Hip Range of Motion: Which Plane of Motion is More Predictive of - PowerPoint PPT Presentation

Hip Range of Motion: Which Plane of Motion is More Predictive of Lower Extremity Injury in Elite Soccer Players? Sarav S. Shah, Isaac Gammal, Joseph Sullivan, Roger Gerland, Jeffrey Goldstein, Brian Sheridan, Michael Mashura, Aalok S. Shah, Andrew Goodwillie, Randy M. Cohn Northwell Health- Long Island Jewish Medical Center

Background LE injury has previously been correlated with iliopsoas tightness as well as a decreased arc of hip rotation • Ibrahim et al. in a study of male professional soccer players in Australia described decreased rotation at the hip as an etiological factor in the occurrence of adductor strains. • In a case-control study, Gomes et al. demonstrated there was a decreased internal rotation (IR) at the hip in soccer players with anterior cruciate ligament (ACL) tears compared to controls. • Krivickas and Feinberg described iliopsoas tightness (using the Thomas test) being associated with knee injuries specifically overuse injuries. • In their study of elite soccer players, Bradley et al. reported decreased hip flexor ROM correlates with muscle strain injuries.

Background • Aim: to compare validated risk factors [Thomas test (TT) representing sagittal plane tightness and IR/external rotation (ER) measurements representing the rotational plane] to further delineate the pathophysiology and to determine which plane of motion is more predictive of LE injury in collegiate and professional soccer players. • Hypothesis: decreased hip IR would have a stronger association with in-season LE injury than iliopsoas tightness.

Methods • Bilateral hip ROM measurements in internal rotation (IR), external rotation (ER), extension (E) and flexion (F) were taken along with the Thomas test (TT) during preseason physicals of a professional and a collegiate male soccer team • Injury was defined as any LE injury caused by soccer participation that kept a player out of practice or a game. • Odds of ipsilateral lower extremity injury were estimated from a binary logistic regression model, using the binary outcome of injury as the dependent variable

Results

Discussion • This study prospectively examined the association of hip ROM in multiple planes of motion with the incidence of LE injury in a cohort of professional and collegiate soccer players • Our findings suggest that muscle tightness in the transverse (horizontal) plane about the vertical axis may be more important than the sagittal plane tightness about the frontal axis at the hip for predicting LE injury • One reason for this finding is sporting activities such as soccer require free IR of the hip joint in both flexion and extension. • Fricker et al. proposed the hip joint undergoes inflammation and scarring as part of an overuse syndrome, the resulting stiffness is a manifestation of reflex muscle spasm of hip rotators. Without free IR, the biomechanics of the entire kinetic chain is affected during athletic play.

Limitations • Femoroacetabular Impingement (FAI) may be a possible source of decreased IR especially considering the high prevalence in soccer players, however none of the players had a history of FAI or complained of hip/groin pain at the time of examination. • Radiographic evaluation was not performed on the study population. Thus, it is difficult to differentiate muscle tightness as a cause from FAI. • The validity of goniometric measurements is limited since the two-dimensional goniometry is only an estimation of the real flexibility • Extremities with multiple injuries were treated as individual injuries; this is a limitation as each injury may not be completely independent of other injuries in the same extremity

Key Points • Findings: Muscle tightness in the transverse (horizontal) plane about the vertical axis may be more important than the sagittal plane about the frontal axis at the hip for predicting LE injury in elite level soccer players. • Implications: Clinicians should direct their attention to identifying a safe zone of motion in the rotational plane for high level soccer players, as decreased hip IR is associated with in-season lower extremity injury. • Caution: An appropriate radiographic evaluation for FAI should be performed for all at risk athletes as bony constraint may be a possible cause of decreased IR. There are extrinsic variables that may account for LE injuries which were not analyzed including level of competition, skill level, and playing surface

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