THE EFFECT OF A CORE STRENGTHENING PROTOCOL ON PROFESSIONAL ATHLETES UNDERGOING SURGICAL TREATMENT FOR ATHLETIC PUBALGIA: ANALYSIS OF 100 CASES

C. Koutserimpas¹, K. Raptis¹, A. Kosmopoulos², T. Vikatou², G. Georgoudis^3,2

¹“251” Hellenic Air Force General Hospital of Athens, Department of Orthopaedics and Traumatology, Athens, Greece, ²Physiopain Group, Pain Management & Rehabilitation Clinics, Athens - Pireaus, Greece, ³University of West Attica, Musculoskeletal Physiotherapy Research Laboratory, Athens, Greece

Background: Athletic pubalgia is an obscure sports injury, presenting mainly with groin pain during twisting movements.

Purpose: The purpose of the study was to evaluate a core-strengthening protocol in the rehabilitation of professional athletes undergoing surgical treatment of pubalgia, in comparison to non-athletes undergone a similar laparoscopic surgery without attending any rehabilitation protocol.

Methods:A total of 100 consecutive professional athletes (group1) suffering from athletic pubalgia were laparoscopically treated, during an 8-year period. The Total Extra-Peritoneal technique with mesh-placement was employed followed by a 3-week core-strengthening rehabilitation protocol. During the first week, patients resumed their daily activities and increased their walking. In the second week, they progressed to mildly resistive activities, including pool-walking, standing hip-abduction, flexion, extension and heel rises, combined with stretching. During the third week, loading was further increased in all movements, using 1,5 kg increments, and also pool exercises (e.g. running backwards, side-slides, scissors), jogging (at least 0.5 km), advanced strengthening exercises (e.g. Stairmaster, mild sprinting and upper body exercises). A control-group of 100 non-athlete patients (group2) treated laparoscopically for pubalgia without attending a rehabilitation protocol were included in the study. The outcome measures used were: the pain post-operatvely, the return to previous routine (training for group1 / usual everyday routine for group2) and patients’ satisfaction. Pain was evaluated using a VAS scale on the day before the surgery (t1), after the surgery (48hrs post-op) (t2), in 3 weeks (t3) and in 4 months (t4). Patients' satisfaction was estimated on a 7-point likert scale (-3:most unsatisfied to +3: most satisfied) at t2, t3 and t4. Mean time to return to sports activity/everyday routine was measured at t4. The repeated-measures ANOVA, Chi-square test and paired t-test were employed to assess pain, patients' satisfaction and mean-time to return to sports/work, respectively. Statistical significance was set at p<0.05.

Results: The mean age of group1 was 26.7+3.7 and 43.6+10.2 years for group2, respectively. Between-groups comparisons showed: 1. Pain pre- and postoperatively (t1 and t2) were non-significant (NS). At t3, group1 described significantly less pain (F-value: 7.243, df: 2,98, p<0.002) which remained significant at 4 months-(t4) (F:3.312, df: 2,98, p<0.05), 2. Patients' satisfaction was NS at t2 but reached significance at t3 (x²:130.86, df:98, p<0.05) and t4 (x²:132.98, df:98, p<0.05), 3. The mean time to return to sports activity was found to be 6.27 weeks (SD=3.02) for group1 and 8 weeks (SD= 4.2) for group2 (paired t-test, p<0.001).

Conclusions: The present study has shown that a 3-week strengthening protocol after a laparoscopic pubalgia surgery reduces pain significantly and patients are more satisfied at 3 weeks and 4 months post-operatively. The rehabilitation protocol showed also a diminished time interval for the patients to reach usual functionality (training for the athletes and routine activities for the non-athletes). One has to consider possible additional confounding factors that may have an important role to play in a subgroup patients athletes or non-athletes.

Implications: This study implicates the need for tailored and detailed rehabilitation strengthening protocols for professional athletes undergoing surgery for pubalgia, as compared to non-athlete controls.

Funding acknowledgements: N/A

Keywords:
Post-operative rehabilitation pubalgia
Strengthening post-operatively
Athletic injury rehabilitation protocol

Topics:
Musculoskeletal
Pelvic, sexual and reproductive health
Sport & sports injuries

Did this work require ethics approval? Yes

Institution: National & Capodistrian University of Athens (EKPA)

Committee: ETHICAL COMMITTEE of EKPA

Ethics number: 83/ 5-6-2019