Are we failing athletes with recurrent groin pain by focusing on group-level biomechanical analysis of their movement strategies?

Introduction: Groin pain recurrence occurs in a variety of sports that require repetitive change of direction (COD) to evade an opponent(s). Although three-dimensional (3D) motion analysis exploring between-group differences during COD is the traditional approach, it limits the identification of individual differences and potential clinical implications. This exploratory study questions if group-level analysis overlooks individual differences in reactive COD technique observed with individual analysis of male athletes with and without a self-reported history of groin pain.
Methods: Using 3D motion capture, we recorded male athletes with (n=7) and without (n=10) historical groin pain performing a reactive COD. Between-group statistical differences in joint kinematics and kinetics and 3D ground reaction forces were explored using generalised mixed models. Individual analysis of graphical representations of joint angle and moment data for each athlete
were explored for kinematic and kinetic variables identified in previous studies to be associated with leg injuries.
Results: Between-group analysis identified athletes with historical groin pain had greater mean lumbopelvic lateral flexion away from the COD exit at all critical COD time points (pcontrols. Individual analysis of all athletes observed 19 kinematic and five kinetic variables previously associated with groin pain (kinematic n=8; kinetic n=1), acute leg injuries (n=10; n=3) and poor load absorption/alignment (n=2; n=1). The number of variables observed in an individual athlete ranged from five
(kinematic n=2; kinetic n=3) to 20 (n=15; n=5) in those with historical groin pain and six (n=4; n=2) to 18 (n=13; n=5) in those without. Variables such as knee abduction angle >9° throughout stance and switching from lumbopelvic rotation away from the COD exit to towards the exit in the first 25% of stance were observed in individual athletes with historical groin pain. Two ankle variables (Discussion/Conclusion: Group-level differences between male athletes with and without historical groin pain were identified predominantly in proximal joints, despite ankle, knee and hip variables associated with injury being observed in individual COD techniques. Distinct movement strategies that may be overlooked
with group-level analysis were observed in each athlete with historical groin pain during individual analysis which could contribute to their pain. Variables associated with a variety of leg injuries were observed during individual analysis, suggesting multiple factors may contribute to inefficiencies in load absorption
of the kinetic chain.
Impact/Application to the field (can be 1-2 dot points):
• Group-level biomechanical analysis of movement strategies during COD may discount joint angle and moment findings that predispose individual male athletes to groin pain recurrence indicating further research exploring this issue is warranted.
• In clinical settings, tailored intervention strategies developed via individual movement analysis of male athletes with groin pain may be more beneficial over standardised group interventions to avoid overlooking individual differences in reactive COD technique.