Holmich Protocol and Myofascial Release Technique Effect on Groin Pain in Tennis Players

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Male Gender
* Age: 18 - 35 years
* Groin pain for at least 2 months
* 3 - 7 pain score on NPRS
* Playing Sports for atleast 1 year

Exclusion Criteria:

* Femoral or inguinal hernia
* Chronic urinary tract disorder or prostatitis
* Disease, fracture of the pelvis or the lower limbs inhibiting the participant from the completing the treatment plan
* Entrapment of the genitofemoral or back pain felt between T10 and L5 levels and consisting of the facet joints
* Virulent Ilioinguinal nerve
* Inability to follow the active physical training plan
* Use of non-steroidal anti-inflammatory drugs during the study
* Participation in principled strength training of the hip adductors for more than once a week in the 6 months prior to the study.