Objectives.-To test the predictive accuracy of gender-specific operational equations to determine the Fixed Blood Lactate Concentration (FBLC) thresholds, and to examine the relationships between the FBLC thresholds and the performance on the 30-15 Intermittent Fitness Test (VIFT). Methods.-FBLC thresholds and VIFT were determined in a semi-professional female soccer team (n = 15). Cross-validation of the equations predicting FBLC thresholds was performed. The relationships between the FBLC thresholds and the VIFT were examined. Results.-Cross-validation analyses indicated mean differences between estimated and measured FBLC thresholds to be < 6% and standard errors of the measurements < 4%. Pearson's coefficients ranged from 0.79 to 0.97 (P < 0.01), intraclass correlation coefficients from 0.85 to 0.98 (P < 0.01), and coefficients of variation were < 7%. Regression analyses showed FBLC thresholds to be related to VIFT (r = 0.697 to 0.705; P < 0.005; standard errors of the estimates approximate to 5.7%). Cross-validation analyses denoted sex-specific equations for estimation of FBLC thresholds to be generally valid. Conclusion.-Equations to predict FBLC thresholds from the costless VIFT might help reducing the burden associated with cardiorespiratory testing. The equations developed for prediction of VIFT from submaximal procedures (FBLC thresholds) might be of great utility to guide endurance training when no high intensity running exposures are allowed. This is the first study validating FBLC prediction equations and reporting the relationships between aerobic capacity and intermittent aerobic power in female footballers. Reported results are applicable in real training situations and, hence, might interest the supporting staff of female soccer squads. (c) 2024 Elsevier Masson SAS. All rights reserved.

This study investigated the associations between pre-season and in-season performance with external workload in professional soccer players. Twenty-one players completed hamstring strength, countermovement jump (CMJ), 20-m sprint, and Yo-Yo intermittent recovery tests before (pre-season) and after 8 weeks (in-season). External workload (total distance, high-intensity running distance, number of sprints, and power plays) was quantified during this period, and used to divide the average above and below subgroups outcome by outcome for further analyses. Significance was accepted when P <= 0.05. Hamstring strength declined from pre- to in-season [- 6%; p=0.014; effect size (ES): - 0.41], while Yo-Yo performance improved (46%; p=0.001; ES: 1.31). When divided by high-intensity running distance, only the below-average subgroup improved CMJ performance (5%; p=0.030). For minutes played, the above-average subgroup improved Yo-Yo performance (41%; p<0.001), but not the below-average subgroup. Furthermore, playing time correlated with improved Yo-Yo performance (p=0.040; r=0.534). Improved 20-m sprint performance associated with more sprints performed (p=0.045; r=- 0.453). Physical capabilities changed over a competitive season and were related to, and differentiated by, external workload. Because hamstring strength decreased and CMJ only improved in players exposed to less high-intensity external load, practitioners should individualize approaches to counteract these conditions when high external workload is performed over the season.

PURPOSE:To identify the physical conditioning and functional injury-screening characteristics of elite female soccer players. METHODS:This review was prospectively registered (PROSPERO CRD4202346765). Searches were conducted in PubMed/MEDLINE, Cochrane Library, Scopus, and Web of Science (from inception in March 2023 to July 2023). Updated searches were conducted in October 2023 and April 2024. Included studies were quantitative studies conducted on female soccer players. Main outcomes were functional and physical profiles. Screening, data extraction, and quality assessment (Quality Assessment Tool for Quantitative Studies and the Oxford Levels of Evidence scales) were performed. Mean differences between preseason and in-season testing periods were estimated by Hedges g effect size. Methods and results were reported according to PRISMA guidelines. RESULTS:The search yielded 1727 articles, of which 10 were included. Overall methodological quality of the studies was strong, with a moderate level of evidence. Players exhibited mean maximal oxygen uptake of 52.6 (4.5) mL·min-1·kg-1, 20-m linear-sprint performance of 3.58 (0.18) seconds, countermovement jump of 31.0 (2.9) cm, unilateral countermovement jump of 14.4 (2.1) cm, and quadriceps and hamstring peak torque at 60°·s-1 of 133 (23) and 87 (17) N·m, respectively. Mean scores recorded during in-season were 2% to 22% better than in preseason (effect size: small to very large). CONCLUSIONS:This review provides valuable normative physical conditioning and functional injury-risk assessment data for elite female soccer players. Coaches and conditioning staff can use these insights to interpret their own records and optimize their training processes. Furthermore, this study identifies methodological limitations to address in future research.

Purpose: We examined the effects of two 8-week resisted-sprint training programs under different magnitudes of velocity loss (VL) on the speed-related performance of highly trained soccer players. Methods: Twenty-one soccer players (age: 25.9 [5.4] y) were randomly assigned to 1 of 2 groups: (1) the "moderate-load group," players who trained with sled loads that induced 15%VL relative to unloaded sprint velocity (n = 11); and (2) the "heavy-load group," players who trained with sled loads that induced 40% VL relative to unloaded sprint velocity (n = 10). Linear sprint (10 m), curve sprint, change-of-direction speed, resisted-sprint performance at 15% VL and 40% VL, and vertical jumping ability were tested pretraining and posttraining. A 2-way repeated measures analysis of variance was used to test for differences between groups. In addition, percentage changes were calculated for speed-related abilities and compared with their respective coefficients of variation to determine whether individual changes in performance were greater than the test variance (ie, "true change"). Results: A main effect of time was detected for 10-m sprint, curve sprint, change-of-direction speed, and 15% VL and 40% VL resisted-sprint times, with significant decreases in sprint times (P = .003, P = .004, P = .05, P = .036, and P = .019, respectively). Jump variables did not change significantly over time. There were no group-by-time interactions for any tested variable (P > .05), but the "true change" analysis revealed meaningful individual changes in both groups. Conclusions: Both moderate-and heavy-sled loading conditions may optimize the development of speed-related abilities in highly trained soccer players. Nevertheless, resisted-sprint training responses may differ meaningfully when assessed on an individual basis.

Abstract In some compound muscle action potentials (M waves) recorded using the belly–tendon configuration, the tendon electrode makes a noticeable contribution to the M wave. However, this finding has only been demonstrated in some hand and foot muscles. Here, we assessed the contribution of the tendon potential to the amplitude of the vastus lateralis, biceps brachii and tibialis anterior M waves, and we also examined the role of this tendon potential in the shoulder‐like feature appearing in most M waves. M waves were recorded separately at the belly and tendon locations of the vastus lateralis, biceps brachii and tibialis anterior from 38 participants by placing the reference electrode at a distant (contralateral) site. The amplitude of the M waves and the latency of their peaks and shoulders were measured. In the vastus lateralis, the tendon potential was markedly smaller in amplitude (∼75%) compared to the belly M wave (P = 0.001), whereas for the biceps brachii and tibialis anterior, the tendon and belly potentials had comparable amplitudes. In the vastus lateralis, the tendon potential showed a small positive peak coinciding in latency with the shoulder of the belly–tendon M wave, whilst in the biceps brachii and tibialis anterior, the tendon potential showed a clear negative peak which coincided in latency with the shoulder. The tendon potential makes a significant contribution to the belly–tendon M waves of the biceps brachii and tibialis anterior muscles, but little contribution to the vastus lateralis M waves. The shoulder observed in the belly–tendon M wave of the vastus lateralis is caused by the belly potential, the shoulder in the biceps brachii M wave is generated by the tendon potential, whereas the shoulder in the tibialis anterior M wave is caused by both the tendon and belly potentials.

Data-based methods and statistical models are given special attention to the study of sports injuries to gain in-depth understanding of its risk factors and mechanisms. The objective of this work is to evaluate the use of shared frailty Cox models for the prediction of occurring sports injuries, and to compare their performance with different sets of variables selected by several regularized variable selection approaches. The study is motivated by specific characteristics commonly found for sports injury data, that usually include reduced sample size and even fewer number of injuries, coupled with a large number of potentially influential variables. Hence, we conduct a simulation study to address these statistical challenges and to explore regularized Cox model strategies together with shared frailty models in different controlled situations. We show that predictive performance greatly improves as more player observations are available. Methods that result in sparse models and favour interpretability, e.g. Best Subset Selection and Boosting, are preferred when the sample size is small. We include a real case study of injuries of female football players of a Spanish football club.

INTRODUCTION:In the compound muscle action potential (M wave) recorded using the belly-tendon configuration, the contribution of the tendon electrode is assumed to be negligible compared to the belly electrode. We tested this assumption by placing the reference electrode at a distant (contralateral) site, which allowed separate recording of the belly and tendon contributions. METHODS:M waves were recorded at multiple selected sites over the right quadriceps heads and lower leg using two different locations for the reference electrode: the ipsilateral (right) and contralateral (left) patellar tendon. The general parameters of the M wave (amplitude, area, duration, latency, and frequency) were measured. RESULTS:(1) The tendon potential had a small amplitude (<30%) compared to the belly potential; (2) Changing the reference electrode from the ipsilateral to the contralateral patella produced moderate changes in the M wave recorded over the innervation zone, these changes affecting significantly the amplitude of the M-wave second phase (p = 0.006); (3) Using the contralateral reference system allowed recording of short-latency components occurring immediately after the stimulus artefact, which had the same latency and amplitude (p = 0.18 and 0.25, respectively) at all recording sites over the leg. CONCLUSIONS:The potential recorded at the "tendon" site after femoral nerve stimulation is small (compared to the belly potential), but not negligible, and makes a significant contribution to the second phase of belly-tendon M wave. Adopting a distant (contralateral) reference allowed recording of far-field components that may aid in the understanding of the electrical formation of the M wave.

BACKGROUND:Volleyball is a complex intermittent sport characterized by short explosive technical movements, many of which involve vertical jumping. The assessment of mechanical jumping variables in relation to both injury prevention and performance enhancement through the use of wearable technologies is becoming a new training tool among professional volleyball players.METHODS:The present study aimed to assess the vertical jumping mechanics before and after a controlled load (volume and intensity) of a routine volleyball training session among male professional players. Twelve male elite professional volleyball players (23.7±4.9 years, 198.1±6.2 cm, 92.2±10.3 kg) of national and international level belonging to the same Brazilian first league team were recruited. Biomechanical analysis of vertical unilateral countermovement jump (CMJ) and bilateral CMJ tests were performed before and after a routine training session of these players at their usual training court. An inertial orientation sensor placed at the third lumbar vertebra was employed for biomechanical data collection.RESULTS:In relation to the unilateral CMJ, a 10% decrease (P=0.02) in the vertical ground reaction force after training compared to pretraining values was observed. However, no significant differences were observed in the remaining outcomes. Regarding the bilateral CMJ, no significant differences were observed in all assessed outcomes.CONCLUSIONS:Our findings showed no evidence of fatigue after a controlled regular in season volleyball training session in professional players. In addition, this volleyball training session induced a significant reduction in the vertical ground reaction force during unilateral CMJ in volleyball players.

Background Due to the devastating impact of the anterior cruciate ligament (ACL) injury has on the female athlete´s career, anthropometrics and biomechanics-related risk factor screenings have been widely designed. However, the relation of aberrant movement patterns and other anthropometrical variables still remains controversial. Objective The aim of this study was to analyse if lower limb anthropometrics and knee kinematics could explain landing kinetics during a drop jump maneuver, as primary ACL injury risk factors in a female football environment. Design Prospective cross-sectional descriptive study. Testing methodology was settled inside an anatomical, biomechanical and functional conditioning risk factor screening. Data collection was made during the pre-season period. Setting 4 different teams from the region of the Basque Country (Spain). 2 youth second teams and 2 senior teams competing in the Spanish second division. Patients (or Participants) 64 youth female football players (age 20,32±4,9). Every available (non-injured) athlete was included. No lost participants during the data collection. Interventions (or Assessment of Risk Factors) Pelvic width and femur length were measured as anthropometrical gold variables. Knee valgus kinematics and landing kinetics during the bilateral and unilateral drop jump were registered. Main Outcome Measurements Knee valgus kinematic data (femur-tibia angle <180°) was captured by a video analysis tracker software. Landing kinetics were registered using inertial sensor unit technology. Results There was a little correlation (r=0,303) between landing peak VGRF and knee valgus kinematics, at p = 0,01 significance level, and also with the femur length (r=-0,338). In addition, the linear regression analysis showed that the pelvic width, femur length and knee valgus kinematics explained in 89,1% (R2) the landing kinetics results (p=<0,05). Conclusions A moderate significance level between lower limb anthropometrics, knee valgus kinematics and landing kinetics was the main finding at the present study. More exhaustive surveillance screening re-tests are needed in order to detect the main contributors for ACL injury mechanics in a female football context.

PURPOSE To develop gender-specific operational equations for prediction of cardiorespiratory fitness in female footballers. METHOD Forty-eight semiprofessional female footballers performed an intermittent progressive maximal running test for determination of fixed blood lactate concentration (FBLC) thresholds. Relationships between FBLC thresholds and the physiological responses to submaximal running were examined. Developed equations (n = 48) were compared with equations previously obtained in another investigation performed in males (n = 100). RESULTS Submaximal velocity associated with 90% maximal heart rate was related to FBLC thresholds (r = .76 to .79; P < .001). Predictive power (R2 = .82 to .94) of a single blood lactate concentration (BLC) sample measured at 10 or 11.5 km·h-1 was very high. A single BLC sample taken after a 5-minute running bout at 8.5 km·h-1 was related to FBLC thresholds (r = -.71; P < .001). No difference (P = .15) in the regression lines predicting FBLC thresholds from velocity associated with 90% maximal heart rate was observed between the female and male cohorts. However, regressions estimating FBLC thresholds by a single BLC sample were different (P = .002). CONCLUSIONS Velocity associated with 90% maximal heart rate was robustly related to FBLC thresholds and might serve for mass field testing independently of sex. BLC equations accurately predicted FBLC thresholds. However, these equations are gender-specific. This is the first study reporting operational equations to estimate the FBLC thresholds in female footballers. The use of these equations reduces the burden associated with cardiorespiratory testing. Further cross-validation studies are warranted to validate the proposed equations and establish them for mass field testing.

The main objectives of the present study were to describe the injury incidence and to analyze the anthropometric and physical characteristics of players from three high-level women’s football teams. The present study involved 54 female football players (21.9 ± 4.9 years old) from three different teams competing in the Spanish Reto Iberdrola-Segunda División PRO league. A battery of tests was carried out to determine the anthropometric and physical performance characteristics of the players along with an injury incidence record during a full competitive season. The obtained results showed that there was a high incidence of injury, as 38% of the players suffered some type of injury during the season (range 1–5; 1.75 ± 1.02 injuries per player). Injuries occurred in both matches and during training at a similar percentage (48.6 vs. 51.4%), and the majority of the registered episodes were graded as moderate or severe injury types (60%). Players suffering from an injury accumulated a total of 1587 chronological days off work due to injury during the season, with a recurrence rate of 55%. Considering the high incidence of injury, and the injury burden and the reinjure rate observed in this research, it seems necessary to apply the most efficient prevention and recovery measures possible in these female football teams. These descriptive data could serve athletic trainers and medical staff of female football teams to better understand their own screening procedure-derived data.

Background Due to the devastating impact of the anterior cruciate ligament (ACL) injury has on the female athlete´s career, anthropometrics and biomechanics-related risk factor screenings have been widely designed. However, the relation of aberrant movement patterns and other anthropometrical variables still remains controversial. Objective The aim of this study was to analyse if lower limb anthropometrics and knee kinematics could explain landing kinetics during a drop jump maneuver, as primary ACL injury risk factors in a female football environment. Design Prospective cross-sectional descriptive study. Testing methodology was settled inside an anatomical, biomechanical and functional conditioning risk factor screening. Data collection was made during the pre-season period. Setting 4 different teams from the region of the Basque Country (Spain). 2 youth second teams and 2 senior teams competing in the Spanish second division. Patients (or Participants) 64 youth female football players (age 20,32±4,9). Every available (non-injured) athlete was included. No lost participants during the data collection. Interventions (or assessment of risk factors) Pelvic width and femur length were measured as anthropometrical gold variables. Knee valgus kinematics and landing kinetics during the bilateral and unilateral drop jump were registered. Main outcome measurements Knee valgus kinematic data (femur-tibia angle <180°) was captured by a video analysis tracker software. Landing kinetics were registered using inertial sensor unit technology. Results There was a little correlation (r=0,303) between landing peak VGRF and knee valgus kinematics, at p=0,01 significance level, and also with the femur length (r=-0,338). In addition, the linear regression analysis showed that the pelvic width, femur length and knee valgus kinematics explained in 89,1% (R2 ) the landing kinetics results (p≤0,05). Conclusions A moderate significance level between lower limb anthropometrics, knee valgus kinematics and landing kinetics was the main finding at the present study. More exhaustive surveillance screening re-tests are needed in order to detect the main contributors for ACL injury mechanics in a female football context.

Abstract Grazioli, R, Loturco, I, Lopez, P, Setuain, I, Goulart, J, Veeck, F, Inácio, M, Izquierdo, M, Pinto, RS, and Cadore, EL. Effects of moderate-to-heavy sled training using different magnitudes of velocity loss in professional soccer players. J Strength Cond Res 37(3): 629–635, 2023—This study investigated the effects of a 11-week moderate-to-heavy sled training intervention with different magnitudes of velocity loss on sprint and jump performance, mechanical muscle function, and body composition in professional soccer players. Seventeen players (age 25.8 ± 4.3 years; height 180.0 ± 8.6 cm; mass 77.7 ± 9.7 kg) were randomly allocated into 2 groups, based on different magnitudes of velocity loss: 10% of velocity decrease (G10, n = 8) and 20% of velocity decrease (G20, n = 9). The velocity-based sled training consisted of 20-m resisted sprints with a progressive loading increase from 45 to 65% of body-mass throughout the intervention. Pre-intervention and postintervention sprint and jump performance, hamstring and quadriceps peak torque and isometric rate of torque development, and lower-limb lean mass measured by dual X-ray absorptiometry were assessed and compared. Two-way repeated measures analysis of variance revealed a significant time-effect for decreases in 10- and 20-m sprint times (p = 0.018 and p = 0.033, respectively), but without a time-group interaction. The G10 showed greater beneficial effects than G20 for both 10-m (−5.5 ± 3.3%, magnitude-based inference [MBI]: possibly vs. −1.7 ± 5.9%, MBI: possibly trivial) and 20-m (−2.5 ± 2.1%, MBI: possibly vs. −1.4 ± 3.7%, MBI: likely trivial) sprint times. Moreover, there was a significant time effect for countermovement jump height and quadriceps isometric peak torque, which decreased significantly after training (p = 0.019 and p = 0.010, respectively), with no within-group effect of time vs. group interaction for these respective outcomes. The novel velocity-based sled model proposed here, especially under lower magnitudes of velocity loss, was able to significantly improve linear sprint performance in professional soccer players.

The purpose of the first study was to validate two newly proposed core stability tests; Prone Plank test (PPT) and Closed Kinetic Chain test (CCT), for evaluating the strength of the body core. Subsequently, these tests were employed in a longitudinal prospective study implementing a core stability training program with a professional Spanish football team. For the validation study, 22 physically active men (Tegner Scale 6–7) performed three trials of the PPT and CCT tests in two different testing sessions separated by one week. In the longitudinal study, 13 male professional football players were equally evaluated (PPT and CCT) before and after the competitive session in which they completed a core training program. Intra-/intersession, and intertester, reliability was analyzed. PPT and CCT demonstrated excellent to good test–retest reliability and acceptable error measurement (ICCs for intratester and intrasession reliability ranged from 0.77 to 0.94 for the PPT, and 0.8–0.9 for the CCT) in all but one of the testing conditions (female tester for CCT test; ICC = 0.38). Significant improvements on core strength were found from pre to post evaluation in both the PPT (P < 0.01) and CCT (P < 0.01) after the implementation of a core training program in professional football players.

Introduction: Understanding the recovery in response to different sprint protocols is important for optimizing neuromuscular gains and organizing training sessions in sports. The current study aimed to investigate acute neuromuscular changes following a moderate volume of sprint protocols with and without change-of-direction. Methods: 26 well-trained male collegiate athletes from different sports were randomly allocated into straight-line group (SLG) or change-of-direction group (CODG). The protocols were 1 x 15 repetitions of 20-meter sprints in line (SLG) or with two changes in each repetition (CODG). Knee extension maximal and explosive strength, jump performance, serum creatine kinase, and quadriceps and hamstrings echo intensity were collected pre-, post- 0, 24, 48, and 72 h post-exercise. Results: There were no significant changes in any of the variables at any time point after the exercise protocols in comparison with pre-exercise values (p > 0.05). Conclusions: The present study suggests that sprint training with moderate volume with or without change of direction does not induce neuromuscular or physiological changes during 72 h post-exercise. This information is especially important for sports staff in order to optimize training prescription and frequency. (C) 2019 Published by Elsevier Ltd.

Background Handball is a strenuous body-contact team sport that places high loads on the knee joint. Anterior cruciate ligament (ACL) tear is one of the most devastating injuries that any handball player can suffer, and female athletes are at particular risk due to their intrinsic anatomical, hormonal, neuromuscular and biomechanical characteristics. The purpose of this study was to analyze the horizontal jumping biomechanics of female elite handball players with or without previous ACL reconstruction. Methods Twenty-one female participants (6 with previous ACL reconstruction and 15 uninjured controls) were recruited. Two horizontal hopping tasks were evaluated using inertial sensor unit (ISU)-based technology to assess jumping biomechanics through a direct mechanics-based approach. Results The athletes with previous ACL reconstruction demonstrated a significant ( P < 0.05) reduction in the unilateral triple hop for distance compared with the healthy controls. Furthermore, during the initial propulsive phase of the unilateral cross-over hop, the control participants generated significantly ( P < 0.05) higher force values in the mediolateral direction (the X axis) with their dominant limb compared with the ACL-reconstructed (ACL-R) limb of previously injured participants. Conclusions Three-dimensional horizontal jumping biomechanics analyses using ISU-based technologies could provide clinicians with more accurate information regarding the horizontal jumping biomechanical patterns among elite handball female athletes. Furthermore, several mechanical alterations could still be observed among those players who had undergone previous ACL reconstruction, even when several years have passed since the original ACL injury.

PURPOSE:To compare the concentric and eccentric training effects on fatigue induced by eccentric and concentric protocols. METHODS:A total of 22 men and women (22 [3.6] y) were assigned to concentric (GCON, n = 11) or eccentric training (GECC, n = 11). The concentric (CON) and eccentric (ECC) protocols were composed of 4 sets of 20 knee-extension/flexion repetitions. Force losses were analyzed by comparing 10 repetitions' mean torques during the protocols and by verifying the maximal voluntary contraction and rate of torque development before and after the protocols. Muscle damage was assessed using echo intensity of the vastus lateralis 48 h after the protocols. Training consisted of 6 wk of isokinetic exercise at 60°/s (concentric or eccentric) twice weekly. RESULTS:Before training, both protocols resulted in dynamic and isometric force losses in GCON and GECC (P < .01), but the magnitude was greater after the CON protocol than after the ECC protocol (P < .001). After training, both GCON and GECC showed similar force decreases during the CON and ECC protocols (P < .01), and these changes were not different from the pretraining decreases. Regarding maximal voluntary contraction after training, GECC showed lower force decreases than GCON after ECC exercise (-13.7% vs -22.3%, respectively, P < .05), whereas GCON showed lower maximal voluntary contraction decreases after CON exercise compared with pretraining (-29.2%, P < .05). Losses in rate of torque development were similar after the protocols before and after the training regimens. No changes in echo intensity were observed after the protocols before and after training. CONCLUSION:Both interventions resulted in similar force decreases during fatigue protocols compared with those associated with pretraining.

BACKGROUNDWhile both manipulative treatment and physical exercises are used to treat cervical pain, it remains unclear which is most effective.OBJECTIVETo compare the short-term effects of high-velocity, low-amplitude manipulation techniques (MT) with those of home-exercise (HE) with stretching and low-intensity (10% of max) isometric contractions on pain and function.METHODSSingle-blind randomized clinical trial was performed. A total of 27 asymptomatic subjects were randomly assigned to 2 groups: manipulation techniques (MT, n= 13) and home exercise (HE, n= 14). The visual analogue scale (VAS); neck disability index (NDI); pressure pain thresholds; cervical spine range of motion and electromyography during the cranio-cervical flexion test was measured before and one week after the intervention.RESULTSAfter the intervention, both groups showed improved (P< 0.05) NDI and VAS scores and flexion in both rotation ranges compared with the pre-intervention values. For the NDI, pain intensity, and neck flexion, the effects sizes were large; for the majority of the other measurements, the effect sizes were small to moderate. The MT group showed significantly better results than the HE group for 2 out of 17 tests.CONCLUSIONSBoth interventions improved function and pain after one week, with only marginal between-group differences in favor of MT.

Context • Alternatives to medication for immediate pain relief are needed because long-term use of pain medication has been associated with adverse effects. High-velocity, low-amplitude (HVLA) manipulation techniques (MTs) and craniocervical flexion (CCF) exercises have been frequently used in the management of chronic cervical pain. Objective • The study intended to compare the immediate effects on pain of a treatment using HVLA manipulation versus one using a CCF exercise protocol. Design • The research team designed a single-blinded, randomized clinical trial. Setting • The study was conducted at osteopathic clinics. Participants • Participants were 25 volunteer patients with chronic neck pain. Intervention • Participants were randomly enrolled in one of 2 groups: the HVLA manipulation group (MT group), n = 12, or the CCF exercise protocol group (CCF group), n = 13. Participants in the CCF group performed the exercise for 10 repetitions of a 10-s duration, with a 10-s rest interval between each contraction, for a total contraction time of 100 s and a total time of the session of 190 s. Outcome Measures • The outcomes were measured at baseline and at 60 s postintervention. The measures included (1) a visual analogue scale (VAS) completed during range of motion (ROM) measurement, (2) an evaluation of the ROM of the cervical spine, (3) a test of pressure pain thresholds (PPTs), and (4) electromyographic (EMG) activation of sternocleidomastoid muscle during a craniocervical flexion test. Results • Following both interventions, significant changes were found between baseline and immediately postintervention in the VAS score during ROM measurement for both groups, with P = .004 and P = .015, respectively. In the MT group, the measures for flexion (P = .001), right-side bending (P = .002), and left rotation (P = .005) changed significantly between baseline and postintervention; however, only flexion (P = .026) and extension (P = .040) ROM changed significantly between baseline and postintervention in the CCF group. Significant changes were observed in upper trapezius PPT following both interventions-MT group, P = .043, and CCF group, P = .005. In addition, significant changes in C5 PPT had occurred in the CCR group (P = .020). Between-group differences were significant for extension and right-side-bending ROM, with P = .019 and P = .012, respectively, and the changes between baseline and postintervention were greater in the MT group. None of the interventions led to changes in EMG. Conclusions • Although both interventions were associated with immediately improved ROM and pain after treatment, HVLA manipulation was more effective than CCF exercise in improving ROM and VAS during ROM. None of the interventions led to changes in EMG.