Holmich Protocol and Myofascial Release Technique Effect on Groin Pain in Tennis Players
Condition: Sports Physical Therapy
Study type: Interventional

Summary: 
      The aim of this study is to determine the effect of Homlich Protocol and Myofacial release
      technique on groin pain in tennis players. A total of 14 players will be included in the
      clinical trail. There will be one group of 7 players in which Holmich protocol will be
      applied while in the other group of 7 players will be given Myofascial Release Technique
      which includes Transverse friction massage and Stretching. Data will be collected by outcome
      measures before and after the exercise protocol is given. Treatment will be administered
      three times a week (on even or odd days). The duration of Holmich Protocol each session is
      about 90 min for module 1 (first two weeks) and 120 min for module 2 (from the third week).
      From the third week, the athletes will be asked to perform exercises from module 1 every
      other day, between the treatment sessions. While passive treatment will be given for 30 mins
      per session. During the treatment course and before the final evaluation, no athletic
      activity will be permitted . Injuries data will be collected prospectively by respective
      coaches. Coaches will be trained for identification and classification of injuries.
    

Detailed description: 
      Groin pain arising from sports injuries is widespread, especially among those who participate
      in sports that involve repetitive rotational movements such as kicking and turning as in
      soccer. This type of injury is the fourth most common sports injury, with soccer players
      suffering from long-term symptoms and frequent relapses. The injury rate is 1.015-1.133 per
      1000 hours of play, which is equivalent to 11%-16% of all sports injuries. The prognosis for
      exercise- related groin pain is not clear. Injured athletes may be forced to wait a long time
      before returning to sports activity free of restriction.

      It is known that adductor-related groin injuries are the most common cause of groin injury,
      accounting for 69% of groin injuries in football and 58% across all forms of sport. As
      limited range of hip abduction and hip internal rotation and decreased hip adductor strength
      (absolute and comparative to the hip abductors) are considered potential risk factors for
      groin injury. Adductor-related groin pain is often treated without surgery. Among different
      conservative approaches, it appears that exercise therapy (ET) is more effective than other
      conservative treatment methods such as electrotherapy, manual therapy or steroid injections.
      Unfortunately, however, many important factors including frequency, duration and the exact
      amount of resistance or perceived exertion to be used in the ET protocols have not been
      carefully recorded in clinical trials. To our best knowledge, the randomised clinical trial
      carried out by Holmich et al in 1999 still offers the best evidence for the effectiveness of
      exercise as a prescription for the treatment of adductor-related groin pain. Holmich et al
      collated the results of ET (based on isometric and isotonic strengthening of the hip
      abductor/adductor and the abdominal muscles) with results from physiotherapy. They evaluated
      successful treatment (based on pain measures), patients' subjective global assessments and
      their return to sport without groin pain at the same level as before the injury. 'Successful
      treatment' as described in their study is an unfeasible and non-validated measure for
      evaluating outcome; on the other hand, the published results by Holmich et al was not
      compared with any such other treatment.

      Yousefzadeh A et al conducted a study which checked the effect of Holmich Protocol on groin
      pain and its results showed to be an effective treatment.

      Weir A et al performed multi modal treatment(MMT) in comparison to exercise therapy(ET),
      results showed MMT to be more effective then ET.

      Sernar A et al did a systemic review on treatment of groin players which showed low quality
      studies present for groin injury management.

      Holmich P et al performed a randomized trial on effects of active physical training(AT) on
      groin pain, results showed AT to be very effective on groin pain.

      Kalichman L and Ben David C did a narrative review on the effect of self-myofascial
      release(SMFR) and concluded that there was a significant increase in joint range of motion
      and no decrease in muscle force.

      Timothy C.Mauntel et al performed myofascial release technique to increase physical
      performance measurements to check its effectiveness. The systematic review observed a
      significant change in range of motion but no significant change in muscle function.

      Melih Paksoy and Umit Sekmen performed a review of current diagnosis and treatment modilities
      which showed that response rates to conservative treatment for inguinal pain is very low.

      Dines et al performed a study on tennis injuries and showed that groin pain to be present
      around 3% to 21%.

      In the current study, we will reproduce Holmich et al research along with Myofascial release
      technique to treat long-standing adductor-related groin pain (LSAGP) and analyse the
      short-term flow of alterations in pain and functional ability. Furthermore, as limited range
      of hip abduction and hip internal rotation and decreased hip adductor strength (absolute and
      comparative to the hip abductors) are considered potential risk factors for groin injury, we
      will also measure these variables as our outcomes. The purpose of this study is to obtain an
      objective evaluation of the effect of Holmich protocol and Myofascial release technique to
      compare which is better in treating LSAGP.
    

Intervention name(s): Holmich Protocol; Myofascial Release Technique
Intervention type(s): Procedure; Procedure
Intervention description(s): Module 1 (1st two weeks):
i)Isometric adduction ii)Abdominal sit-ups iii)Isometric adduction iv)Compound abdominal sit-ups and hip flexion v)Balance exercise on wobble board vi)One-foot exercise on sliding board
Module 2 (from 3rd week):
i)Leg abduction and adduction exercise carried out in side lying ii)Low back extension exercise prone on the end of bench iii)One leg weight pulling abduction/adduction standing iv)Abdominal sit ups v)One leg coordination exercise vi)Training in sideways motion vii)Balance exercise on wobble board; Transverse friction massage: 10 mins on painful area of adductor-tendon insertion into pubic bone
Stretching of adductor muscles, hamstrings muscles and hip flexors:3 times and each stretch is 30s with Contract relax technique
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Groin pain; Holimch protocol; Myofascial release technique