The aim of our study was to test the effectiveness of an abdominal training program and gluteus medius-specific training for improving lumbo-pelvic stability and adductor muscle strength in soccer players. Both interventions improved lumbo-pelvic stability and adductor muscle strength to the same extent, without evidence of one being more effective than the other.
Few scientific articles have been found in the literature that provide data on the incidence, etiology, prevention or treatment of injuries in women's soccer. Rosas et al. [30] conducted a study with the largest sample size (n = 25), equivalent to that recruited in the present study.
Our study has been developed based on different work protocols in healthy subjects, focusing on the increase of stability and strength, the ultimate goal being to establish the potential impact on the prevention of injuries. The most comprehensive protocols in terms of muscle groups, are those developed by Hölmich et al. [8] and Krommes et al. [10] applied to the adductor muscles, and by Krause et al. [25], on activation of the gluteus medius. To date, no article has developed an intervention program addressing more than one muscle group or different structures. Our study aims to assess the efficacy of an exercise program which targets different tissues and structures.
Subjects who only performed abdominal training (control group), improved the values related to adductor muscle strength and lumbo-pelvic stability. It should be noted that the protocols developed by Hölmich et al. [8] and Krommes et al. [10] only accounted for the adductor strength variable. Based on our results, abdominal training may have an impact on neighboring structures.
On the other hand, the experimental group exhibited increased improvement of adductor strength and lumbo-pelvic stability. Published studies [25,26,28] on gluteus medius training alone have not shown improvements when implemented through a variety of exercises. However, Monteiro et al. [24] reported gluteus medius activation achieved through a protocol based on a single exercise (pelvic drop). This may suggest that excessive activation of this muscle could lead to fatigue and, hence, overtraining can be counterproductive.
Our results may contribute to promote the development of an abdominal training protocol with the long-term goal of providing benefits in terms of injury prevention, without fatiguing the gluteus medius muscle. This would offer the advantage of saving time in training as the injury prevention protocol would not focus on the gluteus medius.
Limitations of the study
This study presents some limitations that could affect the interpretation of the results supporting the hypothesis and that should be taken into account in future studies to overcome these difficulties. The low sample size is the main limitation, although the authors have compensated for this by implementing a number of methodological quality contributions (blinding of the rater, calculation of the interobserver reliability analysis, follow-up assessment, etc.).
There are also psychological, physiological or nutritional factors that can affect the sports performance of each player, these being beyond our control, and which might have altered their performance, directly affecting the results of the study.
Relevance to clinical practice
The results obtained may reinforce some of the concepts already existing in the area of injury prevention in soccer. In the first place, an attempt is made to establish the relationship, in terms of muscle and myofascial chains, between the abdominal and lumbo-pelvic central stability region, and the adductor muscles. This is one of the structures most often injured in soccer players, a possible cause often being poor stability of the central core itself.
The results of this study can serve as the basis for prevention plans in footballers of both sexes, as the incidence of injury, although not the same, is similar. In the same way, the injured structures tend to be the same so it can be used in both sexes. Moreover, the plan described would involve a low-cost resource with short sessions, something which favors its applicability.
The relationship between the gluteus medius muscle (an important stabilizer of the lower limbs) and the lumbo-pelvic region and the role of this muscle in lumbar pathologies should be taken into account in the development of preventive plans or for the treatment of the lumbar spine and pelvic region. Lastly, the aim is to promote and contribute to the prevention of injuries in women's soccer, and to provide evidence towards the prevention of diseases that currently account for a significant proportion of injuries in soccer.
Recommendations for future research
Future studies would ideally involve a longer research period, to deepen in the search of relevant scientific articles and in the design of an intervention plan suited to the needs of the population. A larger sample size is essential to improve the strength of the results.
Lastly, this growing line of research in the field of women's soccer should be encouraged, and more specifically in the field of injury prevention, since this represents an important factor to increase and optimize sports performance.