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Coene JR, Reeves PT. Marching Band Injuries in Children Presenting to Emergency Departments in the United States, 2012-2021: A Trebling Tale. Clin Pediatr (Phila) 2024; 63:1106-1114. [PMID: 37924241 DOI: 10.1177/00099228231210656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
Marching band is both a sport and a performance art. Organized athletics like American football, soccer, and cheerleading all have established epidemiologic trends of injury, including stigmata from head trauma. Despite the potential for mild to severe injury, there is a paucity of data on marching band-related morbidity. We examined the National Electronic Injury Surveillance System from 2012 to 2021 to describe demographic information and injury patterns. There were an estimated 20 335 marching band injuries (95% confidence interval: 12 892-27 777). The majority of injuries occurred in females (70%), and those aged 14 to 18 years (85%). Fifty percent of all injuries occurred in the lower extremity, and soft tissue injuries were the most frequently observed diagnosis (49%). Mild traumatic brain injury accounted for 6% of all injuries. Of marching band injury, 98% did not require escalation of care. Based on these findings, we suggest targeted public health intervention by sports medicine teams.
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Affiliation(s)
- Jacob R Coene
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Patrick T Reeves
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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2
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Kierkegaard M, Tegern M, Halvarsson A, Broman L, Larsson H. High Physical Exposure During Female Recruits' Basic Military Training in Sweden-A Descriptive Study. Mil Med 2024; 189:e674-e682. [PMID: 37625078 PMCID: PMC10898928 DOI: 10.1093/milmed/usad335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION There is a knowledge gap concerning the occurrence of physical complaints/injuries, i.e., musculoskeletal disorders (MSD), among Swedish women who undergo basic military training (BMT). The aims were to describe prevalence and factors related to MSD and explore physical exposure and performance in Swedish female recruits during BMT. MATERIALS AND METHODS A total of 144 females (mean age 22 years) who underwent BMT in 2016 participated in this cross-sectional study. Data regarding self-reported MSD, physical performance, physical activity and exercise, motivation and mental and physical preparation, and physical exposure during BMT and perceived health were collected at the end of BMT through the Musculoskeletal Screening Protocol questionnaire. Additional data on muscle strength were retrieved from IsoKai isokinetic lift tests. Descriptive and analytic (paired samples t-test and logistic binary regression) statistics were used. RESULTS The prevalence of MSD was high, with 33% (n = 48) reporting MSD before BMT, 78% (n = 113) during, and 50% (n = 72) at the end of BMT. Knee and upper back were the most frequently reported MSD locations. Forty-four (30%) participants felt insufficiently physically prepared for BMT. The physical exposure was high with loaded marches/runs and carrying heavy loads as the most demanding tasks. The longest walking distance was reportedly 55 km, and the reported maximum load was 50 kg. Forty-five participants (31%) had carried a load representing over 50% of their body weight. Most participants reported good to excellent health at the end of BMT. There was a small (8 N) but significant (P = 0.045) increase in mean force over time. Two variables, MSD before BMT (odds ratio 2.24, P = 0.03) and being physically unprepared (odds ratio 3.03, P < 0.01), were associated with MSD at the end of BMT. CONCLUSION This study showed that the prevalence of MSD in Swedish female recruits was high before, during, and at the end of BMT, with knee and upper back as the most frequent locations. Although the physical exposure during BMT was occasionally high, self-rated health was mainly perceived as good to excellent at the end of BMT. Previous MSD and being physically unprepared were related to MSD at the end of BMT. These important and relevant findings indicate the necessity for implementing interventions to increase physical fitness and treat MSD at the beginning of BMT.
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Affiliation(s)
- Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm SE-141 83, Sweden
- Academic Specialist Center, Center of Neurology, Stockholm Health Services, Stockholm SE-113 65, Sweden
| | - Matthias Tegern
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm SE-141 83, Sweden
- Department of Community Medicine and Rehabilitation, Unit of Physiotherapy, Umeå University, Umeå SE-901 87, Sweden
| | - Alexandra Halvarsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm SE-141 83, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational therapy and Physiotherapy, Karolinska University Hospital, Stockholm SE-141 86, Sweden
| | - Lisbet Broman
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm SE-141 83, Sweden
| | - Helena Larsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm SE-141 83, Sweden
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Hudson S, Barwood M, Low C, Wills J, Fish M. A systematic review of the physiological and biomechanical differences between males and females in response to load carriage during walking activities. APPLIED ERGONOMICS 2024; 114:104123. [PMID: 37625283 DOI: 10.1016/j.apergo.2023.104123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
The purpose of this review was to systematically assess literature on differences between males and females in the physiological and biomechanical responses to load carriage during walking. PubMed, CINAHL, Scopus, Web of Science and the Cochrane library were searched. A total of 4637 records were identified and screened. Thirty-three papers were included in the review. Participant characteristics, load carriage conditions, study protocol, outcome measures and main findings were extracted and qualitatively synthesised. Absolute oxygen uptake and minute ventilation were consistently greater in males but there were limited sex-specific differences when these were expressed relative to physical characteristics. There is limited evidence of sex-specific differences in spatio-temporal variables, ground reaction forces (normalised to body mass) or sagittal plane joint angles with load. However, differences have been found in hip and pelvic motions in the frontal and horizontal planes, which might partly explain an economical advantage for females proposed by some authors.
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Affiliation(s)
- Sean Hudson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom.
| | - Martin Barwood
- School of Health, Sport and Life Sciences, Leeds Trinity University, United Kingdom
| | - Chris Low
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
| | - Jodie Wills
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Michael Fish
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
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4
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Sturdy JT, Rizeq HN, Silder A, Sessoms PH, Silverman AK. Concentric and eccentric hip musculotendon work depends on backpack loads and walking slopes. J Biomech 2024; 163:111942. [PMID: 38219556 DOI: 10.1016/j.jbiomech.2024.111942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
Hip muscle weakness is associated with low back and leg injuries. In addition, hiking with heavy loads is linked to high incidence of overuse injuries. Walking with heavy loads on slopes alters hip biomechanics compared to unloaded walking, but individual muscle mechanical work in these challenging conditions is unknown. Using movement simulations, we quantified hip muscle concentric and eccentric work during walking on 0° and ±10° slopes with, and without 40% bodyweight added loads, and with and without a hip belt. For gluteus maximus, psoas, iliacus, gluteus medius, and biceps femoris long head, both concentric and eccentric work were greatest during uphill walking. For rectus femoris and semimembranosus, concentric work was greatest during uphill and eccentric work was greatest during downhill walking. Loaded walking had greater concentric and eccentric work from rectus femoris, biceps femoris long head, and gluteus maximus. Psoas concentric work was greatest while carrying loads regardless of hip belt usage, but eccentric work was only greater than unloaded walking when using a hip belt. Loaded and uphill walking had high concentric work from gluteus maximus, and high eccentric work from gluteus medius and biceps femoris long head. Carrying heavy loads uphill may lead to excessive hip muscle fatigue and heightened injury risk. Effects of the greater eccentric work from hip flexors when wearing a hip belt on lumbar spine forces and pelvic stability should be investigated. Military and other occupational groups who carry heavy backpacks with hip belts should maintain eccentric strength of hip flexors and hamstrings.
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Affiliation(s)
- Jordan T Sturdy
- Department of Mechanical Engineering, Colorado School of Mines, United States.
| | - Hedaya N Rizeq
- Military and Veterans Health Solutions, Leidos Inc, United States; Warfighter Performance Department, Naval Health Research Center, United States
| | - Amy Silder
- Warfighter Performance Department, Naval Health Research Center, United States
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, United States
| | - Anne K Silverman
- Department of Mechanical Engineering, Colorado School of Mines, United States; Quantitative Biosciences and Engineering, Colorado School of Mines, United States
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5
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Selvakumar S, Li SM, Fahey P, Cheung RTH. Effect of surface inclination on vertical loading rate and footstrike pattern in trail and road runners. Sports Biomech 2023:1-10. [PMID: 37955262 DOI: 10.1080/14763141.2023.2278163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
Trail runners have been reported to be more injury prone than road runners. Limited past studies have examined the difference in the running biomechanics between the two groups of runners. More importantly, the effect of surface inclination has not been fully investigated. Hence, this study examined the effect of surface inclination on running biomechanics in trail and road runners. Twenty trails and 20 road runners were recruited in this study. Trail runners appeared to be more experienced and had longer training distance per week (p < 0.001) compared to road runners. All participants ran at a self-selected pace on an instrumented treadmill in three inclination conditions (i.e., level, +10% uphill and -10% downhill) in a random order. Vertical average loading rate (VALR), vertical instantaneous loading rate (VILR) and footstrike angle (FSA) were measured using established methods. Trail runners experienced greater VILR (p = 0.039, Cohen's d = 2.9) with a greater FSA (p = 0.002, Cohen's d = 1.1) during downhill running than road runners. No significant differences in VALR, VILR and FSA were found between the two groups during level and uphill running. Our findings provide potential biomechanical rationale to explain a higher injury incidence among trail runners.
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Affiliation(s)
- Sharon Selvakumar
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Sin Ming Li
- Physiotherapy Department, Tseung Kwan O Hospital, Hong Kong, China
| | - Paul Fahey
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Roy T H Cheung
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
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6
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Ross JA, Heebner NR. No pain, no gain: The military overtraining hypothesis of musculoskeletal stress and injury. Physiother Theory Pract 2023; 39:2289-2299. [PMID: 35695302 DOI: 10.1080/09593985.2022.2082346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 04/16/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
Abstract
The purpose of this manuscript is to present a model of military overtraining and subsequent injury, discharge, and disability. Military training and combat operations are physically and physiologically demanding, placing great strain on the musculoskeletal system of warfighters. Non-battle musculoskeletal injuries (MSKI) are common and present a serious threat to operational readiness in today's military. MSKI risk stratification and prevention are an active area of research and is steeped in the background of sports science. Here, a model is proposed that incorporates the theory of General Adaptation Syndrome to describe how military training stressors may exceed that of training in traditional athletics and may induce sub-optimal training stressors. Positive feedback loops are discussed to explain how military overtraining (MOT) creates a system of ever-increasing stressors that can only be fully understood in the greater context of all environmental factors leading to overtraining. The Military Overtraining Hypothesis (MOTH) is proposed as a model that encapsulates the elevated MSKI risk in combat arms and other operational military personnel as an effort to broaden understanding of multifactorial military MSKI etiologies and as a tool for researchers and commanders to contextualize MSKI research and risk mitigation interventions.
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Affiliation(s)
- Jeremy A Ross
- Sports Medicine Research Institute, University of Kentucky, Lexington USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, University of Kentucky, Lexington USA
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7
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Gashi F, Kovacic T, Gashi AI, Boshnjaku A, Shalaj I. Predicting Risk Factors of Lower Extremity Injuries in Elite Women's Football: Systematic Review and Meta-Analysis. Sports (Basel) 2023; 11:187. [PMID: 37755864 PMCID: PMC10537545 DOI: 10.3390/sports11090187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
This study identified and analyzed the risk factors of lower extremity injuries (LEI) in elite women football players to improve career and health outcomes. To address this aim, a systematic review and meta-analysis methodology was used. In total, four relevant research articles were identified through database searching and screening using the PRISMA flow diagram. From these articles, eight predictors were identified that influence the risk of LEI among elite women football players: higher body mass index (OR 1.51, 95% CI); previous knee injury (OR 3.57, 95% CI); low normalized knee separation (≤10th percentile) (RR 1.92, 95% CI); all previous injury (previous ACL tear: OR 5.24, 95% CI; ankle sprain: 1.39, 95% CI; knee sprain: 1.50, 95% CI); and previous injury in the lower body (OR 2.97, 95% CI). Meanwhile, lower knee valgus angle in a drop-jump landing (OR 0.64, 95% CI) was found to decrease the risk of LEI among elite women football players.
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Affiliation(s)
- Feim Gashi
- Physiotherapy Program, Faculty of Medicine, Alma Mater Europaea—ECM, 2000 Maribor, Slovenia;
| | - Tine Kovacic
- Physiotherapy Department, Faculty for Health Science, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Arbnore Ibrahimaj Gashi
- Physiotherapy Program, Faculty of Medicine, University “Hasan Prishtina”, 10000 Pristina, Kosovo;
| | - Arben Boshnjaku
- Physiotherapy Program, Faculty of Medicine, University “Fehmi Agani”, 50000 Gjakova, Kosovo;
| | - Ismet Shalaj
- Physiotherapy Department, Faculty of Medical Sciences, Alma Mater Europaea Campus College Rezonanca, 10000 Prishtina, Kosovo
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8
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Krajewski KT, Johnson CC, Ahamed NU, Moir GL, Mi Q, Flanagan SD, Anderst WJ, Connaboy C. Recruit-aged adults may preferentially weight task goals over deleterious cost functions during short duration loaded and imposed gait tasks. Sci Rep 2023; 13:4910. [PMID: 36966216 PMCID: PMC10039906 DOI: 10.1038/s41598-023-31972-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/20/2023] [Indexed: 03/27/2023] Open
Abstract
Optimal motor control that is stable and adaptable to perturbation is reflected in the temporal arrangement and regulation of gait variability. Load carriage and forced-marching are common military relevant perturbations to gait that have been implicated in the high incidence of musculoskeletal injuries in military populations. We investigated the interactive effects of load magnitude and locomotion pattern on motor variability, stride regulation and spatiotemporal complexity during gait in recruit-aged adults. We further investigated the influences of sex and task duration. Healthy adults executed trials of running and forced-marching with and without loads at 10% above their gait transition velocity. Spatiotemporal parameters were analyzed using a goal equivalent manifold approach. With load and forced-marching, individuals used a greater array of motor solutions to execute the task goal (maintain velocity). Stride-to-stride regulation became stricter as the task progressed. Participants exhibited optimal spatiotemporal complexity with significant but not meaningful differences between sexes. With the introduction of load carriage and forced-marching, individuals relied on a strategy that maximizes and regulates motor solutions that achieve the task goal of velocity specifically but compete with other task functions. The appended cost penalties may have deleterious effects during prolonged execution, potentially increasing the risk of musculoskeletal injuries.
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Affiliation(s)
- Kellen T Krajewski
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Camille C Johnson
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nizam U Ahamed
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gavin L Moir
- Exercise Science Department, East Stroudsburg University, East Stroudsburg, PA, USA
| | - Qi Mi
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn D Flanagan
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Anderst
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chris Connaboy
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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9
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Sturdy JT, Rizeq HN, Silder A, Sessoms PH, Silverman AK. WALKING SLOPE AND HEAVY BACKPACK LOADS AFFECT TORSO MUSCLE ACTIVITY AND KINEMATICS. J Electromyogr Kinesiol 2023; 70:102769. [PMID: 37004379 DOI: 10.1016/j.jelekin.2023.102769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023] Open
Abstract
The independent effects of sloped walking or carrying a heavy backpack on posture and torso muscle activations have been reported. While the combined effects of sloped walking and backpack loads are known to be physically demanding, how back and abdominal muscles adapt to walking on slopes with heavy load is unclear. This study quantified three-dimensional pelvis and torso kinematics and muscle activity from longissimus, iliocostalis, rectus abdominis, and external oblique during walking on 0° and ± 10° degree slopes with and without backpack loads using two different backpack configurations (hip-belt assisted and shoulder-borne). Iliocostalis activity was greater during downhill and uphill compared to level walking, but longissimus was only greater during uphill. Rectus abdominis activity was greater during downhill and uphill compared to level, while external oblique activity decreased as slopes progressed from down to up. Longissimus, but not iliocostalis, activity was reduced during both backpack configurations compared to walking with no pack. Hip-belt assisted load carriage required less rectus abdominis activity compared to using shoulder-borne only backpacks; however, external oblique was not influenced by backpack condition. Our results revealed different responses between iliocostalis and longissimus, and between rectus abdominis and external obliques, suggesting different motor control strategies between anatomical planes.
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Affiliation(s)
- Jordan T Sturdy
- Department of Mechanical Engineering, Colorado School of Mines, United States.
| | - Hedaya N Rizeq
- Warfighter Performance Department, Naval Health Research Center, United States; Military and Veterans Health Solutions, Leidos, Inc, United States
| | - Amy Silder
- Warfighter Performance Department, Naval Health Research Center, United States
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, United States
| | - Anne K Silverman
- Department of Mechanical Engineering, Colorado School of Mines, United States; Quantitative Biosciences and Engineering Program, Colorado School of Mines, United States
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10
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Martin J, Kearney J, Nestrowitz S, Burke A, Sax van der Weyden M. Effects of load carriage on measures of postural sway in healthy, young adults: A systematic review and meta-analysis. APPLIED ERGONOMICS 2023; 106:103893. [PMID: 36152447 DOI: 10.1016/j.apergo.2022.103893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023]
Abstract
Load carriage (LC) is a contributing factor to musculoskeletal injury in many occupations. Given that falls are a common mechanism of injury for those frequently engaging in LC, understanding the effects of LC on postural stability (PS) is necessary. A systematic review and meta-analysis was conducted to examine effects of LC on PS. Sixteen and 9 studies were included in the qualitative and quantitative synthesis, respectively. In most studies, it was found that LC leads to a decrease in PS with significant effects on center of pressure (COP) sway area (standardized mean difference = 0.45; p < 0.005) and COP anterior-posterior excursion (standardized mean difference = 0.52; p < 0.05). Furthermore, load magnitude and load placement are factors which can significantly affect COP measures of PS. It is recommended to minimize load magnitude and equally distribute load when possible to minimize LC effects on PS. Future research should examine additional factors contributing to differences in individual PS responses to LC such as changes in muscle activation and prior LC experience.
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Affiliation(s)
- Joel Martin
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Virginia, USA.
| | - James Kearney
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Virginia, USA
| | - Sara Nestrowitz
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Virginia, USA
| | - Adam Burke
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Virginia, USA
| | - Megan Sax van der Weyden
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Virginia, USA
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11
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McNairn J, Tait J, Harlow M, Yang P, Beaudette B, Dhillon P. Putting your best weighted foot forward: Reviewing lower extremity injuries by sex in weighted military marching. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2022. [DOI: 10.3138/jmvfh-2021-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
LAY SUMMARY International marching events, such as the Nijmegen Marches, have a prominent place in Canadian military history, and participation continues today. In the Dutch military, the load carriage requirements previously differed by sex, with men carrying 10 kilograms during the march and women carrying no weight. The Canadian delegation requires both male and female participants to carry 10 kilograms. This article examines the effect of this policy on possible injuries using a Gender-based Analysis Plus lens. Weight carriage should focus on anthropometric factors, not sex, which will allow for appropriate and equal increased stresses (weight) for march participants while minimizing injuries.
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Affiliation(s)
- Jacinta McNairn
- Canadian Forces Health Services Group (Atlantic), Halifax, Nova Scotia, Canada
| | - Justin Tait
- Department of Family Medicine, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Madeline Harlow
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter Yang
- Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
| | | | - Paul Dhillon
- 12 (Vancouver) Field Ambulance, Canadian Forces Health Services Group, Vancouver, British Columbia, Canada
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12
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Faghy MA, Shei R, Armstrong NCD, White M, Lomax M. Physiological impact of load carriage exercise: Current understanding and future research directions. Physiol Rep 2022; 10:e15502. [PMID: 36324291 PMCID: PMC9630762 DOI: 10.14814/phy2.15502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Load carriage (LC) refers to the use of personal protective equipment (PPE) and/or load-bearing apparatus that is mostly worn over the thoracic cavity. A commonplace task across various physically demanding occupational groups, the mass being carried during LC duties can approach the wearer's body mass. When compared to unloaded exercise, LC imposes additional physiological stress that negatively impacts the respiratory system by restricting chest wall movement and altering ventilatory mechanics as well as circulatory responses. Consequently, LC activities accelerate the development of fatigue in the respiratory muscles and reduce exercise performance in occupational tasks. Therefore, understanding the implications of LC and the effects specific factors have on physiological capacities during LC activity are important to the implementation of effective mitigation strategies to ameliorate the detrimental effects of thoracic LC. Accordingly, this review highlights the current physiological understanding of LC activities and outlines the knowledge and efficacy of current interventions and research that have attempted to improve LC performance, whilst also highlighting pertinent knowledge gaps that must be explored via future research activities.
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Affiliation(s)
- Mark A. Faghy
- Biomedical Research Theme, School of Human SciencesUniversity of DerbyDerbyUK
| | - Ren‐Jay Shei
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Nicola C. D. Armstrong
- Defence Science and Technology LaboratorySalisburyUK
- Extreme Environments Laboratory, School of Sport, Health and Exercise ScienceUniversity of PortsmouthPortsmouthUK
| | - Mark White
- Rocky Mountain University of Health ProfessionsProvoUtahUSA
| | - Mitch Lomax
- Extreme Environments Laboratory, School of Sport, Health and Exercise ScienceUniversity of PortsmouthPortsmouthUK
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13
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Middleton K, Vickery-Howe D, Dascombe B, Clarke A, Wheat J, McClelland J, Drain J. Mechanical Differences between Men and Women during Overground Load Carriage at Self-Selected Walking Speeds. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3927. [PMID: 35409609 PMCID: PMC8997774 DOI: 10.3390/ijerph19073927] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022]
Abstract
Few studies have directly compared physical responses to relative loading strategies between men and women during overground walking. This study aimed to compare gait mechanics of men and women during overground load carriage. A total of 30 participants (15 male, 15 female) completed three 10-min walking trials while carrying external loads of 0%, 20% and 40% of body mass at a self-selected walking speed. Lower-body motion and ground reaction forces were collected using a three-dimensional motion capture system and force plates, respectively. Female participants walked with a higher cadence (p = 0.002) and spent less absolute time in stance (p = 0.010) but had similar self-selected walking speed (p = 0.750), which was likely due to the female participants being shorter than the male participants. Except for ankle plantarflexion moments, there were no sex differences in spatiotemporal, kinematic, or kinetic variables (p > 0.05). Increasing loads resulted in significantly lower self-selected walking speed, greater stance time, and changes in all joint kinematics and kinetics across the gait cycle (p < 0.05). In conclusion, there were few differences between sexes in walking mechanics during overground load carriage. The changes identified in this study may inform training programs to increase load carriage performance.
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Affiliation(s)
- Kane Middleton
- Discipline of Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora 3086, Australia; (D.V.-H.); (A.C.)
| | - Danielle Vickery-Howe
- Discipline of Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora 3086, Australia; (D.V.-H.); (A.C.)
| | - Ben Dascombe
- Applied Sport Science and Exercise Testing Laboratory, School of Life and Environmental Sciences, University of Newcastle, Ourimbah 2258, Australia;
| | - Anthea Clarke
- Discipline of Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora 3086, Australia; (D.V.-H.); (A.C.)
| | - Jon Wheat
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S10 2BP, UK;
| | - Jodie McClelland
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora 3086, Australia;
| | - Jace Drain
- Land Division, Defence Science and Technology Group, Fishermans Bend 3207, Australia;
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14
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Sammito S, Hadzic V, Karakolis T, Kelly KR, Proctor SP, Stepens A, White G, Zimmermann WO. Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model. Mil Med Res 2021; 8:66. [PMID: 34886915 PMCID: PMC8662851 DOI: 10.1186/s40779-021-00357-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Musculoskeletal injuries (MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training, operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available. METHODS A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed (using the "snowball method"). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made. RESULTS In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the "order of importance" and including concepts that are modifiable/non-modifiable, as well as extrinsic/intrinsic risk factors. CONCLUSIONS This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.
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Affiliation(s)
- Stefan Sammito
- Section Experimental Aerospace Medicine Research, German Air Force Centre of Aerospace Medicine, Flughafenstraße 1, 51147 Cologne, Germany
- Occupational Medicine, Faculty of Medicine, Otto-Von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Vedran Hadzic
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Thomas Karakolis
- Defence Research and Development Canada, Toronto, ON M3K 2C9 Canada
| | - Karen R. Kelly
- Warfighter Performance, Naval Health Research Center, San Diego, CA 92106-3599 USA
| | - Susan P. Proctor
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760 USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130 USA
| | - Ainars Stepens
- Centre for Military Medicine Research, Riga Stradins University, Riga, 1007 Latvia
| | - Graham White
- Human and Social Sciences Group, Defense Science and Technology Laboratory, Portsdown Hill Road, Fareham, PO17 6AD UK
| | - Wes O. Zimmermann
- Department of Military Sports Medicine, Royal Netherlands Army, 3584 AB Utrecht, The Netherlands
- Department of Military/Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814 USA
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15
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Ross JA, Winters JD, Royer SD, Hoch MC, Bergin R, Morelli N, Conley C, Sheppard RL, Heebner NR. Comparisons and Intercorrelations of Physical Performance Variables of Operational Preparedness in Special Operations Forces. Mil Med 2021; 188:e1109-e1116. [PMID: 34850087 DOI: 10.1093/milmed/usab425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Marine Forces Special Operations Command (MARSOC) deploys teams of operators (OP) and enablers (EN) to accomplish special operations missions. OP and EN are required to train and deploy together to accomplish these missions; however, they have different training and selection pipelines. Advanced strength and conditioning training strategies are applied to both OP and EN to enhance physical preparedness; however, it is unclear how the selection pipeline of these two personnel types affects overall physical preparedness and the relationships between performance variables. The purpose of this study is to gain a greater understanding of the relationships of a wide array of physical preparedness variables in OP and EN in an effort to streamline testing and training strategies. MATERIALS AND METHODS For this study, 155 male (82 OP, 73 EN) MARSOC personnel (age: 29.5 ± 4.9 years, mass: 87.9 ± 11.1 kg, height: 1.79 ± 0.07 m) completed a physical preparedness assessment that included a DEXA assessment of body composition (BF%), 27.4 m sprint (30 yd), countermovement jump (VJ), 5-10-5 pro-agility (Agility), medicine ball toss (UBP), isometric mid-thigh pull (IMTP), and a 30 second (AnC) and 5 minute (AC) non-motorized treadmill run. Independent samples t tests, Mann-Whitney U tests, and Spearman's Rank correlations were used to compare variables between OP and EN. RESULTS OP demonstrated greater VJ, UBP, IMTP, AnC, and AC (P < 0.05); and significantly lower BF% and agility time (P < 0.05). Measurements of mass, height, body mass index, and 30 yd were not significantly different (P > 0.05). Weak to moderate correlations were seen between anthropometric and performance variables. OP and EN demonstrated similar correlations for most performance and anthropometric variables. CONCLUSIONS These results suggest that MARSOC OP demonstrate better physical preparedness over EN, while similar trends are observed between performance variables. Tests with moderate to high correlations may be removed from the protocol to account for testing time constraints. Height, weight, and BF% variables are poorly correlated with performance, particularly in OP, questioning their value in physical performance assessments in this population.
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Affiliation(s)
- Jeremy A Ross
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Joshua D Winters
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Scott D Royer
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Reiley Bergin
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Nathan Morelli
- Department of Physical Therapy, High Point University, High Point, NC 27268, USA
| | - Caitlin Conley
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Ryan L Sheppard
- Marine Forces Special Operations Command, Camp Lejeune, NC 28542, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
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16
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MacGregor AJ, Fogleman SA, Dougherty AL, Ryans CP, Janney CF, Fraser JJ. Sex Differences in the Incidence and Risk of Ankle-Foot Complex Stress Fractures Among U.S. Military Personnel. J Womens Health (Larchmt) 2021; 31:586-592. [PMID: 34846948 DOI: 10.1089/jwh.2021.0292] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: The objective of this study was to evaluate sex differences in the incidence and risk of ankle-foot complex (AFC) stress fractures among U.S. military personnel, which could assist in developing management strategies as females assume a greater role in U.S. military operations. Materials and Methods: The Defense Medical Epidemiology Database was used to identify all diagnosed AFC stress fractures in military personnel from 2006 to 2015. Cumulative incidence of AFC stress fractures was calculated and compared by year, service branch, and military rank. Sex differences in the risk of AFC stress fractures by occupation were examined, and integrated (i.e., male and female) occupations were compared with nonintegrated (i.e., male only) occupations. Results: A total of 43,990 AFC stress fractures were identified. The overall incidence rate was 2.76 per 1,000 person-years (p-y) for males and 5.78 per 1,000 p-y for females. Females consistently had higher incidence of AFC stress fractures across all subgroups, particularly among enlisted personnel. Female enlisted service members had the highest risk of AFC stress fractures in aviation (relative risk [RR] = 5.74; 95% confidence interval [CI]: 4.80-6.87) and artillery/gunnery (RR = 5.15; 95% CI: 4.62-5.75) occupations. Females in integrated occupations had significantly higher rates of AFC stress fractures than males in both integrated and nonintegrated occupations (i.e., special forces, infantry, and mechanized/armor). Conclusions: Females in the U.S. military have a higher risk of AFC stress fractures than males. As integration of females into previously sex-restricted occupations continues, focused prevention efforts may be needed to reduce injury burden and maximize medical readiness.
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Affiliation(s)
- Andrew J MacGregor
- Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA.,Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA.,Axiom Resource Management, Inc., San Diego, California, USA
| | - Sarah A Fogleman
- Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA.,Department of Orthopedic Surgery, Naval Medical Center San Diego, California, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA.,Leidos, Inc., San Diego, California, USA
| | - Camille P Ryans
- Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA.,Department of Orthopedic Surgery, Naval Hospital Jacksonville, Jacksonville, Florida, USA
| | - Cory F Janney
- Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA.,Department of Orthopedic Surgery, Naval Medical Center San Diego, California, USA
| | - John J Fraser
- Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA.,Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, California, USA
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17
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Michael SW, Siddall AG, O'Leary TJ, Groeller H, Sampson JA, Blacker SD, Drain JR. Monitoring work and training load in military settings - what's in the toolbox? Eur J Sport Sci 2021; 22:58-71. [PMID: 34463198 DOI: 10.1080/17461391.2021.1971774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Military personnel are required to complete physically demanding tasks when performing work and training, which may be quantified through the physical stress imposed (external load) or the resultant physiological strain (internal load). The aim of this narrative review is to provide an overview of the techniques used to monitor work and training load in military settings, summarise key findings, and discuss important practical, analytical, and conceptual considerations. Most investigations have focused upon measuring external and internal load in military training environments; however, limited data exist in operational settings. Accelerometry has been the primary tool used to estimate external load, with heart rate commonly used to quantify internal load. Supplemental to heart rate, psychophysiological and biochemical measures have also been investigated to elucidate aspects of internal load. Broadly, investigations have revealed that military training requires personnel to perform relatively large volumes of physical activity (e.g. averaging ∼15,000 steps·day-1) of typically low-moderate intensity activity (<6 MET), although considerable temporal and inter-individual variability is observed from these gross mean estimates. There are limitations associated with these measures and, at best, estimates of external and internal load can only be inferred. These limitations are particularly pertinent for military tasks such as load carriage and manual material handling, which often involve complex activities performed individually or in teams, in a range of operational environments, with multiple layers of protection, over a protracted duration. Comprehensively quantifying external and internal loads during these functional activities poses substantial practical and analytical challenges.
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Affiliation(s)
- Scott W Michael
- Centre of Medical and Exercise Physiology, University of Wollongong, Wollongong, Australia
| | - Andrew G Siddall
- Occupational Performance Research Group, Institute of Sport, University of Chichester, Chichester, UK
| | - Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, UK
| | - Herbert Groeller
- Centre of Medical and Exercise Physiology, University of Wollongong, Wollongong, Australia
| | - John A Sampson
- Centre of Medical and Exercise Physiology, University of Wollongong, Wollongong, Australia
| | - Sam D Blacker
- Occupational Performance Research Group, Institute of Sport, University of Chichester, Chichester, UK
| | - Jace R Drain
- Land Division, Defence Science and Technology Group, Melbourne, Australia
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18
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Almonroeder TG, Harding L, Seubert B, Cowley H, Kernozek T. The effects of incremental changes in rucksack load on lower extremity joint Kinetic patterns during ruck marching. ERGONOMICS 2021; 64:971-982. [PMID: 33688792 DOI: 10.1080/00140139.2021.1893391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
Injuries are often attributed to ruck marching. Therefore, it is important to examine how load carriage influences gait mechanics. The purpose of this study was to examine how subtle changes in rucksack load influence joint torque patterns during marching. Fourteen Army ROTC cadets marched with light, moderate, and heavy rucksack loads. Kinetic and kinematic data were recorded via an instrumented treadmill and motion capture system and principal component analysis was used to analyse the joint torque waveforms. Cadets exhibited moderate-large increases in knee extension torques during early stance (effect sizes ≥0.45) and small-moderate increases in ankle plantarflexion torques during push off (effect sizes ≥0.23) with each incremental increase in rucksack load. The lighter load also resulted in lower hip extension torques during early stance and flexion torques during late stance, vs. the moderate and heavier loads (effect sizes ≥0.23). It appears that subtle changes in rucksack load influence marching mechanics. Practitioner Summary: The purpose of this study was to examine how relatively subtle changes in rucksack load influence marching mechanics. Army ROTC cadets marched with relatively light, moderate, and heavy rucksack loads. Our results indicate that even subtle changes in rucksack load influence joint torque patterns of the hip, knee, and ankle. Abbreviations: ROTC: reserve officer training corps; RoF: rating-of-fatigue; PC: principal component; ICC: intraclass correlation coefficient; ES: effect size.
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Affiliation(s)
- Thomas Gus Almonroeder
- Department of Health Professions, Physical Therapy Program, University of Wisconsin - La Crosse, La Crosse, WI, USA
| | - Lauren Harding
- Department of Health Professions, Physical Therapy Program, University of Wisconsin - La Crosse, La Crosse, WI, USA
| | - Brooke Seubert
- Department of Health Professions, Physical Therapy Program, University of Wisconsin - La Crosse, La Crosse, WI, USA
| | - Hanni Cowley
- Department of Health Professions, Physical Therapy Program, University of Wisconsin - La Crosse, La Crosse, WI, USA
| | - Thomas Kernozek
- Department of Health Professions, Physical Therapy Program, University of Wisconsin - La Crosse, La Crosse, WI, USA
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19
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Hauschild VD, Rappole CA, Forrest LJ, Dada EO, Beymer MR, Grier T, Jones BH. Comparison of injuries between US Army paratroopers and their non-paratrooper soldier counterparts. BMJ Mil Health 2021; 169:236-242. [PMID: 34244378 DOI: 10.1136/bmjmilitary-2021-001791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military studies have investigated acute injuries associated with parachute jumps, but the literature does not address paratroopers' cumulative microtraumatic (CMT) injury risk, nor does it compare injury risks between paratroopers and the rest of the military population. This study determined whether US active duty Army paratroopers experienced greater injury risks than their non-paratrooper soldier counterparts and whether their injuries cost more to treat suggesting greater injury severity. METHODS This retrospective study evaluated electronic medical records (2016-2018) for 31 621 paratroopers and a randomly selected comparison group of 170 715 non-paratrooper soldiers. Analyses included univariate and multivariate regression to quantify odds of injuries associated with risk variables and additional descriptive statistics. RESULTS Paratroopers had a 57% increase in the odds of experiencing one or more injuries (OR=1.57, 95% CI: 1.52 to 1.62) after controlling for sex, race and age, with a greater proportion of acute injuries (OR=1.38, 95% CI: 1.34 to 1.42), relative to comparison group soldiers. Injury types proportionally higher among paratroopers included head trauma and shoulder injuries. Average injury cost among paratroopers was 13% lower than for non-paratroopers ($2470 vs $2830 per injury). Among both populations, acute injury costs were notably higher than for CMT injuries (paratroopers, $1710/$630; non-paratroopers, $1860/$880 per injury). CONCLUSIONS Paratroopers were more likely to incur injury, especially an acute injury, than non-paratroopers. However, paratroopers' average injury costs were less. This may be due to higher return-to-duty motivations, fitness levels, and/or facility-specific cost of care. Future studies should investigate causes of injuries found to be proportionally higher among paratroopers.
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Affiliation(s)
- Veronique D Hauschild
- Military Injury Prevention Division, US Army Public Health Command Epidemiology and Disease Surveillance, Aberdeen Proving Ground, Maryland, USA
| | - C A Rappole
- Military Injury Prevention Division, US Army Public Health Command Epidemiology and Disease Surveillance, Aberdeen Proving Ground, Maryland, USA
| | - L J Forrest
- Army Satellite Support - Aberdeen Proving Ground, MD, Defense Health Agency, Falls Church, Virginia, USA
| | - E O Dada
- Military Injury Prevention Division, US Army Public Health Command Epidemiology and Disease Surveillance, Aberdeen Proving Ground, Maryland, USA
| | - M R Beymer
- Army Satellite Support - Aberdeen Proving Ground, MD, Defense Health Agency, Falls Church, Virginia, USA
| | - T Grier
- Military Injury Prevention Division, US Army Public Health Command Epidemiology and Disease Surveillance, Aberdeen Proving Ground, Maryland, USA
| | - B H Jones
- Military Injury Prevention Division, US Army Public Health Command Epidemiology and Disease Surveillance, Aberdeen Proving Ground, Maryland, USA
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20
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Vaara JP, Groeller H, Drain J, Kyröläinen H, Pihlainen K, Ojanen T, Connaboy C, Santtila M, Agostinelli P, Nindl BC. Physical training considerations for optimizing performance in essential military tasks. Eur J Sport Sci 2021; 22:43-57. [PMID: 34006204 DOI: 10.1080/17461391.2021.1930193] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Physically demanding essential military tasks include load carriage, manual material handling and casualty evacuation. This narrative review characterizes the main physical attributes related to performance of these occupational tasks and reviews physical training intervention studies in military settings to improve performance in these military tasks. Load carriage performance requires both aerobic and neuromuscular fitness with greater emphasis on maximal strength and absolute maximal oxygen uptake, especially when carrying heavier loads. In manual material handling, maximal strength and power are strongly associated with discrete lifting, while muscular strength, muscular endurance and aerobic fitness are also associated with repetitive lifting performance. Maximal strength including grip strength, muscular endurance, absolute maximal oxygen uptake and anaerobic capacity are associated with casualty evacuation performance. The results of the present review particularly emphasize the role of muscular fitness in successful performance of the reviewed military occupational tasks. Training intervention studies indicate that load carriage performance can be effectively improved by combining strength, aerobic and specific load carriage training. Improvement in maximal lifting capacity can be achieved by strength training or combined strength and aerobic training, while strength and aerobic training alone, or their combination are effective in improving repetitive lifting, and carry tasks. Only a few studies are available for casualty evacuation and the results are inconclusive but may indicate benefits of strength or combined training. Moreover, emphasis on lower volume but higher intensity in combined training may be a feasible and effective mode to improve military occupational performance in recruits and active-duty soldiers.
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Affiliation(s)
- Jani P Vaara
- National Defence University, Department of Leadership and Military Pedagogy, Helsinki, Finland
| | - Herbert Groeller
- Centre for Medical and Exercise Physiology, School of Medicine, University of Wollongong, Wollongong, Australia
| | - Jace Drain
- Defence Science and Technology Group, Fishermans Bends, Australia
| | - Heikki Kyröläinen
- National Defence University, Department of Leadership and Military Pedagogy, Helsinki, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Kai Pihlainen
- Defence Command, Training Division, Finnish Defence Forces, Helsinki, Finland
| | - Tommi Ojanen
- Finnish Defence Research Agency, Human Performance Division, Finnish Defence Forces, Tuusula, Finland
| | - Chris Connaboy
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matti Santtila
- National Defence University, Department of Leadership and Military Pedagogy, Helsinki, Finland
| | - Philip Agostinelli
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brad C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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21
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Orr R, Pope R, Lopes TJA, Leyk D, Blacker S, Bustillo-Aguirre BS, Knapik JJ. Soldier Load Carriage, Injuries, Rehabilitation and Physical Conditioning: An International Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4010. [PMID: 33920426 PMCID: PMC8069713 DOI: 10.3390/ijerph18084010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
Soldiers are often required to carry heavy loads that can exceed 45 kg. The physiological costs and biomechanical responses to these loads, whilst varying with the contexts in which they are carried, have led to soldier injuries. These injuries can range from musculoskeletal injuries (e.g., joint/ligamentous injuries and stress fractures) to neurological injuries (e.g., paresthesias), and impact on both the soldier and the army in which they serve. Following treatment to facilitate initial recovery from injuries, soldiers must be progressively reconditioned for load carriage. Optimal conditioning and reconditioning practices include load carriage sessions with a frequency of one session every 10-14 days in conjunction with a program of both resistance and aerobic training. Speed of march and grade and type of terrain covered are factors that can be adjusted to manipulate load carriage intensity, limiting the need to adjust load weight alone. Factors external to the load carriage program, such as other military duties, can also impart physical loading and must be considered as part of any load carriage conditioning/reconditioning program.
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Affiliation(s)
- Robin Orr
- Tactical Research Unit, Bond University, Gold Coast 4213, Australia; (R.P.); (J.J.K.)
| | - Rodney Pope
- Tactical Research Unit, Bond University, Gold Coast 4213, Australia; (R.P.); (J.J.K.)
- School of Community Health, Charles Sturt University, Albury 2640, Australia
| | - Thiago Jambo Alves Lopes
- Research Laboratory of Exercise Science, Centro de Educação Física Almirante Adalberto Nunes, Brazilian Navy, Rio de Janeiro 21941-901, Brazil;
- Post-Graduation Program in Operational Human Performance/PPGDHO, Brazilian Air Force, University of the Air Force, Rio de Janeiro 21941-901, Brazil
| | - Dieter Leyk
- Research Group Epidemiology of Performance, German Sport University Cologne, 50933 Cologne, Germany;
- Bundeswehr Institute for Preventive Medicine, 56626 Andernach, Germany
| | - Sam Blacker
- Occupational Performance Research Group, Institute of Sport, University of Chichester, West Sussex PO19 6PE, UK;
| | - Beatriz Sanz Bustillo-Aguirre
- Ministry of Defence, Paseo de la Castellana 109, 28046 Madrid, Spain;
- Universidad San Pablo-CEU, CEU Universities, Avenida Montepríncipe s/n, Bohadilla del Monte, 28668 Madrid, Spain
| | - Joseph J. Knapik
- Tactical Research Unit, Bond University, Gold Coast 4213, Australia; (R.P.); (J.J.K.)
- United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
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22
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Lovalekar M, Hauret K, Roy T, Taylor K, Blacker SD, Newman P, Yanovich R, Fleischmann C, Nindl BC, Jones B, Canham-Chervak M. Musculoskeletal injuries in military personnel-Descriptive epidemiology, risk factor identification, and prevention. J Sci Med Sport 2021; 24:963-969. [PMID: 33824080 DOI: 10.1016/j.jsams.2021.03.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To provide an overall perspective on musculoskeletal injury (MSI) epidemiology, risk factors, and preventive strategies in military personnel. DESIGN Narrative review. METHODS The thematic session on MSIs in military personnel at the 5th International Congress on Soldiers' Physical Performance (ICSPP) included eight presentations on the descriptive epidemiology, risk factor identification, and prevention of MSIs in military personnel. Additional topics presented were bone anabolism, machine learning analysis, and the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on MSIs. This narrative review focuses on the thematic session topics and includes identification of gaps in existing literature, as well as areas for future study. RESULTS MSIs cause significant morbidity among military personnel. Physical training and occupational tasks are leading causes of MSI limited duty days (LDDs) for the U.S. Army. Recent studies have shown that MSIs are associated with the use of NSAIDs. Bone MSIs are very common in training; new imaging technology such as high resolution peripheral quantitative computed tomography allows visualization of bone microarchitecture and has been used to assess new bone formation during military training. Physical activity monitoring and machine learning have important applications in monitoring and informing evidence-based solutions to prevent MSIs. CONCLUSIONS Despite many years of research, MSIs continue to have a high incidence among military personnel. Areas for future research include quantifying exposure when determining MSI risk; understanding associations between health-related components of physical fitness and MSI occurrence; and application of innovative imaging, physical activity monitoring and data analysis techniques for MSI prevention and return to duty.
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Affiliation(s)
- Mita Lovalekar
- Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, USA.
| | - Keith Hauret
- U.S. Army Public Health Center, Aberdeen Proving Ground, USA
| | - Tanja Roy
- U.S. Army Research Institute of Environmental Medicine, USA
| | - Kathryn Taylor
- U.S. Army Research Institute of Environmental Medicine, USA
| | | | | | - Ran Yanovich
- Institute of Military Physiology, Israel Defense Forces Medical Corps, Israel; Department of Military Medicine, Hebrew University School of Medicine, Israel
| | - Chen Fleischmann
- Institute of Military Physiology, Israel Defense Forces Medical Corps, Israel; Department of Military Medicine, Hebrew University School of Medicine, Israel
| | - Bradley C Nindl
- Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, USA
| | - Bruce Jones
- U.S. Army Public Health Center, Aberdeen Proving Ground, USA
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23
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Robitaille E, Larter V, Heipel S, Reilly T, Chasse E, Tingelstad HC. The feasibility of implementing an evidence-based physical training program during a Canadian Armed Forces basic infantry course. J Sci Med Sport 2021; 24:886-893. [PMID: 33865697 DOI: 10.1016/j.jsams.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Determine the feasibility of implementing an evidence-based training program compared to a control during a basic infantry training course, and compare their effectiveness on measures of injuries and associated burdens. DESIGN Prospective, cohort, feasibility study. METHODS Infantry candidates awaiting course between 01-April-2019 and 31-March-2020 were invited to participate while those releasing from the military, awaiting occupational transfer or having >5 medical employment limitation days were excluded. Consenting participants were allocated to an infantry course prospectively scheduled to host either the evidence-based program or a control. The evidence-based program adapted modified physical training strategies from previous studies reporting reduced injuries in recruits and was supervised by certified fitness professionals, while the control was at the discretion of infantry instructors. RESULTS With the exception of intervention duration which was limited due to operational factors, all feasibility outcomes were met including a recruitment rate of 171/203=84.2% and an intervention adherence of 126/144=87.5%. Stakeholders reported that the evidence-based program implementation was feasible, posing a manageable demand on resources without compromising operations. Evidence-based program participants reported 68% fewer overuse musculoskeletal injuries, 296 fewer medical employment limitation days and 11 fewer attritions than control participants. CONCLUSIONS An evidence-based training program is feasible to implement on a basic infantry training course, and results in fewer musculoskeletal injuries, medical employment limitation days and attrition. Given these results, this program should be generalizable for a full experimental trial, and may be scaled for intermediate/advanced infantry and/or other combat occupation courses to promote an evolution towards evidence-based training.
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Affiliation(s)
- Eric Robitaille
- 31 Canadian Forces Health Services Centre Detachment Meaford, Canadian Forces Health Services, 4th Canadian Division Training Centre, Canada.
| | - Vanessa Larter
- 31 Canadian Forces Health Services Centre Detachment Meaford, Canadian Forces Health Services, 4th Canadian Division Training Centre, Canada
| | - Scott Heipel
- Personnel Support Program, Canadian Forces Morale & Welfare Services, 4th Canadian Division Training Centre, Canada
| | - Tara Reilly
- Human Performance Research, Directorate of Fitness, Canadian Forces Morale & Welfare Services, Canada
| | - Etienne Chasse
- Human Performance Research, Directorate of Fitness, Canadian Forces Morale & Welfare Services, Canada
| | - Hans Christian Tingelstad
- Human Performance Research, Directorate of Fitness, Canadian Forces Morale & Welfare Services, Canada
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24
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Roy TC, Faller TN, Richardson MD, Taylor KM. Characterization of Limited Duty Neuromusculoskeletal Injuries and Return to Duty Times in the U.S. Army During 2017-2018. Mil Med 2021; 187:e368-e376. [PMID: 33420792 DOI: 10.1093/milmed/usaa392] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/03/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Neuromusculoskeletal injuries (MSKI) are the leading cause of medical encounters, lost or limited duty days, medical evacuations, and disability in the U.S. Army. In the U.S. Army, objective MSKI incidence rate metrics can be determined through medical encounter data (M2SKIs) with International Classification of Diseases (ICD) 9 and ICD 10 codes or through documented limited duty profiles (LDPs) documenting time-loss MSKI (TLMSKI). The purpose of the current study was to characterize the population incidence of TLMSKIs among U.S. Army soldiers. MATERIALS AND METHODS This study was approved by the Medical Research and Development Command's Institutional Review Board. This was a retrospective population-level study. The U.S. Army's eProfile system was utilized to characterize all LDPs issued during 2017-2018 and to describe the body regions injured and activities associated with these TLMSKIs. RESULTS The incidence rate of TLMSKIs was found to be 44 and 40 TLMSKI/100 soldier-years for 2017 and 2018, respectively, which is lower than previously published incidence rates using MSKI receiving medical care. Approximately one quarter of the total active duty Army population in 2017 and 2018 recorded limited duty injuries, where those to the ankle/foot region resulted in the most LDPs and those to the knee resulted in the most lost duty days. The majority of all TLMSKIs were associated with fitness training-related activities. CONCLUSION This descriptive study is the first to present the U.S. Army population rates for MSKIs that result in LDPs, representing key time losses when soldiers cannot participate in their military occupational and physical training tasks. This study utilizes the LDP system to calculate limited duty days instead of attempting to estimate this information from other means. The eProfile system is limited in that it combines body regions such as ankle/foot and does not allow isolation of ankle or foot independently. It is recommended that research and training programs target the identification, development, and validation of effective and scaleable strategies to maximize performance without severely reducing combat effectiveness because of training TLMSKIs.
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Affiliation(s)
- Tanja C Roy
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Theresa N Faller
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Melissa D Richardson
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Kathryn M Taylor
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
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25
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Abstract
Over the past 20 years, research on the training-load-injury relationship has grown exponentially. With the benefit of more data, our understanding of the training-performance puzzle has improved. What were we thinking 20 years ago, and how has our thinking changed over time? Although early investigators attributed overuse injuries to excessive training loads, it has become clear that rapid spikes in training load, above what an athlete is accustomed, explain (at least in part) a large proportion of injuries. In this respect, it appears that overuse injuries may arise from athletes being underprepared for the load they are about to perform. However, a question of interest to both athletic trainers (ATs) and researchers is why some athletes sustain injury at low training loads, while others can tolerate much greater training loads? A higher chronic training load and well-developed aerobic fitness and lower body strength appear to moderate the training-injury relationship and provide a protective effect against spikes in load. The training-performance puzzle is complex and dynamic-at any given time, multiple inputs to injury and performance exist. The challenge facing researchers is obtaining large enough longitudinal data sets to capture the time-varying nature of physiological and musculoskeletal capacities and training-load data to adequately inform injury-prevention efforts. The training-performance puzzle can be solved, but it will take collaboration between researchers and clinicians as well as an understanding that efficacy (ie, how training load affects performance and injury in an idealized or controlled setting) does not equate to effectiveness (ie, how training load affects performance and injury in the real-world setting, where many variables cannot be controlled).
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Affiliation(s)
- Tim J. Gabbett
- Gabbett Performance Solutions, Brisbane, and Centre for Health Research, University of Southern Queensland, Ipswich, Australia
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26
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Ryan-Moore E, Mavrommatis Y, Waldron M. Systematic Review and Meta-Analysis of Candidate Gene Association Studies With Fracture Risk in Physically Active Participants. Front Genet 2020; 11:551. [PMID: 32612634 PMCID: PMC7308497 DOI: 10.3389/fgene.2020.00551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Fractures are common in physically active populations and genetic differences may mediate injury risk. Objective: To meta-analyse the pooled results of candidate gene association studies with non-osteoporotic fracture risk in physically active humans. Methods: Systematic searching of databases returned 11 eligible studies published in English. Pooled odds ratios (ORs) with 95% confidence intervals (CI) were produced using allele contrast, recessive and homozygote contrast meta-analysis models to evaluate associations of risk alleles in the COL1A1 (rs1800012), COL2A1 (rs412777), CTR (rs1801197), ESR1 (rs2234693 and rs9340799) LRP5 (rs3736228), VDR (rs10735810, rs7975232, rs1544410, and rs731236) genes with fracture incidence. Results: Eligible study quality was generally low (7/11) and no significant overall effect was found for any genetic variant with any comparison model (p > 0.05). A trivial reduction in fracture risk was found for female participants with the COL1A1 Sp1 (rs1800012) T allele (OR = 0.48, 95% CI = 0.25–0.91, p = 0.03, d = –0.18). Conclusions: No overall effect was found from the pooled results of included genetic variants on fracture risk in physically active participants. The COL1A1 Sp1 rs1800012 T allele may reduce fracture risk in physically active females but further high-quality research with sex-specific analysis is required. Trial Registration: (PROSPERO; CRD42018115008).
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Affiliation(s)
- Edward Ryan-Moore
- Faculty of Sport, Health and Applied Sciences, St Mary's University, London, United Kingdom.,Fulham Football Club, Sports Science and Medicine, London, United Kingdom
| | - Yiannis Mavrommatis
- Faculty of Sport, Health and Applied Sciences, St Mary's University, London, United Kingdom.,Nell Health Ltd., Genetics & Nutrition, London, United Kingdom
| | - Mark Waldron
- Research Centre in Applied Sports, Technology, Exercise and Medicine, Swansea University, Swansea, United Kingdom.,School of Science and Technology, University of New England, Armidale, NSW, Australia
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27
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Grier T, Dinkeloo E, Reynolds M, Jones BH. Sleep duration and musculoskeletal injury incidence in physically active men and women: A study of U.S. Army Special Operation Forces soldiers. Sleep Health 2020; 6:344-349. [DOI: 10.1016/j.sleh.2020.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
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28
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Bissas A, Havenetidis K, Walker J, Hanley B, Nicholson G, Metaxas T, Christoulas K, Cronin NJ. Muscle-tendon morphology and function following long-term exposure to repeated and strenuous mechanical loading. Scand J Med Sci Sports 2020; 30:1151-1162. [PMID: 32246562 DOI: 10.1111/sms.13669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/16/2020] [Accepted: 03/13/2020] [Indexed: 01/12/2023]
Abstract
We mapped structural and functional characteristics of muscle-tendon units in a population exposed to very long-term routine overloading. Twenty-eight military academy cadets (age = 21.00 ± 1.1 years; height = 176.1 ± 4.8 cm; mass = 73.8 ± 7.0 kg) exposed for over 24 months to repetitive overloading were profiled via ultrasonography with a senior subgroup of them (n = 11; age = 21.4 ± 1.0 years; height = 176.5 ± 4.8 cm; mass = 71.4 ± 6.6 kg) also tested while walking and marching on a treadmill. A group of eleven ethnicity- and age-matched civilians (age = 21.6 ± 0.7 years; height = 176.8 ± 4.3 cm; mass = 74.6 ± 5.6 kg) was also profiled and tested. Cadets and civilians exhibited similar morphology (muscle and tendon thickness and cross-sectional area, pennation angle, fascicle length) in 26 out of 29 sites including the Achilles tendon. However, patellar tendon thickness along the entire tendon was greater (P < .05) by a mean of 16% for the senior cadets compared with civilians. Dynamically, cadets showed significantly smaller ranges of fascicle length change and lower shortening velocity in medial gastrocnemius during walking (44.0% and 47.6%, P < .05-.01) and marching (27.5% and 34.3%, P < .05-.01) than civilians. Furthermore, cadets showed lower normalized soleus electrical activity during walking (22.7%, P < .05) and marching (27.0%, P < .05). Therefore, 24-36 months of continuous overloading, primarily occurring under aerobic conditions, leads to more efficient neural and mechanical behavior in the triceps surae complex, without any major macroscopic alterations in key anatomical structures.
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Affiliation(s)
| | | | - Josh Walker
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Brian Hanley
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | | | - Thomas Metaxas
- Laboratory of Evaluation of Human Biological Performance, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kosmas Christoulas
- Laboratory of Evaluation of Human Biological Performance, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Neil J Cronin
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department for Health, University of Bath, Bath, UK
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29
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Molloy JM, Pendergrass TL, Lee IE, Chervak MC, Hauret KG, Rhon DI. Musculoskeletal Injuries and United States Army Readiness Part I: Overview of Injuries and their Strategic Impact. Mil Med 2020; 185:e1461-e1471. [DOI: 10.1093/milmed/usaa027] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/07/2019] [Accepted: 01/29/2020] [Indexed: 12/25/2022] Open
Abstract
Abstract
Introduction
Noncombat injuries (“injuries”) greatly impact soldier health and United States (U.S.) Army readiness; they are the leading cause of outpatient medical encounters (more than two million annually) among active component (AC) soldiers. Noncombat musculoskeletal injuries (“MSKIs”) may account for nearly 60% of soldiers’ limited duty days and 65% of soldiers who cannot deploy for medical reasons. Injuries primarily affect readiness through increased limited duty days, decreased deployability rates, and increased medical separation rates. MSKIs are also responsible for exorbitant medical costs to the U.S. government, including service-connected disability compensation. A significant subset of soldiers develops chronic pain or long-term disability after injury; this may increase their risk for chronic disease or secondary health deficits potentially associated with MSKIs. The authors will review trends in U.S. Army MSKI rates, summarize MSKI readiness-related impacts, and highlight the importance of standardizing surveillance approaches, including injury definitions used in injury surveillance.
Materials/Methods
This review summarizes current reports and U.S. Department of Defense internal policy documents. MSKIs are defined as musculoskeletal disorders resulting from mechanical energy transfer, including traumatic and overuse injuries, which may cause pain and/or limit function. This review focuses on various U.S. Army populations, based on setting, sex, and age; the review excludes combat or battle injuries.
Results
More than half of all AC soldiers sustained at least one injury (MSKI or non-MSKI) in 2017. Overuse injuries comprise at least 70% of all injuries among AC soldiers. Female soldiers are at greater risk for MSKI than men. Female soldiers’ aerobic and muscular fitness performances are typically lower than men’s performances, which could account for their higher injury rates. Older soldiers are at greater injury risk than younger soldiers. Soldiers in noncombat arms units tend to have higher incidences of reported MSKIs, more limited duty days, and higher rates of limited duty days for chronic MSKIs than soldiers in combat arms units. MSKIs account for 65% of medically nondeployable AC soldiers. At any time, 4% of AC soldiers cannot deploy because of MSKIs. Once deployed, nonbattle injuries accounted for approximately 30% of all medical evacuations, and were the largest category of soldier evacuations from both recent major combat theaters (Iraq and Afghanistan). More than 85% of service members medically evacuated for MSKIs failed to return to the theater. MSKIs factored into (1) nearly 70% of medical disability discharges across the Army from 2011 through 2016 and (2) more than 90% of disability discharges within enlisted soldiers’ first year of service from 2010 to 2015. MSKI-related, service-connected (SC) disabilities account for 44% of all SC disabilities (more than any other body system) among compensated U.S. Global War on Terrorism veterans.
Conclusions
MSKIs significantly impact soldier health and U.S. Army readiness. MSKIs also figure prominently in medical disability discharges and long-term, service-connected disability costs. MSKI patterns and trends vary between trainees and soldiers in operational units and among military occupations and types of operational units. Coordinated injury surveillance efforts are needed to provide standardized metrics and accurately measure temporal changes in injury rates.
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Affiliation(s)
- Joseph M Molloy
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830
- U.S. Army Office of the Surgeon General, Physical Performance Service Line, G 3/5/7, Falls Church, VA 22042
| | - Timothy L Pendergrass
- U.S. Army Office of the Surgeon General, Physical Performance Service Line, G 3/5/7, Falls Church, VA 22042
| | - Ian E Lee
- Solution Delivery Division, U.S. Defense Health Agency, Falls Church, VA 22042
| | - Michelle C Chervak
- U.S. Army Public Health Center, Injury Prevention Program, Aberdeen Proving Ground, Aberdeen, MD 21005
| | - Keith G Hauret
- U.S. Army Public Health Center, Injury Prevention Program, Aberdeen Proving Ground, Aberdeen, MD 21005
| | - Daniel I Rhon
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830
- U.S. Army Office of the Surgeon General, Physical Performance Service Line, G 3/5/7, Falls Church, VA 22042
- Center for the Intrepid, Brooke Army Medical Center, Joint Base San Antonio Fort Sam Houston, TX 78234
- Duke Clinical Research Institute, Duke University, Durham, NC 27701
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30
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The relationship between neck angles and ground reaction forces in schoolchildren during backpack carriage. BIOMEDICAL HUMAN KINETICS 2020. [DOI: 10.2478/bhk-2020-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Summary
Study aim: This study aimed to examine the effect of carrying backpacks on neck posture and ground reaction forces (GRFs) and to investigate the relationship between neck angles and GRFs during backpack carriage in schoolchildren.
Material and methods: The craniohorizontal angle (CHA), craniovertebral angle (CVA), sagittal shoulder posture (SSP) and GRFs were measured in right-handed schoolchildren (14 male and 12 female) with mean age 10.17 ± 1.15 years during loaded and unloading conditions. The Qualisys motion analysis system with a force plate was used to assess the neck angles and GRFs.
Results: During backpack carriage there was a significant increase in the CHA (p = 0.001), significant decrease in the CVA and SSP (p = 0.001, 0.016 respectively), no significant difference in the normalized (scaled to body weight) vertical GRFs (p > 0.05), and a significant increase in the anterior braking and posterior propulsive GRFs (p = 0.035, 0.002 respectively) compared to the unloading condition. While carrying a backpack there was a moderate negative correlation between the SSP and first vertical GRF (r = –0.464) and a strong negative correlation with the second vertical GRF (r = –0.571) and the posterior propulsive GRF (r = –0.587).
Conclusion: Carrying a backpack weighing 15% of the child’s body weight changes the head posture and increases the normalized value of the anterior-posterior shear force. During backpack carriage, decreasing the SSP is associated with increasing the load acceptance, thrusting and posterior propulsive forces. Increasing the shearing force may lead to development of postural abnormities. Consequently, the ideal backpack weight should be considered by parents and teachers.
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31
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Females and males use different hip and knee mechanics in response to symmetric military-relevant loads. J Biomech 2019; 95:109280. [DOI: 10.1016/j.jbiomech.2019.07.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/03/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
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32
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Using causal energy categories to report the distribution of injuries in an active population: An approach used by the U.S. Army. J Sci Med Sport 2019; 22:997-1003. [DOI: 10.1016/j.jsams.2019.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 12/31/2022]
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33
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Expanding the injury definition: evidence for the need to include musculoskeletal conditions. Public Health 2019; 169:69-75. [DOI: 10.1016/j.puhe.2019.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/12/2018] [Accepted: 01/03/2019] [Indexed: 11/18/2022]
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34
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Gabbett TJ. Debunking the myths about training load, injury and performance: empirical evidence, hot topics and recommendations for practitioners. Br J Sports Med 2018; 54:58-66. [PMID: 30366966 DOI: 10.1136/bjsports-2018-099784] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, QLD, Australia.,University of Southern Queensland, Institute for Resilient Regions, Ipswich, QLD, Australia
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35
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Jones BH, Hauschild VD, Canham-Chervak M. Musculoskeletal training injury prevention in the U.S. Army: Evolution of the science and the public health approach. J Sci Med Sport 2018; 21:1139-1146. [PMID: 29602720 DOI: 10.1016/j.jsams.2018.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/12/2018] [Accepted: 02/22/2018] [Indexed: 11/17/2022]
Abstract
Injuries cause more morbidity among soldiers in the U.S. Army than any other health condition. Over two-thirds of U.S. soldiers' injuries occur gradually from cumulative micro-traumatic damage to the musculoskeletal system as a result of physical training activities. Paradoxically, the very physical training activities required to improve soldier performance also result in injury. Determining the amounts and types of physical training that maximize performance while minimizing injuries requires scientific evidence. This evidence must be incorporated into a framework that ensures scientific gaps are addressed and prevention efforts are evaluated. The five-step public health approach has proven to be an effective construct for Army public health to organize and build an injury prevention program. Steps include: 1) surveillance to define the magnitude of the problem, 2) research and field investigations to identify causes and risk factors, 3) intervention trials and systematic reviews to determine what works to address leading risk factors, 4) program and policy implementation to execute prevention, and 5) program evaluation to assess effectiveness. Dissemination is also needed to ensure availability of scientific lessons learned. Although the steps may not be conducted in order, the capability to perform each step is necessary to sustain a successful program and make progress toward injury control and prevention. As with many U.S. public health successes (e.g., seatbelts, smoking cessation), the full process can take decades. As described in this paper, the U.S. Army uses the public health approach to assure that, as the science evolves, it is translated into effective prevention.
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Affiliation(s)
- Bruce H Jones
- Injury Prevention Division, Army Public Health Center, United States.
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