Comparing the Effects of Holmich Protocol Exercise Therapy and Joint Mobilization Training on Pain, Balance, Function of the Lower Limb, and Muscle Activity in Soccer Players with Athletic Groin Pain.

NCT ID: NCT06831630

Last Updated: 2025-02-18

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-04-20
• Study Completion Date: 2025-11-20

Brief Summary

The goal of this clinical trial is comparison the Holmich protocol exercise therapy and joint mobilization training, investigating their respective effects on muscle activity in soccer players with athletic groin pain.

The main questions it aims to answer are:

Is there a difference between Holmich protocol exercise therapy and joint mobilization training on pain, balance, function of the lower limb, and Muscle activity in Soccer Players with athletic Groin Pain ?

Researchers will compare Holmich protocol exercise therapy (HT)with joint mobilization training (JMT) to see if the exercises are effective on pain, balance, lower limb function, and muscle activity.

Participants will:

Practice Holmich protocol exercise therapy (HT) three times a week, 90 minutes per session, for 12 weeks.

Practice joint mobilization training (JMT) for 12 weeks.

Conditions

Groin Pain

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Holmich protocol exercise

Group Type: EXPERIMENTAL

Holmich protocol exercise

Intervention Type: OTHER

The treatment consisted of exercise therapy (ET) protocol suggested by Holmich et al and was started under the supervision of a trained sport physiotherapist who ensured that the exercise was carried out correctly and adhered to the original protocol. No treatment other than ET was applied. Although the ET protocol exactly mirrored the randomised clinical trial of Holmich et al, details such as the perceived resistance or weights (in exercise 3 in module 2) and the rest period between the exercise sets and repetitions, which were not defined in the Holmich study, were explained here for the athletes' benefit (tables 1 and 2). Treatment was administered three times a week (on even or odd days). The duration of each session was 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 were asked to perform exercises from module 1 every other day, between the treatment sessions. Although adductor muscle stretching was for

Joint Mobilization

Group Type: EXPERIMENTAL

Joint Mobilization

Intervention Type: OTHER

Focus of treatment was on reducing hip joint pain using joint mobilization techniques provided by the physical therapist and exercises performed in the HEP. Based on published literature, we developed a standard set of mobilizations to target hip joint motion limitations, defined as stiffness or pain that limited joint range of motion. Joint mobilization techniques were prioritized based on patient-specific tasks and the motion used during those tasks, followed by the hip motion limitations. The choice of joint mobilization techniques and grade used was based on direction of hip motion limitation and the relationship of pain and stiffness during hip motion assessment. The HEP included commonly used joint motion and stretching exercises to complement techniques performed during supervised sessions.

The exercises will be conducted over a period of 12 weeks, which is explained below Techniques will be prioritized based on restrictions noted on baseline examination.

1. Caudal glide

2. Lat

control

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Holmich protocol exercise

The treatment consisted of exercise therapy (ET) protocol suggested by Holmich et al and was started under the supervision of a trained sport physiotherapist who ensured that the exercise was carried out correctly and adhered to the original protocol. No treatment other than ET was applied. Although the ET protocol exactly mirrored the randomised clinical trial of Holmich et al, details such as the perceived resistance or weights (in exercise 3 in module 2) and the rest period between the exercise sets and repetitions, which were not defined in the Holmich study, were explained here for the athletes' benefit (tables 1 and 2). Treatment was administered three times a week (on even or odd days). The duration of each session was 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 were asked to perform exercises from module 1 every other day, between the treatment sessions. Although adductor muscle stretching was for

Intervention Type: OTHER

Joint Mobilization

Focus of treatment was on reducing hip joint pain using joint mobilization techniques provided by the physical therapist and exercises performed in the HEP. Based on published literature, we developed a standard set of mobilizations to target hip joint motion limitations, defined as stiffness or pain that limited joint range of motion. Joint mobilization techniques were prioritized based on patient-specific tasks and the motion used during those tasks, followed by the hip motion limitations. The choice of joint mobilization techniques and grade used was based on direction of hip motion limitation and the relationship of pain and stiffness during hip motion assessment. The HEP included commonly used joint motion and stretching exercises to complement techniques performed during supervised sessions.

The exercises will be conducted over a period of 12 weeks, which is explained below Techniques will be prioritized based on restrictions noted on baseline examination.

1. Caudal glide

2. Lat

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. Male

2. between 18-35 years old

3. Have a normal body mass index (BMI)

4. Desire to return to the former level of sports activity

5. groin pain for at least 2 months

6. Pain at palpation of the adductor tendons or the insertion of the pubic bone or both; Groin pain during active adduction against resistance (squeeze test); Pain during adduction against resistance had to be less than six*, based on the visual analogue scale (VAS).

7. In addition, at least two of the following criteria had to be present: a clear history of groin pain and stiffness in the morning, cough induced or sneeze-induced groin pain, nocturnal groin pain or radiological evidence demonstrating osteitis pubis or pain at the symphysis pubis due to palpation.

Exclusion Criteria

1. Receiving physical therapy or other conventional therapy in the past 6 months.

2. Absence in one of the pre- or post-test sessions.

3. Absence of more than two sessions in practice sessions.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 35 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

Yeditepe University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

References

Yousefzadeh A, Shadmehr A, Olyaei GR, Naseri N, Khazaeipour Z. Effect of Holmich protocol exercise therapy on long-standing adductor-related groin pain in athletes: an objective evaluation. BMJ Open Sport Exerc Med. 2018 Jun 26;4(1):e000343. doi: 10.1136/bmjsem-2018-000343. eCollection 2018.

Reference Type: BACKGROUND

PMID: 30018787 (View on PubMed)

Tak I PhD, MScPT, Langhout R MMT PT, Bertrand B MScPT, Barendrecht M MPTS, Stubbe J PhD, Kerkhoffs G PhD, MD, Weir A PhD, MBBS. Manual therapy and early return to sport in football players with adductor-related groin pain: A prospective case series. Physiother Theory Pract. 2020 Sep;36(9):1009-1018. doi: 10.1080/09593985.2018.1531096. Epub 2018 Oct 11.

Reference Type: BACKGROUND

PMID: 30307775 (View on PubMed)

Jha S, Bajpai S, Mishra R. The Comparative Study between Active Physical Training versus Active Resistance Training in Groin Pain among Young Gymnasts. Central India Journal of Medical Research. 2023;2(01):8-12.

Reference Type: BACKGROUND

Harris-Hayes M, Zorn P, Steger-May K, Buss J, Burgess MM, DeMargel RD, et al. Comparison of Joint Mobilization and Movement Pattern Training for Hip-related Groin Pain: Ancillary Analysis to Assess 12 Month Outcomes of a Pilot Randomized Clinical Trial. JOSPT Open. 2024;2(1):1-26.

Reference Type: BACKGROUND

Delahunt E, Thorborg K, Khan KM, Robinson P, Holmich P, Weir A. Minimum reporting standards for clinical research on groin pain in athletes. Br J Sports Med. 2015 Jun;49(12):775-81. doi: 10.1136/bjsports-2015-094839.

Reference Type: BACKGROUND

PMID: 26031644 (View on PubMed)

Verrall GM, Slavotinek JP, Fon GT, Barnes PG. Outcome of conservative management of athletic chronic groin injury diagnosed as pubic bone stress injury. Am J Sports Med. 2007 Mar;35(3):467-74. doi: 10.1177/0363546506295180. Epub 2007 Jan 31.

Reference Type: BACKGROUND

PMID: 17267768 (View on PubMed)

Zeppieri G, Smith MS, Roach RP. Nonsurgical Management of Adductor-related groin pain with Ultrasound-Guided Platelet-Rich Plasma Injection and Physical Therapy in a Competitive Soccer Player: A Case Report. Int J Sports Phys Ther. 2024 Jul 1;19(7):898-909. doi: 10.26603/001c.120209. eCollection 2024.

Reference Type: BACKGROUND

PMID: 38966832 (View on PubMed)

Holmich P, Uhrskou P, Ulnits L, Kanstrup IL, Nielsen MB, Bjerg AM, Krogsgaard K. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet. 1999 Feb 6;353(9151):439-43. doi: 10.1016/S0140-6736(98)03340-6.

Reference Type: BACKGROUND

PMID: 9989713 (View on PubMed)

Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients. Br J Sports Med. 2007 Apr;41(4):247-52; discussion 252. doi: 10.1136/bjsm.2006.033373. Epub 2007 Jan 29.

Reference Type: BACKGROUND

PMID: 17261557 (View on PubMed)

Other Identifiers

Farzadyeditepe

Identifier Type: -

Identifier Source: org_study_id