The Correlational and Predictive Ability of Pre-season Risk Screenings on Hip and Groin Problems in Competitive Male Ice Hockey Players

Date of Award

8-2023

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Kieran Fogarty, Ph.D.

Second Advisor

Stacie Fruth, DSc

Third Advisor

Paul Whitehead, Ph.D.

Abstract

Background

Symptoms and disability due to conditions affecting the hip and groin are common in competitive male ice hockey players and can lead to long-term adverse health consequences. It is common practice for injury risk screenings at the beginning of the competitive season (preseason) to identify those with hip and groin symptoms and disability and guide primary and secondary prevention strategies. Commonly cited risk factors include total hip rotation range of motion (ROM), hip adductor strength, and the ratio of hip adductor to abductor strength. However, there is conflicting research regarding the utility of these preseason risk screenings, and the limited research available is only on professional ice hockey players.

Purpose

The purpose of this study is to identify the association between commonly utilized injury risk screening measurements and subjectively reported hip symptoms and disability, as well as identify the predictive value of preseason measurements on the reported hip symptoms and disability at the end of the season.

Methods

The first part of this study was a cross-sectional cohort study. Fifty-nine (59) male club collegiate ice hockey players from two teams had preseason measurements performed for clinical measurements, including total hip ROM, isometric hip adductor strength, and the ratio of hip adductor to abductor strength. Hip symptoms and disability were assessed with the Copenhagen Hip and Groin Outcome Score (HAGOS) Sport and Quality of Life (QoL) subscales. The association between the clinical measurements and the HAGOS subscales was assessed with a multiple linear regression. A post-hoc point-biserial correlation was calculated between the ratio of hip adductor to abductor strength and the HAGOS subscales due to the visual appearance of a non-linear relationship. The second part of this study was a prospective observational cohort study. Fifty-one (51) male club collegiate ice hockey players from the same two teams had additional measurements for the HAGOS Sport and QoL at the end of the season. Multiple linear regression was performed to assess the predictive ability of the preseason assessment of both clinical measurements and symptoms and disability subscales. Additionally, odds ratios for the preseason HAGOS subscale categories were calculated for future HAGOS subscale categories, and paired-samples t-tests were used to assess the change in subscale scores from the beginning to the end of the season. Human Subjects Review Board approval was obtained at Western Michigan University.

Results

The multiple linear regression models were statistically significant for an association between clinical measurements and both preseason HAGOS Sport(F3,55 = 4.997, p<0.01, R2 = 0.21) and preseason HAGOS QoL (F3,55 = 3.095, p=0.03, R2 = 0.14). Only isometric hip adductor strength contributed to the models in a statistically significant manner. Having a ratio of hip adductor to abductor strength lower than 0.95 was significantly associated with lower HAGOS Sport (r=0.38, 95% CI = 0.14-0.58, p<0.01) and QoL (r=0.26, 95% CI = 0.01-0.48, p=0.04) subscale scores. The predictive ability of preseason measurements of both clinical measures and hip and groin problems subscales was statistically significant for both the end of season HAGOS Sport(F5,45=2.592, p=0.03, R2 = 0.22) and end of season HAGOS QoL(F5,45=6.56, p<0.01, R2 = 0.42). Only the preseason HAGOS Sport contributed to the end of the season HAGOS Sport model in a statistically significant manner. The preseason HAGOS QoL and the preseason isometric hip adductor strength contributed to the end of the season HAGOS QoL in a statistically significant manner. Having a preseason HAGOS Sport and HAGOS QoL below 100 were associated with end of the season HAGOS Sport(Odds Ratio(OR): 8.62, 95% CI=2.36-31.42, p<0.01) and QoL(OR: 7.43, 95% CI=2.06-26.78, p<0.01) score below 100, respectively. Having a preseason HAGOS Sport and HAGOS QoL score below 90 was associated with having an end of the season HAGOS Sport(OR: 7.63, 95% CI=1.74-33.58, p<0.01) and QoL(OR: 14.50, 95% CI=2.70-77.78, p<0.01) below 90, respectively. There was a statistically significant decline in both HAGOS Sport (-4.1, 95%CI=0.1-8.3, p=0.05) and HAGOS QoL (-3.6, 95%CI=0.8-6.3, p=0.01) at the end of the season compared to the preseason.

Discussion

There was a significant association between hip adductor strength and the ratio of hip adductor to abductor strength with present symptoms. However, the predictive ability of preseason measurements was very limited in this study. Hip and groin problems do not appear to be self-limiting and may worsen throughout a single competitive ice hockey season. These results have significant implications for injury risk screening practices and primary and secondary prevention strategies for all practitioners who work with competitive male ice hockey players.

Access Setting

Dissertation-Abstract Only

Restricted to Campus until

8-1-2025

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