Mosler Andrea B, Heerey Joshua J, Kemp Joanne L, Semciw Adam I, King Matthew G, Agricola Rintje, Lawrenson Peter R, Scholes Mark J, Mentiplay Benjamin F, Crossley Kay M
La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.
Nutrition and Health Innovation Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.
Orthop J Sports Med. 2024 Oct 25;12(10):23259671241277662. doi: 10.1177/23259671241277662. eCollection 2024 Oct.
The relationship between hip/groin pain and hip range of motion (ROM) is unclear.
To explore the relationship between hip/groin pain and hip joint ROM and examine the influence of sex and cam morphology on this relationship.
Cross-sectional study; Level of evidence, 3.
Included were 184 amateur soccer and Australian Rules football players (276 hips; 20% women; median age, 26 years; interquartile range, 24-30 years) with hip/groin pain >6 months and a positive flexion-adduction-internal-rotation (FADIR) test, and 50 matched asymptomatic control players (98 hips; 28% women, median age, 26 years; interquartile range, 23-31 years). Hip ROM measures were flexion, internal and external rotation at 90° of hip flexion, total rotation (internal and external), and bent-knee fall out (BKFO). Cam morphology was determined from anteroposterior pelvis or 45° Dunn radiographs, defined by an alpha angle ≥60°. Linear regression models with generalized estimating equations were used to examine the relationship between group (symptomatic and asymptomatic) and each ROM measure. Interaction terms (group × cam morphology or group × sex) were included to examine if relationships between group and hip ROM were influenced by cam morphology or sex. Where appropriate, models were adjusted for sex, age, and cam morphology.
An interaction between the relationship between group × cam and internal rotation ROM was found. Symptomatic players with cam morphology had lower internal rotation ROM than controls with cam morphology (adjusted mean difference [AMD] = -4.5°; 95% CI, -7.4° to -1.6°). Hip/groin pain was not associated with internal rotation ROM if cam morphology was absent. A significant interaction was also found for group × sex and BKFO and total rotation ROM. Symptomatic women had lower total rotation ROM than control women (AMD = -8.2°; 95% CI, -14.1° to -2.2°), but no difference was seen in men. BKFO range was lower in men with hip/groin pain compared with control men (AMD = 1.6 cm; 95% CI, 0.3-3.0 cm), but no difference was seen in women. Flexion and external rotation ROM did not differ between symptomatic and control hips.
Cam morphology was an effect modifier of the relationship between hip/groin pain and internal rotation ROM. Sex-related differences were also observed in the relationship between hip/groin pain and hip ROM.
髋部/腹股沟疼痛与髋关节活动范围（ROM）之间的关系尚不清楚。
探讨髋部/腹股沟疼痛与髋关节ROM之间的关系，并研究性别和凸轮形态对这种关系的影响。
横断面研究；证据等级，3级。
纳入184名患有髋部/腹股沟疼痛超过6个月且屈曲-内收-内旋（FADIR）试验阳性的业余足球和澳式橄榄球运动员（276个髋关节；20%为女性；中位年龄26岁；四分位间距24 - 30岁），以及50名匹配的无症状对照运动员（98个髋关节；28%为女性，中位年龄26岁；四分位间距23 - 31岁）。髋关节ROM测量指标包括髋关节屈曲90°时的屈曲、内旋和外旋、总旋转（内旋和外旋）以及屈膝外展（BKFO）。凸轮形态通过骨盆前后位或45°邓恩位X线片确定，定义为α角≥60°。使用带有广义估计方程的线性回归模型来检验组（有症状和无症状）与每个ROM测量指标之间的关系。纳入交互项（组×凸轮形态或组×性别）以检验组与髋关节ROM之间的关系是否受凸轮形态或性别的影响。在适当情况下，模型对性别、年龄和凸轮形态进行了调整。
发现组×凸轮与内旋ROM之间的关系存在交互作用。有凸轮形态的有症状运动员的内旋ROM低于有凸轮形态的对照运动员（调整后平均差值[AMD] = -4.5°；95%可信区间，-7.4°至 -1.6°）。如果不存在凸轮形态，髋部/腹股沟疼痛与内旋ROM无关。还发现组×性别与BKFO和总旋转ROM之间存在显著交互作用。有症状的女性的总旋转ROM低于对照女性（AMD = -8.2°；95%可信区间，-14.1°至 -2.2°），但男性未见差异。与对照男性相比，患有髋部/腹股沟疼痛的男性的BKFO范围更低（AMD = 1.6 cm；95%可信区间，0.3 - 3.0 cm），但女性未见差异。有症状和对照髋关节之间的屈曲和外旋ROM没有差异。
凸轮形态是髋部/腹股沟疼痛与内旋ROM之间关系的效应修饰因素。在髋部/腹股沟疼痛与髋关节ROM之间的关系中也观察到了性别相关差异。
