Strength measurements - Par le Docteur K.Thorborg Lors de la 1ère journée européenne de la pubalgie Clinique du Sport Bordeaux Mérignac

1. Dr. Kristian Thorborg
Strength measurements
in groin pain

2. Many different hip-adduction strength tests exist today

3. Many different hip-adduction strength tests exist today
Isometric testing
Eccentric testing

4. Unilateral strength test:
Lever arm and body weight
Arthroscopic Centre Amager,
Copenhagen
1) Force contribution from testing
side
2) Able to compare sides
3) Able to calculate ratios (Add/abd)
4) Adjusting for lever arm
5) Able to measure relative
muscle strength
(Normalized to bodyweight Nm/kg)
200 N

5. Isometric hip adduction strength
testing
• Test-retest variation
• Best of 4 rep.
• ICC= 0.93-0.98
• SEM%= 6 %
• No systematic variation
Arthroscopic Centre Amager,
Copenhagen

6. Eccentric hip adduction
strength testing
Arthroscopic Centre Amager,
Copenhagen
• Test-retest variation
• Mean of 2 rep with
5 % force-plateau
• ICC= 0.91
• SEM%= 7%
• No systematic variation
(Thorborg et al., 2009)

7. Publications (2010-14)
1: Thorborg K, Petersen J, Nielsen MB, Hölmich P. Clinical
recovery of two hip adductor longus ruptures: a case-report of a
soccer player. BMC Res Notes. 2013 May 22;6(1):205. [Epub
ahead of print]
2: Thorborg K, Bandholm T, Hölmich P. Men are stronger than
women-also in the hip. J Sci Med Sport. 2013 Sep;16(5):E1-3.
3: Jacobsen JS, Thorborg K, Søballe K, Ulrich-Vinther M. Eccentric
hip abductor weakness in patients with symptomatic external
snapping hip. Scand J Med Sci Sports. 2012 Dec;22(6):e140-6.
5: Thorborg K, Bandholm T, Hölmich P. Hip- and knee-strength
assessments using a hand-held dynamometer with external belt
fixation are inter-tester reliable. Knee Surg Sports Traumatol
Arthrosc. 2013 Mar;21(3):550-5.
6: Jensen J, Hölmich P, Bandholm T, Zebis MK, Andersen LL,
Thorborg K. Eccentric strengthening effect of hip-adductor
training with elastic bands in soccer players: a randomised
controlled trial. Br J Sports Med. 2012 Jul 4.[Epub ahead of print]
7 : Thorborg K, Bandholm T, Schick M, Jensen J, Hölmich P. Hip
strength assessment using handheld dynamometry is subject to
ntertester bias when testers are ofdifferent sex and strength.
Scand J Med Sci Sports. 2013 Aug;23(4):487-93.
8: Bandholm T, Thorborg K, Andersson E, Larsen T, Toftdahl M,
Bencke J, Hölmich P. Increased external hip-rotation strength
relates to reduced dynamic knee control in females: paradox or
adaptation? Scand J Med Sci Sports. 2011 Dec;21(6):e215-21.
9: Thorborg K, Serner A, Petersen J, Madsen TM, Magnusson P,
Hölmich P. Hip adduction and abduction strength profiles in elite
soccer players: implications for clinical evaluation of hip
adductor muscle recovery afterinjury. Am J Sports Med. 2011
Jan;39(1):121-6.
10: Thorborg K, Bandholm T, Petersen J, Weeke KM, Weinold C,
Andersen B, Serner A, Magnusson SP, Hölmich P. Hip abduction
strength training in the clinical setting: with or without external
loading? Scand J Med Sci Sports. 2010 Oct;20 Suppl 2:70-7.
11: Thorborg K, Couppé C, Petersen J, Magnusson SP, Hölmich P.
Eccentric hip adduction and abduction strength in elite soccer
players and matched controls: a cross-sectional study. Br J Sports
Med. 2011 Jan;45(1):10-3.
12: Thorborg K, Petersen J, Magnusson SP, Hölmich P. Clinical
assessment of hip strength using a hand-held dynamometer is
reliable. Scand J Med Sci Sports. 2010 Jun;20(3):493-501.
13: Ramskov D, Pedersen MB, Kastrup K, Lønbro S, Jacobsen JS,
Thorborg K, Nielsen RO, Rasmussen S. Normative values of
eccentric hip abduction strength in novice runners: an equation
adjusting for age and gender. Int J Sports Phys Ther. 2014
Feb;9(1):68-75.

8. Strength measurements
and groin pain
1) Prevention
2) Management
Arthroscopic Centre Amager,
Copenhagen

9. Strength measurements
and groin pain
1) Prevention
Arthroscopic Centre Amager,
Copenhagen

10. What about
inter-tester reliability?
Arthroscopic Centre Amager,
Copenhagen

11. Inter-tester reliability
Arthroscopic Centre Amager,
Copenhagen
• Systematic bias
between testers
• Gender and strength
a problem
(Thorborg et al., SJMSS 2012)

12. Fixed set-up eliminates
inter-tester bias
(Thorborg et al., 2013)
Arthroscopic Centre Amager,
Copenhagen

13. Risk-factors for groin injury in soccer
(Engebretsen et al., 2010)
Arthroscopic Centre Amager,
Copenhagen

14. Risk-factors for groin injury in soccer
(Engebretsen et al., 2010)
weak or not weak
Arthroscopic Centre Amager,
Copenhagen

15. Hip muscle strength as a predictor of injury:
(Icehockey)
(Tyler et al., 2001)
• 47 professional players
• Followed during 2 seasons
• 11 adductor strains (3 bilateral)
• Low adduction to abduction
strength ratio (< 0.8) increase the
hip adductor strain injury risk
(17 times)

16. Hip muscle strength as a predictor of injury:
(Icehockey)
(Tyler et al., 2001)
• 47 professional players
• Followed during 2 seasons
• 11 adductor strains (3 bilateral)
• Low adduction to abduction
strength ratio (< 0.8) increase the
hip adductor strain injury risk
(17 times)

17. Hip adduction/abduction strength ratio as a
predictor of adductor injury:
(Icehockey)
(Tyler et al., 2001)

18. Down on the squeeze!
(Crow et al., 2010)
(Mens et al., 2006)

19. Strength measurements
and groin pain
1) Prevention
2) Management
Arthroscopic Centre Amager,
Copenhagen

20. Strength measurements
and groin pain
2) Management
Arthroscopic Centre Amager,
Copenhagen

21. Hip adduction strength deficit
Malliaras et al., 2009
unspecific groin pain
(Australien Rules Football)

22. Hip adduction strength deficit
unspecific groin pain
(Australien Rules Football)
20 % reduced
Malliaras et al., 2009

23. Hip adduction strength deficit
(Gaelic footballers with adductor related groin pain)
Nevin and Delahunt., 2013
25 % reduced

24. Hip adduction strength deficit
(Soccer players with adductor related groin pain)
Arthroscopic Centre Amager,
Copenhagen
(Thorborg et al., 2014)

25. Pain during strength testing (0-10) in soccer players with and
without adductor related groin pain
Soccer players (dominant leg)
Strength test
Adductor-related
groin pain(n=21)
Controls
(n=16)
Median (25-75)
Median (25-75)
p-values
HADD-ECC 5.0 (3.5 – 6.5) 0.0 (0.0 – 0.0) <0.001
HADD- ISO
6.0 (3.0 – 7.0) 0.0 (0.0 – 0.0) <0.001
HADD ECC, Eccentric hip adduction; HADD-ISO, Isometric hip adduction
(Thorborg et al., 2014)

26. Eccentric strength deficits
Arthroscopic Centre Amager,
Copenhagen
(Jakobsen et al., 2013)

27. Eccentric hip abduction
(Ramskov et al. 2014)
Arthroscopic Centre Amager,
Copenhagen

28. The acute case

29. Hip adduction strength
Arthroscopic Centre Amager,
Copenhagen
(Thorborg et al., 2013)

30. Strength measurements
and groin pain
1) Prevention
2) Management
Arthroscopic Centre Amager,
Copenhagen
Eccentric testing (ratio)
Squeeze test
Isometric (acute)
Eccentric
(longstanding)
Squeeze test
(longstanding)

31. Thank you
Arthroscopic Centre Amager,
Copenhagen