Pelvic kinematics during single-leg drop-landing in sports participants with chronic groin pain

Janse van Rensburg, Lienke (2014-04)

Thesis (MScPhysio)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Introduction: Chronic groin injuries are common among athletes and have the potential to lead to chronic and career-ending pain. There is no evidence available whether pelvic kinematics can be perceived as a risk factor in developing chronic groin pain in sport or be the cause of further injuries of the lower quadrant or lumbar spine. Objective: The purpose of this study was to determine if there are any differences in pelvic kinematics of active sports participants with chronic groin pain compared to healthy controls during a single-leg drop-landing. Methodology: A descriptive study was conducted. The three-dimensional (3D) pelvic kinematics of ten cases with chronic groin pain and ten asymptomatic controls was analyzed. Pelvic kinematics was analyzed at the FNB 3D Vicon Laboratory at Stellenbosch University using an eight camera Vicon system. A physical examination, including functional movements, posture analysis, hip, knee and ankle passive range of motion measurements, sacro-iliac tests and anthropometric measurements was done by two physiotherapists prior to the 3D analysis. To analyze the pelvic kinematics, each participant performed six single-leg drop-landings. The main outcome measure was 3D pelvic kinematics at initial foot contact (IFC) and foot contact at lowest vertical position (LVP). The following sub-groups were analyzed: seven with unilateral groin pain and three with bilateral groin pain; the latter was further divided into those with the most painful leg and the least painful leg. Mean and standard deviations (SD) for pelvic kinematics were calculated and significant differences between sub-groups were determined using two-tailed Student’s t-tests. The Cohen’s D effect size calculator was used to calculate the effect size of significant differences in pelvic kinematics between case and control groups. Results: The findings indicated a significant difference (p=0.03) in frontal plane pelvic kinematics at IFC for the unilateral group. The most painful groin group showed significant differences at IFC (p=0.004) and at LVP (p=0.04) in the frontal plane pelvic kinematics. The least painful groin group showed a significant difference at LVP (p=0.01). All cases landed with pelvic downward lateral tilt during the landing phase compared to matched controls. The groin pain group with bilateral pain showed significant differences at IFC (p < 0.001) and LVP (p=0.005) for the most painful groin; and the least painful groin at IFC (p=0.01) and LVP (p=0.01) in the sagittal plane pelvic kinematics. The bilateral groin pain group showed an increase of anterior pelvic tilt in the sagittal plane during the landing phase when compared to matched controls. Increased internal pelvic rotation in the transverse plane was significant for the unilateral group at IFC (p=0.04) and for the most painful groin group at IFC (p < 0.001) and LVP (p < 0.001) compared to matched controls. Conclusion: Results from this study shows that pelvic kinematic changes in the frontal, sagittal and transverse planes do occur in patients with chronic groin pain when compared to controls. This may imply that muscle weakness around the hip and pelvis may contribute to the development of chronic groin pain in active sports participants. Rehabilitation of these muscles should be taken into consideration when treating patients with chronic groin injuries. Further research should be focused on muscular recruitment patterns in sports participants with groin pain to critically define the muscular causal factors in more depth.

AFRIKAANSE OPSOMMING: Inleiding: Kroniese lies beserings is ‘n algemene verskynsel onder die aktiewe sport populasie. Dit mag tot kroniese pyn lei en het die potensiaal om ‘n sport loopbaan te be-eindig. Tans, is daar geen verdere navorsing beskikbaar oor die invloed van bekken kinematika op onderste ledemaat beserings asook die moontlike oorsaak tot kroniese lies pyn in atlete nie. Oogmerk: Die doel van hierdie studie was om vas te stel watter verskille in die bekken kinematika ontstaan tussen aktiewe sport deelnemers met kroniese lies pyn teenoor aktiewe sport deelnemers sonder enige pyn of beserings tydens ‘n enkel been aftrap beweging. Metodologie: Tien deelnemers met kroniese lies pyn en tien asimptomatiese deelnemers is gebruik om die verskille tussen die 3D bekken kinematika te bepaal. Die FNB 3D Vicon Lab by die Stellenbosch Universiteit is gebruik vir die data analise en insameling. Deelnemers het ‘n fisiese ondersoek ondergaan wat die voglende ingesluit het: funksionele bewegings, postuur analise, omvang van beweging van die heup, knie en enkel, toetse ter uitsluiting van die ilio-sakrale gewrig asook antropometriese aftmetings. Elke deelnemer is versoek om ses enkel-been aftrap sessies te doen. Die hoof uitkomsmeting was die bekken hoeke in the frontale vlak by inisiële voet kontak (IVK) asook die voet kontak teen die laagste vertikale posisie (LVP). Resultate: Die resultate wys ’n beduidende verskil (p=0.03) in die frontale vlak vir bekken kinematika by IVK vir die unilaterale groep. Die mees geaffekteerde been wys ’n beduidende verskil by IVK (p=0.004) en by LVK (p=0.04) in die frontale vlak vir bekken kinematika. Die groep met die minste geaffekteerde been toon ’n beduidende verskil by LVP (p=0.01). Alle simptomatiese deelnemers het met die bekken in afwaartse bekken kanteling geland tydens die landings fase. Die groep met bilaterale pyn toon ’n beduidende verskil by IVK (p < 0.001) en by LVP (p=0.005) vir die mees geaffekteerde been en vir die minste geaffekteerde been by IVK (p=0.01) en LVP (0.01) in die sagittale vlak vir bekken kinematika. Die bilaterale groep met kroniese lies pyn land met meer anterior bekken kanteling in die sagittale vlak gedurende die landings fase teenoor die asimptomatiese groep. Interne bekken rotasie was beduidend meer vir die unilaterale groep by IVK (p=0.04) en vir die mees geaffekteerde been by IVK (p < 0.001) en LVP (p < 0.001) teenoor asimptomatiese deelnemers. Gevolgtrekking: Die resultate van hierdie studie bewys dat daar wel ‘n verskil is in die bekken kinematika van deelnemers met kroniese lies pyn teenoor asimptomatiese deelnemers. Hierdie verskille is waarneembaar in die frontale, sagittale en transverse vlakke. Dit impliseer dat spier swakheid van die bekken en heup spiere ‘n bydrae mag he tot die ontwikkeling van kroniese lies beserings in atlete. Rehabilitasie van bogenoemde spiere is belangrik in die behandeling van kroniese lies beserings. Verdere navorsing oor spier aktiverings patrone in aktiewe, sports deelnemers met kroniese lies pyn word benodig, om die oorsprongs faktore te ondersoek.

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