Acute adductor injuries Tyler et al, AJSM, 2002
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1 Acute adductor injuries Tyler et al, AJSM, 2002 Passive treatments Low load isometric exercises Flexibility Adduction against gravity Multiple adductor exercises Strength & Stability Flexibility PROM & adduction Strength 75% symmetry Load progression Sports-specific technique Adduction strength symmetry ADD:ABD ratio 0.9
2 Exercise dosage? Load magnitude Sets & Reps Rest-in-between sets Sessions (per day/week) Muscle failure Range of motion Velocity Time under tension Contraction type Toigo & Boutellier, EJAP, 2006
3 Headache Paracetamol Aspirin Ibuprofen 200 mg 400 mg 500 mg 1 g Or just rest???
4 Time to return to play but still, if you have a muscle problem, it takes 21 days. It took 21 days 30 years ago. Arsène Wenger The Guardian, Sep 2017
5 Ekstrand et al, AJSM, 2011 Adductor injury severity Minimal (1-3 days) 119 (18%) Mild (4-7 days) 210 (31%) Moderate (8-28 days) 275 (41%) Severe ( 28 days) 68 (10%)
6 Our challenge How do we beat time?
7 Reduce RTP time Creighton et al, CJSM, 2010 Shrier, BJSM, 2015 Increase risk tolerance?
8 Re-injury risk 18% Adductor injury Ekstrand et al, AJSM, % Acute groin injury Mosler et al, AJSM, 2017
9 Reduce RTP time Can we influence tissue capacity? Can we influence tissue stress? Creighton et al, CJSM, 2010 Shrier, BJSM, 2015
10 Muscle regeneration Järvinen et al, AJSM, 2005 Mackey & Kjaer, SM, days post-injury (200 forced lengthening contractions with electric stimulation)
11 What about the MTJ? Serner et al, SJMSS, 2017
12 What about the MTJ? Knudsen et al, SJMSS, 2014
13 MTJ & exercise Increased surface area Non-exercise group Exercise group Kojima et al, JOS, 2008 Curzi et al, EJH, 2008
14 MRI fibrosis & re-injury No association Reurink, AJSM, 2015 Patients without re-injury = More fibrosis on MRI Strength of the new junctions?
15 Collagen & resistance training Net synthesis of collagen >36 hours after exercise Extracellular matrix Magnusson et al, 2010 Gillies et al, MM, 2014
16 Isolate painful structure(s) Why? Maximise effect of mechanical stimulus (mechanotransduction) Limit atrophy & inhibition Facilitate re-capillarisation & neuronal resprouting Improve structural and functional capacity Monitor load capacity (pain response) Glasgow et al, BJSM, 2015, Khan & Scott, BJSM, 2009
17 Isolate painful structure(s) Usable with low load Easily adjusted for progression Long muscle length Adductor longus muscle activity Serner et al, BJSM, 2013, Delmore et al, JSR, 2013, Krommes et al, IJSPT, 2017
18 Dosage? What about pain? Toigo & Boutellier, EJAP, 2006
19 Training to volitional fatigue Similar muscle protein synthesis Similar perceived exertion 30% vs 90% of 1RM % of 1RM Borg Scale Vasquez et al, PMS, 2013 Burd et al, APNM, 2012
20 Acute adductor injuries Velocity Intensity 10 RM Phase 4 4 sets of PRM 15 PRM from Concentric : Eccentric 3s : 3s to <1s : 3s Concentric : Eccentric Phase 2 Phase 3 3 sets of PRM 20 PRM 2 sets of 20+ PRM
21 Copenhagen Adduction exercise Serner et al, BJSM, 2013 Ishøi et al, SJMSS, 2015 Harøy et al, AJSM, t/w, 2-3 sets, 6-15 reps 8 weeks 3t/w, 1 set, 3-15 reps 36% 9% Prevention RCT Joar Harøy et al, submitted
22 Focus on synergists in painful movements Acute adductor longus injuries Open chain Rapid change of movement involving hip extension to hip flexion? Rapid change of movement involving hip abduction to hip adduction? Hip externally rotated? Ball impact Kicking Yes Yes Yes Yes Kicking Yes Yes Yes Yes Kicking - Yes - Yes Kicking Yes - Yes Yes Kicking No Yes No Yes Jumping Yes - - No Jumping Yes - - No Acute groin injuries Closed chain Involving hip extension? Involving hip abduction? Hip externally rotated? Change of direction No Yes - Change of direction Change of direction Yes Yes Yes Change of direction Yes - Yes Change of direction Yes Yes Yes Change of direction No Yes Yes Reaching for ball Yes - - Reaching for ball No Yes - Reaching for ball Yes Yes Yes Unsure Reaching for ball = uncertain. Serner et al, AJSM, 2015, Serner et al, unpublished
23
24 Focus on synergists in painful movements Kicking (Pull) Hip adductors Hip flexors Abdominals Change of direction (Push off) Hip abductors & extensors Knee extensors Plantar flexors Trunk rotators & lateral flexors
25 Train actual functions What are we aiming for? How do we standardize?
26 Train actual functions Start with basics & progress Ladder Linear running Zig-Zag Increase sports specificity introduce reactive component
27 Evidence is poor! Guidelines: Isolate painful structure Push load & reps (2/10 pain) Focus on synergists in painful movements Anterior & posterior kinetic chain Train actual functions Start early Take home messages Treatment
28 Thank you! Aspetar Sports Groin Pain Center
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WTC I Term 2 Notes/Assessments Muscle Identification The human body consists of many muscles and muscle groups. We will focus on a select few that are most prevalent when training. The muscular system
Title: Hip strength and range of motion: Normal values from a professional football league
Title: Hip strength and range of motion: Normal values from a professional football league Author: Andrea B. Mosler Kay M. Crossley Kristian Thorborg Rod J. Whiteley Adam Weir Andreas Serner Per Hölmich
External Obliques Abdominal muscles that attaches at the lower ribs, pelvis, and abdominal fascia.
The Core The core is where most of the body s power is derived. It provides the foundation for all movements of the arms and legs. The core must be strong, have dynamic flexibility, and function synergistically