Efficacy of Ultrasound-Guided Percutaneous Electrolysis for Hip Pain in Male Ice Hockey Players

Overview

Groin pain is a common and limiting condition in ice hockey players, often related to the high mechanical demands placed on the hip during skating. Repetitive movements involving hip flexion, abduction, and rotation may contribute to functional impairment and persistent symptoms. Recent clinical interest has focused on the relationship between the iliopsoas muscle and the anterior hip capsule, as their close anatomical and functional interaction may play a role in the development of hip-related groin pain. Percutaneous needle electrolysis (PNE) is a minimally invasive, ultrasound-guided technique used to promote tissue remodeling and pain reduction in musculoskeletal conditions. However, its application to the anterior hip capsule has not yet been investigated. This pilot experimental study aims to evaluate the effects of three sessions of PNE applied to the anterior hip capsule in male ice hockey players with groin pain. The main hypothesis is that this intervention may improve hip function by reducing pain and enhancing mobility and muscle strength. Outcomes include hip flexor strength, hip flexion range of motion, FADIR test results, and patient-reported outcomes measured with the HAGOS questionnaire. Assessments will be performed before and after the intervention, as well as at a 4-week follow-up.

Groin pain represents one of the most frequent and challenging musculoskeletal conditions in athletes, particularly in sports characterized by high mechanical demands on the hip joint, such as ice hockey. The skating motion involves repetitive cycles of hip flexion, abduction, and rotation performed at high intensity, exposing the hip joint and surrounding soft tissues to substantial mechanical stress. These repetitive loads are considered a key contributing factor in the development of chronic symptoms, functional limitations, and performance impairment. From a clinical and biomechanical perspective, increasing attention has been directed toward the relationship between the iliopsoas muscle and the anterior capsule of the hip joint. Due to their close anatomical proximity and continuous interaction during dynamic activities, these structures are subjected to repetitive frictional and tensile forces. This mechanical interaction may contribute to the development of adaptive changes in the periarticular tissues, potentially leading to reduced mobility, altered neuromuscular control, and persistent pain in the anterior hip or groin region. The complexity of groin pain in athletes has been highlighted in international consensus statements, which describe it as a multifactorial condition involving different anatomical structures and clinical entities. Within this framework, hip-related groin pain and iliopsoas-related pain are recognized as relevant components, reinforcing the importance of investigating periarticular hip structures, including the anterior capsule. Percutaneous needle electrolysis (PNE), also referred to as musculoskeletal percutaneous electrolysis (EPM), is a minimally invasive intervention performed under ultrasound guidance. The technique involves the application of a controlled galvanic current through a fine needle inserted into the target tissue. This intervention is thought to induce a localized electrochemical response that promotes tissue remodeling, modulates the inflammatory process, and facilitates the regeneration of altered or dysfunctional soft tissues. The clinical use of PNE has been widely described in the treatment of chronic musculoskeletal conditions characterized by degenerative or fibrotic tissue changes, such as tendinopathies. Experimental evidence also suggests that this technique may have beneficial effects in fibrotic environments by promoting structural reorganization and improving tissue function. However, despite these promising findings, there is currently no available literature specifically investigating the effects of PNE applied to the anterior capsule of the hip joint. In this context, the present study is designed as a pilot experimental trial aimed at exploring the potential clinical effects of PNE when applied to the anterior hip capsule in male ice hockey players presenting with groin pain. The exploratory nature of this study is intended to generate preliminary data and to assess the feasibility and potential clinical relevance of this intervention in a population exposed to high biomechanical demands. The working hypothesis is that targeted application of PNE at the level of the anterior hip capsule may contribute to improvements in hip function by reducing pain, enhancing joint mobility, and improving muscle performance. To evaluate these effects, a set of objective, clinical, and patient-reported outcomes will be collected at baseline, immediately after the intervention period, and at a short-term follow-up. Objective measures will focus on hip flexor muscle strength and passive hip flexion range of motion, while clinical assessment will include the FADIR test as a provocation test for hip-related symptoms. Subjective outcomes will be assessed using the Hip and Groin Outcome Score (HAGOS), a validated questionnaire covering symptoms, pain, daily activities, sports participation, and quality of life. The results of this pilot study are expected to provide initial insights into the potential role of PNE in the management of hip-related groin pain and to support the development of future controlled and randomized studies with larger sample sizes.