Lower Limb Biomechanics of Football Players with Hip-Related Pain

Submission note: This thesis is submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the La Trobe Sport and Exercise Medicine Research Centre, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services, and Sport, College of Science, Health, and Engineering, La Trobe University, Victoria, Australia.

Hip-related pain is common in football players, with persistent pain associated with poor quality of life and restricted participation. Hip-related pain is a movement-related disorder; however, information on how people with hip-related pain move is scarce. A greater understanding of the movement limitations associated with hip-related pain is needed to develop interventions and preventative strategies to improve long-term outcomes. A systematic review established that people with more severe presentations of hip-related pain walk with a lower peak hip extension angle and were unable to squat as deep as asymptomatic controls. The review found no information on people with hip-related pain still participating in sport and physical activities. This thesis aimed to extend our knowledge of the movement limitations in this condition by evaluating the biomechanics of football players with hip-related pain. The lower limb biomechanics of 88 football players (median age: 26 years, 23 women) with hip-related pain and 30 (median age: 27 years, 13 women) asymptomatic players were compared during walking and the single leg drop jump. This thesis demonstrated that: 1)Men and women with hip-related pain move differently. Future studies should consider if the relationship between hip-related pain and biomechanics is sex-dependent.2)The relationship between hip-related pain and biomechanics is modified by sex. Male football players with hip-related pain demonstrated biomechanical impairments at the hip and pelvis in the transverse plane and women demonstrated impairments at the knee.3)Differences observed between football players with and without hip-related pain were few in number, small in magnitude, and rarely at the hip. In conclusion, biomechanical impairments were not common among football players with hip-related pain. It is unknown whether the biomechanical impairments observed affect disease progression or long-term outcomes. Longitudinal evaluations of biomechanics in people with hip-related pain will assist in further contextualising the thesis findings.