Intrarater reliability of the adductor squeeze test in Gaelic Games athletes.
Delahunt E, McEntee BL, Kennelly C, Green BS, Coughlan GF. J Athl Train. 2011;46(3):241-5.
Groin pain is a common problem among athletes, particularly in sports involving speed, strength, and agility demands (e.g., rugby, lacrosse, field hockey, soccer). The strength of the adductor muscles is of particular interest in the diagnosis and treatment of groin pain.  Different special tests such as the pubic symphysis gap test and the squeeze test have been used in the diagnosis of groin injuries. The squeeze test requires maximum bilateral contraction of the hip adductor muscles but different hip positions have been used.  Pain localized to the adductor muscles or pubic region are positive findings with the squeeze tests.  The objective of this study was to look at differences in adductor squeeze values in 3 positions of hip flexion (0, 45, and 90 degrees) and assess intrarater reliability of the squeeze test using a sphygmomanometer.  Eighteen male Gaelic Games players (age = 21.1 ± 2.5 years, height = 1.8 ± 0.1 m, mass = 78.2 ± 11.8 kg) were included in the study.  Participant had no history of groin or pelvic injury and no lower extremity injury during the previous 6 months. Each participant visited the lab on 2 occasions separated by at least one week. Upon arriving for the first session each participant was informed of the test positions and allowed 3 sub-max trials in the 3 test positions. Participants then performed 3 max trials at each test position (0, 45, and 90 degrees of hip flexion). The hip joints were kept in neutral and the order of hip flexion positions was randomized.  The highest pressure value on the sphygmomanometer was recorded during each max adductor squeeze test. Two minutes of rest was allowed between performances of the squeeze test at each position. Excellent reliability was noted in all positions and the maximum squeeze value was highest at 45 degrees of hip flexion.  No participants had any complaints of groin pain during the testing. This study has shown that the sphygmomanometer is a reliable tool for assessing adductor squeeze values in athletes.  One limitation to this study was that the 90 degrees test position might be better served with the legs supported rather than actively held in position. 
The data gathered in this study was interesting from the standpoint of determining differences in adductor squeeze values in different hip positions and because it demonstrated that sphygmomanometer, a low cost readily available piece of equipment, can be used to assess strength. Future studies to determine normative values would be of benefit, but clinicians can see a typical pattern with strength outcomes and hip position (45>0>90 degrees in terms of adductor squeeze pressure). It’s not surprising that the adductor strength was weakest at 90 degrees compared to the other angles because in sporting activities we often use our adductors in lateral movements of the body when our hips are less flexed. This data can aide in selecting hip positions for strengthening exercises when athletes present with either acute or chronic injuries. Furthermore, this study demonstrated that the sphygmomanometer is a reliable method of measuring adductor squeeze values.  After an initial assessment it can be used to document gains via increased squeeze values which can be helpful, along with other measures, for increased activity/return to play decisions. Prior to reading this article, I started using the sphygmomanometer with trunk/pelvic stabilization exercises.  Initially when I teach transverse abdominous isolation through the “draw in” maneuver, this device provides the patient feedback to maintain a neutral spine and prevent excessive substitution of accessory abdominal muscles.  This part of the program is critical and forms the foundation for progression of more challenging tasks/exercises.
It would be interesting if any clinicians use this tool for groin or other areas with rehab.
Written by: Thomas Martin
Reviewed by: Jeffrey Driban