The Development and Evaluation of a Dynamic Elastomeric Fabric Orthosis to Support the Management of Athletic Pelvic/Groin Injury

Abstract

Athletic pelvic / groin injuries can be difficult to define, diagnose and therefore manage. These injuries are often the result of multifactorial dysfunction, making them susceptible to becoming chronic. Transverse pelvic belts have shown effectiveness in reducing pain and improving function in athletes with pelvic / groin pain, but there may be better alternatives. Exploring different pelvic belt configurations with athletes with pelvic / groin pain confirmed the role of a transverse belt but also found that diagonal belts produced significantly (<0.05) greater effects upon clinical measures of pain and function. Dynamic elastomeric fabric orthoses (DEFOs) are Lycra®-based orthoses theorised as providing stability and enhancing proprioception. A DEFO was designed to apply diagonal force to the pelvic girdle and mimic transverse belt application. In a series of single case studies the DEFO was found to have beneficial effects upon pain and / or function in selected athletes with pelvic / groin pain. Athletes’ subjective reports suggested that balance and power may have also been positively influenced. Further work exploring appropriate measures of athletic balance led to the investigation of the intra-rater reliability of a functional measure; the multiple single-leg hop-stabilisation test. Good to excellent reliability (ICC = 0.85; CI 0.61-0.90) confirmed this measure as being reliable for use in a future study, and highlighted relationships with other factors such as age and training status. The findings of a pilot RCT indicated that with minor revisions this protocol could be effectively implemented in informing a future RCT. Findings also indicated that the DEFO led to moderate to large effect sizes on clinical measures (d = 0.6-1.1) of active straight leg raise and squeeze test force, and negligible to small effects on measures of power and functional balance (d = 0.1-0.3). This thesis therefore outlines the development and initial evaluation of a novel DEFO for supporting the management of athletic pelvic / groin injury. Further work is required to undertake a fully powered RCT, and to explore the mechanistic action of this DEFO.