Comparative Preseason Assessment of Isometric Strength, Range of Motion, and Balance in Track and Field Para Athletes

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Design : Cross-sectional study Settings : Assessments were performed during the preseason and included the lunge test, Y-Balance test, and isometric strength testing of hip and knee extensors. Participants : Twenty-one Para athletes from track and field modalities. Main outcome measures : The Shapiro-Wilk test assessed data normality. Paired t-test compared dominant and non-dominant limbs, and independent t-tests compared impairment types. Effect sizes were calculated using Cohen's d and U3. Results : Significant differences between impairment types were found for the lunge test (p<0,02) and Y-balance test (p<0,001), both with a small effect size. A significant difference was observed in non-dominant hip extensor isometric strength (p < 0.01), with a larger effect size. Conclusion : Differences in hip extensor strength and functional test performance across impairment groups suggest asymmetries that may have biomechanical relevance for musculoskeletal injury risk in Para athletes. Paralympic Sports Impairments Track Field Hip Knee Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION In Paralympic athletics, Para athletes with motor, visual, and intellectual impairments participate under a functional classification system. (L. S. P. Pinheiro et al., 2024). Despite variations across events, track and field disciplines such as running and jumping exhibit a high incidence of musculoskeletal injuries in the lower limbs, frequently caused by repetitive movements during training and competition (Blauwet et al., 2016). Among Para athletes, the knee and ankle are the most frequently injured sites (Blauwet et al., 2016). Chronic injuries are predominantly tendinopathies (Longo et al., 2009), while acute muscle injuries are also common. These injuries often impair performance, cause functional limitations (A. da Silva et al., 2013), and may lead to prolonged absence from sports or even premature retirement. Intrinsic risk factors for non-impaired athletes encompass previous injuries, older age, and male sex (Vlist et al., 2019), deficits in specific muscle groups, and biomechanical alterations (Sancho et al., 2019; Vlist et al., 2019). Athletes with Achilles tendinopathy (Hein et al., 2013), patellofemoral pain (Nakagawa et al., 2012), or ankle sprains (Denyer et al., 2013) frequently present with restricted ankle joint mobility, which may predispose them to these conditions. Additionally, balance impairments have been linked to patellofemoral tendinopathy (Silva et al., 2016) and patellofemoral pain (Nakagawa et al., 2020). Reduced strength in the knee and hip extensor muscles is another contributing factor associated with patellofemoral pain (Neal et al., 2019), patellar tendinopathy (Silva et al., 2016), and hamstring injuries. Para athletes with intellectual and visual impairments frequently exhibit physical comorbidities such as postural balance impairments and reduced muscle strength (Pinheiro et al., 2024). Those with motor impairments commonly exhibit restricted joint range of motion, muscle weakness, and altered biomechanical adaptations to training loads (Pinheiro et al., 2024; Sanchis et al., 2025). In addition, individuals with spastic cerebral palsy demonstrate musculoskeletal alterations, including changes in tendon collagen organization and extracellular matrix structure (Gagliano et al., 2013). These characteristics may contribute to transient tissue weakness, increasing susceptibility to cumulative load damage and the eventual development of clinically evident injuries (Gagliano et al., 2013). Sports teams routinely assess musculoskeletal parameters and use physical performance tests to guide injury rehabilitation and evaluate athletes’ injury risk profiles (Barbosa et al., 2024; Schwank et al., 2022 ). These assessments should align with the specific demands of each sport (Schwank et al., 2022 ). Performance-based tests are rapid, low-tech, and easily administered (Barbosa et al., 2024), typically measuring muscle strength, balance, and joint range of motion (ROM) (Sanchis et al., 2025). The results of these assessments inform the implementation of preventive strategies by health professionals (Sanchis et al., 2025). Notably, individuals with lower-limb motor impairments (e.g., hemiplegia, amputations) often present reduced ROM and strength in the affected limbs compared to non-impaired athletes (Ravichandran & Janakiraman, 2021), highlighting the impact of impairment type on musculoskeletal function. Given the high prevalence and incidence of sport-related musculoskeletal injuries in athletics, along with the musculoskeletal consequences associated with different impairment types, it becomes essential to investigate preseason flexibility, balance, and muscle strength in Para athletes. The present study aims to compare the dorsiflexion range of motion, dynamic balance, and isometric strength of hip and knee extensors between limbs (dominant vs. non-dominant) and across impairment categories. These insights can support health professionals working with Para athlete teams in designing targeted injury prevention programs and implementing precise strategies to mitigate injury risk. By understanding how impairment-specific factors (e.g., restricted mobility, strength deficits) interact with sport-specific demands, practitioners can identify modifiable risk factors and adapt interventions, tailor interventions to the unique needs of Para athletes, and ultimately enhance both injury prevention and athletic performance. METHODS This cross-sectional study was conducted over three years (2022 to December 2024). We recruited Para athletes from the track and field teams at the Sports Training Center of the Federal University of Minas Gerais (CTE/UFMG). The study adhered to the Declaration of Helsinki, and the project received approval from the Research Ethics Committee of the Universidade Federal de Minas Gerais (CAAE: 2718619.4.0000.5149). Participants The study employed a non-probabilistic, convenience-based sampling approach. Participants consisted of Para athletes from the track and field teams at the CTE/UFMG (athletes with visual impairment [T11 to T13/F11 to F13], intellectual impairment [T20/F20], upper-limb impairment [T45 to T47/F45 to F46], and cerebral palsy [T35 to T38/F35 to F38]). Recruitment was conducted during the preseason period of each year (January/February). Exclusion criteria included undergoing any surgical procedure within the six months before the initial assessment; presenting pain during activity or rest (scoring > 4/10 on the Visual Analog Scale [VAS]). If pain exceeding 4/10 was reported, the assessment was postponed by one week, and participants were excluded if pain persisted. Additionally, Para athletes classified functionally within the F31–F34/T31–T34 categories, those with a clinical diagnosis of spinal cord injury, severe paraplegia, or any impairment preventing upright posture during assessments, were excluded. Variables Descriptive variables Initially, descriptive data were collected, including age, gender, mass, height, type of impairment, and dominant limb. Individuals were categorized by type of impairment (1. Intellectual and visual impairment; 2. Motor impairment (lower/upper limb amputation, lower/upper limb malformation, short stature, diplegia, and hemiplegia). Dorsiflexion Range of Motion – Lunge test The Lunge test was utilized to evaluate ankle dorsiflexion ROM. A line was demarcated on the floor, and a vertical reference line was marked on the wall. The foot of the assessed limb was positioned on the floor line, perpendicular to the wall. Participants were instructed to advance the knee of the assessed limb forward until it contacted the wall line, while maintaining heel contact with the floor and avoiding trunk or pelvic rotations. An analog inclinometer was positioned 15 cm below the tibial tuberosity to measure the angle between the lower leg and the vertical axis (Xixirry et al., 2019). Dynamic Balance – Y-Balance Test Dynamic balance of the lower limbs was assessed using the Y-Balance Test (YBT), which evaluates dynamic stability limits and asymmetric balance in three directions (anterior, posteromedial, and posterolateral) (Shaffer et al., 2013). The testing grid was demarcated on the floor with white tape, forming three lines: one anterior and two posterior lines (posteromedial and posterolateral). The posterior lines were separated by a 90° angle and positioned at 135° relative to the anterior line. During the test, participants stood on one leg and used the contralateral lower limb to slide a reach indicator to the maximum achievable distance (Shaffer et al., 2013). Para-athletes completed three practice trials per limb for familiarization. Subsequently, three measurements were recorded in each direction (anterior, posteromedial, posterolateral) for both limbs. For data analysis, the mean reach distance for each direction was first calculated. A composite score was then derived by dividing the mean reach distance of each direction by the participant’s lower limb length and multiplying the result by 100. Muscle strength A handheld dynamometer (microFET®2, Hoggan Scientific, LLC, USA) was used for evaluating the isometric muscular strength of the shoulder's hip, and knee extensors. Non-elastic straps were employed to stabilize participants and the dynamometer, thereby minimizing evaluator-induced force interference (Scattone & Serrão, 2014). For hip extension torque assessment, participants were positioned in a prone position with the hip in neutral alignment across all planes, the knee of the assessed limb flexed to 90°, and the pelvis secured to the examination table via a strap. Participants were permitted to grasp the table with their upper limbs to stabilize the trunk, while the dynamometer was placed proximally to the popliteal fossa (Silva et al., 2016). Verbal instructions prompted participants to “push as if attempting to lift the foot toward the ceiling.” For knee extension torque measurement, participants were positioned supine with the knee flexed to 30°, an angle selected to simulate the flexion required during jumping tasks (Silva et al., 2016). The dynamometer was proximal to the midpoint between the lateral and medial malleoli, and participants were instructed to cross their arms over their chest and “push to extend the knee.” During testing, each protocol included one practice trial followed by three experimental trials (5-second duration each), separated by 15-second rest intervals. The values were recorded in Newtons. Lever arms were defined as follows: the hip lever arm corresponded to the distance between the greater trochanter and lateral femoral epicondyle; the knee lever arm spanned from the lateral femoral epicondyle to the lateral malleolus; and the ankle lever arm extended from the calcaneus to the first metatarsophalangeal joint (Silva et al., 2016). Limb symmetry was calculated as the ratio of dominant limb peak torque to non-dominant limb peak torque, multiplied by 100. Procedures Before data collection, a standardized training session was conducted between two experienced physiotherapists to ensure protocol consistency. Evaluator training comprised three theoretical and practical sessions focused on familiarization with assessment instruments and procedures. Before each evaluation session, participants completed a 5-minute warm-up involving bodyweight exercises such as squats, lungs, upper-limb movements, and stationary jogging. Para-athletes requiring modifications performed partial or assisted squats and lungs using a wall or chair for stability. Lower-limb movements were tailored to individual capabilities, emphasizing small, controlled motions or abbreviated ranges of motion to accommodate comfort and physical limitations. Clear verbal instructions, visual demonstrations, and tactile guidance were provided as needed. Rest periods were integrated to ensure participants could perform pain-free movements and at self-selected pacing. Assessments began with ankle dorsiflexion flexibility testing, followed by YBT and the muscle isometric strength evaluation. Para-athletes with visual impairments received tactile and verbal cues to facilitate task execution and directional orientation. Subsequent evaluations targeted isometric muscle strength. Throughout testing, standardized verbal encouragement (e.g., “Push as hard as possible!”) was administered to maximize effort. Statistical Analysis For statistical analysis, data normality was first assessed using the Shapiro-Wilk test. To evaluate differences between groups (type of impairment), parametric variables were analyzed with Student’s t-test, while non-parametric variables were examined via the Mann-Whitney U test. Differences between dominant and non-dominant limbs were assessed using the Wilcoxon test. Subsequently, Cohen’s d was calculated for variables exhibiting statistical differences to quantify effect size, followed by the U3 statistic to determine the percentage (%) difference between groups. A significant level of 5% (α = 0.05) was adopted for all analyses. RESULTS A total of 22 Para athletes were initially enrolled in the study. Four Para athletes were excluded due to lower-limb impairments (classified as F32, F33, T33, and T34), and one additional participant was excluded for having less than one year of sports practice. Consequently, 17 Para athletes were included in the final analysis. Demographic characteristics, including sample size, means, standard deviations, and percentages, are detailed in Table 1 . The participants were distributed across the following functional classifications: seven in T11, and one each in T12, T13, T37, T46, T47, F12, F20, F35, F37, and F38. Table 1 – Demographic data of parathletes with number (n) of distribution and percentages (%). Sex Age BMI Total F M Sport Mean (SD) Mean (SD) n (%) n n Track 32.7 (± 11.7) 20.6 (± 2.2) 12 (70.6) 5 7 Field 21.3 (± 6.6) 19.7 (± 1.5) 5 (29.4) 1 4 Legend: SD: Standard Deviation; n: number; %: percentage; F: female; M: Male; Int/Vis: Intellectual and Visual Impairment; LL: Lower limb impairment; UL: Upper limb impairment. Analysis of Table 2 revealed a Cohen’s d value of 0.13 for the Lunge-D variable, demonstrating a negligible difference between impairment groups (intellectual/visual impairment vs. motor impairment). Cohen’s U3 indicated that 55.2% of the intellectual/visual impairment group scored above the mean of the motor impairment group, with 94.8% overlap between the two distributions. For the YBT–D variable, a Cohen’s D of 0.41 suggested a small between-group difference. Cohen’s U3 showed that 65.9% of the intellectual/visual impairment group scored above the motor impairment group’s mean, with an overlap of 83.8% between distributions. For the non-dominant hip extension muscle torque variable, a Cohen’s D of 0.82 indicated a large effect size between impairment groups (intellectual/visual impairment vs. motor impairment). Cohen’s U3 revealed that 79.4% of the intellectual/visual impairment group scored above the mean of the motor impairment group. In contrast, hip extension strength asymmetry exhibited a Cohen’s D of 2.54, reflecting a very large clinical difference. Here, 98% of the intellectual/visual impairment group exceeded the motor impairment group’s mean (U3), suggesting minimal distributional overlap. Table 2 – Mean values of measured variables in the study, including ankle dorsiflexion ROM, dynamic balance, and hip/knee extensor isometric strength, stratified by impairment type, presented with corresponding means, standard deviations (SD), and p-values. Impairment Visual/Intellectual Motor Variable Mean (SD) Mean (SD) p-value p-value # Lunge – D 35.6 (4,6) 36 (11,8) 0.02 0.31 Lunge – ND 32.1 (9,9) 32.5 (13,8) 0.35 YBT – D 76.7 (4,7) 80.1 (12,9) < 0.01 0.91 YBT – ND 76.3 (5,2) 78.6 (12) 0.80 T. knee – D 5.2 (0,9) 5.4 (1,2) 0.8 T. knee – ND 6.1 (1,9) 4.1 (2,4) 0.2 Asymmetry – Knee 115.2 (19,3) 72.6 (25,7) 0.7 T. Hip. – D 4.0 (1,2) 4.3 (2,6) 0.06 T. Hip – ND 4.1 (0,9) 2.7 (2,4) < 0.01 Asymmetry – Hip 104.4 (15) 54.3 (24,6) < 0.01 Legend: YBT: Y-Balance Test; T: Torque; D: Dominant; ND: Non-dominant; SD: Standard Deviation. * DISCUSSION The premise of this study was that ankle dorsiflexion ROM, dynamic balance performance, and hip/knee extensor strength would differ across impairment types in Para athletes. To our knowledge, this is the first cross-sectional study to examine these variables in this population. We observed a statistically significant difference between impairment groups for dominant-side ankle dorsiflexion ROM, although with a negligible effect size, and for dominant-side YBT performance, which showed a small effect size. These findings indicate minimal functional differences between Para-athletes with intellectual/visual impairments and those with motor impairments during the pre-season period. On the other hand, non-dominant hip extensor strength demonstrated a large effect size difference between impairment types, suggesting a meaningful disparity in muscular performance. Regarding ankle dorsiflexion ROM, a statistically significant difference was observed on the dominant side between impairment types, although the effect size indicated no clinical relevance. In the literature, dorsiflexion values below 11° have been linked to Achilles tendinopathy (Vlist et al., 2019) and patellar tendinopathy (Silva et al., 2016). Conversely, other studies found no difference in dorsiflexion ROM between symptomatic and asymptomatic limbs (Scattone Silva et al., 2022). When compared to normative data, the Para athletes in our study exhibited ROMs values like the general population (36°–44°) rather than athletic populations (40°–50°), with no values indicative of functional limitation (< 30°) (Powden et al., 2015). Previous studies have shown reduced dorsiflexion ROM in individuals with cerebral palsy (Maas et al., 2015), stroke (Harlaar et al., 2000; Ravichandran & Janakiraman, 2021), and Parkinson’s disease (Smania et al., 2010). Notably, dorsiflexion values below 35° have been associated with increased Achilles tendon stress in able-bodied track and field athletes (Malliaras et al., 2013). Although no clinically relevant differences were observed between impairment types, the values found in our sample (some below 35°) may suggest a potentially elevated risk for Achilles and patellar tendinopathy, as well as patellofemoral pain. These findings underscore the importance of incorporating targeted flexibility and load management strategies into preseason injury prevention protocols for Para athletes. In the YBT, Para athletes with intellectual/visual impairments demonstrated lower dominant-side scores than those with motor impairments, although the effect size indicated only a small between-group difference, potentially influenced by the limited sample size. The YBT is a validated tool for identifying athletes at higher risk of lower-limb injury, with composite scores below 90% associated with a 3.5-fold increased risk of musculoskeletal injury (Mendonça et al., 2018). However, while composite YBT scores may not distinguish military personnel with patellar tendinopathy from healthy controls, differences have been observed in the anterior reach direction (Nakagawa et al., 2020). In our study, regardless of impairment type, YBT composite scores suggested a high injury risk compared to normative benchmarks, with additional inter-impairment differences observed in dominant-side performance. These findings highlight the need for multidisciplinary teams to integrate preventive strategies focused on improving lateral balance and reach capacity into preseason conditioning programs for Para athletes. A statistically and clinically significant difference in hip extensor torque and asymmetry was observed between intellectual/visual impairment and motor impairment groups, whereas no significant differences were found for knee extensors. To our knowledge, no previous studies have assessed hip extensor strength in Para athletes, limiting direct comparisons. Hip extensor weakness may increase reliance on knee extensors to dissipate ground reaction forces during sports, potentially contributing to musculoskeletal conditions such as tendinopathy (Silva et al., 2016) and patellofemoral pain (Prins & van der Wurff, 2009). While able-bodied athletes with patellar tendinopathy and patellofemoral pain often exhibit reduced hip extensor strength (Silva et al., 2016), our findings differ from reports of knee extensor deficits in athletes with hemiplegic cerebral palsy (Chiu et al., 2023). However, they align with results from Para swimmers showing strength differences in the non-dominant limbs (Sanchis et al., 2025). These results emphasize the need for sport-specific biomechanical interventions and targeted hip strengthening programs to mitigate injury risk in para-athletes with motor impairments. This study provides valuable insights into preseason physical performance variables among Para athletes. However, some limitations should be considered. The small sample size may restrict the generalizability of findings to the broader Paralympic population, and chronic factors such as delayed-onset muscle fatigue could act as potential confounders. Additionally, although sample heterogeneity reflects the inherent diversity of adaptive sports, it may also influence the observed outcomes. Preseason assessments are essential for optimizing performance, reducing injury risk, and guiding tailored prevention strategies (Schwank et al., 2022 ). However, generic prevention protocols that overlook impairment-specific variations, as highlighted in this study, may be insufficient. We recommend integrating systematic assessments of the studied variables into pre-season protocols, with a particular emphasis on monitoring hip strength for Para athletes with motor impairments. This approach would enable dynamic adjustments to prevention strategies, fostering comprehensive injury risk mitigation throughout the competitive season. CONCLUSION Our findings revealed negligible to small differences between impairment groups for ankle dorsiflexion range of motion and dynamic balance. In contrast, hip extensor strength—particularly on the non-dominant side—demonstrated a large effect size, and hip extensor asymmetry exhibited a very large effect size between groups. These results indicate that, while flexibility and balance appear comparable across impairment categories, hip extensor strength and symmetry are markedly influenced by impairment type. Such discrepancies may have meaningful biomechanical implications, potentially contributing to altered load distribution and increased musculoskeletal injury risk. These insights reinforce the importance of incorporating impairment-specific considerations into preseason screening and targeted strength interventions to optimize injury prevention strategies in Para athletes. Declarations Author Contribution All authors of this manuscript have made substantial contributions as follows: Geronimo José Bouzas Sanchis - (1) conception and design of the study, and analysis and interpretation of data, (2) drafting the article, (3) final approval of the version to be submitted; Renan Alves Resende - (2) critically revising it for important intellectual content, (3) final approval of the version to be submitted; Paula de Faria Fernandes Martins - (1) acquisition of data; Marco Túlio de Mello - (3) final approval of the version to be submitted; Juliana de Melo Ocarino - (3) final approval of the version to be submitted; Yasser Alanhar Mohmara - (2) critically revising it for important intellectual content, (3) final approval of the version to be submitted; Andressa Silva - (2) drafting the article, (3) final approval of the version to be submitted. Acknowledgement This study was supported by Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), Conselho Nacional de Desenvolvimento Científico e Tecnológico (N. 444769/2023-4) (CNPQ), Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES); Centro de Estudos em Psicobiologia e Exercício (CEPE), Centro Multidisciplinar em Sonolência e Acidentes (CEMSA), Pró-reitora de Pesquisa (PRPq) - UFMG, Fundação de Apoio ao Ensino, Pesquisa e Extensão (FEPE/ UFMG), Centro de Treinamento Esportivo (CTE/EEFFTO/UFMG), Ministério do Esporte do Governo Federal (Brasília, Brazil — Protocol Numbers: 58000.008978/2018—37 and number: 71000.056251/2020— 49), Comitê Paralímpico Brasileiro (CPB), Academia Paralímpica Brasileira (APB). References Batalha, N.M.P., Raimundo, A.M. de M., Tomas-Carus, P., Barbosa, T.M., Silva, A.J., 2013. Shoulder Rotator Cuff balance, strength, and endurance in young Swimmers during a competitive season. Journal of Strength and Conditioning Research 27. Derman, W., Runciman, P., Schwellnus, M., Jordaan, E., Blauwet, C., Webborn, N., Lexell, J., van de Vliet, P., Tuakli-Wosornu, Y., Kissick, J., Stomphorst, J., 2018. High precompetition injury rate dominates the injury profile at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days. Br J Sports Med 52, 24–31. https://doi.org/10.1136/bjsports-2017-098039 Dutton, M., Tam, N., Brown, J.C., Gray, J., 2019. The cricketer’s shoulder: Not a classic throwing shoulder. Physical Therapy in Sport 37, 120–127. https://doi.org/10.1016/j.ptsp.2019.03.014 Dwelly, P.M., Tripp, B.L., Tripp, P.A., Eberman, L.E., Gorin, S., 2009. Glenohumeral rotational range of motion in collegiate overhead-throwing athletes during an athletic season. J Athl Train 44, 611–616. https://doi.org/10.4085/1062-6050-44.6.611 Fieseler, G., Jungermann, P., Koke, A., Irlenbusch, L., Delank, K.S., Schwesig, R., 2015a. Range of motion and isometric strength of shoulder joints of team handball athletes during the playing season, part II: Changes after midseason. J Shoulder Elbow Surg 24, 391–398. https://doi.org/10.1016/j.jse.2014.07.019 Fieseler, G., Jungermann, P., Koke, A., Irlenbusch, L., Delank, K.S., Schwesig, R., 2015b. Glenohumeral range of motion (ROM) and isometric strength of professional team handball athletes, part III: changes over the playing season. Arch Orthop Trauma Surg 135, 1691–1700. https://doi.org/10.1007/s00402-015-2308-5 Finley, M.A., Ebaugh, D., 2017. Association of Pectoralis Minor Muscle Extensibility, Shoulder Mobility, and Duration of Manual Wheelchair Use, in Archives of Physical Medicine and Rehabilitation. W.B. Saunders, pp. 2028–2033. https://doi.org/10.1016/j.apmr.2017.03.029 Frye, S.K., Geigle, P.R., York, H.S., Sweatman, W.M., 2020. Functional passive range of motion of individuals with chronic cervical spinal cord injury. J Spinal Cord Med 43, 257–263. https://doi.org/10.1080/10790268.2019.1622239 Gillet, B., Begon, M., Sevrez, V., Berger-Vachon, C., Rogowski, I., 2017. Adaptive alterations in shoulder range of motion and strength in young tennis players. J Athl Train 52, 137–144. https://doi.org/10.4085/1062-6050.52.1.10 Haines, M.R., Fish, M., O’Sullivan, D., 2019. Seasonal changes in glenohumeral joint isokinetic strength in professional rugby league players. Physical Therapy in Sport 39, 32–37. https://doi.org/10.1016/j.ptsp.2019.06.005 Higson, E., Herrington, L., Butler, C., Horsley, I., 2018. The short-term effect of swimming training load on shoulder rotational range of motion, shoulder joint position sense, and pectoralis minor length. Shoulder Elbow 10, 285–291. https://doi.org/10.1177/1758573218773539 John Thomas, S., Swanik, K.A., Swanik, C., Huxel, K.C., n.d. Glenohumeral Rotation and Scapular Position Adaptations After a Single High School Female Sports Season. Lewis, J.S., Valentine, R.E., 2007. The pectoralis minor length test: a study of the intra-rater reliability and diagnostic accuracy in subjects with and without shoulder symptoms. BMC Musculoskelet Disord 8, 64. https://doi.org/10.1186/1471-2474-8-64 Mayrhuber, L., Rietveld, T., de Vries, W., van der Woude, L.H. V., de Groot, S., Vegter, R.J.K., 2022. A Scoping Review on Shoulder Injuries of Wheelchair Tennis Players: Potential Risk-Factors and Musculoskeletal Adaptations. Frontiers in Rehabilitation Sciences 3. https://doi.org/10.3389/fresc.2022.862233 McLaine, S.J., Ginn, K.A., Fell, J.W., Bird, M.L., 2018. Isometric shoulder strength in young swimmers. J Sci Med Sport 21, 35–39. https://doi.org/10.1016/j.jsams.2017.05.003 Morrien, F., Taylor, M.J.D., Hettinga, F.J., 2016. Biomechanics in Paralympics: Implications for Performance. Int J Sports Physiol Perform 0, 34. Nascimento, L.R., Teixeira-Salmela, L.F., Polese, J.C., Ada, L., Faria, C.D.C.M., Laurentino, G.E.C., 2014. Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke. Braz J Phys Ther 18, 268–275. https://doi.org/10.1590/bjpt-rbf.2014.0030 Navarro-Ledesma, S., Fernandez-Sanchez, M., Luque-Suarez, A., 2018. Does the pectoralis minor length influence acromiohumeral distance, shoulder pain function, and range of movement? Physical Therapy in Sport 34, 43–48. https://doi.org/10.1016/j.ptsp.2018.08.009 Ona Ayala, K.E., Li, X., Huang, P., Derman, W.E., Kissick, J., Webborn, N., Blauwet, C., Stomphorst, J., Tuakli-Wosornu, Y.A., 2019. Injury epidemiology and preparedness in powerlifting at the Rio 2016 Paralympic Games: An analysis of 1410 athlete‐days. Transl Sports Med 2, 358–369. https://doi.org/10.1002/tsm2.107 Ranstam, J., 2012. Why the P-value culture is bad and confidence intervals a better alternative. Osteoarthritis Cartilage. https://doi.org/10.1016/j.joca.2012.04.001 Resnik, L., Borgia, M., Cancio, J., Heckman, J., Highsmith, M.J., Levy, C., Phillips, S., Webster, J., 2022. Understanding Implications of Residual Limb Length, Strength, and Range-of-Motion Impairments of Veterans with Upper Limb Amputation. Am J Phys Med Rehabil 101, 545–554. https://doi.org/10.1097/PHM.0000000000001862 Rosa, D.P., Santos, R. V., Gava, V., Borstad, J.D., Camargo, P.R., 2019. Shoulder external rotation range of motion and pectoralis minor length in individuals with and without shoulder pain. Physiother Theory Pract 35, 986–994. https://doi.org/10.1080/09593985.2018.1459985 Schwank, A., Blazey, P., Asker, M., Møller, M., Hägglund, M., Gard, S., Skazalski, Christopher, Andersson, S.H., Horsley, I., Whiteley, R., Cools, A.M., Bizzini, M., Ardern, C.L., Albrecht, C., Andersson, S., Ashworth, B., Asker, M., Bizzini, M., Clarsen, B., Cools, A., Ellenbecker, T., Fanning, E., Fredriksen, H., Gard, S., Gibson, J., Hägglund, M., Horsley, I., Jaggi, A., Johansson, F., Johansson, K., Kuppens, K., Lewis, J., McCreesh, K., Michener, L., Mirkovic, M., Møller, M., Mosler, A., Mutch, S., Olds, M., Pizzari, T., Pluim, B., Reinold, M., Seitz, A., Singh, V., Skazalski, Chris, Struyf, F., Warby, S., Whiteley, R., Wilk, K., Wright, A., Ardern, C., Asker, M., Bizzini, M., Blazey, P., Cools, A., Gard, S., Hägglund, M., Horsley, I., Møller, M., Schwank, A., 2022. 2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. Journal of Orthopaedic and Sports Physical Therapy 52, 11–28. https://doi.org/10.2519/JOSPT.2022.10952 Shimura, K., Koizumi, K., Yoshizawa, T., Aoki, T., 2021. Physique, range of motion, and gross muscle strength in hemiplegic para swimmers: a cross-sectional case series. Sil, A., Betkerur, J., Das, N., 2019. P-Value demystified. Indian Dermatol Online J 10, 745. https://doi.org/10.4103/idoj.IDOJ_368_19 Struyf, F., Tate, A., Kuppens, K., Feijen, S., Michener, L.A., 2017. Musculoskeletal dysfunctions are associated with swimmers’ shoulders. Br J Sports Med. https://doi.org/10.1136/bjsports-2016-096847 Tate, A., Sarver, J., DiPaola, L., Yim, J., Paul, R., Thomas, S.J., 2020. Changes in clinical measures and tissue adaptations in collegiate swimmers across a competitive season. J Shoulder Elbow Surg 29, 2375–2384. https://doi.org/10.1016/j.jse.2020.03.028 Thomas, S.J., Swanik, K.A., Swanik, C., Huxel, K.C., 2009. Glenohumeral rotation and scapular position adaptations after a single high school female sports season. J Athl Train 44, 230–237. https://doi.org/10.4085/1062-6050-44.3.230 Watanabe, S., 2000. Research Report Alterations in Shoulder Kinematics and Associated Muscle Activity in People with Shoulder Impingment 276–291. Willick, S.E., Cushman, D.M., Blauwet, C.A., Emery, C., Webborn, N., Derman, W., Schwellnus, M., Stomphorst, J., Van de Vliet, P., 2016. The epidemiology of injuries in powerlifting at the London 2012 Paralympic Games: An analysis of 1411 athlete-days. Scand J Med Sci Sports 26, 1233–1238. https://doi.org/10.1111/sms.12554 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7374381","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542183819,"identity":"ed094aa4-5ee0-4394-96fa-d69edbf8b5cd","order_by":0,"name":"Geronimo José Bouzas 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16:39:27","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":113174,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7374381/v1/8b2e11de331b75138c152427.html"},{"id":95663969,"identity":"03b64a1e-7874-4f6e-a014-7a06b65a9c18","added_by":"auto","created_at":"2025-11-11 16:39:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":203822,"visible":true,"origin":"","legend":"\u003cp\u003eDorsiflexion Range of Motion – Lunge test\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7374381/v1/21e0e74804d1c799cb4da4af.png"},{"id":95663924,"identity":"026f777f-563a-4c3c-b933-0a6f2131bb61","added_by":"auto","created_at":"2025-11-11 16:39:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":328866,"visible":true,"origin":"","legend":"\u003cp\u003eDynamic Balance – Y-Balance Test\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7374381/v1/a0c6dbfe7e4d91bc3f2d6065.png"},{"id":95663999,"identity":"f184645b-1f0d-4145-bcf2-db52443dc602","added_by":"auto","created_at":"2025-11-11 16:39:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":242342,"visible":true,"origin":"","legend":"\u003cp\u003eIsometric Muscle strength of Hip extensors\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7374381/v1/c7351817f535da1a19874368.png"},{"id":95664000,"identity":"e71d91f7-5dde-4bcd-8299-4a307842af10","added_by":"auto","created_at":"2025-11-11 16:39:30","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":416610,"visible":true,"origin":"","legend":"\u003cp\u003eIsometric Muscle strength of Knee extensors\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7374381/v1/b3884d1ae34cbb0df26df0d0.jpeg"},{"id":102821587,"identity":"1d21fa70-2367-4ee2-87e1-f94c5b703270","added_by":"auto","created_at":"2026-02-17 07:41:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1934681,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7374381/v1/3c1a7d8a-6683-4b0f-8f7d-800247b7ce96.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eComparative Preseason Assessment of Isometric Strength, Range of Motion, and Balance in Track and Field Para Athletes\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eIn Paralympic athletics, Para athletes with motor, visual, and intellectual impairments participate under a functional classification system. (L. S. P. Pinheiro et al., 2024). Despite variations across events, track and field disciplines such as running and jumping exhibit a high incidence of musculoskeletal injuries in the lower limbs, frequently caused by repetitive movements during training and competition (Blauwet et al., 2016). Among Para athletes, the knee and ankle are the most frequently injured sites (Blauwet et al., 2016). Chronic injuries are predominantly tendinopathies (Longo et al., 2009), while acute muscle injuries are also common. These injuries often impair performance, cause functional limitations (A. da Silva et al., 2013), and may lead to prolonged absence from sports or even premature retirement.\u003c/p\u003e\u003cp\u003eIntrinsic risk factors for non-impaired athletes encompass previous injuries, older age, and male sex (Vlist et al., 2019), deficits in specific muscle groups, and biomechanical alterations (Sancho et al., 2019; Vlist et al., 2019). Athletes with Achilles tendinopathy (Hein et al., 2013), patellofemoral pain (Nakagawa et al., 2012), or ankle sprains (Denyer et al., 2013) frequently present with restricted ankle joint mobility, which may predispose them to these conditions. Additionally, balance impairments have been linked to patellofemoral tendinopathy (Silva et al., 2016) and patellofemoral pain (Nakagawa et al., 2020). Reduced strength in the knee and hip extensor muscles is another contributing factor associated with patellofemoral pain (Neal et al., 2019), patellar tendinopathy (Silva et al., 2016), and hamstring injuries.\u003c/p\u003e\u003cp\u003ePara athletes with intellectual and visual impairments frequently exhibit physical comorbidities such as postural balance impairments and reduced muscle strength (Pinheiro et al., 2024). Those with motor impairments commonly exhibit restricted joint range of motion, muscle weakness, and altered biomechanical adaptations to training loads (Pinheiro et al., 2024; Sanchis et al., 2025). In addition, individuals with spastic cerebral palsy demonstrate musculoskeletal alterations, including changes in tendon collagen organization and extracellular matrix structure (Gagliano et al., 2013). These characteristics may contribute to transient tissue weakness, increasing susceptibility to cumulative load damage and the eventual development of clinically evident injuries (Gagliano et al., 2013).\u003c/p\u003e\u003cp\u003eSports teams routinely assess musculoskeletal parameters and use physical performance tests to guide injury rehabilitation and evaluate athletes\u0026rsquo; injury risk profiles (Barbosa et al., 2024; Schwank et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These assessments should align with the specific demands of each sport (Schwank et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Performance-based tests are rapid, low-tech, and easily administered (Barbosa et al., 2024), typically measuring muscle strength, balance, and joint range of motion (ROM) (Sanchis et al., 2025). The results of these assessments inform the implementation of preventive strategies by health professionals (Sanchis et al., 2025). Notably, individuals with lower-limb motor impairments (e.g., hemiplegia, amputations) often present reduced ROM and strength in the affected limbs compared to non-impaired athletes (Ravichandran \u0026amp; Janakiraman, 2021), highlighting the impact of impairment type on musculoskeletal function.\u003c/p\u003e\u003cp\u003eGiven the high prevalence and incidence of sport-related musculoskeletal injuries in athletics, along with the musculoskeletal consequences associated with different impairment types, it becomes essential to investigate preseason flexibility, balance, and muscle strength in Para athletes. The present study aims to compare the dorsiflexion range of motion, dynamic balance, and isometric strength of hip and knee extensors between limbs (dominant vs. non-dominant) and across impairment categories. These insights can support health professionals working with Para athlete teams in designing targeted injury prevention programs and implementing precise strategies to mitigate injury risk. By understanding how impairment-specific factors (e.g., restricted mobility, strength deficits) interact with sport-specific demands, practitioners can identify modifiable risk factors and adapt interventions, tailor interventions to the unique needs of Para athletes, and ultimately enhance both injury prevention and athletic performance.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis cross-sectional study was conducted over three years (2022 to December 2024). We recruited Para athletes from the track and field teams at the Sports Training Center of the Federal University of Minas Gerais (CTE/UFMG). The study adhered to the Declaration of Helsinki, and the project received approval from the Research Ethics Committee of the Universidade Federal de Minas Gerais (CAAE: 2718619.4.0000.5149).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThe study employed a non-probabilistic, convenience-based sampling approach. Participants consisted of Para athletes from the track and field teams at the CTE/UFMG (athletes with visual impairment [T11 to T13/F11 to F13], intellectual impairment [T20/F20], upper-limb impairment [T45 to T47/F45 to F46], and cerebral palsy [T35 to T38/F35 to F38]). Recruitment was conducted during the preseason period of each year (January/February). Exclusion criteria included undergoing any surgical procedure within the six months before the initial assessment; presenting pain during activity or rest (scoring\u0026thinsp;\u0026gt;\u0026thinsp;4/10 on the Visual Analog Scale [VAS]). If pain exceeding 4/10 was reported, the assessment was postponed by one week, and participants were excluded if pain persisted. Additionally, Para athletes classified functionally within the F31\u0026ndash;F34/T31\u0026ndash;T34 categories, those with a clinical diagnosis of spinal cord injury, severe paraplegia, or any impairment preventing upright posture during assessments, were excluded.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eDescriptive variables\u003c/p\u003e\u003cp\u003eInitially, descriptive data were collected, including age, gender, mass, height, type of impairment, and dominant limb.\u003c/p\u003e\u003cp\u003eIndividuals were categorized by type of impairment (1. Intellectual and visual impairment; 2. Motor impairment (lower/upper limb amputation, lower/upper limb malformation, short stature, diplegia, and hemiplegia).\u003c/p\u003e\u003cp\u003eDorsiflexion Range of Motion \u0026ndash; Lunge test\u003c/p\u003e\u003cp\u003eThe Lunge test was utilized to evaluate ankle dorsiflexion ROM. A line was demarcated on the floor, and a vertical reference line was marked on the wall. The foot of the assessed limb was positioned on the floor line, perpendicular to the wall. Participants were instructed to advance the knee of the assessed limb forward until it contacted the wall line, while maintaining heel contact with the floor and avoiding trunk or pelvic rotations. An analog inclinometer was positioned 15 cm below the tibial tuberosity to measure the angle between the lower leg and the vertical axis (Xixirry et al., 2019).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eDynamic Balance \u0026ndash; Y-Balance Test\u003c/p\u003e\u003cp\u003eDynamic balance of the lower limbs was assessed using the Y-Balance Test (YBT), which evaluates dynamic stability limits and asymmetric balance in three directions (anterior, posteromedial, and posterolateral) (Shaffer et al., 2013). The testing grid was demarcated on the floor with white tape, forming three lines: one anterior and two posterior lines (posteromedial and posterolateral). The posterior lines were separated by a 90\u0026deg; angle and positioned at 135\u0026deg; relative to the anterior line. During the test, participants stood on one leg and used the contralateral lower limb to slide a reach indicator to the maximum achievable distance (Shaffer et al., 2013). Para-athletes completed three practice trials per limb for familiarization. Subsequently, three measurements were recorded in each direction (anterior, posteromedial, posterolateral) for both limbs.\u003c/p\u003e\u003cp\u003eFor data analysis, the mean reach distance for each direction was first calculated. A composite score was then derived by dividing the mean reach distance of each direction by the participant\u0026rsquo;s lower limb length and multiplying the result by 100.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eMuscle strength\u003c/h3\u003e\n\u003cp\u003eA handheld dynamometer (microFET\u0026reg;2, Hoggan Scientific, LLC, USA) was used for evaluating the isometric muscular strength of the shoulder's hip, and knee extensors. Non-elastic straps were employed to stabilize participants and the dynamometer, thereby minimizing evaluator-induced force interference (Scattone \u0026amp; Serr\u0026atilde;o, 2014).\u003c/p\u003e\u003cp\u003eFor hip extension torque assessment, participants were positioned in a prone position with the hip in neutral alignment across all planes, the knee of the assessed limb flexed to 90\u0026deg;, and the pelvis secured to the examination table via a strap. Participants were permitted to grasp the table with their upper limbs to stabilize the trunk, while the dynamometer was placed proximally to the popliteal fossa (Silva et al., 2016). Verbal instructions prompted participants to \u0026ldquo;push as if attempting to lift the foot toward the ceiling.\u0026rdquo; For knee extension torque measurement, participants were positioned supine with the knee flexed to 30\u0026deg;, an angle selected to simulate the flexion required during jumping tasks (Silva et al., 2016). The dynamometer was proximal to the midpoint between the lateral and medial malleoli, and participants were instructed to cross their arms over their chest and \u0026ldquo;push to extend the knee.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eDuring testing, each protocol included one practice trial followed by three experimental trials (5-second duration each), separated by 15-second rest intervals. The values were recorded in Newtons. Lever arms were defined as follows: the hip lever arm corresponded to the distance between the greater trochanter and lateral femoral epicondyle; the knee lever arm spanned from the lateral femoral epicondyle to the lateral malleolus; and the ankle lever arm extended from the calcaneus to the first metatarsophalangeal joint (Silva et al., 2016). Limb symmetry was calculated as the ratio of dominant limb peak torque to non-dominant limb peak torque, multiplied by 100.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eProcedures\u003c/h3\u003e\n\u003cp\u003eBefore data collection, a standardized training session was conducted between two experienced physiotherapists to ensure protocol consistency. Evaluator training comprised three theoretical and practical sessions focused on familiarization with assessment instruments and procedures.\u003c/p\u003e\u003cp\u003e Before each evaluation session, participants completed a 5-minute warm-up involving bodyweight exercises such as squats, lungs, upper-limb movements, and stationary jogging. Para-athletes requiring modifications performed partial or assisted squats and lungs using a wall or chair for stability. Lower-limb movements were tailored to individual capabilities, emphasizing small, controlled motions or abbreviated ranges of motion to accommodate comfort and physical limitations. Clear verbal instructions, visual demonstrations, and tactile guidance were provided as needed. Rest periods were integrated to ensure participants could perform pain-free movements and at self-selected pacing.\u003c/p\u003e\u003cp\u003eAssessments began with ankle dorsiflexion flexibility testing, followed by YBT and the muscle isometric strength evaluation. Para-athletes with visual impairments received tactile and verbal cues to facilitate task execution and directional orientation. Subsequent evaluations targeted isometric muscle strength. Throughout testing, standardized verbal encouragement (e.g., \u0026ldquo;Push as hard as possible!\u0026rdquo;) was administered to maximize effort.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eFor statistical analysis, data normality was first assessed using the Shapiro-Wilk test. To evaluate differences between groups (type of impairment), parametric variables were analyzed with Student\u0026rsquo;s t-test, while non-parametric variables were examined via the Mann-Whitney U test. Differences between dominant and non-dominant limbs were assessed using the Wilcoxon test. Subsequently, Cohen\u0026rsquo;s d was calculated for variables exhibiting statistical differences to quantify effect size, followed by the U3 statistic to determine the percentage (%) difference between groups. A significant level of 5% (α\u0026thinsp;=\u0026thinsp;0.05) was adopted for all analyses.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 22 Para athletes were initially enrolled in the study. Four Para athletes were excluded due to lower-limb impairments (classified as F32, F33, T33, and T34), and one additional participant was excluded for having less than one year of sports practice. Consequently, 17 Para athletes were included in the final analysis. Demographic characteristics, including sample size, means, standard deviations, and percentages, are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The participants were distributed across the following functional classifications: seven in T11, and one each in T12, T13, T37, T46, T47, F12, F20, F35, F37, and F38.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Demographic data of parathletes with number (n) of distribution and percentages (%).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSport\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.7 (\u0026plusmn;\u0026thinsp;11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.6 (\u0026plusmn;\u0026thinsp;2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (70.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eField\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.3 (\u0026plusmn;\u0026thinsp;6.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.7 (\u0026plusmn;\u0026thinsp;1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLegend: SD: Standard Deviation; n: number; %: percentage; F: female; M: Male; Int/Vis: Intellectual and Visual Impairment; LL: Lower limb impairment; UL: Upper limb impairment.\u003c/p\u003e\u003cp\u003eAnalysis of Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e revealed a Cohen\u0026rsquo;s d value of 0.13 for the \u003cem\u003eLunge-D\u003c/em\u003e variable, demonstrating a negligible difference between impairment groups (intellectual/visual impairment vs. motor impairment). Cohen\u0026rsquo;s U3 indicated that 55.2% of the intellectual/visual impairment group scored above the mean of the motor impairment group, with 94.8% overlap between the two distributions. For the YBT\u0026ndash;D variable, a Cohen\u0026rsquo;s D of 0.41 suggested a small between-group difference. Cohen\u0026rsquo;s U3 showed that 65.9% of the intellectual/visual impairment group scored above the motor impairment group\u0026rsquo;s mean, with an overlap of 83.8% between distributions.\u003c/p\u003e\u003cp\u003eFor the non-dominant hip extension muscle torque variable, a Cohen\u0026rsquo;s D of 0.82 indicated a large effect size between impairment groups (intellectual/visual impairment vs. motor impairment). Cohen\u0026rsquo;s U3 revealed that 79.4% of the intellectual/visual impairment group scored above the mean of the motor impairment group. In contrast, hip extension strength asymmetry exhibited a Cohen\u0026rsquo;s D of 2.54, reflecting a very large clinical difference. Here, 98% of the intellectual/visual impairment group exceeded the motor impairment group\u0026rsquo;s mean (U3), suggesting minimal distributional overlap.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Mean values of measured variables in the study, including ankle dorsiflexion ROM, dynamic balance, and hip/knee extensor isometric strength, stratified by impairment type, presented with corresponding means, standard deviations (SD), and p-values.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eImpairment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eVisual/Intellectual\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMotor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLunge \u0026ndash; D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e35.6 (4,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (11,8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLunge \u0026ndash; ND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e32.1 (9,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.5 (13,8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYBT \u0026ndash; D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e76.7 (4,7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80.1 (12,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYBT \u0026ndash; ND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e76.3 (5,2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78.6 (12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT. knee \u0026ndash; D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e5.2 (0,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.4 (1,2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT. knee \u0026ndash; ND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e6.1 (1,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1 (2,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsymmetry \u0026ndash; Knee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e115.2 (19,3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72.6 (25,7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT. Hip. \u0026ndash; D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e4.0 (1,2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.3 (2,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT. Hip \u0026ndash; ND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e4.1 (0,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7 (2,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsymmetry \u0026ndash; Hip\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e104.4 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54.3 (24,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eLegend: YBT: Y-Balance Test; T: Torque; D: Dominant; ND: Non-dominant; SD: Standard Deviation. *\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe premise of this study was that ankle dorsiflexion ROM, dynamic balance performance, and hip/knee extensor strength would differ across impairment types in Para athletes. To our knowledge, this is the first cross-sectional study to examine these variables in this population. We observed a statistically significant difference between impairment groups for dominant-side ankle dorsiflexion ROM, although with a negligible effect size, and for dominant-side YBT performance, which showed a small effect size. These findings indicate minimal functional differences between Para-athletes with intellectual/visual impairments and those with motor impairments during the pre-season period. On the other hand, non-dominant hip extensor strength demonstrated a large effect size difference between impairment types, suggesting a meaningful disparity in muscular performance.\u003c/p\u003e\u003cp\u003eRegarding ankle dorsiflexion ROM, a statistically significant difference was observed on the dominant side between impairment types, although the effect size indicated no clinical relevance. In the literature, dorsiflexion values below 11\u0026deg; have been linked to Achilles tendinopathy (Vlist et al., 2019) and patellar tendinopathy (Silva et al., 2016). Conversely, other studies found no difference in dorsiflexion ROM between symptomatic and asymptomatic limbs (Scattone Silva et al., 2022). When compared to normative data, the Para athletes in our study exhibited ROMs values like the general population (36\u0026deg;\u0026ndash;44\u0026deg;) rather than athletic populations (40\u0026deg;\u0026ndash;50\u0026deg;), with no values indicative of functional limitation (\u0026lt;\u0026thinsp;30\u0026deg;) (Powden et al., 2015). Previous studies have shown reduced dorsiflexion ROM in individuals with cerebral palsy (Maas et al., 2015), stroke (Harlaar et al., 2000; Ravichandran \u0026amp; Janakiraman, 2021), and Parkinson\u0026rsquo;s disease (Smania et al., 2010). Notably, dorsiflexion values below 35\u0026deg; have been associated with increased Achilles tendon stress in able-bodied track and field athletes (Malliaras et al., 2013). Although no clinically relevant differences were observed between impairment types, the values found in our sample (some below 35\u0026deg;) may suggest a potentially elevated risk for Achilles and patellar tendinopathy, as well as patellofemoral pain. These findings underscore the importance of incorporating targeted flexibility and load management strategies into preseason injury prevention protocols for Para athletes.\u003c/p\u003e\u003cp\u003eIn the YBT, Para athletes with intellectual/visual impairments demonstrated lower dominant-side scores than those with motor impairments, although the effect size indicated only a small between-group difference, potentially influenced by the limited sample size. The YBT is a validated tool for identifying athletes at higher risk of lower-limb injury, with composite scores below 90% associated with a 3.5-fold increased risk of musculoskeletal injury (Mendon\u0026ccedil;a et al., 2018). However, while composite YBT scores may not distinguish military personnel with patellar tendinopathy from healthy controls, differences have been observed in the anterior reach direction (Nakagawa et al., 2020). In our study, regardless of impairment type, YBT composite scores suggested a high injury risk compared to normative benchmarks, with additional inter-impairment differences observed in dominant-side performance. These findings highlight the need for multidisciplinary teams to integrate preventive strategies focused on improving lateral balance and reach capacity into preseason conditioning programs for Para athletes.\u003c/p\u003e\u003cp\u003eA statistically and clinically significant difference in hip extensor torque and asymmetry was observed between intellectual/visual impairment and motor impairment groups, whereas no significant differences were found for knee extensors. To our knowledge, no previous studies have assessed hip extensor strength in Para athletes, limiting direct comparisons. Hip extensor weakness may increase reliance on knee extensors to dissipate ground reaction forces during sports, potentially contributing to musculoskeletal conditions such as tendinopathy (Silva et al., 2016) and patellofemoral pain (Prins \u0026amp; van der Wurff, 2009). While able-bodied athletes with patellar tendinopathy and patellofemoral pain often exhibit reduced hip extensor strength (Silva et al., 2016), our findings differ from reports of knee extensor deficits in athletes with hemiplegic cerebral palsy (Chiu et al., 2023). However, they align with results from Para swimmers showing strength differences in the non-dominant limbs (Sanchis et al., 2025). These results emphasize the need for sport-specific biomechanical interventions and targeted hip strengthening programs to mitigate injury risk in para-athletes with motor impairments.\u003c/p\u003e\u003cp\u003eThis study provides valuable insights into preseason physical performance variables among Para athletes. However, some limitations should be considered. The small sample size may restrict the generalizability of findings to the broader Paralympic population, and chronic factors such as delayed-onset muscle fatigue could act as potential confounders. Additionally, although sample heterogeneity reflects the inherent diversity of adaptive sports, it may also influence the observed outcomes.\u003c/p\u003e\u003cp\u003ePreseason assessments are essential for optimizing performance, reducing injury risk, and guiding tailored prevention strategies (Schwank et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, generic prevention protocols that overlook impairment-specific variations, as highlighted in this study, may be insufficient. We recommend integrating systematic assessments of the studied variables into pre-season protocols, with a particular emphasis on monitoring hip strength for Para athletes with motor impairments. This approach would enable dynamic adjustments to prevention strategies, fostering comprehensive injury risk mitigation throughout the competitive season.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur findings revealed negligible to small differences between impairment groups for ankle dorsiflexion range of motion and dynamic balance. In contrast, hip extensor strength\u0026mdash;particularly on the non-dominant side\u0026mdash;demonstrated a large effect size, and hip extensor asymmetry exhibited a very large effect size between groups. These results indicate that, while flexibility and balance appear comparable across impairment categories, hip extensor strength and symmetry are markedly influenced by impairment type. Such discrepancies may have meaningful biomechanical implications, potentially contributing to altered load distribution and increased musculoskeletal injury risk. These insights reinforce the importance of incorporating impairment-specific considerations into preseason screening and targeted strength interventions to optimize injury prevention strategies in Para athletes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors of this manuscript have made substantial contributions as follows: Geronimo Jos\u0026eacute; Bouzas Sanchis - (1) conception and design of the study, and analysis and interpretation of data, (2) drafting the article, (3) final approval of the version to be submitted; Renan Alves Resende - (2) critically revising it for important intellectual content, (3) final approval of the version to be submitted; Paula de Faria Fernandes Martins - (1) acquisition of data; Marco T\u0026uacute;lio de Mello - (3) final approval of the version to be submitted; Juliana de Melo Ocarino - (3) final approval of the version to be submitted; Yasser Alanhar Mohmara - (2) critically revising it for important intellectual content, (3) final approval of the version to be submitted; Andressa Silva - (2) drafting the article, (3) final approval of the version to be submitted.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis study was supported by Funda\u0026ccedil;\u0026atilde;o de Amparo \u0026agrave; Pesquisa do Estado de Minas Gerais (FAPEMIG), Conselho Nacional de Desenvolvimento Cient\u0026iacute;fico e Tecnol\u0026oacute;gico (N. 444769/2023-4) (CNPQ), Funda\u0026ccedil;\u0026atilde;o Coordena\u0026ccedil;\u0026atilde;o de Aperfei\u0026ccedil;oamento de Pessoal de N\u0026iacute;vel Superior (CAPES); Centro de Estudos em Psicobiologia e Exerc\u0026iacute;cio (CEPE), Centro Multidisciplinar em Sonol\u0026ecirc;ncia e Acidentes (CEMSA), Pr\u0026oacute;-reitora de Pesquisa (PRPq) - UFMG, Funda\u0026ccedil;\u0026atilde;o de Apoio ao Ensino, Pesquisa e Extens\u0026atilde;o (FEPE/ UFMG), Centro de Treinamento Esportivo (CTE/EEFFTO/UFMG), Minist\u0026eacute;rio do Esporte do Governo Federal (Bras\u0026iacute;lia, Brazil \u0026mdash; Protocol Numbers: 58000.008978/2018\u0026mdash;37 and number: 71000.056251/2020\u0026mdash; 49), Comit\u0026ecirc; Paral\u0026iacute;mpico Brasileiro (CPB), Academia Paral\u0026iacute;mpica Brasileira (APB).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBatalha, N.M.P., Raimundo, A.M. de M., Tomas-Carus, P., Barbosa, T.M., Silva, A.J., 2013. Shoulder Rotator Cuff balance, strength, and endurance in young Swimmers during a competitive season. Journal of Strength and Conditioning Research 27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDerman, W., Runciman, P., Schwellnus, M., Jordaan, E., Blauwet, C., Webborn, N., Lexell, J., van de Vliet, P., Tuakli-Wosornu, Y., Kissick, J., Stomphorst, J., 2018. High precompetition injury rate dominates the injury profile at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days. Br J Sports Med 52, 24\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bjsports-2017-098039\u003c/span\u003e\u003cspan address=\"10.1136/bjsports-2017-098039\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDutton, M., Tam, N., Brown, J.C., Gray, J., 2019. The cricketer\u0026rsquo;s shoulder: Not a classic throwing shoulder. Physical Therapy in Sport 37, 120\u0026ndash;127. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ptsp.2019.03.014\u003c/span\u003e\u003cspan address=\"10.1016/j.ptsp.2019.03.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDwelly, P.M., Tripp, B.L., Tripp, P.A., Eberman, L.E., Gorin, S., 2009. Glenohumeral rotational range of motion in collegiate overhead-throwing athletes during an athletic season. J Athl Train 44, 611\u0026ndash;616. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4085/1062-6050-44.6.611\u003c/span\u003e\u003cspan address=\"10.4085/1062-6050-44.6.611\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFieseler, G., Jungermann, P., Koke, A., Irlenbusch, L., Delank, K.S., Schwesig, R., 2015a. Range of motion and isometric strength of shoulder joints of team handball athletes during the playing season, part II: Changes after midseason. J Shoulder Elbow Surg 24, 391\u0026ndash;398. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jse.2014.07.019\u003c/span\u003e\u003cspan address=\"10.1016/j.jse.2014.07.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFieseler, G., Jungermann, P., Koke, A., Irlenbusch, L., Delank, K.S., Schwesig, R., 2015b. Glenohumeral range of motion (ROM) and isometric strength of professional team handball athletes, part III: changes over the playing season. Arch Orthop Trauma Surg 135, 1691\u0026ndash;1700. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00402-015-2308-5\u003c/span\u003e\u003cspan address=\"10.1007/s00402-015-2308-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFinley, M.A., Ebaugh, D., 2017. Association of Pectoralis Minor Muscle Extensibility, Shoulder Mobility, and Duration of Manual Wheelchair Use, in Archives of Physical Medicine and Rehabilitation. W.B. Saunders, pp. 2028\u0026ndash;2033. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.apmr.2017.03.029\u003c/span\u003e\u003cspan address=\"10.1016/j.apmr.2017.03.029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFrye, S.K., Geigle, P.R., York, H.S., Sweatman, W.M., 2020. Functional passive range of motion of individuals with chronic cervical spinal cord injury. J Spinal Cord Med 43, 257\u0026ndash;263. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/10790268.2019.1622239\u003c/span\u003e\u003cspan address=\"10.1080/10790268.2019.1622239\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGillet, B., Begon, M., Sevrez, V., Berger-Vachon, C., Rogowski, I., 2017. Adaptive alterations in shoulder range of motion and strength in young tennis players. J Athl Train 52, 137\u0026ndash;144. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4085/1062-6050.52.1.10\u003c/span\u003e\u003cspan address=\"10.4085/1062-6050.52.1.10\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaines, M.R., Fish, M., O\u0026rsquo;Sullivan, D., 2019. Seasonal changes in glenohumeral joint isokinetic strength in professional rugby league players. Physical Therapy in Sport 39, 32\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ptsp.2019.06.005\u003c/span\u003e\u003cspan address=\"10.1016/j.ptsp.2019.06.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHigson, E., Herrington, L., Butler, C., Horsley, I., 2018. The short-term effect of swimming training load on shoulder rotational range of motion, shoulder joint position sense, and pectoralis minor length. Shoulder Elbow 10, 285\u0026ndash;291. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1758573218773539\u003c/span\u003e\u003cspan address=\"10.1177/1758573218773539\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJohn Thomas, S., Swanik, K.A., Swanik, C., Huxel, K.C., n.d. Glenohumeral Rotation and Scapular Position Adaptations After a Single High School Female Sports Season.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLewis, J.S., Valentine, R.E., 2007. The pectoralis minor length test: a study of the intra-rater reliability and diagnostic accuracy in subjects with and without shoulder symptoms. BMC Musculoskelet Disord 8, 64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1471-2474-8-64\u003c/span\u003e\u003cspan address=\"10.1186/1471-2474-8-64\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMayrhuber, L., Rietveld, T., de Vries, W., van der Woude, L.H. V., de Groot, S., Vegter, R.J.K., 2022. A Scoping Review on Shoulder Injuries of Wheelchair Tennis Players: Potential Risk-Factors and Musculoskeletal Adaptations. Frontiers in Rehabilitation Sciences 3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fresc.2022.862233\u003c/span\u003e\u003cspan address=\"10.3389/fresc.2022.862233\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcLaine, S.J., Ginn, K.A., Fell, J.W., Bird, M.L., 2018. Isometric shoulder strength in young swimmers. J Sci Med Sport 21, 35\u0026ndash;39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jsams.2017.05.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jsams.2017.05.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorrien, F., Taylor, M.J.D., Hettinga, F.J., 2016. Biomechanics in Paralympics: Implications for Performance. Int J Sports Physiol Perform 0, 34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNascimento, L.R., Teixeira-Salmela, L.F., Polese, J.C., Ada, L., Faria, C.D.C.M., Laurentino, G.E.C., 2014. Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke. Braz J Phys Ther 18, 268\u0026ndash;275. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1590/bjpt-rbf.2014.0030\u003c/span\u003e\u003cspan address=\"10.1590/bjpt-rbf.2014.0030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNavarro-Ledesma, S., Fernandez-Sanchez, M., Luque-Suarez, A., 2018. Does the pectoralis minor length influence acromiohumeral distance, shoulder pain function, and range of movement? Physical Therapy in Sport 34, 43\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ptsp.2018.08.009\u003c/span\u003e\u003cspan address=\"10.1016/j.ptsp.2018.08.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOna Ayala, K.E., Li, X., Huang, P., Derman, W.E., Kissick, J., Webborn, N., Blauwet, C., Stomphorst, J., Tuakli-Wosornu, Y.A., 2019. Injury epidemiology and preparedness in powerlifting at the Rio 2016 Paralympic Games: An analysis of 1410 athlete‐days. Transl Sports Med 2, 358\u0026ndash;369. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/tsm2.107\u003c/span\u003e\u003cspan address=\"10.1002/tsm2.107\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRanstam, J., 2012. Why the P-value culture is bad and confidence intervals a better alternative. Osteoarthritis Cartilage. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.joca.2012.04.001\u003c/span\u003e\u003cspan address=\"10.1016/j.joca.2012.04.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eResnik, L., Borgia, M., Cancio, J., Heckman, J., Highsmith, M.J., Levy, C., Phillips, S., Webster, J., 2022. Understanding Implications of Residual Limb Length, Strength, and Range-of-Motion Impairments of Veterans with Upper Limb Amputation. Am J Phys Med Rehabil 101, 545\u0026ndash;554. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/PHM.0000000000001862\u003c/span\u003e\u003cspan address=\"10.1097/PHM.0000000000001862\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosa, D.P., Santos, R. V., Gava, V., Borstad, J.D., Camargo, P.R., 2019. Shoulder external rotation range of motion and pectoralis minor length in individuals with and without shoulder pain. Physiother Theory Pract 35, 986\u0026ndash;994. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09593985.2018.1459985\u003c/span\u003e\u003cspan address=\"10.1080/09593985.2018.1459985\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchwank, A., Blazey, P., Asker, M., M\u0026oslash;ller, M., H\u0026auml;gglund, M., Gard, S., Skazalski, Christopher, Andersson, S.H., Horsley, I., Whiteley, R., Cools, A.M., Bizzini, M., Ardern, C.L., Albrecht, C., Andersson, S., Ashworth, B., Asker, M., Bizzini, M., Clarsen, B., Cools, A., Ellenbecker, T., Fanning, E., Fredriksen, H., Gard, S., Gibson, J., H\u0026auml;gglund, M., Horsley, I., Jaggi, A., Johansson, F., Johansson, K., Kuppens, K., Lewis, J., McCreesh, K., Michener, L., Mirkovic, M., M\u0026oslash;ller, M., Mosler, A., Mutch, S., Olds, M., Pizzari, T., Pluim, B., Reinold, M., Seitz, A., Singh, V., Skazalski, Chris, Struyf, F., Warby, S., Whiteley, R., Wilk, K., Wright, A., Ardern, C., Asker, M., Bizzini, M., Blazey, P., Cools, A., Gard, S., H\u0026auml;gglund, M., Horsley, I., M\u0026oslash;ller, M., Schwank, A., 2022. 2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. Journal of Orthopaedic and Sports Physical Therapy 52, 11\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2519/JOSPT.2022.10952\u003c/span\u003e\u003cspan address=\"10.2519/JOSPT.2022.10952\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShimura, K., Koizumi, K., Yoshizawa, T., Aoki, T., 2021. Physique, range of motion, and gross muscle strength in hemiplegic para swimmers: a cross-sectional case series.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSil, A., Betkerur, J., Das, N., 2019. P-Value demystified. Indian Dermatol Online J 10, 745. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/idoj.IDOJ_368_19\u003c/span\u003e\u003cspan address=\"10.4103/idoj.IDOJ_368_19\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStruyf, F., Tate, A., Kuppens, K., Feijen, S., Michener, L.A., 2017. Musculoskeletal dysfunctions are associated with swimmers\u0026rsquo; shoulders. Br J Sports Med. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bjsports-2016-096847\u003c/span\u003e\u003cspan address=\"10.1136/bjsports-2016-096847\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTate, A., Sarver, J., DiPaola, L., Yim, J., Paul, R., Thomas, S.J., 2020. Changes in clinical measures and tissue adaptations in collegiate swimmers across a competitive season. J Shoulder Elbow Surg 29, 2375\u0026ndash;2384. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jse.2020.03.028\u003c/span\u003e\u003cspan address=\"10.1016/j.jse.2020.03.028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThomas, S.J., Swanik, K.A., Swanik, C., Huxel, K.C., 2009. Glenohumeral rotation and scapular position adaptations after a single high school female sports season. J Athl Train 44, 230\u0026ndash;237. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4085/1062-6050-44.3.230\u003c/span\u003e\u003cspan address=\"10.4085/1062-6050-44.3.230\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWatanabe, S., 2000. Research Report Alterations in Shoulder Kinematics and Associated Muscle Activity in People with Shoulder Impingment 276\u0026ndash;291.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWillick, S.E., Cushman, D.M., Blauwet, C.A., Emery, C., Webborn, N., Derman, W., Schwellnus, M., Stomphorst, J., Van de Vliet, P., 2016. The epidemiology of injuries in powerlifting at the London 2012 Paralympic Games: An analysis of 1411 athlete-days. Scand J Med Sci Sports 26, 1233\u0026ndash;1238. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/sms.12554\u003c/span\u003e\u003cspan address=\"10.1111/sms.12554\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Paralympic Sports, Impairments, Track, Field, Hip, Knee","lastPublishedDoi":"10.21203/rs.3.rs-7374381/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7374381/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To compare the dorsiflexion range of motion, dynamic balance, and isometric strength of hip and knee extensors between limbs (dominant vs. non-dominant) and between impairment types in Para athletes during the preseason.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e: Cross-sectional study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSettings\u003c/strong\u003e: Assessments were performed during the preseason and included the lunge test, Y-Balance test, and isometric strength testing of hip and knee extensors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e: Twenty-one Para athletes from track and field modalities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain outcome measures\u003c/strong\u003e: The Shapiro-Wilk test assessed data normality. Paired t-test compared dominant and non-dominant limbs, and independent t-tests compared impairment types. Effect sizes were calculated using Cohen's d and U3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Significant differences between impairment types were found for the lunge test (p\u0026lt;0,02) and Y-balance test (p\u0026lt;0,001), both with a small effect size. A significant difference was observed in non-dominant hip extensor isometric strength (p \u0026lt; 0.01), with a larger effect size.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Differences in hip extensor strength and functional test performance across impairment groups suggest asymmetries that may have biomechanical relevance for musculoskeletal injury risk in Para athletes.\u003c/p\u003e","manuscriptTitle":"Comparative Preseason Assessment of Isometric Strength, Range of Motion, and Balance in Track and Field Para Athletes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 16:35:50","doi":"10.21203/rs.3.rs-7374381/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f5895dd-bc5f-491a-bc07-5bb498a188ce","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T07:40:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 16:35:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7374381","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7374381","identity":"rs-7374381","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}