As part of our continuing effort to service and educate our membership, each Thursday U.S. Soccer will provide an informative article from one of its departments. Once a week, we will bring you an article/paper/essay that will hopefully enhance your enjoyment and knowledge of the game of soccer - on and off the field.
This month, Dr. Donald T. Kirkendall, who works with U.S. Soccer’s National Teams, examines the prevention of groin injuries.
Preventing Groin Injuries
The typical groin strain is a common injury in soccer, which is why players stretch these muscles as a part of their pre-game routine. U.S. Men’s National Team players Tony Sanneh and Claudio Reyna have missed playing time with this injury, and most recently Ante Razov has been sidelined as well. The injury is not unique to soccer, however, as athletes in many other sports, including ice hockey, often suffer from this injury.
In soccer players, groin strains are often a result of rapid changes of speed/direction or reaching to the side to make a tackle. In ice hockey, groin injuries are common because of the diagonal stride in skating puts the groin (or adductor) muscles under strain. Many sports require quick changes of direction and/or bursts of speed, and these are the leading causes of groin injuries.
While treating these injuries is a major focus of sports medicine, prevention of injuries is also an important goal. Before preventing injuries, it is important for doctors to know how the injury occurs. The next step is to examine the difference of the muscles and joints between the athletes who are injured and those who are not.
The doctors at the Lennox Hill Hospital in New York City have been studying adductor injuries for a number of years.
Lennox Hill’s team of doctors chose to focus their study on a large group of professional hockey players. The doctors measured flexibility and strength of the hip on each player initially and then charted their groin injuries over two seasons. After this period, the researchers reviewed their data to see if there were any differences between the injured and uninjured players.
There was no difference between groups when comparing flexibility, but the injured players had remarkably lower adduction strength. Does that mean all that time spent stretching the groin is ineffective?
Not necessarily, it is probably a combination of strength and flexibility. Professional ice hockey players seemed to be very flexible, making it appear that poor groin strength was a major factor is predicting groin injuries.
The next step the Lennox Hill team took was to devise a training program to improve groin strength. The three-step process included a warm-up, strengthening and some ice hockey specific exercises.
1. Warmup: stationary cycling, groin stretching, sumo squats, side lunges, kneeling pelvic tilts
2. Strengthening: ball squeezes with different size balls, concentric adduction against gravity, cable/elastic standing adduction, seated adduction machine, slide board forward, slide board with simultaneous adduction (spread legs and bring both together at the same time), one-legged lunges
3. Ice hockey specific: on-ice kneeling adductor pull-togethers, cable cross-over pulls, slide skating, cable resisted striding.
Over the next two years, 58 players followed the program. Based on pre-training tests, 33 players were classified as being at risk of a groin injury due to low adductor strength. The injury rate of these players fell more than 400 percent – from 3.2/1,000 game-exposures the two years before to .7/1,000 game-exposures during the prevention phase. That is a huge reduction in groin injuries.
Most coaches encourage flexibility work on the groin area, but need to add some adductor strengthening to their work. Players must take some responsibility by preparing for the season by strengthening these muscles using some of the exercises listed above, or other groin-specific exercises.
In addition to the weeks it can take for these injuries to heal, athletes often do not realize how much these muscles are used in day-to-day activities until they suffer this injury.
The research by the Lennox Hill team clearly shows that flexibility and strength reduce the risk of groin injuries, which should encourage every player to take all recommended steps toward prevention.
Questions can be directed to Hughie O'Malley, U.S. Soccer's Manager of Sports Medicine Administration. Hughie can be reached at email@example.com or at (312) 528-1225.
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