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BACKGROUND: Movement System Impairment (MSI) classification and treatment effectively diagnose and treat the individual with neck pain. There is a lacuna in the current neck pain management guidelines addressing movement-specific mechanical diagnosis. MSI is based on the movement-specific mechanical diagnosis and kinesiopathologic model. PURPOSE: The present study aimed to investigate the effectiveness of the movement system impairment model among neck pain individuals. METHODS: This study was designed as a randomized controlled trial. Eighty-two participants were screened for eligibility; Sixty individuals fulfilling the inclusion criteria were randomized into the experimental group (n = 30) and control group (n = 30). A total of 52 individuals completed the study, 26 in both groups. The experimental and the control group received treatment as recommended by the MSI model and clinical practice guideline (CPG) for neck pain with mobility deficits. All participants were assessed for pain intensity, cervical range of motion, deep cervical muscle strength, endurance, and disability at baseline and the end of 3rd week of treatment. RESULTS: Significant differences were found in pain intensity, cervical range of motion, cervical muscle strength, endurance, and disability with both groups at the end of 10 sessions of treatment spread over three weeks (p < 0.05). However, the experimental group (MSI) demonstrated more clinical benefits than CPG based neck mobility deficits treatment. CONCLUSION: The movement system impairment model may effectively diagnose and treat neck pain in individuals with mobility deficits. Future research is warranted to establish its long-term effect.

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The objective of this study is to investigate the effects of functional corrective training and static stretching on the quality of movement patterns and physical fitness in college students. The study was conducted with 30 male college students from a university in Guangzhou, China. The participants were randomly assigned to either the functional corrective training group (FCT, n = 15, age = 20.93 ± 0.85, BMI = 22.07 ± 2.33) or the static stretching group (SS, n = 13, age = 20.85 ± 0.86, BMI = 21.98 ± 1.80). Two participants from the SS group dropped out due to personal reasons, leaving 13 subjects in that group. Both groups underwent a 6-week training intervention, with sessions held twice a week. The FCT group participated in flexibility training, and/or static motor control training, and/or dynamic motor control training for 10-15 min. The SS group performed static stretching exercises targeting five specific muscles, with 30 s per side and two sets. The Functional Movement Screen (FMS), body composition, sit-and-reach, standing long jump, and pull-ups were assessed before and after the intervention. Differences in FMS outcomes were analyzed using two samples of the Mann-Whitney U test. Physical fitness outcomes were analyzed using a repeated measures analysis of variance (ANOVA) with a 2 (group) × 2 (time) design. After 6 weeks of intervention, the FCT group showed statistically significant improvements in the hurdle step (Z = -2.449, p = 0.014), inline lunge (Z = -2.000, p = 0.046), rotary stability (Z = -2.309, p = 0.021), and composite scores (Z = -3.316, p = 0.001). Comparisons between groups indicated that BMI (FCT, ES = 0.04; SS, ES = -0.11), 30-m sprint (FCT, ES = 0.12; SS, ES = 0.28), body fat percentage (BF%) (FCT, ES = -0.25; SS, ES = -0.07), and sit-and-reach (FCT, ES = 0.17; SS, ES = 0.06) were not statistically significant in both the pre- and post-tests. The effect sizes of all physical fitness indicators were greater in the FCT group than in the SS group. The FCT, consisting of two sessions per week for 6 weeks, has been proven to be effective in improving the quality of movement patterns by improved stability and advanced movements. However, the improvements in physical fitness did not reach statistical significance. FMS and FCT are generally affordable and accessible for college students. College students have the opportunity to employ the FMS tool to assess potential injury risks and address them, thereby reducing the risk of injuries.

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The purpose of this study was to compare the preliminary effects of movement pattern training (MoveTrain) versus strengthening/flexibility (standard) treatment on hip and pelvic biomechanics in patients with chronic hip-related groin pain. This is a secondary analysis of data collected during a pilot randomized clinical trial. Thirty patients with hip pain, between the ages of 15 and 40 years, were randomized to MoveTrain or standard. Both groups completed 10 treatment sessions over 12 weeks along with a daily home exercise program. Three-dimensional motion analysis was used to collect kinematic and kinetic data of the pelvis and hip during a single-leg squat task at pretreatment and immediately posttreatment. Compared with the standard group, the MoveTrain group demonstrated smaller hip adduction angles (P = .006) and smaller hip external adduction moments (P = .008) at posttreatment. The desired changes to hip joint biomechanics, as found in this study, may require specificity in training that could allow health care professionals to better customize the rehabilitation of patients with hip pain. These findings can also be applied to the design and implementation of future clinical trials to strengthen our understanding of the long-term implications of different rehabilitation techniques for patients with hip pain.

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OBJECTIVE: The objective of this study was to assess the feasibility of completing a randomized clinical trial (RCT) and examine the preliminary effects of 2 interventions for hip-related groin pain (HRGP). METHODS: In this pilot RCT, patients with HRGP, who were 18 to 40 years old, were randomized (1:1 ratio) to a joint mobilization (JtMob) group or a movement pattern training (MoveTrain) group. Both treatments included 10 supervised sessions and a home exercise program. The goal of JtMob was to reduce pain and improve mobility through peripherally and centrally mediated pain mechanisms. The key element was physical therapist-provided JtMob. The goal of MoveTrain was to reduce hip joint stresses by optimizing the biomechanics of patient-specific tasks. The key element was task-specific instruction to correct abnormal movement patterns displayed during tasks. Primary outcomes were related to future trial feasibility. The primary effectiveness outcome was the Hip Disability and Osteoarthritis Outcome Score. Examiners were blinded to group; patients and treatment providers were not. Data collected at baseline and immediately after treatment were analyzed with analysis of covariance using a generalized linear model in which change was the dependent variable and baseline was the covariate. The study was modified due to the coronavirus disease 2019 (COVID-19) pandemic. RESULTS: The COVID-19 pandemic affected participation; 127 patients were screened, 33 were randomized (18 to the JtMob group and 15 to the MoveTrain group), and 29 (88%) provided posttreatment data. Treatment session adherence was 85%, and home exercise program component adherence ranged from 71 to 86%. Both groups demonstrated significant mean within-group improvements of ≥5 points on Hip Disability and Osteoarthritis Outcome Score scales. There were no between-group differences in effectiveness outcomes. CONCLUSIONS: A large RCT to assess the effects of JtMob and MoveTrain for patients with HRGP may be feasible. Preliminary findings suggested that JtMob or MoveTrain may result in improvements in patient-reported pain and activity limitations. IMPACT: The COVID-19 pandemic interfered with participation, but a randomized controlled trial may be feasible. Modification may be needed if the trial is completed during future pandemics.

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As a continuation of our previous work, in this paper, we examine in greater detail the genome organization and some protein properties of the members of a potential group named Reclovirids and belonging to Benyviridae-related viruses. It can be proposed that the single-component Reclovirid genomes encode previously undiscovered transport genes. Indeed, analysis of the coding potential of these novel viral genomes reveals one or more cistrons ranging in size from 40 to 80 to about 600 codons, located in the 3'-terminal region of the genomic RNA, encoding proteins with predicted hydrophobic segments that are structurally diverse among Reclovirids and have no analogues in other plant RNA viruses. Additionally, in many cases, the possible methyltransferase domain of Reclovirid replicases is preceded by membrane-embedded protein segments that are not present in annotated members of the Benyviridae family. These observations suggest a general association of most Reclovirid proteins with cell membranes.

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Leaders and scholars from multiple academies of the American Physical Therapy Association are developing and defining movement system diagnoses to guide practice. However, there is no consensus on the need for or content of such frameworks. This Perspective describes current thought about movement system diagnoses in physical therapy and summarizes the work of the Academy of Geriatrics (APTA Geriatrics) Movement System Diagnosis Task Force (GMS-TF) as it contributes to the movement system diagnosis discussion within the profession. Initially convened to define movement system diagnostic labels unique to older adults, the GMS-TF's developmental process identified the need for a clearer diagnostic framework onto which specific diagnoses will later be added. Although The World Health Organization International Classification of Functioning, Disability and Health model is a strong foundation for the patient-client management model, the GMS-TF proposes formal incorporation of the Geriatric 5Ms (mobility, medications, memory, multi-complexity, and "what matters most") into a movement system framework for older adults. The GMS-TF concurs with the APTA Academy of Neurology Movement System Task Force proposal that observation and analysis of key functional tasks are the foundation of any examination of older adults. The GMS-TF suggests adding several additional movement tasks that are important for older adults. The GMS-TF believes that this strategy highlights the health care needs of older adults and prioritizes physical therapist care for older adults with complex needs. This Perspective is the foundation for a future movement system diagnosis model for older adults that will complement and facilitate the development of models of care to be applied across the lifespan.

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Introduction: Low back pain (LBP) is a musculoskeletal disorder that affects more than 80% of people in the United States at least once in their lifetime. LBP is one of the most common complaints prompting individuals to seek medical care. The purpose of this study was to determine the effects of spinal stabilization exercises (SSEs) on movement performance, pain intensity, and disability level in adults with chronic low back pain (CLBP). Methods: Forty participants, 20 in each group, with CLBP were recruited and randomly allocated into one of two interventions: SSEs and general exercises (GEs). All participants received their assigned intervention under supervision one to two times per week for the first four weeks and then were asked to continue their program at home for another four weeks. Outcome measures were collected at baseline, two weeks, four weeks, and eight weeks, including the Functional Movement ScreenTM (FMSTM), Numeric Pain Rating Scale (NPRS), and Modified Oswestry Low Back Pain Disability Questionnaire (OSW) scores. Results: There was a significant interaction for the FMSTM scores (p = 0.016), but not for the NPRS and OSW scores. Post hoc analysis showed significant between-group differences between baseline and four weeks (p = 0.005) and between baseline and eight weeks (p = 0.026) favor SSEs over GEs. Further, the results demonstrated that all participants, regardless of group, had significant improvements in movement performance, pain intensity, and disability level over time. Conclusion: The results of the study favor SSEs over GEs in improving movement performance for individuals with CLBP, specifically after four weeks of the supervised SSE program.

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Background: Valgus extension overload syndrome (VEOS) of the elbow is a condition associated with overhead athletes. However, the non-surgical management of these individuals is not well documented. Purpose: To discuss the unique presentation, management, and outcomes of an adolescent baseball player with a chronic history of VEOS experienced during hitting. Case Description: A 15-year-old right-handed high school baseball catcher presented with a six-month history of right-sided ulnar elbow pain. Elbow MRI w/ contrast was consistent with VEOS. The initial examination demonstrated excessive resting right-sided humeral external rotation compared to his left. Valgus stress testing in the subject's hitting position reproduced symptoms, which were alleviated with retest while correcting excessive humeral external rotation. Weakness of the humeral internal rotators and stiffness/shortness of the posterior shoulder were found and thought to relate to the humeral contribution to his elbow movement dysfunction. Rehabilitation emphasized addressing impairments contributing to excessive humeral external rotation with reintegration into batting. Outcomes: After five weeks of physical therapy, the subject returned to soft toss hitting at approximately 75% velocity for the first time since symptom onset, without pain. At seven months after discharge, a phone conversation confirmed that the subject had returned to baseball without limitations. Discussion: Despite the concept of 'regional interdependence', common proximal impairments are often assumed to contribute to elbow pain without a clear biomechanical rationale. Future research demonstrating the specific biomechanical effects of the shoulder on the elbow is needed, in addition to more accessible examination strategies to assess their relationship. Level of Evidence: 5.

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Nonlinear dynamics have become a new perspective on model human movement variability; however, it is still a debate whether chaotic behavior is indeed possible to present during a rhythmic movement. This paper reports on the nonlinear dynamical behavior of coupled and synchronization models of a planar rhythmic arm movement. Two coupling schemes between a planar arm and an extended Duffing-Van der Pol (DVP) oscillator are investigated. Chaos tools, namely phase space, Poincare section, Lyapunov Exponent (LE), and heuristic approach are applied to observe the dynamical behavior of orbit solutions. For the synchronization, an orientation angle is modeled as a single well DVP oscillator implementing a Proportional Derivative (PD)-scheme. The extended DVP oscillator is used as a drive system, while the orientation angle of the planar arm is a response system. The results show that the coupled system exhibits very rich dynamical behavior where a variety of solutions from periodic, quasi-periodic, to chaotic orbits exist. An advanced coupling scheme is necessary to yield the route to chaos. By modeling the orientation angle as the single well DVP oscillator, which can synchronize with other dynamical systems, the synchronization can be achieved through the PD-scheme approach.

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Several negative adaptations to the musculoskeletal system occur following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) such as arthrogenic muscle inhibition, decreased lower extremity muscle size, strength, power, as well as alterations to bone and cartilage. These changes have been associated with worse functional outcomes, altered biomechanics, and increased risk for re-injury and post-traumatic osteoarthritis. After ACL injury and subsequent ACLR, examination and evaluation of the musculoskeletal system is paramount to guiding clinical decision making during the rehabilitation and the return to sport process. The lack of access many clinicians have to devices necessary for gold standard assessment of muscle capacities and force profiles is often perceived as a significant barrier to best practices. Fortunately, testing for deficits can be accomplished with methods available to the clinician without access to costly equipment or time-intensive procedures. Interventions to address musculoskeletal system deficits can be implemented with a periodized program. This allows for restoration of physical capacities by adequately developing and emphasizing physical qualities beginning with mobility and movement, and progressing to work capacity and neuromuscular re-education, strength, explosive strength, and elastic or reactive strength. Additional considerations to aid in addressing strength deficits will be discussed such as neuromuscular electrical stimulation, volume and intensity, eccentric training, training to failure, cross-education, and biomechanical considerations. The American Physical Therapy Association adopted a new vision statement in 2013 which supported further development of the profession's identity by promoting the movement system, yet validation of the movement system has remained a challenge. Application of a multi-physiologic systems approach may offer a unique understanding of the musculoskeletal system and its integration with other body systems after ACLR. The purpose of this clinical commentary is to highlight important musculoskeletal system considerations within a multi-physiologic system approach to human movement following ACLR. LEVEL OF EVIDENCE: 5.

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BACKGROUND: The Functional Movement ScreenTM (FMSTM) is a tool designed to screen a series of movements that aids in the identification of compensatory fundamental movement patterns, functional limitations, and asymmetrical movement patterns. A previous systematic review and meta-analysis has shown that athletes with an FMSTM score <13-14 are considered "high-risk" and are more likely to be injured. There are discrepancies regarding the efficacy of physical intervention programs in improving FMSTM scores. PURPOSE: The aim of this systematic review was to assess the role of physical intervention programs in increasing functional movement in "high-risk" athletes as measured by the FMSTM. STUDY DESIGN: Systematic Review. METHODS: A computerized search was performed in 2019 according to PRISMA guidelines searching Embase, Science Direct, Ovid, and PubMed. The studies were assessed for quality and risk of bias using the Modified Downs and Black checklist. Participant demographics, intervention routines, and FMSTM scores were extracted from the included studies. RESULTS: Six studies met the inclusion criteria and demonstrated a fair methodological quality. Comparisons across all studies revealed significant improvement in FMSTM scores following implementation of a variety of physical intervention programs. These programs included those that utilized functional training, foot muscle strengthening, Pilates, core stability training, and resistance movements. Despite variations in the corrective exercises performed, the number of training sessions, and the length of the intervention program, all studies demonstrated an increase in the total FMSTM score following program implementation. CONCLUSION: The included intervention programs significantly improved total FMSTM scores in "high-risk" athletes. Despite variations in the corrective exercises (interventions) performed, the number of training sessions, and the length of the program, all studies demonstrated a significant increase in the total FMSTM score following program implementation.

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BACKGROUND: Low back pain is a condition present during both adulthood and adolescence. Adolescents with low back pain may benefit from treatment focused on improving abdominal muscle performance and motor control. The supine double leg lowering test (SDLLT) may be a reliable measure to assess core stability in adults, but adolescent performance on the SDLLT has not yet been established in the literature. PURPOSE: To examine performance on the SDLLT in healthy adolescents ages 13 to 18 years and describe influences of gender, age, body mass index, and participation in sport. STUDY DESIGN: Cross-Sectional Study. METHODS: Four licensed physical therapists administered the SDLLT with a Stabilizer pressure biofeedback cuff and inclinometer in 90 adolescents without low back pain (females = 41, males = 49) from three schools in a mid-western metropolitan area. Descriptive statistics, independent sample t-tests, two-way analysis of variance, and Pearson correlation coefficients were utilized to analyze the data. RESULTS: Average SDLLT score was 72.36 +/- 12.54 degrees. A significant difference between SDLLT score was present between genders with males performing better than females. No interactions between performance and involvement in sport were demonstrated. CONCLUSIONS: Female and male adolescents appear to perform differently on the SDLLT with a stabilizer and appear to perform worse than scores recorded for adults. The SDLLT may be used to measure motor control in adolescents, but clinicians should utilize age-appropriate data for clinical decision making. LEVELS OF EVIDENCE: Level 2c.

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BACKGROUND: Forward and side lunge exercises strengthen hip and thigh musculature, enhance patellofemoral joint stability, and are commonly used during patellofemoral rehabilitation and training for sport. HYPOTHESIS/PURPOSE: The purpose was to quantify, via calculated estimates, patellofemoral force and stress between two lunge type variations (forward lunge versus side lunge) and between two step height variations (ground level versus 10 cm platform). The hypotheses were that patellofemoral force and stress would be greater at all knee angles performing the bodyweight side lunge compared to the bodyweight forward lunge, and greater when performing the forward and side lunge at ground level compared to up a 10cm platform. STUDY DESIGN: Controlled laboratory biomechanics repeated measures, counterbalanced design. METHODS: Sixteen participants performed a forward and side lunge at ground level and up a 10cm platform. Electromyographic, ground reaction force, and kinematic variables were collected and input into a biomechanical optimization model, and patellofemoral joint force and stress were calculated as a function of knee angle during the lunge descent and ascent and assessed with a repeated measures 2-way ANOVA (p<0.05). RESULTS: At 10° (p=0.003) knee angle (0° = full knee extension) during lunge descent and 10° and 30° (p<0.001) knee angles during lunge ascent patellofemoral joint force and stress were greater in forward lunge than side lunge. At 40°(p=0.005), 50°(p=0.002), 60°(p<0.001), 70°(p=0.006), 80°(p=0.005), 90°(p=0.002), and 100°(p<0.001) knee angles during lunge descent and 50°(p=0.002), 60°(p<0.001), 70°(p<0.001), 80°(p<0.001), and 90°(p<0.001) knee angles during lunge ascent patellofemoral joint force and stress were greater in side lunge than forward lunge. At 60°(p=0.009) knee angle during lunge descent and 40°(p=0.008), 50°(p=0.009), and 60°(p=0.007) knee angles during lunge ascent patellofemoral joint force and stress were greater lunging at ground level than up a 10cm platform. CONCLUSIONS: Patellofemoral joint loading changed according to lunge type, step height, and knee angle. Patellofemoral compressive force and stress were greater while lunging at ground level compared to lunging up to a 10 cm platform between 40° - 60° knee angles, and greater while performing the side lunge compared to the forward lunge between 40° - 100° knee angles. LEVEL OF EVIDENCE: II.

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Diagnostic classification is a foundational underpinning of providing care of the highest quality and value. Diagnosis is pattern recognition that can result in categories of conditions that ideally direct treatment. While pathoanatomic diagnoses are common and traditional in orthopaedic practice, they often are limited with regard to directing best practice physical therapy intervention. Replacement of pathoanatomic labels with non-specific regional pain labels has been proposed, and occurs frequently in clinical practice. For example non-specific low back pain or shoulder pain of unknown origin. These labels avoid some disadvantages of tissue specific pathoanatomic labels, but are not specific enough to direct treatment. A previously introduced movement system diagnostic framework is proposed and updated with application to shoulder conditions. This framework has potential for broad development and application across musculoskeletal physical therapist practice. Movement system diagnostic classification can advance and streamline practice if considered while recognizing the inherent movement variability across individuals.

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The 4-Element Movement System Model describes primary elements (motion, force, motor control, and energy) essential to the performance of all movements. The model provides a framework or scaffolding which allows for consistent processes to be used in examination and intervention decisions. The process starts with task identification followed by a systematic observation of control, amount, speed, symmetry, and symptoms during movement. Testable hypotheses are generated from the observations which inform the examination and the interventions. This commentary describes the use of the 4-Element Movement System Model in entry level and post-graduate residency educational programs and in clinical care with three common sports-related diagnoses. LEVEL OF EVIDENCE: 5.

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The cardiopulmonary system plays a pivotal role in athletic and rehabilitative activities following anterior cruciate ligament reconstruction, along with serving as an important support for the functioning of other physiologic systems including the integumentary, musculoskeletal, and nervous systems. Many competitive sports impose high demands upon the cardiorespiratory system, which requires careful attention and planning from rehabilitation specialists to ensure athletes are adequately prepared to return to sport. Cardiopulmonary function following anterior cruciate ligament reconstruction (ACLR) can be assessed using a variety of methods, depending on stage of healing, training of the clinician, and equipment availability. Reductions in cardiovascular function may influence the selection and dosage of interventions that are not only aimed to address cardiopulmonary impairments, but also deficits experienced in other systems that ultimately work together to achieve goal-directed movement. The purpose of this clinical commentary is to present cardiopulmonary system considerations within a multi-physiologic systems approach to human movement after ACLR, including a clinically relevant review of the cardiopulmonary system, assessment strategies, and modes of cardiopulmonary training to promote effective, efficient movement. LEVEL OF EVIDENCE: 5.

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Postoperative management of anterior cruciate ligament (ACL) reconstruction has traditionally focused on the evaluation and intervention of musculoskeletal components such as range of motion and patients' reports of function. The integumentary system can provide early indications that rehabilitation may be prolonged due to protracted or poor healing of the incision sites. Full evaluation of the reconstruction over time, including direction of the incisions, appearance of surgical sites, level of residual innervation, and health of the individual should be considered when determining time-based goals and plans for returning an athlete to activity. Skin care techniques should be used to minimize strain and promote wound healing at the surgical sites, which in turn allows for implementation of other interventions that target other body systems such as locomotion, strength training, and cardiopulmonary conditioning. The integration of the integumentary system with cardiovascular, neurological, and muscular systems is required for a successful return to activity. A multi-physiologic systems approach may provide a unique viewpoint when aiming to attain a greater appreciation of the integumentary system and its integration with other body systems following ACL reconstruction. The purpose of this clinical commentary is to discuss integumentary considerations within a multi-physiologic systems approach to human movement after ACL reconstruction, including an anatomical review, key elements of assessment, and integrated intervention strategies. LEVEL OF EVIDENCE: 5.

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Despite the prevalence of forefoot related problems in athletes, there are few comprehensive summaries on examination and intervention strategies for those with forefoot related symptoms. While many factors may contribute to pathology and injury, the presence of abnormal foot alignment can negatively affect lower extremity biomechanics and be associated with injuries. Physical therapists may use the characteristics associated abnormal pronation or abnormal supination to describe the movement system disorder and serve as a guide for evaluating and managing athletes with forefoot pathologies. Athletes with an abnormal pronation movement system diagnosis typically demonstrate foot hypermobility, have decreased strength of the tibialis posterior muscle, and present with a medially rotated lower extremity position. Athletes with abnormal supination movement system diagnosis typically demonstrate foot hypomobility, decreased strength of the fibularis muscles, and a laterally rotated lower extremity position. Interventions of manual therapy, taping, strengthening exercises, and neuromuscular reeducation can be directed at the identified impairments and abnormal movements. The purpose of this clinical commentary is to integrate a movement system approach in pathoanatomical, evaluation, and intervention considerations for athletes with common forefoot pathologies, including stress fractures, metatarsalgia, neuroma, turf toe, and sesamoiditis. By applying a prioritized, objective problem list and movement system diagnosis, emphasis is shifted from a pathoanatomical diagnosis-based treatment plan to a more impairment and movement focused treatment. LEVEL OF EVIDENCE: 5.