Pre-season risk factors for groin problems in female football players: A prospective cohort study

OBJECTIVE: To investigate pre-season characteristics associated with in-season groin problems and to assess the discriminatory performance of clinical markers using a predictive modelling approach. DESIGN: Prospective cohort study. SETTING: Spanish female football (tiers II and III). PARTICIPANTS: Thirty-seven players. MAIN OUTCOME MEASURES: Pre-season assessments included isometric hip adduction (5-s squeeze test), hip mobility (bent-knee fall-out [BKFO]), adductor endurance (Brazilian Adductor Performance Test), HAGOS-Sport scores, and limb length. In-season groin problems were monitored via the OSTRC-O2 questionnaire. RESULTS: Fourteen players (37%) reported groin problems. Players who developed symptoms were older (g = 0.95), heavier (g = 0.87) and had lower adductor torque (g = -0.72) than uninjured counterparts. Adductor torque asymmetry (AUC = 0.86, 95% CI: 0.74-0.97) and BKFO test (AUC = 0.78, 95% CI: 0.64-0.94) showed the highest clinical predictive performance. While limb length also yielded high AUC, this requires cautious interpretation due to the sample size. CONCLUSIONS: Pre-season adductor strength imbalance and hip mobility emerged as relevant indicators of groin problem risk in female football players. These findings highlight the potential utility of individualized screening to identify vulnerable players. However, the small sample size warrants cautious interpretation, and larger cohorts are needed to refine these predictive approaches.