Hip and groin pain in athletes: morphology, function and injury from a clinical perspective

Background: Whether hip range of motion (ROM) is a risk factor for groin pain in athletes is unknown.A systematic review is required to synthesise the available evidence and provide clinical interpretations. Objectives:To systematically review the relationship between hip ROM and groin pain in athletes.Study design: Systematic review, prospectively registered (PROSPERO) according PRISMA guidelines.Methods: PubMed, Embase, CINAHL and SPORTDiscus were systematically searched to December 2015.Two authors performed study selection, data extraction/analysis, quality assessment (Critical Appraisal Skills Program) and strength of evidence synthesis.Results: We identified 7 prospective and 4 case-control studies.The total quality score ranged 29-92%.Heterogeneity in groin pain classification, injury definitions and physical assessment precluded data-pooling.There was strong evidence that lower total rotation of both hips below 85 measured at the pre-season screening was a risk factor for groin pain development.Strong evidence suggested internal rotation, abduction and extension were neither associated with the risk nor the presence of groin pain. Conclusion:Total hip ROM is the factor most consistently related to groin pain in athletes.Screening for hip ROM is unlikely to correctly identify an athlete at risk because of the small ROM differences found and the poor measurement properties.