Booysen N.C.L.1,2, Warner M.1,2, Gimpel M.3, Comerford M.4, Mottram S.4, Stokes M.1,2
1University of Southampton, Faculty of Health Sciences, Southampton, United Kingdom, 2Arthritis Research UK, Centre for Sport, Exercise and Osteoarthritis, Southampton, United Kingdom, 3Southampton Football Club, Southampton, United Kingdom, 4Movement Performance Solutions, Bristol, United Kingdom
Background: Hip and groin pain are common in footballers, accounting for 5-15% of injuries. It is suggested that Femoroacetabular Impingement (FAI) is a major cause of this pain. Physical demands placed on hip joints during critical stages of development place young people at risk of abnormalities consistent with FAI, a precursor of hip osteoarthritis (OA). A high percentage (72%) of footballers have FAI morphological changes, which are not always associated with pain. There may be a link between FAI and altered movement, so movement screening may be useful for characterising abnormalities in footballers to inform interventions. However, no studies have investigated movement abnormalities of the hip that specifically inform exercise programmes for improving movement quality to reduce the risk of developing FAI (symptomatic or asymptomatic) and later OA.
Purpose: To establish the ability to control lower limb movement in young male footballers during a Hip and Lower Limb Movement Screen, informing exercise interventions to improve movement quality.
Methods: Thirty-six academy footballers at a Premiership Football Club, aged 9-18 years were studied using convenience sampling. A Hip and Lower Limb Movement Screening tool was developed to assess movement patterns. The screen includes seven tests: a small knee bend (SKB), SKB with trunk rotation, deep squat, standing and sitting hip flexion to 110° and side-lying hip abduction with the leg laterally and then medially rotated. The investigator observes movements during the tests and grades movement control against benchmark criteria.
Results: Altered movement patterns were observed during all seven tests compared to the benchmark but were most marked during the SKB, deep squat and hip abduction with lateral rotation tests. Participants were unable to control hip flexion for one or more criteria of hip control. The movement faults indicating poor hip flexion control during the SKB test were: trunk leaning forwards (56% of footballers demonstrated this fault bilaterally) and anterior pelvic tilt (44% on right side; 53% left). Further evidence of poor hip flexion was seen in the deep squat test, with 75% presenting with the trunk leaning forwards and 44% with anterior pelvic tilt. During the hip abduction with lateral rotation test, the footballers could not control the movement bilaterally, with abnormal movements of backward pelvic rotation (75% right; 69% left) and hip flexion (78% right; 64% left).
Conclusion(s): Young academy footballers showed altered movement patterns on all seven tests but most noticeably during the SKB, deep squat and hip abduction with lateral rotation tests. The main movement abnormality identified was the inability to control hip flexion during these tests. Although altered movements were marked in three of the seven tests, further research is needed to establish the relationships between tests and whether all seven are needed to screen footballers.
Implications: Identifying movement patterns may inform exercise interventions and correcting movement abnormalities in footballers may be key to effectively prevent and manage hip and groin symptoms. Furthermore, improving movement quality may alter hip joint loading, reducing the likelihood of joint damage, FAI (symptomatic or asymptomatic) and OA developing, leading to a longer active lifestyle.
Funding acknowledgements: National Institute of Health Research (UK); Solent NHS Trust & Health Education Wessex Internships (Southampton, UK); Arthritis Research UK.
Topic: Human movement analysis
Ethics approval: Study was reviewed and approved by the Faculty of Health Sciences at the University of Southampton (ethics approval number: FoHS_ETHICS_5802).
All authors, affiliations and abstracts have been published as submitted.
