Bent Knee Fall Research Articles

Relationship Between Hip and Groin Pain and Hip Range of Motion in Amateur Soccer and Australian Rules Football Players

Background: The relationship between hip/groin pain and hip range of motion (ROM) is unclear. Purpose: To explore the relationship between hip/groin pain and hip joint ROM and examine the influence of sex and cam morphology on this relationship. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 184 amateur soccer and Australian Rules football players (276 hips; 20% women; median age, 26 years; interquartile range, 24-30 years) with hip/groin pain >6 months and a positive flexion-adduction-internal-rotation (FADIR) test, and 50 matched asymptomatic control players (98 hips; 28% women, median age, 26 years; interquartile range, 23-31 years). Hip ROM measures were flexion, internal and external rotation at 90° of hip flexion, total rotation (internal and external), and bent-knee fall out (BKFO). Cam morphology was determined from anteroposterior pelvis or 45° Dunn radiographs, defined by an alpha angle ≥60°. Linear regression models with generalized estimating equations were used to examine the relationship between group (symptomatic and asymptomatic) and each ROM measure. Interaction terms (group × cam morphology or group × sex) were included to examine if relationships between group and hip ROM were influenced by cam morphology or sex. Where appropriate, models were adjusted for sex, age, and cam morphology. Results: An interaction between the relationship between group × cam and internal rotation ROM was found. Symptomatic players with cam morphology had lower internal rotation ROM than controls with cam morphology (adjusted mean difference [AMD] = −4.5°; 95% CI, −7.4° to −1.6°). Hip/groin pain was not associated with internal rotation ROM if cam morphology was absent. A significant interaction was also found for group × sex and BKFO and total rotation ROM. Symptomatic women had lower total rotation ROM than control women (AMD = −8.2°; 95% CI, −14.1° to −2.2°), but no difference was seen in men. BKFO range was lower in men with hip/groin pain compared with control men (AMD = 1.6 cm; 95% CI, 0.3-3.0 cm), but no difference was seen in women. Flexion and external rotation ROM did not differ between symptomatic and control hips. Conclusion: Cam morphology was an effect modifier of the relationship between hip/groin pain and internal rotation ROM. Sex-related differences were also observed in the relationship between hip/groin pain and hip ROM.

Normal hip strength and range of motion values in youth and adult female national football teams: Data from 504 assessments

ObjectivesTo determine normal hip adduction- and abduction strength and range of motion (ROM) values for youth and adult female national team football players, and evaluate if increasing age, playing position and leg dominance were associated with these strength and ROM values. DesignCohort study. SettingNational football center. Participants344 unique asymptomatic female football players. Main outcome measuresHip internal/external rotation (°), Bent Knee Fall Out test (cm), hip adduction/abduction strength(N) and ratio, and normalised hip adduction/abduction torque (Nm/kg). ResultsA total of 504 assessments were performed. A total of 107 players underwent two (n = 67), three (n = 27) or four (n = 13) assessments. Mean peak hip adduction strength was 39% greater in 20 + Y old players 170 (±53 N) than in 13Y old players 122 (±28 N). Normalised hip adduction torque was 9% greater: 2.5 (±0.8Nm/kg) versus 2.3 (±0.5Nm/kg). A positive association between age and all strength measurements was found, while a negative association between age and hip external rotation and total hip rotation was found. No clinically relevant differences were found for the associations between playing position, leg dominance and hip strength- and ROM values. ConclusionNormal values for hip strength and range of motion in youth and adult female national football players are presented that can be used as clinical reference values.

Hip Muscle Strength, Range of Motion, and Functional Performance in Young Elite Male Australian Football Players.

Hip and groin injuries are common in field sports such as football, with measurement of hip strength and range of motion (ROM) recommended for assessment of these conditions. We aimed to report hip strength, hip ROM, and functional task performance in young elite Australian football athletes. Cross-sectional study. Fifty-eight newly drafted Australian Football League athletes completed hip abduction, adduction, internal rotation, external rotation, and flexion strength testing with an adjustable stabilized or hand-held dynamometer. Hip internal rotation and external rotation, bent knee fall out, and ankle dorsiflexion ROM were also measured. Players completed hop for distance, side bridge, and star excursion balance functional tests. We compared findings between the dominant and nondominant limbs. We found small deficits unlikely to be clinically meaningful in the dominant limb for hip abduction and adduction strength, and a small deficit in the nondominant limb for external rotation strength and side bridge time. Athletes had lower hip internal rotation (mean difference 2.56°; 95% confidence interval, 0.87 to 4.26) and total rotation ROM (2.03°; 95% confidence interval, 0.06 to 4.01) on the dominant limb. There were no meaningful differences between dominant and nondominant limbs for hip strength, ROM, or functional tests. Our results may be used for benchmarking young male Australian football athletes when targeting optimal strength and returning from injury.

Immediate effect of MWM adductor stretch, myofascial release, and conventional stretching in asymptomatic individuals with hip adductor tightness: A randomized controlled trial

BackgroundHip adductors are the group of muscles that stabilize the pelvis during weight transfer in lower limbs in a gait cycle. As the full range of motion is seldomly used, this group of muscles commonly go into tightness which in turn may be a predisposing factor in development of back pain and knee pain. Methods54 healthy individuals were selected after screening for bilateral hip adductor tightness by measuring hip abduction range of motion using goniometer. They were randomized to either mobilization with movement (MWM) adductor stretch, myofascial release, or conventional stretching group. All subjects were assessed pre and post intervention. Outcome measure used were hip abduction range of motion and bent knee fall out test. ResultsStatistically significant difference was noted between the experimental and the control group in terms of hip abduction range of motion and bent knee fall out test. ConclusionIntervention showed significant results in all three groups; however, MWM adductor stretch when used in conjunction with conventional stretching has proved to be more effective than myofascial release with foam roller and conventional stretching in increasing the abduction range of motion and bent knee fall out test.

The Effect of Eight-Week Functional Core Training on Core Stability in Young Rhythmic Gymnasts: A Randomized Clinical Trial.

It is suggested that core stability (CS) might improve rhythmic gymnasts’ performance. Nevertheless, the effect of core stability training (CST) in CS performance is not clear. Purpose: Evaluating the effect of an eight-week functional CST on young rhythmics gymnasts’ CS performance. Method: A sample of 45 young female rhythmic gymnasts from a competitive team (age = 10.5 ± 1.8 years, height = 144.1 ± 10.6 cm, weight 38.2 ± 8.9 kg, peak height velocity (PHV) = 12.2 ± 0.6 years) participated in the study. The participants were randomly allocated into the control group (CG) and experimental group (EG) and completed pre-tests and post-tests of specific CS tests using a pressure biofeedback unit (PBU). The CS was assessed by the bent knee fall out (BKFO), the active straight leg raise (ASLR) tests and the pelvic tilt test, all performed on the right and left sides. The EG (n = 23) performed an eight-week functional CST program based on rhythmic gymnastics (RG) technical requirements added to the traditional RG training sessions. Meanwhile, the CG (n = 22) received the traditional RG training sessions. Results: Mixed model analysis showed non-significant interaction effects; however, the ANOVA omnibus test showed a time effect (p < 0.05) in right BKFO (F1,42 = 4.60; p = 0.038) and both pelvic tilt tests (right F1,42 = 22.01, p < 0.001; left F1,42 = 19.13, p < 0.001). There were non-significant interaction effects. The fixed effects estimated parameters for right BKFO showed that both groups had less pressure variation after intervention compared with pre-intervention (β = −1.85 mmHg, 95%CI = [−3.54 to −0.16], t42 = −2.14, p = 0.038). Furthermore, the left pelvic tilt (β = 37.0 s, 95%CI = [20.4 to 53.6], t42 = 4.37, p < 0.001) improved 8.9 s more than the right pelvic tilt (β = 28.1 s, 95%CI = [16.3 to 39.8], t42 = 4.69, p < 0.001) considering both groups together. Conclusions: Adding a functional CST to regular training showed a trend in improving the performance of CS-related variables, which could help improve RG-specific performance. Coaches working with rhythmic gymnasts should consider adding a functional CST to regular training to improve CS performance leading to increased specific RG performance.

The Relationship between Preseason Common Screening Tests to Identify Inter-Limb Asymmetries in High-Level Senior and Professional Soccer Players

This study sought to examine inter-limb asymmetries in common screening tests performed during preseason and to analyze the relationship between the performance in the different tests. Nineteen high-level senior and professional soccer players (age: 23.2 ± 3.1 years; height: 181 ± 0.06 cm; body mass: 75.2 ± 4.8 kg) performed several common screening tests during preseason: Dorsiflexion lunge test (DLT); bent knee fall out test (BKFO); y-balance anterior test (YBT A); y-balance posterolateral test (YBT PL); Y-balance posteromedial test (YBT PM); Heel-rise test (HRT) and single leg hamstring bridge test (SLHBT). High levels of reliability (ICC &gt; 0.88 and &lt;0.94) were observed in all the studied variables. Inter-limb significant differences were observed in DLT and YBT PM test (p &lt; 0.01) but YBT A, HRT and SLHBT presented trivial effect size (ES) (0.03; 0.07 and 0.13, respectively), contrary to DLT, BKFO and YBT PL, all with small ES (0.20; −0.23 and −0.22) and YBT PM, which revealed very large ES (2.91). Considering all data, high-level senior and professional soccer players present fairly good mean values of lower limb symmetry. Performance considering all tests was different, a fact associated with different biomechanical dynamics (e.g., YBT), nonetheless, the correlations between tests underline the relationship between these, which could represent important evidence to consider for injury prevention and performance enhancement programs.

Evaluation of the bent knee fall out test pre- and post- an adductor longus tenotomy

ObjectiveTo investigate the immediate effect of an adductor longus tenotomy on the results of the bent knee fall out test, and whether there was a correlation between pre-tenotomy measures and the magnitude of change. DesignObservational study. MethodsWe included recreational to elite athletes with longstanding adductor-related groin pain (specifically adductor longus insertion pain) undergoing unilateral or bilateral full adductor longus tenotomy. The bent knee fall out test was performed immediately prior and immediately after the surgical procedure. We used Wilcoxon signed-rank test to compare test results pre- and post-tenotomy, and Spearman’s rho (rs) to analyse correlation between pre-tenotomy values and the magnitude of change in the bent knee fall out test. ResultsWe consecutively included 60 male adult athletes. There was a statistically significant difference (p < 0.001) in the bent knee fall out result from pre-surgery (median 11.5 cm [IQR 9–15], range 5–25 cm) to post-surgery (median 8 cm [IQR 6–10], range 3–15 cm). The mean difference was 3.9 ± 2 cm, range 0–11 cm, corresponding to a large effect size, d = 1.92. There was a moderate correlation between the bent knee fall out measurement pre-tenotomy and the difference from pre-to-post, rs = 0.75, p < 0.001. ConclusionThe bent knee fall out measurements changed considerably immediately after an adductor longus tenotomy, showing that the test is assessing adductor longus flexibility in male athletes with longstanding adductor-related groin pain. There was a moderate correlation between the bent knee fall out measure pre-tenotomy and the magnitude of change.

Comparing Motor Control of the Lumbosacral Region and Pelvic Floor Muscle Strength and Performance in Women with C-Section and Vaginal Birth

Background: Delivery is a physiological process that may cause neurophysiological changes in the lumbosacral region. Objectives: The current study aimed to compare motor control of the lumbosacral region and pelvic floor muscle strength and performance in women with C-section and vaginal birth. Methods: In this cross-sectional study, 120 prim parous women referring to healthcare centers in Karaj (Iran) during 2019 are studied. The participants were selected using convenience sampling. The motor control of the lumbosacral region was examined by four clinical tests (standing bent, active straight leg raising, bent knee fall out, and knee lift abdominal test) using a pressure biofeedback unit. Muscle strength and performance were measured using the Oxford scoring system and the PFPI-20 questionnaire, respectively. Data were analyzed using independent t-test, Mann-Whitney, and Chi-square tests. Statistical significance was considered when P value &lt; 0.05. Results: Based on the standing bent test, a significant difference was found between those in vaginal delivery and C-section groups (P = 0.011). Also, the mean scores of muscular strengths (P = 0.009) and pelvic floor muscular function (P = 0.01) in the vaginal delivery group were significantly higher than the C-section group. Conclusions: the mean scores of pelvic floor motor control, pelvic floor muscular strength, and function in the C-section group were higher than those in the vaginal delivery group. This study demonstrated the necessity of postpartum pelvic floor muscle rehabilitation, especially in vaginal delivery.

Normal values for hip muscle strength and range of motion in elite, sub-elite and amateur male field hockey players

ObjectivesTo determine normal values for hip strength and range of motion (ROM) of elite, sub-elite and amateur male field hockey players and to examine the effect of age, leg dominance, playing position, playing level and non-time-loss groin pain on hip strength and ROM. DesignCross-sectional study. SettingPhysical testing took place at field hockey clubs. ParticipantsMale field hockey players competing in the three highest Dutch field hockey leagues (n = 104). Main outcome measuresEccentric adduction, eccentric abduction, adductor squeeze strength, adduction/abduction ratio, internal rotation, external rotation and bent knee fall out (BKFO). ResultsStrength and ROM values (mean ± standard deviation) were: adduction = 2.8 ± 0.4 Nm/kg, abduction = 2.6 ± 0.4 Nm/kg, adduction/abduction ratio = 1.1 ± 0.2, squeeze test = 4.5 ± 0.8 N/kg, internal rotation = 34° ± 11°, external rotation = 47° ± 9°, BKFO = 15 ± 4 cm. Age, leg dominance, playing position, playing level and non-time-loss groin pain had no effect on these profiles. ConclusionsNormal values were established for hip strength and ROM of male field hockey players and showed to be independent of age, leg dominance, playing position, playing level and non-time-loss groin pain.

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.

The effect of acute match play loading on hip adductor strength and flexibility in soccer players.

Deficits in adductor strength and flexibility are considered risk factors for soccer hip/groin injury, yet little is known about the acute effects of soccer match play on these physical features. The aim of this study was to examine the changes in adductor strength and flexibility before; during and immediately after soccer match play. Twenty male university soccer players (mean age 22.35±1.98 years) participated in this field-based, within subject, repeated measures study. Each participant performed three adductor squeeze tests measured using a pressure sphygmomanometer in 0° and 45° hip flexed test positions alongside a bent knee fall out test. Tests were performed before (0 mins) half time (45 mins) and at full time (90 mins) of a competitive match. Adductor strength decreased by 17.7% in 0° test position and 19.1% in 45° test position at 90 minutes of soccer play, whilst BKFO scores increased by 15% indicating a reduction in adductor flexibility. Statistical analysis showed significant effects of time vs. adductor strength and squeeze test position (P≤0.005), Positive correlations between time played and BKFO scores, and BKFO scores vs adductor squeeze scores at 0 and 45 minutes (P≤0.005) were also observed. University soccer players exhibit decreased adductor squeeze test and BKFO values as soccer match duration increases. These findings may have implications hip/groin injury management and recovery strategies, post or during soccer matches.

Hip strength and range of motion: Normal values from a professional football league.

To determine the normal profiles for hip strength and range of motion (ROM) in a professional football league in Qatar, and examine the effect of leg dominance, age, past history of injury, and ethnicity on these profiles. Cross-sectional cohort study. Participants included 394 asymptomatic, male professional football players, aged 18-40 years. Strength was measured using a hand held dynamometer with an eccentric test in side-lying for hip adduction and abduction, and the squeeze test in supine with 45° hip flexion. Range of motion measures included: hip internal and external rotation in 90° flexion, hip IR in prone, bent knee fall out and hip abduction in side-lying. Demographic information was collected and the effect on the profiles was analysed using linear mixed models with repeated measures. Strength values (mean±SD) were: adduction=3.0±0.6Nm/kg, abduction=2.6±0.4Nm/kg, adduction/abduction ratio=1.2±0.2, Squeeze test=3.6±0.8N/kg. Range of motion values: internal rotation in flexion=32±8°, external rotation=38±8°, internal rotation in prone=38±8°, bent knee fall out=13±4.4cm, abduction in side-lying=50±7.3°. Leg dominance had no clinically relevant effect on these profiles. Multivariate analysis demonstrated that age had a minor influence on squeeze strength (-0.03N/kg/year), external rotation (-0.30°/year) and abduction range (-0.19°/year) but past history of injury, and ethnicity did not. Normal values are documented for hip strength and range of motion that can be used as reference profiles in the clinical assessment, screening, and management of professional football players. Leg dominance, recent past injury history and ethnicity do not need to be accounted for when using these profiles for comparison purposes.

Hip Range of Motion Is Lower in Professional Soccer Players With Hip and Groin Symptoms or Previous Injuries, Independent of Cam Deformities

Background: Soccer (football) players often have hip and groin symptoms (HGS), and a previous groin injury is a risk factor for a relapse. Decreased hip range of motion (HROM) has been related to both hip and groin pain and the presence of a cam deformity. How these factors interact is unknown. Purpose: The first aim was to study whether HGS are associated with HROM. The second aim was to study the association of the presence of a cam deformity with HROM. Additionally, the influence of a cam deformity on the relationship between HGS and HROM was examined. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Seasonal screening data of 2 professional soccer clubs were used. Variables for HGS were current hip or groin pain, the Copenhagen Hip and Groin Outcome Score (HAGOS), and previous hip- and groin-related time-loss injuries (HGTIs). HROM was determined for hip internal rotation (IR), external rotation, and total rotation (TR) in the supine position and for the bent knee fall out (BKFO) test. A cam deformity was defined by an alpha angle >60° on standardized anteroposterior pelvic and frog-leg lateral radiographs. Results: Sixty players (mean [±SD] age, 23.1 ± 4.2 years) were included. All were noninjured at the time of screening. Current hip or groin pain was not associated with HROM. Hips of players in the lowest HAGOS interquartile range (thus most affected by complaints; n = 12) showed less IR (23.9° ± 8.7° vs 28.9° ± 7.8°, respectively; P = .036) and TR (58.2° ± 13.5° vs 65.6° ± 11.8°, respectively; P = .047) than those in the highest interquartile range (n = 29). No such differences were found for BKFO (P = .417). Hips of players with a previous HGTI showed less IR (21.1° ± 6.8° vs 28.3° ± 8.9°, respectively; P < .001) and TR (56.0° ± 8.2° vs 64.5° ± 13.6°, respectively; P < .001) than those without a previous HGTI. This was independent of the presence of a cam deformity. BKFO did not differ between groups (P = .983). Hips with a cam deformity showed less but nonsignificant IR (25.5° ± 10.3° vs 29.0° ± 7.1°, respectively; P = .066) and TR (P = .062) and higher but nonsignificant BKFO values (17.1 cm ± 3.4 cm vs 14.2 cm ± 4.6 cm, respectively; P = .078) than those without a cam deformity. Conclusion: Decreased HROM in professional soccer players is associated with more hip- and groin-related symptoms and with previous injuries, independent of the presence of a cam deformity.

Lumbopelvic motor control and low back pain in elite soccer players: a cross-sectional study

ABSTRACTThis study aimed to investigate the relationship between the history of low back pain and quality of lumbopelvic motor control in soccer players. Forty-three male elite soccer players (mean age, 18.2 ± 1.4 years) filled in questionnaires related to low back pain and attended a session to assess lumbopelvic motor control by means of five tests (the bent knee fall out test, the knee lift abdominal test, the sitting knee extension test, the waiter’s bow and the transversus abdominis test). A physiotherapist, blinded to the medical history of the participants, scored (0 = failed, 1 = correct) the performance of the players for each of the tests resulting in a lumbopelvic motor control score ranging from 0 to 5. Forty-seven per cent of the soccer players reported a disabling low back pain episode lasting at least two consecutive days in the previous year. These players scored worse lumbopelvic motor control than players without a history of low back pain (lumbopelvic motor control score of 1.8 vs. 3.3, P < 0.01). The between-groups difference was particularly marked for the bent knee fall out test, the knee lift abdominal test and the transversus abdominis test (P < 0.01). In conclusion, most soccer players with a history of low back pain had an altered lumbopelvic motor control. Further research should examine whether lumbopelvic motor control is etiologically involved in low back pain episodes in soccer players.

Reproducibility of a battery of commonly used clinical tests to evaluate lumbopelvic motor control

ObjectiveTo determine reproducibility of a battery of clinical tests for evaluating lumbopelvic motor control (LMC). DesignTest-retest design. ParticipantsFifty healthy subjects. Outcome MeasuresTwo raters independently examined performance on 12 clinical tests for evaluating LMC. All tests were scored on a seven-point scale, based on qualitative and quantitative performance. Subjects were measured twice, with a two week interval between examinations. Intra- and inter-rater reproducibility of each test were determined using intraclass correlation coefficients (ICCs), standard error of measurement, smallest detectable change (SDC) and limits of agreement. ResultsReliability of the tests ranged from poor to excellent. Intra-rater ICCs ranged from 0.00 to 0.82, whereas inter-rater ICCs varied from 0.00 to 0.96. SDC values were smallest for supine leg raising, bent knee fall out, prone bridge and unilateral prone bridge (<2 points). ConclusionThis study shows limited reproducibility of a battery of 12 clinical tests for the evaluation of LMC in a healthy population. Supine leg raising, bent knee fall out, prone bridge, and unilateral prone bridge showed the smallest measurement errors. The other 8 tests were found to have large measurement errors. Based on these results, dichotomization of the rating method might be considered in order to improve reproducibility values.

Kinematic and kinetic changes in a hurdle hop task following athletic groin pain rehabilitation

in side-lying using an eccentric break test with a hand held dynamometer (HHD) and were normalized to body weight and lever arm. The squeeze test at 45◦ hip flexion was also performed using the HHD. Flexibility measures included hip internal rotation (IR) in both 90◦ flexion and prone, hip Abd in side-lying and bent knee fall out (BKFO). Demographic information was collected pertaining to age, height, weight, leg dominance, past history of hip and groin injury and ethnicity. Pain on each testing procedure was recorded using a numerical rating scale. The effect each of these variables had on the strength and flexibility profiles was analysed using statistical methods appropriate for the variable type. Results: Normative values for strength were as follows (mean± SD); hip Add non-dominant =3.2±0.6Nm/kg, dominant =3.1±0.6Nm/kg; hip Abd both legs 2.4±0.4Nm/kg; Add:Abd ratios non-dominant =1.4±0.3, dominant =1.3±0.3; squeeze test 3.2±0.8N/kg; hip IR in flexion both legs =37±8◦, hip IR in prone non-dominant =36±8◦, dominant =37±8◦, hip Abd in side lying both legs =47±8◦, BKFO non-dominant =13.5±4.1 cm, dominant =13.7±4.1 cm. Leg dominance and a past history of injury had no clinically relevant effect on the strength and flexibility profiles of the footballers. However, players with pain on squeeze testing recorded significantly lower scores (p≤0.05). Discussion: These reference profiles in footballers can now be used by clinicians in their assessment and management of footballers. The results demonstrate that a clinician can confidently compare the strength and flexibility profile with the non-injured leg when assessing a player with unilateral pain. Pain on clinical testing resulted in lower squeeze values, but a past history of hip or groin injury does not affect these profiles in a healthy group of footballers.

Acute responses of soccer match play on hip strength and flexibility measures: potential measure of injury risk

Regular measurements of groin risk factors may offer a preventive measure against injury. Therefore, the aim of this study was to (1) determine minimal detectable change (MDC) and reliability of hip flexibility and strength measures and to (2) identify the effect soccer match play load has on these measures. Reliability was determined for bent knee fall out test, hip abduction and adduction (hand-held dynamometry (HHD)) in 20 trained youth male soccer players. Reliability was evaluated with the intra-class correlation coefficient (ICC[2,1]), 95% confidence intervals (CI). Hip strength and flexibility measures were taken before and after an international friendly match. Intra-rater reliability ICC ranges were bent knee fall out (0.75–0.90), abduction (0.83–0.90) and adduction (0.72–0.96). Inter-rater ICCs (95% CI) were bent knee fall out test [0.75 (0.39–0.90) right, 0.71 (0.27–0.89) left hip]; abduction [0.80 (0.50–0.92) right, 0.81 (0.53–0.92) left hip] and adduction [0.72 (0.31–0.89) right, 0.70 (0.26–0.88) left hip]. MDCs were as low as 20.7% of the mean for hip flexibility and 12.5% for strength. In conclusion, HHD and the bent knee fall out test are reliable tools to measure changes in hip strength and flexibility. Finally, a threshold may exist in which match play load negatively impacts hip flexibility.

Factors that influence low back pain in people with a stoma

Purpose: People with a stoma believe that there is a link between their surgery and low back pain (LBP). Aim: To explore factors relating to (i) core stability in people with a stoma and LBP and (ii) biopsychosocial factors related to LBP. Methods: Adults with an ileostomy and LBP (n = 17) completed (i) a range of standardised instruments, (ii) clinical tests and (iii) an ultrasound scan of right and left transversus abdominis (TrA). Results: The findings showed moderate pain and disability: RMDQ: median = 12 (IQR: 9.5–13), EQ-5D health state: mean = 6.9 (±1.75), BPI pain severity: median = 4.5 (IQR: 2.87–5.4). The TrA contraction was less on the operated than the unoperated side and this was linked to less control for BKFO to the operated side, and the presence of a parastomal hernia. Co-morbidities were associated with greater balance problems during the stork test (p < 0.05). Men had more fear avoidance (p < 0.05) on the FABQ regarding physical activity. Discussion: Abdominal function may be altered after stoma surgery leading to reduced ability to perform functional tasks and a possible increased risk of back pain. These results should be viewed with caution due to the small sample size.Implications for RehabilitationBack pain in people with a stoma is a complex problem including both physical and psychological issues.The ability of transversus abdominis (TrA) to contract efficiently is unclear; however, those with a thinner TrA had poorer balance and core stability (as measured by bent knee fall out).The psychological factors of fear avoidance must be addressed alongside any physical interventions for motor control, muscle strengthening and rehabilitation of function after surgery.This research needs to be repeated with a larger sample due to the small numbers in this exploratory study (n = 17).

Inter-examiner reproducibility of tests for lumbar motor control.

BackgroundMany studies show a relation between reduced lumbar motor control (LMC) and low back pain (LBP). However, test circumstances vary and during test performance, subjects may change position. In other words, the reliability - i.e. reproducibility and validity - of tests for LMC should be based on quantitative data. This has not been considered before. The aim was to analyse the reproducibility of five different quantitative tests for LMC commonly used in daily clinical practice.MethodsThe five tests for LMC were: repositioning (RPS), sitting forward lean (SFL), sitting knee extension (SKE), and bent knee fall out (BKFO), all measured in cm, and leg lowering (LL), measured in mm Hg. A total of 40 subjects (14 males, 26 females) 25 with and 15 without LBP, with a mean age of 46.5 years (SD 14.8), were examined independently and in random order by two examiners on the same day. LBP subjects were recruited from three physiotherapy clinics with a connection to the clinic's gym or back-school. Non-LBP subjects were recruited from the clinic's staff acquaintances, and from patients without LBP.ResultsThe means and standard deviations for each of the tests were 0.36 (0.27) cm for RPS, 1.01 (0.62) cm for SFL, 0.40 (0.29) cm for SKE, 1.07 (0.52) cm for BKFO, and 32.9 (7.1) mm Hg for LL. All five tests for LMC had reproducibility with the following ICCs: 0.90 for RPS, 0.96 for SFL, 0.96 for SKE, 0.94 for BKFO, and 0.98 for LL. Bland and Altman plots showed that most of the differences between examiners A and B were less than 0.20 cm.ConclusionThese five tests for LMC displayed excellent reproducibility. However, the diagnostic accuracy of these tests needs to be addressed in larger cohorts of subjects, establishing values for the normal population. Also cut-points between subjects with and without LBP must be determined, taking into account age, level of activity, degree of impairment and participation in sports. Whether reproducibility of these tests is as good in daily clinical practice when used by untrained examiners also needs to be examined.

Altered breathing patterns during lumbopelvic motor control tests in chronic low back pain: a case-control study.

The objective of the study was to evaluate the breathing pattern in patients with chronic non-specific low back pain (LBP) and in healthy subjects, both at rest and during motor control tests. Ten healthy subjects and ten patients with chronic LBP participated at this case-control study. The breathing pattern was evaluated at rest (standing and supine position during both relaxed breathing and deep breathing) and while performing clinical motor control tests, i.e. bent knee fall out and active straight leg raise. A blinded observer analyzed the breathing pattern of the participants using visual inspection and manual palpation. Costo-diaphragmatic breathing was considered as optimal breathing pattern. Subjects filled in visual analog scales for the assessment of pain intensity during the tests. At rest, no significant differences were found between the breathing pattern of patients and healthy subjects (P > 0.05). In contrast, significantly more altered breathing patterns were observed in chronic LBP-patients during motor control tests (P = 0.01). Changes in breathing pattern during motor control tests were not related to pain severity (P > 0.01), but were related to motor control dysfunction (P = 0.01).