Adductor Strains Research Articles

Hip Sideline Emergencies and Hip Injuries in Elite Athletes.

Hip injuries in elite athletes are an increasingly recognized problem and range from chronic overuse injuries, such as adductor strains and labral tears, to acute traumatic injuries such as hip dislocations. In this article, we review common hip pathology experienced by elite athletes and sideline management of emergent hip injuries. Elite athletes are subject to unique physical and mental stresses and therefore must be evaluated and treated in a unique manner. Hip and groin injuries account for approximately 6% of sport injuries overall and 3-15% of all injuries in professional sports. Hip sideline emergencies were rare but can include hip dislocations, subluxations, and avulsion fractures. Hip and groin injuries represent an important subset of injuries which can greatly impact an athlete's ability to perform. Understanding the physiology and types of hip/groin injuries, which athletes are prone to injuries, the impact on recovery time, recurrence risk, and the potential need for surgery aid sports medicine physicians in decision-making.

Impact of COVID-19 lockdown on injury risk in Qatar's professional football

ObjectivesTo compare injury incidence, burden and characteristics between the pre- and post-COVID-19 lockdown periods in Qatari professional football. DesignProspective cohort study. MethodsInjury and exposure data for two post-COVID-19 lockdown periods [early post-lockdown period: short-term ~2 months (54 matches) and late post-lockdown period: long-term 8-months (183 matches)] were compared to the benchmark of the same periods from the three previous seasons (2017/18–2019/20). ResultsWe observed no difference in overall, training or match incidence between early post-lockdown period and the benchmark reference. However, this short-term period resulted in lower burden for overall- (RR 0.80, P < 0.0001), training- (RR 0.73, P < 0.0001) and match-injuries (RR 0.40, P < 0.0001) compared to the benchmark. During late post-lockdown period match injury incidence (RR 0.72, P = 0.0010) and match injury burden (RR 0.69, P < 0.001) were lower than the benchmark. In contrast, both overall- (RR 1.30, P < 0.001) and training-injury burden (RR 1.65, P < 0.001) were higher. A significant increase in adductor strains in both post-lockdown periods was observed. ConclusionsImmediately after the COVID-19 lockdown (short-term effect), there was no difference in injury incidence but a lower injury burden compared to benchmark. Moreover, the rapid return to competition for the successive season (long-term effect) was associated with a higher overall- and training-injury burden, but a lower match-injury burden compared to the benchmark.

Current Clinical Concepts: Exercise and Load Management of Adductor Strains, Adductor Ruptures, and Long-Standing Adductor-Related Groin Pain.

Adductor-related groin pain is a common problem in sports. Evidence-based management of athletes with adductor strains, adductor ruptures, and long-standing adductor-related groin pain can be approached in a simple yet effective and individualized manner. In most cases, managing adductor-related pain in athletes should be based on specific exercises and loading strategies. In this article, I provide an overview of the different types of adductor injuries, from acute to overuse, including their underlying pathology, functional anatomy, diagnosis, prognosis, mechanisms, and risk factors. This information leads to optimal assessment and management of acute to long-standing adductor-related problems and includes primary, secondary, and tertiary prevention strategies that focus on exercise and load-based strategies. In addition, information on different options and contexts for exercise selection and execution for athletes, athletic trainers, and sports physical therapists in adductor injury rehabilitation is provided.

Lower Extremity Strains in the US National Football League, 2015-2019

Background: Lower extremity (LEX) strains, including hamstring, quadriceps, adductor, and calf strains, are among the most common injuries in sports. These injuries lead to high burden, resulting in significant missed participation time. Purpose: To describe the incidence of LEX strains in professional American football. Study Design: Descriptive epidemiology study. Methods: This study included all players who played in ≥1 National Football League (NFL) game or sustained a LEX strain during participation in the 2015-2019 seasons. LEX strain frequency was calculated by setting (game, practice, conditioning), timing in season (offseason, preseason, regular season, postseason), and roster position. Game incidence rates were calculated for season, roster position, and play type. LEX strains were identified in the standardized leaguewide electronic health record (n = 32 teams). Results: Across 5 years, 5780 LEX strains were reported among 2769 players (1-year risk, 26.7%; 95% CI, 26.0%-27.3%); 69% (n = 4015) resulted in time loss. Among all LEX strains, 54.7% were hamstring (n = 3163), 24.1% adductor (n = 1393), 12.6% calf (n = 728), 8.3% quadriceps (n = 477), and 0.3% multiple muscle groups (n = 19). Most were reported during preseason practices (n = 1076; 27%) and regular season games (n = 1060; 26%). The 2-week period of training camp practices comprised 19% of all time-loss strains. Among game injuries, preseason games had the highest rate of LEX strain (2.9/10,000 player-plays; 95% CI, 2.6-3.2). Defensive secondary players accounted for the highest proportion of time-loss LEX strains (27%; n = 1082). In games, punt plays had nearly twice the injury rate of kickoff plays (14.9/1000 plays [95% CI, 13.1-17.0] vs 7.5/1000 plays [95% CI, 6.2-8.9], respectively) and >3 times the rate of pass plays (4.3/1000 plays; 95% CI, 4.0-4.7) and run plays (2.6/1000 plays; 95% CI, 2.3-2.9). In aggregate, LEX strains led to an estimated 16,748 participation days missed each year and a median 12 days missed per injury. Conclusion: LEX strains affected 1 in 4 NFL players each year, resulting in a high burden of injury in terms of time lost from practice and competition. Safe return to the NFL season during training camp and reduction of injuries during regular season games are key focuses for future injury reduction.

Adductor Strains in Athletes.

Acute adductor injuries are a common occurrence in sport. The overall incidence of adductor strains across 25 college sports was 1.29 injuries per 1000 exposures, with men's soccer (3.15) and men's hockey (2.47) having the highest incidences. As with most muscle strains there is a high rate of recurrence for adductor strains; 18% in professional soccer and 24% in professional hockey. Effective treatment, with successful return to play, and avoidance of reinjury, can be achieved with a proper understanding of the anatomy, a thorough clinical exam yielding an accurate diagnosis, and an evidence-based treatment approach, including return to play progression.

Hip Adduction and Abduction Strength Profiles Among Bantam, High School, Juniors, and Collegiate American Ice Hockey Players.

BackgroundAdductor strains are the most common non-contact musculoskeletal injury sustained in ice hockey. Systematic reviews have determined higher level of play and lower hip adduction to abduction strength ratios to be associated with an increased risk of adductor strain across multiple sports. Limited research exists regarding hip adduction and abduction strength profiles across various levels of ice hockey players.PurposeTo compare isometric hip adduction and abduction strength profiles among bantam, high school, tier one juniors, and NCAA Division I collegiate ice hockey players. A secondary purpose was to identify whether differences in strength profiles between dominant and non-dominant limbs exist.Study DesignCross-sectional cohort study.MethodsA questionnaire of demographic data, hockey, and injury specific information was completed by all subjects. The mean of three reps of maximal hip isometric adduction and abduction strengths were quantified using a handheld dynamometer with external belt-fixation. Ratios of hip adduction-to-abduction strength were calculated and normalized for body weight.ResultsA total of 87 uninjured skaters were included in this study with a mean age of 17 years. Mean hip adductor-to-abductor ratios for Bantam hockey players were 121% followed by collegiate (115%), Juniors (111%), and high school (109%) hockey players. No statistically significant differences were found between peak hip adduction and abduction isometric strength and playing level. In addition, there was no difference between unilateral hip strength ratios and shooting hand or leg dominance. While 34.5% of subjects reported a history of adductor injury, no significant differences existed regarding strength ratios during bilateral comparison or when compared to their team norms. Three subjects were found to have unilateral ratios of less than 80%, while two subjects demonstrated bilateral ratios of less than 80%.ConclusionsSymmetry is illustrated between dominant and non-dominant legs in ice hockey players with and without a history of adductor injury. Results align well with previously established cross-sectional data from Australian football, with ratios of 103% in high school players, 107% in semi-professional players, and 113% in collegiate players.Level of EvidenceLevel 3

Incidence of Injury for Professional Soccer Players in the United States: A 6-Year Prospective Study of Major League Soccer.

Background:Despite an abundance of injury research focusing on European professional soccer athletes, there are limited injury data on professional soccer players in the United States.Purpose:To describe the epidemiology of injury across multiple years in Major League Soccer (MLS) players.Study Design:Descriptive epidemiology study.Methods:A web-based health management platform was used to prospectively collect injury data from all MLS teams between 2014 and 2019. An injury was defined as an incident that required medical attention and was recorded into the health management platform anytime over the course of the 2014-2019 seasons. Injuries and exposure data were recorded in training and match settings to calculate injury incidence.Results:A total of 9713 injuries were recorded between 2014 and 2019. A mean 1.1 injuries per year per player were identified, with midfielders sustaining the largest number of injuries. The most common injuries were hamstring strains (12.3%), ankle sprains (8.5%), and adductor strains (7.6%). The mean time missed per injury was 15.8 days, with 44.2% of injuries resulting in no days missed. Overall injury incidence was 8.7 per 1000 hours of exposure, declining over the course of the investigation, with a 4.1-times greater mean incidence during matches (14.0/1000 h) than training (3.4/1000 h).Conclusion:Between 2014 and 2019, the most commonly reported injuries in MLS players were hamstring strains, ankle sprains, and adductor strains. Injury incidence during matches was 4.1 times greater when compared with training, while overall injury incidence was found to decline during the course of the study period.

Injuries in elite-level women's football-a two-year prospective study in the Irish Women's National League.

We investigated the pattern of injuries in elite-level women's football in Ireland, during a two-season prospective injury surveillance study in the Women's National League (WNL). Seven out of the eight clubs (271 players) in the WNL were followed prospectively during the 2018 and 2019 seasons. The injury incidence rate in matches (19.2/1000h) was 7.5times higher than in training (2.5/1000h). Players, on average, sustained 0.69injuries per season (266injuries/383player seasons), which equates to 15time-loss injuries per season for a squad of 22players. The majority of the injuries sustained by players were lower extremity injuries (85%), of which, 46% had a non-contact injury mechanism. Muscle, ligament, and contusion injuries were the most common injury types, while the ankle, knee, and thigh were the most commonly injured body sites. The most common injuries sustained over the two seasons were lateral ankle sprains (13.9%), hamstring strains (12.4%), knee meniscus/cartilage injuries (7.5%), adductor strains (6%), quadriceps strains (4.5%), and ankle contusions (4.5%). The injuries with the highest injury burden were ACL injuries (59days lost/1000h), knee meniscus/cartilage injuries (23/1000h), lateral ankle sprains (21/1000h), hamstring strains (12/1000h), MCL sprains (11/1000h), and quadriceps strains (11/1000h). There were 8 ACL tears documented over the 2seasons, which accounted for 28% of all time lost to injury with a mean days lost per injury of 247. We recommend that clubs in the WNL in Ireland should implement injury risk mitigation strategies, with a particular focus on injuries with a high injury burden.

The Neuromuscular Effects of the Copenhagen Adductor Exercise: A Systematic Review.

BackgroundGroin strains are one of the most common time-loss injuries in athletes. The Copenhagen Adductor Exercise (CAE) eccentrically strengthens the adductors and may function to prevent adductor strains, similar to the eccentric mechanism in which the Nordic Hamstrings exercise acts to prevent hamstring strains.ObjectiveThe purpose of this study was to systematically review the literature on the CAE and its effects on adductor muscle strength and muscle activity in athletes.Study DesignSystematic ReviewMethodsA systematic search of the literature was performed in the following databases: Pubmed; Medline (EBSCO); Sportdiscus; Scopus; Web of Science; CINAHL; Proquest; Cochrane Library; Physiotherapy Evidence Database (PEDro). Inclusion criteria consisted of 1) implements CAE, 2) includes athletes of any age participating in at least one sport, 3) study type is a cohort study or randomized control trial. Studies were excluded if they were not written in English or did not measure strength as an outcome. Data were extracted on eccentric hip adductor strength (EHAD), eccentric hip abductor strength (EHAB), EHAD:EHAB ratio, and electromyography (EMG) activity of the adductor muscles. Quality assessment was performed on all included studies using Quality Assessment Tool for Quantitative Studies.ResultsFive articles were identified for inclusion, four of which received a strong rating, and one a moderate rating on the Quality Assessment Tool for Quantitative Studies. The CAE significantly increased EHAD in four of the four studies that examined it; significantly increased EHAB and EHAD:EHAB in three of the three studies that examined them, and increased the EMG activity of the adductors in the dominant leg 108%.ConclusionOverall, the CAE increases EHAD, EHAB, EHAD:EHAB, and EMG activity in the hip adductors in male soccer players. The increase in strength may reduce adductor muscle injuries, although more research needs to be done in this area to identify a clear relationship between the CAE and groin injury prevention.Level of Evidence1b

Offseason Workout Recommendations for Baseball Players.

Offseason training programs are crucial for the baseball athlete. Preparation for the competitive season should be carefully planned to allow long-term athletic success. The two goals of the offseason training program are to optimize performance and reduce injury risk. These goals can only be accomplished with an understanding of the unique physical demands of the sport, and how these demands relate to performance and injury. The purpose of this article is to review the unique demands of baseball training along with current strength and conditioning principles to optimize offseason training for the baseball athlete. Traditional strength and conditioning programs used in other sports may not maximize the qualities necessary for optimal baseball performance. Traditional strength and conditioning exercises, such as squat and deadlift, primarily train sagittal plane movement while frontal and transverse plane movements are likely equally as important for baseball players. Biomechanical studies have shown that trunk rotation power has the largest influence on throwing velocity in pitchers. Programs should also be designed to reduce injury risk for common injuries. The most common injuries in baseball include hamstring strains, throwing arm injuries, paralumbar muscle strains, hip adductor strains, and oblique muscle strains. This review describes the typical periodization phases of the offseason and provides a sample program outlining an offseason program for a professional baseball player from September through February.

Correlation Between Pelvic Tilt Angle, Hip Range Of Motion And Hip Muscles Torque Ratios

Anterior pelvic tilt is associated with excessive foot pronation, excessive hip internal rotation (HIR), and knee valgus, which may lead to hip muscles strains, sciatic nerve compressions, and sacroiliac and lumbosacral joint instability. Posterior pelvic tilt is associated with feet supination and increased hip external rotation (HER), which may lead to tibial stress fractures, medial tibial stress syndrome, knee pain, anterior cruciate ligament injury, and low back pain. Hip adductors/abductors (add/abd) torque ratio (TR) below 80%, was associated with adductor strains. The average hip flexors/extensors (flex/ext) TR in sport performance was found to be 70%. There is a lack of evidence that correlates pelvic tilt angle with limited HIR, HER, add/abd TR, and flex/ext TR. PURPOSE: to examine the correlation between natural pelvic tilt angle and HIR, HER, add/abd TR, and flex/ext TR. METHODS: Twenty-six subjects participated in this study, fifteen females (22.0±2.8 years old, 163.5±7.5 cm, 65.9±10.4 kg) and eleven males (22.0±2.2 years old, 178.5±4.5 cm, 78.4±8.7 kg). Using a 3D motion analysis system, the measurement of both natural pelvic tilt (NPT) in standing natural position and HIR and HER in lunge position, for the right and left limbs, were recorded. Hip torques were collected with an isokinetic dynamometer, five trials at 30 deg/s and at 60 deg/s. RESULTS: The mean value for NPT was 5.7±5.4 deg. There were no significant correlations between NPT and the dependent variables for the right limb: HIR (r=-0.16, p=0.43), HER (r=-0.11, p=0.58), add/abd TR at 30 deg/s (r=-0.19 p=0.34), add/abd TR at 60 deg/s (r=-0.13 p=0.51), flex/ext TR at 30 deg/s (r=0.32 p=0.10) and flex/ext TR at 60 deg/s (r=-0.70 p=0.70). Similar results were observed for the left limb: HIR (r=-0.20, p=0.89), HER (r=-0.25, p=0.21), add/abd TR at 30 deg/s (r=-0.17 p=0.38), add/abd TR at 60 deg/s (r=-0.12 p=0.55), flex/ext TR at 30 deg/s (r=0.60 p=0.75) and flex/ext TR at 60 deg/s (r=-0.19 p=0.33). CONCLUSION: the measurement of NPT angle in standing natural position is not a good predictor of HIR, HER, add/abd TR, and flex/ext TR. Future research should look at these relations during functional dynamic movements and during pelvic tilt end range of motion.

Incidence of Lower Extremity Injury in the National Football League: 2015 to 2018

Background: Lower extremity injuries are the most common injuries in professional sports and carry a high burden to players and teams in the National Football League (NFL). Injury prevention strategies can be refined by a foundational understanding of the occurrence and effect of these injuries on NFL players. Purpose: To determine the incidence of specific lower extremity injuries sustained by NFL players across 4 NFL seasons. Study Design: Descriptive epidemiology study. Methods: This retrospective, observational study included all time-loss lower extremity injuries that occurred during football-related activities during the 2015 through 2018 seasons. Injury data were collected prospectively through a leaguewide electronic health record (EHR) system and linked with NFL game statistics and player participation to calculate injury incidence per season and per 10,000 player-plays for lower extremity injuries overall and for specific injuries. Days lost due to injury were estimated through 2018 for injuries occurring in the 2015 to 2017 seasons. Results: An average of 2006 time-loss lower extremity injuries were reported each season over this 4-year study, representing a 1-season risk of 41% for an NFL player. Incidence was stable from 2015 to 2018, with an estimated total missed time burden each NFL season of approximately 56,700 player-days lost. Most (58.7%) of these injuries occurred during games, with an overall higher rate of injuries observed in preseason compared with regular season (11.5 vs 9.4 injuries per 10,000 player-plays in games). The knee was the most commonly injured lower extremity region (29.3% of lower body injuries), followed by the ankle (22.4%), thigh (17.2%), and foot (9.1%). Hamstring strains were the most common lower extremity injury, followed by lateral ankle sprains, adductor strains, high ankle sprains, and medial collateral ligament tears. Conclusion: Lower extremity injuries affect a high number of NFL players, and the incidence did not decrease over the 4 seasons studied. Prevention and rehabilitation protocols for these injuries should continue to be prioritized.

Measuring the Hip Adductor to Abductor Strength Ratio in Ice Hockey and Soccer Players: A Critically Appraised Topic.

Clinical Scenario: Ice hockey and soccer are both dynamic sports that involve continuous, unpredictable play. These athletes consistently demonstrate higher rates of groin strains compared with other contact sports. Measuring the hip adductor/abductor ratio has the potential to expose at-risk players, reduce injury rates, and preserve groin health in players with chronic strains. Focused Clinical Question: What is the clinical utility of measuring the hip adductor/abductor ratio for preseason and in-season ice hockey and soccer players? Summary of Key Findings: Three studies, all of which were prospective cohort designs, were included. One study involved assessing preseason strength and flexibility as a risk factor for adductor strains in professional ice hockey players. Another study performed with the same professional hockey team used preseason hip adductor/abductor strength ratios to screen for those players who would benefit from a strengthening intervention aimed at reducing the incidence of adductor strains. The final study, which was performed in elite U17 soccer players, assessed the effectiveness of monthly in-season strength monitoring as a guide to trigger in-season interventions to decrease injury incidence. Clinical Bottom Line: Measuring the hip adductor/abductor strength ratio in hockey and soccer players can be a beneficial preseason and in-season tool to predict future groin strain risk and screen for athletes who might benefit from a strengthening intervention. Strength of Recommendation: Level 3 evidence exists to support monitoring the hip adductor/abductor strength ratio to assess and reduce the risk of adductor strains in ice hockey and soccer players.

A Decade of Hip Injuries in National Collegiate Athletic Association Football Players: An Epidemiologic Study Using National Collegiate Athletic Association Surveillance Data.

The complex, high-energy nature of football puts players at risk for hip injuries. To analyze National Collegiate Athletic Association (NCAA) Injury Surveillance Program data for men's football hip injuries from 2004-2005 through 2013-2014. Descriptive epidemiologic study. National Collegiate Athletic Association football teams. Data on collegiate football players was provided by the NCAA Injury Surveillance System from 2004-2005 through 2013-2014. The incidence, risk factors, rates, and distribution of hip injuries over the 10-year period from 2004-2005 through 2013-2014 were determined. Rates and distribution of injuries were analyzed by injury type, time loss, event type, time of season, recurrence, mechanism of injury, player position, and if surgery was required. Injury rate ratios were calculated to compare rates between event types and by time of season. A total of 1618 hip injuries occurred during 3 121 380 athlete-exposures (AEs), resulting in an overall hip injury rate of 5.18 per 10 000 AEs. Adductor strains (38.63%) were the most common type, followed by hip-flexor strains (28.55%) and hip contusions (18.23%). Players were 3.56 (95% confidence interval [CI] = 3.19, 3.98) times more likely to sustain a hip injury during competitions compared with practices. They were 2.37 (95% CI = 2.15, 2.62) and 3.56 (95% CI = 2.49, 5.08) times more likely to sustain a hip injury during the preseason than in-season or the postseason, respectively. During the 10-year period, NCAA football players sustained higher rates of hip injuries during competitions and the preseason. The majority were noncontact injuries, resulted in time loss of less than 6 days, and did not require surgery. The injuries varied with player position and occurred most often to defensive backs. Muscle strains were the most frequent group of hip injuries, while adductor strains, hip-flexor strains, and hip contusions were the most common injury types.

Hip Injuries in Overhead Athletes

Hip injuries in the overhead athlete have attracted little attention in the past; however, hip and groin injuries make up 5.5% of all professional baseball injuries and continue to increase in prevalence. Hip and groin injuries are exacerbated by the repetitive extremes of motion required for throwing, serving, and spiking a ball as well as the rapid acceleration and deceleration involved in overhead athletics. The diagnosis and management of these injuries in overhead athletes can be challenging, and often involves multiple pain sources. These athletes commonly experience adductor strains and athletic pubalgia/core muscle injuries which often occur concurrently with underlying bony pathology such as femoroacetabular impingement, which leads to limitations in hip range-of-motion. Hip and groin injuries in the overhead athlete can be debilitating and recurring; therefore, accurate and prompt diagnosis and management of these injuries are critical.

Hip and Groin Injuries Among Collegiate Male Soccer Players: The 10-Year Epidemiology, Incidence, and Prevention.

The physical and demanding style of play in soccer places these athletes at an elevated risk for hip and groin injuries. Several studies have examined hip and groin injuries in professional and youth soccer in European countries, but few have involved American counterparts. Hip injury data were analyzed retrospectively from the National Collegiate Athletic Association Injury Surveillance Program for the 2004 to 2014 academic years for collegiate men's soccer. This study found that hip and groin injuries among collegiate male soccer players were most often new injuries (87.8%; n=527) that were noncontact in nature (77.3%; n=464) and resulted in time loss of less than 7 days (67.5%; n=405). Hip injuries were significantly more likely during the pre-season (5.72 per 1000 athlete exposures) relative to in-season (injury proportion ratio, 1.64; 95% confidence interval, 1.39-1.94) and post-season (injury proportion ratio, 1.69; 95% confidence interval, 1.18-2.41). Further, they were more likely in competition relative to practice (injury proportion ratio, 2.33; 95% confidence interval, 1.98-2.74). The most common injuries were adductor strains (46.5%; n=279) followed by hip flexor strains (27.3%; n=164) and hip contusions (10.8%; n=65). Among these injuries, adductor (73.1%; n=204) and hip flexor (59.8%; n=98) strains were more commonly noncontact related and occurred in practice, whereas hip contusions were due to contact and during competition. The study of the complex and lingering nature of hip and groin injuries in soccer players is critical because these injuries not only are prevalent but also have multifactorial risks associated with coexisting pathologies that make them difficult to prevent and treat effectively. [Orthopedics. 2018; 41(6):e831-e836.].

Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes, 2009/2010-2014/2015

Background: Little research has examined the rates and patterns of hip flexor or hip adductor strains in student-athletes in the National Collegiate Athletic Association (NCAA). Purpose: To describe the epidemiology of hip flexor and adductor strains in NCAA athletes during the 2009/2010-2014/2015 academic years. Study Design: Descriptive epidemiology study. Methods: Rates and patterns of hip flexor and adductor strains in collegiate sports were examined in a convenience sample of NCAA varsity teams from 25 sports. Rates and distributions of strains by mechanism, recurrence, and participation restriction time were examined. Injury rate ratios (IRRs) and proportion ratios were calculated to compare rates within and between sports by event type, sex, mechanism, recurrence, and participation restriction time. Results: A total of 770 hip flexor and 621 hip adductor strains were reported, resulting in overall injury rates of 1.60 and 1.29 per 10,000 athlete-exposures (AEs), respectively. In men, the rate of hip flexor strains was 1.81 per 10,000 AEs, and that for hip adductor strains was 1.71 per 10,000 AEs. In women, the rate of hip flexor strains was 1.59 per 10,000 AEs, and the rate of hip adductor strains was 1.15 per 10,000 AEs. The highest rates of strains were found in men’s soccer and men’s ice hockey (range, 2.47-3.77 per 10,000 AEs). Most hip flexor and hip adductor strains occurred in practice, but both had higher rates in competition. In sex-comparable sports, hip flexor strain rates did not differ between the sexes (IRR = 1.14; 95% CI, 0.96-1.36), but the rate of hip adductor strains was higher in men than women (IRR = 1.49; 95% CI, 1.22-1.81). Noncontact was the most common mechanism for both types of strains (hip flexor strains, 59.4%; hip adductor strains, 62.5%); 10.1% of hip flexor strains and 11.1% of hip adductor strains were recurrent. The highest rates of recurrence of both types of strain were found in men’s and women’s ice hockey (range, 16.0%-30.6%). Most hip flexor and hip adductor strains resulted in <1 week of participation restriction (hip flexor strains, 83.8%; hip adductor strains, 82.9%). Conclusion: The NCAA sports with the highest rates of hip flexor and hip adductor strains were men’s soccer and men’s ice hockey. In sex-comparable sports, men had a higher rate of hip adductor, but not hip flexor, strains. Recurrence rates were remarkably high in ice hockey. Male sports teams, especially soccer and ice hockey, should place an emphasis on prevention programs for hip adductor strains. Secondary prevention programs involving thorough rehabilitation and strict return-to-play criteria should be developed and implemented to curb the high recurrence rate of these injuries, particularly in ice hockey.

Athletic Hip Injuries.

Historically, athletic hip injuries have garnered little attention; however, these injuries account for approximately 6% of all sports injuries and their prevalence is increasing. At times, the diagnosis and management of hip injuries can be challenging and elusive for the team physician. Hip injuries are seen in high-level athletes who participate in cutting and pivoting sports that require rapid acceleration and deceleration. Described previously as the "sports hip triad," these injuries consist of adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement. These disorders can happen in isolation but frequently occur in combination. To add to the diagnostic challenge, numerous intra-articular disorders and extra-articular soft-tissue restraints about the hip can serve as pain generators, in addition to referred pain from the lumbar spine, bowel, bladder, and reproductive organs. Athletic hip conditions can be debilitating and often require a timely diagnosis to provide appropriate intervention.

Assessment and management of adductor strain

Although athletic injuries about the hip and groin occur less commonly than injuries in the extremities, adductor muscle strain is one of these most common injuries in athletes who are involved in sports requiring sudden change of direction. High forces occur in the adductor tendons when the athlete must shift direction suddenly in the opposite direction. As a result, the adductor muscles contract to generate opposing forces. An adductor strain that is treated improperly can become chronic and career threatening. Despite the identification of risk factors and strengthening intervention for athletes, adductor strains continue to occur throughout sport. The prevention and management of groin injury remains a substantial issue. The purpose of this article is to let the readers know regarding the conservative treatment options for adductor strain and provide recommendations for sports medicine clinicians for improved treatment and patient outcomes.

Hip adductor activations during run-to-cut manoeuvres in compression shorts: implications for return to sport after groin injury

Athletes at high risk of groin strains in sports such as hockey and soccer often choose to wear shorts with directional compression to aid in prevention of or recovery from hip adductor strains. Large, eccentric contractions are known to result in or exacerbate strain injuries, but it is unknown if these shorts have a beneficial effect on hip adductor muscle activity. In this study, surface electromyography (EMG) of the adductor longus and ground reaction force (GRF) data were obtained simultaneously on 29 healthy individuals without previous history of serious injury while performing unanticipated 45° run-to-cut manoeuvres in a laboratory setting wearing shorts with non-directional compression (control, HeatGear, Under Armour, USA) or shorts with directional compression (directional, CoreShort PRO, Under Armour, USA), in random order. Average adductor activity in the stance leg was significantly lower in the directional condition than in the control condition during all parts of stance phase (all P < 0.042). From this preliminary analysis, wearing directional compression shorts appears to be associated with reduced stance limb hip adductor activity. Athletes seeking to reduce demand on the hip adductors as they approach full return to activities may benefit from the use of directional compression shorts.