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Groin Injuries Among Football Players DISSERTATION from the NORWEGIAN SCHOOL of SPORT SCIENCES 2018

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Groin Injuries Among Football Players DISSERTATION from the NORWEGIAN SCHOOL of SPORT SCIENCES 2018 Joar Harøy // Groin injuries among football players among football injuries // Groin Joar Harøy DISSERTATION FROM THE NORWEGIAN SCHOOL OF SPORT SCIENCES 2018 Joar Harøy Groin injuries among football players - A substantial but preventable problem Joar Harøy Groin injuries among football players - A substantial but preventable problem DISSERTATION FROM THE NORWEGIAN SCHOOL OF SPORT SCIENCES • 2018 ISBN 978-82-502-0562-8 No individual can win a game by himself. Pelé Table of Contents Acknowledgements .................................................................................................................................. I List of publications .................................................................................................................................. III Summary ................................................................................................................................................ IV Sammendrag på norsk ............................................................................................................................ VI Abbreviations ....................................................................................................................................... VIII Background .............................................................................................................................................. 1 What is a groin injury?......................................................................................................................... 1 Anatomical overview ........................................................................................................................... 2 Which structures are injured? ............................................................................................................. 3 Sequence of prevention ...................................................................................................................... 7 Groin injury epidemiology in football players ..................................................................................... 8 Male football ................................................................................................................................. 11 Female football .............................................................................................................................. 12 Groin injuries - more than missing training or matches ................................................................ 12 Risk factors for groin injury in football .............................................................................................. 13 Non-modifiable risk factors ........................................................................................................... 15 Modifiable risk factors ................................................................................................................... 16 Muscle and tendon response to strength training ............................................................................ 18 Prevention of groin injuries in football ............................................................................................. 20 Different strategies, but no clear effect on groin injury rates ...................................................... 22 Exercise selection .......................................................................................................................... 22 Compliance with the exercise programmes .................................................................................. 25 Aims of the thesis .................................................................................................................................. 27 Methods ................................................................................................................................................ 28 Design, participants and interventions ............................................................................................. 28 Groin problems among Norwegian football players (Paper I) ...................................................... 28 Strength and sprint effects of the FIFA 11+ (Paper II) ................................................................... 28 Prevention of groin problems among male football players (Paper III) ........................................ 29 Attitudes and beliefs about groin injuries (Paper IV) .................................................................... 30 Data collection methods ................................................................................................................... 30 Statistical analyses ............................................................................................................................. 33 Research ethics .................................................................................................................................. 35 Results ................................................................................................................................................... 36 Groin problems among Norwegian football players (Paper I) .......................................................... 36 Strength and sprint effects of the FIFA 11+ (Paper II) ....................................................................... 37 Prevention of groin problems among male football players (Paper III) ............................................ 39 Implementation of the Adductor Strengthening Programme (Paper IV).......................................... 41 Discussion .............................................................................................................................................. 43 Weekly prevalence of groin problems .............................................................................................. 43 What is a groin problem, and what are we preventing? ................................................................... 44 Why does the Adductor Strengthening Programme reduce the risk of groin problems? ................ 45 Methodological considerations ......................................................................................................... 49 Future implementation of the Adductor Strengthening Programme ............................................... 51 Conclusions ............................................................................................................................................ 53 References ............................................................................................................................................. 54 Acknowledgements I am grateful for the opportunity to do my PhD at Oslo Sports Trauma Research Center and the Department of Sports Medicine at the Norwegian School of Sports Sciences. I am forever thankful for the hard work from many people involved in this project. First and foremost, I would like to thank my supervisors Professor Roald Bahr, MD PhD and Professor Thor Einar Andersen, MD PhD. Roald, your knowledge in sports medicine is impressive and it has been a privilege learning from you the last years. Several times, you have guided me out of ‘impossible’ challenges after a short clarifying talk. You have encouraged me to work hard, deliver in time and be critical. Thanks for always sharing your great knowledge and introducing me to great researchers and colleagues around the world. Thor Einar, you introduced me to this field. Learning from your experience in sports medicine has been inspiring and I look forward to continue learning from you in the clinical practice. I am thankful for the doors you have opened at Idrettens Helsesenter and with the national team. Finally, your personal qualities cannot be emphasised enough and I appreciate your warm care for my family and me. Ben Clarsen, your first-hand experience with the injury registration method has been crucial. I appreciate that you, even during busy times, have taken time to explain and sort out both methodological and technical issues. Per Hölmich, Kristian Thorborg and Andreas Serner, our Danish collaborators and co-authors on three of the papers. Although our first meeting in London in 2015 was bit of a shock for a fresh PhD student, I am grateful for your involvement in the project. Thanks for your critical and often demanding input. Your knowledge and experience in the groin-research field have been decisive for the outcome of this project. I hope we will continue working together in the future. A special thanks to physiotherapists, Marianne Lislevand, Kenneth Hammond Rosbach, Kevin Nordanger Martin, Even Eide Eriksen, Anders Megård and Arve Næss Kjøsnes, which all took part in the different data collections. Also to the master students involved, Linn Rolstad-Martinez, Mari Glomnes Øyen, Espen Guldahl Wiger and André Bjørkheim. I am impressed with your positive attitude, especially in busy times, when I have been overloading you with work. Thank you to all my colleagues and friends at SIM for creating a workplace I have been looking forward to coming to every day. In particularly, Kam-Ming Mok for the warm welcome and Stig Haugsbø Anderson for having walked the path for me with the Handball project. I hope that we will I have more time for a beer in the future. Sigmund Andersen, thank you for being the enthusiastic leader (and football supporter) you are. Tone Rasmussen Øritsland and Solveig Sunde, thanks for always being positive and helping with practical issues. Finally, Inge
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