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Intrinsic Risk Factors For Hip-Related Pain In Elite Rowers

Arnold, Elizabeth

Intrinsic Risk Factors For Hip-Related Pain In Elite Rowers Thumbnail


Elizabeth Arnold



Background: The role of hip motion in relation to rowing performance has been well documented, yet the concept of hip health in rowers is poorly understood. In elite international rowing where high volumes of endurance training are critical to performance, injury prevention research is paramount to supporting both the health and performance of the individual.
Aim: The primary aim of this thesis was to the explore the association between intrinsic risk factors and hip-related pain (HRP) in a cohort of elite rowers. Furthermore, the thesis aimed to advance the understanding of HRP in elite rowers to inform the future screening and injury prevention practices.
Methods: A literature review was carried out examining the accuracy of clinical assessments in the diagnosis of femoroacetabular impingement syndrome (FAIS). A narrative review followed which explored both the physical and biomechanical presentations of individuals with HRP. This was used to identify potential risk factors and their assessments to inform the methodologies of the forthcoming chapters. Reliability of identified assessments was established, and standard error of measurements were quantified. A retrospective study was carried out to determine relationships between intrinsic risk factors and historical HRP in elite rowers, and to identify which factors were to be utilised in a further prospective study. This experimental chapter prospectively analysed the screening data of 55 elite rowers. Rowers were screened every six months over a course of two and a half seasons to ascertain which intrinsic, modifiable risk factors were associated with the development of HRP. Finally, a case report was carried out using the identified risk factors to ascertain whether a 3-month personalised exercise programme was able to positively influence both risk factors and injury incidence.
Results: The reliability of assessments used in the experimental chapters were deemed to be moderate to excellent for hip internal rotation (IR), 2-dimensional squat analysis, Y-balance assessments, single leg squat using a compound qualitative scoring system and isometric frontal plane hip strength using a hand-held dynamometer. Rowers with a history of HRP had shallower squat depths (HRP 52.5%; Control 50.5%) and reduced hip IR (HRP 40.4°; Control 37.1°). Furthermore, male rowers with a history of HRP had significantly smaller hip IR ranges (HRP 28.8°, Control 36.4°; p ≤ 0.05). The prospective study identified that individuals who went on to develop HRP presented with smaller hip IR ranges of motion (mean difference (MD) = 2.4 – 7.8°), and shallower squat depths (MD = 3.9 – 6.3%) when compared with those without HRP. Both factors were also associated with increased risk of developing HRP and experiencing time-loss HRP injuries (IR OR: 0.86-0.92; Squat depth OR: 1.08-1.09). Key findings of the thesis were the differences found in physical and functional assessments between males and females. Males presented with smaller IR ranges and larger adduction strength and adduction:abduction strength ratios (p <0.01). In the subsequent case report, two rowers were identified as ‘high-risk’ for the development of HRP. Following a personalised exercise programme, no time-loss due to HRP was experienced and improvements in squat depth were seen (6-7%) and sustained over a 6-month period (4-9%).
Practical Implications: This thesis identified internal risk factors for the development of HRP in elite rowers. Although causation was not established, both risk factors have the potential to increase hip joint loading, which may lead to the development of pain and pathology. Results also provided initial evidence to support the role of exercise-based strategies in the prevention of HRP in elite rowers. The results of the thesis also highlight the importance of sex-specific screening protocols and management strategies in elite rowers. These findings should be investigated in larger cohorts of elite rowers to ascertain the predictive capabilities of these assessments.


Arnold, E. (2023). Intrinsic Risk Factors For Hip-Related Pain In Elite Rowers. (Thesis). University of Salford

Thesis Type Thesis
Deposit Date Aug 24, 2023
Publicly Available Date Oct 30, 2023
Award Date Sep 29, 2023


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