Groin pain is a frequently encountered clinical entity in Gaelic Games athletes.7
To our knowledge, no authors to date have investigated the intrarater reliability of the adductor squeeze test in asymptomatic Gaelic Games athletes using a commercially available sphygmomanometer. Thus, we are the first to investigate this issue and to analyze the differences in squeeze values across the 3 test positions.
The ICC values calculated for each of the test positions demonstrated excellent reliability, with values of 0.89, 0.92, and 0.90 for the 0°, 45°, and 90° of hip flexion test positions, respectively. These results concur with those of Fulcher et al15
and Malliaras et al.16
Malliaras et al16
used a commercially available sphygmomanometer to examine squeeze test values in elite junior Australian rules football and soccer players. They obtained ICC values for the 0°, 30°, and 45° hip flexion test positions of 0.81,0.91, and 0.94, respectively. We also tested 0° and 45° of hip flexion and found ICC values of 0.89 and 0.92, respectively. Furthermore, the squeeze values we observed are somewhat comparable to those of Malliaras et al,16
who reported 210.8 ± 39.3 mm Hg in the 0° of hip flexion test position and 209.6 ± 42.3 mm Hg in the 45° of hip flexion test position. Fulcher et al15
quantified adductor strength in male semiprofessional soccer players in the test positions of 0°, 45°, and 90° of hip flexion using a handheld dynamometer. Their ICC values were 0.85, 0.77, and 0.87, respectively, which are consistent with the ICC values we obtained.
In addition to computing ICC values, we also undertook statistical analysis to determine if maximum squeeze values differed among the 3 test positions. On both days, the mean squeeze value was higher at 45° of hip flexion than at 0° and 90° of hip flexion (). Additionally, η2p values for day 1 and day 2 were 0.78 and 0.82, respectively, indicating strong effect sizes. Given that the 45° of hip flexion test position was associated with the greatest squeeze value, the greatest stress on the adductor musculature and pubic bone during the adductor squeeze test is likely to occur in this testing position. For this reason, we believe that when assessing both groin pain and adductor squeeze values, 45° of hip flexion is the optimal testing position. To confirm our hypothesis, further testing is required to determine electromyographic activity of the adductor longus muscle at the different positions of hip-joint flexion.
The present study does have a number of points worth noting. All participants were free from groin pain, according to the aforementioned inclusion criteria, and, therefore, there were no confounding issues stemming from a previous history of groin pain. This factor is in contrast to the studies of Fulcher et al15
and Malliaras et al.16
Fulcher et al15
found that 30% of participants reported a degree of groin discomfort during the testing. Furthermore, 70% of participants reported a previous history of groin pain.
Test-retest methods are criticized by many researchers as a method of gauging reliability. Among the difficulties associated with these methods is the fact that short intervals between administrations of the instrument can yield reliability estimates that are too high. In our study, the interval between test and retest was a minimum of 7 days (mean = 9 days). In previous studies,15,16
retesting was carried out during the same session. We believe that our testing protocol better simulates the process of assessing and monitoring athletes in a clinical environment. Furthermore, in our study, for the retest session, the examiner was blinded to the initial test session results, which reduced the risk of reporting bias.
Early detection and intervention are the keys to optimal management and prevention of chronic injury. The current lack of reliable clinical indicators (ie, clinical and functional screening tests) to assess the likelihood of developing chronic groin pain makes it difficult to establish effective prophylactic strategies.20
For the adductor squeeze test, 45° of hip flexion was the best testing position. No participants had groin pain; hence, a true picture of normative data in a healthy population is provided. We found excellent intrarater reliability for measuring adductor squeeze values using a sphygmomanometer in healthy male Gaelic Games athletes. We propose that a commercially available sphygmomanometer is a cost-effective method of assessing adductor squeeze values in clinical practice. It allows for the objective measurement of adductor squeeze values, which could be readily used by clinicians to monitor potential injury risk, advance rehabilitation, and determine suitability for return to sport participation.
Future studies are now warranted to determine the predictive power of the adductor squeeze test in identifying athletes at risk of developing groin pain. This question could be answered by a prospective study, with regular testing of squeeze values across the course of an athletic season. Also, the interrater reliability of the adductor squeeze test needs to be established in Gaelic Games athletes. In addition, investigators should concentrate on the acquisition of squeeze values in athletes with acute and chronic groin pain.