title: Hip Range of Motion Is Lower in Professional Soccer Players With Hip and Groin Symptoms or Previous Injuries, Independent of Cam Deformities.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sports Rehabilitation and Manual Therapy Department, Physiotherapy Utrecht Oost, Utrecht, the Netherlands Department of Orthopaedics, Academic Medical Centre, Amsterdam, the Netherlands Academic Centre for Evidence based Sports Medicine (ACES), Amsterdam, the Netherlands Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands igor.tak@gmail.com.
authors.forename: Igor
authors.initials: I
authors.lastname: Tak
authors.affiliation: Sports Institute of Northern Ireland, Belfast, Northern Ireland Sports Medicine Department, Ulster University, Belfast, Northern Ireland.
authors.forename: Philip
authors.initials: P
authors.lastname: Glasgow
authors.affiliation: Sports and Manual Therapy, Physiotherapy Dukenburg, Nijmegen, the Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Langhout
authors.affiliation: Sports Medicine Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Adam
authors.initials: A
authors.lastname: Weir
authors.affiliation: Department of Orthopaedics, Academic Medical Centre, Amsterdam, the Netherlands Academic Centre for Evidence based Sports Medicine (ACES), Amsterdam, the Netherlands Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands.
authors.forename: Gino
authors.initials: G
authors.lastname: Kerkhoffs
authors.affiliation: Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Rintje
authors.initials: R
authors.lastname: Agricola
mesh_terms: D003430:Cross-Sectional Studies; D006119:Groin / Q000503:physiopathology*; D025981:Hip Injuries / Q000209:etiology; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D007718:Knee Injuries / Q000209:etiology; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology*; D012307:Risk Factors; D012399:Rotation; D012916:Soccer / Q000293:injuries*; D055815:Young Adult
keywords: cam deformity; femoroacetabular impingement; football (soccer); groin pain; hip; range of motion