Title: Exercise programmes for hip control to protect lower limb joints during recreational exercise in adolescents: a proof of concept and feasibility trial
Funder: Health Education England

Abstract: Background Arthritis is the biggest cause of pain and disability, with musculoskeletal conditions costing the NHS 5 billion per annum in England. Known risk factors for osteoarthritis (OA) include excessive activity, abnormal loading and obesity, which could be prevented. Moderate exercise is beneficial for joint cartilage and we need ways of exercising safely to prevent joint damage and subsequent OA. The hip is one of the most common sites for OA and Femoracetabular Impingement (FAI), a strong biomarker in the young for later OA, provides a useful model for developing prevention programmes. In FAI, altered bony geometry of the femoral head and acetabulum causes jamming within the hip. FAI occurs in 14-35% of the general population, 24% of military recruits, 39% of hockey players and 72% of footballers, who have a high incidence of OA and hip replacement surgery. The government's drive for a more active nation has increased uptake of football, so preventive programmes to protect joints are needed urgently. This project builds on laboratory studies of academy footballers and school children that identified movement patterns associated with FAI and abnormal loading on joints. Functional assessments were developed to identify abnormal movement patterns to inform exercise programmes, which will be finalised in collaboration with international experts in movement control. The next stage is to test the proof of concept (PoC) and feasibility of evaluating exercises in recreationally active adolescents in the general population.Research Questions: 1) Does a movement control exercise programme improve movement patterns?; 2) Is it feasible to conduct a clinical trial of preventive exercises in recreationally active adolescents? Aims and Plan of Investigation: 1.Determine interrater and test-retest reliability of movement control tests 2.Finalise development of an exercise programme to improve hip movement control 3.Provide PoC that exercises improve hip control and movement patterns to reduce abnormal loading during functional tasks (by validation in a related biomechanical study) 4.Examine feasibility of conducting a full clinical trial in a community setting 5.Measure the rates of non-contact lower limb injuries 6.Examine post-study adherence to the exercise programmeParticipants will be assessed by a Physiotherapist using the movement screening tool and will complete the Hip and Groin outcome score pre and post intervention. The exercises will be taught to coaches who will instruct participants to conduct them as part of their warm-up programme to pre-activate' muscles prior to training and matches for 12 weeks. Feasibility of recruitment, acceptability and compliance will be examined. The findings will underpin a cluster randomised controlled trial with internal pilot to test the effectiveness of exercises targeted at improving control of hip movements, to reduce abnormal lower limb joint loading and prevent damage that leads to OA. Engagement with PPI representatives of players, coaches, parents and people with FAI and OA is key to this research, which will also be overseen by the PPI community within the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis. Potential Benefits to Patients and the NHS Effective targeted exercises would ensure correct use of muscles to avoid abnormal loading of lower limb joints, improving conservative evidence based treatment. Including programmes in school physical education lessons would ensure quality of movement to protect joints during development, particularly in very active or obese children. The exercises may help those with OA to be more active and limit further damage and avoid surgery. Ensuring safe exercise to prevent obesity would have direct impact on the government Get Active to Get Healthy' initiative. Prevention of recurrent joint problems would improve efficiency, saving NHS resources, in accordance with the Quality, Innovation, Prevention and Productivity (QIPP) Agenda.

Lay abstract: Objective: We aim to see whether exercises to protect joints in elite sports can be adapted for the general population. Design: Tests of abnormal hip movements and exercises to correct them will be studied in boys who play football. Outcomes: Reliable tests and suitable exercises will be ready for a large study to prove if they are effective. Benefit: As more people are exercising for a healthier lifestyle, this research will help protect joints from injuries leading to osteoarthritis. Exercising safely is vital, especially while young people are still growing, to improve health and reduce NHS costs.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MUSCULOSKELETAL