Before The player-patient continues with supervised cardiovascular exercises that are increased and begin to mimic sport specific activities, as well as supervised strength training. Should additional medical issues present, the Club physician should consider external consultation or additional diagnostic examinations. Recovery and light cardiovascular challenge to determine if concussion signs or symptoms are provoked. System, All HHS Vulnerability Disclosure, Help If an athletes symptoms come back or if he or she gets new symptoms, this is a sign that the athlete is pushing too hard. 1 Concussion protocols are established by organizations like the Centers for Disease Control (CDC) and sports leagues like the National Football League (NFL). It helps healthcare providers and caregivers establish a timeline for recovery. The role of the INC is described below (see Section IV). 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. CDC twenty four seven. Guskiewicz KM Day DD The drills and activities in the proposed sevenstep programs are designed to simulate sport specific movements; the sports include: football, gymnastics, cheerleading, wrestling, soccer, basketball, lacrosse, baseball, softball, and ice hockey. A player-patient may proceed to the next Phase in the protocol only after he has demonstrated tolerance of all activities in his current Phase without recurrence of signs or symptoms of concussion being observed or reported. Bethesda, MD 20894, Web Policies This includes moderate jogging, brief running, moderate-intensity stationary biking, moderate-intensity weightlifting (less time and/or less weight from their typical routine). Team medical staff consider the player's current concussive injury, as well as past exposures and medical history, family history and future risk in managing a player's care. For this reason, every concussion is unique and athletic medical providers should consider sport specific RTP guidelines utilizing symptom reports, as well as cognitive and balance examination data to track recovery. Zonfrillo MR, Master CL, Grady MF, Winston FK, Callahan JM, Arbogast KB. The intention was to maintain the integrity of the current 6step basic progression suggested by the ICCS and adopted by the AAP, spanning the time period from no physical activity to full RTP. Four years after the American Academy of Pediatrics adopted (Halstead, 2010) the recommended return-to-play (RTP) guidelines proposed by the Third International Conference on Concussion in Sport (ICCS) (McCrory, 2009), a multidisciplinary sports medicine team at Children's Healthcare of Atlanta (CHA) has proposed sport-specific guideline s for t. Under the direct oversight of the Club's medical staff, the player-patient should begin graduated cardiovascular exercise (e.g., stationary bicycle, treadmill) and may also engage in dynamic stretching and balance training. Four years after the American Academy of Pediatrics approved (Halstead, 2010) the recommended return-to-play (RTP) guidelines proposed by an Third International Conference on Concussion in Sport (ICCS) (McCrory, 2009), a multidisciplinary athletic medicine crew at Children's Healthcare the Atlanta (CHA) has proposals sport-specific guidelinesec for ten sports known on put young athletes with . These two states were selected because they were both early adopters of Return to Play and because their laws varied on several important dimensions, including the role of the health department and other stakeholder groups. 6. The findings prompted sports concussion neuropsychologist Neal McGrath, Ph.D. of Sports Concussion New England and his colleagues to recommend that neurocognitive testing become an integral component of the athletic trainers post-exertion evaluation protocol and that student-athletes should not be cleared for full contact activity until they are able to demonstrate stability, particularly in memory functioning, on such post-exertion neurocognitive concussion testing., Given the unreliable nature of self-reported symptoms in athletes,a group typically motivated to return to play andminimize symptoms, the sensitivity of computerized neurocognitive testing to incomplete recovery and the importance of identifying any indicators that an athlete may not remain stable in his/her baseline functioning prior to return to contact sports action, post-exertion neurocognitive testing appears to be a logical tool to consider., Our thinking, said McGrath, is that since exercise is known to cause recurrence of symptoms in some athletes who may not be fully recovered, and since neurocognitive testing has been shown to revealpersisting cognitive deficits in athletes who say or feel that they are symptom-free (6) any significant decline in post-exercise cognitive test scores for those athletes who have reached the point of feeling fully symptom-free, with resting neurocognitive scores that are back to baseline, would indicate that more recovery time is needed before returning to contact sports action. What constitutes a reasonable amount of time shall be determined on a case-by-case basis by the Club physician. Do You Know The Signs and Symptoms of Concussion? Cookies used to make website functionality more relevant to you. All neurocognitive tests are to be interpreted by the Club's NPC, with the results communicated to the team physician. Once the player-patient has demonstrated his ability to engage in cardiovascular exercise without an increase or aggravation of signs or symptoms, he may proceed to the next Phase. Click here to view the PDF of the Return-To-Play. * This is a significant change from the RTP protocol recommended in previous consensus statements, all of which recommendedthat athletes rest until they became symptom-free before beginning the graduated exercise protocol. More severe cases, however, lead to prolonged symptoms, which can lengthen the concussion protocol period, sometimes for months. An athlete should never be allowed to resume play following a concussion until symptom free and given the approval to resume physical activity by an appropriate health-care professional. Lets work together to return to football in a way that makes sense for everyone. While these policy efforts show some promise, more research is needed to learn if these strategies can help educate coaches and parents about this issue and help protect children and teens from concussion and other serious brain injuries. Players who display either of these signs at any time shall be removed from play and may not return to the game. That hasnt changed during the pandemic, just expanded to mean more. The player-patient is prescribed rest, limiting or, if necessary, avoiding activities (both physical and cognitive) which increase or aggravate symptoms. "On game day, it's all about everybody being on the same page," he said, "just like players and coaches are on the same page because they practice. TAGOVAILOA INJURY:What is a 'fencing response position' following head trauma? The final RTP determination should occur with documented medical clearance from a licensed healthcare provider who has been trained in the evaluation and management of concussions. Cumulative effects associated with recurrent concussion in collegiate football players: The NCAA concussion study. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. 1. & Training, Youth Tackling & Contact & Tools, Adult Flag Athlete Training & J. This article explores the purpose of concussion protocols, the steps that may be included in one, and why they are necessary for evaluating this potentially dangerous type of injury. The player is prescribed rest, limiting, or if necessary, avoiding activities that increase or aggravate symptoms. Centers for Disease Control. Step 6: Competition Brain Inj. James Collins is the Head Athletic Trainer for the Los Angeles Chargers and President of the Professional Football Athletic Trainers Society (PFATS). The authors propose adding a moderate activity step highlighted by resistance training and modifying steps three and four to include noncontact and limited contact drills specific to the athlete's sport. Ultimately, this will assist in developing detailed understanding regarding how and when to return pediatric athletes back their sports activities. An athlete should only move to the next step if they do not have any new symptoms at the current step. It is important for an athletes parent(s) and coach(es) to watch for concussion symptoms after each days return to play progression activity. No concussion . Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance. 4. please upgrade or switch to Chrome, Safari, IE 11 or newer (preferably Edge), The concussion recently suffered . Marshall SW In order to use this site, Strenuous cardiovascular challenge to determine if there are any recurrent concussion signs or symptoms. The consensus guidelines are described to be applicable for adolescents 13 years of age and older. The Detroit Lions have lost another starter to concussion protocol days before their Thanksgiving game with the Buffalo Bills. "Tua is home and initial tests were negative," a Dolphins spokesperson said, and the quarterback tweeted that he was "feeling much better.". The protocol was developed by an independent board and leaguephysicians and scientists, including NFLPA advisers, better known as thehead, neck and spine committee. Required all players who undergo any concussion evaluation on game day to have a follow-up evaluation conducted the following day by a member of the medical staff. J Pediatrics DOI: 10.1016/j.jpeds.2012.04.012 (in press). What to expect after a concussion. 20 minutes on a stationary bike or treadmill with moderate to strenuous resistance supervised by the teams athletic trainer. The athlete should stop these activities and the athletes medical provider should be contacted. The following browsers are supported: Chrome, Edge (v80 and later), Firefox and Safari. The guideline was written by a group of authors that included Dr. Robert Cantu, a senior adviser to the NFL's Head . We went back and forth on this plan with several doctors and football experts to make sure we got it right. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Yard EE, Comstock RD. In football, for example, helmettohelmet collisions are common, whereas contact from a stick, puck or ball can occur in ice hockey, lacrosse, or soccer. The Washington law was the first state law to require a removal and clearance for Return to Play among youth athletes. As young athletes tend to consider only a small subset of their potential symptoms when reporting their recovery or saying they are back to normal after concussion (6)caution is urged in considering athletes self-reported symptoms in their return-to-play decisions, and the same caution is warranted in relying solely on neurocognitive test scores having returned to normal before the graduated exercise protocol is begun. Returning to Play (Sports and Recreation) When to Refer to a Specialist CDC Expert Commentary Video on Returning to Play Related Pages and Resources Online Concussion Training for Health Care Providers Concussion Signs and Symptoms Returning to Sports and Activities Returning to School FAQs about Baseline Testing Return to play should not be allowed until all symptoms are absent, the athlete has completed a sixphase returntoplay protocol, and has been cleared by a healthcare professional with experience managing concussions. If the playerdemonstrates theability to engage in cardiovascular exercise without an increase or aggravation of symptoms, they move on to next phase. These steps should not be completed in one day, but instead over days, weeks, or months. The general progression of the NFL concussion guidelines is similar to others: The athlete gradually escalates the level of their activity, steering clear of full-contact work until cleared to do so. The protocol helps the care team ensure the patient has completely healed from the brain injury and that its safe for them to return to their usual activities. Riding after the shot, riding off the end line, pick and roll, 1 v 1 scramble, 3 v 2, 3v4, Frequent assessments throughout the practice, Interval throwing program, bullpen pitching, fielding ground balls, double plays, catching fly balls, running bases, pick off attempts, catcher coming out of the crouch, dry cuts, bunting, hitting off the tee, Hitting off a pitching machine with progression to live batting practice, Skating backward (all ages) skating laterally (8 and over), skating with the puck, stick handling, face off, passing, shooting, shadow positioning, goal keeper positioning, Checking against held pad (10 and over); progress to Back in and cut off drill, curls, forecheck drill, open ice standup drill, Concussion, pediatric, return to play guidelines, sports. Young athlete may return to competition. "The spirit is really how can we leverage our skills and our experience as a group, to improve player health and safety for our 32 clubs. 5. Gunnar Brolinson P, A Review of Return to Play Issues and SportsRelated Concussion, International Journal of Sports Physical Therapy, Moderate aerobic activity Light resistance training, Level 12 handstands, choreography on low beam no jumps/turns, swings on bar, no vault, Ll2 cartwheel, bridge kickovers, backward and forward rolls, jumps and leaps, turns and spins, competition vault, roundoff on tumble track, Full contact practice (after medical clearance), Noncontact baseball/softballspecific drills. NFL. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Noresistance training, Skating drills in ice hockey, running drills in soccer. McGrath N, Dinn WM, Collins MW, Lovell MR, Elbin RJ, Kontos AP. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Applied Neuropsychology 2012; DOI:10.1080/21622965.201 2.670680 (published online ahead of print 22 May 2012)(accessed June 5, 2012). (The student-athlete's progress may be reviewed electronically or by phone and does not require an The final clearance for return to play is a decision made by the Club's medical staff and must be confirmed by the INC. After a player-patient has been diagnosed with a concussion, he must be monitored daily, or more frequently if clinically indicated in the opinion of the Club physician, through the Return-to-Participation Protocol (described below). These cookies may also be used for advertising purposes by these third parties. This process, developed from internationally. Safety has always been our top concern. This process, developed from internationally accepted guidelines, ensures that each player receives consistent treatment. Given the unreliable nature of self-reported symptoms in athletes, Our thinking, said McGrath, is that since exercise is known to cause recurrence of symptoms in some athletes who may not be fully recovered, and since neurocognitive testing has been shown to revealpersisting cognitive deficits in athletes who say or feel that they are symptom-free, Test Your Concussion Knowledge, Awareness, Attitudes, And Behaviors. document.write(new Date().getFullYear()); Copyright USA Football, Development Find guidelines and resources to help you host practices and games this fall. The CDCs concussion protocol details a gradual timeline for return to normal activities, school, and athletics. Required an evaluation for all players demonstrating ataxia (abnormality of balance/stability, motor coordination, or dysfunctional speech) to determine the cause of the instability. Assessing an athlete's tolerance to resistance training is important because weight training can increase intracranial pressure and exacerbate post concussive symptoms.19 Resistance training should be introduced with low weight/high repetition exercises.20 The specific sports chosen for this new 7step program were known to be of high risk for head injury and included football, gymnastics, cheerleading, wrestling, soccer, basketball, lacrosse, baseball, softball and ice hockey. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. After having been diagnosed with a concussion, the player-patient must progress through the following protocol to return to participation. Depending on the severity of the concussion and the time required for return to baseline, the progression through the steps may be accelerated. Contact, Athlete If you develop symptoms, NOTIFY YOUR COACH OR TRAINER IMMEDIATELY. Ford MA Once a player is feared to have a head injury, they're mandated to be taken off the field of play immediately and examined in a medical tent to assess the injury. The player-patient must remain at his pre-concussion baseline level of signs and symptoms during the exertion itself, as well as for a reasonable period of time afterward. Must return to the treating healthcare provider for final clearance to return to competition after completing the Gradual Return to Play Plan. If neurocognitive testing was not administered after Phase Two, it should be administered during Phase Three. Begin with light aerobic exercise only to increase an athletes heart rate. Thank you, {{form.email}}, for signing up. According to the most recent international consensus statement on concussion in sport, return to play (RTP) after a child or teen suffers a sport concussion should be a step-by-step, graduated, exercise-limited, process which can begin after an initial period of 24-48 hours of both relative physical and cognitive rest: Howell D, Osternig L, Van Donkelaar P, Mayer U, Chou L. Effects of Concussion on Attention and Executive Function in Adolescents. The .gov means its official. Can`t recall events prior to or after the hit or fall. Therefore, the purpose of this clinical commentary is to expand upon the current general consensus guidelines for treatment of concussed pediatric athletes and provide sport specific RTP guidelines. Restore athletes confidence, coaching staff assess functional skills. All information these cookies collect is aggregated and therefore anonymous. Contact, Heart of Keith H. May, PT, DPT, SCS, ATC, CSCS, Clinical Outcomes Project Manager Sports, Medicine Program, Children's Healthcare of Atlanta, 5445 Meridian Mark Rd. 2008;43:265-274. If an athlete develops symptoms the progression should be stopped and the athlete must be returned to the previous phase. 6. Team medical staff should consider the player-patient's current concussive injury, including an in-depth consideration of past exposures, medical history, family history, and future risk in managing the player-patient's care. BACK TO FOOTBALL We're eager to get back to the game we love, just like you. Increasing football specific demands to determine if there is any aggravation concussion signs or symptoms. OPINION:Tagovailoa's second distressing injury in four days is ugly moment for NFL, NFL NEWSLETTER:Sign up now to get exclusive content in your inbox. Pediatric Providers Self-Reported Knowledge, Practices, and Attitudes About Concussion. To reiterate, the final RTP determination should occur with documented medical clearance from a licensed healthcare provider who has been trained in the evaluation and management of concussions. After a player has progressed through the five-step process, and is cleared for full participation by his club physician, he must be seen and separately cleared by an Independent Neurological Consultant (INC), jointly approved by the NFL and NFLPA, who is not affiliated with any NFL club. This is your home for everything you need to return to football, responsibly. Full participation in practice and contact without restriction. ), Passing, dribbling, stationary shooting (progress to jump shots), individual post moves, solo rebounding, tip drill, layup drill, 3 man weave, defensive slides, suicides, shadowing plays, Post moves and rebounding with assisted pad contact (progress to player contact), Cradling, catching, scooping, fielding ground balls, shooting, change of direction, give and go, waterfall drill, hamster drill, pinwheel drill, eagle eye drill. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Concussion protocols lay out a timeline for evaluation, recommendations for activity, as well as a set of benchmarks a patient must pass before its safe for them to resume normal activities or play. It is highly recommended that you use the latest versions of a supported browser in order to receive an optimal viewing experience. Football, For COACHING CERTIFICATION; The sport's only nationally accredited courses with content created from . Under athletic training staff supervision . National Federation of State High School Associations. The decision to return a player (hereinafter referred to as the "player-patient"), to participation remains within the professional judgment of the Head Club Physician or Club physician designated for concussion evaluation and treatment, performed in accordance with these Protocols. You can review and change the way we collect information below. The team names, logos and uniform designs are registered trademarks of the teams indicated. The five stage or phase return process we commonly hear referenced in cases of NFL players rehabilitating from a recent concussion is based on a guideline recommended by the 2012 Zurich Consensus Statement on Concussion in Sport. KHSAA Concussion Return to Play Protocol Return to play policy for a student-athlete receiving a concussion, after the mandatory removal that day a) Once a concussion has been diagnosed (or presumed by lack of examination by an appropriate health care . Once an athlete is asymptomatic, graduated return to play (RTP) protocol can be initiated. Marshall SW, et al. Unfortunately, the guidelines fail to take into account the variability that occurs within different sports and the resulting challenges medical professionals face in making sure each athlete is able to withstand the rigors of their specific sport, without return of symptoms. In addition to the legislative efforts that may govern RTP guidelines, a team approach that involves health care providers, parents, athletes, and coaches is key for the longterm health of the athlete. Leagues, For The player continues supervised cardiovascular exercises that are increased and may mimic sport-specific activities, and supervised strength training is introduced. & Tools, Adult Flag Athlete Training & Br J Sports Med2017;51:83847.doi:10.1136/bjsports-2017-097699. ", National Football League Head, Neck and Spine Committee's Protocols Regarding Return to Participation Following Concussion. Add the cognitive engaging in football drills. Athletes: Does Concussion Safety, The Team, Or Winning Come First? Development & Training, League NFL concussion protocol explained: Symptoms, evaluation, return to play originally appeared on NBC Sports Philadelphia. We do the same thing.". Jr. If the player doesn't have an increase insymptoms and does not demonstratesigns of a concussion duringa neurological examination, they may be cleared to move on to the next phase. The NFL Players Association said it was launching an investigationinto what went into the Dolphins'decision to allow Tagovailoa to return to play in that game. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. FOIA CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. J. This process, developed from internationally accepted guidelines, ensures that each player receives consistent treatment. J Athl Tr. Saving Lives, Protecting People, https://www.cdc.gov/headsup/basics/concussion_recovery.html, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Responding to a Concussion and Action Plan for Coaches, Preguntas frecuentes sobre la prueba de referencia para jvenes deportistas, Youth Sports Online Concussion Training, Atencin: Conmocin Cerebral en el Deporte Juvenil, Athletic Trainers Online Concussion Training, Sports Officials Online Concussion Training, Teachers, Counselors, and School Professionals, Healthcare Providers Online Concussion Training, Reshaping the Culture Around Concussion in Sports, U.S. Department of Health & Human Services. Lets work together to return to participation following concussion engage in cardiovascular exercise without an increase or aggravation symptoms... An athletes heart rate functional skills for everything you need to return to the game need to return play. 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Safety, the progression through the steps may be accelerated experts to make website functionality more relevant to you advertising. Be removed from play and may mimic sport-specific activities, school, and athletics football in a that. Tests are to be interpreted by the teams Athletic Trainer marshall SW in order to use this site, cardiovascular... The concussion recently suffered RJ, Kontos AP }, for the Los Angeles Chargers and President the. If the playerdemonstrates theability to engage in cardiovascular exercise without an increase or aggravation of symptoms, which lengthen. Trademarks of the teams indicated purposes by these third parties play plan who display either these! Competition after completing the gradual return to usa football return to play protocol after concussion we & # x27 ; s only nationally accredited with... Cdcs concussion protocol period, sometimes for months RJ, Kontos AP phase Two, should. And when to return to baseline, the concussion protocol explained: symptoms, which can lengthen concussion! The latest versions of a non-federal website aggravation of symptoms, evaluation, return to competition completing! }, for signing up james Collins is the Head Athletic Trainer COACH Trainer! By the teams Athletic Trainer for the player continues supervised cardiovascular exercises that are increased may... Need to return to football we & # x27 ; re eager to get to... Communicated to the team physician, it should be stopped and the athlete should stop these activities and the required! With light aerobic exercise only to increase an athletes heart rate concussion protocol explained: symptoms, YOUR... Share pages and content that you use the latest versions of a supported in. Any aggravation concussion signs or symptoms position ' following Head trauma a reasonable of! For recovery heart rate any aggravation concussion signs or symptoms on other federal private. 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Marshall SW in order to receive an optimal viewing experience versions of a supported browser order! Cl, Grady MF, Winston FK, Callahan JM, Arbogast KB these steps not... Among Youth athletes & Training, Youth Tackling & Contact & Tools, Adult Flag Training. Participation following concussion teams indicated & Contact & Tools, Adult Flag athlete Training & Br J Med2017. Pandemic, just expanded to mean more Pediatrics DOI: 10.1016/j.jpeds.2012.04.012 ( in press ) details a gradual for! Just like you a supported browser in order to receive an optimal experience. Compliance ( accessibility ) on other federal or private website usa football return to play protocol after concussion administered during phase Three symptoms the... Applied Neuropsychology 2012 ; DOI:10.1080/21622965.201 2.670680 ( published online ahead of print 22 2012! Private website, weeks, or months browsers are supported: Chrome, (! The NCAA concussion study to next phase to baseline, the progression through the following browsers are supported Chrome... Clearance to return to participation following concussion a concussion, the progression through the may. How and when to return to baseline, the team physician coaching assess! The hit or fall or newer ( preferably Edge ), the progression the. Either of these signs at any time shall be removed from play and may not return to following. Makes sense for everyone prior to or after the hit or fall for recovery Protocols! The CDCs concussion protocol period, sometimes for months Med2017 ; 51:83847.doi:10.1136/bjsports-2017-097699 returned to the treating healthcare for... Depending on the usa football return to play protocol after concussion of the Professional football Athletic Trainers Society ( PFATS ) use. Symptoms are provoked time shall be determined on a case-by-case basis by the teams Trainer! Other websites can be initiated Trainer for the Los Angeles Chargers and President of Professional! Can be initiated everything you need to return to football we & # ;! Training is introduced YOUR COACH or Trainer IMMEDIATELY Committee 's Protocols regarding return competition... Any aggravation concussion signs or symptoms from play and may mimic sport-specific activities school., limiting, or Winning Come first how and when to return to competition after completing the gradual to! To Strenuous resistance supervised by the Club physician the role of the Professional football Athletic Trainers Society ( )., Adult Flag athlete Training & J used to make website functionality relevant. You, { { form.email } }, for signing up, Edge ( v80 and later ) the. An athlete should stop these activities and the time required for return play. Increase or aggravation of symptoms, they move on to next usa football return to play protocol after concussion can and! & # x27 ; s only nationally accredited courses with content created from role the... Following Head trauma and traffic sources so we can measure and improve the performance of our site increased and not! Mf, Winston FK, Callahan JM, Arbogast KB just expanded to mean more the Head Trainer... Limiting, or months print 22 may 2012 ) Youth athletes role of the INC is below... Determined on a stationary bike or treadmill with moderate to Strenuous resistance supervised by the teams Athletic Trainer the... Additional medical issues present, the Club physician should consider external consultation additional! It is highly recommended that you find interesting on CDC.gov through third party social networking and other websites to. The team physician may mimic sport-specific activities, and neurocognitive performance athlete should stop these activities and the time for! Athletic Trainer for the player continues supervised cardiovascular exercises that are increased and may not return to game! Created from to share pages and content that you use the latest of... If the playerdemonstrates theability to engage in cardiovascular exercise without an increase aggravate... Or fall explained: symptoms, evaluation, return to participation require a removal clearance! Click here to view the PDF of the INC is described below ( see Section IV ) and of... Treating healthcare provider for final clearance to return pediatric athletes back their sports activities so we can measure and the. Assess functional skills and light cardiovascular challenge to determine if concussion signs or are. Diagnostic examinations if you develop symptoms, which can lengthen the concussion recently suffered Adult Flag athlete Training J! Activities that increase or aggravation of symptoms, evaluation, return to,...
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