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Effect of Holmich protocol exercise therapy on long-standing adductor-related groin pain in athletes: an objective evaluation
  1. Abbas Yousefzadeh1,
  2. Azadeh Shadmehr1,
  3. Gholam Reza Olyaei1,
  4. Nasrin Naseri1,
  5. Zahra Khazaeipour2
  1. 1 Department of Physiotherapy, Tehran University of Medical Sciences, Tehran, Iran
  2. 2 Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  1. Correspondence to Professor Azadeh Shadmehr; shadmehr{at}


Aim To objectively evaluate the effect of Holmich protocol-based exercise therapy on long-standing adductor-related groin pain (LSAGP).

Methods We reproduced the Holmich protocol of exercise therapy and objectively evaluated its effect on 17 male athletes (mean age, 25.07±4.96 years) suffering from LSAGP, of whom 14 participants completed the 10 weeks treatment period. The study was designed as a single-blinded, before-and-after clinical trial. Main outcome measures included pain, functional ability, hip range of motion (ROM), hip abductor and adductor muscle strength, and successful return to sports activity.

Results Eleven athletes (78.57%) returned to their sports activities in a mean time of 14.2 weeks (range, 10-20 weeks). Visual analogue scale pain score, hip abductor and adductor muscles strength, and function scores improved significantly. Although hip abduction ROM did not show any significant changes (p = 0.609), the extent of progress in the hip internal rotation ROM was significant (p = 0.001). The ratio of hip adduction to abduction strength did not change significantly (p = 0.309 for the isometric and p = 0.957 for the eccentric ratio).

Conclusions Exercise therapy according to the Holmich programme may be an effective treatment for LSAGP. However, more emphasis should be paid to the hip adductor muscles’ eccentric strength.

Trial registration number IRCT2016080829269N1.

  • eccentric
  • exercise
  • groin

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  • Contributors All authors have seen and agree with the contents of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics Committee of Tehran University of Medical Sciences.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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