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Vincenzo Ricci and Levent Özçakar

improvement in the thoracic spine range of motions, with a complete return to play 3 months after the injury. No setbacks or complications were encountered during the rehabilitation process. Discussion Interscapular pain is a common problem in clinical practice with multiple etiologies including discogenic

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Sergio Jiménez-Rubio, Archit Navandar, Jesús Rivilla-García and Victor Paredes-Hernández

forcing an early return to play. 25 This implies that although the previously mentioned protocols, programs, and exercises have shown to be effective with the general athletic population, there appears to be a need for a soccer-specific rehabilitation program. Such a program must have loads and movement

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Caroline Westwood, Carolyn Killelea, Mallory Faherty and Timothy Sell

Context: Concussions are consequence of sports participation. Recent reports indicate there is an increased risk of lower-extremity musculoskeletal injury when returning to sport after concussion suggesting that achieving “normal” balance may not fully indicate the athlete is ready for competition. The increased risk of injury may indicate the need to refine a screening tool for clearance. Objective: Assess the between-session reliability and the effects of adding a cognitive task to static and dynamic postural stability testing in a healthy population. Setting: Clinical laboratory. Participants: Twelve healthy subjects (6 women; age 22.3 [2.9] y, height 174.4 [7.5] cm, weight 70.1 [12.7] kg) participated in this study. Design: Subjects underwent static and dynamic postural stability testing with and without the addition of a cognitive task (Stroop test). Test battery was repeated 10 days later. Dynamic postural stability testing consisted of a forward jump over a hurdle with a 1-legged landing. A stability index was calculated. Static postural stability was also assessed with and without the cognitive task during single-leg balance. Variability of each ground reaction force component was averaged. Main Outcome Measures: Interclass correlation coefficients (ICC2,1) were computed to determine the reliability. Standard error of measure, mean standard error, mean detectable change, and 95% confidence interval were all calculated. Results: Mean differences between sessions were low, with the majority of variables having moderate to excellent reliability (static .583–.877, dynamic .581–.939). The addition of the dual task did not have any significant effect on reliability of the task; however, generally, the ICC values improved (eyes open .583–.770, dual task .741–.808). Conclusions: The addition of a cognitive load to postural stability assessments had moderate to excellent reliability in a healthy population. These results provide initial evidence on the feasibility of dual-task postural stability testing when examining risk of lower-extremity musculoskeletal injury following return to sport in a concussed population.

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Rachel S. Johnson, Mia K. Provenzano, Larynn M. Shumaker, Tamara C. Valovich McLeod and Cailee E. Welch Bacon

Clinical Scenario:

It is hypothesized that cognitive activity following a concussion may potentially hinder patient recovery. While the recommendation of cognitive rest is often maintained and rationalized, a causal relationship between cognitive activity and symptom duration has yet to be established.

Clinical Question:

Does the implementation of cognitive rest as part of the postconcussion management plan reduce the number of days until the concussed adolescent patient is symptom free compared to a postconcussion management plan that does not incorporate cognitive rest?

Summary of Key Findings:

A thorough literature search returned 7 possible studies; 5 studies met the inclusion criteria and were included. Three studies indicated that increased cognitive activity is associated with longer recovery from a concussion, and, therefore, supported the use of cognitive rest. One study indicated that the recommendation for cognitive rest was not significantly associated with time to concussion symptom resolution. One study indicated that strict rest, defined as 5 days of no school, work, or physical activity; might prolong symptom duration.

Clinical Bottom Line:

There is moderate evidence to support the prescription of moderate cognitive rest for concussed patients. Clinicians who intend on implementing cognitive rest in their concussion protocols should be aware of inconsistencies and be open-minded to alternative treatment progressions while taking into consideration each individual patient and maintaining adequate patient-centered care principles.

Strength of Recommendation:

Grade B evidence exists that prescription of moderate cognitive rest for concussed patients may be beneficial as a supplement to physical rest as treatment for symptom reduction in adolescents.

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Taylor K. Wise

). Return-to-play should be determined by the medical factors associated with the athlete’s condition and the acceptable level of risk (individual to each athlete) that would accompany participating in their specific sport ( Creighton, Shrier, Shultz, Meeuwisse, & Matheson, 2010 ). Eating disorder policies

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Sinéad O’Keeffe, Niamh Ní Chéilleachair and Siobhán O’Connor

injury assessment, the injured participant completed the AFAQ, 19 which will be termed the AFAQ1 for the purpose of clarity in this study. Those who sustained a time-loss injury completed the AFAQ a second time immediately before their first training or match when returning to play, termed the AFAQ2

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Jessica E. Digiacomo, Riann M. Palmieri-Smith, John A. Redman III and Lindsey K. Lepley

Review Board. Table 1 Participant Demographics (Mean ± SD) Group N Age (y) Weight (kg) Height (m) Graft type Preinjury IKDC Preinjury Tegner Return to play IKDC Return to play Tegner Primary ACL surgery to return to play (mo) Return to play to reinjury (mo) Return to play without reinjury (mo, as of

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Krista M. Hixson, Alex N. Allen, Andrew S. Williams and Tamara C. Valovich McLeod

Clinical Scenario:

Mild traumatic brain injury, or concussion, has been associated with physical, cognitive, and emotional sequelae. Little is understood in regard to many characteristics, such as anxiety, and their effect on post-concussion symptoms.

Clinical Question:

Is state anxiety, trait anxiety, or anxiety sensitivity a clinical predictor of symptoms in those presenting with mild traumatic brain injury or concussion?

Summary of Key Findings:

A literature search returned 3 possible studies; 3 studies met inclusion criteria and included. One study reported in athletes that greater social support was associated with decreased state-anxiety, lower state anxiety post-concussion was associated with increased social support, and that those with greater social support may experience reduced anxiety, regardless of injury type sustained. One study reported baseline trait anxiety in athletes was not significantly associated with post-concussion state anxiety, but that symptoms of depression at baseline was the strongest predictor for post-concussion state anxiety. Three studies reported that state and trait anxiety are not related to increased post-concussion symptom scores. One study reported that greater anxiety sensitivity is related to higher reported post-concussion symptom scores, which may manifest as somatic symptoms following concussion, and revealed that anxiety sensitivity may be a risk factor symptom development.

Clinical Bottom Line:

There is low-level to moderate evidence to support that anxiety sensitivity is linked to post-concussion symptoms. State and trait anxiety do not appear to be related to post-concussion symptoms alone. Post-concussion state anxiety may occur if post-concussion symptoms of depression are present or if baseline symptoms of depression are present. Better social support may improve state anxiety post-concussion.

Strength of Recommendation:

There is grade B evidence to support that state and trait anxiety are not risk factors for post-concussion symptom development. There is grade C evidence to support anxiety sensitivity as a risk factor for developing post-concussion symptoms.

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Lynda Mainwaring and Max Trenerry

This current special issue of the Journal of Clinical Sport Psychology was conceived and developed to provide a resource for clinicians who have contact with athletes who are at risk for or have sustained a concussion during sport participation. The special issue is part of an exciting two-issue series. This first installment contains papers from leaders in the field of sport concussion who review the frequency and mechanisms of concussion, models for managing concussion, the emotional aspects of concussion in sport, practical examples from a model sport concussion clinic, and the importance of sport concussion education and prevention. As Guest Editors, we hope that this timely and unique special series will be used by clinicians who help care for athletes and their families who have experienced concussion in their sport life.

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Tracey Covassin, Kyle M. Petit and Morgan Anderson

/symptoms, prevalence), concussion education and awareness, concussion assessment and management, concussion recovery and return to play, concussion treatment, and future research and recommendations for youth sport stakeholders. We also address sex and developmental considerations throughout this review. In reviewing