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Courtney W. Hess, Stacy L. Gnacinski and Barbara B. Meyer

theory the lone-physician approach to injury rehabilitation is considered inferior to approaches aligned with the biopsychosocial model, it is still commonly used in practice as evidenced by continual reports of return-to-play decisions based only on physical measures of healing ( Creighton et al., 2010

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Michael Girdwood, Liam West, David Connell and Peter Brukner

tactical training. At this stage, he was kicking on the affected side without restriction. He resumed full contact training a week later. Outcomes The player was able to return to play a full match at 8 weeks. The player did not report any ongoing issues for the rest of the season. Given the unusual nature

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Caroline Lisee, Lindsay Slater, Jay Hertel and Joe M. Hart

knee injury after initial ACLR. 8 Understanding how to better prepare these populations at higher risk of encountering these challenges, especially at the time of return to play, is important throughout the rehabilitation process. To improve return-to-play rates and minimize risk of secondary injury

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Jenny H. Conviser, Amanda Schlitzer Tierney and Riley Nickols

and recovery status and, as such, ongoing re-evaluation by the MDTT during treatment is necessary. It is critical that the MDTT agree upon previously established parameters for return to play ( Cook et al., 2016 ) since a premature return to sport may increase risk of aggravated illness, injury or re

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Bhanu Sharma and Brian W. Timmons

inform return-to-play decisions ( 11 ). Therefore, exercise testing can help assess concussion recovery as it relates to symptom burden, although future studies should incorporate alternate recovery end points and outcome measures (cognitive and/or neuroimaging) to determine whether non

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Matt Hausmann, Jacob Ober and Adam S. Lepley

Clinical Scenario Ankle sprains are the most prevalent athletic-related musculoskeletal injury treated by athletic trainers, often affecting activities of daily living and delaying return to play. 1 Most of these cases present with pain and swelling in the ankle, resulting in decreased range of

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Luke M. Mueller, Ben A. Bloomer and Chris J. Durall

Clinical Scenario:

Anterior cruciate ligament (ACL) injuries are associated with a lengthy recovery time, decreased performance, and an increased rate of reinjury. To improve performance of the injured knee, affected athletes often undergo surgical reconstruction and rehabilitation. Determining when an athlete is ready to safely return to play (RTP), however, can be challenging for clinicians. Although various outcome measures have been recommended, their ability to predict a safe RTP is questionable.

Focused Clinical Question:

Which outcome measures should be used to determine readiness to return to play after ACL reconstruction?

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Iñigo Mujika, Juanma Santisteban, Paco Angulo and Sabino Padilla

A 7-week, 10-session individual training program was implemented with a youth elite football (soccer) player who had been underperforming because of poor aerobic fitness. The intervention focused on developing aerobic power and high lactate production and contributed to a 32.3% improvement in a football-specific performance test. The player was able to return to play and exceed expected performance levels during competitive match play.

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Nicole Reams, Rodney A. Hayward, Jeffrey S. Kutcher and James F. Burke


Lingering neurologic injury after concussion may expose athletes to increased risk if return to play is premature. The authors explored whether on-field performance after concussion is a marker of lingering neurologic injury.


Retrospective cohort study on 1882 skill-position players who played in the National Football League (NFL) during 2007–2010.


Players with concussion based on the weekly injury report were compared with players with other head and neck injuries (controls) on measures of on-field performance using Football Outsiders’ calculation of defense-adjusted yards above replacement (DYAR), a measure of a player’s contribution controlling for game context. Changes in performance, relative to a player’s baseline level of performance, were estimated before and after injury using fixed-effects models.


The study included 140 concussed players and 57 controls. Players with concussion performed no better or worse than their baseline on return to play. However, a decline in DYAR relative to their prior performance was noted 2 wk and 1 wk before appearing on the injury report. Concussed players performed slightly better than controls in situations where they returned to play the same week as appearing on the injury report.


On return, concussed NFL players performed at their baseline level of performance, suggesting that players have recovered from concussion. Decline in performance noted 2 wk and 1 wk before appearing on the injury report may suggest that concussion diagnosis was delayed or that concussion can be a multihit phenomenon. Athletic performance may be a novel tool for assessing concussion injury and recovery.

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Alex J. Rhinehart and Caroline C. Guindon

A 21-year-old female NCAA Division III soccer player presented with an insidious onset of posterior ankle pain. Lateral radiographs revealed a Stieda process, leading to a physician diagnosis of posterior ankle impingement (PAI). Mulligan Concept mobilizations with movement (MWM) were used to ameliorate patient complaints. The MWM glide was maintained during activity using a tape application. Return to play and patient improvement occurred dramatically faster while utilizing the MWM technique than other traditional methods used to treat this condition. This case report demonstrates a novel approach to treating Stieda process-related PAI that warrants further clinical inquiry.