Prevalence of hip pain in elite badminton players

doi:10.21203/rs.3.rs-4842945/v1

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Prevalence of hip pain in elite badminton players

https://doi.org/10.21203/rs.3.rs-4842945/v1

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Background

A number of studies have investigated injuries in badminton players, but none have focused on investigating hip pathologies in this population. Therefore, the purpose of the present study is to (i) report the prevalence of hip pain in elite badminton players currently registered at a national sports institute, (ii) describe their hip pathologies, and (iii) evaluate expectations regarding hip pain before and after becoming elite athletes.

Methods

All badminton players at a national sports institute on 01/09/2023 were contacted by the medical team to complete a questionnaire comprising training information, prevalence of hip pain, and expectations regarding hip pain. The medical database was reviewed to identify all hip pathologies recorded.

Results

Of the 20 elite badminton players registered at the national sports institute (10 females and 10 males, aged 23.8 ± 3.9 years), 9 (45%) reported experiencing hip pain while registered at the institute, 4 at their dominant side only and 5 bilaterally. Six players had cam-type femoroacetabular impingement (FAI), concomitant with coxofemoral chondropathy and/or muscle tears in 3 athletes (requiring femoroplasty in 3). Furthermore, 3 more players had coxofemoral chondropathy and/or muscle tears. Before playing badminton at a high-level, 12 (60%) thought that becoming elite players could cause joint pain; however, none (0%) thought that it would cause pain specifically at their hip joint.

Conclusions

Nine of 20 elite badminton players have experienced hip pain while registered at a national sports institute, with the most common hip pathologies being cam-type FAI (n = 6; 30%) and muscle tears (n = 4; 20%). Although before playing badminton at a high-level, none of the athletes thought that becoming an elite badminton player could cause pain specifically at the hip joint, at the time of the questionnaire, 19 athletes (95%) thought this was common. These findings could allow coaches and medical staff to align expectations regarding the likelihood of hip pain and hip pathologies in badminton players training at an elite level.

Competitive athletes are increasingly experiencing hip and groin injuries [1–5], which can lead to the development of hip pathologies. Hip pathologies may develop from traumatic injuries that result in fractures or tears, as well as from repetitive events, such as abnormal joint contact [2, 6–8], which can lead to femoroacetabular impingement (FAI). These pathologies can cause chronic pain that can hinder or even end professional careers [9–12].

Several studies have investigated hip pathologies in athletes, and have found cam-type FAI to be one of the most common hip pathologies in this population, with prevalences as high as 70% [13–16]. Although the exact mechanism for the development of cam-type FAI in athletes is yet to be fully understood, a proposed theory is the impingement of the femoral neck agasint the anterior aspect of the acetabular rim during sports practice [14].

Badminton is an asymmetric overhead racket sport, that requires continuous repetitions of high intensity jumps, landings, and changes of direction, which place high stresses and ranges of motion on the lower limbs [17]. Thus, badminton players may be prone to develop specific hip pathologies. A number of studies have investigated injuries in badminton players [18–21], but none have focused on investigating hip pathologies in this population. Therefore, the purpose of the present study is to (i) report the prevalence of hip pain in elite badminton players currently registered at a national sports institute, (ii) describe their hip pathologies, and (iii) evaluate expectations regarding hip pain before and after becoming elite athletes.

All badminton players registered at a national sports institute in September 2023 were contacted by the medical team to complete a questionnaire consisting of six sections (Supplementary Appendix 1). The institute is a high-level training center for more than 700 top-level athletes in 24 sports, including badminton, and is dedicated to excellence in sports. All badminton players registered at the institute compete nationally and/or internationally. Section A of the questionnaire comprised the University of California Los Angeles (UCLA) activity score. Section B comprised information related to their badminton career, including how long they had been playing, as well as their expectations regarding hip pain before and after becoming an elite athlete. Section C comprised information related to their career at the institute, including the number of playing hours while in good shape and ranking, as well as whether they had hip pain before and/or while registered at the institute. Section D was only for players that had hip pain while registered at the institute and comprised questions about the onset of hip pain and the intensity of pain on a visual analogue scale (VAS; 0, no pain; 10, excruciating pain), as well as the effect of pain on their playing capabilities and ranking, and their return to play following hip pain. Section E comprised the treatment received for hip pain. Finally, Section F comprised questions regarding the athlete’s concern on how a hip pathology may affect their future career and quality of life. Furthermore, the medical database at the institute was retrospectively reviewed to identify all hip joint injuries and pathologies recorded by the medical team. Athletes provided informed consent for their data to be used for research and publication purposes, and research was carried out in accordance with the Declaration of Helsinki. Institutional Review Board approval was obtained from ‘GCS Ramsay Santé pour l’Enseignement et la Recherche’ (#COS-RGDS-2024-07-002-TOURABALY-I).

Data analysis

Due to the small cohort size, only descriptive statistics were used to summarise the data.

In September 2023, there were 20 elite badminton players registered at a national sports institute, comprising 10 females and 10 males, with a mean age of 23.8 ± 3.9 years (range, 18–31) and body mass index (BMI) of 22.8 ± 1.7 kg/m² (range, 20–26) (Table 1). The right side was dominant for 19 of the 20 athletes (95%). The athletes had been playing badminton at a club for 16.9 ± 4.0 years (range, 10–24) and played badminton for 18.7 ± 4.0 hours per week (range, 8–25) while in good shape. The UCLA activity score was 10 for all 20 athletes. Their national ranking ranged from 1–36 (including both singles and doubles), while their international ranking ranged from 7–356 (including both singles and doubles).

Before playing badminton at a high-level, 12 athletes (60%) thought that becoming an elite badminton player could cause joint pain; however, none (0%) thought that becoming an elite badminton player could cause pain specifically at the hip joint. Interestingly, at the time of the questionnaire, 19 athletes (95%) thought it was common for elite badminton players to have hip pain. Furthermore, 9 athletes (45%) were concerned that a hip pathology may affect their future career, and 9 (45%) were concerned that a hip pathology may affect their future quality of life.

Nine of the 20 athletes (45%) reported experiencing hip pain while registered at the institute, with 5 of these athletes (25%) currently experiencing hip pain at the time of the questionnaire (Table 1). Four athletes had hip pain at their dominant side only, while 5 had bilateral hip pain; interestingly, none had hip pain at their non-dominant side only (Table 2). The onset of pain was sudden in 4 athletes and incremental in 5. While hip pain was at maximum intensity, the average pain on VAS while playing badminton was 5.8 ± 4.0 (range, 0–10) at the dominant side and 3.4 ± 4.4 (range, 0–10) at the non-dominant side. Hip pain was concomitant with reduction in range of motion in 7 athletes, night pain and/or morning stiffness in 6 athletes, and cracking and/or snapping at the hip in 6 athletes. Five athletes reported that their hip pain affected their quality of life. While hip pain was at maximum intensity, 3 athletes had to completely stop playing, 3 had to reduce the number of hours of play, and 3 had no change in their ability to play.

A review of the medical database revealed that, of the 9 athletes who reported experiencing hip pain, 6 had radiologically confirmed cam-type FAI, which was bilateral in 2, on the dominant side in 3, and on the non-dominant side in 1. Cam-type FAI was concomitant with coxofemoral chondropathy only in 2 athletes, and coxofemoral chondropathy and sartorius muscle tear in 1 athlete (Table 3). Regarding the 3 athletes without FAI, 1 had bilateral coxofemoral chondropathy with adductor magnus muscle tear and labral tear in the dominant side, another had coxofemoral chondropathy with adductor magnus muscle tear in the dominant side, and the other had gracilis muscle tear in the dominant side and adductor magnus tear in the non-dominant side. Physical rehabilitation was prescribed for all 9 athletes, training modification for 5, non-steroidal anti-inflammatory drug (NSAID) for 5, corticosteroid injection for 2, pain killers for 1, and hyaluronic acid injection for 1. Furthermore, 3 athletes underwent primary unilateral arthroscopic femoroplasty of the right hip for cam-type FAI.

Regarding the 3 athletes that underwent femoroplasty, 1 reported that hip pain at their operated side had reduced by 100% following surgery (Athlete #1), 1 reported it had reduced by 95% (Athlete #5), while 1 reported that it had reduced by 50% (Athlete #2). All 3 athletes were able to return to play badminton following femoroplasty, 2 athletes (Athletes #1 and #5) returned to play at a better level than before hip pain started and played more hours per week than before hip pain started, while 1 athlete (Athlete #2) returned to play at the same level and played the same number of hours per week than before hip pain started.

The most important finding of this study on hip pathologies in elite badminton players at a national sports institute was that 9 of the 20 athletes have experienced hip pain while registered at the institute. Furthermore, the most common hip pathologies were cam-type FAI (n = 6; 30%), which required arthroscopic femoroplasty in 3 athletes, and muscle tears (n = 4; 20%). Before playing badminton at a high-level, 12 athletes (60%) thought that becoming an elite badminton player could cause joint pain; however, none (0%) thought that becoming an elite badminton player could cause pain specifically at the hip joint. Interestingly, at the time of the questionnaire, 19 athletes (95%) thought it was common for elite badminton players to have hip pain. Finally, 9 athletes (45%) were concerned that a hip pathology may affect their future career, and 9 (45%) were concerned that it may affect their future quality of life. These findings could allow coaches and medical staff to align expectations regarding the likelihood of hip pain and hip pathologies in badminton players training at an elite level.

Badminton is a fast-paced game where athletes need quick reaction times to anticipate the direction and speed of the shuttle, movements that are comparable to cutting in other sports. Besier et al.[22] investigated the forces on the knee during badminton, and found some evidence that unanticipated movements result in greater varus/valgus and internal/external rotation moments at the knee compared to anticipated ones. Greater forces increase the strain through the joint which could amplify the potential for injury. Even though the study of Besier et al.[22] was specifically on the knee, this could imply that a similar effect would occur at the hip joint.

Hip and groin injuries are a recognised and important problem in competitive athletes, as they can lead to chronic pain that can hinder or even end professional careers [9–12]. A recent systematic review by Cruz et al. [9] on National Collegiate Athletic Association (NCAA) athletes found that hip pain is highest in impingement-type sports such as ice hockey (97%), followed by contact sports, such as football and wrestling (60%). Cruz et al. [9] also investigated asymmetric/overhead sports, which include tennis, baseball, softball and volleyball, and found a rate of hip injuries of 31%; however none of the included studies reported on badminton, which is an asymmetric sport.

A study by Reeves et al.[20] investigated the epidemiological incidence of injuries in badminton players between 2006 and 2011, and found that lower extremity injuries account for 44% of the total. Miyake et al.[19] only investigated injured tournament-level athletes and found that most injuries occurred during practice compared to during matches. Finally, an older study by Yung et al.[21] investigated the epidemiology of injuries in Hong Kong elite badminton athletes and found an injury incidence of 5.04 per 1000 player-hours. Furthermore, the study by Yung et al. found that most injuries were strains, followed by sprains, and, interestingly, spinal facet injuries. Although these studies have reported on the injury incidence in badminton players, none of the published literature has focused on the type of hip pathologies in this specific patient population. The present study found that 6 athletes (30%) had cam-type FAI, of which 2 had bilateral, 3 had on their dominant side only, and 1 had on their non-dominant side only. Furthermore, FAI was sometimes concomitant with coxofemoral chondropathy, muscle tears, and adductor tendinopathy. Additionally, 2 athletes (20%) had coxofemoral chondropathy, in both cases with concomitant muscle tears, and 1 athlete (5%) had adductor magnus and gracilis muscle tears. It is interesting to note that most hip pathologies occurred in the dominant side, which is to be expected in an asymmetric sport such as badminton.

The most important question for elite athletes is when they can return to sport following an injury, and in the authors’ opinion this is closely related to the timing of the treatment. In cases that require only an infiltration, there might be quick pain decrease which allows the athlete to return to play. However, in severe cases, hip pathologies in high-level athletes may require surgery. In the present study, 3 of the 9 athletes with hip pain required primary unilateral arthroscopic femoroplasty for cam-type FAI, after which all (100%) were able to return to play, 2 at a higher level and 1 at the same level. This data is promising, as it shows that the rate of return to play is high in this specific patient population. These findings are corroborated by a recent meta-analysis, which has shown that hip arthroscopy is a successful treatment for FAI, resulting in a high rate of postoperative patient satisfaction and an improvement in patient-reported outcomes, including pain, with a low rate of complications and reoperations [23]. Maldonado et al. [24] investigated return to play after hip arthroscopy for the treatment of FAI with labral tears in tennis players, and found that 75% returned to play, most of which returned at the same or higher level. In a systematic review by Nicola et al. [25], 87% of athletes with symptomatic FAI returned to their sport after hip arthroscopy, and 82% returned to preinjury level. Furthermore, a more recent meta-analysis by Lovett-Carter et al. [26] reported that 88% of athletes with symptomatic FAI returned to their sport after hip arthroscopy, and 85% returned to preinjury level.

The results of this study should be interpreted with the following limitations in mind. First, athletes were asked retrospectively about their playing capabilities and hip pain, which may affect the accuracy of this data, resulting in athletes over- or under-estimating their pain scores. Second, the present study only considered the time frame while athletes were registered at the institute. Third, the present study evaluated a small cohort of professional badminton players registered at a single elite institute at one time point, thus these findings cannot be generalised or extrapolated to badminton players at other institutes. Finally, due to the small cohort size, it was not possible to perform uni- and multi-variable analyses to identify which athlete characteristics could be risk factors for hip pathologies.

Femoroacetabular impingement (FAI)

University of California Los Angeles (UCLA)

Visual analogue scale (VAS)

Body mass index (BMI)

Non-steroidal anti-inflammatory drug (NSAID)

National Collegiate Athletic Association (NCAA)

Ethics approval and consent to participate

Athletes provided informed consent for their data to be used for research purposes, and research was carried out in accordance with the Declaration of Helsinki.

Consent for publication

Athletes provided informed consent for their data to be used for publication purposes.

Availability of data and materials

Data is available from the corresponding author upon reasonable request.

Competing interests

None of the authors declare any conflict of interest in the authorship or publication of this contribution.

Funding

Clinique Trenel provided funding for data analysis and manuscript writing.

Acknowledgements

The authors are grateful to Adrien Revault for his assistance with data collection and project management.

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Tables 1 to 3 are available in the Supplementary Files section.

No competing interests reported.

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You are reading this latest preprint version

Prevalence of hip pain in elite badminton players

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Abstract

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Introduction

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Data analysis

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