7%) and 7 occasions for short-lever squeeze (MDC = 15%). On 17 occasions, participant BKFO scores reduced beyond the MDC (21%). A relationship between both squeeze tests and HAGOS (sport) was observed explaining 12% variance for short-lever (R2 = 0.121, p = 0.006) and 7% for long-lever (R2 = 0.065, p = 0.046) tests. The BKFO showed no statistically significant (P = > 0.05) correlation to either squeeze test (rp = 0.153/0.193) or HAGOS (sport) (rp = 0.182). Conclusion: This study adds to literature surrounding monitoring of hip/groin measures in footballers. The long-lever adductor squeeze detected meaningful changes more frequently than the short-lever. Both tests shared weak, albeit statistically significant relationships with HAGOS (sport), whilst the BKFO did not. A larger prospective study is warranted to increase confidence in selecting these measures in this setting.

Editorial

The scientific interest about the whole-bodyvibrations exercise (WBVE) has grown along of thetime worldwide. WBVE is generated in an individualin contact with the base of a vibratory platform.Hence, mechanical vibration produced in theplatform is transmitted to the body of the individual.This mechanical vibration is a physical agent thatis characterized by an oscillatory, harmonic anddeterministic motion; and biomechanical parameters,as frequency and peak-to-peak displacement must bewell defined to the safety and feasibility of the WBVEintervention.Clinical and experimental studies have beenperformed to try to improve the comprehension ofthe effects of the WBVE. Publications have suggestedthat biological effects would be associated with thetonic vibration reflex and/or to the neuroendocrineresponses.Several important clinical effects of the WBVEhave been described, such as (i) increase of the trunkflexibility, strength and power muscle and bonedensity, (ii) improvement of the quality of life, ofthe balance and cognition, and (iii) decrease of bothpain and risk of falls. Therefore, WBVE can be used interms of fitness, disease treatment, in rehabilitationprogram, and, in general termos, for the preventionand promotion of health.WBVE has been used as an intervention in variouspopulations, as (a) trained and untrained, (b) healthyand unhealthy and (c) young, adult or elderly. Somebenefits have been reported. Animals (dog, horse) havealso been submitted to the WBVE.In sports, improvements in the fitness have beendescribed in soccer players, divers, swimmers andcombat athletes, athletic throwers, dancers, and icehockeyplayers.Several publications have shown investigationswith postmenopausal women evaluating the action ofWBVE related to the frailty and in the improvementof the bone density and in reduction of the fallrisks. Individuals with metabolic syndrome, kneeosteoarthritis, chronic obstructive pulmonary disease,diabetes and obesity have had benefits due to WBVEintervention. The rehabilitation of subjects holdingsome disability related to diseases, such as cerebralpalsy, osteogenesis imperfecta, spinal cord injury,multiple sclerosis, Parkinson disease, stroke, when usingWBVE has revealed the relevance of this intervention.In addition, studies about the applicability of wholebodyvibration therapy in intensive care patients havealso been reported.Putting together all the previous considerations, itis very important to highlight the importance of thisspecial issue of HUPE Journal to all Health Sciencesprofessionals that have common interest in thetreatment and prevention of diseases, as well as in thepromotion of the health.The readers of this issue will have the opportunityto verify, in the the original papers section, thepossibility of applications of the WBVE to cardiacsurgery postoperative care. In individuals withmetabolic syndrome it is shown the improvementof the flexibility and the reduction of the pain level.Considering the aging, a significant increase in themuscle strength of the hip adductors and the kneeextensor muscles in elderly is also reported. Immediateeffects of WBVE on thermal symmetry of the lowerlegs and ankles of healthy subjects are revealed. Inaddition, the applicability of WBVE as a new tool inVeterinary Medicine is shown. Besides all WBVE uses,it is possible to point out that this clinical interventionis safe, feasible, and cost-effective.The human cutaneous mechanoreceptive afferentsresponse and the benefits of WBVE to individualswith knee osteoarthritis are reviewed, together withapplications of the WBVE in Intensive Care Unit.

Changes in lower extremity function and pitching performance with increasing numbers of pitches in baseball pitchers.

Compared to upper extremity function, the changes in lower extremity function with increasing numbers of pitches have not fully been investigated in baseball pitchers. In addition, little is known about the correlation between lower extremity function and pitching performance. The purpose of this study was to evaluate the effect of fatigue on lower extremity function and pitching performance in a simulated baseball game. Eighteen collegiate baseball pitchers threw 117 pitches in 9 innings (13 pitches per inning) with 5-min rest between innings at an official pitching distance in a simulated game. Isometric hip muscle strength (abduction and adduction) and squat jump performance (height, mean/peak power, and mean/peak velocity) were measured before and after the game. The mean ball velocity and pitching accuracy were assessed per inning. Ball velocity significantly decreased in the 7th (P=0.026) and 9th (P=0.001) innings compared to the 1st inning, but pitching accuracy did not change significantly. Hip abduction (P=0.009) and adduction (P=0.001) strength significantly decreased after the game, but squat jump performance did not significantly change before and after the game. A significant correlation between decreased ball velocity in the 9th inning and decreased hip adduction strength was found (P=0.011, r=0.583). Our findings suggest that hip abduction and adduction strength are susceptible to fatigue owing to repetitive throwing motions and that hip adduction strength, especially, is an important physical fitness factor for maintaining ball velocity during a game in baseball pitchers.

The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial

BackgroundGroin injuries represent a considerable problem in male football. Previous groin-specific prevention programmes have not shown a significant reduction in groin injury rates. An exercise programme using the Copenhagen Adduction...

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

AimTo objectively evaluate the effect of Holmich protocol-based exercise therapy on long-standing adductor-related groin pain (LSAGP).MethodsWe reproduced the Holmich protocol of exercise therapy and objectively evaluated its effect on 17...

Effects of 4-week self-cross body stretching with scapular stabilization on shoulder motions and horizontal adductor strength in subjects with limited shoulder horizontal adduction: cross body stretching with stabilization

Posterior shoulder tightness is related to shoulder conditions such as shoulder impingement and limited shoulder horizontal adduction (SHA). The purpose of this study was to compare the effects of self-cross body stretching (CBS) with and without scapular stabilization (SS) on SHA and shoulder internal rotation (SIR) range of motion (ROM) and shoulder horizontal adductor strength (SHAS) in subjects with limited SHA. Twenty-six subjects (14 males, 12 females) with limited SHA was participated in this study. The SS group and without stabilization (WS) group were assigned randomly. The SS group performed self-CBS with SS by applying belt just under the subject's axilla. The subjects were asked to perform self-CBS 4 times a week for 4 weeks. SHA and SIR RM were measured by Clinometer smartphone application, and SHAS by hand-held dynamometer before and after 4-week self-CBS. 2 × 2 mixed analysis of variance (ANOVA) was used to identify the significance. If there was an interaction effect, t-test was used to confirm the simple effect. There was a significant interaction in SHA ROM and SHAS. The post-test value of SHA ROM was significantly greater in SS group than WS group (P<0.0125). In SHAS, there was no significant difference between groups (P>0.0125). SS during self-CBS could enhance to improve SHA, SIR ROM, and SHAS in individuals with limited SHA.

Hip Injury - Soccer

ACSM 2018 National Conference Clinical Case Abstract Submission Title: Hip Injury - Soccer Author: James Alex, Heather Gillespie, Maine Medical Center, Portland, ME. Email: [email protected] (Sponsor: Heather Gillespie, FACSM) HISTORY: A 13 year old male soccer player without significant past medical history sustained an acute onset of anterior right hip pain while sprinting during a soccer game. He was immediately unable to walk and was carried off the field by teammates. He developed occasional transient episodes of pain radiating down his right leg without numbness or tingling noted. He was evaluated in the emergency department that evening, given oxycodone for analgesia, crutches to maintain non-weight-bearing status, and was referred to sports medicine for follow-up. PHYSICAL EXAM: Examination in the office 2 days after injury revealed no hip, leg, or abdominal abnormalities on inspection. He was able to bear about 50% of his weight on the right leg without crutches. Mild tenderness to palpation was noted anterior to the right lesser trochanter. Right hip active range of motion was limited to 10 degrees of flexion in the supine position with normal passive range of motion throughout and intolerance of resisted hip flexion. Normal resisted adduction strength was noted. Neurovascular testing of the right lower extremity was normal. DIFFERENTIAL DIAGNOSIS: 1. Iliopsoas strain 2. Apophyseal avulsion fracture: AIIS, ASIS, or lesser trochanter. 3. Adductor strain 4. Femoral neck stress fracture 5. Slipped capital femoral epiphysis TESTS AND RESULTS: 2-view xray of the right hip reveals apophyseal avulsion fracture of the lesser trochanter of the right femur with 20mm of proximal displacement. FINAL DIAGNOSIS: Closed, proximally-displaced apophyseal avulsion fracture of the lesser trochanter of the right femur. TREATMENT AND OUTCOME: 1. Case reviewed with multiple surgeons (sports, trauma, pediatric orthopedics) regarding potential screw fixation. 2. Non-operative management pursued. 3. Stable proximal displacement visualized on repeat xray post-injury day 6. 4. Non-weight-bearing on crutches for 3 weeks. 5. OTC analgesia after post-injury day 3. 6. Gradual weight bearing by week 4. 7. Final return to sport pending at the time of submission.

Hip Strength and Range of Movement Are Associated With Dynamic Postural Control Performance in Individuals Scheduled for Arthroscopic Hip Surgery.

Study Design Cross-sectional. Background Hip pain is associated with reduced muscle strength and range of movement (ROM). These impairments may contribute to decreased postural stability and balance. The Star Excursion Balance Test (SEBT) is a reliable and valid method to measure dynamic postural control. Objectives To evaluate the association between SEBT performance and hip strength, hip ROM, trunk endurance, and group characteristics in individuals with hip pain. Methods One hundred eleven individuals with hip pain, scheduled for arthroscopic hip surgery, were matched with 62 healthy controls. Hip ROM and muscle strength, trunk endurance, and SEBT reach were measured prior to surgery. Data were analyzed for between-group differences using t tests, and associations between SEBT reach and hip strength, hip ROM, and population characteristics were evaluated with Pearson correlation coefficients and stepwise backward regression analyses. Results Star Excursion Balance Test performance (P<.01), hip strength (P<.01), and hip ROM (P<.05) were lower in the presurgery group compared to controls. In the presurgery group, when adjusted for height and weight, hip flexion strength and internal rotation ROM accounted for 44% of the variance in anteromedial SEBT reach. In the posteromedial direction, hip adduction strength and sex accounted for 53% of the variance. For the posterolateral direction, hip adduction and internal rotation strength accounted for 46% of reach variance. Conclusion The individuals who were scheduled for arthroscopic hip surgery were significantly weaker, had less hip mobility, and had reduced dynamic balance compared to controls. In this population, dynamic balance performance was associated with various hip strength and ROM measurements in a direction-specific manner. J Orthop Sports Phys Ther 2018;48(4):280-288. doi:10.2519/jospt.2018.7946.