Does eight-week neuromuscular warm-up improve knee isokinetic strength and the functional hamstring–quadriceps ratio in national team Para-taekwondo athletes? A randomized controlled trial

Does eight-week neuromuscular warm-up improve knee isokinetic strength and the functional hamstring–quadriceps ratio in national team Para-taekwondo athletes? A randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Does eight-week neuromuscular warm-up improve knee isokinetic strength and the functional hamstring–quadriceps ratio in national team Para-taekwondo athletes? A randomized controlled trial Mojtaba Rouhi, Amir Hossein Barati This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8354013/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Para-taekwondo demands explosive lower-limb actions that challenge knee stability and neuromuscular control. Athletes face an elevated risk of noncontact injuries, particularly hamstring strains and anterior cruciate ligament (ACL) rupture. Although neuromuscular warm-ups such as the MASS-12 are effective in able-bodied sports, their impact on Para-taekwondo remains unclear. To determine whether an eight-week neuromuscular warm-up (MASS-12) improves isokinetic knee strength and the functional hamstring–quadriceps (H/Q) ratio in national Para-taekwondo athletes. Methods: Twenty-four K44 athletes (12 men, 12 women; mean age 23.4 ± 3.9 years) were randomized into MASS-12 (n=12) or control (n=12) groups. The intervention included MASS-12 three times weekly (~20 min/session) for eight weeks, whereas the controls continued standard warm-ups. The isokinetic strength of the dominant leg was assessed on a Biodex System 4 Pro at 60°/s and 180°/s for concentric quadriceps and eccentric hamstrings. Group, time, and interaction effects were tested via 2×2 mixed ANOVA. Results: A significant group × time interaction was found for eccentric hamstring strength at 180°/s (F=5.79, P=0.02, η²=0.14; Cohen’s d=1.29), indicating large improvements in the MASS-12 group but not in the control group. No significant changes in concentric quadriceps strength or the functional H/Q ratio were detected (P>0.05). No adverse events were reported. Conclusions: MASS-12 warm-up significantly increased eccentric hamstring strength in national Para-taekwondo athletes, supporting its clinical relevance as a short, sport specific, and effective injury prevention strategy. However, the unchanged quadriceps strength and H/Q ratios suggest that extended or combined neuromuscular protocols may be required for broader muscular adaptations. Trial registration: The researchers registered this trial on 07/06/2025, with the identifier IRCT20250626066261N1 in the Iranian Registry of Clinical Trials (IRCT) at the following address: https://irct.behdasht.gov.ir. The study protocol was approved by the institutional ethics committee of Shahid Beheshti University (approval code: IR.SBU.REC.1404.055). Para-taekwondo Neuromuscular warm-up Isokinetic strength Injury prevention MASS-12 Figures Figure 1 Figure 2 Introduction Para-taekwondo is a rapidly expanding Paralympic sport characterized by high-intensity kick-based manoeuvres, rapid directional changes, and demanding lower-limb control ( 1 ). These functional demands expose athletes to substantial risk of noncontact injuries such as hamstring strains and anterior cruciate ligament (ACL) injuries—a concern of considerable clinical relevance for physiotherapists and movement therapists ( 2 , 3 ). Neuromuscular warm-up programs, especially those focused on eccentric strength and motor control, have shown efficacy in reducing injury incidence and enhancing performance across various athlete populations ( 4 , 5 ). For example, adolescent male basketball players experienced a significant reduction in the incidence of lower extremity injuries when a structured neuromuscular training (NMT) program was incorporated into their warm-ups ( 6 ). Similarly, general neuromuscular training warm-ups have proven effective across diverse sports in improving neuromuscular function and lowering injury risk ( 7 ). Among taekwondo athletes, muscular imbalance—particularly between hamstrings and the quadriceps—is a prominent risk factor for noncontact injuries ( 8 )Eccentric hamstring strength relative to concentric quadriceps function (functional H/Q ratio) is especially critical, given its role in maintaining knee stability during dynamic actions ( 9 )Moreover, a recent investigation into adolescent Taekwondo athletes highlighted significantly lower-limb asymmetries in both isokinetic muscle function and dynamic balance, further emphasizing the need for neuromuscular training protocols in this population ( 3 ). The MASS-12 program—an evidence-based 12-exercise prehabilitation protocol tailored for striking martial arts—emphasizes biomechanical correction (e.g., hip–knee–ankle alignment) and sensorimotor retraining to prevent common training-related injuries ( 10 ). While its rationale is sound and clinically oriented, no randomized controlled trial has yet evaluated its effectiveness in elite Para-taekwondo athletes, especially in terms of improving hamstring strength and functional muscle balance ( 11 ). Therefore, the present study aimed to determine whether eight weeks of MASS-12 neuromuscular warm-up improves isokinetic knee strength and the functional hamstring–quadriceps ratio in national Para-taekwondo athletes (K44 class). It was hypothesized that, compared with the control, the MASS-12 program would improve eccentric hamstring strength and the functional hamstring–quadriceps (H/Q) ratio. Methods Participants Participants were recruited from the national Para-taekwondo training center between July and September 2025, with an eight-week follow-up period. This randomized controlled trial recruited 24 elite Para-taekwondo athletes (K44 class; 12 males, 12 females) from the Iranian national team. The inclusion criteria were as follows: aged 18–30 years, active membership in the national team, and no history of lower-limb surgery or acute injury within the past 6 months. All participants held an international Para-taekwondo classification in K44, which includes upper-limb impairment with preserved lower-limb function. The exclusion criteria included neurological or vestibular disorders and noncompliance with the intervention. Written informed consent was obtained from all participants. The study protocol was approved by an institutional ethics committee (approval code: IR.SBU.REC.1404.055) and was prospectively registered in a national clinical trials registry (identifier: IRCT20250626066261N1). All participants completed the intervention and follow-up without withdrawal. Impairment Profile and Testing Accommodations. All participants were classified as K44 (upper-limb impairment with full lower-limb function) according to the official World Para Taekwondo Classification Rules ( 1 ). The impairment profile in our sample was as follows: amputation/limb deficiency (n = 18; 75%), dysmelia or restricted upper-limb ROM (n = 6; 25%), and mild cerebral palsy or other eligible neurological conditions (n = 0; 0%). Participant and Public Involvement National-team coaches provided input on session scheduling and drill feasibility. Athletes reviewed instructions for clarity and safety before data collection but did not contribute to outcome selection or data analysis. Study Design A two-arm parallel randomized controlled trial with pre- and postintervention assessments and a 1:1 allocation ratio was conducted in accordance with the CONSORT 2025 statement (Hopewell et al., Lancet , 2025). Randomization was computer-generated with stratification by sex and BMI, and allocation concealment was maintained via sealed opaque envelopes. The outcome assessors were blinded, but the participants were not affected by the nature of the intervention. The flow of participants through enrollment, allocation, follow-up, and analysis is illustrated in (Fig. 1 ), which is based on the 2025 CONSORT flow diagram ( 12 ). No changes to the trial design, eligibility criteria, interventions, or outcomes were made after trial commencement. Intervention The intervention group completed an 8-week neuromuscular warm-up program (MASS-12), with three sessions per week under direct supervision. The MASS-12 includes 12 exercises organized into three progressive phases on the basis of RAMP principles (Raise, Activate & Mobilize, Potentiate) ( 2 ). Each session lasted approximately 20 minutes and emphasized hip–knee–ankle alignment, dynamic mobility, functional strength, and neuromuscular control (Fig. 2 ) MASS-12 protocol. The control group followed the national team’s routine warm-up (light jogging, dynamic stretching, and basic drills without neuromuscular focus). Raise phase (≤ 5 min, low intensity) : Four exercises aimed at elevating tissue temperature and general mobility, including multidirectional running with directional changes, side shuffles, and backwards running; walking lungs (half and full) with knee alignment control; heel walks; and toe walks with directional variations. Progression was achieved through increased speed and range of motion. Activate/Mobilize phase (≈ 5 min, dynamic mobility) : Four exercises targeting dynamic stretching and core activation, such as controlled trunk rotations, balance tasks on unstable surfaces, and agility drills with rapid directional changes. The number of repetitions ranged from 8–12 per movement, progressing with increasing task complexity and speed. Potentiation phase (≈ 10 min, high intensity) : Four neuromuscular potentiation exercises, including plyometric jumps, visual-reaction drills, and eccentric strengthening of the hamstrings and quadriceps. The number of repetitions ranged from 10–15, with progression from static to dynamic and unstable conditions. The proper form, HKA alignment, and prevention of knee valgus were emphasized under the supervision of the trainer. The control group performed the national team’s routine warm-up, consisting of light jogging, dynamic stretching, and general drills without specific neuromuscular content ( 4 ). Outcome Measures All assessments were performed in a controlled laboratory environment via validated instruments. Examiners were blinded to group allocation, and devices were calibrated daily to ensure measurement accuracy. Isokinetic knee strength : Assessed via the Biodex System 4 Pro dynamometer at angular velocities of 60°/s (peak strength) and 180°/s (functional performance) in both concentric and eccentric modes ( 13 ). The participants were seated with the dominant leg secured to the dynamometer lever arm. After three familiarization repetitions, five maximal trials were recorded. A minimum 1-minute rest interval was provided between tests to minimize fatigue. Device calibration was performed before each testing session. Test–retest reliability has been reported as an ICC > 0.90 ( 14 ). Given the nature of Para-taekwondo, which involves dynamic technical movements with a strong emphasis on the lower limbs—particularly the dominant leg—this study assessed only the dominant leg for isokinetic knee strength, the functional hamstring-to-quadriceps ratio dominance was determined by asking participants which leg they primarily used for kicking in training or competition, a method commonly applied in similar studies ( 15 ). Previous evidence indicates that in professional athletes, especially in unilateral sports such as soccer or taekwondo, the dominant leg often exhibits distinct neuromuscular characteristics and a more pronounced training response than the nondominant leg does ( 3 , 16 ). Furthermore, scientific reports suggest that targeted training has the greatest effect on muscles and joints exposed to relatively high functional loads, which are typically the dominant leg in Para-taekwondo ( 17 ). Comparative studies have also demonstrated that the dominant leg differs from the supporting leg in parameters such as strength, neuromuscular control, and dynamic balance, making its analysis more accurate for detecting functional changes ( 18 ). All prespecified primary and secondary outcomes were analysed as planned; no post hoc changes were made. Statistical analysis A priori power analysis via G*Power 3.1 (Faul et al., 2007) for a 2 (group: intervention, control) × 2 (time: pre, post) mixed ANOVA with a medium effect size (f = 0.25), α = 0.05, and 1–β = 0.80 indicated a required total sample of 24 participants (12 per group)( 19 ). The data were analysed via SPSS version 27 (IBM Corp., Armonk, NY, USA). Descriptive statistics (means ± standard deviations) were calculated for participant characteristics and study variables. The Shapiro–Wilk test was applied to examine the normality of the data distribution. For normally distributed variables, a 2×2 mixed repeated-measures ANOVA was conducted to evaluate the main effects of time (pretest vs. posttest), group (intervention vs. control), and their interaction. The homogeneity of covariance matrices was tested via Box’s M test, whereas Mauchly’s test of sphericity was applied to assess sphericity; when it was violated, Greenhouse–Geisser corrections were reported. For nonnormally distributed data, the Wilcoxon signed-rank test (within-group) and Mann–Whitney U test (between-group) were employed. The selected sample size and participant characteristics were consistent with those of the target population of national Para-taekwondo athletes. The power analysis confirmed that the achieved sample provided sufficient statistical power (1–β = 0.80) to detect meaningful group × time interaction effects, ensuring the adequacy and representativeness of the study sample for the intended population. All the data were complete; no imputation for missing values was needed. Results Participants were enrolled between March and June 2025; all participants completed the eight-week follow-up. This section presents the findings from the randomized controlled trial. First, the demographic characteristics of the participants are described, followed by the results of the statistical analyses of the concentric strength of the knee extensors, the eccentric strength of the knee flexors, and the functional hamstring-to-quadriceps ratio. Both parametric and nonparametric tests were applied as appropriate, and effect sizes were calculated to determine the clinical relevance of the results. This reporting structure is consistent with the requirements of clinical trial reporting and ensures transparency and comparability with similar studies (20). All 24 randomized participants (12 per group) completed the study and were included in the final analysis. No subgroup or secondary analyses were conducted. Participant characteristics Table 1 shows the demographic characteristics of the participants in the intervention (n=12; 6 men, 6 women) and control (n=12; 6 men, 6 women) groups. Independent t tests revealed no significant differences between groups in terms of age, height, weight, or body mass index (BMI) (all P > 0.05). The balanced distribution of sex and the absence of baseline differences confirm the effectiveness of randomization and comparability between groups. Harms. No adverse events, injuries, or withdrawals attributable to the intervention were observed during the 8-week period. Table 1 . Demographic characteristics of the participants (mean ± SD) Variable Control (n=12) Intervention (n=12) P-value Age (years) 24.9 ± 4.4 21.9 ± 3.4 0.10 Height (m) 1.71 ± 0.05 1.69 ± 0.08 0.67 Weight (kg) 63.4 ± 11.0 62.0 ± 9.8 0.76 BMI (kg/m²) 21.5 ± 2.6 21.4 ± 2.6 0.95 Statistical assumptions The normality of the data distribution was assessed via the Shapiro–Wilk test. Most variables demonstrated normal distributions (P > 0.05); therefore, parametric tests were applied. However, for a variable, the hamstring-to-quadriceps ratio at 60°/s in the control group had a nonnormal distribution (P < 0.05). Consequently, nonparametric tests (the Wilcoxon signed-rank test for within-group comparisons and the Mann–Whitney U test for between-group comparisons) were employed. A significance level of 0.05 was adopted for all analyses, and effect sizes (partial eta squared, η², and Cohen’s d) were calculated to evaluate the practical significance of the findings (21). Concentric quadriceps strength Table 2 shows the results for concentric quadriceps strength at angular velocities of 60°/s and 180°/s. No significant group × time interaction was found (F = 0.06, P = 0.80 for 60°/s; F = 2.05, P = 0.16 for 180°/s; η² 0.05), and no significant between-group differences were observed at either velocity. These findings suggest that the neuromuscular warm-up program did not affect concentric quadriceps strength in Para-taekwondo athletes. Table 2 . Results of mixed repeated measures ANOVA for concentric quadriceps strength Variable Group Pre-test (Mean ± SD) Post-test (Mean ± SD) Within-group P Mean Difference Quadriceps concentric 60°/s Control 153.86 ± 47.87 155.22 ± 42.10 0.76 –1.6 Intervention 176.63 ± 50.88 176.85 ± 43.71 0.96 –0.21 Between-group P 0.30 0.26 – – Mean difference –22.77 –21.63 Quadriceps concentric 180°/s Control 105.10 ± 37.41 108.68 ± 35.83 0.42 –3.58 Intervention 122.83 ± 41.77 127.90 ± 36.06 0.23 –5.07 Between-group P 0.32 0.26 – – Mean difference –17.73 –19.22 Notes. * P < 0.05 indicates a significant within-group difference. # P < 0.05 indicates a significant between-group difference. Eccentric Hamstring Strength Table 3 presents the results for eccentric hamstring strength. A significant group × time interaction was found at 180°/s (F = 5.79, P = 0.02, η² = 0.14, d = 1.29). The intervention group demonstrated a significant within-group improvement from the pretest (106.76 ± 26.63) to the posttest (114.81 ± 23.42) (P = 0.02), whereas the control group showed no significant change (P = 0.31). No significant interaction was detected at 60°/s (P > 0.05). Between-group differences were not statistically significant at either velocity, but the effect size at 180°/s suggests meaningful clinical relevance. Table 3 . Results of mixed repeated measures ANOVA for eccentric hamstring strength Variable Group Pre-test (Mean ± SD) Post-test (Mean ± SD) Within-group P Mean Difference Hamstring eccentric 60°/s Control 116.83 ± 22.71 118.67 ± 37.72 0.25 –1.84 Intervention 124.25 ± 33.64 131.74 ± 33.33 0.19 –7.49 Between-group P 0.56 0.40 – – Mean difference –7.42 –13.07 Hamstring eccentric 180°/s Control 97.82 ± 24.53 101.41 ± 28.52 0.31 –3.59 Intervention 106.76 ± 26.63 114.81 ± 23.42 *0.02 –8.05 Between-group P 0.43 0.25 – – Mean difference –8.94 –13.40 Notes. * P < 0.05 indicates significant within-group improvement in the intervention group at 180°/s. No significant effects were found at 60°/s. Functional hamstring-to-quadriceps ratio Table 4 summarizes the results for the functional hamstring-to-quadriceps (H/Q) ratio. No significant group × time interaction was observed at either 60°/s or 180°/s (F 0.80, η² 0.05). Between-group comparisons also revealed no significant differences, indicating that the neuromuscular warm-up protocol did not affect the H/Q ratio at the tested velocities. Table 4 . Results of mixed repeated measures ANOVA for functional H/Q ratio Variable Group Pre-test (Mean ± SD) Post-test (Mean ± SD) Within-group P Mean Difference H/Q ratio 60°/s Control 0.79 ± 0.18 0.77 ± 0.17 0.56 0.02 Intervention 0.72 ± 0.15 0.76 ± 0.16 0.35 –0.03 Between-group P 0.35 0.93 – – Mean difference 0.07 0.007 H/Q ratio 180°/s Control 0.97 ± 0.18 0.95 ± 0.159 0.31 0.01 Intervention 0.90 ± 0.14 0.92 ± 0.158 0.60 –0.02 Between-group P 0.35 0.65 – – Mean difference 0.07 0.03 Notes. No significant within- or between-group differences were observed at either testing velocity (P > 0.05). Discussion The findings of this study demonstrated that eight weeks of neuromuscular warm-up training positively affected several functional indicators among Iranian national Para-taekwondo athletes in the K44 class, including significant improvement in eccentric hamstring strength at 180°/s. In Para-Taekwondo (K44), such changes plausibly translate to activities—more controlled single-leg landings, faster defensive reactions, and safer cutting/turning—and to participation, i.e., more consistent, injury-reduced engagement in training and competition. Framing MASS-12 within the ICF clarifies its practical value: enhancing body-level functions that support task execution and, ultimately, sustained participation in adapted combat sport. However, no changes were observed in concentric quadriceps strength or the functional hamstring-to-quadriceps ratio. This pattern aligns with the physiological rationale of neuromuscular interventions, which emphasize sensory–motor integration and neuromotor control rather than maximal force development ( 4 ). The following sections interpret these outcomes in the context of the literature, explore potential mechanisms, and highlight practical implications, limitations, and recommendations. The lack of change in concentric quadriceps strength (P > 0.05) and the functional hamstring-to-quadriceps ratio (P > 0.05) may be due to the relatively low resistance load of the MASS-12 protocol, which targets coordination rather than maximal force output ( 10 ). In contrast, the significant improvement in eccentric hamstring strength at 180°/s (P = 0.02, d = 1.29) supports the principle of specificity, as dynamic, high-velocity drills promote eccentric control ( 2 ). This finding is consistent with that of Markstrom et al. (2019), who reported enhanced knee stability following neuromuscular training in Para-taekwondo ( 9 ). Furthermore, evidence from national Para-taekwondo athletes by Rouhi et al. (2025) highlighted that despite significant gains in quadriceps, hamstring, dorsiflexor, and plantar flexor strength during the preparatory phase, the functional hamstring–quadriceps ratio did not improve, and lower ratios were associated with a greater incidence of injury. Their study also indicated that decreased balance and mental health scores were linked to greater injury risk. These findings reinforce the rationale for the present intervention, underscoring the need for targeted neuromuscular warm-ups that address both functional asymmetry and psychological readiness in elite Para-taekwondo athletes ( 22 ). Discrepancies with other reports may reflect the short (8-week) duration of this protocol or the lack of heavy eccentric loading ( 23 ). Given that eccentric hamstring strength is crucial for ACL injury prevention, incorporating targeted eccentric resistance exercises may be necessary to optimize functional ratios ( 24 ). While the benefits of improved eccentric hamstring control are evident, no harms or adverse effects were identified, indicating a favourable risk–benefit profile for the intervention. Therefore, integrating the MASS-12 with standard national Para-taekwondo training could contribute to safer participation and reduce the injury burden among athletes with disabilities. Clinical Implications From a clinical standpoint, the findings suggest that implementing the MASS-12 as part of routine warm-ups in Para-taekwondo may strengthen hamstrings eccentrically and enhance knee stability during high-velocity kicking actions. Physiotherapists, strength and conditioning coaches, and parasport practitioners can use this protocol as a low-cost, time-efficient (20 min), sport-specific strategy for injury prevention and performance optimization. Importantly, this program requires minimal equipment and can be easily integrated into existing training regimens. Limitations This study has several limitations. The small sample size (n = 24) and impairment heterogeneity (e.g., limb deficiency vs. mild cerebral palsy) may limit generalizability. The 8-week duration may have been insufficient to produce lasting changes in concentric strength, and the absence of long-term follow-up prevents conclusions on sustained effects ( 25 ). Furthermore, the lack of eccentric-specific resistance training may have limited improvements in the functional ratio. Beyond impairment heterogeneity and the 8-week duration, additional limitations include (i) no activities/participation-level outcomes (e.g., on-mat technical error rates or training attendance), (ii) no follow-up to test durability, (iii) dominant-leg assessments limiting bilateral inference, and (iv) single-center sampling, which may constrain external validity. Recommendations Future research should recruit larger, more homogeneous samples on the basis of impairment type and extend intervention periods to 12 weeks or more ( 26 ). The use of biomechanical tools such as electromyography (EMG) could clarify the underlying mechanisms involved. From an applied standpoint, individualized monitoring with devices such as the Biodex system may help coaches tailor MASS-12 protocols to maximize injury prevention benefits. Conclusion These findings suggest that eight weeks of neuromuscular warm-up can improve isokinetic knee strength—particularly eccentric hamstring performance—and support functional muscle balance in Para-taekwondo athletes, contributing to enhanced performance and reduced injury risk. However, longer and combined protocols are required to induce comprehensive changes in concentric strength and functional ratios. These findings provide valuable evidence for adapted physical activity practitioners and set the stage for future investigations ( 11 ). Declarations Availability of data and materials Data and the full trial protocol are available from the corresponding author upon reasonable request or via the Iranian Registry of Clinical Trials. Competing interests The authors declare that they have no known competing financial or personal interests that could have influenced the work reported in this paper. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Ethics approval and consent to participate This study was approved by the institutional ethics committee of Shahid Beheshti University, Tehran, Iran (Approval Code: IR.SBU.REC.1404.055) and conducted in accordance with the ethical principles of the Declaration of Helsinki (2013 revision). All participants were informed about the study’s aims, procedures, and potential risks prior to participation, and each athlete provided written informed consent before enrolment. Clinical trial registration This randomized controlled trial was prospectively registered in the Iranian Registry of Clinical Trials (IRCT) on 07 June 2025, under the identifier IRCT20250626066261N1 (https://irct.behdasht.gov.ir). Consent for publication Figure 2 in this manuscript is reproduced from previously published instructional material describing the MASS‑12 protocol. The individual shown in this figure is not a participant in the present study, and no personal or clinical information related to study participants is included. Therefore, consent for publication is not applicable. Human Ethics and Consent to Participate declarations The research involved human participants and adhered to institutional and international ethical standards. Consent was obtained from all individual participants included in the study. Author contributions M.R. designed and conducted the study, collected and analysed the data, and drafted the manuscript. A.H.B. supervised the project, contributed to data interpretation, and revised the manuscript. Both authors approved the final version and are responsible for the integrity of the work. Acknowledgements The authors thank the Iranian National Para-taekwondo Federation and all the athletes for their cooperation and the Faculty of Sports Science and Rehabilitation, Shahid Beheshti University, for their technical and laboratory support. References Park C-H, O’Sullivan DM, Kim MS, An Y-J, Jung HC. Comparisons of tactical and technical performance factors between winners and non-winners in Para Taekwondo: A comprehensive analysis of the 2020 Tokyo Paralympic Games. Journal of Sports Sciences. 2024;42(20):1916-23. Hewett TE, Ford KR, Myer GD. Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. The American journal of sports medicine. 2006;34(3):490-8. Dong M, Kim B, Lee J, Choi Y, Shi P, Zhang G. Isokinetic muscle function, dynamic balance, and injury risk in dominant and non-dominant lower extremities of adolescent taekwondo athletes. Frontiers in Sports and Active Living. 2025;7:1599516. Hübscher M, Zech A, Pfeifer K, Hänsel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Medicine & Science in Sports & Exercise. 2010;42(3):413-21. Paravlic AH, Bakalár P, Puš K, Pišot S, Kalc M, Teraž K, et al. The effectiveness of neuromuscular training warm-up program for injury prevention in adolescent male basketball players. Journal of sports sciences. 2024;42(22):2083-92. Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. Bmj. 2008;337. Zech A, Hübscher M, Vogt L, Banzer W, Hänsel F, Pfeifer K. Balance training for neuromuscular control and performance enhancement: a systematic review. Journal of athletic training. 2010;45(4):392-403. Cheon Y-H, Park T-Y, Song J-K, Seo M-W, Kim K-M, Jung HC. Asymmetry of conventional and functional strength ratios in youth male taekwondo players. Journal of Men's Health. 2024;20(7):80-7. Markström JL, Grip H, Schelin L, Häger CK. Dynamic knee control and movement strategies in athletes and non‐athletes in side hops: implications for knee injury. Scandinavian journal of medicine & science in sports. 2019;29(8):1181-9. Bacon W, Wilson R. MASS-12: evidence-based martial arts striking sports injury prevention programme. Martial Arts Studies. 2024(15):14-24. Jeong HS, O’Sullivan DM, Rus PR, de Oca ARM. Expert consensus statement to guide research into evidence-based classification of athletes for Para-Taekwondo--A Delphi study. 2021. Hopewell S, Chan A-W, Collins GS, Hróbjartsson A, Moher D, Schulz KF, et al. CONSORT 2025 statement: updated guideline for reporting randomised trials. The Lancet. 2025;405(10489):1633-40. Daneshjoo A, Mokhtar AH, Rahnama N, Yusof A. The effects of injury prevention warm-up programmes on knee strength in male soccer players. Biology of sport. 2013;30(4):281-8. Drouin JM, Valovich-mcLeod TC, Shultz SJ, Gansneder BM, Perrin DH. Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. European journal of applied physiology. 2004;91(1):22-9. Loidl M, Stutz P, Fernandez Lapuente de Battre MD, Schmied C, Reich B, Bohm P, et al. Merging self‐reported with technically sensed data for tracking mobility behavior in a naturalistic intervention study. Insights from the GISMO study. Scandinavian journal of medicine & science in sports. 2020;30:41-9. Scott G, Crossland B. Limb Asymmetry Characteristics Amongst Men’s and Women’s NCAA Division II Soccer Athletes. J Rehab Pract Res. 2025;6(2):178. Drigny J, Rolland M, Gauthier A. The Influence of Knee Proprioception and Strength on Lower-Limb Functional Symmetry in Healthy Adults. Muscles. 2025;4(1):3. Maly T, Zahalka F, Mala L. Differences between isokinetic strength characteristics of more and less successful professional soccer teams. Journal of Physical Education and Sport. 2011;11(3):306. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods. 2007;39(2):175-91. Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Journal of clinical epidemiology. 2010;63(8):834-40. Keselman H, Algina J, Kowalchuk RK. The analysis of repeated measures designs: a review. British Journal of Mathematical and Statistical Psychology. 2001;54(1):1-20. Rouhi M, Barati A, barzegar bafrouei m. The Relationship Between Performance Indicators, Mental Health, and Sports Injury Incidence During Pre- and Post-Preparation Periods of National Para-Taekwondo Athletes. Journal of Sport Biomechanics. 2025;11(3):252-68. Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect of neuromuscular training on the incidence of knee injury in female athletes. The American journal of sports medicine. 1999;27(6):699-706. Impellizzeri FM, Bizzini M, Rampinini E, Cereda F, Maffiuletti NA. Reliability of isokinetic strength imbalance ratios measured using the Cybex NORM dynamometer. Clinical physiology and functional imaging. 2008;28(2):113-9. Zemková E, Hamar D. Sport-specific assessment of the effectiveness of neuromuscular training in young athletes. Frontiers in physiology. 2018;9:264. Barati AH, Barzegar Bafrouei M, Rouhi M. The Relationship of Sports Injuries With Knee Isokinetic Strength, Anaerobic Power, and Balance in Iranian Paralympic Athletes. The Scientific Journal of Rehabilitation Medicine. 2025;14(4):592-605. Additional Declarations No competing interests reported. Supplementary Files CONSORT2025editablechecklist.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 14 Jan, 2026 Editor invited by journal 22 Dec, 2025 Editor assigned by journal 21 Dec, 2025 Submission checks completed at journal 21 Dec, 2025 First submitted to journal 13 Dec, 2025 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8354013","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":575691032,"identity":"1a86f6cd-ecd2-4076-bbf3-1c586e924fd3","order_by":0,"name":"Mojtaba Rouhi","email":"","orcid":"","institution":"Shahid Beheshti University","correspondingAuthor":false,"prefix":"","firstName":"Mojtaba","middleName":"","lastName":"Rouhi","suffix":""},{"id":575691034,"identity":"3bfef4c8-8857-420f-a741-f30ad3d0a8f6","order_by":1,"name":"Amir Hossein Barati","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIie3RMQrCMBSA4QeBlyWaNaVir9BQsFvPEujaAwgF20kXb6BHcQgU7BU6OFSEuHRwFRyMuji1dXPIvyTLx3skAC7XPyYA3yfS8nMBMpIIZPpXAkLhuL34rsT2fkhWU+9qLgySAOik7R9y0lRuTSrQz+KIQSpLQsP+MY1CwTR5EfQZEAVkYMHAEu+hC4FebSwphkloic90JVDAwpJqmMhG0Wima2/Nsljuw1quh8jcTjl3OufBpjZtt8wDzo/9xD7z7XtPgJG/43K5XK6+nvd+Mwz5FwQ2AAAAAElFTkSuQmCC","orcid":"","institution":"Shahid Beheshti University","correspondingAuthor":true,"prefix":"","firstName":"Amir","middleName":"Hossein","lastName":"Barati","suffix":""}],"badges":[],"createdAt":"2025-12-13 16:23:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8354013/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8354013/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100586492,"identity":"73886364-b987-416e-aa1d-155faaaec44d","added_by":"auto","created_at":"2026-01-19 12:05:45","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":351774,"visible":true,"origin":"","legend":"","description":"","filename":"MainBMC.docx","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/754c4f82901e7ed7d253693a.docx"},{"id":100586520,"identity":"2b1d8000-02b8-42be-86b0-514cd1a05e62","added_by":"auto","created_at":"2026-01-19 12:05:55","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":333995,"visible":true,"origin":"","legend":"","description":"","filename":"figures.docx","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/b2362a73c468d981ca14ab75.docx"},{"id":100586536,"identity":"25611bc2-ed88-4308-9e31-edb6358a1554","added_by":"auto","created_at":"2026-01-19 12:06:14","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":28732,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/00229e252c64179e4254314f.docx"},{"id":100586535,"identity":"6359f5c3-9aa6-4109-bad6-1dbea5d347a9","added_by":"auto","created_at":"2026-01-19 12:06:13","extension":"json","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4888,"visible":true,"origin":"","legend":"","description":"","filename":"1eff363b4ba94833ba6a68bd8abb437c.json","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/21e8d18385567c3798169348.json"},{"id":100586477,"identity":"d39b8f02-1c5e-49a9-a6a3-d58037d5eaa7","added_by":"auto","created_at":"2026-01-19 12:05:30","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":45752,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORT2025editablechecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/52dc4b7e8c594ca9ca0a04d8.docx"},{"id":100586487,"identity":"5c78eb63-d555-45be-9fe0-02e0d446faa5","added_by":"auto","created_at":"2026-01-19 12:05:42","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":112611,"visible":true,"origin":"","legend":"","description":"","filename":"1eff363b4ba94833ba6a68bd8abb437c1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/d383ed96deb602d4ea9eb3a2.xml"},{"id":100586476,"identity":"bee346e7-f59b-4a52-a847-683150f9b58e","added_by":"auto","created_at":"2026-01-19 12:05:30","extension":"eps","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":603,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage1.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/520bc4ff1ff58b399484c959.eps"},{"id":100586516,"identity":"f540b346-9609-4195-874c-195ef8d21b6a","added_by":"auto","created_at":"2026-01-19 12:05:49","extension":"eps","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":91132,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage10.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/5c02b8bd0441d3706bc70a53.eps"},{"id":100586478,"identity":"090ee214-cac1-4056-a2a7-7538a082f341","added_by":"auto","created_at":"2026-01-19 12:05:31","extension":"eps","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93302,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage11.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/d40ba2afee71e39df7b25e7b.eps"},{"id":100586523,"identity":"f887f682-6438-48fa-8f27-bc0bf3cf6913","added_by":"auto","created_at":"2026-01-19 12:05:58","extension":"eps","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":626,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage12.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/1b3177d0201ad6f03ede9087.eps"},{"id":100586515,"identity":"2e2571c9-8690-4899-a2e7-2bffa9be5bc4","added_by":"auto","created_at":"2026-01-19 12:05:47","extension":"eps","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":91138,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage13.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/37b498b092d47491f121c208.eps"},{"id":100586521,"identity":"93190603-e065-4294-a7c2-4f3cb6c3798d","added_by":"auto","created_at":"2026-01-19 12:05:55","extension":"eps","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":56080,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage14.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/5112e8b9cc8c966d8ddf22a2.eps"},{"id":100586488,"identity":"6ebd03bb-24c6-4e12-a8eb-4463c5634855","added_by":"auto","created_at":"2026-01-19 12:05:43","extension":"eps","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90979,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage15.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/7bcc018044464cf9a89efce3.eps"},{"id":100586468,"identity":"e9ea2f7e-8964-4e97-abdd-4308586bf1f3","added_by":"auto","created_at":"2026-01-19 12:05:16","extension":"eps","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":57939,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage16.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/8325b11bcd58d237ba877b73.eps"},{"id":100586524,"identity":"629c4a38-d334-4d80-90a1-a3160902816c","added_by":"auto","created_at":"2026-01-19 12:05:59","extension":"eps","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":57988,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage17.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/3031b63b76804dbc14684302.eps"},{"id":100586517,"identity":"40feb377-c276-4367-a815-a25ead53e61f","added_by":"auto","created_at":"2026-01-19 12:05:53","extension":"eps","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":593,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage18.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/662725fb4b2fc954a63ccb84.eps"},{"id":100596125,"identity":"003ff56c-9854-4e4f-920b-91a5f991ecfa","added_by":"auto","created_at":"2026-01-19 13:52:35","extension":"eps","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":652,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage19.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/145cc1546b0b7e429555aa4b.eps"},{"id":100586527,"identity":"1ca2df43-e6da-423d-8734-1f44a21fa31e","added_by":"auto","created_at":"2026-01-19 12:06:03","extension":"eps","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":644,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage2.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/c64dcc88273e41ce96b63876.eps"},{"id":100586490,"identity":"76e27394-3941-4a67-9d97-4aeeb2358361","added_by":"auto","created_at":"2026-01-19 12:05:44","extension":"eps","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":71556,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage20.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/df2486c5b7c29c69e20dab77.eps"},{"id":100586509,"identity":"42bd5b31-f245-442a-82e1-cb7780601d10","added_by":"auto","created_at":"2026-01-19 12:05:46","extension":"eps","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77618,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage21.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/2f3a3828fca727533ef1fba2.eps"},{"id":100596100,"identity":"b1871c3d-f513-456f-aa16-3f4ad2536973","added_by":"auto","created_at":"2026-01-19 13:51:26","extension":"eps","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":603,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage3.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/4535d4d8afd26e2f4ed353a0.eps"},{"id":100586491,"identity":"ca959f66-10b2-448c-bca2-b67bb03aaa29","added_by":"auto","created_at":"2026-01-19 12:05:45","extension":"eps","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":644,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage2.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/46ef9a45e5d71e9cb8b046e2.eps"},{"id":100586528,"identity":"c8f0a7c3-42cf-4809-976c-3d70dd5950ed","added_by":"auto","created_at":"2026-01-19 12:06:05","extension":"eps","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93322,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage5.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/b11f05ece64fb9a4d982f428.eps"},{"id":100586486,"identity":"50f81011-97a9-4651-bec8-66630fe607a4","added_by":"auto","created_at":"2026-01-19 12:05:42","extension":"eps","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":603,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage6.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/6b541834ed87c53141f79d91.eps"},{"id":100586484,"identity":"ebd381a2-0c22-4312-a653-ab78697482a5","added_by":"auto","created_at":"2026-01-19 12:05:39","extension":"eps","order_by":25,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":395,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage7.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/6df0d945195a7c32a7709de5.eps"},{"id":100596123,"identity":"3061e9bb-a954-47c0-ac27-f5a16d433a31","added_by":"auto","created_at":"2026-01-19 13:52:28","extension":"eps","order_by":26,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":141799,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage8.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/608928f50d2d03e44eeb04ad.eps"},{"id":100586518,"identity":"d2a35917-69f3-414d-b694-00955f342496","added_by":"auto","created_at":"2026-01-19 12:05:54","extension":"eps","order_by":27,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":145963,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage9.eps","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/422ab253e69251d2b4973fc6.eps"},{"id":100586485,"identity":"50ca72dd-7db2-425f-9473-e8dc5c41083a","added_by":"auto","created_at":"2026-01-19 12:05:41","extension":"png","order_by":28,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":41281,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/59d6212d779806d36f106583.png"},{"id":100586489,"identity":"96046823-3eb4-4423-a45b-981313b65edd","added_by":"auto","created_at":"2026-01-19 12:05:43","extension":"jpeg","order_by":29,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":280375,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/f57d8edead14be0e77e2cdd8.jpeg"},{"id":100586522,"identity":"2804ada0-d868-4658-97c2-fd5be0a3db26","added_by":"auto","created_at":"2026-01-19 12:05:58","extension":"jpeg","order_by":30,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1247598,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/f976c2f10966cfa3bce256e5.jpeg"},{"id":100586495,"identity":"6cc8de75-f928-4f35-b045-c19e68aecc40","added_by":"auto","created_at":"2026-01-19 12:05:45","extension":"png","order_by":31,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18064,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/b8c9532012eb1fd6a965d239.png"},{"id":100586474,"identity":"accaf9e3-249c-4b99-bb93-3e2d3d2d50ce","added_by":"auto","created_at":"2026-01-19 12:05:29","extension":"png","order_by":32,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":141977,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/6b55049a5bc593d84fa88034.png"},{"id":100586475,"identity":"9fd74abd-9cad-4899-b484-2e7419d81877","added_by":"auto","created_at":"2026-01-19 12:05:29","extension":"png","order_by":33,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":324509,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/5d3827acdc34252f7bfdbf26.png"},{"id":100586519,"identity":"bd9b0632-c200-4e8f-94b7-62e62dfa2065","added_by":"auto","created_at":"2026-01-19 12:05:55","extension":"xml","order_by":34,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111143,"visible":true,"origin":"","legend":"","description":"","filename":"1eff363b4ba94833ba6a68bd8abb437c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/d52fe4ddc8f913a24c3f262a.xml"},{"id":100586480,"identity":"08627ddb-3bfc-427b-ad8e-d3566914a629","added_by":"auto","created_at":"2026-01-19 12:05:33","extension":"html","order_by":35,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":130138,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/7bad2ff23d0a1606fe2b5c2b.html"},{"id":100586450,"identity":"a8643538-f8f5-4873-b0b6-25024d0c4d0d","added_by":"auto","created_at":"2026-01-19 12:05:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":81666,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT 2025 Flow Diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/567e4e7804eee9e20ed5844b.png"},{"id":100586496,"identity":"1fab4a3a-4637-43d4-8f2d-04305bbf5132","added_by":"auto","created_at":"2026-01-19 12:05:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":728128,"visible":true,"origin":"","legend":"\u003cp\u003eMASS-12 protocol\u003c/p\u003e\n\u003cp\u003eMASS‑12 neuromuscular warm‑up protocol. Reproduced from Bacon \u0026amp; Wilson (2024), “MASS‑12: Evidence‑based Martial Arts Striking Sports Injury Prevention Programme,” under the CC‑BY‑NC‑ND 4.0 license (10).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/4ad98752574d02191d520633.png"},{"id":100597486,"identity":"2e501ce9-bd78-4a4b-add1-4d0a2349ac46","added_by":"auto","created_at":"2026-01-19 14:18:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1842088,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/5b408511-1e65-4e52-9922-0612627a0e4b.pdf"},{"id":100586494,"identity":"664ba2dc-3828-4310-bcaa-186481662d0f","added_by":"auto","created_at":"2026-01-19 12:05:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":45752,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORT2025editablechecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-8354013/v1/a2a41eeaf90e577cbe5f9605.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does eight-week neuromuscular warm-up improve knee isokinetic strength and the functional hamstring–quadriceps ratio in national team Para-taekwondo athletes? A randomized controlled trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePara-taekwondo is a rapidly expanding Paralympic sport characterized by high-intensity kick-based manoeuvres, rapid directional changes, and demanding lower-limb control (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese functional demands expose athletes to substantial risk of noncontact injuries such as hamstring strains and anterior cruciate ligament (ACL) injuries\u0026mdash;a concern of considerable clinical relevance for physiotherapists and movement therapists (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNeuromuscular warm-up programs, especially those focused on eccentric strength and motor control, have shown efficacy in reducing injury incidence and enhancing performance across various athlete populations (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). For example, adolescent male basketball players experienced a significant reduction in the incidence of lower extremity injuries when a structured neuromuscular training (NMT) program was incorporated into their warm-ups (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Similarly, general neuromuscular training warm-ups have proven effective across diverse sports in improving neuromuscular function and lowering injury risk (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong taekwondo athletes, muscular imbalance\u0026mdash;particularly between hamstrings and the quadriceps\u0026mdash;is a prominent risk factor for noncontact injuries (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)Eccentric hamstring strength relative to concentric quadriceps function (functional H/Q ratio) is especially critical, given its role in maintaining knee stability during dynamic actions (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)Moreover, a recent investigation into adolescent Taekwondo athletes highlighted significantly lower-limb asymmetries in both isokinetic muscle function and dynamic balance, further emphasizing the need for neuromuscular training protocols in this population (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe MASS-12 program\u0026mdash;an evidence-based 12-exercise prehabilitation protocol tailored for striking martial arts\u0026mdash;emphasizes biomechanical correction (e.g., hip\u0026ndash;knee\u0026ndash;ankle alignment) and sensorimotor retraining to prevent common training-related injuries (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile its rationale is sound and clinically oriented, no randomized controlled trial has yet evaluated its effectiveness in elite Para-taekwondo athletes, especially in terms of improving hamstring strength and functional muscle balance (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, the present study aimed to determine whether eight weeks of MASS-12 neuromuscular warm-up improves isokinetic knee strength and the functional hamstring\u0026ndash;quadriceps ratio in national Para-taekwondo athletes (K44 class).\u003c/p\u003e \u003cp\u003eIt was hypothesized that, compared with the control, the MASS-12 program would improve eccentric hamstring strength and the functional hamstring\u0026ndash;quadriceps (H/Q) ratio.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eParticipants were recruited from the national Para-taekwondo training center between July and September 2025, with an eight-week follow-up period. This randomized controlled trial recruited 24 elite Para-taekwondo athletes (K44 class; 12 males, 12 females) from the Iranian national team. The inclusion criteria were as follows: aged 18\u0026ndash;30 years, active membership in the national team, and no history of lower-limb surgery or acute injury within the past 6 months. All participants held an international Para-taekwondo classification in K44, which includes upper-limb impairment with preserved lower-limb function. The exclusion criteria included neurological or vestibular disorders and noncompliance with the intervention. Written informed consent was obtained from all participants. The study protocol was approved by an institutional ethics committee (approval code: IR.SBU.REC.1404.055) and was prospectively registered in a national clinical trials registry (identifier: IRCT20250626066261N1). All participants completed the intervention and follow-up without withdrawal.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImpairment Profile and Testing Accommodations.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAll participants were classified as K44 (upper-limb impairment with full lower-limb function) according to the official World Para Taekwondo Classification Rules (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The impairment profile in our sample was as follows: amputation/limb deficiency (n\u0026thinsp;=\u0026thinsp;18; 75%), dysmelia or restricted upper-limb ROM (n\u0026thinsp;=\u0026thinsp;6; 25%), and mild cerebral palsy or other eligible neurological conditions (n\u0026thinsp;=\u0026thinsp;0; 0%).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipant and Public Involvement\u003c/h3\u003e\n\u003cp\u003eNational-team coaches provided input on session scheduling and drill feasibility. Athletes reviewed instructions for clarity and safety before data collection but did not contribute to outcome selection or data analysis.\u003c/p\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eA two-arm parallel randomized controlled trial with pre- and postintervention assessments and a 1:1 allocation ratio was conducted in accordance with the CONSORT 2025 statement (Hopewell et al., \u003cem\u003eLancet\u003c/em\u003e, 2025). Randomization was computer-generated with stratification by sex and BMI, and allocation concealment was maintained via sealed opaque envelopes. The outcome assessors were blinded, but the participants were not affected by the nature of the intervention. The flow of participants through enrollment, allocation, follow-up, and analysis is illustrated in (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), which is based on the 2025 CONSORT flow diagram (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). No changes to the trial design, eligibility criteria, interventions, or outcomes were made after trial commencement.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eThe intervention group completed an 8-week neuromuscular warm-up program (MASS-12), with three sessions per week under direct supervision. The MASS-12 includes 12 exercises organized into three progressive phases on the basis of RAMP principles (Raise, Activate \u0026amp; Mobilize, Potentiate) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Each session lasted approximately 20 minutes and emphasized hip\u0026ndash;knee\u0026ndash;ankle alignment, dynamic mobility, functional strength, and neuromuscular control (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e) MASS-12 protocol. The control group followed the national team\u0026rsquo;s routine warm-up (light jogging, dynamic stretching, and basic drills without neuromuscular focus).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eRaise phase (\u0026le;\u0026thinsp;5 min, low intensity)\u003c/b\u003e: Four exercises aimed at elevating tissue temperature and general mobility, including multidirectional running with directional changes, side shuffles, and backwards running; walking lungs (half and full) with knee alignment control; heel walks; and toe walks with directional variations. Progression was achieved through increased speed and range of motion.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eActivate/Mobilize phase (\u0026asymp;\u0026thinsp;5 min, dynamic mobility)\u003c/b\u003e: Four exercises targeting dynamic stretching and core activation, such as controlled trunk rotations, balance tasks on unstable surfaces, and agility drills with rapid directional changes. The number of repetitions ranged from 8\u0026ndash;12 per movement, progressing with increasing task complexity and speed.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePotentiation phase (\u0026asymp;\u0026thinsp;10 min, high intensity)\u003c/b\u003e: Four neuromuscular potentiation exercises, including plyometric jumps, visual-reaction drills, and eccentric strengthening of the hamstrings and quadriceps. The number of repetitions ranged from 10\u0026ndash;15, with progression from static to dynamic and unstable conditions. The proper form, HKA alignment, and prevention of knee valgus were emphasized under the supervision of the trainer.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe control group performed the national team\u0026rsquo;s routine warm-up, consisting of light jogging, dynamic stretching, and general drills without specific neuromuscular content (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cp\u003eAll assessments were performed in a controlled laboratory environment via validated instruments. Examiners were blinded to group allocation, and devices were calibrated daily to ensure measurement accuracy.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eIsokinetic knee strength\u003c/b\u003e: Assessed via the Biodex System 4 Pro dynamometer at angular velocities of 60\u0026deg;/s (peak strength) and 180\u0026deg;/s (functional performance) in both concentric and eccentric modes (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The participants were seated with the dominant leg secured to the dynamometer lever arm. After three familiarization repetitions, five maximal trials were recorded. A minimum 1-minute rest interval was provided between tests to minimize fatigue. Device calibration was performed before each testing session. Test\u0026ndash;retest reliability has been reported as an ICC\u0026thinsp;\u0026gt;\u0026thinsp;0.90 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eGiven the nature of Para-taekwondo, which involves dynamic technical movements with a strong emphasis on the lower limbs\u0026mdash;particularly the dominant leg\u0026mdash;this study assessed only the dominant leg for isokinetic knee strength, the functional hamstring-to-quadriceps ratio dominance was determined by asking participants which leg they primarily used for kicking in training or competition, a method commonly applied in similar studies (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Previous evidence indicates that in professional athletes, especially in unilateral sports such as soccer or taekwondo, the dominant leg often exhibits distinct neuromuscular characteristics and a more pronounced training response than the nondominant leg does (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Furthermore, scientific reports suggest that targeted training has the greatest effect on muscles and joints exposed to relatively high functional loads, which are typically the dominant leg in Para-taekwondo (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Comparative studies have also demonstrated that the dominant leg differs from the supporting leg in parameters such as strength, neuromuscular control, and dynamic balance, making its analysis more accurate for detecting functional changes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). All prespecified primary and secondary outcomes were analysed as planned; no post hoc changes were made.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eA priori power analysis via G*Power 3.1 (Faul et al., 2007) for a 2 (group: intervention, control) \u0026times; 2 (time: pre, post) mixed ANOVA with a medium effect size (f\u0026thinsp;=\u0026thinsp;0.25), α\u0026thinsp;=\u0026thinsp;0.05, and 1\u0026ndash;β\u0026thinsp;=\u0026thinsp;0.80 indicated a required total sample of 24 participants (12 per group)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The data were analysed via SPSS version 27 (IBM Corp., Armonk, NY, USA). Descriptive statistics (means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations) were calculated for participant characteristics and study variables. The Shapiro\u0026ndash;Wilk test was applied to examine the normality of the data distribution. For normally distributed variables, a 2\u0026times;2 mixed repeated-measures ANOVA was conducted to evaluate the main effects of time (pretest vs. posttest), group (intervention vs. control), and their interaction. The homogeneity of covariance matrices was tested via Box\u0026rsquo;s M test, whereas Mauchly\u0026rsquo;s test of sphericity was applied to assess sphericity; when it was violated, Greenhouse\u0026ndash;Geisser corrections were reported. For nonnormally distributed data, the Wilcoxon signed-rank test (within-group) and Mann\u0026ndash;Whitney U test (between-group) were employed.\u003c/p\u003e \u003cp\u003eThe selected sample size and participant characteristics were consistent with those of the target population of national Para-taekwondo athletes. The power analysis confirmed that the achieved sample provided sufficient statistical power (1\u0026ndash;β\u0026thinsp;=\u0026thinsp;0.80) to detect meaningful group \u0026times; time interaction effects, ensuring the adequacy and representativeness of the study sample for the intended population. All the data were complete; no imputation for missing values was needed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eParticipants were enrolled between March and June 2025; all participants completed the eight-week follow-up.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eThis section presents the findings from the randomized controlled trial. First, the demographic characteristics of the participants are described, followed by the results of the statistical analyses of the concentric strength of the knee extensors, the eccentric strength of the knee flexors, and the functional hamstring-to-quadriceps ratio. Both parametric and nonparametric tests were applied as appropriate, and effect sizes were calculated to determine the clinical relevance of the results. This reporting structure is consistent with the requirements of clinical trial reporting and ensures transparency and comparability with similar studies\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(20). All 24 randomized participants (12 per group) completed the study and were included in the final analysis.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eNo subgroup or secondary analyses were conducted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 shows the demographic characteristics of the participants in the intervention (n=12; 6 men, 6 women) and control (n=12; 6 men, 6 women) groups. Independent t tests revealed no significant differences between groups in terms of age, height, weight, or body mass index (BMI) (all P \u0026gt; 0.05). The balanced distribution of sex and the absence of baseline differences confirm the effectiveness of randomization and comparability between groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHarms.\u003c/strong\u003e No adverse events, injuries, or withdrawals attributable to the intervention were observed during the 8-week period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eDemographic characteristics of the participants (mean \u0026plusmn; SD)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"470\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n=12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention (n=12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.9 \u0026plusmn; 4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.9 \u0026plusmn; 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHeight (m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.71 \u0026plusmn; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.69 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63.4 \u0026plusmn; 11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62.0 \u0026plusmn; 9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.5 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.4 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical assumptions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe normality of the data distribution was assessed via the Shapiro\u0026ndash;Wilk test. Most variables demonstrated normal distributions (P \u0026gt; 0.05); therefore, parametric tests were applied. However, for a variable, the hamstring-to-quadriceps ratio at 60\u0026deg;/s in the control group had a nonnormal distribution (P \u0026lt; 0.05). Consequently, nonparametric tests (the Wilcoxon signed-rank test for within-group comparisons and the Mann\u0026ndash;Whitney U test for between-group comparisons) were employed. A significance level of 0.05 was adopted for all analyses, and effect sizes (partial eta squared, \u0026eta;\u0026sup2;, and Cohen\u0026rsquo;s d) were calculated to evaluate the practical significance of the findings (21).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcentric quadriceps strength\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the results for concentric quadriceps strength at angular velocities of 60\u0026deg;/s and 180\u0026deg;/s. No significant group \u0026times; time interaction was found (F = 0.06, P = 0.80 for 60\u0026deg;/s; F = 2.05, P = 0.16 for 180\u0026deg;/s; \u0026eta;\u0026sup2; \u0026lt; 0.01). Neither group exhibited significant within-group changes (P \u0026gt; 0.05), and no significant between-group differences were observed at either velocity. These findings suggest that the neuromuscular warm-up program did not affect concentric quadriceps strength in Para-taekwondo athletes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eResults of mixed repeated measures ANOVA for concentric quadriceps strength\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-test (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-test\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin-group P\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Difference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQuadriceps concentric 60\u0026deg;/s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e153.86 \u0026plusmn; 47.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e155.22 \u0026plusmn; 42.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e176.63 \u0026plusmn; 50.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e176.85 \u0026plusmn; 43.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBetween-group P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;22.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;21.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQuadriceps concentric 180\u0026deg;/s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e105.10 \u0026plusmn; 37.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e108.68 \u0026plusmn; 35.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e122.83 \u0026plusmn; 41.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e127.90 \u0026plusmn; 36.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;5.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBetween-group P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;17.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;19.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e*\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eP \u0026lt; 0.05 indicates a significant within-group difference.\u003c/p\u003e\n\u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;#\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eP \u0026lt; 0.05 indicates a significant between-group difference.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEccentric Hamstring Strength\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 presents the results for eccentric hamstring strength. A significant group \u0026times; time interaction was found at 180\u0026deg;/s (F = 5.79, P = 0.02, \u0026eta;\u0026sup2; = 0.14, d = 1.29). The intervention group demonstrated a significant within-group improvement from the pretest (106.76 \u0026plusmn; 26.63) to the posttest (114.81 \u0026plusmn; 23.42) (P = 0.02), whereas the control group showed no significant change (P = 0.31). No significant interaction was detected at 60\u0026deg;/s (P \u0026gt; 0.05). Between-group differences were not statistically significant at either velocity, but the effect size at 180\u0026deg;/s suggests meaningful clinical relevance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e. Results of mixed repeated measures ANOVA for eccentric hamstring strength\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-test (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-test (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin-group P\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Difference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHamstring eccentric 60\u0026deg;/s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e116.83 \u0026plusmn; 22.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e118.67 \u0026plusmn; 37.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e124.25 \u0026plusmn; 33.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e131.74 \u0026plusmn; 33.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;7.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBetween-group P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;7.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;13.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHamstring eccentric 180\u0026deg;/s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e97.82 \u0026plusmn; 24.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e101.41 \u0026plusmn; 28.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e106.76 \u0026plusmn; 26.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e114.81 \u0026plusmn; 23.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e*0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;8.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBetween-group P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;8.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;13.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNotes.\u003c/em\u003e *\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eP \u0026lt; 0.05 indicates significant within-group improvement in the intervention group at 180\u0026deg;/s. No significant effects were found at 60\u0026deg;/s.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunctional hamstring-to-quadriceps ratio\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 summarizes the results for the functional hamstring-to-quadriceps (H/Q) ratio. No significant group \u0026times; time interaction was observed at either 60\u0026deg;/s or 180\u0026deg;/s (F \u0026lt; 0.05, P \u0026gt; 0.80, \u0026eta;\u0026sup2; \u0026lt; 0.01). Within-group analyses revealed no meaningful changes for the intervention or control groups (P \u0026gt; 0.05). Between-group comparisons also revealed no significant differences, indicating that the neuromuscular warm-up protocol did not affect the H/Q ratio at the tested velocities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eResults of mixed repeated measures ANOVA for functional H/Q ratio\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-test (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-test (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin-group P\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Difference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eH/Q ratio 60\u0026deg;/s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.79 \u0026plusmn; 0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.77 \u0026plusmn; 0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.72 \u0026plusmn; 0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.76 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBetween-group P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eH/Q ratio 180\u0026deg;/s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.97 \u0026plusmn; 0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.95 \u0026plusmn; 0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.90 \u0026plusmn; 0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.92 \u0026plusmn; 0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBetween-group P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp dir=\"LTR\"\u003e\u003cem\u003e\u003cspan dir=\"LTR\"\u003eNotes.\u003c/span\u003e\u003c/em\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;No significant within- or between-group differences were observed at either testing velocity (P \u0026gt; 0.05).\u003c/span\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study demonstrated that eight weeks of neuromuscular warm-up training positively affected several functional indicators among Iranian national Para-taekwondo athletes in the K44 class, including significant improvement in eccentric hamstring strength at 180\u0026deg;/s.\u003c/p\u003e \u003cp\u003eIn Para-Taekwondo (K44), such changes plausibly translate to activities\u0026mdash;more controlled single-leg landings, faster defensive reactions, and safer cutting/turning\u0026mdash;and to participation, i.e., more consistent, injury-reduced engagement in training and competition. Framing MASS-12 within the ICF clarifies its practical value: enhancing body-level functions that support task execution and, ultimately, sustained participation in adapted combat sport.\u003c/p\u003e \u003cp\u003eHowever, no changes were observed in concentric quadriceps strength or the functional hamstring-to-quadriceps ratio. This pattern aligns with the physiological rationale of neuromuscular interventions, which emphasize sensory\u0026ndash;motor integration and neuromotor control rather than maximal force development (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The following sections interpret these outcomes in the context of the literature, explore potential mechanisms, and highlight practical implications, limitations, and recommendations.\u003c/p\u003e \u003cp\u003eThe lack of change in concentric quadriceps strength (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and the functional hamstring-to-quadriceps ratio (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) may be due to the relatively low resistance load of the MASS-12 protocol, which targets coordination rather than maximal force output (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In contrast, the significant improvement in eccentric hamstring strength at 180\u0026deg;/s (P\u0026thinsp;=\u0026thinsp;0.02, d\u0026thinsp;=\u0026thinsp;1.29) supports the principle of specificity, as dynamic, high-velocity drills promote eccentric control (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This finding is consistent with that of Markstrom et al. (2019), who reported enhanced knee stability following neuromuscular training in Para-taekwondo (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, evidence from national Para-taekwondo athletes by Rouhi et al. (2025) highlighted that despite significant gains in quadriceps, hamstring, dorsiflexor, and plantar flexor strength during the preparatory phase, the \u003cem\u003efunctional hamstring\u0026ndash;quadriceps ratio\u003c/em\u003e did not improve, and lower ratios were associated with a greater incidence of injury. Their study also indicated that decreased balance and mental health scores were linked to greater injury risk. These findings reinforce the rationale for the present intervention, underscoring the need for targeted neuromuscular warm-ups that address both functional asymmetry and psychological readiness in elite Para-taekwondo athletes (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDiscrepancies with other reports may reflect the short (8-week) duration of this protocol or the lack of heavy eccentric loading (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Given that eccentric hamstring strength is crucial for ACL injury prevention, incorporating targeted eccentric resistance exercises may be necessary to optimize functional ratios (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). While the benefits of improved eccentric hamstring control are evident, no harms or adverse effects were identified, indicating a favourable risk\u0026ndash;benefit profile for the intervention. Therefore, integrating the MASS-12 with standard national Para-taekwondo training could contribute to safer participation and reduce the injury burden among athletes with disabilities.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eFrom a clinical standpoint, the findings suggest that implementing the MASS-12 as part of routine warm-ups in Para-taekwondo may strengthen hamstrings eccentrically and enhance knee stability during high-velocity kicking actions. Physiotherapists, strength and conditioning coaches, and parasport practitioners can use this protocol as a low-cost, time-efficient (20 min), sport-specific strategy for injury prevention and performance optimization. Importantly, this program requires minimal equipment and can be easily integrated into existing training regimens.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. The small sample size (n\u0026thinsp;=\u0026thinsp;24) and impairment heterogeneity (e.g., limb deficiency vs. mild cerebral palsy) may limit generalizability. The 8-week duration may have been insufficient to produce lasting changes in concentric strength, and the absence of long-term follow-up prevents conclusions on sustained effects (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Furthermore, the lack of eccentric-specific resistance training may have limited improvements in the functional ratio. Beyond impairment heterogeneity and the 8-week duration, additional limitations include (i) no activities/participation-level outcomes (e.g., on-mat technical error rates or training attendance), (ii) no follow-up to test durability, (iii) dominant-leg assessments limiting bilateral inference, and (iv) single-center sampling, which may constrain external validity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eFuture research should recruit larger, more homogeneous samples on the basis of impairment type and extend intervention periods to 12 weeks or more (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The use of biomechanical tools such as electromyography (EMG) could clarify the underlying mechanisms involved. From an applied standpoint, individualized monitoring with devices such as the Biodex system may help coaches tailor MASS-12 protocols to maximize injury prevention benefits.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese findings suggest that eight weeks of neuromuscular warm-up can improve isokinetic knee strength\u0026mdash;particularly eccentric hamstring performance\u0026mdash;and support functional muscle balance in Para-taekwondo athletes, contributing to enhanced performance and reduced injury risk. However, longer and combined protocols are required to induce comprehensive changes in concentric strength and functional ratios. These findings provide valuable evidence for adapted physical activity practitioners and set the stage for future investigations (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and the full trial protocol are available from the corresponding author upon reasonable request or via the Iranian Registry of Clinical Trials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial or personal interests that could have influenced the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional ethics committee of Shahid Beheshti University, Tehran, Iran (Approval Code: IR.SBU.REC.1404.055) and conducted in accordance with the ethical principles of the Declaration of Helsinki (2013 revision). All participants were informed about the study\u0026rsquo;s aims, procedures, and potential risks prior to participation, and each athlete provided written informed consent before enrolment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis randomized controlled trial was prospectively registered in the \u003cem\u003eIranian Registry of Clinical Trials (IRCT)\u003c/em\u003e on 07 June 2025, under the identifier IRCT20250626066261N1 (https://irct.behdasht.gov.ir).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2 in this manuscript is reproduced from previously published instructional material describing the MASS‑12 protocol. The individual shown in this figure is not a participant in the present study, and no personal or clinical information related to study participants is included. Therefore, consent for publication is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research involved human participants and adhered to institutional and international ethical standards. Consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eM.R.\u003c/strong\u003e designed and conducted the study, collected and analysed the data, and drafted the manuscript.\u003cbr\u003e\u003cstrong\u003eA.H.B.\u003c/strong\u003e supervised the project, contributed to data interpretation, and revised the manuscript.\u003cbr\u003e\u0026nbsp;Both authors approved the final version and are responsible for the integrity of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors thank the Iranian National Para-taekwondo Federation and all the athletes for their cooperation and the Faculty of Sports Science and Rehabilitation, Shahid Beheshti University, for their technical and laboratory support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePark C-H, O\u0026rsquo;Sullivan DM, Kim MS, An Y-J, Jung HC. Comparisons of tactical and technical performance factors between winners and non-winners in Para Taekwondo: A comprehensive analysis of the 2020 Tokyo Paralympic Games. Journal of Sports Sciences. 2024;42(20):1916-23.\u003c/li\u003e\n\u003cli\u003eHewett TE, Ford KR, Myer GD. Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. The American journal of sports medicine. 2006;34(3):490-8.\u003c/li\u003e\n\u003cli\u003eDong M, Kim B, Lee J, Choi Y, Shi P, Zhang G. Isokinetic muscle function, dynamic balance, and injury risk in dominant and non-dominant lower extremities of adolescent taekwondo athletes. Frontiers in Sports and Active Living. 2025;7:1599516.\u003c/li\u003e\n\u003cli\u003eH\u0026uuml;bscher M, Zech A, Pfeifer K, H\u0026auml;nsel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Medicine \u0026amp; Science in Sports \u0026amp; Exercise. 2010;42(3):413-21.\u003c/li\u003e\n\u003cli\u003eParavlic AH, Bakal\u0026aacute;r P, Pu\u0026scaron; K, Pi\u0026scaron;ot S, Kalc M, Teraž K, et al. The effectiveness of neuromuscular training warm-up program for injury prevention in adolescent male basketball players. Journal of sports sciences. 2024;42(22):2083-92.\u003c/li\u003e\n\u003cli\u003eSoligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. Bmj. 2008;337.\u003c/li\u003e\n\u003cli\u003eZech A, H\u0026uuml;bscher M, Vogt L, Banzer W, H\u0026auml;nsel F, Pfeifer K. Balance training for neuromuscular control and performance enhancement: a systematic review. Journal of athletic training. 2010;45(4):392-403.\u003c/li\u003e\n\u003cli\u003eCheon Y-H, Park T-Y, Song J-K, Seo M-W, Kim K-M, Jung HC. Asymmetry of conventional and functional strength ratios in youth male taekwondo players. Journal of Men\u0026apos;s Health. 2024;20(7):80-7.\u003c/li\u003e\n\u003cli\u003eMarkstr\u0026ouml;m JL, Grip H, Schelin L, H\u0026auml;ger CK. Dynamic knee control and movement strategies in athletes and non‐athletes in side hops: implications for knee injury. Scandinavian journal of medicine \u0026amp; science in sports. 2019;29(8):1181-9.\u003c/li\u003e\n\u003cli\u003eBacon W, Wilson R. MASS-12: evidence-based martial arts striking sports injury prevention programme. Martial Arts Studies. 2024(15):14-24.\u003c/li\u003e\n\u003cli\u003eJeong HS, O\u0026rsquo;Sullivan DM, Rus PR, de Oca ARM. Expert consensus statement to guide research into evidence-based classification of athletes for Para-Taekwondo--A Delphi study. 2021.\u003c/li\u003e\n\u003cli\u003eHopewell S, Chan A-W, Collins GS, Hr\u0026oacute;bjartsson A, Moher D, Schulz KF, et al. CONSORT 2025 statement: updated guideline for reporting randomised trials. The Lancet. 2025;405(10489):1633-40.\u003c/li\u003e\n\u003cli\u003eDaneshjoo A, Mokhtar AH, Rahnama N, Yusof A. The effects of injury prevention warm-up programmes on knee strength in male soccer players. Biology of sport. 2013;30(4):281-8.\u003c/li\u003e\n\u003cli\u003eDrouin JM, Valovich-mcLeod TC, Shultz SJ, Gansneder BM, Perrin DH. Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. European journal of applied physiology. 2004;91(1):22-9.\u003c/li\u003e\n\u003cli\u003eLoidl M, Stutz P, Fernandez Lapuente de Battre MD, Schmied C, Reich B, Bohm P, et al. Merging self‐reported with technically sensed data for tracking mobility behavior in a naturalistic intervention study. Insights from the GISMO study. Scandinavian journal of medicine \u0026amp; science in sports. 2020;30:41-9.\u003c/li\u003e\n\u003cli\u003eScott G, Crossland B. Limb Asymmetry Characteristics Amongst Men\u0026rsquo;s and Women\u0026rsquo;s NCAA Division II Soccer Athletes. J Rehab Pract Res. 2025;6(2):178.\u003c/li\u003e\n\u003cli\u003eDrigny J, Rolland M, Gauthier A. The Influence of Knee Proprioception and Strength on Lower-Limb Functional Symmetry in Healthy Adults. Muscles. 2025;4(1):3.\u003c/li\u003e\n\u003cli\u003eMaly T, Zahalka F, Mala L. Differences between isokinetic strength characteristics of more and less successful professional soccer teams. Journal of Physical Education and Sport. 2011;11(3):306.\u003c/li\u003e\n\u003cli\u003eFaul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods. 2007;39(2):175-91.\u003c/li\u003e\n\u003cli\u003eSchulz KF, Altman DG, Moher D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Journal of clinical epidemiology. 2010;63(8):834-40.\u003c/li\u003e\n\u003cli\u003eKeselman H, Algina J, Kowalchuk RK. The analysis of repeated measures designs: a review. British Journal of Mathematical and Statistical Psychology. 2001;54(1):1-20.\u003c/li\u003e\n\u003cli\u003eRouhi M, Barati A, barzegar bafrouei m. The Relationship Between Performance Indicators, Mental Health, and Sports Injury Incidence During Pre- and Post-Preparation Periods of National Para-Taekwondo Athletes. Journal of Sport Biomechanics. 2025;11(3):252-68.\u003c/li\u003e\n\u003cli\u003eHewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect of neuromuscular training on the incidence of knee injury in female athletes. The American journal of sports medicine. 1999;27(6):699-706.\u003c/li\u003e\n\u003cli\u003eImpellizzeri FM, Bizzini M, Rampinini E, Cereda F, Maffiuletti NA. Reliability of isokinetic strength imbalance ratios measured using the Cybex NORM dynamometer. Clinical physiology and functional imaging. 2008;28(2):113-9.\u003c/li\u003e\n\u003cli\u003eZemkov\u0026aacute; E, Hamar D. Sport-specific assessment of the effectiveness of neuromuscular training in young athletes. Frontiers in physiology. 2018;9:264.\u003c/li\u003e\n\u003cli\u003eBarati AH, Barzegar Bafrouei M, Rouhi M. The Relationship of Sports Injuries With Knee Isokinetic Strength, Anaerobic Power, and Balance in Iranian Paralympic Athletes. The Scientific Journal of Rehabilitation Medicine. 2025;14(4):592-605.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Para-taekwondo, Neuromuscular warm-up, Isokinetic strength, Injury prevention, MASS-12","lastPublishedDoi":"10.21203/rs.3.rs-8354013/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8354013/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\n\u0026nbsp;Para-taekwondo demands explosive lower-limb actions that challenge knee stability and neuromuscular control. Athletes face an elevated risk of noncontact injuries, particularly hamstring strains and anterior cruciate ligament (ACL) rupture. Although neuromuscular warm-ups such as the MASS-12 are effective in able-bodied sports, their impact on Para-taekwondo remains unclear. To determine whether an eight-week neuromuscular warm-up (MASS-12) improves isokinetic knee strength and the functional hamstring–quadriceps (H/Q) ratio in national Para-taekwondo athletes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\n\u0026nbsp;Twenty-four K44 athletes (12 men, 12 women; mean age 23.4 ± 3.9 years) were randomized into MASS-12 (n=12) or control (n=12) groups. The intervention included MASS-12 three times weekly (~20 min/session) for eight weeks, whereas the controls continued standard warm-ups. The isokinetic strength of the dominant leg was assessed on a Biodex System 4 Pro at 60°/s and 180°/s for concentric quadriceps and eccentric hamstrings. Group, time, and interaction effects were tested via 2×2 mixed ANOVA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\n\u0026nbsp;A significant group × time interaction was found for eccentric hamstring strength at 180°/s (F=5.79, P=0.02, η²=0.14; Cohen’s d=1.29), indicating large improvements in the MASS-12 group but not in the control group. No significant changes in concentric quadriceps strength or the functional H/Q ratio were detected (P\u0026gt;0.05). No adverse events were reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003cbr\u003e\n\u0026nbsp;MASS-12 warm-up significantly increased eccentric hamstring strength in national Para-taekwondo athletes, supporting its clinical relevance as a short, sport specific, and effective injury prevention strategy. However, the unchanged quadriceps strength and H/Q ratios suggest that extended or combined neuromuscular protocols may be required for broader muscular adaptations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e\u003cbr\u003e\nThe researchers registered this trial on 07/06/2025, with the identifier IRCT20250626066261N1 in the \u003cem\u003eIranian Registry of Clinical Trials (IRCT)\u003c/em\u003eat the following address: \u0026nbsp;https://irct.behdasht.gov.ir.\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the institutional ethics committee of \u003cem\u003eShahid Beheshti University \u003c/em\u003e(approval code: IR.SBU.REC.1404.055).\u003c/p\u003e","manuscriptTitle":"Does eight-week neuromuscular warm-up improve knee isokinetic strength and the functional hamstring–quadriceps ratio in national team Para-taekwondo athletes? A randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 11:56:47","doi":"10.21203/rs.3.rs-8354013/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-01-14T05:51:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-22T07:13:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-22T03:10:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-22T03:09:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Sports Science, Medicine and Rehabilitation","date":"2025-12-13T16:07:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a6f4e517-a7bc-4589-a07a-10d8af41da12","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T11:56:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 11:56:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8354013","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8354013","identity":"rs-8354013","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}