As most sports physiotherapists would know, injuries of the groin are very common. This is particularly true in sports that require lateral movements and kicking; think football, rugby and AFL (Waldén et al., 2005; O’Connor, 2004; Orchard and Seward, 2002). In fact in some sports the incidence of groin pain is as high as 13% (Ekstrand and Ringbord, 2001). This means that we are regularly assessing groin pathologies, and should be aware of the most effective and reliable techniques to assess deficits in adductor function. This article will discuss new research on the Adductor Squeeze Test that can inform and improve your clinical practice.
Why Do We Care About Adductor Strength?
It may be obvious to many sports physiotherapists, but we care about adductor strength for a number of reasons. Adductor strength is an important objective outcome for both rehabilitation and prevention of groin injuries, as it has been shown:
- Decreased hip adductor strength precedes groin injury in some populations (Crow et al., 2010)
- Weak adductor muscles are an intrinsic risk factor for groin injuries (Engebretsen et al., 2010)
- Hip adductor strength is reduced by groin injury (Crow et al., 2010)
- Adductor strength can be utilised as an outcome to show improvements and may be helpful to gauge return to play readiness
Thus, it is obvious that there are many reasons why sports physiotherapists are interested in an athlete’s groin strength, and the above list is in no way exhaustive. So, how is the best way to measure the adductor strength?
What Is The Best Way To Perform The Adductor Squeeze Test?
The Adductor Squeeze Test is widely used in clinical practice as a technique to evaluate the strength of the adductor muscles, through the use of a forceful bilateral isometric contraction of the adductor muscles onto the pressure cuff of a sphygmomanometer that is pre-inflated to 10mmHg (Delahunt et al., 2011). However, until recently we have had only anecdotal evidence to identify the ideal position of hip flexion for optimal force production and adductor muscle activity.
Enter Delahunt and colleagues (2011), who evaluated the Adductor Squeeze Test in 18 asymptomatic male Gaelic football players. The authors compared 3 test positions (0, 45 and 90 degrees of hip flexion) for sEMG activity of the adductor muscles and force production. Interestingly, they found that 45 degrees of hip flexion elicited the greatest EMG activity of the adductor mass and this correlated to the greatest force production (mean 236.76 ± 47.29 mmHg). This was followed by 0 degrees (202.50 ± 57.28 mmHg) and finally 90 degrees (186.11 ± 44.01 mmHg).
This suggests 45 degrees of hip flexion as the optimal Adductor Squeeze Test position. Importantly, it also serves as a preliminary profile of ‘normal’ results in this population. Unfortunately, this sEMG study does not allow for differentiation between the individual muscles of the adductor mass in the different testing positions. This, of course, would be useful in improving diagnostic accuracy of the clinical examination of groin pain. This research should also be repeated in various injury groups, e.g. acute vs chronic, to establish generalisability to other populations. Clearly, further research in this field is warranted and I for one cannot wait…
- Adductor strength is a clinical indicator used in both injury prevention and rehabilitation, and should be monitored
- 45 degrees of hip flexion provides optimal force and adductor muscle activity during the Adductor Squeeze Test in this population
What are your thoughts on this research and the use of the Adductor Squeeze Test in clinical practice? Be sure to let me know in the comments or you could:
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Photo Credit: BabaSteve
Crow JF, Pearce AJ, Veale JP, Vander Westhuizen D, Coburn PT, Pizzari T. Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players. Journal of Sciences and Medicine in Sport 2010;13(2):202-4.
Delahunt E, Kennelly C, McEntee BL, Coughlan GF, Green BS. The thigh adductor squeeze test: 45 of hip flexion as the optimal test position for eliciting adductor muscle activity and maximum pressure values. Manual Therapy 2011;16:476-480.
Ekstrand J, Ringborg S. Surgery versus conservative treatment in soccer players with chronic groin pain: a prospective randomised study in soccer players. Eur J Sports Traumatol 2001;23:141–5.
Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study. American Journal of Sports Medicine 2010;38(10):2051-7.
O’Connor D. Groin injuries in professional rugby league players: a prospective study. Journal of Sports Sciences 2004;22(7):629e36.
Orchard J, Seward H. Epidemiology of injuries in the Australian football league, seasons 1997-2000. British Journal of Sports Medicine 2002;36(1):39-44.
Waldén M, Hägglund M, Ekstrand J. UEFA champions league study: a prospective study of injuries in professional football during the 2001-2002 season. British Journal of Sports Medicine 2005;39(8):542-6.