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Relationship Between Spinal-Pelvic Sagittal Balance and Pelvic-Femoral Injuries in Professional Soccer Players

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Relationship Between Spinal-Pelvic Sagittal Balance and Pelvic-Femoral Injuries in Professional Soccer Players

Antoine Ferenczi et al. Orthop J Sports Med.

Abstract

Background: Pelvic-femoral injuries are a common problem in football (soccer) players. However, the risk factors for these injuries are unclear. Our knowledge of spinal-pelvic sagittal balance has increased considerably over the past few years, notably as a result of new radiographic techniques such the EOS radiographic imaging system.

Purpose: To investigate the link between spinal-pelvic sagittal balance on EOS imaging and the incidence of pelvic-femoral injuries.

Study design: Cohort study; Level of evidence, 2.

Methods: Players in a League 1 professional soccer team were observed for 5 consecutive seasons. All players included in the study underwent EOS radiographic imaging. All acute and microtraumatic injuries to the pelvic-femoral complex were recorded prospectively: hamstrings, psoas, quadriceps, adductors, obturators, and pubic symphysis. We analyzed the relationship between injury incidence and key radiographic parameters involved in pelvic balance.

Results: A total of 61 players were included (mean age, 24.5 years; n = 149 injuries; mean pelvic tilt, 9.08° ± 5.6°). A significant link was observed between the incidence of pelvic-femoral injuries and pelvic tilt (P = .02). A significant link was also observed between the incidence of acute pelvic-femoral injuries and pelvic tilt (P = .05). In both cases, a high pelvic tilt was associated with a low incidence of injuries.

Conclusion: In professional soccer players, a low pelvic tilt was associated with a high incidence of all pelvic-femoral injuries as well as acute pelvic-femoral injuries. These results could lead to new preventive methods for these musculotendinous injuries through physical therapy.

Keywords: EOS imaging; acute injury; adductors; hamstrings; obturators; pelvic tilt; pelvic-femoral injury; quadriceps; spinal-pelvic sagittal balance.

Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Full spine contouring on paired frontal and lateral views on an EOS radiograph, with appropriate manually placed landmarks and automatically provided angles.
Figure 2.
Figure 2.
Schematics of spine parameters used in this study obtained through the EOS system with appropriate landmarks. To assess spine parameters, angles were measured through use of the Cobb method (angles formed by the tangent lines to the endplates of the extreme vertebrae limiting a given curvature). Thoracic kyphosis (“cyphose”) T1/T12 is the angle between the upper vertebral tray of T1 and lower tray of T12. Thoracic kyphosis T4-T12 is the angle between the upper vertebral tray of T4 and lower tray of T12. Lumbar lordosis (“lordose”) L1/L5 is the angle between the upper vertebral tray of L1 and lower tray of L5. Lumbar lordosis L1/S1 is the angle between the upper vertebral tray of L1 and sacral endplate.
Figure 3.
Figure 3.
Schematics of pelvic parameters used in this study obtained through the EOS system with appropriate landmarks. To assess the 3 sagittal pelvic parameters, it was necessary to draw different points and lines on sagittal views: the center of the femoral heads (C point); the midpoint of the sacral endplate (S point); the CS line; a vertical line passing through the C point; a line tangent to the sacral endplate; a line perpendicular to this tangent, passing through the S point; and a horizontal line cutting this tangent. Pelvic incidence (“incidence pelvienne”) is the angle that is between CS and perpendicular to the tangent at the sacral endplate; sacral slope (“pente sacrée”) is the angle between the tangent at the sacral endplate; and horizontal and pelvic tilt (“version pelvienne”) is the angle between vertical and the CS line.
Figure 4.
Figure 4.
Schematics of knee parameters used in this study obtained through the EOS system with appropriate landmarks. Femoral length (“longueur femur”) is the distance between the center of the femoral head and the center of the trochlea. Tibial length (“longueur tibia”) is the distance between the center of the tibial spine (intercondylar eminence) and the center of the ankle joint. Femur torsion (“torsion fémorale”) is the angle between the femoral neck axis and posterior condylar line. Difference in overall leg length between the right (“droite”) and left (“gauche”) sides was also calculated.
Figure 5.
Figure 5.
Flowchart of the study population.
Figure 6.
Figure 6.
Distribution of injuries. Left, total injuries; right, acute injuries.

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References

    1. Busquet L. Les Chaînes Musculaires: Lordoses, Cyphoses, Scolioses et Déformations Thoraciques. Vol 2 Paris: Frison-Roche; 1992.
    1. Cho M, Lu Z, Lee C. Influence of hamstring tightness in pelvic, lumbar and trunk range of motion in low back pain and asymptomatic volunteers during forward bending. Asian Spine J. 2015;9(4):535–540. - PMC - PubMed
    1. Congdon R, Bohannon R, Tiberio D. Intrinsic and imposed hamstring length influence posterior pelvic rotation during hip flexion. Clin Biomech (Bristol, Avon). 2005;20(9):947–951. - PubMed
    1. Cristóbal RV, Miñarro PAL, Cárceles FA, Ros FE. Efectos del método Pilates sobre la extensibilidad isquiosural, la inclinación pélvica y la flexión del tronco. Nutr Hosp. 2015;32(5):1967–1986. - PubMed
    1. Croisier J-L, Ganteaume S, Binet J, Genty M, Ferret J-M. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med. 2008;36(8):1469–1475. - PubMed

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