Risikofaktoren für Leistenschmerzen in den Sportspielen: Eine systematische Literaturrecherche

Zusammenfassung

Hintergrund In den Sportspielen kommen Leistenschmerzen relativ häufig vor und können zu wiederholten längeren Ausfallzeiten führen. Daher sind Kenntnisse über geeignete evidenzbasierte Präventionsmaßnahmen wichtig. Ziel dieser systematischen Literaturrecherche war es, den Einfluss von Risikofaktoren und Präventionsprogrammen auf Leistenschmerzen in den Sportspielen gemäß internationalen Richtlinien zu untersuchen und methodisch nachvollziehbar nach ihrer Evidenz einzuordnen.

Methoden Die systematische Literaturrecherche erfolgte gemäß der PRISMA-Richtlinien in den elektronischen Datenbanken PubMed, Web of Science und SPOLIT mittels eines PICO-Schemas. Eingeschlossen wurden sämtliche Interventions- und Beobachtungsstudien, die den Einfluss von Risikofaktoren und Präventionsprogrammen auf Leistenschmerzen in den Sportspielen untersucht haben. Zur Überprüfung der methodischen Qualität wurde die PEDro-Skala genutzt. Ferner wurde jeder Studie ein Evidenzlevel nach dem OCEBM-Modell zugeordnet. Nach der Synthese der Ergebnisse anhand der Studienquantität und -qualität sowie des Evidenzlevels erfolgte eine Einordnung des Evidenzniveaus der Risikofaktoren.

Ergebnisse Eine moderate Evidenz konnte für 4 Risikofaktoren mit einem signifikanten Einfluss auf das Leistenschmerzrisiko gefunden werden: männliches Geschlecht, vorangegangene Leistenschmerzen, geringere Kraft der Hüftadduktoren und die Nichtdurchführung des FIFA 11+ Kids. Ebenfalls konnte eine moderate Evidenz für folgende nichtsignifikanten Risikofaktoren gefunden werden: höheres Alter, Körpergröße und -gewicht, höherer BMI, Körperfettanteil, Spielposition, dominantes Bein, Trainingsstunden, eingeschränkte ROM der Hüftabduktion, -adduktion, -extension, -flexion und -innenrotation, Kraft der Hüftflexoren, Kräftigung der Hüftabduktoren, -adduktoren, -flexoren und Bauchmuskulatur sowie Balancetraining, klinische Hüftmobilitätstests und konditionelle Faktoren.

Schlussfolgerung Die identifizierten Risikofaktoren können als Anhaltspunkte für die Entwicklung von Präventionsmaßnahmen zur Vermeidung von Leistenschmerzen in den Sportspielen dienen. Dabei sollten im Sinne einer Priorisierung nicht nur die signifikanten, sondern auch die nichtsignifikanten Risikofaktoren reflektiert werden.

Abstract

Background In sports games, epidemiological data show that groin pain is relatively common and can lead to repeated loss of time. Consequently, it is essential to be aware of the evidence-based prevention strategies. The aim of this systematic review was to examine risk factors and prevention strategies for groin pain and to rank them based on their evidence in sports games.

Methods The review was conducted according to the PRISMA guidelines, using a PICO-scheme in the PubMed, Web of Science and SPOLIT databases. We included all available intervention and observational studies on the influence of risk factors and prevention strategies on groin pain in sports games. The methodological quality and level of evidence was assessed using the PEDro-Scale and OCEBM model, respectively. Finally, the quantity, quality and level of evidence was used to rank each risk factor for its grade.

Results Moderate evidence was found for four risk factors that significantly influence the risk of groin pain: male sex, previous groin pain, hip adductor strength and not participating in the FIFA 11+ Kids. Moreover, moderate evidence was found for the following non-significant risk factors: older age, body height and weight, higher BMI, body fat percentage, playing position, leg dominance, training exposure, reduced hip abduction, adduction, extension, flexion, and internal rotation-ROM, hip flexor strength, hip abductor, adductor, flexor and core strengthening with balance exercises, clinical hip mobility tests and physical capacities.

Conclusion The identified risk factors can be considered when developing prevention strategies to reduce the risk of groin pain in sports games. Thereby, not only the significant, but also the non-significant risk factors should be considered for prioritisation.

Schlüsselwörter

Fußball - Handball - Leistenverletzungen - Prävention - Rehabilitation - Tennis

Keywords

football - handball - groin injuries - prevention - rehabilitation - tennis

Publication History

Received: 26 January 2022

Accepted after revision: 24 July 2022

Article published online:
06 March 2023

• Literatur

• 1 Harper DJ, Carling C, Kiely J. High-intensity acceleration and deceleration demands in elite team sports competitive match play: a systematic review and meta-analysis of observational studies. Sports Med 2019; 49: 1923-1947
• 2 Hagglund M, Walden M, Ekstrand J. Injuries among male and female elite football players. Scand J Med Sci Sports 2009; 19: 819-827
• 3 Drakos MC, Domb B, Starkey C. et al. Injury in the National Basketball Association: a 17-year overview. Sports Health 2010; 2: 284-290
• 4 Ornon G, Ziltener JL, Fritschy D. et al. Epidemiology of injuries in professional ice hockey: a prospective study over seven years. J Exp Orthop 2020; 7
• 5 Ekstrand J, Hagglund M, Kristenson K. et al. Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 2013; 47: 732-737
• 6 Chamari K, Haddad M, Wong del P. et al. Injury rates in professional soccer players during Ramadan. J Sports Sci 2012; 30 (Suppl. 01) 93-102
• 7 Bahr R. No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports. Br J Sports Med 2009; 43: 966-972
• 8 Haroy J, Clarsen B, Thorborg K. et al. Groin problems in male soccer players are more common than previously reported. Am J Sports Med 2017; 45: 1304-1308
• 9 Fuller CW, Ekstrand J, Junge A. et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Scand J Med Sci Sports 2006; 16: 83-92
• 10 Schroder JH, Conze J, Dora C. et al. Diagnostic algorithm “FAI and sports hernia”: results of the consensus meeting for groin pain in athletes. Orthopade 2020; 49: 211-217
• 11 Feeley BT, Powell JW, Muller MS. et al. Hip injuries and labral tears in the National Football League. Am J Sports Med 2008; 36: 2187-2195
• 12 Muschaweck U, Koch A. Sportsmen’s groin: definition, differential diagnosis and treatment. Radiologe 2019; 59: 224-233
• 13 Weir A, Brukner P, Delahunt E. et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 2015; 49: 768-774
• 14 Werner J, Hagglund M, Walden M. et al. UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 2009; 43: 1036-1040
• 15 Tuominen M, Stuart MJ, Aubry M. et al. Injuries in men’s international ice hockey: a 7-year study of the International Ice Hockey Federation adult world championship tournaments and Olympic Winter Games. Br J Sports Med 2015; 49: 30-36
• 16 O’Connor D. Groin injuries in professional rugby league players: a prospective study. J Sports Sci 2004; 22: 629-636
• 17 Ekstrand J, Krutsch W, Spreco A. et al. Time before return to play for the most common injuries in professional football: a 16-year follow-up of the UEFA elite club injury study. Br J Sports Med 2020; 54: 421-426
• 18 Mosler AB, Weir A, Eirale C. et al. Epidemiology of time loss groin injuries in a men’s professional football league: a 2-year prospective study of 17 clubs and 606 players. Br J Sports Med 2018; 52: 292-297
• 19 Worner T, Thorborg K, Eek F. High prevalence of hip and groin problems in professional ice hockey players, regardless of playing position. Knee Surg Sports Traumatol Arthrosc 2020; 28: 2302-2308
• 20 Hallen A, Ekstrand J. Return to play following muscle injuries in professional footballers. J Sports Sci 2014; 32: 1229-1236
• 21 Patel BH, Okoroha KR, Jildeh TR. et al. Adductor injuries in the National Basketball Association: an analysis of return to play and player performance from 2010 to 2019. Phys Sportsmed 2020; 48: 450-457
• 22 Kerbel YE, Smith CM, Prodromo JP. et al. Epidemiology of hip and groin injuries in collegiate athletes in the United States. Orthop J Sports Med 2018; 6: 2325967118771676
• 23 Hagglund M, Walden M, Ekstrand J. Risk factors for lower extremity muscle injury in professional soccer: the UEFA injury study. Am J Sports Med 2013; 41: 327-335
• 24 Serner A, Tol JL, Jomaah N. et al. Diagnosis of acute groin injuries: a prospective study of 110 athletes. Am J Sports Med 2015; 43: 1857-1864
• 25 Serner A, Mosler AB, Tol JL. et al. Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis. Br J Sports Med 2019; 53: 158-164
• 26 Atkinson HD, Johal P, Falworth MS. et al. Adductor tenotomy: its role in the management of sports-related chronic groin pain. Arch Orthop Trauma Surg 2010; 130: 965-970
• 27 Jack RA, Evans DC, Echo A. et al. Performance and return to sport after sports hernia surgery in NFL players. Orthop J Sports Med 2017; 5
• 28 Holmich P, Uhrskou P, Ulnits L. et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet 1999; 353: 439-443
• 29 Paajanen H, Brinck T, Hermunen H. et al. Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman’s hernia (athletic pubalgia). Surgery 2011; 150: 99-107
• 30 Schilders E, Dimitrakopoulou A, Cooke M. et al. Effectiveness of a selective partial adductor release for chronic adductor-related groin pain in professional athletes. Am J Sports Med 2013; 41: 603-607
• 31 Emery CA, Meeuwisse WH. Risk factors for groin injuries in hockey. Med Sci Sports Exerc 2001; 33: 1423-1433
• 32 van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, aetiology and prevention of sports injuries: a review of concepts. Sports Med 1992; 14: 82-99
• 33 Finch C. A new framework for research leading to sports injury prevention. J Sci Med Sport 2006; 9: 3-9
• 34 Whittaker JL, Small C, Maffey L. et al. Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med 2015; 49: 803-809
• 35 Ryan J, DeBurca N, Mc Creesh K. Risk factors for groin/hip injuries in field-based sports: a systematic review. Br J Sports Med 2014; 48: 1089-1096
• 36 Charlton PC, Drew MK, Mentiplay BF. et al. Exercise interventions for the prevention and treatment of groin pain and injury in athletes: a critical and systematic review. Sports Med 2017; 47: 2011-2026
• 37 Maffey L, Emery C. What are the risk factors for groin strain injury in sport? A systematic review of the literature. Sports Med 2007; 37: 881-894
• 38 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6
• 39 O’Connor D, Green S, Higgins JP. Defining the review question and developing criteria for including studies. In: Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons, Ltd; 2008: 81-94
• 40 PEDro PED. PEDro-Skala. Accessed May 26, 2021 at: http://www.pedro.org.au/wp-content/uploads/PEDro_scale_german.pdf
• 41 Howick J, Phillips B, Ball C. et al. Oxford centre for evidence-based medicine: levels of evidence 2009. Accessed May 26, 2021 at: http://www.cebm.net
• 42 van Tulder M, Furlan A, Bombardier C. et al. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine 2003; 28: 1290-1299
• 43 Arnason A, Sigurdsson SB, Gudmundsson A. et al. Risk factors for injuries in football. Am J Sports Med 2004; 32: 5-16
• 44 Beaudouin F, Rossler R, Aus der Funten K. et al. Effects of the ‘11+ Kids’ injury prevention programme on severe injuries in children’s football: a secondary analysis of data from a multicentre cluster-randomised controlled trial. Br J Sports Med 2019; 53: 1418-1423
• 45 Bengtsson H, Ekstrand J, Hagglund M. Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 2013; 47: 743-747
• 46 Bourne MN, Williams M, Jackson J. et al. Preseason hip/groin strength and HAGOS scores are associated with subsequent injury in professional male soccer players. J Orthop Sports Phys Ther 2020; 50: 234-242
• 47 Chalmers S, Magarey ME, Esterman A. et al. The relationship between pre-season fitness testing and injury in elite junior Australian football players. J Sci Med Sport 2013; 16: 307-311
• 48 Crow JF, Pearce AJ, Veale JP. et al. Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players. J Sci Med Sport 2010; 13: 202-204
• 49 Delahunt E, Fitzpatrick H, Blake C. Pre-season adductor squeeze test and HAGOS function sport and recreation subscale scores predict groin injury in Gaelic football players. Phys Ther Sport 2017; 23: 1-6
• 50 Ekstrand J, Timpka T, Hagglund M. Risk of injury in elite football played on artificial turf versus natural grass: a prospective two-cohort study. Br J Sports Med 2006; 40: 975-980
• 51 Engebretsen AH, Myklebust G, Holme I. et al. Prevention of injuries among male soccer players: a prospective, randomized intervention study targeting players with previous injuries or reduced function. Am J Sports Med 2008; 36: 1052-1060
• 52 Engebretsen AH, Myklebust G, Holme I. et al. Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study. Am J Sports Med 2010; 38: 2051-2057
• 53 Evans KL, Hughes J, Williams MD. Reduced severity of lumbo-pelvic-hip injuries in professional Rugby Union players following tailored preventative programmes. J Sci Med Sport 2018; 21: 274-279
• 54 Gabbe BJ, Bailey M, Cook JL. et al. The association between hip and groin injuries in the elite junior football years and injuries sustained during elite senior competition. Br J Sports Med 2010; 44: 799-802
• 55 Hagglund M, Walden M, Ekstrand J. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med 2006; 40: 767-772
• 56 Hagglund M, Walden M, Ekstrand J. Injury recurrence is lower at the highest professional football level than at national and amateur levels: does sports medicine and sports physiotherapy deliver?. Br J Sports Med 2016; 50: 751-758
• 57 Haroy J, Clarsen B, Wiger EG. et al. The adductor strengthening programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med 2019; 53: 150-157
• 58 Holmich P, Larsen K, Krogsgaard K. et al. Exercise program for prevention of groin pain in football players: a cluster-randomized trial. Scand J Med Sci Sports 2010; 20: 814-821
• 59 Holmich P, Thorborg K, Dehlendorff C. et al. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med 2014; 48: 1245-1250
• 60 Ibrahim A, Murrell GA, Knapman P. Adductor strain and hip range of movement in male professional soccer players. J Orthop Surg 2007; 15: 46-49
• 61 Junge A, Rosch D, Peterson L. et al. Prevention of soccer injuries: a prospective intervention study in youth amateur players. Am J Sports Med 2002; 30: 652-659
• 62 Karlsson MK, Dahan R, Magnusson H. et al. Soccer and gender effect of groin pain. Dtsch Z Sportmed 2014; 65: 38-42
• 63 Langhout R, Tak I, van Beijsterveldt AM. et al. Risk factors for groin injury and groin symptoms in elite-level soccer players: a cohort study in the dutch professional leagues. J Orthop Sports Phys Ther 2018; 48: 704-712
• 64 Langhout R, Weir A, Litjes W. et al. Hip and groin injury is the most common non-time-loss injury in female amateur football. Knee Surg Sports Traumatol Arthrosc 2019; 27: 3133-3141
• 65 Larruskain J, Lekue JA, Diaz N. et al. A comparison of injuries in elite male and female football players: a five-season prospective study. Scand J Med Sci Sports 2018; 28: 237-245
• 66 Le Gall F, Carling C, Reilly T. Biological maturity and injury in elite youth football. Scand J Med Sci Sports 2007; 17: 564-572
• 67 Longo UG, Loppini M, Berton A. et al. The FIFA 11+ program is effective in preventing injuries in elite male basketball players: a cluster randomized controlled trial. Am J Sports Med 2012; 40: 996-1005
• 68 Malliaras P, Hogan A, Nawrocki A. et al. Hip flexibility and strength measures: reliability and association with athletic groin pain. Br J Sports Med 2009; 43: 739-744
• 69 Markovic G, Sarabon N, Pausic J. et al. Adductor muscles strength and strength asymmetry as risk factors for groin injuries among professional soccer players: a prospective study. Int J Environ Res Public Health 2020; 17: 1-9
• 70 McCunn R, Aus der Funten K, Whalan M. et al. Soccer Injury Movement Screen (SIMS) composite score is not associated with injury among semiprofessional soccer players. J Orthop Sports Phys Ther 2018; 48: 630-636
• 71 Moreno-Perez V, Travassos B, Calado A. et al. Adductor squeeze test and groin injuries in elite football players: a prospective study. Phys Ther Sport 2019; 37: 54-59
• 72 Mosler AB, Weir A, Serner A. et al. Musculoskeletal screening tests and bony hip morphology cannot identify male professional soccer players at risk of groin injuries: a 2-year prospective cohort study. Am J Sports Med 2018; 46: 1294-1305
• 73 Orchard JW, Chaker Jomaa M, Orchard JJ. et al. Fifteen-week window for recurrent muscle strains in football: a prospective cohort of 3600 muscle strains over 23 years in professional Australian rules football. Br J Sports Med 2020; 54: 1103-1107
• 74 Paajanen H, Ristolainen L, Turunen H. et al. Prevalence and etiological factors of sport-related groin injuries in top-level soccer compared to non-contact sports. Arch Orthop Trauma Surg 2011; 131: 261-266
• 75 Rossler R, Junge A, Bizzini M. et al. A multinational cluster randomised controlled trial to assess the efficacy of ‘11+ Kids’: a warm-up programme to prevent injuries in children’s football. Sports Med 2018; 48: 1493-1504
• 76 Silvers-Granelli H, Mandelbaum B, Adeniji O. et al. Efficacy of the FIFA 11+ injury prevention program in the collegiate male soccer player. Am J Sports Med 2015; 43: 2628-2637
• 77 Soligard T, Myklebust G, Steffen K. et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 2008; 337
• 78 Steffen K, Myklebust G, Andersen TE. et al. Self-reported injury history and lower limb function as risk factors for injuries in female youth soccer. Am J Sports Med 2008; 36: 700-708
• 79 Steffen K, Myklebust G, Olsen OE. et al. Preventing injuries in female youth football – a cluster-randomized controlled trial. Scand J Med Sci Sports 2008; 18: 605-614
• 80 Tyler TF, Nicholas SJ, Campbell RJ. et al. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med 2001; 29: 124-128
• 81 Tyler TF, Nicholas SJ, Campbell RJ. et al. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. Am J Sports Med 2002; 30: 680-683
• 82 van Beijsterveldt AM, van de Port IG, Krist MR. et al. Effectiveness of an injury prevention programme for adult male amateur soccer players: a cluster-randomised controlled trial. Br J Sports Med 2012; 46: 1114-1118
• 83 van Beijsterveldt AM, Stubbe JH, Schmikli SL. et al. Differences in injury risk and characteristics between Dutch amateur and professional soccer players. J Sci Med Sport 2015; 18: 145-149
• 84 Verrall GM, Slavotinek JP, Barnes PG. et al. Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport 2007; 10: 463-466
• 85 Witvrouw E, Danneels L, Asselman P. et al. Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players: a prospective study. Am J Sports Med 2003; 31: 41-46
• 86 Yeomans C, Comyns TM, Cahalan R. et al. The relationship between physical and wellness measures and injury in amateur rugby union players. Phys Ther Sport 2019; 40: 59-65
• 87 Bahr R. Why screening tests to predict injury do not work-and probably never will...: a critical review. Br J Sports Med 2016; 50: 776-780
• 88 Bahr R, Holme I. Risk factors for sports injuries – a methodological approach. Br J Sports Med 2003; 37: 384-392
• 89 Baumgart C, Schubert M, Hoppe MW. et al. Do ground reaction forces during unilateral and bilateral movements exhibit compensation strategies following ACL reconstruction?. Knee Surg Sports Traumatol Arthrosc 2017; 25: 1385-1394
• 90 Rossler R, Donath L, Bizzini M. et al. A new injury prevention programme for children’s football – FIFA 11+ Kids – can improve motor performance: a cluster-randomised controlled trial. J Sports Sci 2016; 34: 549-556
• 91 Faude O, Rossler R, Petushek EJ. et al. Neuromuscular adaptations to multimodal injury prevention programs in youth sports: a systematic review with meta-analysis of randomized controlled trials. Front Physiol 2017; 8
• 92 Seil R, Tischer T. Primärprävention von Sportverletzungen und -schäden. 1. Aufl.. Vopelius: Jena; 2020
• 93 Taylor JB, Wright AA, Dischiavi SL. et al. Activity demands during multi-directional team sports: a systematic review. Sports Med 2017; 47: 2533-2551
• 94 Zech A, Hollander K, Junge A. et al. Sex differences in injury rates in team-sport athletes: a systematic review and meta-regression analysis. J Sport Health Sci 2021;
• 95 Spinks AB, McClure RJ. Quantifying the risk of sports injury: a systematic review of activity-specific rates for children under 16 years of age. Br J Sports Med 2007; 41: 548-557
• 96 Blasimann A, Eberle S, Scuderi MM. Effekt eines Rumpfkräftigungsprogramms (inklusive Unterarm- und seitlichem Unterarmstütz) auf die Verletzungsrate von erwachsenen Fußballspielern: eine systematische Literaturübersicht. Sportverletzung Sportschaden: Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin 2018; 32 (01) 35-46