1 Appendix A

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3 Rehabilitation Intervention
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5 Each rehabilitation session was approximately 1 hour in length and took place

6 with a physiotherapist every 12-16 days depending on subject availability. Two

7 physiotherapists undertook all physical assessments and exercise prescription

8 and reviewed their practice together every two months to ensure continuity

9 between them. The first rehabilitation session started on the same day as the

10 initial diagnostic assessment.

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12 Exercise Selection

13 Level 1

14 The subjects were taken through each of the level 1 rehabilitation exercise

15 streams (Table 1 & 2; Figure 1) with the difficulty of the exercise selected

16 progressed or regressed depending on the subjects ability to execute with

17 appropriate technique (good form and no reproduction of symptoms). Exercises

18 focused not only on segmental control between 2 segments across one joint (i.e.

19 hip flexor, abdominal, lateral control) but also multisegmental co-ordination

20 through squat, lunge and deadlift. Where a weight was included (i.e. deadlift) the

21 weight selected was modified to allow the subject reach the appropriate number

22 of repetitions and progressed as strength improved. The equipment required

23 was a squat rack, a high and low box or chair and cones. The importance of

24 correct technique was repeatedly emphasized. Level 1 exercises were included

25 throughout the duration of the rehabilitation programme with those streams

26 that the athlete displayed full competency on being maintained in 1 session per

27 week.

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29 Level 2

30 These sessions commenced with linear running drills focusing on lumbopelvic

31 control and posture, swing leg recovery and increased rate of force development

32 (Table 3 & 4). Once they had completed the drills they carried out the Linear A

33 running programme (Table 5) which was designed to complement the running

34 drills while assessing the subjects’ running load tolerance and suitability for

35 progression. It started with low volume and low intensity, both of which

36 increased at different points through the programme. If a subject had any

37 increase in symptoms the morning after a running session, they were instructed

38 to repeat the same running session when scheduled until they could tolerate it

39 and then progress to the next session.

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41 Level 3

42 In Level 3, the linear running was progressed to Linear B running programme

43 (Table 6) which saw a reduction in volume but increase in intensity starting first

44 from a rolling start but then progressing to a standing start. The linear running

45 drills were maintained as a warm up to this session and were accompanied by

46 multidirectional drills. The focus of the multidirectional drills was to improve

47 segmental control, lateral rate of force development and improve agility prior to

48 returning to sports specific movement (Tables 7 & 8). They were executed at as

49 high an intensity as possible without reproduction of symptoms. If a subject had

50 any increase in symptoms the morning after a Level 3 session, they were

51 instructed to repeat the same session at the same intensity when scheduled until

52 they could tolerate it and then progress to the next session.

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54 Progression Criteria

55 Progression from level 1 to level 2 was indicated once the subject had a negative

56 crossover sign(13) which was usually achieved by the second session.

57 Progression from level 2 to level 3 was indicated once the subject had

58 symmetrical internal hip rotation at 90°, pain-free squeeze at 45° and symptom

59 free completion of the Linear A running programme.

60 Progression from level 3 to repeat 3D testing and return to play was symptom

61 free completion of the Linear B running programme and symptom free

62 completion of the multidirectional drills at maximum intensity.

63 Any subject who did not meet the criteria to progress to the next level at their

64 review appointment went back through each of the components of that level of

65 the rehabilitation programme and a rehab tracker, which they filled out between

66 appointments charting progress, to identify any potential barriers to progression

67 at the next review appointment.

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69 Dosage

70 The subjects were instructed to complete 3-4 sets of 6-8 reps of each exercise in

71 Level 1 four times per week (i.e. two days on, 1 day off) at their own training

72 base.

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74 The level 2 linear running sessions were also introduced 3 times per week, with

75 at least one day rest in between sessions. They could be done on the same day or

76 another day as a Level 1 session as best suited the subjects schedule. On days

77 when both sessions were done on the same day, the level 1 session was to be

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78 completed first. The linear drills were carried out for 5-6 reps and 3-4 sets with a

79 high emphasis on quality and intensity prior to commencing linear running

80 programme A.

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82 The level 3 sessions followed the same schedule as level 2 (3 times per week

83 with 1 day rest in between). The multidirectional drills were carried out for 5-6

84 reps and 3-4 sets with a high emphasis on quality and intensity and were

85 preceded by the linear drills and followed by the Linear B running programme.

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87 Programme Compliance

88 Each subject was given a printed handout of all the exercises and main cues for

89 each, in addition to each exercise being captured on video using Dartfish™

90 software for all exercises and levels of the programme and the videos hosted

91 online for the subject to review between sessions. Subjects completed a “rehab

92 tracker” between review sessions which noted compliance as well as any issues

93 with any of the exercises which could be assessed at the next review. Subjects

94 were advised that should any exercise reproduce their groin symptoms, they

95 should review their videos and amend their technique to resolve and if unable to

96 do so these exercises should be discontinued and their assigned physiotherapist

97 contacted.

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104 Table 1 – Level 1 Exercise streams and reason for inclusion

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110 Table 2 – Level 1 streams and progressions
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113 Figure 1 – Intersegmental control and strength – Deadlift

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 Linear Drills Reason for Inclusion
Focus on maintaining neutral lumbopelvic position and trunk posture while maximising vertical ground reaction
Marching/Skipping force production
Barbell/Overhead Running Focus on maintaining neutral lumbopelvic position and minimising overstride and excessive trunk rotation
Leg Change Drill Focus on stance leg stiffness and swing leg recovery
121 Table 3 Linear Running Drills and reason for inclusion
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126 Table 4 – Linear Running Drills Instruction
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139 Table 5– Linear A Running Programme
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143 Table 6 – Linear B Running Programme
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147 Figure 2 Linear running mechanics – skipping

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150 Table 7 - Multidirectional Running Drills and reason for inclusion
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154 Table 8 – Multidirectional Running Drills
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163 Figure 3 Multidirectional Drill – Shuffle Drill

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