Is hip adductor or abductor strength in healthy athletes associated with future groin pain? A systematic review and meta-analysis

Objective To systematically review the association between hip adduction and abduction strength, and adduction-to-abduction strength ratio in healthy athletes with the occurrence of future groin pain and time-loss groin injuries. Design Systematic review with meta-analysis. Data sources PubMed, Web of Science, SPORTDiscus, PEDro, Embase, and Scopus. Eligibility criteria Studies included had to (1) measure hip adductor or abductor strength in healthy athletes, (2) conduct a follow-up period to assess the occurrence of groin pain, (3) present strength data separately for participants who remained uninjured and those who suffered an injury and (4) use a prospective design. Risk of bias was assessed according to the Quality in Prognosis Studies tool. The certainty in the evidence appraised was measured using the Grading of Recommendations Assessment Development and Evaluation approach. Results Thirteen prospective cohort studies met the inclusion criteria. Overall study risk of bias was rated as low. Players who remained uninjured had stronger adduction strength compared with players who subsequently suffered groin pain (standardised mean differences with 95% CIs (SMD=−0.5, 95% CI −0.92 to −0.09)) and time-loss groin pain (SMD=−0.68, 95% CI −1.31 to −0.06). Trivial effects were observed for abduction strength (groin pain SMD=0.03, 95% CI −0.11 to 0.17; time-loss SMD=−0.07, 95% CI −0.25 to 0.11) and adduction-to-abduction strength ratio (groin pain SMD=−0.02, 95% CI −0.55 to 0.51; time-loss SMD=−0.11, 95% CI −1.11 to 0.89). Age and diagnostic criteria were not significant moderators of the relationship between adductor strength and groin pain (p=0.72 and p=0.12). Conclusion There is a moderate effect of hip adductor strength on the occurrence of groin pain, while there is no relationship between either abductor strength or the ratio of adductor-to-abductor strength with the occurrence of groin pain. PROSPERO registration number CRD42024548630. Data are available upon reasonable request.