Korean Journal of Physiology and Pharmacology, Volume 27, Issue 4, 2023 DOI:10.25463/kjpp.27.4.2023.

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ISSN:1226-4512 1

Effect Of Copenhagen Adduction Exercise On Groin

Pain And The Adductor Flexibility Among Amateur
Male Football Players
K.N. Jeeva1, D. Latha2, K. Sujatha3, G. Murugan4, A. Monik
Melina5
1,3,4.5
Assistant Professor, Takshashil University, Tindivanam,
TamilNadu
2
Assistant Professor, APCOPT, melmaruvathur, India

Abstract
BACKGROUND: Groin injuries represent a considerable problem in male football players, accounting for 4%-9% of all time injuries.
The most frequent mechanisms for groin injuries in football are kicking and changes of direction, as a result of the large eccentric
forces when these movements are performed are at high speeds.
The Copenhagen adduction exercise has demonstrated high activation of the adductor longus muscle, as well as considerable eccentric
strength gains. This exercise has shown considerable changes in hip adduction eccentric strength, when following a standardized
protocol.
OBJECTIVE: To determine the effect of Copenhagen adduction exercise on pain and adductor flexibility among amateur male
football players using goniometer
STUDY DESIGN: A Quasi-Experimental study
MATERIALS AND METHODOLOGY: The study included 25subjects between the age group of 19 and 30 based on the inclusion
and exclusion criteria and were trained with Copenhagen adduction exercise for a period of 8 weeks, 3 training sessions per week,
sessions for 10-15 mins. The outcome measures were ROM and pain and assessed before and after the treatment session using
RESULT: The pre-test and post-test values were assessed using the paired ‘t’ test and the results show a significant difference between
the pretest and posttest values of pain and adductor flexibility among amateur male football players
CONCLUSION: Hence the study concluded that the Copenhagen adduction exercise was effective on amateur male football players.

Keywords: Amateur male football players, Copenhagen adduction exercise, Visual analogue scale, Goniometer

I. INTRODUCTION
Groin injuries represent a considerable problem in male foot football players, accounting for 4% - 19% of all time injuries. The most frequent
mechanisms for groin injuries in football are kicking and changes of direction, as a result of the large eccentric forces when these movements
are performed at high speeds [1]. Football is an intermittent team sport with high physical, technical, and tactical demands [2]. Associated with
the high physical demands of this team sport, studies have reported a relatively high injury incidence in football players, with 20-35 injuries per
1000 players. Reports indicated that 60% of groin injuries in football players are adductor related [3]. When the condition becomes long
standing, the athlete usually waits a relatively long period of time before returning to sports daily.

Football players have increased eccentric strength in the hip-abductors, but not in the hip-abductors, compared with activity-matched controls.
This indicates that football play may substantially increase eccentric hip-adduction strength. The hip-adduction muscle-tendinous complex is
stressed substantially in football, especially during kicking [4].

The adductor longus muscle is the biggest of the groin muscle group and most prone to injury in soccer. The groin muscles are used mostly
during the swing phase of kicking and are at the greatest risk of injury when the athlete begins to bring the leg forward towards the ball [going
from eccentric to concentric contraction]. Groin muscles also require good strength and are at risk of injury during a 50/50 tackle against the
opponent [7].

The Copenhagen adduction exercise, is a side plank variation that targets the muscles of the inner thigh and groin – the adductors [8]. The
Copenhagen protocol is a graduated eccentric training regime that strengthens hip adduction and optimizes the EHAB: EHAD ratio. The
apparent advantage of this exercise is that no equipment is needed. Furthermore, large adductor eccentric contraction demands in sports
training and competition seem to be one of the reasons to have a high prevalence of adductor injuries. Thus, many different exercises have been
including in preventive programs, focused on improving adductor strength, in order to avoid injuries and limit the amount of losing time in
competition.
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II. NEED FOR THE STUDY:

Groin pain and reduced adductor flexibility among male amateur football players has been explored by various researchers using various
treatment approaches. The current study focuses on groin pain and adductor flexibility over the same population.

Copenhagen adduction exercise have proved to show faster recovery, which improves the quality of living and also a better technique
rehabilitation of groin pain and adductor flexibility. Therefore, this study mainly focused on the effect of Copenhagen adductor exercise, on
groin pain and adductor flexibility among male amateur football players.

AIM: The aim of this study is to find the effect of Copenhagen adduction exercises on groin pain and adductor flexibility among male amateur
football players.

III. REVIEW OF LITERATURE:

Vincent Morelli, Victor Weaver et al., [2005] conducted a study based on sports injuries to the hip and groin region have been noted in 5% to
9% of high schools. These injuries occur most commonly in athletes participating in sports involving side-to-side cutting, quick accelerations
and decelerations, and sudden directional episodes of mild discomfort to severe and chronic career-ending pain.

Yehuda E., Serner et al., [2018] conducted this descriptive epidemiology study that describes the rate, mechanisms, sex- based differences, and
severity of hip/groin injuries across 25 collegiate sports and concludes that Hip/groin injuries are most common in sports that involve kicking
or skating and sudden changes in direction and speed. Most hip/groin injuries in collegiate athletes are noncontact and do not result in time lost
from competition, and few require surgery. The information can help guide treatment and prevention measures to limit such injuries in male
and female collegiate athletes.

Sean Lanzinger et al., [2020] This study analysed the results of a criteria-based rehabilitation protocol for athletes with acute adductor injuries.
Athletes with an MRI grade 0-2 adductor injury were clinically pain- free after approximately 2 weeks and returned to full team training after
approximately 3 weeks. Most athletes with an MRI grade 3 adductor injury were pain-free and returned to full team training within 3 months.
Meeting the clinically pain-free criteria resulted in fewer injuries compared with not meeting the criteria.

IV. MATERIALS AND METHODOLOGY:

STUDY DESIGN A Quasi-experimental study

SAMPLE SIZE 25 subjects were selected

STUDY POPULATION Male amateur football players

SAMPLING TECHNIQUE Non probability purposive sampling

STUDY SETTING Football club

TREATMENT DURATION 8 Weeks, 3 training sessions per week, sessions for

10-15 mins
OUTCOME MEASURES • Groin Pain
• Adductor flexibility

MEASUREMENT TOOLS • Visual analogue scale

• Goniometer - It is an instrument that used to
measure the available range of motion at a
joint.

SELECTION CRITERIA Inclusion criteria

❖ Amateur male football players
❖ Age 19-30 years
❖ Current groin pain due to sport of at
least 6 weeks duration
❖ Presence of pain during resisted
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adduction
❖ Players with no other surgical or pre-
occurrence of hip related pathology
❖ Players who could participate in the
whole duration of the intervention
❖ Individual who is willing for the post
training match session
❖ Individuals who are beginners at the
club and regular
Exclusion criteria
❖ Palpable inguinal or femoral hernia or
pain felt above the conjoint tendon
❖ Clinical signs or symptoms of
prostatitis or urinary tract infection
❖ Back pain felt from T10 to L5
❖ Osteoarthritis of the hip joint
❖ Clinical suspicion of a nerve
entrapment syndrome
❖ Individuals with hip pathology
❖ Recent fractures
❖ Individuals with pubic related
pathology
❖ Individuals with sacroiliac pathology
❖ Lumbar herniated intervertebral disc
❖ Previous shoulder related pathology or
dislocations
❖ Core muscle instability or previous
surgeries on abdomen

HYPOTHESIS
Null hypothesis
H01- There is no significant difference between pre – test and post – test values of Numeric Pain Rating Scale among male football players
who received Copenhagen adduction exercise.
H02- There is no significant difference between pre – test and post – test values of Range of motion measured using goniometer among male
football players who received Copenhagen adduction exercise.

Alternative hypothesis
HA1-. There is a significant difference between pre – test and post – test values of Visual Analog Scale among male amateur football players
who received Copenhagen adduction exercise.
HA2- There is a significant difference between pre – test and post – test values of Range of motion measured using goniometer among amateur
male football players who received Copenhagen adduction exercise.

STUDY METHOD
Procedure
25 players are selected based on the selection criteria. The purposive sampling is done for the selection of subjects who is having groin pain
based on the inclusion and exclusion criteria. Those who showed willingness to participate in the study were asked to fill and sign the informed
consent form. Pre-test measures were taken on Goniometer before the prescription of the exercises and post-test measures were taken after the
treatment duration.

Intervention
Copenhagen adduction exercise
❖ The player who is exercising is in a side-lying position using the forearm as support on the floor, the other arm is placed on the body,
the upper leg is held by the partner, approximately at the height of his hip, with one hand on the ankle and the another one on the knee.
❖ Then, the player must raise the body from the floor, around 3 s eccentric hip adduction, until the body is in a straight line, so the feet
are touching each other.
❖ The body is lowered halfway to the ground, around 3 s eccentric adduction, until touching the floor without using it for support.
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Protocol
❖ 3 training sessions per week for 8 weeks.
❖ Begins with 2 sets of 6 reps, progress to 3 sets of 6 reps.3-5 mins rest for each set

Fig 1. Initial stage of Copenhagen adduction exercise

Fig 2. Adducted stage of Copenhagen exercise

STATISTICAL ANALYSIS
Paired ‘t’ test:

Paired ‘t’ test is done to compare the pre-test ad post-test of the experimental group.

𝑑×√𝑛
t= 𝑆

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∑ 𝑑2 −(𝑑)2 ×𝑛
Where,S=√ 𝑛−1

n = total no. of samples in paired t test

S = standard deviation
𝑑 = mean of deviation
𝛴𝑑2 = sum of squared deviation
DATA PRESENTATION
DATA TABULATION
Paired 't' test:

SUBJECT'S PRE-TEST AND POST TEST VALUES OF PAIN

Mean value
Outcome measure Calculated 't' Table 't' Value P value and level of
Pre test Post test Value significance

Numeric pain 7.48 5.84 4.74 2.064 P <0.05

rating scale Significant

SUBJECT'S PRE-TEST AND POST TEST VALUES OF ADDUCTOR TIGHTNESS

Mean value
Outcome measure Calculated 't' Table 't' Value P value and level of
Pre test Post test Value significance

Goniometer 32 35.4 3.39 2.064 P < 0.05

Significant

GRAPHICAL REPRESENTATION:
SUBJECT'S PRETEST AND POST TEST VALUES OF PAIN AND RANGE OF MOTION:

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SUBJECT'S PRETEST AND POST TEST VALUES OF RANGE OF MOTION:

RESULTS:
DATA ANALYSIS
Data analysis is a method by which the validity of a research study is evaluated and is essential for constructing the validity of a research study
purpose. It requires a number of closely related operations beginning from the establishment of a category to raw data through coding, drawing
statistical inferences and also finally tabulation of the data that have been collected.

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A total of 25 male amateur football players between the age of 19 to 30 years who met the inclusion criteria were selected by convenience
sampling method, then they received the Copenhagen adduction exercise.

Pre-test and post-test data collected and were statistically analysed using Paired ‘t’ test to find out the statistical differences. Pre and post-test
values of the group were obtained on the first day of treatment and at the end of eight weeks. The ‘p’ value was set at < 0.05. Corresponding
formulas for Paired ‘t’ test was used. The ‘t’ values obtained from pre-test and post-test values of pain and flexibility were 4.74 and 3.39
respectively.

DATA INTERPRETATION:
Interpretation of data means to examine the results from the data analysis, where it forms the conclusion and also exploring the significance of
the findings and also suggesting further studies. The results concluded that the Copenhagen adductor exercise reduces groin pain and improves
adductor flexibility among male amateur football players.

V. DISCUSSION:
The fact that groin injury is prevalent among athletes and it is estimated that 5–18% of all sports injuries are groin-related. So, this study is
emphasized for improving hip adductor strength and groin function [1]. Based on the mini meta-analysis of Jorge Pérez-Gómez et al, some
recommendations for the Copenhagen adduction training intervention are: (a) eight weeks, 2–3 times per week, seems to be effective, (b)
weekly volume from 9 to 90 reps is enough to achieve a significant improvement. He suggested that is important to highlight the short time
required to carry out the Copenhagen Adduction intervention, which is usually shorter than 15 minutes.

Authors of several studies have identified decreased strength in the adductors preceding and following the onset of groin injuries, which makes
adductor strength training a top priority in prevention and rehabilitation of groin injuries[2]. Resistance training is recommended because it
produces high levels of muscle activity (EMG values > 80%) in the adductor longus. The Copenhagen Adduction has been shown to induce
high muscle activity of 108% of maximal voluntary isometric contraction (MVC), and longitudinal strength gains. However, isometric
exercises induce angle-specific strength gains and are predominantly recommended in the course of muscle injury rehabilitation when pain and
range of motion limits the ability to perform dynamic muscle contractions [4]. Thus, the main purpose of the study is to find out Relative
Effects of Copenhagen Adduction Exercise in Amateur Football players on groin pain and adductor flexibility.

The results of this study revealed that subjects showed improvement in adductor strength and the fact that groin injury is prevalent among
athletes and that it is estimated that 5–18% of all sports injuries are groin-related, this injury still frequently causes sport physiotherapists
trouble due to difficulties in treatment. So, this study is emphasized for improving hip adductor strength and groin function.

VI. CONCLUSION
This study concluded that Copenhagen adduction exercise reduces groin pain and improves adductor flexibility among male amateur football
players.

LIMITATIONS OF THE STUDY

• There is a lack of control group in this study
• This exercise concentrated only on strengthening the Adductor Longus muscle.

RECOMMENDATIONS OF THE STUDY

• Long term follow-up period can be applied.
• Various exercise protocol can be recommended to the athletes in order to strengthen the Adductor muscle thereby improving Groin
pain.

REFERENCES
1. Kristian Thorborg, MSportsPhysio, Michael P.Reiman, Adam Weir, et al. Clinical Examination, Diagnostic Imaging, and Testing of
Athletes with Groin Pain: An Evidencebased Approach to Effective Management. J Orthop sports phys Ther 2018;48[4]:239-249
Epub 6 ,ar 2018. doi:10.2519/jospt.2018.7850
2. 2] Andreas Serner, Casper H van Eijck, Berend R Beumer, et al. Study quality on groin injury management remains low: a systemic
review on treatment of groin pain in athletes. Br J Sports Med 2015 Jun;49[12]:813. doi: 10.1136/bjsports-2014-094256
3. 3] Sailesh V.Tummala, Anikar Chhabra Justin L. Makovicka, et al., Hip and Groin injuries Collegiate male football players: The 10-
year Epidemiology, Incidence, and Prevention. Orthopaedics. 2018 Nov 1;41[6]:e831-e836. doi : 10.3928/01477447-20181010-01
4. 4] Vincent Morelli, Victor Weaver Groin injuries and Groin pain in athletes: Part 1. April 2005 Primary Care Clinics in office Practice
32[1]:163-83 doi : 10.1016/j.pop.2004.11.011 5] Jorge Perez-Gomez, Santos Villafaina, Jose Carmelo Adsuar, et al., Copenhagen
Adduction Exercise to Increase Eccentric Strength: A systematic review and Meta-analysis.
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5. 5] Joar Haroy, Benjamin Clarsen, Espen Guldahl Wiger, Mari Glomnes Oven, Andreas Serner:British journal of sports medicine 53
[3], 150-157, 2019.The adductor strengthening programme prevents groin pain problems among malr football players : A cluster-
randomised controlled trial.
6. 6] Diego Alonso-Fernandez, Rosana Fernandez- Rodriquez, Yaiza Taboada – Iglesias. International Journal of Environmental
research and Public Health 19 [11], 6563, 2022.Effects of Copenhagen on muscle architecture and adductor flexibility.
7. 7] Joar Haroy, Kristian Thorborg, Andreas Serner, Andre Biorkheim, Linn E Rolstad, Per Holmich- The American journal of sports
medicine 45 {13} , 3052-3059, 2017. Including the Copenhagen adduction exercise in the FIFA 11+ provides missing eccentric hip
adduction strength effect in male soccer players : a randomized controlled trial.
8. 8] George Polglass, Adam Burrows, Mathew Willet – BMJ open sport and exercise medicine 5[1], e000570, 2019. Impact of a
modified progressive Copenhagen adduction exercise programme on hip adduction strength and post exercise muscle soreness in
professional footballers.
9. 9] Jack Dawkins, Lasse Ishoi, Jake O Willot, Lars L Andersen, Kristian Thorborg- Translational sports medicine 4[4], 447-457, 2021.
Effects of a low-dose Copenhagen adduction exercise intervention on adduction strength in sub-elite male football players : a
randomised controlled trial.
10. 10] Lasse Ishoi, Kristian Thorborg – British Journal pf sports medicine 55[19], 1066-1067,2021.Copenhagen adduction exercise can
increase eccentric strength and mitigate the risk of groin problems.
11. 11] P Holmich, K Larsen, K Krogsgaard, C Gluud- Scandinavian journal of medicine and science in sports 20[6]. 814-821, 2010.
Exercise program for prevention of groin pain in football players : a cluster- randomised trial

APPENDIX
INFORMED CONSENT FORM
I voluntarily consent to participate in the research study “EFFECT OF COPENHAGEN ADDUCTION EXERCISE ON GROIN PAIN
AND THE ADDUCTOR FLEXIBILITY AMONG AMATEUR MALE FOOTBALL PLAYERS”. The researcher has explained to me the
treatment approach, in brief, and the risks of treatment techniques, and has answered the question related to the research to my satisfaction.

SIGNATURE OF PARTICIPANT:

SIGNATURE OF WITNESS:

SIGNATURE OF RESEARCHER:

ASSESSMENT FORM

NAME :

AGE :

GENDER :

WEIGHT :

DURATION OF GROIN PAIN :

OUTCOME MEASURES :

ADDUCTOR FLEXIBILITY – GONIOMETRY

Pre-test Post-test

VISUAL ANALOG SCALE

Pre-test Post-test

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