Are Hip Physical Examination Findings Predictive of Future Lower-Body Injury Rates in Elite Adolescent Female Soccer Athletes at Minimum 5-Year Follow-Up?

in Journal of Sport Rehabilitation

Click name to view affiliation

Abby L. Cheng
Search for other papers by Abby L. Cheng in
Current site
Google Scholar
PubMed
Close
,
John A. Merlo
Search for other papers by John A. Merlo in
Current site
Google Scholar
PubMed
Close
,
Devyani Hunt
Search for other papers by Devyani Hunt in
Current site
Google Scholar
PubMed
Close
,
Ted Yemm
Search for other papers by Ted Yemm in
Current site
Google Scholar
PubMed
Close
,
Robert H. Brophy
Search for other papers by Robert H. Brophy in
Current site
Google Scholar
PubMed
Close
, and
Heidi Prather
Search for other papers by Heidi Prather in
Current site
Google Scholar
PubMed
Close
Restricted access

Context: Although elite adolescent female soccer athletes have unique injury risk factors and management challenges, limited epidemiological data exist for this population. Objective: To describe lower-body injury patterns and to determine whether a screening hip physical examination is predictive of future injuries in elite adolescent female soccer athletes. Design: Prospective cohort study. Setting: One US premier soccer club. Participants: One hundred seventy-seven female soccer athletes aged 10–18 years (mean [SD] 14.6 [1.8] y) completed a demographic questionnaire and screening hip physical examination that included range of motion and provocative tests. Interventions: At least 5 years after baseline screening, athletes completed an electronic follow-up injury survey. Injury was defined as pain that interfered with sporting activity. Main Outcome Measures: In addition to descriptive analyses of athletes’ injury profiles, associations between players’ baseline demographics and subsequent injury profiles were evaluated using chi-square tests, and potential predictors of injury based on players’ baseline hip examinations were evaluated using multivariable logistic regression. Results: Ninety-four of 177 athletes (53%) were contacted for follow-up, and 88/94 (93.6%) completed the survey. With mean follow-up of 91.9 (9.3) months (range 66–108 mo), 42/88 (47.7%) reported sustaining a new lower-body injury. The low back was the most common injury region (16/42, 38.1%). Almost half of all injured athletes (20/42, 47.6%) sustained overuse injuries, and 16/42 (38.1%) had an incomplete recovery. Higher body mass index and reaching menarche were associated with sustaining an injury (P = .03 and .04, respectively). Athletes’ baseline hip examinations were not predictive of their subsequent rate of lower-body, lumbopelvic, overuse, or incomplete recovery injury (all P > .05). Conclusions: Lower-body injuries were common in elite adolescent female soccer athletes, with over one third of injured athletes reporting permanent negative impact of the injury on their playing ability. Baseline hip physical examinations were not associated with future injury rate.

Cheng, Hunt, and Prather with the Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO. Merlo is with the Ross University School of Medicine, Miramar, FL. Yemm is with PEAK Sport and Spine, Crestwood, MO. Brophy is with the Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.

Cheng (ChengAL@wustl.edu) is corresponding author.
  • Collapse
  • Expand
  • 1.

    Koutures CG, Gregory AJ. Injuries in youth soccer. Pediatrics. 2010;125(2):410414. PubMed ID: 20100755 doi:10.1542/peds.2009-3009

  • 2.

    Bell DR, Post EG, Trigsted SM, et al. Sport specialization characteristics between rural and suburban high school athletes. Orthop J Sports Med. 2018;6(1):232596711775138. PubMed ID: 29376086 doi:10.1177/2325967117751386

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Kemper GL, van der Sluis A, Brink MS, Visscher C, Frencken WG, Elferink-Gemser MT. Anthropometric injury risk factors in elite-standard youth soccer. Int J Sports Med. 2015;36(13):11121117. PubMed ID: 26258817 doi:10.1055/s-0035-1555778

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Schmikli SL, de Vries WR, Inklaar H, Backx FJ. Injury prevention target groups in soccer: injury characteristics and incidence rates in male junior and senior players. J Sci Med Sport. 2011;14(3):199203. PubMed ID: 21169057 doi:10.1016/j.jsams.2010.10.688

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Pfirrmann D, Herbst M, Ingelfinger P, Simon P, Tug S. Analysis of injury incidences in male professional adult and elite youth soccer players: a systematic review. J Athl Train. 2016;51(5):410424. PubMed ID: 27244125 doi:10.4085/1062-6050-51.6.03

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Cheng A, Prather H. Chapter 7: hip. In: Casey E, Rho M, Press J, eds. Sex Differences in Sports Medicine. 1st ed. New York, NY: Demos Medical Publishing; 2016:103120.

    • Search Google Scholar
    • Export Citation
  • 7.

    Caldwell M, Casey E, Powell B, Shultz S. Chapter 1: sex hormones. In: Casey E, Rho M, Press J, eds. Sex Differences in Sports Medicine. 1st ed. New York, NY: Demos Medical Publishing; 2016:129.

    • Search Google Scholar
    • Export Citation
  • 8.

    Ghannad L, Dubon M, LaBella C. Chapter 16: the young athlete. In: Casey E, Rho M, Press J, eds. Sex Differences in Sports Medicine. 1st ed. New York, NY: Demos Medical Publishing, 2016:209226.

    • Search Google Scholar
    • Export Citation
  • 9.

    Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):4251. doi:10.2519/jospt.2010.3337

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Powers CM, Ghoddosi N, Straub RK, Khayambashi K. Hip strength as a predictor of ankle sprains in male soccer players: a prospective study. J Athl Train. 2017;52(11):10481055. PubMed ID: 29116830 doi:10.4085/1062-6050-52.11.18

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    McCann RS, Bolding BA, Terada M, Kosik KB, Crossett ID, Gribble PA. Isometric hip strength and dynamic stability of individuals with chronic ankle instability. J Athl Train. 2018;53(7):672678. PubMed ID: 30084648 doi:10.4085/1062-6050-238-17

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Steinberg N, Dar G, Dunlop M, Gaida JE. The relationship of hip muscle performance to leg, ankle and foot injuries: a systematic review. Phys Sportsmed. 2017;45(1):4963. PubMed ID: 28067582 doi:10.1080/00913847.2017.1280370

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Reinking MF, Austin TM, Richter RR, Krieger MM. Medial tibial stress syndrome in active individuals: a systematic review and meta-analysis of risk factors. Sports Health. 2017;9(3):252261. PubMed ID: 27729482 doi:10.1177/1941738116673299

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Siebenrock KA, Ferner F, Noble PC, Santore RF, Werlen S, Mamisch TC. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res. 2011;469(11):32293240. PubMed ID: 21761254 doi:10.1007/s11999-011-1945-4

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Prather H, Hunt D, Rho M, Yemm T, Fong K, Brophy RH. Abnormal hip physical examination findings in asymptomatic female soccer athletes. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):21062114. PubMed ID: 24150125 doi:10.1007/s00167-013-2713-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Decloe MD, Meeuwisse WH, Hagel BE, Emery CA. Injury rates, types, mechanisms and risk factors in female youth ice hockey. Br J Sports Med. 2014;48(1):5156. PubMed ID: 23446642 doi:10.1136/bjsports-2012-091653

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Toohey LA, Drew MK, Cook JL, Finch CF, Gaida JE. Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis. Br J Sports Med. 2017;51(23):16701678. PubMed ID: 28784622 doi:10.1136/bjsports-2017-097500

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Della Villa F, Mandelbaum BR, Lemak LJ. The effect of playing position on injury risk in male soccer players: systematic review of the literature and risk considerations for each playing position. Am J Orthop. 2018;47(10). doi:10.12788/ajo.20180092

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Brophy R, Silvers HJ, Gonzales T, Mandelbaum BR. Gender influences: the role of leg dominance in ACL injury among soccer players. Br J Sports Med. 2010;44(10):694697. PubMed ID: 20542974 doi:10.1136/bjsm.2008.051243

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Gajdosik RL, Bohannon RW. Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity. Phys Ther. 1987;67(12):18671872. PubMed ID: 3685114 doi:10.1093/ptj/67.12.1867

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Holm I, Bolstad B, Lutken T, Ervik A, Rokkum M, Steen H. Reliability of goniometric measurements and visual estimates of hip ROM in patients with osteoarthrosis. Phys Res Int. 2000;5(4):241248.

    • Search Google Scholar
    • Export Citation
  • 22.

    Prather H, Harris-Hayes M, Hunt DM, Steger-May K, Mathew V, Clohisy JC. Reliability and agreement of hip range of motion and provocative physical examination tests in asymptomatic volunteers. PM R. 2010;2(10):888895. PubMed ID: 20970757 doi:10.1016/j.pmrj.2010.05.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Hoppenfeld S. Physical examination of the hip and pelvis. In: Hoppenfeld S, ed. Physical Examination of the Spine and Extremities. Norwalk, CT: Appleton & Lange; 1976:143169.

    • Search Google Scholar
    • Export Citation
  • 24.

    Krabak B, Jarmain S, Prather H. Physical examination of the hip. In: Malanga GA, Nadler S, eds. Musculoskeletal Physical Examination: An Evidence-Based Approach. Philadelphia, PA: Elsevier Mosby, 2006:251278.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):11691176. PubMed ID: 27629403 doi:10.1136/bjsports-2016-096743

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Clohisy JC, Nunley RM, Carlisle JC, Schoenecker PL. Incidence and characteristics of femoral deformities in the dysplastic hip. Clin Orthop Relat Res. 2009;467(1):128134. PubMed ID: 19034600 doi:10.1007/s11999-008-0481-3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Greenwood NL, Duffell LD, Alexander CM, McGregor AH. Electromyographic activity of pelvic and lower limb muscles during postural tasks in people with benign joint hypermobility syndrome and nonhypermobile people. A pilot study. Man Ther. 2011;16(6):623628. PubMed ID: 21831693 doi:10.1016/j.math.2011.07.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Booshanam DS, Cherian B, Joseph CP, Mathew J, Thomas R. Evaluation of posture and pain in persons with benign joint hypermobility syndrome. Rheumatol Int. 2011;31(12):15611565. PubMed ID: 20490806 doi:10.1007/s00296-010-1514-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Nilstad A, Andersen TE, Bahr R, Holme I, Steffen K. Risk factors for lower extremity injuries in elite female soccer players. Am J Sports Med. 2014;42(4):940948. PubMed ID: 24500914 doi:10.1177/0363546513518741

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Mosler AB, Weir A, Serner A, et al. Musculoskeletal screening tests and bony hip morphology cannot identify male professional soccer players at risk of groin injuries: a 2-year prospective cohort study. Am J Sports Med. 2018;46(6):12941305. PubMed ID: 29585730 doi:10.1177/0363546518763373

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Dorrel B, Long T, Shaffer S, Myer GD. The functional movement screen as a predictor of injury in national collegiate athletic association division II athletes. J Athl Train. 2018;53(1):2934. PubMed ID: 29251533 doi:10.4085/1062-6050-528-15

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Bardenett SM, Micca JJ, DeNoyelles JT, Miller SD, Jenk DT, Brooks GS. Functional movement screen normative values and validity in high school athletes: can the FMS be used as a predictor of injury? Int J Sports Phys Ther. 2015;10(3):3038. PubMed ID: 26075145

    • Search Google Scholar
    • Export Citation
  • 33.

    Suzue N, Matsuura T, Iwame T, et al. Prevalence of childhood and adolescent soccer-related overuse injuries. J Med Invest. 2014;61(3–4):369373. doi:10.2152/jmi.61.369

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol. 2007;34(4):804809. PubMed ID: 17407233

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Bell DR, Blackburn JT, Hackney AC, Marshall SW, Beutler AI, Padua DA. Jump-landing biomechanics and knee-laxity change across the menstrual cycle in women with anterior cruciate ligament reconstruction. J Athl Train. 2014;49(2):154162. PubMed ID: 24568229 doi:10.4085/1062-6050-49.2.01

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Casey E, Hameed F, Dhaher YY. The muscle stretch reflex throughout the menstrual cycle. Med Sci Sports Exerc. 2014;46(3):600609. PubMed ID: 24091990 doi:10.1249/MSS.0000000000000134

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Prather H, Hunt D, McKeon K, et al. Are elite female soccer athletes at risk for disordered eating attitudes, menstrual dysfunction, and stress fractures? PM R. 2016;8(3):208213. PubMed ID: 26188245 doi:10.1016/j.pmrj.2015.07.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 2174 925 120
Full Text Views 56 12 1
PDF Downloads 53 13 4