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IRCT2016080829269N1 IRCT 2016-11-27 Research Assistance of Faculty of Rehabilitation, Tehran University of Medical Science Study of effect and comparison of two therapeutic exercise protocols on function and pain relief in athletes with long - standing adductor – related groin pain Study of effect and comparison of two therapeutic exercise protocols on functional outcomes and pain relief in athletes with long - standing adductor – related groin pain 2016-06-21 anticipated 60 Complete https://irct.ir/trial/23572 interventional Randomization: Randomized, Blinding: Double blinded, Placebo: Not used, Assignment: Parallel, Purpose: Treatment. N/A chronic groin pain. Intervention 1: group 1. protocol 1 ( Holmich protocol): 1 - Static adduction against soccer ball placed between feet when lying supine; each adduction 30 s, ten repetitions. 2 - Static adduction against soccer ball placed between knees when lying supine; each adduction 30s, ten repetitions. 3 - Abdominal sit-ups both in straightforward direction and in oblique direction; five series of ten repetitions. 4 - Combined abdominal sit-up and hip flexion, starting from supine position and with soccer ball placed between knees (folding knife exercise); five series of ten repetitions. 5 - Balance training on wobble board for 5 min. 6 - One-foot exercises on sliding board, with parallel feet as well as with 90° angle between feet; five sets of 1 min continuous work with each leg, and in both positions. Module II (from third week; module II was done twice at each training session) 1- Leg abduction and adduction exercises lying on side; five series of ten repetitions of each exercise. 2 - Low-back extension exercises prone over end of couch; five series of ten repetitions. 3 - One-leg weight-pulling abduction/adduction standing; five series of ten repetitions for each leg. 4 - Abdominal sit-ups both in straightforward direction and in oblique direction; five series of ten repetitions. 5 - One-leg coordination exercise flexing and extending knee and swinging arms in same rhythm (cross country skiing on one leg); five series of ten repetitions for each leg. 6 - Training in sidewards motion on a “Fitter” (rocking base curved on top and bottom; user stands on platform that rolls laterally on tracks on top of rocking base) for 5 min. 7 - Balance training on wobble board for 5 min. 8 - Skating movements on sliding board; five times 1 min continuous work (Holmich, Uhrskou et al. 1999). Participants in this group have not permission to stretch adductor muscles at any stage of the treatment but they can stretch any other muscle at the end of each session if neccessary. Intervention 2: group2 Protocol 2 ( Concentric - Eccentric training at high velocity using elastic bands): Module 1 will be the same as Holmich protocol. Instead of number 3 of Module II, Leg abduction and adduction exercises in standing position will be done using Theraband as an external loading. In the standing position, the elastic band will be attached to a fixation point, and the participants will have the elastic band around the ankle of the leg nearest to the fixation point (the training leg). The pelvis should be in the horizontal plane; the upper body should be straight and fixated by holding on to a stationary object with both hands. This is the starting position. The exercise is performed in full range of motion from hip-abduction to hip-adduction. A repetition is performed from the starting position, as rapidly as possible to full adduction. The concentric hip-adduction is performed until the distance between the training leg and the standing leg is one foot width in the frontal plane, and at the same time, the training leg was a half foot length behind the standing leg in the sagittal plane. In this position, 2 s of isometric hip-adduction is performed, followed by 3 s of eccentric hip-adduction, until full hip-abduction range of motion is reached (without pelvic lateral tilt). Before the next repetition, a 2-s pause in maximal hip-abduction is performed. Time under tension is supervised by the physiotherapist. For abduction, the method is the same as adduction, but the motion is started from a position that the distance between the training leg and the standing leg is one foot width in the frontal plane, and at the same time, the training leg is a half foot length in front of the standing leg in the sagittal plane. From this position a concentric hip abduction is dine as rapidly as possible up to 45 degree of abduction.Then, in this angle, a 2-s isometric hip abduction is done, followed by a 3-s eccentric hip abduction, untill the training limb comes back to the starting point. Before the next repetition, a 2-s pause in starting point is performed. This exercise is performed 5 series of 10 repetition for abduction as well as adduction by affected limb. External load used in this part, is the maximum resistance overcome by the participant 10 times without aggravating pain. Elastic band used in this study is "Thera band" (Thera-Band, Hygienic Corporation, Akron, OH) which its different resistances are determined by different colors. In this study blue, black, silver and golden colors are used( blue<black<silver<golden). In order to increase the resistance, we can apply stronger theraband or add extra theraband. All therabands used in this study are prepared with defined and fixed length and the distance between the testing limb and fixed point is also marked in a way that in the beginning of abduction or adduction, the elastic band not be stretched or slack. In this way the strongest combination of theraband which is overcome 10 times by each subject, is estimated as his 10RM. In this protocol, adductors stretching is practiced 5 times a week. Stretching is performed pain freely 2 times each session for 15 seconds, while the participant is in sitting position with bent knees and his soles are in contact together. Furthermore, the participants should also practice the exercises 1 , 4 and 8 as rapidly as possible.
public Abbas Yousefzadeh
Faculty of Rehabilitation, Tehran University of Medical Science, Piche Shemiran
Tehran Iran (Islamic Republic of) +98 21 7753 3939 rehabilitation@tums.ac.ir Faculty of Rehabilitation, Tehran University of Medical Science scientific Dr Azadeh Shadmehr
Faculty of Rehabilitation, Tehran University of Medical Science, Piche Shemiran
Tehran Iran (Islamic Republic of) +98 21 7753 3939 shadmehr@tums.ac.irrehabilitation@tums.ac.ir Faculty of Rehabilitation, Tehran University of Medical Science Iran (Islamic Republic of) inclusion criteria:the subjects should be male; suffering from groin pain at hip adductor tendon region; between 18-35 years old; The pain should be chronic with the previous history of minimum two months and accompanied with sport activities; The participants should be of those who are continuing their sport activities more or less; During squeeze test and maximum isometric contraction of hip adductors, they should feel pain that its severity according to VAS must not be more than 5; they should have at least two of following symptoms: a history of morning groin pain and stiffness, nighttime groin pain and groin pain while coughing and sneezing. Exclusion criteria: inguinal or femoral hernia; prostatitis, urinary tract chronic disorders; referential pain due to 10th thoracic down to 5th lumbar segment; malignant disorders; fracture in pelvis or lower limbs; other injuries of lower limbs; ilioinguinal, genitofemoral and lateral femoral cutaneous nerve entrapment; bursitis; osteoarthritis or any other hip joint disorders( according to clinical findings and previous history reported by the subjects); trigger points in adductor muscles belly; NSAID consumption during the study; Lack of cooperation and inability to do therapeutic protocols or to participate in assessments. 18 years 35 years Male M62.6 muscle strain Rehabilitation Rehabilitation group 1. protocol 1 ( Holmich protocol): 1 - Static adduction against soccer ball placed between feet when lying supine; each adduction 30 s, ten repetitions. 2 - Static adduction against soccer ball placed between knees when lying supine; each adduction 30s, ten repetitions. 3 - Abdominal sit-ups both in straightforward direction and in oblique direction; five series of ten repetitions. 4 - Combined abdominal sit-up and hip flexion, starting from supine position and with soccer ball placed between knees (folding knife exercise); five series of ten repetitions. 5 - Balance training on wobble board for 5 min. 6 - One-foot exercises on sliding board, with parallel feet as well as with 90° angle between feet; five sets of 1 min continuous work with each leg, and in both positions. Module II (from third week; module II was done twice at each training session) 1- Leg abduction and adduction exercises lying on side; five series of ten repetitions of each exercise. 2 - Low-back extension exercises prone over end of couch; five series of ten repetitions. 3 - One-leg weight-pulling abduction/adduction standing; five series of ten repetitions for each leg. 4 - Abdominal sit-ups both in straightforward direction and in oblique direction; five series of ten repetitions. 5 - One-leg coordination exercise flexing and extending knee and swinging arms in same rhythm (cross country skiing on one leg); five series of ten repetitions for each leg. 6 - Training in sidewards motion on a “Fitter” (rocking base curved on top and bottom; user stands on platform that rolls laterally on tracks on top of rocking base) for 5 min. 7 - Balance training on wobble board for 5 min. 8 - Skating movements on sliding board; five times 1 min continuous work (Holmich, Uhrskou et al. 1999). Participants in this group have not permission to stretch adductor muscles at any stage of the treatment but they can stretch any other muscle at the end of each session if neccessary. group2 Protocol 2 ( Concentric - Eccentric training at high velocity using elastic bands): Module 1 will be the same as Holmich protocol. Instead of number 3 of Module II, Leg abduction and adduction exercises in standing position will be done using Theraband as an external loading. In the standing position, the elastic band will be attached to a fixation point, and the participants will have the elastic band around the ankle of the leg nearest to the fixation point (the training leg). The pelvis should be in the horizontal plane; the upper body should be straight and fixated by holding on to a stationary object with both hands. This is the starting position. The exercise is performed in full range of motion from hip-abduction to hip-adduction. A repetition is performed from the starting position, as rapidly as possible to full adduction. The concentric hip-adduction is performed until the distance between the training leg and the standing leg is one foot width in the frontal plane, and at the same time, the training leg was a half foot length behind the standing leg in the sagittal plane. In this position, 2 s of isometric hip-adduction is performed, followed by 3 s of eccentric hip-adduction, until full hip-abduction range of motion is reached (without pelvic lateral tilt). Before the next repetition, a 2-s pause in maximal hip-abduction is performed. Time under tension is supervised by the physiotherapist. For abduction, the method is the same as adduction, but the motion is started from a position that the distance between the training leg and the standing leg is one foot width in the frontal plane, and at the same time, the training leg is a half foot length in front of the standing leg in the sagittal plane. From this position a concentric hip abduction is dine as rapidly as possible up to 45 degree of abduction.Then, in this angle, a 2-s isometric hip abduction is done, followed by a 3-s eccentric hip abduction, untill the training limb comes back to the starting point. Before the next repetition, a 2-s pause in starting point is performed. This exercise is performed 5 series of 10 repetition for abduction as well as adduction by affected limb. External load used in this part, is the maximum resistance overcome by the participant 10 times without aggravating pain. Elastic band used in this study is "Thera band" (Thera-Band, Hygienic Corporation, Akron, OH) which its different resistances are determined by different colors. In this study blue, black, silver and golden colors are used( blue<black<silver<golden). In order to increase the resistance, we can apply stronger theraband or add extra theraband. All therabands used in this study are prepared with defined and fixed length and the distance between the testing limb and fixed point is also marked in a way that in the beginning of abduction or adduction, the elastic band not be stretched or slack. In this way the strongest combination of theraband which is overcome 10 times by each subject, is estimated as his 10RM. In this protocol, adductors stretching is practiced 5 times a week. Stretching is performed pain freely 2 times each session for 15 seconds, while the participant is in sitting position with bent knees and his soles are in contact together. Furthermore, the participants should also practice the exercises 1 , 4 and 8 as rapidly as possible. Pain intensity at hip adductor tendon region. Timepoint: outcome measurement in this study is done in two time sections.first at the day before begining intervention and the second at the day after finishing intervention that is after 8 weeks. Method of measurement: VAS is used. Maximum isometric muscle strength. Timepoint: outcome measurement in this study is done in two time sections.first at the day before begining intervention and the second at the day after finishing intervention that is after 8 weeks. Method of measurement: hand held dynamometer. Maximum eccentric muscle strength. Timepoint: outcome measurement in this study is done in two time sections.first at the day before begining intervention and the second at the day after finishing intervention that is after 8 weeks. Method of measurement: hand held dynamometer. Range of motion. Timepoint: outcome measurement in this study is done in two time sections.first at the day before begining intervention and the second at the day after finishing intervention that is after 8 weeks. Method of measurement: goniameter. Function. Timepoint: outcome measurement in this study is done in two time sections.first at the day before begining intervention and the second at the day after finishing intervention that is after 8 weeks. Method of measurement: TT,ESST,THT tests. Research Assistance of Faculty of Rehabilitation, Tehran University of Medical Science Approved 2016-07-18 Ethics Committee of Tehran University of Medical Science Tehran University of Medical Science, Enghelab Square,Tehran Tehran Iran (Islamic Republic of)