Fig. 1

Flowchart illustrating the process from participant recruitment to the final data analysis. Regular participation refers to the attendance of at least two consecutive measurement sessions out of the four conducted over a competitive season. Athletes were considered continuously asymptomatic with VISA-P scores consistently above 87 points. A reduction of ≥ 13 points was considered “turning symptomatic” with a significant aggravation of symptoms. Other constellations (e.g., reporting less or equal to 87 points, yet with small stepwise reductions with each measurement) were excluded from the analysis