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Distinct cut task strategy in Australian football players with a history of groin pain
Abstracts / Journal of Science and Medicine in Sport 20S (2017) e2–e31
60 Kinetic characteristics of kicking motion between football players with or without groin pain: From motion analysis of the instep kick K. Murakami 1,∗ , S. Miyazawa 2 , H. Nagamoto 3 1
Faculty of Sports Science, Sendai University, Japan Faculty of Health and Sports Science, University of Tsukuba, Japan 3 Department of Orthopaedic Surgery, Kurihara Central Hospital, Japan 2
Introduction: Although the incidence rate of groin pain among football players is said to be low, the treatment becomes challenging as it may become chronic once it develops. It has been reported that kicking motion relates to the groin pain. However, its mechanism is still unclear. The purpose of this study was to reveal the characteristic motion of kicking between football players with or without groin pain. Methods: Ten players with the history of groin pain in the past year (GP group) and ten players without the history of groin pain (NP group) were included in the study. All the players kicked the ball 3 times to the target, which was 10 m away. Kicking motion was analyzed by 3D motion analysis (Vicon T020×10; 250 Hz) and mutually-synchronized force plate (Kistler×1; 1000 Hz), used motion analyzing software SIMM6.0. Analyzing interval was from the maximum hip extension (MHE) of the kicking leg through the foot contact (FC) of the pivot leg to the ball impact (BI) of the kicking leg. Results: The maximum flexion torque of the hip from MHE to BI in the kicking leg was not significant between the GP and the NP group. However, maximum knee extension torque to BI of the kicking leg in the GP group (164.1 ± 46.1 N/kg) was significantly higher than that of the NP group (113.3 ± 90.3 N/kg). Relative rotation angle of the upper and lower trunk in the GP group (9.1 ± 6.4◦ ) was significantly smaller than that of the NP group (19.2 ± 5.7◦ ). Average speed of the translation direction of the body mass center was significantly smaller in the GP group (during FC – BI 3.0 ± 0.3 m/s) than that of the NP group (during FC – BI 3.2 ± 0.3 m/s). Discussion: The distinctive point about instep kick in the GP group was that it depended on knee extension torque of the kicking leg and the rotation angle of the upper and lower trunk was less compared to the NP group. In addition, decreased average speed of FC to BI phase was observed compared to TO to FC phase, although average speed of the same phase increased in the NP group. These results may suspect that the groin pain occurrence may have a relationship with kinetic stress of the knee extensors, and motion depending on the kicking leg because of ineffective motion and decreased speed.
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clinicians to use mobile applications to objectively assess postural sway using convenient low cost methods. The SWAY Balance Application (SWAY) is one example which provides scores ranging from 0 to 100 (higher scores indicating better balance). Previous validations of SWAY utilised only anterior-posterior accelerations; however, validation of the current version of SWAY, which utilises all three axes of the device’s accelerometer are lacking. Therefore, the purpose of the present study was to compare SWAY scores, with force plate-derived measures of postural sway (centre of pressure (CoP) path length (PL) and CoP 95% confidence ellipse area (95% CEA)). Methods: Twenty recreationally active adults (15 females; 33.1 ± 8.0 years, 26.1 ± 3.7 kg m−2 ) completed a Modified Balance Error Scoring System (mBESS) test on a force plate while simultaneously recording postural sway using SWAY on an iPhone6. Pearson’s correlations examined the relationship between CoP PL, CoP 95% CEA, and SWAY score for each of the five mBESS tasks. Results: For Double Limb Stance task, non-significant weak negative relationships were observed between SWAY score and CoP PL, and between SWAY score and CoP 95% CEA (r = −0.25 and −0.17, respectively). For Tandem Stance tasks, moderate-to-strong negative correlations between SWAY score and CoP PL, and between SWAY score and COP 95% CEA were observed (r = −0.62 to −0.92, p < 0.05). Similarly for Single Leg Stance tasks, moderate-to-strong negative relationships were observed between SWAY score and CoP PL, and between SWAY score and COP 95% CEA (r = −0.76 to −0.86, p < 0.05). Discussion: For the majority of mBESS tasks, significant moderate-to-strong negative relationships were observed between SWAY scores and force-plate derived measures of postural sway; such that as SWAY scores increased (indicating better balance), force-plate derived measures of postural sway decreased (also indicating better balance). The weak negative relationships between SWAY scores and force-plate derived measures of postural sway during the Double Limb Stance task, are likely due to a ‘ceiling effect’, with participants achieving a maximal or near maximal SWAY score (>95). Overall, this study suggests SWAY is a valid tool for measuring postural sway during more challenging balance tasks. Whether SWAY is sufficiently sensitive to detect clinically important differences is unknown and more research is required. http://dx.doi.org/10.1016/j.jsams.2016.12.065 62 Distinct cut task strategy in Australian football players with a history of groin pain S. Edwards 1,∗ , H. Brooke 2 , J. Cook 3 1
The University of Newcastle, Australia Charles Sturt University, Australia 3 La Trobe University, Australia 2
http://dx.doi.org/10.1016/j.jsams.2016.12.064 61 Assessment of postural sway using smartphone technologies: Comparison with force plate measures C. Kean ∗ , M. Hayman, T. Doering, R. Stanton School of Medical and Applied Sciences, Central Queensland University, Australia Background: Assessment of postural sway is an important functional outcome. However, in clinical settings, assessment of postural sway is often subjective, and reliant on observer experience. Recent innovations in smartphone technology allows
Introduction: Acute groin injuries are the leading overuse injury in Australian football with a high incidence and recurrence rate. This injury has been associated in sports with sudden changeof-direction, and rapid acceleration and deceleration. Whilst the importance of adequate change-of-direction strategies has been investigated in other sports and knee joint injuries, no research was located to help identify movement patterns that may predispose players to groin injury. By exploring if change-of-direction techniques differ in players with and without a history of groin pain, clinicians may be able to intervene and decrease the risk of groin injury. This study aimed to explore the differences in the strategies utilised during unanticipated change-of-direction movement between players with and without a history of groin pain.
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Abstracts / Journal of Science and Medicine in Sport 20S (2017) e2–e31
Methods: Male Australian football players either with (HISTORY; n = 7) or without (CONTROL; n = 10) a history of groin pain performed 10 successful trials of an unanticipated change-ofdirection task with a defensive opponent and 5 maximal isokinetic hip abduction-adduction contractions. Three-dimensional ground reaction forces (GRF) and kinematics were recorded during the change-of-direction task. The weight acceptance phase was defined from initial contact (IC) when the vertical GRF exceeded 10 N, to the first local minimum (FWA ) after peak vertical GRF (FV ). Any between-group differences were determined using independentsamples t-tests and a Bayesian approach (precision of estimation and magnitude-based inferences). Moderate or large effect sizes (d) were defined as substantial changes to enable a more informative inferential assertions regarding magnitude. Results: There were substantial between-group differences for majority of the variables including HISTORY group displaying decreased knee flexion (d: IC 0.91, FV 0.61, FWA 0.78) and hip internal rotation (d: IC 0.74, FV 0.87, FWA 0.94), increased knee internal rotation (d: IC 0.86, FV 0.75, FWA −0.95) and T12-L1 right rotation (d: IC 1.17, FV 0.99, FWA 0.78), and higher GRFs (d: FV 0.52, FWA 0.82, FPOST 0.50), and decreased right adductor/abductor muscle strength ratio (d: 0.78). Discussion: Weak hip adductor muscular strength may have served as a precursor for the impaired ability of the HISTORY group to control lower limb function and alignment while executing the change-of-direction task. They also utilised decreased hip internal rotation, which is associated with groin injury and increased demands on the pubic symphysis. This provides evidence to support current rehabilitation methods of improving hip adduction-abduction muscular imbalances, and suggests the inclusion of lower limb alignment and control during a change-ofdirection task within rehabilitation. http://dx.doi.org/10.1016/j.jsams.2016.12.066 63 The joint health of recreational runners – An analysis of symptoms, injury history and osteoarthritis R. Leech 1,∗ , K. Flatters 1 , M. Batt 2 , K. Edwards 1 1
University of Nottingham, Arthritis Research UK Nottingham University Hospitals, Arthritis Research UK 2
Introduction: Running is becoming increasingly popular. Over 3 million individuals in England participate in athletics on a monthly basis whilst an equivalent percentage of the Australian population (7.4%) run or jog regularly. The importance of emphasising and encouraging an active lifestyle is critical within the wider societal context. Thus, the effect of running – one of the most easily accessible sporting pastimes – on musculoskeletal health must be understood. The Health of Adults’ Longitudinal Observational (HALO) study aims to explore the association between physical activity (including running) and other lifestyle factors on health and chronic disease, such as osteoarthritis (OA). This paper aims to examine the associations between running behaviour, prevalence and severity of joint symptoms and injury history. Methods: As part of the HALO study, recreational runners from across the United Kingdom and Australia have been recruited (n = 1345 runners, male = 563, female = 782, mean age = 47.3 years (range 18–81). Participants completed a questionnaire providing detail on demographics, health and wellbeing, occupational and recreational physical activity, injury, joint symptoms and OA. Differences between running groups were assessed using c2 test.
Results: The majority of participants considered themselves to be road runners (n = 970; 72.1%). Across all runners (road, trail, track, adventure racer, other) history of running ranged from 1 month – 67 years. 57.5% reported a history of injury (55.2% road; 60.9% trail; p = 0.12) and 13.2% have undergone joint surgery (12.9% road; 13.6% trail; p = 0.78). Overall, 17.5% had a clinical diagnosis of OA (15.2% road; 23.0% trail; p = 0.14), with the knee the most commonly affected joint. 30.4% reported a history of knee joint pain (28.6% road; 35.0% trail; p = 0.05), 12.9% morning stiffness (12.2% road; 14.4% trail; p = 0.38) and 29.9% joint crepitus (29.4% road; 32.5% trail; p = 0.35) persisting for one month or more. Discussion: Evidence supports the overall beneficial health effects of running, whilst greater joint loading has been hypothesised as a risk factor for OA onset and progression. Anecdotally, many believe that running on hard surfaces, such as tarmac, will be detrimental to the joints. Findings from the present study suggest that running on different terrain provides no significant effect on the incidence of knee symptoms. In contrast to much of the previous data in this area, this cohort includes many younger runners therefore the relatively high prevalence of knee pain and OA is of significant interest. http://dx.doi.org/10.1016/j.jsams.2016.12.067 64 Patellar cartilage status in people after ACL reconstruction: Influence of timing of return to sports and infrapatellar fat pad morphology A. Van Ginckel Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Australia Introduction: People after ACL reconstruction (ACLR) are at higher risk of knee osteoarthritis (OA). We showed that knee cartilage at 6 months post-ACLR has low in vivo resiliency when compared to controls, which may render the cartilage more vulnerable to dissipate repetitive high impact loads typically occurring during sports. Previous reports, however, have largely focussed on the tibiofemoral joint despite growing evidence indicating that the patellofemoral joint (PFJ) may also be a pertinent source of pathology and symptoms. Additionally, the infrapatellar fat pad (IPFP) is closely aligned to the PFJ and may show a variety of abnormalities following ACLR including oedema and scarring, all of which may affect the proper function of the knee. The purpose of this study was: (1) to compare patellar cartilage morphology and resiliency between ACLR patients and matched controls, (2) to explore associations between patellar cartilage status and timing of return to sports as well as IPFP morphology. Methods: Fifteen patients at 6 months from isolated ACL reconstruction were compared with 15 matched controls. A 3 T MRI evaluation was performed entailing morphological characteristics of cartilage and IPFP (3D volume/thickness, presence of scarring/oedema) and cartilage resiliency (after a 30-min run: in vivo deformation including recovery up to 54 min following exercise). Timing of return to sports was queried using researcher-designed questionnaires. Results: No significant differences existed between groups for patellar cartilage volume (p = 0.25) and thickness (p = 0.63). Similarly, patellar cartilage deformational behaviour and extent of recovery following the 30-min run appeared similar between groups (p = 0.52). Return at 5 months or sooner was associated with less recovery of patellar cartilage volumes following the exercise (at 30 min after exercise: rs = 0.79, p = 0.02). In patients, but not in controls, larger normalised IPFP volumes were associated with greater
60 Kinetic characteristics of kicking motion between football players with or without groin pain: From motion analysis of the instep kick K. Murakami 1,∗ , S. Miyazawa 2 , H. Nagamoto 3 1
Faculty of Sports Science, Sendai University, Japan Faculty of Health and Sports Science, University of Tsukuba, Japan 3 Department of Orthopaedic Surgery, Kurihara Central Hospital, Japan 2
Introduction: Although the incidence rate of groin pain among football players is said to be low, the treatment becomes challenging as it may become chronic once it develops. It has been reported that kicking motion relates to the groin pain. However, its mechanism is still unclear. The purpose of this study was to reveal the characteristic motion of kicking between football players with or without groin pain. Methods: Ten players with the history of groin pain in the past year (GP group) and ten players without the history of groin pain (NP group) were included in the study. All the players kicked the ball 3 times to the target, which was 10 m away. Kicking motion was analyzed by 3D motion analysis (Vicon T020×10; 250 Hz) and mutually-synchronized force plate (Kistler×1; 1000 Hz), used motion analyzing software SIMM6.0. Analyzing interval was from the maximum hip extension (MHE) of the kicking leg through the foot contact (FC) of the pivot leg to the ball impact (BI) of the kicking leg. Results: The maximum flexion torque of the hip from MHE to BI in the kicking leg was not significant between the GP and the NP group. However, maximum knee extension torque to BI of the kicking leg in the GP group (164.1 ± 46.1 N/kg) was significantly higher than that of the NP group (113.3 ± 90.3 N/kg). Relative rotation angle of the upper and lower trunk in the GP group (9.1 ± 6.4◦ ) was significantly smaller than that of the NP group (19.2 ± 5.7◦ ). Average speed of the translation direction of the body mass center was significantly smaller in the GP group (during FC – BI 3.0 ± 0.3 m/s) than that of the NP group (during FC – BI 3.2 ± 0.3 m/s). Discussion: The distinctive point about instep kick in the GP group was that it depended on knee extension torque of the kicking leg and the rotation angle of the upper and lower trunk was less compared to the NP group. In addition, decreased average speed of FC to BI phase was observed compared to TO to FC phase, although average speed of the same phase increased in the NP group. These results may suspect that the groin pain occurrence may have a relationship with kinetic stress of the knee extensors, and motion depending on the kicking leg because of ineffective motion and decreased speed.
e27
clinicians to use mobile applications to objectively assess postural sway using convenient low cost methods. The SWAY Balance Application (SWAY) is one example which provides scores ranging from 0 to 100 (higher scores indicating better balance). Previous validations of SWAY utilised only anterior-posterior accelerations; however, validation of the current version of SWAY, which utilises all three axes of the device’s accelerometer are lacking. Therefore, the purpose of the present study was to compare SWAY scores, with force plate-derived measures of postural sway (centre of pressure (CoP) path length (PL) and CoP 95% confidence ellipse area (95% CEA)). Methods: Twenty recreationally active adults (15 females; 33.1 ± 8.0 years, 26.1 ± 3.7 kg m−2 ) completed a Modified Balance Error Scoring System (mBESS) test on a force plate while simultaneously recording postural sway using SWAY on an iPhone6. Pearson’s correlations examined the relationship between CoP PL, CoP 95% CEA, and SWAY score for each of the five mBESS tasks. Results: For Double Limb Stance task, non-significant weak negative relationships were observed between SWAY score and CoP PL, and between SWAY score and CoP 95% CEA (r = −0.25 and −0.17, respectively). For Tandem Stance tasks, moderate-to-strong negative correlations between SWAY score and CoP PL, and between SWAY score and COP 95% CEA were observed (r = −0.62 to −0.92, p < 0.05). Similarly for Single Leg Stance tasks, moderate-to-strong negative relationships were observed between SWAY score and CoP PL, and between SWAY score and COP 95% CEA (r = −0.76 to −0.86, p < 0.05). Discussion: For the majority of mBESS tasks, significant moderate-to-strong negative relationships were observed between SWAY scores and force-plate derived measures of postural sway; such that as SWAY scores increased (indicating better balance), force-plate derived measures of postural sway decreased (also indicating better balance). The weak negative relationships between SWAY scores and force-plate derived measures of postural sway during the Double Limb Stance task, are likely due to a ‘ceiling effect’, with participants achieving a maximal or near maximal SWAY score (>95). Overall, this study suggests SWAY is a valid tool for measuring postural sway during more challenging balance tasks. Whether SWAY is sufficiently sensitive to detect clinically important differences is unknown and more research is required. http://dx.doi.org/10.1016/j.jsams.2016.12.065 62 Distinct cut task strategy in Australian football players with a history of groin pain S. Edwards 1,∗ , H. Brooke 2 , J. Cook 3 1
The University of Newcastle, Australia Charles Sturt University, Australia 3 La Trobe University, Australia 2
http://dx.doi.org/10.1016/j.jsams.2016.12.064 61 Assessment of postural sway using smartphone technologies: Comparison with force plate measures C. Kean ∗ , M. Hayman, T. Doering, R. Stanton School of Medical and Applied Sciences, Central Queensland University, Australia Background: Assessment of postural sway is an important functional outcome. However, in clinical settings, assessment of postural sway is often subjective, and reliant on observer experience. Recent innovations in smartphone technology allows
Introduction: Acute groin injuries are the leading overuse injury in Australian football with a high incidence and recurrence rate. This injury has been associated in sports with sudden changeof-direction, and rapid acceleration and deceleration. Whilst the importance of adequate change-of-direction strategies has been investigated in other sports and knee joint injuries, no research was located to help identify movement patterns that may predispose players to groin injury. By exploring if change-of-direction techniques differ in players with and without a history of groin pain, clinicians may be able to intervene and decrease the risk of groin injury. This study aimed to explore the differences in the strategies utilised during unanticipated change-of-direction movement between players with and without a history of groin pain.
e28
Abstracts / Journal of Science and Medicine in Sport 20S (2017) e2–e31
Methods: Male Australian football players either with (HISTORY; n = 7) or without (CONTROL; n = 10) a history of groin pain performed 10 successful trials of an unanticipated change-ofdirection task with a defensive opponent and 5 maximal isokinetic hip abduction-adduction contractions. Three-dimensional ground reaction forces (GRF) and kinematics were recorded during the change-of-direction task. The weight acceptance phase was defined from initial contact (IC) when the vertical GRF exceeded 10 N, to the first local minimum (FWA ) after peak vertical GRF (FV ). Any between-group differences were determined using independentsamples t-tests and a Bayesian approach (precision of estimation and magnitude-based inferences). Moderate or large effect sizes (d) were defined as substantial changes to enable a more informative inferential assertions regarding magnitude. Results: There were substantial between-group differences for majority of the variables including HISTORY group displaying decreased knee flexion (d: IC 0.91, FV 0.61, FWA 0.78) and hip internal rotation (d: IC 0.74, FV 0.87, FWA 0.94), increased knee internal rotation (d: IC 0.86, FV 0.75, FWA −0.95) and T12-L1 right rotation (d: IC 1.17, FV 0.99, FWA 0.78), and higher GRFs (d: FV 0.52, FWA 0.82, FPOST 0.50), and decreased right adductor/abductor muscle strength ratio (d: 0.78). Discussion: Weak hip adductor muscular strength may have served as a precursor for the impaired ability of the HISTORY group to control lower limb function and alignment while executing the change-of-direction task. They also utilised decreased hip internal rotation, which is associated with groin injury and increased demands on the pubic symphysis. This provides evidence to support current rehabilitation methods of improving hip adduction-abduction muscular imbalances, and suggests the inclusion of lower limb alignment and control during a change-ofdirection task within rehabilitation. http://dx.doi.org/10.1016/j.jsams.2016.12.066 63 The joint health of recreational runners – An analysis of symptoms, injury history and osteoarthritis R. Leech 1,∗ , K. Flatters 1 , M. Batt 2 , K. Edwards 1 1
University of Nottingham, Arthritis Research UK Nottingham University Hospitals, Arthritis Research UK 2
Introduction: Running is becoming increasingly popular. Over 3 million individuals in England participate in athletics on a monthly basis whilst an equivalent percentage of the Australian population (7.4%) run or jog regularly. The importance of emphasising and encouraging an active lifestyle is critical within the wider societal context. Thus, the effect of running – one of the most easily accessible sporting pastimes – on musculoskeletal health must be understood. The Health of Adults’ Longitudinal Observational (HALO) study aims to explore the association between physical activity (including running) and other lifestyle factors on health and chronic disease, such as osteoarthritis (OA). This paper aims to examine the associations between running behaviour, prevalence and severity of joint symptoms and injury history. Methods: As part of the HALO study, recreational runners from across the United Kingdom and Australia have been recruited (n = 1345 runners, male = 563, female = 782, mean age = 47.3 years (range 18–81). Participants completed a questionnaire providing detail on demographics, health and wellbeing, occupational and recreational physical activity, injury, joint symptoms and OA. Differences between running groups were assessed using c2 test.
Results: The majority of participants considered themselves to be road runners (n = 970; 72.1%). Across all runners (road, trail, track, adventure racer, other) history of running ranged from 1 month – 67 years. 57.5% reported a history of injury (55.2% road; 60.9% trail; p = 0.12) and 13.2% have undergone joint surgery (12.9% road; 13.6% trail; p = 0.78). Overall, 17.5% had a clinical diagnosis of OA (15.2% road; 23.0% trail; p = 0.14), with the knee the most commonly affected joint. 30.4% reported a history of knee joint pain (28.6% road; 35.0% trail; p = 0.05), 12.9% morning stiffness (12.2% road; 14.4% trail; p = 0.38) and 29.9% joint crepitus (29.4% road; 32.5% trail; p = 0.35) persisting for one month or more. Discussion: Evidence supports the overall beneficial health effects of running, whilst greater joint loading has been hypothesised as a risk factor for OA onset and progression. Anecdotally, many believe that running on hard surfaces, such as tarmac, will be detrimental to the joints. Findings from the present study suggest that running on different terrain provides no significant effect on the incidence of knee symptoms. In contrast to much of the previous data in this area, this cohort includes many younger runners therefore the relatively high prevalence of knee pain and OA is of significant interest. http://dx.doi.org/10.1016/j.jsams.2016.12.067 64 Patellar cartilage status in people after ACL reconstruction: Influence of timing of return to sports and infrapatellar fat pad morphology A. Van Ginckel Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Australia Introduction: People after ACL reconstruction (ACLR) are at higher risk of knee osteoarthritis (OA). We showed that knee cartilage at 6 months post-ACLR has low in vivo resiliency when compared to controls, which may render the cartilage more vulnerable to dissipate repetitive high impact loads typically occurring during sports. Previous reports, however, have largely focussed on the tibiofemoral joint despite growing evidence indicating that the patellofemoral joint (PFJ) may also be a pertinent source of pathology and symptoms. Additionally, the infrapatellar fat pad (IPFP) is closely aligned to the PFJ and may show a variety of abnormalities following ACLR including oedema and scarring, all of which may affect the proper function of the knee. The purpose of this study was: (1) to compare patellar cartilage morphology and resiliency between ACLR patients and matched controls, (2) to explore associations between patellar cartilage status and timing of return to sports as well as IPFP morphology. Methods: Fifteen patients at 6 months from isolated ACL reconstruction were compared with 15 matched controls. A 3 T MRI evaluation was performed entailing morphological characteristics of cartilage and IPFP (3D volume/thickness, presence of scarring/oedema) and cartilage resiliency (after a 30-min run: in vivo deformation including recovery up to 54 min following exercise). Timing of return to sports was queried using researcher-designed questionnaires. Results: No significant differences existed between groups for patellar cartilage volume (p = 0.25) and thickness (p = 0.63). Similarly, patellar cartilage deformational behaviour and extent of recovery following the 30-min run appeared similar between groups (p = 0.52). Return at 5 months or sooner was associated with less recovery of patellar cartilage volumes following the exercise (at 30 min after exercise: rs = 0.79, p = 0.02). In patients, but not in controls, larger normalised IPFP volumes were associated with greater