strength measurements - dr k.thorborg - 1ère journée européenne de la pubalgie - clinique du...

Strength measurements

in groin pain

Dr. Kristian Thorborg

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Many different hip-adduction strength tests exist today

Many different hip-adduction strength tests exist today

Isometric testingEccentric testing

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


Isometric hip adduction strength testing

• Test-retest variation

• Best of 4 rep.

• ICC= 0.93-0.98

• SEM%= 6 %

• No systematic variation




Eccentric hip adductionstrength testing

• Test-retest variation

• Mean of 2 rep with

5 % force-plateau

• ICC= 0.91

• SEM%= 7%

• No systematic variation

(Thorborg et al., 2009)


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.

Publications (2010-14)

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. 2014Feb;9(1):68-75.

Strength measurements and groin pain


1) Prevention

2) Management




1) Prevention


What about inter-tester reliability?




Inter-tester reliability

• Systematic bias between testers

• Gender and strength a problem

(Thorborg et al., SJMSS 2012)



Fixed set-up eliminates inter-tester bias




Risk-factors for groin injury in soccer (Engebretsen et al., 2010)



Risk-factors for groin injury in soccer (Engebretsen et al., 2010)

weak or not weak


Hip muscle strength as a predictor of injury:(Icehockey)

• 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)

(Tyler et al., 2001)

Hip adduction/abduction strength ratio as a predictor of adductor injury:

(Icehockey)

(Tyler et al., 2001)

Down on the squeeze!

(Crow et al., 2010)(Mens et al., 2006)



1) Prevention

2) Management



2) Management


Malliaras et al., 2009

Hip adduction strength deficit unspecific groin pain

(Australien Rules Football)


Hip adduction strength deficit unspecific groin pain

(Australien Rules Football)

Malliaras et al., 2009

20 % reduced


Hip adduction strength deficit (Gaelic footballers with adductor related groin pain)

Nevin and Delahunt., 2013

25 % reduced



Hip adduction strength deficit (Soccer players with adductor related groin pain)



Pain during strength testing (0-10) in soccer players with and without adductor related groin pain

Soccer players (dominant leg)

Strength test

Adductor-relatedgroin 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



Eccentric strength deficits


(Jakobsen et al., 2013)


Eccentric hip abduction (Ramskov et al. 2014)



The acute case


Hip adduction strength





1) Prevention

2) Management

Eccentric testing (ratio)

Squeeze test (longstanding)

Isometric (acute)

Eccentric (longstanding)

Squeeze test


Thank you



strength measurements - dr k.thorborg - 1ère journée européenne de la pubalgie - clinique du...

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