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Context: The Upper Limb Functional Index (ULFI) is a popular tool with valid psychometric properties to assess upper limb function in patients with musculoskeletal conditions. The aim of the study was to cross-culturally adapt and validate the German version of the ULFI. Design: Cross-cultural validation. Methods: A 2-stage cross-cultural adaptation of the ULFI was performed according to international guidelines through consecutive forward and backward translations. Psychometric properties of internal consistency, test–retest reliability, criterion, face and content validity, and factor structure were determined from the included German participants suffering from upper limb conditions (n = 100), who fulfilled the following inclusion criteria: (1) older than 18 years old, (2) German as native language, and (3) medical diagnosis of musculoskeletal upper limb condition. Participants completed the ULFI; Disabilities of the Arm, Shoulder, and Hand; EuroQol Health Questionnaire 5 Dimensions; and Short Form-12 questionnaires. Results: The ULFI-G showed good internal consistency (α = .88); excellent test–retest reliability (intraclass correlation coefficient_2:1 = .98); directly strong correlation with Disabilities of the Arm, Shoulder, and Hand (r = .84); fair correlation with Disabilities of the Arm, Shoulder, and Hand-sport (r = .54); inversely fair correlation with EuroQol Health Questionnaire 5 Dimensions (r = −.62); and Short Form 12’s physical health domain (r = −.7). A single-factor structure was revealed. Conclusions: The ULFI-G showed adequate psychometric properties and proved to be a valid tool for upper limb functional assessment in German population.

Implicit biases are attitudes, emotions, or stereotypes that occur in an unconscious manner and have the potential to negatively affect behaviors, actions, and decisions. Recent studies have suggested that even when certain factors are controlled for, health care workers do not provide equitable care to patients from different demographics. When patients are not receiving equitable health care, there is a potential for disparities in patient-related outcomes. The purpose of this study was to determine attitudes toward implicit bias among athletic trainers. A secondary purpose of this study was to assess differences and correlations between attitudes toward implicit bias and demographic factors including age, years of experience, gender identity, sexual orientation, and race. Participants were recruited for this study by emailing athletic trainers from publicly available staff directories at institutions of higher education and high schools, and athletic training education program directors. The survey consisted of questions gathering demographic information and questions taken from the Attitudes Toward Implicit Bias Instrument. A total of 218 athletic trainers (age = 38 [11] y, years of certified experience = 14 [11] y) opened and completed the survey. On average, participants scored 71.0 [11.2] on the Attitudes Toward Implicit Bias Instrument. This mean score indicated that the average participant felt that implicit bias had the potential to negatively impact patient care and needed to be addressed through education. There was a significant, negligible negative correlation between age and attitudes toward implicit bias (r[216] = −.157, P = .02). Examining implicit bias among athletic trainers warrants further research to understand how implicit bias can negatively affect access to equitable health care opportunities. The development of high-quality interventions for identifying and addressing implicit bias is crucial to ensuring optimal patient outcomes in athletic training and all medical settings.

Context: Instrument-assisted soft tissue mobilization (IASTM) continues to increase in popularity and utilization among manual therapists. Despite its popularity, little is known about the consistency in peak or average forces that clinicians apply when performing IASTM treatments with a 2-handed grip. The purpose of this study was to examine intraclinician consistency in peak and average forces when applying a 2-handed IASTM grip. Design: Randomized crossover study conducted in a university biomechanics laboratory. Methods: Five (5) licensed athletic trainers with prior IASTM training used 5 different IASTM instruments to apply simulated treatment. Average peak forces (F_peak) and average mean forces (F_mean) were collected via force plate for all 5 IASTM instruments with a skin simulant attached. Descriptive statistics, coefficients of variation (CVs), box and density plots, and Bland–Altman plots were assessed. Results: The clinicians’ average F_peak ranged from 3.0 N to 11.6 N and average F_mean from 1.9 N to 8.1 N. F_peak CVs for all instruments ranged from 14% to 31%, and F_mean CVs ranged from 15% to 35%. Bland–Altman plots indicated that for both F_peak and F_mean, 97% of the data points fell within the limits of agreement across instruments and clinicians. Mean differences across instruments ranged from 0.9 N (91.8 g) to 4.1 N (418.1 g) for F_peak and from 1.0 N (102.0 g) to 2.8 N (285.5 g) for F_mean. Thus, CVs, box and density plots, and Bland–Altman plots supported general force application consistency. Conclusion: Trained IASTM clinicians produced consistent treatment application forces (ie, F_peak and F_mean) within treatment sessions during 2-handed simulated application.

Context: As blood flow restriction gains popularity across different populations (eg, young and older adults) and settings (eg, clinical and sports rehabilitation), the accuracy of blood flow restricted percentage becomes crucial. We aimed to compare manually measured arterial occlusion pressure (AOP) among young adults to understand whether lower limb composition affects the pressure required to achieve AOP. The results will shed light on the adequacy of published calculations used to estimate AOP in practical and research settings. Design: An observational cross-sectional study design was implemented to examine the relationship between lower limb composition, lower limb circumference, and measured AOP. Methods: Twenty-two participants (12 males, 26 [4] y, 1.74 [0.07] m, 73.2 [12.5] kg) underwent a whole-body Dual-energy X-ray Absorptiometry scan before AOP (in millimeters of mercury) and lower limb circumference (in centimeters) were determined. In a supine position, a 10-cm wide cuff was manually inflated on the dominant leg to the point where a pulse could no longer be detected by a Doppler ultrasound of the posterior tibial artery to determine AOP. Lower limb composition (fat, muscle, and bone mass [in grams]) was obtained from the Dual-energy X-ray Absorptiometry scan. Results: Lower limb muscle mass had a moderate negative relationship with AOP (r ² = .433, β = −0.004) and a moderate positive relationship with lower limb circumference (r ² = .497, β = 0.001). Lower limb circumference had the weakest relationship with AOP (r ² = .316, β = 0.050) of all measures. Conclusions: The reported relationships between lower limb muscle mass, lower limb circumference, and AOP suggest that as muscle mass increases, lower limb circumference also increases, yet AOP decreases. This implies that limb circumference should not be used as the primary measure for calculating AOP within the sampled population. We recommend individually measuring AOP when implementing blood flow restriction in all exercise modalities.

Context: Racial identity may associate with clinical outcomes following sport-related concussion (SRC). This study compared clinical outcome scores before and after recovery from a SRC between Black or White college athletes. Design: Prospective cohort. Methods: Participants were self-reported White (n = 61, 18.5 [1.1] y of age) and Black (n = 24, 18.3 [1.1] y of age) NCAA Division 1 college athletes. The revised Head Injury Scale (HIS-r), the Immediate Postconcussion and Cognitive Test (ImPACT) battery, and the Sensory Organization Test (SOT) at baseline (T1), upon symptom resolution (T2) following a diagnosed SRC, and upon establishing a new baseline assessment (T3). Race was collected from paper and electronic medical records. The revised Head Injury Scale total symptom severity, ImPACT’s Verbal Memory, Visual Memory, Visual Motor Speed (VMS), and Reaction Time, and the SOT Equilibrium Score, were compared between groups at each time point. Multivariate analyses of variance (2 [group] × 3 [time]) were used to compare revised Head Injury Scale, ImPACT, and SOT outcome scores. Post hoc analyses consisted of independent and paired sample t tests. Results: A significant main effect for time (λ = 0.66, F _2,82 = 21.55, P < .001, ${\eta }_{\mathrm{p}}^2=.34$ ) was observed for the SOT. White athletes significantly improved on the Equilibrium Score between all time points (all P < .006). Similarly, Black athletes significantly improved on the Equilibrium Score between T1–T2 and T1–T3 (all P < .001). A significant main effect of time was observed for ImPACT’s Verbal Memory, Visual Memory, and VMS outcome scores (all P < .001). VMS improved for White athletes between T1–T2 (P = .02) and T3 (P = .006). Black athletes had improved VMS scores between T1–T3 (P = .015) and T2–T3 (P = .005). A between-group difference was observed for VMS at T2 (P = .004). Conclusions: There was 1 small and not clinically significant difference between groups for the VMS score at T2. Overall, groups performed consistently or improved upon their baseline balance, cognition, and symptom outcome scores at clinically relevant time points following a SRC.

Context: The Neurotracker CORE assessment is an 8-minute multiple object tracking (MOT) program used in sport science research and clinical rehabilitation as a perceptual-cognitive training tool; however, it has garnered interest for its potential use as an acute assessment of cognitive performance. Although some data exist regarding the learning effect of repeated exposures, it is often overlooked with investigators focusing primarily on the presence of transfer effects to other cognitive realms. As a result, exclusive data on the effect of repeated testing, or subsequent periods of no testing (ie, detraining) on test–retest reliability, and on MOT performance are sparse. Design: Repeated-measures/reliability. Methods: Twenty-three recreationally active men and women completed 15 training sessions consisting of 2 CORE assessments per session (30 assessments). Participants were randomized to either 1 or 2 weeks of detraining prior to completing 15 retraining sessions (30 assessments). Training and retraining periods were divided into 10 blocks (3 assessments/block) for analysis. MOT speed threshold (MOT-ST), consistency, fastest trial score success speed, lowest trial score miss speed, the number of perfect, near misses, and significant miss trials within each block were used to determine performance. Intraclass correlation coefficient, standard error of measurement, and minimal detectable change were used to determine reliability. Results: Significant improvements in MOT-ST and fastest trial score success speed were noted within training blocks 1 to 6 and 1 to 7, respectively (P < .05). MOT-ST and fastest trial score success speed demonstrated excellent test–retest reliability between blocks 8 and 9. There was no effect of detraining period on performance during retraining. Conclusions: Eighteen tests are necessary to overcome training effects and establish a reliable baseline when MOT-ST is used as the performance outcome. Detraining periods up to 2 weeks did not impact performance. The average of 3 discrete tests should be used when assessing MOT-ST performance.

Context: Foot/ankle pain is common among runners. Inadequate management of runners with foot/ankle pain can lead to lost training time, competition removal, and other activity limitations. Neurodynamics, which refers to the integrated biomechanical, physiological, and structural function of the nervous system during movement, can be overlooked in patients with foot/ankle pain. Although a link between the cervical spine, neurodynamics, and upper quarter pain has been studied, less is known about the relationship between the lumbar spine and lower quarter. This case series describes the successful management of 3 runners with foot/ankle pain. Case Presentations: Three female runners (ages 23, 24, and 45 y) presented to physical therapy with foot/ankle pain and difficulty running. Each patient had positive examination findings with local foot/ankle testing. A comprehensive lumbar spine examination demonstrated impairments in range of motion and joint mobility that were hypothesized to be contributing. Positive lower quarter neurodynamic tests were also found. Management and Outcomes: All patients were treated with nonthrust lumbar spine mobilization and lower quarter neural tissue mobilization. Changes in the Patient-Specific Functional Scale, Numerical Pain Rating Scale, Lower Extremity Functional Scale, and Global Rating of Change occurred after intervention targeting the lumbar spine and lower-extremity neurodynamics in all patients. Conclusions: This case series demonstrates the importance of including a thorough lumbar spine examination and neurodynamic testing to identify appropriate interventions while managing patients with foot/ankle pain, even when patients have signs indicative of local ankle/foot pathology. These examination procedures should be performed particularly when a patient is not responding to management targeting local foot/ankle structures.

Context: Several clinical tests are available to assess static postural stability in individuals with chronic ankle instability (CAI); however, it is unclear which test should be used. Objective: To determine which noninstrumented clinical tests should be used to detect static postural stability deficits in individuals with CAI. Evidence Acquisition: We searched 4 databases from their inception to February 2023, and included studies comparing static postural stability in individuals with CAI and healthy controls using noninstrumented assessments. Two reviewers independently extracted study characteristics, participant information, static postural stability assessment methods, and results. We calculated the pooled standardized mean difference (SMD) and 95% confidence interval using a random effects meta-analysis and assessed the certainty of the evidence. Evidence Synthesis: Fourteen cross-sectional studies (293 participants with CAI and 284 healthy controls) were included. The meta-analysis showed no significant differences between the CAI and healthy groups in the double-leg stance condition of the Balance Error Scoring System (BESS) (SMD, −0.03; low-certainty evidence). Significant group differences were found in the BESS single-leg stance (SLS) on firm and foam surfaces (SLS firm: SMD, 0.47, very low-certainty evidence; SLS foam: SMD, 0.80, very low-certainty evidence), the tandem stance (TS) on firm and foam surfaces (TS firm: SMD, 0.39, low-certainty evidence; TS foam: SMD, 0.76, low-certainty evidence), and the total BESS in the foam conditions (SMD, 1.12, very low certainty evidence). Significant differences were also found between the CAI and healthy groups in the foot-lift (SMD, 1.24; very low certainty evidence) and time-in-balance tests (SMD, −0.94; very low certainty evidence). Conclusions: Due to the large magnitude of the differences, the SLS foam, TS foam, and the total BESS in the foam conditions, as well as the foot-lift test or time-in-balance test, may be the most appropriate to clinically identify static postural stability impairment in individuals with CAI.

Context: Analyzing flick movement kinematics biomechanically is important to prevent sport-related injuries in underwater hockey players since the aquatic-based flick movement is completely different from land-based flick movements. The study aimed to describe the flick movement kinematic biomechanically in underwater hockey players. Moreover, this study further aimed to investigate the effect of the Thrower’s Ten exercises on flick movement kinematics in underwater hockey players. Design: Descriptive laboratory study. Methods: Seventeen underwater hockey players (age: 26.2 [4.3] y; sports age: 6.2 [4.5] y) were included. First, 2 underwater cameras using motion capture video analysis MATLAB were used to biomechanically analyze the angular changes on the shoulder, elbow, wrist, and body while players were performing the flick movements. Players were then recruited to the Thrower’s Ten exercise program for 6 weeks. Flick movement kinematics and flick-throwing distance were recorded at baseline and 6 weeks. Results: The flick movement kinematic patterns demonstrated increased shoulder flexion (from 102.5° to 144.9°), wrist extension (from 9.5° to 10.8°), and upper-extremity rotation (from 5.7° to 56.8°) while decreased elbow extension (from 107.7° to 159.2°) from the stick met the puck until the competition of the movement. The Thrower’s Ten exercises improved the elbow extension (P = .04), wrist extension (P = .01), body rotation (P < .001), and flick-throwing distance (P < .001) from baseline to 6 weeks. Conclusion: This study describes the underwater flick kinematic technique biomechanically and interprets preliminary findings for the first time. Thus, 6 weeks of Thrower’s Ten exercise program provides more body muscle movements than the smaller ones during the flick movements and higher flick-throwing distance in underwater hockey players.