Five-second squeeze testing in 333 professional and semi-professional male ice hockey players: how are hip and groin symptoms, strength, and sporting function related

Key points

1. 01Higher pain during the 5-second squeeze test was linked to worse self-reported sporting function (HAGOS Sport) and lower hip adduction and abduction strength.
2. 02The traffic light approach (green NRS 0-2, yellow NRS 3-5, red NRS 6-10) successfully separated all three groups for self-reported function.
3. 03Players with a yellow or red light had significantly lower adduction strength than green-light players (Hedges g 0.75, p < 0.001).
4. 04The correlation between 5SST and sporting function was moderate (rho -0.319), weaker than previously reported in soccer players.
5. 05The test takes only 5 seconds to administer and can be used for regular in-season monitoring.

How it was conducted

Design

Cross-sectional study (Level of evidence 3)

Participants

333 professional and semiprofessional male ice hockey players from 13 Swedish teams, mean age 23.0 years

Intervention/Test

5-second maximal isometric adduction squeeze; pain rated on 0-10 NRS and categorised green (0-2), yellow (3-5), red (6-10)

Self-reported outcome

HAGOS Sport subscale (0-100; higher = better function)

Objective outcome

Bilateral hip adduction and abduction torque normalised to body weight, measured with handheld dynamometry

Statistical methods

Spearman rank-order correlations; Kruskal-Wallis and ANOVA for group comparisons; Hedges g and r as effect sizes

What they found

• 5SST correlated with HAGOS Sport score: rho -0.319, p < 0.01 (moderate strength).
• 5SST correlated with adduction strength: rho -0.305, p < 0.01 (moderate strength).
• 5SST correlated with abduction strength: rho -0.157, p < 0.01 (small strength).
• 5SST correlated with adduction-to-abduction ratio: rho -0.197, p < 0.01 (small strength).
• HAGOS Sport scores differed significantly between all three traffic light groups (p < 0.01); effect sizes r = 0.23 (green vs yellow), r = 0.33 (green vs red), r = 0.29 (yellow vs red, p = 0.005).
• Green-light players had higher adduction strength than yellow-light players: mean difference 0.35 Nm/kg (95% CI 0.23-0.47), p < 0.001, Hedges g = 0.75.
• Green-light players had higher adduction strength than red-light players: mean difference 0.43 Nm/kg (95% CI 0.20-0.65), p < 0.001, Hedges g = 0.91.
• Green-light vs yellow-light abduction strength: mean difference 0.10 Nm/kg (95% CI 0.01-0.18), p = 0.031, Hedges g = 0.30.
• Green-light vs red-light abduction strength: mean difference 0.17 Nm/kg (95% CI -0.01 to 0.34), p = 0.058 (not significant), Hedges g = 0.51.
• No significant strength differences were found between yellow-light and red-light players (adduction p = 0.54, abduction p = 0.45).

Limitations

• Cross-sectional design prevents causal inference about whether weakness causes pain or pain inhibits strength.
• Abduction strength was only measured in 10 of 13 teams (Stockholm area), limiting generalisability of abduction findings.
• The relatively small number of red-light players reduced statistical power for some comparisons, particularly green vs red abduction.
• The study included only male players, so findings may not generalise to female ice hockey players.

Why it matters

For patients

Ice hockey players with groin pain rated above 2/10 during the squeeze test are likely to have meaningful strength deficits and reduced sporting function, suggesting they should seek assessment and targeted strengthening.

For clinicians

The 5SST traffic light approach provides a quick, objective field tool for in-season monitoring; a yellow or red light should prompt further strength assessment and individualised load management or rehabilitation.

For readers

This large cross-sectional study validates the 5SST in ice hockey, extending earlier soccer findings and supporting its routine use as a practical screening tool for hip and groin health in team sport.