Athletic groin pain (part 2): a prospective cohort study on the biomechanical evaluation of change of direction identifies three clusters of movement patterns

Background: Athletic groin pain (AGP) is prevalent in sports involving repeated accelerations, decelerations, kicking and change-of-direction movements. Clinical and radiological examinations lack the ability to assess pathomechanics of AGP, but three-dimensional biomechanical movement analysis may be an important innovation. Aim: The primary aim was to describe and analyse movements used by patients with AGP during a maximum effort change-of-direction task. The secondary aim was to determine if specific anatomical diagnoses were related to a distinct movement strategy. Methods: 322 athletes with a current symptom of chronic AGP participated. Structured and standardised clinical assessments and radiological examinations were performed on all participants. Additionally, each participant performed multiple repetitions of a planned maximum effort change-of-direction task during which whole body kinematics were recorded. Kinematic and kinetic data were examined using continuous waveform analysis techniques in combination with a subgroup design that used gap statistic and hierarchical clustering. Results: Three subgroups (clusters) were identified. Kinematic and kinetic measures of the clusters differed strongly in patterns observed in thorax, pelvis, hip, knee and ankle. Cluster 1 (40%) was characterised by increased ankle eversion, external rotation and knee internal rotation and greater knee work. Cluster 2 (15%) was characterised by increased hip flexion, pelvis contralateral drop, thorax tilt and increased hip work. Cluster 3 (45%) was characterised by high ankle dorsiflexion, thorax contralateral drop, ankle work and prolonged ground contact time. No correlation was observed between movement clusters and clinically palpated location of the participant's pain. Conclusions: We identified three distinct movement strategies among athletes with long-standing groin pain during a maximum effort change-of-direction task. These movement strategies were not related to clinical assessment findings but highlighted targets for rehabilitation in response to possible propagative mechanisms. Trial registration number NCT02437942, pre results.

The 'Arc of prosperity' revisited: Homelessness policy change in north western Europe

This paper compares continuity and change in homelessness policy in Ireland, Scotland and Norway with a particular focus on the period of post-crisis austerity measures (2008-2016). The analytical approach draws on institutional theory and the notion of path dependency, which has rarely been applied to comparative homelessness research. The paper compares welfare and housing systems in the three countries prior to presenting a detailed analysis of the conceptualisation and measurement of homelessness; the institutions which address homelessness; and the evidence of change in the post-2008 period. The analysis demonstrates that challenges remain in comparing the nature of homelessness and policy responses across nation states, even where they have a number of similar characteristics, and despite some EU influence towards homelessness policy convergence. Similarly, national-level homelessness policy change could not be interpreted as entirely a result of the external shock of the 2008 general financial crisis, as existing national policy goals and programmes were also influential. Overall, embedded national frameworks and institutions were resilient, but sufficiently flexible to deliver longer term policy shifts in response to the changing nature of the homelessness problem and national policy goals. Institutionalism and path dependency were found to be useful in developing the comparative analysis of homelessness policy change and could be fruitfully applied in future longitudinal, empirical research across a wider range of countries.