title: Athletic groin pain (part 2): a prospective cohort study on the biomechanical evaluation of change of direction identifies three clusters of movement patterns.
abstract: BACKGROUND
  Athletic groin pain (AGP) is prevalent in sports involving repeated accelerations, decelerations, kicking and change-of-direction movements. Clinical and radiological examinations lack the ability to assess pathomechanics of AGP, but three-dimensional biomechanical movement analysis may be an important innovation.
  
  
  OBJECTIVE
  The primary aim was to describe and analyse movements used by patients with AGP during a maximum effort change-of-direction task. The secondary aim was to determine if specific anatomical diagnoses were related to a distinct movement strategy.
  
  
  METHODS
  322 athletes with a current symptom of chronic AGP participated. Structured and standardised clinical assessments and radiological examinations were performed on all participants. Additionally, each participant performed multiple repetitions of a planned maximum effort change-of-direction task during which whole body kinematics were recorded. Kinematic and kinetic data were examined using continuous waveform analysis techniques in combination with a subgroup design that used gap statistic and hierarchical clustering.
  
  
  RESULTS
  Three subgroups (clusters) were identified. Kinematic and kinetic measures of the clusters differed strongly in patterns observed in thorax, pelvis, hip, knee and ankle. Cluster 1 (40%) was characterised by increased ankle eversion, external rotation and knee internal rotation and greater knee work. Cluster 2 (15%) was characterised by increased hip flexion, pelvis contralateral drop, thorax tilt and increased hip work. Cluster 3 (45%) was characterised by high ankle dorsiflexion, thorax contralateral drop, ankle work and prolonged ground contact time. No correlation was observed between movement clusters and clinically palpated location of the participant's pain.
  
  
  CONCLUSIONS
  We identified three distinct movement strategies among athletes with long-standing groin pain during a maximum effort change-of-direction task These movement strategies were not related to clinical assessment findings but highlighted targets for rehabilitation in response to possible propagative mechanisms.
  
  
  BACKGROUND
  NCT02437942, pre results.
authors.affiliation: Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland.|Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Franklyn-Miller
authors.affiliation: Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Richter
authors.affiliation: Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland.|Department of Life Sciences, Roehampton University, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: King
authors.affiliation: Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland.|INSIGHT Research Centre, Dublin City University, Dublin, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Gore
authors.affiliation: INSIGHT Research Centre, Dublin City University, Dublin, Ireland.|School of Health and Human Performance, Dublin City University, Dublin, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Moran
authors.affiliation: Department of Life Sciences, Roehampton University, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Strike
authors.affiliation: Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland.|Department of Medicine, University College Cork, Cork, Ireland.
authors.forename: E C
authors.initials: EC
authors.lastname: Falvey
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000502:physiology; D056352:Athletes; D001265:Athletic Injuries / Q000209:etiology*; D001696:Biomechanical Phenomena; D006119:Groin / Q000503:physiopathology*; D006621:Hip Joint / Q000502:physiology; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D008297:Male; D009068:Movement; D010146:Pain / Q000175:diagnosis*; D011446:Prospective Studies; D012399:Rotation; D012420:Running / Q000293:injuries; D013177:Sports; D055815:Young Adult
keywords: Biomechanics; Groin; Overuse injury; Performance