The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol

Table 1

Modified Hölmich et al. protocol: part 1.

Exercise	Amount	Rest period
(1) Brief warm-up using a stationary bicycle	10 min (25 W load at 20 km/h)	—
Isometric, pain-free adduction against a soccer ball placed between the knees in the crook lying position	3 sets of 10 reps. (each rep. for 10 sec)	10 sec rest after each rep.  and 2 min rest after each set
Bilateral straight leg raising in a seated V position, as in Figure 1(a)	3 sets of 10 reps. (each rep. for 10 sec)	10 sec rest after each rep.   and 2 min rest after each set
Isometric standing hip adduction using elastic bands (both legs should be trained)	5 sets of 10 reps. (each rep. for 10 sec)	10 sec rest after each rep.  and 2 min rest after each set
Abdominal sit-ups in both straight and oblique directions	4 sets of 15 reps.	1 min rest after 15  consecutive reps.
Prone bridging on forearms and toes (the back should be completely straight)	10 reps. (each rep. for 15 sec)	15–20 sec rest after each rep.
Side bridging on the elbow (the trunk should be in neutral alignment, as in Figure 1(b))	10 reps. for each side (each rep. for 15 sec)	15–20 sec rest after each rep.
Unilateral bridge exercise starting from the crook lying position (with one knee flexed and the opposite hip and knee extended so that trunk is in neutral spine alignment, as in Figure 1(c))	10 reps. of 12 sec (each rep. consists of 6 sec right leg raising followed by 6 sec of left leg raising)	15–20 sec rest after each rep.
Wobble board balance training (beginning with both feet and gradual increase in difficulty by single leg standing and then adding some maneuvers like small knee bends to challenge the balance	8 min (the legs are switched once a minute when single leg standing)	—