The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol
Table 2
Modified Hölmich et al. protocol: part 2 (from the 3rd week onward).
Exercise
Amount
Rest period
Brief warm-up using stationary bicycle
10 min (25 W load at 20 km/h)
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Low back extension exercise in the prone position with arms at the sides
3 sets of 10 reps.
30 sec rest after each set
Abdominal sit-ups, in both straight and oblique directions, while holding a 3 kg medicine ball in hands
4 sets of 15 reps.
1 min rest after 15 consecutive reps.
Standing hip add-abd. exercise with elastic bands (both legs) (Jensen et al., 2014). Figures 1(d) and 1(e) show the starting and end position of hip add. exercise
5 sets of 10 reps. for add. and 5 sets of 10 reps. for abd. (concentric phase = 1 sec and eccentric phase = 3 sec)
2–5 sec rest after each rep. and 1 min rest after each set
Folding knife sit-ups beginning from the crook lying position, with a soccer ball located between the knees, simultaneous ab. sit-ups and hip flex (Hölmich et al., 1999)
5 sets of 10 reps.
1 min rest after 10 consecutive reps.
In the prone position with arms stretched overhead, partial lifting of opposite arm and leg for 6 sec and then reverse sides
2 sets of 10 reps. (each rep. consists of 6 sec lift for one side and 6 sec for the opposite side)
6 sec rest after each rep. and 2 min rest after each set
Prone bridging on forearms and toes with single limb lifting (Rt. arm, Lt. arm, Rt. leg, and Lt. leg are lifted consecutively, as in Figure 1(f))
8 reps. (6 sec for lifting each limb and total time of 24 sec for each rep.)
30 sec rest after each rep.
Side bridging on the elbow plus single hip abd., as in Figure 1(g)
10 reps. for each side (each rep. for 10 sec)
15–20 sec rest after each rep.
Unilateral bridge exercise. Start from crook lying position with one knee flexed and the opposite hip and knee extended while the flexed limb is on an unstable surface such as a Dyna Disc®, as in Figure 1(h)
10 reps. of 12 sec (each rep. consists of 6 sec Rt. leg raising followed by 6 sec Lt. leg raising)
15–20 sec rest after each rep.
Wobble board balance training including small knee bends, catching and throwing a ball, hands touching the standing foot alternately, and gentle side kicking of the ball (during end weeks)
10 min (the legs are alternated)
Single leg, cross-country skiing (Hölmich et al., 1999)
5 sets of 10 reps. for each leg
1 min rest after 1 set for each leg
Copenhagen Adduction exercise beginning from the 7th week, if it does not provoke pain (Ishøi et al., 2016; Serner et al., 2014), as in Figures 1(i) and 1(j)
Begin with 2 sets of 6 reps., can progress to 3 sets of 6 reps. and then to 3 sets of 10 reps. when it does not provoke pain
3–5 min rest after each set
Pain-free adductor stretching in a sitting position with flexed knees and feet together
