INJURY PREVENTION

THE PREVENTION OF PELVIC & GROIN INJURIES

By David Fevre, MCSP, MSc

Knowledge of soccer injuries and their aeti- ology is limited, inconsistent and far from complete. Many studies exist but are limit- ed due to the many variables that exist, such as level of competition, gender and age or involve isolated case studies that have no value in identifying the risk fac- tors involved. As already stated, statistics varying from 5%-28% have been recorded for the occurrence of groin injuries in a sport such as soccer so prevention of both recurring and new injuries is of key impor- tance particularly at professional level.

Pre-season screening The use of pre-season screening has often been suggested as a means of assessment to determine if a certain type of individual is more likely to be injured due to features in their physical characteristics. In England, the Medical Committee for the Football Association has recently intro- duced (season 1999-2000) an orthopaedic musculoskeletal screening programme for all Football Academies. This involves a full skeletal assessment of every adolescent attached to the Academy of each club. In time this should provide important research statistics into the relationship between injury prevalence and the chang- ing adolescent skeleton.

Abdominal programmes One of the ‘buzz’ words in rehabilitation circles over the last few years has been core stability work and its effects in enhancing dynamic stability. To be more specific, this has been recognized in terms of altered patterns of abdominal muscle activation and its relationship to chronic injury, particularly in individuals with low back pain (8). Most soccer players are familiar with regimented abdominal work in the form of sit-ups and its various alter- natives.

Unfortunately this work mainly

applies stress to the rectus abdominis and hip flexors, ignoring the role and demands

of the other abdominals, the obliques and transversus abdominis, in relation to func- tional activity. For many years, players, coaches and even medical personnel have worked with the ethic that the only way to increase abdominal strength is to increase the number of sit ups each player must perform.

Recognition of abdominal dysfunction is difficult in the untrained eye and much of the research and case studies in the med- ical literature are based on subject testing using EMG and theoretical rationale. Research has demonstrated that certain abdominal exercises activate the deep abdominals in preference to rectus abdo- minis (9). It has therefore been hypothe- sized that these exercises provide a more ideal pattern of muscle activation in pro- viding a stabilizing effect of the deep abdominal muscles. In relation to PAWD, the introduction of such exercise drills should have a positive effect on the epi- demic of injuries that have occurred over the last few years.

Training programme Overuse injuries can occur at any age and in relation to groin injuries a large propor- tion of them are due to degenerative changes in the associated tissues. The intensity of competition in soccer and many other sports has led to the wider recognition of overuse injuries and the long term effects of ‘overplay’. In children and adolescents, (10) suggests four main causative factors: ● Amount of training ● Technique ● Posture ● Equipment

In response to this, the Football Association’s Medical Committee has pro- duced various advisory leaflets on the risks of overuse and overplay for parents and coaches. All youth coaching courses run by the FA include lectures in relation to this

problem. Various rule changes in relation to size of pitch and duration of matches for youth players have also been introduced to try and reduce the degree of physical stress on such players. In the long term, the screening programme for all Academy play- ers may well produce significant statistics on the effects of full time training on the adolescent skeleton.

Use of comparative data Use of normative data in relation to strength and flexibility is often suggested as a means of predicting injury. It is impor- tant to consider both aspects in relation to the research that is available and the role it may play in the prevention of injury.

1. Muscle strength Most of the research related to muscle strength and the prevention of injury has been performed using isokinetic dynamom- etry. There appears to be little support for the argument that prediction of injury is possible with pre-season isokinetic testing. In fact the only research paper to suggest there may be a link was performed on women athletes (11), so it is questionable as to whether the conclusions of this paper can be related to male soccer players.

Non-athletic (12) Soccer (13) Extension Flexion

Flexion

Adduction Abduction

Medial rotation

Extension Adduction Abduction

Lateral rotation Lateral rotation Medial rotation

Table 2: Comparison of muscle strengths at the hip in the general population versus soccer players

However, isokinetic dynamometry is useful in relation to the prevention of injury in the soccer player. The information it pro- vides may help to:

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