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Alexe DI, Čaušević D, Čović N, Rani B, Tohănean DI, Abazović E, Setiawan E, Alexe CI. The Relationship between Functional Movement Quality and Speed, Agility, and Jump Performance in Elite Female Youth Football Players. Sports (Basel) 2024; 12:214. [PMID: 39195590 PMCID: PMC11359347 DOI: 10.3390/sports12080214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/29/2024] Open
Abstract
The association between movement screening and physical fitness testing in athletes is conflicting, and therefore, this study aimed to examine the relationship between Functional Movement Screen (FMS) performance and physical performance in elite female youth football players. Twenty-two players from the national U16 team of Bosnia and Herzegovina underwent FMS and physical performance tests, including speed, agility, and jump assessments. Jump and speed performance score correlated well with ASLR, while the overall FMS score was not associated with any of the performance variables. These findings suggest that while certain movement patterns may impact athletic performance, the relationship between movement screening and physical performance is delicate. Coaches and practitioners should consider individual variations and sport-specific demands when interpreting FMS results in order to optimize and maximize athlete performance and reduce injury risks.
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Affiliation(s)
- Dan Iulian Alexe
- Department of Physical and Occupational Therapy, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania;
| | - Denis Čaušević
- Faculty of Sport and Physical Education, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina; (D.Č.); (N.Č.); (E.A.)
| | - Nedim Čović
- Faculty of Sport and Physical Education, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina; (D.Č.); (N.Č.); (E.A.)
| | - Babina Rani
- Department of Physical Rehabilitation & Medicine (Physiotherapy), Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Dragoș Ioan Tohănean
- Department of Motric Performance, Transilvania University of Brașov, 500036 Brașov, Romania
| | - Ensar Abazović
- Faculty of Sport and Physical Education, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina; (D.Č.); (N.Č.); (E.A.)
| | - Edi Setiawan
- Faculty of Teacher Training and Education, Suryakancana University, Cianjur Kidul 43216, Indonesia;
| | - Cristina Ioana Alexe
- Department of Physical Education and Sports Performance, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania
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Fitton Davies K, Sacko RS, Lyons MA, Duncan MJ. Association between Functional Movement Screen Scores and Athletic Performance in Adolescents: A Systematic Review. Sports (Basel) 2022; 10:sports10030028. [PMID: 35324637 PMCID: PMC8954950 DOI: 10.3390/sports10030028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
This study systematically reviews the literature examining the relationship between Fundamental Movement Screen (FMS©) scores and athletic performance in youth. We searched English-language papers on PubMed/MEDLINE, SportsDiscus, CINAHL, and EBSCO for the following inclusion criteria: Participants aged between 11 and 17 years, studies had to include the Functional Movement Screen© (FMS©) and at least one of the following performance outcomes, highlighted by athletic development models (i.e., long-term athletic development (LTAD), youth physical development (YPD)): agility, speed, power, strength, endurance, and balance (YPD), fitness (LTAD), or sport-specific skill (LTAD and YPD). A total of 3146 titles were identified, with 13 relevant studies satisfying the inclusion criteria after full-text screening. The results of this systematic review suggest that children and youth who score highly on the FMS© also tend to have better scores for agility, running speed, strength, and cardiovascular endurance. The strength of associations was weak to moderate in nature. Only one study was considered or controlled for biological maturation in their analysis. These results provide evidence that, while there is a relationship between FMS© scores and tests of athletic performance in youth, they are not the same thing and should be considered conceptually different constructs.
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Affiliation(s)
- Katie Fitton Davies
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry CV1 5FB, UK;
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UG, UK
| | - Ryan S. Sacko
- Department of Health and Human Performance, The Citadel, Charleston, SC 29409, USA;
| | - Mark A. Lyons
- Sport and Human Performance Research Centre, University of Limerick, V94 T9PX Limerick, Ireland;
| | - Michael J. Duncan
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry CV1 5FB, UK;
- Correspondence: ; Tel.: +44-2476887688
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Assessment of Dysfunctional Movements and Asymmetries in Children and Adolescents Using the Functional Movement Screen-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312501. [PMID: 34886227 PMCID: PMC8657295 DOI: 10.3390/ijerph182312501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
The Functional Movement Screen (FMS) is a screening tool that identifies dysfunctional movements in seven test items requiring an interplay of cognitive, perceptual, proprioceptive, and motor functions that involve muscular strength/endurance, flexibility, mobility, coordination, and balance. The results of the FMS include an overall composite score, scores on the individual test items, and identification of compensatory movement patterns and left-right asymmetries on 5 bilateral test items. Although there is a plethora of literature on the use of the FMS in adults, there is a growing body of evidence indicating its use in children. The available research in children involves school children and young athletes in at least 20 different sports in over 20 countries and comparisons between pre- and post-pubescent children, and normal weight, overweight, and obese children. Studies that include measures of adiposity and physical activity levels, or report prevalence of asymmetries and dysfunctional movement patterns are not well represented in the children’s literature. The purpose of this paper is to synthesize the currently available literature in children and suggest potential uses of the FMS by coaches, physical educators, and other health/fitness professionals, appropriate interpretation of results, and future research in children.
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The Assessment of Functional Movement in Children and Adolescents: A Systematic Review and Meta-Analysis. Sports Med 2021; 52:37-53. [PMID: 34524655 PMCID: PMC8761122 DOI: 10.1007/s40279-021-01529-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
Background The Functional Movement Screen™ (FMS™) is an assessment of human movement that may signal potential deficits that could predispose an otherwise healthy person to injury risk. FMS™ scores are well reported in both athletic and adult samples. However, to date, there has been no comprehensive systematic review and meta-analysis of FMS™ data among school-aged children and adolescents. Objective We aimed to systematically review and analyse functional movement proficiency of children and adolescents, specifically when assessed using the FMS™, and to establish initial normative values for the FMS™ in this population group and to further estimate differences in functional movement proficiency between the sexes, by school level (i.e., between primary and secondary school-level children and adolescents), and based on differences in child and adolescent body mass index (BMI). Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, prospective studies were identified from searches across eight databases (MEDLINE, SPORTDiscus, CINAHL, Web of Science, EMBASE, ERIC, PsychINFO and PubMed), without any date restrictions, up to December 2020. The primary meta-analysis estimated the overall FMS™ score for school-aged children and adolescents across published studies. An additional three subgroup meta-analyses estimated comparisons for FMS™ data with school level, sex, and BMI across published studies. FMS™ data were meta-analysed using a number of different meta packages (Schwarzer et al. in Meta-Analysis with R, 1st ed, Springer International Publishing, Berlin, 2015), available in R Studio. Results A total of 19 articles were included in the systematic review. Meta-analysis revealed a weighted FMS™ mean score of 14.06, with a standardised Tau value of 0.56, signalling a moderate-to-large degree of variability in FMS™ means between studies. The difference in FMS™ means between samples of males (weighted FMS™ mean 13.91) and females (weighted FMS™ mean 14.56) was compatible with a possible small effect size (standardised mean difference − 0.27). The variability in FMS™ means between studies was approximately five times greater in samples of secondary school children (factor difference in Tau values 5.16). The final meta-regression identified a negative association between BMI and FMS™ scores (r = − 0.42), which signalled a moderate-to-large difference in FMS™ scores between healthy weight and overweight children/adolescents. Conclusion This systematic review and meta-analysis represents a novel and important synthesis of published FMS™ data from groups of children and adolescents. The study signals possible sex- and age-related differences in FMS™ scores, as well as a clear negative relationship between BMI and functional movement proficiency. More longitudinal research is needed to better understand the developmental trajectory and the effects of maturation milestones on FMS™ proficiency. Additional research is also needed to identify the types of interventions that could improve functional movement proficiency among ‘at risk’ groups, who are susceptible to functional movement deficiency, and whether changes in body composition mediate the relationship between these interventions and the improvement of FMS™ scores.
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Lisman P, Hildebrand E, Nadelen M, Leppert K. Association of Functional Movement Screen and Y-Balance Test Scores With Injury in High School Athletes. J Strength Cond Res 2021; 35:1930-1938. [PMID: 30844987 DOI: 10.1519/jsc.0000000000003082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Lisman, P, Hildebrand, E, Nadelen, M, and Leppert, K. Association of functional movement screen and Y-Balance Test scores with injury in high school athletes. J Strength Cond Res 35(7): 1930-1938, 2021-The purpose of this study was to determine the association between functional movement screen (FMS) and Y-Balance Test (YBT) performance and lower extremity injury in a sample of male high school athletes. A total of 124 high school football (n = 89), lacrosse (n = 25), and baseball (n = 10) players underwent FMS and YBT before the start of their competitive seasons. Time loss lower extremity injury incidence data were tracked by each team's certified athletic trainer and used for analysis. Receiver operating characteristic (ROC) curves were calculated to determine the optimal cutpoints for FMS composite score (CS) and YBT measures, including CS and reach distance asymmetry for anterior, posteromedial, and posterolateral directions, for predicting injury. No cutpoints on the ROC curves maximized sensitivity and specificity; therefore, FMS CS and YBT measures (CS and asymmetry) were analyzed as continuous variables. Logistic regression models adjusted for age and sport revealed no significant associations between FMS CS and lower extremity injury (odds ratio [OR] = 0.99; 95% confidence interval [CI] = 0.83-1.20). Similar findings were found for YBT asymmetry in all directions (ORs ranged from 0.98 to 1.08) and CS (OR = 0.99; 95% CI = 0.95-1.04). There were also no significant associations between the presence of asymmetry and low score (score of 1) on any individual FMS test and injury. Overall, FMS and YBT were not associated with increased risk of lower extremity injury in this sample of high school athletes. These findings do not support the use of FMS and YBT as stand-alone injury risk assessments in high school athletes.
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Affiliation(s)
- Peter Lisman
- Department of Kinesiology, Towson University, Towson, Maryland
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Vehrs PR, Barker H, Nomiyama M, Vehrs Z, Tόth M, Uvacsek M, Mitchel UH, Johnson AW. Sex Differences in Dysfunctional Movements and Asymmetries in Young Normal Weight, Overweight, and Obese Children. CHILDREN-BASEL 2021; 8:children8030184. [PMID: 33804388 PMCID: PMC7998576 DOI: 10.3390/children8030184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022]
Abstract
This study evaluated overall performance on the functional movement screen (FMS), prevalence of asymmetries and dysfunctional movements, and the relationship between measures of adiposity and the FMS score. Methods: Ninety-four (53 boys; 41 girls) 10–12-year-old children in Hungary and Germany who were participating in daily physical education performed the FMS. The mean FMS score in girls (14.1) was significantly higher than in boys (12.9). Individual test item scores were similar, except girls scored higher on the straight-leg raise. Most children (55% of boys, 68% of girls) presented with at least one asymmetry and 72% of boys and 76% of girls had at least one dysfunctional score. Measures of adiposity were negatively correlated to performance on all test items. Underweight and normal weight children performed significantly better on the FMS than overweight and obese children. Sex differences and the high prevalence of asymmetries and dysfunctional scores should be interpreted with caution since they may be due to dynamic changes in strength, proprioception, balance, and motor control that occur as part of growth and involvement in activities. Nevertheless, the high prevalence of asymmetries and dysfunctional scores indicate that most children have movement limitations.
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Affiliation(s)
- Pat R. Vehrs
- Department of Exercise Sciences, Brigham Young University, Provo, UT 84045, USA; (H.B.); (M.N.); (Z.V.); (U.H.M.); (A.W.J.)
- Correspondence:
| | - Haley Barker
- Department of Exercise Sciences, Brigham Young University, Provo, UT 84045, USA; (H.B.); (M.N.); (Z.V.); (U.H.M.); (A.W.J.)
| | - Misea Nomiyama
- Department of Exercise Sciences, Brigham Young University, Provo, UT 84045, USA; (H.B.); (M.N.); (Z.V.); (U.H.M.); (A.W.J.)
| | - Zachary Vehrs
- Department of Exercise Sciences, Brigham Young University, Provo, UT 84045, USA; (H.B.); (M.N.); (Z.V.); (U.H.M.); (A.W.J.)
| | - Miklόs Tόth
- Department of Health Sciences and Sport Medicine, University of Physical Education, 1123 Budapest, Hungary; (M.T.); (M.U.)
| | - Martina Uvacsek
- Department of Health Sciences and Sport Medicine, University of Physical Education, 1123 Budapest, Hungary; (M.T.); (M.U.)
| | - Ulrike H. Mitchel
- Department of Exercise Sciences, Brigham Young University, Provo, UT 84045, USA; (H.B.); (M.N.); (Z.V.); (U.H.M.); (A.W.J.)
| | - Aaron W. Johnson
- Department of Exercise Sciences, Brigham Young University, Provo, UT 84045, USA; (H.B.); (M.N.); (Z.V.); (U.H.M.); (A.W.J.)
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Pollen TR, Keitt F, Trojian TH. Do Normative Composite Scores on the Functional Movement Screen Differ Across High School, Collegiate, and Professional Athletes? A Critical Review. Clin J Sport Med 2021; 31:91-102. [PMID: 30339631 DOI: 10.1097/jsm.0000000000000672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The Functional Movement Screen (FMS) is a battery of 7 unloaded tests designed to rate human movement competency. Injury rates vary across the different level of a sport. The purpose of this critical review was to determine whether normative FMS composite scores differ across high school, collegiate, and professional athletic populations and to determine whether normative composite scores correlate with rates of severe injury across different collegiate sports. DATA SOURCES PubMed, Web of Science, and EBSCO databases from inception to September 2017 with the following syntax: "functional movement screen*" OR "movement screen*". Additional records were identified by citation tracking and hand search of articles. STUDY SELECTION A total of 708 records identified, of which 36 were included. Studies were included if they reported a FMS composite score for one of the groups. DATA EXTRACTION Two reviewers (T.R.P. and F.K.) screened records for the author and year; sample size; study design; sport(s); number, age, and sex of participants; testing conditions; methodological quality; and mean or median composite score(s). DATA SYNTHESIS Normative FMS composite scores were invariant to level of play, with 61% of reported scores falling between 14 and 16, despite injury rates increasing by level of play. Scores for high school, college, and professional athletes were 14.1, 14.8, and 15.7, respectively. There was a significant positive relationship between composite scores and rate of severe injury in college sports (r(11) = 0.66, P = 0.014). CONCLUSIONS Our findings potentially undermine the FMS's predictive validity. Although the FMS may have other applications, this critical review provides further evidence against the composite score for injury prediction in competitive athletes.
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Affiliation(s)
- Travis R Pollen
- Physical Therapy & Rehabilitation Sciences Department, College of Nursing & Health Professions, Drexel University, Philadelphia, Pennsylvania; and
| | - Frazier Keitt
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Thomas H Trojian
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Boucher B, Rich A, Gobert D, Gardner B, Metzner P, King C, Buse M. The Effectiveness of a Functional Movement Assessment and 4-Week Exercise Training Program for Female High School Athletes. J Strength Cond Res 2021; 35:102-110. [PMID: 29489717 DOI: 10.1519/jsc.0000000000002549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Boucher, BK, Rich, AJ, Gobert, D, Gardner, B, Metzner, P, King, C, and Buse, M. The effectiveness of a functional movement assessment and 4-week exercise training program for female high school athletes. J Strength Cond Res 35(1): 102-110, 2021-The extent to which young females participate in school-sponsored athletics has grown significantly over the past 2 decades. The number of females in high school sports increased for the 25th consecutive year in 2012-2013, reaching an all-time record. Unfortunately, sports-related injury rates for female athletes have also continued to rise. A body of research exists to suggest that dysfunctional movement may be linked to increased risk of injury, and training programs designed to improve movement patterns are effective to both enhance performance and reduce the risk of injury. Effective training programs incorporate corrective exercises to retrain dysfunctional movement patterns. The Functional Movement ScreenTM (FMSTM) is a tool developed to assess 7 fundamental movement patterns. The FMSTM has been used extensively with a wide range of athletes at various levels of performance. The aim of this study was to investigate the effectiveness of a movement-training program with female high school athletes using the FMSTM. The overall purpose was to assess the effectiveness of a 4-week corrective exercise-training program at improving FMSTM scores. Data analysis using Wilcoxon signed-rank test revealed a statistically significant change in total group FMSTM scores (Z = -2.214, p = 0.027) after the corrective exercise-training program. Mean total group FMSTM scores increased from 14.43 ± 1.90 (pretest) to 17.29 ± 1.38 (posttest). Findings suggest that positive outcomes to a corrective exercise-training program, which targets specific movement impairments, can be achieved in a relatively short period of time.
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Affiliation(s)
- Brenda Boucher
- Department of Physical Therapy, Texas State University, San Marcos, Texas
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Comparison of Functional Movement Screen, Star Excursion Balance Test, and Physical Fitness in Junior Athletes with Different Sports Injury Risk. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8690540. [PMID: 32309441 PMCID: PMC7136771 DOI: 10.1155/2020/8690540] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/23/2020] [Accepted: 03/11/2020] [Indexed: 11/23/2022]
Abstract
Objectives The aim of this study was to assess the relationships between functional movement screen (FMS), star excursion balance test (SEBT), agility T test, and vertical jump test scores and sports injury risk in junior athletes. We compared these assessments and the differences between groups with high and low risks of sports injury. Subjects and Methods. Eleven volleyball, 12 basketball, and 9 handball athletes were recruited. All participants followed the routine training in school sports teams. Weekly training schedules followed a similar pattern. The 32 junior athletes (age = 16.06 ± 0.21 years; height = 167.28 ± 6.32 cm; and body mass = 68.45 ± 9.67 kg) were assessed using the FMS, SEBT, agility T test, and vertical jump test in random order. The correlations of composite and individual item scores of these assessments were analyzed, and the differences between groups with high and low risks of sports injury were compared. Results All participants completed the study protocol. No significant differences were observed between FMS, SEBT, agility T test, and vertical jump test scores in groups with high and low risks of sports injuries. Fair and moderate-to-good correlations were observed for anterior reach maximum of SEBT and deep squat (r = 0.47, P = 0.02) as well as inline lunge (r = 0.53, P = 0.01) of FMS. The hurdle step of FMS also exhibited moderate-to-good (r = 0.52, P = 0.01) and fair (r = 0.42, P = 0.04) correlations with posterior medial and posterior lateral reach maximum of SEBT, respectively. A fair correlation was observed between posterior lateral reach maximum of SEBT and rotary stability of FMS (r = −0.23, P = 0.03). Fair and moderate-to-good correlations were identified for agility T test and maximum anterior reach in the SEBT (r = −0.42, P = 0.04) and trunk stability push-up in the FMS, respectively (r = −0.57 and P = 0.006). Conclusions Junior athletes with a high risk of sports injury did not exhibit differences in terms of FMS, SEBT, and physical fitness test scores. Deep squat, hurdle step, inline lunge, and rotary stability scores in the FMS were correlated with the item scores in the SEBT, which may be due to the use of similar movement patterns. Scores for anterior reach maximum in the SEBT and trunk stability push-up in the FMS were correlated with agility T test scores, suggesting a similar task requirement of trunk stability and dynamic weight shifting ability.
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Warren M, Lininger MR, Chimera NJ, Smith CA. Utility of FMS to understand injury incidence in sports: current perspectives. Open Access J Sports Med 2018; 9:171-182. [PMID: 30233259 PMCID: PMC6135213 DOI: 10.2147/oajsm.s149139] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Functional Movement Screen (FMS) is a popular movement screen used by rehabilitation, as well as strength and conditioning, professionals. The FMS, like other movement screens, identifies movement dysfunction in those at risk of, but not currently experiencing, signs or symptoms of a musculoskeletal injury. Seven movement patterns comprise the FMS, which was designed to screen fundamental movement requiring a balance between stability and mobility. The 7 movement patterns are summed to a composite FMS score. For an instrument to have wide applicability and acceptability, there must be high levels of reliability, validity, and accuracy. The FMS is certainly a reliable tool, and can be consistently scored within and between raters. Although the FMS has high face and content validity, the criterion validity (discriminant and convergent) is low. Additionally, the FMS does not appear to be studying a single construct, challenging the use of the summed composite FMS score. The accuracy of the FMS in screening for injury is also suspect, with low sensitivity in almost all studies, although specificity is higher. Finally, within the FMS literature, the concepts of prediction and association are conflated, combined with flawed cohort studies, leading to questions about the efficacy of the FMS to screen for injury. Future research on the use of the FMS, either the composite score or the individual movement patterns, to screen for injury or injury risk in adequately powered, well-designed studies are required to determine if the FMS is appropriate for use as a movement screen.
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Affiliation(s)
- Meghan Warren
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, USA,
| | - Monica R Lininger
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, USA,
| | - Nicole J Chimera
- Department of Athletic Training, Daemen College, Amherst, NY, USA
| | - Craig A Smith
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, USA, .,Smith Performance Center, Tuscon, AZ, USA
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