Interactions among muscle strength, pain, and self-reported outcomes in patients with anterior cruciate ligament reconstruction (ACLR) are not well understood. Clarifying these interactions is of clinical importance because improving physical and psychological function is thought to optimize outcomes after ACLR. To examine the relationships among neuromuscular quadriceps function, pain, self-reported knee function, readiness to return to activity, and emotional response to injury both before and after ACLR. Descriptive laboratory study. Twenty patients (11 females and 9 males; age = 20.9 ± 4.4 years, height = 172.4 ± 7.5 cm, weight = 76.2 ± 11.8 kg) who were scheduled to undergo unilateral ACLR. Quadriceps strength, voluntary activation, and pain were measured at presurgery and return to activity, quantified using maximal voluntary isometric contractions (MVICs), central activation ratio, and the Knee Injury and Osteoarthritis Outcome Score pain subscale, respectively. Self-reported knee function, readiness to return to activity, and emotional responses to injury were evaluated at return to activity using the International Knee Documentation Committee questionnaire (IKDC), ACL Return to Sport After Injury scale (ACL-RSI), and Psychological Response to Sport Injury Inventory (PRSII), respectively. Pearson product moment correlations and linear regressions were performed using raw values and percentage change scores. Presurgical levels of pain significantly predicted 31% of the variance in the ACL-RSI and 29% in the PRSII scores at return to activity. The MVIC and pain collected at return to activity significantly predicted 74% of the variance in the IKDC, whereas only MVIC significantly predicted 36% of the variance in the ACL-RSI and 39% in the PRSII scores. Greater increases in MVIC from presurgery to return to activity significantly predicted 49% of the variance in the ACL-RSI and 59% of the variance in the IKDC scores. Decreased quadriceps strength and higher levels of pain were associated with psychological responses in patients with ACLR. A comprehensive approach using traditional rehabilitation that includes attention to psychological barriers may be an effective strategy to improve outcomes in ACLR patients.Context:
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To quantify quadriceps weakness after anterior cruciate ligament reconstruction (ACLR), researchers have often analyzed only peak torque. However, analyzing other characteristics of the waveform, such as the rate of torque development (RTD), time to peak torque (TTP), and central activation ratio (CAR), can lend insight into the underlying neuromuscular factors that regulate torque development. To determine if interlimb neuromuscular asymmetry was present in patients with ACLR at the time of clearance to return to activity. Cross-sectional study. Laboratory. A total of 10 individuals serving as controls (6 men, 4 women; age = 23.50 ± 3.44 years, height = 1.73 ± 0.09 m, mass = 71.79 ± 9.91 kg) and 67 patients with ACLR (43 men, 24 women; age = 21.34 ± 5.73 years, height = 1.74 ± 0.11 m, mass = 77.85 ± 16.03 kg, time postsurgery = 7.52 ± 1.36 months) participated. Isokinetic (60°/s) and isometric quadriceps strength were measured. Peak torque, TTP, and RTD were calculated across isometric and isokinetic trials, and CAR was calculated from the isometric trials via the superimposed burst. Repeated-measures analyses of variance were used to compare limbs in the ACLR and control groups. No between-limbs differences were detected in the control group (P > .05). In the ACLR group, the involved limb demonstrated a longer TTP for isokinetic strength (P = .04; Cohen d effect size [ES] = 0.18; 95% confidence interval [CI] = −0.16, 0.52), lower RTD for isometric (P < .001; Cohen d ES = 0.73; 95% CI = 0.38, 1.08) and isokinetic (P < .001; Cohen d ES = 0.84; 95% CI = 0.49, 1.19) strength, lower CAR (P < .001; Cohen d ES = 0.37; 95% CI = 0.03, 0.71), and lower peak torque for isometric (P < .001; Cohen d ES = 1.28; 95% CI = 0.91, 1.65) and isokinetic (P < .001; Cohen d ES = 1.15; 95% CI = 0.78, 1.52) strength. Interlimb asymmetries at return to activity after ACLR appeared to be regulated by several underlying neuromuscular factors. We theorize that interlimb asymmetries in isometric and isokinetic quadriceps strength were associated with changes in muscle architecture. Reduced CAR, TTP, and RTD were also present, indicating a loss of motor-unit recruitment or decrease in firing rate.Context:
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Deficits in the propioceptive system of the ankle contribute to chronic ankle instability (CAI). Recently, whole-body–vibration (WBV) training has been introduced as a preventive and rehabilitative tool. To evaluate how a 6-week WBV training program on an unstable surface affected balance and body composition in recreational athletes with CAI. Randomized controlled clinical trial. Research laboratory. Fifty recreational athletes with self-reported CAI were randomly assigned to a vibration (VIB), nonvibration (NVIB), or control group. The VIB and NVIB groups performed unilateral balance training on a BOSU 3 times weekly for 6 weeks. The VIB group trained on a vibration platform, and the NVIB group trained on the floor. We assessed balance using the Biodex Balance System and the Star Excursion Balance Test (SEBT). Body composition was measured by dual-energy x-ray absorptiometry. After 6 weeks of training, improvements on the Biodex Balance System occurred only on the Overall Stability Index (P = .01) and Anterior-Posterior Stability Index (P = .03) in the VIB group. We observed better performance in the medial (P = .008) and posterolateral (P = .04) directions and composite score of the SEBT in the VIB group (P = .01) and in the medial (P < .001), posteromedial (P = .002), and posterolateral (P = .03) directions and composite score of the SEBT in the NVIB group (P < .001). No changes in body composition were found for any of the groups. Only the VIB group showed improvements on the Biodex Balance System, whereas the VIB and NVIB groups displayed better performance on the SEBT.Context:
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Chronic ankle instability (CAI) is a condition characterized by range-of-motion, neuromuscular, and postural-control deficits and subjective disability, reinjury, and posttraumatic osteoarthritis. Differences have been reported in kinematics, kinetics, surface electromyography (EMG), and ground reaction forces during functional tasks performed by those with CAI. These measures are often collected independently, and the research on collecting measures simultaneously during a movement task is limited. To assess the kinematics and kinetics of the lower extremity, vertical ground reaction force (vGRF), and EMG of 4 shank muscles during a drop–vertical-jump (DVJ) task. Controlled laboratory study. Motion-capture laboratory. Forty-seven young, active adults in either the CAI (n = 24) or control (n = 23) group. Three-dimensional motion capture was performed using an electromagnetic motion-capture system. Lower extremity kinematics, frontal- and sagittal-plane kinetics, vGRF, and EMG of the shank musculature were collected while participants performed 10 DVJs. Means and 90% confidence intervals were calculated for all measures from 100 milliseconds before to 200 milliseconds after force-plate contact. Patients with CAI had greater inversion from 107 to 200 milliseconds postcontact (difference = 4.01° ± 2.55°), smaller plantar-flexion kinematics from 11 to 71 milliseconds postcontact (difference = 5.33° ± 2.02°), greater ankle sagittal-plane kinetics from 11 to 77 milliseconds postcontact (difference = 0.17 ± 0.09 Nm/kg) and from 107 to 200 milliseconds postcontact (difference = 0.23 ± 0.03 Nm/kg), and smaller knee sagittal-plane kinematics from 95 to 200 milliseconds postcontact (difference = 8.23° ± 0.97°) than control participants after landing. The patients with CAI had greater vGRF from 94 to 98 milliseconds postcontact (difference = 0.83 ± 0.03 N/kg) and peroneal activity from 17 to 128 milliseconds postcontact (difference = 10.56 ± 4.52 N/kg) than the control participants. Patients with CAI presented with differences in their landing strategies that may be related to continued instability. Kinematic and kinetic changes after ground contact and greater vGRF may be related to a faulty landing strategy. The DVJ task should be considered for rehabilitation protocols in these individuals.Context:
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Despite the high frequency of knee injuries in athletes, few researchers have studied the effects of chronologic age and stage of maturation on knee-joint kinematics in male youth soccer players. To use a coach-friendly screening tool to examine knee-valgus scores for players of different ages and at different stages of maturation. Cross-sectional study. Academy soccer clubs. A total of 400 elite male youth soccer players aged 10 to 18 years categorized by chronologic age and stage of maturation based on their years from peak height velocity (PHV). Knee valgus was evaluated during the tuck-jump assessment via 2-dimensional analysis. Frontal-plane projection angles were subjectively classified as minor (<10°), moderate (10°–20°), or severe (>20°), and using these classifications, we scored knee valgus in the tuck jump as 0 (no valgus), 1 (minor), 2 (moderate), or 3 (severe). A trend toward higher valgus scores was observed in the younger age groups and the pre-PHV group. The lowest frequency of no valgus occurred in the U18 and post-PHV groups. The highest percentages of severe scores were in the U13 and pre-PHV groups for the right limb. Knee-valgus scores were lower for both lower extremities in the U18 group than in all other age groups (P < .001) except the U16 group. Scores were lower for the post-PHV than the pre-PHV group for the right limb (P < .001) and both pre-PHV and circa-PHV groups for the left limb (P < .001). Noteworthy interlimb asymmetries were evident in the U14, U15, and circa-PHV groups. Reductions in knee valgus with incremental age and during the later stages of maturation indicated that this risk factor was more prevalent in younger players. Interlimb asymmetry may also emerge around the time of the peak growth spurt and early adolescence, potentially increasing the risk of traumatic injury.Context:
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Anterior cruciate ligament (ACL) injuries often occur during jump landings and can have detrimental short-term and long-term functional effects on quality of life. Despite frequently performing jump landings, dancers have lower incidence rates of ACL injury than other jump-landing athletes. Planned versus unplanned activities and footwear may explain differing ACL-injury rates among dancers and nondancers. Still, few researchers have compared landing biomechanics between dancers and nondancers. To compare the landing biomechanics of dancers and nondancers during single-legged (SL) drop-vertical jumps. Cross-sectional study. Laboratory. A total of 39 healthy participants, 12 female dancers (age = 20.9 ± 1.8 years, height = 166.4 ± 6.7 cm, mass = 63.2 ± 16.4 kg), 14 female nondancers (age = 20.2 ± 0.9 years, height = 168.9 ± 5.0 cm, mass = 61.6 ± 7.7 kg), and 13 male nondancers (age = 22.2 ± 2.7 years, height = 180.6 ± 9.7 cm, mass = 80.8 ± 13.2 kg). Participants performed SL–drop-vertical jumps from a 30-cm–high box in a randomized order in 2 activity (planned, unplanned) and 2 footwear (shod, barefoot) conditions while a 3-dimensional system recorded landing biomechanics. Overall peak sagittal-plane and frontal-plane ankle-, knee-, and hip-joint kinematics (joint angles) were compared across groups using separate multivariate analyses of variance followed by main-effects testing and pairwise-adjusted Bonferroni comparisons as appropriate (P < .05). No 3-way interactions existed for sagittal-plane or frontal-plane ankle (Wilks λ = 0.85, P = .11 and Wilks λ = 0.96, P = .55, respectively), knee (Wilks λ = 1.00, P = .93 and Wilks λ = 0.94, P = .36, respectively), or hip (Wilks λ = 0.99, P = .88 and Wilks λ = 0.97, P = .62, respectively) kinematics. We observed no group × footwear interactions for sagittal-plane or frontal-plane ankle (Wilks λ = 0.94, P = .43 and Wilks λ = 0.96, P = .55, respectively), knee (Wilks λ = 0.97, P = .60 and Wilks λ = 0.97, P = .66, respectively), or hip (Wilks λ = 0.99, P = .91 and Wilks λ = 1.00, P = .93, respectively) kinematics, and no group × activity interactions were noted for ankle frontal-plane (Wilks λ = 0.92, P = .29) and sagittal- and frontal-plane knee (Wilks λ = 0.99, P = .81 and Wilks λ = 0.98, P = .77, respectively) and hip (Wilks λ = 0.88, P = .13 and Wilks λ = 0.85, P = .08, respectively) kinematics. A group × activity interaction (Wilks λ = 0.76, P = .02) was present for ankle sagittal-plane kinematics. Main-effects testing revealed different ankle frontal-plane angles across groups (F2,28 = 3.78, P = .04), with male nondancers having greater ankle inversion than female nondancers (P = .05). Irrespective of activity type or footwear, female nondancers landed with similar hip and knee kinematics but greater peak ankle eversion and less peak ankle dorsiflexion (ie, positions associated with greater ACL injury risk). Ankle kinematics may differ between groups due to different landing strategies and training used by dancers. Dancers' training should be examined to determine if it results in a reduced occurrence of biomechanics related to ACL injury during SL landing.Context:
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Altered movement patterns, including increased frontal-plane knee movement and decreased sagittal-plane hip and knee movement, have been associated with several knee disorders. Nevertheless, the ability of clinicians to visually detect such altered movement patterns during high-speed athletic tasks is relatively unknown. To explore the association between visual assessment and 2-dimensional (2D) analysis of frontal-plane knee movement and sagittal-plane hip and knee movement during a jump-landing task among healthy female athletes. Cross-sectional study. Gymnasiums of participating volleyball teams. A total of 39 healthy female volleyball players (age = 21.0 ± 5.2 years, height = 172.0 ± 8.6 cm, mass = 64.2 ± 7.2 kg) from Divisions I and II of the Israeli Volleyball Association. Frontal-plane knee movement and sagittal-plane hip and knee movement during jump landing were visually rated as good, moderate, or poor based on previously established criteria. Frontal-plane knee excursion and sagittal-plane hip and knee excursions were measured using free motion-analysis software and compared among athletes with different visual ratings of the corresponding movements. Participants with different visual ratings of frontal-plane knee movement displayed differences in 2D frontal-plane knee excursion (P < .01), whereas participants with different visual ratings of sagittal-plane hip and knee movement displayed differences in 2D sagittal-plane hip and knee excursions (P < .01). Visual ratings of frontal-plane knee movement and sagittal-plane hip and knee movement were associated with differences in the corresponding 2D hip and knee excursions. Visual rating of these movements may serve as an initial screening tool for detecting altered movement patterns during jump landings.Context:
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Scapular taping can offer clinical benefit to some patients with shoulder pain; however, the underlying mechanisms are unclear. Understanding these mechanisms may guide the development of treatment strategies for managing neuromusculoskeletal shoulder conditions. To examine the mechanisms underpinning the benefits of scapular taping. Descriptive laboratory study. University laboratory. A total of 15 individuals (8 men, 7 women; age = 31.0 ± 12.4 years, height = 170.9 ± 7.6 cm, mass = 73.8 ± 14.4 kg) with no history of shoulder pain. Scapular taping. Surface electromyography (EMG) was used to assess the (1) magnitude and onset of contraction of the upper trapezius (UT), lower trapezius (LT), and serratus anterior relative to the contraction of the middle deltoid during active shoulder flexion and abduction and (2) corticomotor excitability (amplitude of motor-evoked potentials from transcranial magnetic stimulation) of these muscles at rest and during isometric abduction. Active shoulder-flexion and shoulder-abduction range of motion were also evaluated. All outcomes were measured before taping, immediately after taping, 24 hours after taping with the original tape on, and 24 hours after taping with the tape removed. Onset of contractions occurred earlier immediately after taping than before taping during abduction for the UT (34.18 ± 118.91 milliseconds and 93.95 ± 106.33 milliseconds, respectively, after middle deltoid contraction; P = .02) and during flexion for the LT (110.02 ± 109.83 milliseconds and 5.94 ± 92.35 milliseconds, respectively, before middle deltoid contraction; P = .06). These changes were not maintained 24 hours after taping. Mean motor-evoked potential onset of the middle deltoid was earlier at 24 hours after taping (tape on = 7.20 ± 4.33 milliseconds) than before taping (8.71 ± 5.24 milliseconds, P = .008). We observed no differences in peak root mean square EMG activity or corticomotor excitability of the scapular muscles among any time frames. Scapular taping was associated with the earlier onset of UT and LT contractions during shoulder abduction and flexion, respectively. Altered corticomotor excitability did not underpin earlier EMG onsets of activity after taping in this sample. Our findings suggested that the optimal time to engage in rehabilitative exercises to facilitate onset of trapezius contractions during shoulder movements may be immediately after tape application.Context:
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An estimated 15.3 million adolescent students are enrolled in US high schools, with approximately 7.8 million participating in athletics. Researchers have examined various demographics in high school athletes; however, athletic participation may play a larger role in test performance than previously thought. Currently, investigations of concussion assessment may rely on uninjured athletes as controls. However, due to the intense nature of athletics, this may not be an appropriate practice. To examine differences between athletes and nonathletes using a common computerized neuropsychological test. Retrospective cross-sectional study. High schools from a school district in Columbus, Ohio. A total of 662 adolescent high school students (athletes: n = 383, female n = 18; nonathletes: n = 279, female n = 193). Participants were administered a computerized neuropsychological test battery (Immediate Post-Concussion Assessment and Cognitive Test [ImPACT]) during baseline concussion assessment. Differences between groups were established for output composite scores. Differences were found between athletes and nonathletes in composite reaction time (F1,522 = 14.855, P < .001) and total symptom score (F1,427 = 33.770, P < .001). Nonathletes reported more symptoms, whereas athletes had faster reaction times. No differences were present in composite verbal memory, composite visual memory, composite visual motor speed, or composite impulse control (P > .05). Symptom reporting and reaction time differed between high school athletes and nonathletes. Participation in extracurricular activities may lead to cognitive differences in adolescents that can influence performance on the Immediate Post-Concussion Assessment and Cognitive Test battery. Researchers should account for these differences in baseline performance when making concussion diagnostic and management decisions.Context:
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Sudden cardiac arrest is the leading cause of death among young athletes. According to the American Heart Association, an automated external defibrillator (AED) should be available within a 1- to 1.5-minute brisk walk from the patient for the highest chance of survival. Secondary school personnel have reported a lack of understanding about the proper number and placement of AEDs for optimal patient care. To determine whether fixed AEDs were located within a 1- to 1.5-minute timeframe from any location on secondary school property (ie, radius of care). Cross-sectional study. Public and private secondary schools in northwest Ohio and southeast Michigan. Thirty schools (24 public, 6 private) volunteered. Global positioning system coordinates were used to survey the entire school properties and determine AED locations. From each AED location, the radius of care was calculated for 3 retrieval speeds: walking, jogging, and driving a utility vehicle. Data were analyzed to expose any property area that fell outside the radius of care. Public schools (37.1% ± 11.0%) possessed more property outside the radius of care than did private schools (23.8% ± 8.0%; F1,28 = 8.35, P = .01). After accounting for retrieval speed, we still observed differences between school types when personnel would need to walk or jog to retrieve an AED (F1.48,41.35 = 4.99, P = .02). The percentages of school property outside the radius of care for public and private schools were 72.6% and 56.3%, respectively, when walking and 34.4% and 12.2%, respectively, when jogging. Only 4.2% of the public and none of the private schools had property outside the radius of care when driving a utility vehicle. Schools should strategically place AEDs to decrease the percentage of property area outside the radius of care. In some cases, placement in a centralized location that is publicly accessible may be more important than the overall number of AEDs on site.Context:
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Current management recommendations for equipment-laden athletes in sudden cardiac arrest regarding whether to remove protective sports equipment before delivering cardiopulmonary resuscitation are unclear. To determine the effect of men's lacrosse equipment on chest compression and ventilation quality on patient simulators. Cross-sectional study. Controlled laboratory. Twenty-six licensed athletic trainers (18 women, 8 men; age = 25 ± 7 years; experience = 2.1 ± 1.6 years). In a single 2-hour session, participants were block randomized to 3 equipment conditions for compressions and 6 conditions for ventilations on human patient simulators. Data for chest compressions (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of optimal compressions) and ventilations (ventilation rate, mean ventilation volume, and percentage of ventilations delivering optimal volume) were analyzed within participants across equipment conditions. Keeping the shoulder pads in place reduced mean compression depth (all P values < .001, effect size = 0.835) and lowered the percentages of both correctly released compressions (P = .02, effect size = 0.579) and optimal-depth compressions (all P values < .003, effect size = 0.900). For both the bag-valve and pocket masks, keeping the chinstrap in place reduced mean ventilation volume (all P values < .001, effect size = 1.323) and lowered the percentage of optimal-volume ventilations (all P values < .006, effect size = 1.038). Regardless of equipment, using a bag-valve versus a pocket mask increased the ventilation rate (all P values < .003, effect size = 0.575), the percentage of optimal ventilations (all P values < .002, effect size = 0.671), and the mean volume (P = .002, effect size = 0.598) across all equipment conditions. For a men's lacrosse athlete who requires cardiopulmonary resuscitation, the shoulder pads should be lifted or removed to deliver chest compressions. The facemask and chinstrap, or the entire helmet, should be removed to deliver ventilations, preferably with a bag-valve mask.Context:
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The heat-tolerance test (HTT) is a screening tool for secondary prevention of exertional heat illness by the Israel Defense Forces. To discern participant tolerance, recruits are exposed to intermediate environmental and exercise stresses, and their physiological responses, core temperature, and heart rate are monitored. When their physiological measures rise at a higher rate or exceed the upper levels of absolute values compared with other participants, heat intolerance (HI) is diagnosed. To develop a mathematical model to interpret HTT results and provide a quantitative estimate of the probability of heat tolerance (PHT). Cross-sectional study. Warrior Health Research Institute. The HTT results of 175 random individuals tested after an episode of exertional heat illness were classified qualitatively and then divided into training (n = 112) and testing (n = 63) datasets. All individuals were male soldiers (age range = 18–22 years) who had sustained an episode of definitive or suspected exertional heat stroke. Based on the decision algorithm used by the Israel Defense Forces for manual interpretation of the HTT, we designed a logistic regression model to predict the heat-tolerance state. The model used a time series of physiological measures (core temperature and heart rate) of individuals to predict the manually assigned diagnosis of HT or HI. It was initially fitted and then tested on 2 separate, random datasets. The model produced a single value, the PHT, and its predictive ability was demonstrated by prediction-density plots, receiver operating characteristic curve, contingency tables, and conventional screening test evaluation measures. According to prediction-density plots of the testing set, all HT patients had a PHT of 0.7 to 1. The receiver operating characteristic curve plot showed that PHT was an excellent predictor of the manual HT interpretations (area under the curve = 0.973). Using a cutoff probability of 0.5 for the diagnosis of HI, we found that PHT had sensitivity, specificity, and accuracy of 100%, 90%, and 92.06%, respectively. The PHT has the potential to be substituted for manual interpretation of the HTT and to serve in a variety of clinical and research applications.Context:
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The unique contexts in which athletic trainers (ATs) work require specific tools in order to understand their attitudes toward diverse patient populations, including sexual and gender minorities. To develop and validate the Attitudes Toward Transgender Patients (ATTP) instrument for ATs. Cross-sectional study. Semistructured interviews, paper-based questionnaire, and electronic questionnaire. Six ATs completed semistructured interviews to develop themes regarding transgender patients. Additionally, 39 students in professional and postprofessional athletic training programs answered questionnaires designed to elicit statements regarding transgender patients. For item reduction, a sample of 3000 ATs were e-mailed (response rate = 17%), and for validation, another sample of 3000 ATs were e-mailed (response rate = 13%). Athletic trainers' e-mail addresses were obtained from the National Athletic Trainers' Association. The 3 phases were (1) exploratory interviews, (2) construct validity and item reduction, and (3) criterion validity. Items were created based on interviews and questionnaires. Principal axis factoring was used for item reduction, and Pearson correlations were used for validation. Thirty-six statements pertaining to transgender patients were developed from the interview and questionnaire data. After item reduction, 10 items remained to form the ATTP (α = .834). For validation, the ATTP and Transphobia Scale were significantly correlated (r = .723; P < .001). The ability to assess attitudes toward transgender patients will allow clinicians to identify needed areas of focus for training and education. The ATTP assesses affective and cognitive attitudes and behavioral intentions toward transgender patients in common clinical settings.Context:
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Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making
Driving After Concussion: Clinical Measures Associated with Post-concussion
The role of shoulder posture in pitching mechanics and injury risk in high school baseball pitchers
Corticospinal Excitability during Standing and Its Association with Postural Control Following Acute Lateral Ankle Sprain.
The socio-economic cost of anterior cruciate ligament injuries and lateral ankle sprains in amateur football and basketball.
JAT eISSN: 1938-162X
JAT ISSN: 1062-6050
ATEJ ISSN: 1947-380X