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Gibson N, Drain JR, Larsen P, Michael S, Groeller H, Sampson JA. A Comprehensive Analysis of Injuries During Army Basic Military Training. Mil Med 2024; 189:652-660. [PMID: 35781513 PMCID: PMC10898870 DOI: 10.1093/milmed/usac184] [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: 04/06/2022] [Revised: 05/25/2022] [Accepted: 08/04/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The injury definitions and surveillance methods commonly used in Army basic military training (BMT) research may underestimate the extent of injury. This study therefore aims to obtain a comprehensive understanding of injuries sustained during BMT by employing recording methods to capture all physical complaints. MATERIALS AND METHODS Six hundred and forty-six recruits were assessed over the 12-week Australian Army BMT course. Throughout BMT injury, data were recorded via (1) physiotherapy reports following recruit consultation, (2) a member of the research team (third party) present at physical training sessions, and (3) recruit daily self-reports. RESULTS Two hundred and thirty-five recruits had ≥1 incident injury recorded by physiotherapists, 365 recruits had ≥1 incident injury recorded by the third party, and 542 recruits reported ≥1 injury-related problems via the self-reported health questionnaire. Six hundred twenty-one, six hundred eighty-seven, and two thousand nine hundred sixty-four incident injuries were recorded from a total of 997 physiotherapy reports, 1,937 third-party reports, and 13,181 self-reported injury-related problems, respectively. The lower extremity was the most commonly injured general body region as indicated by all three recording methods. Overuse accounted for 79% and 76% of documented incident injuries from physiotherapists and the third party, respectively. CONCLUSIONS This study highlights that injury recording methods impact injury reporting during BMT. The present findings suggest that traditional injury surveillance methods, which rely on medical encounters, underestimate the injury profile during BMT. Considering accurate injury surveillance is fundamental in the sequence of injury prevention, implementing additional injury recording methods during BMT may thus improve injury surveillance and better inform training modifications and injury prevention programs.
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Affiliation(s)
- Neil Gibson
- Centre for Medical and Exercise Physiology, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Jace R Drain
- Land Division, Defence Science and Technology Group, Fishermans Bend, VIC 3207, Australia
| | - Penelope Larsen
- Centre for Medical and Exercise Physiology, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Scott Michael
- Centre for Medical and Exercise Physiology, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Herbert Groeller
- Centre for Medical and Exercise Physiology, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - John A Sampson
- Centre for Medical and Exercise Physiology, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
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Marandure TT, Schwellnus MP, Grant C, Jansen van Rensburg A, Jordaan E, Boer P. Patellofemoral Pain Syndrome Is Associated With Chronic Disease and Allergies in 60 997 Distance Runner Race Entrants: SAFER XXX Study. Clin J Sport Med 2023; 33:603-610. [PMID: 37389463 DOI: 10.1097/jsm.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/22/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Patellofemoral pain syndrome (PFPS) is a common running-related injury. Independent risk factors associated with PFPS have not been described in a large cohort of distance runners. DESIGN Descriptive, cross-sectional study. SETTING 21.1 and 56 km Two Oceans Marathon races (2012-2015). PARTICIPANTS 60 997 race entrants. ASSESSMENT OF RISK FACTORS Participants completed a compulsory prerace medical screening questionnaire (history of PFPS in the past 12 months, n = 362; no injury history, n = 60 635). Selected risk factors associated with a history of PFPS were explored using univariate & multivariate analyses: demographics, training/running variables, history of chronic diseases (composite chronic disease score), and any allergy. MAIN OUTCOME MEASURES Prevalence ratios (PRs, 95% confidence intervals). RESULTS Risk factors associated with PFPS (univariate analysis) were increased years of recreational running (PR = 1.09; P = 0.0107), older age (>50 years), and chronic diseases (PR > 2): gastrointestinal disease (PR = 5.06; P < 0.0001), cardiovascular disease (CVD) (PR = 3.28; P < 0.0001), nervous system/psychiatric disease (PR = 3.04; P < 0.0001), cancer (PR = 2.83; P = 0.0005), risk factors for CVD (PR = 2.42; P < 0.0001), symptoms of CVD (PR = 2.38; P = 0.0397), and respiratory disease (PR = 2.00; P < 0.0001). Independent risk factors (multivariate analysis) associated with PFPS (adjusted for age, sex, and race distance) were a higher chronic disease composite score (PR = 2.68 increased risk for every 2 additional chronic diseases; P < 0.0001) and a history of allergies (PR = 2.33; P < 0.0001). CONCLUSIONS Novel independent risk factors associated with PFPS in distance runners are a history of multiple chronic diseases and a history of allergies. Identification of chronic diseases and allergies should be considered as part of the clinical assessment of a runner presenting with a history of PFPS.
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Affiliation(s)
- Tsungai Tirivashe Marandure
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Pretoria, South Africa
| | - Martin P Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
- Emeritus Professor, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Catharina Grant
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Esmè Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa; and
| | - Pieter Boer
- Department of Human Movement Science, Cape Peninsula University of Technology, Cape Town, South Africa
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Nesterovica-Petrikova D, Vaivads N, Stepens A. Increased Barefoot Stride Variability Might Be Predictor Rather than Risk Factor for Overuse Injury in the Military. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6449. [PMID: 37568990 PMCID: PMC10418758 DOI: 10.3390/ijerph20156449] [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: 06/22/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
Footwear usage could be a promising focus in reducing musculoskeletal injury risk in lower extremities commonly observed among the military. The goal of this research was to find potential gait-related risk factors for lower leg overuse injuries. Cases (n = 32) were active-duty infantry soldiers who had suffered an overuse injury in the previous six months of service before enrolling in the study. The control group (n = 32) included infantry soldiers of the same age and gender who did not have a history of lower leg overuse injury. In the gait laboratory, individuals were asked to walk on a 5-m walkway. Rearfoot eversion, ankle plantar/dorsiflexion and stride parameters were evaluated for barefoot and shod conditions. Barefoot walking was associated with higher stride time variability among cases. According to the conditional regression analysis, stride time variability greater than 1.95% (AUC = 0.77, 95% CI (0.648 to 0.883), p < 0.001) during barefoot gait could predict lower leg overuse injury. Increased barefoot gait variability should be considered as a possible predictive factor for lower leg overuse injury in the military, and gait with military boots masked stride-related differences between soldiers with and without lower leg overuse injury.
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Affiliation(s)
| | - Normunds Vaivads
- Joint Headquarters of the Latvian National Armed Forces Medical Service, LV-1006 Riga, Latvia
| | - Ainārs Stepens
- Military Medicine Research and Study Center, Rīga Stradiņš University, LV-1048 Riga, Latvia;
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Castillo-Domínguez A, García-Romero JC, Alvero-Cruz JR, Ponce-García T, Benítez-Porres J, Páez-Moguer J. Systematic Review of Patient-Reported Outcome Measures for Patients with Exercise-Induced Leg Pain. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:841. [PMID: 35888560 PMCID: PMC9318164 DOI: 10.3390/medicina58070841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Background and Objectives: To determine the most commonly used patient-reported outcome measures (PROMs) in exercise-induced leg pain (EILP) and to identify specific PROMs for EILP in order to evaluate their psychometric properties and methodological quality. Materials and Methods: A strategic search was performed in different databases to identify and extract the characteristics of studies based on the use of PROMs in patients with EILP. Specific PROMs were evaluated according to the Terwee et al. and COSMIN criteria. Results: Fifty-six studies were included in the review. The Medial Tibial Stress Syndrome Score (MTSSS), Lower Extremity Functional Scale (LEFS) and Exercise-Induced Leg Pain Questionnaire (EILP-Q) were identified as specific PROMs for EILP. The Visual Analog Scale (VAS) was the most widely used instrument in the assessment of EILP. The methodological quality assessment showed six positive values for the LEFS, four for the MTSSS and three for the EILP-Q for the eight psychometric properties analyzed according to the COSMIN criteria. The evaluation of the nine psychometric properties according to Terwee showed five positive values for the LEFS and MTSSS, and three for the EILP-Q. Conclusions: The overall methodological quality of the PROMs used was low. The VAS was the most widely used instrument in the assessment of EILP, and the LEFS was the highest quality PROM available for EILP, followed by the MTSSS and EILP-Q, respectively.
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Affiliation(s)
| | - Jerónimo C. García-Romero
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - José Ramón Alvero-Cruz
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - Tomás Ponce-García
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - Javier Benítez-Porres
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - Joaquín Páez-Moguer
- Department of Nursing and Podiatry, University of Malaga, 29071 Malaga, Spain;
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Nesterovica D, Vaivads N, Stepens A. Relationship of footwear comfort, selected size, and lower leg overuse injuries among infantry soldiers. BMC Musculoskelet Disord 2021; 22:952. [PMID: 34781944 PMCID: PMC8594192 DOI: 10.1186/s12891-021-04839-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High rates of musculoskeletal injuries such as plantar fasciitis and stress fractures have been observed among physically active military personnel. During service time, infantry soldiers use issued boots daily that should fit well and provide comfort to prevent injuries and decrease lower extremity pain effectively. The association of military boot comfort with overuse injuries remains unclear. This study investigates the relationship between the chosen military boot size, perceived boot comfort and lower leg overuse injury. METHODS During the cross-sectional study, 227 (males, n = 213; females, n = 14) active-duty infantry soldiers at a mean age of 29.5 years old, and with an average service time of 7.2 years were assessed for a history of overuse injury, footprint length, appropriate shoe size, and footwear comfort. Males with a history of overuse injury (n = 32) and non-injured age-matched controls (n = 34) were selected for detailed testing and establishing the possible relationship between footwear comfort and lower leg overuse injury. RESULTS No relationship was found between footwear comfort and a history of lower leg overuse injury. N = 38 (57.6%) of study subjects were wearing an inappropriate shoe size daily. Inappropriate shoe size usage affected footwear comfort ratings significantly. CONCLUSIONS Study results showed that improper boot size was significantly related to comfort ratings but was not associated with a history of lower leg overuse injury.
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Affiliation(s)
- Darja Nesterovica
- Military Medicine Research and Study Centre, Rīga Stradiņš University, 14 Baložu Street, Riga, LV-1048, Latvia.
| | - Normunds Vaivads
- Latvian National Armed Forces Joint Headquarters Medical Service, Kadaga, 2103, Latvia
| | - Ainars Stepens
- Military Medicine Research and Study Centre, Rīga Stradiņš University, 14 Baložu Street, Riga, LV-1048, Latvia
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Holmes HH, Monaghan PG, Strunk KK, Paquette MR, Roper JA. Changes in Training, Lifestyle, Psychological and Demographic Factors, and Associations With Running-Related Injuries During COVID-19. Front Sports Act Living 2021; 3:637516. [PMID: 34164619 PMCID: PMC8215167 DOI: 10.3389/fspor.2021.637516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
The primary purpose of this study was to examine how the type and magnitude of changes in running behavior, as a consequence of COVID-19 pandemic restrictions, influence running-related injuries. Secondarily, we aimed to examine how lifestyle and psychosocial well-being measures may influence running behavior change. An online survey was advertised to individuals over the age of 18 that currently run or have previously participated in running for exercise. The survey questions examined injury history and new injuries sustained during COVID-19 restrictions, as well as changes related to training behavior changes, training environment changes, social behaviors, and psychosocial well-being. Changes reflected differences in running behaviors prior to COVID-19 restrictions (1 month prior to COVID-19 restrictions being imposed) and during COVID-19 restrictions (May 5 to June 10, 2020). A total of 1,035 runners were included in the analysis. Current injuries sustained during COVID-19 occurred in 9.5% of the runners. Injured runners made a greater number of total changes (p = 0.031) as well as training-related (p = 0.042) and environment-related (p = 0.017) changes compared with uninjured runners. A significant relationship was found between injury and those that reported less time to exercise to changes in work environment (p = 0017). This study highlights the multi-dimensional nature of running-related injuries and the need to consider the interaction of multiple changes in running behavior, rather than isolating single factors. Greater understanding of the underlying causes of running-related injuries can help reduce the risk of future injury.
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Affiliation(s)
| | | | - Kamden K. Strunk
- Department of Educational Foundations, Leadership and Technology, Auburn University, Auburn, AL, United States
| | - Max R. Paquette
- College of Health Sciences, University of Memphis, Memphis, TN, United States
| | - Jaimie A. Roper
- School of Kinesiology, Auburn University, Auburn, AL, United States
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Bordoni B, Escher AR, Tobbi F, Ducoux B, Paoletti S. Fascial Nomenclature: Update 2021, Part 2. Cureus 2021; 13:e13279. [PMID: 33604227 PMCID: PMC7880823 DOI: 10.7759/cureus.13279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/14/2022] Open
Abstract
The fascial continuum is a topic of debate, in particular, its classification into a nomenclature that researchers and medical figures can agree on. Most likely, the difficulty in finding the uniqueness of this topic lies in the fact that only some scientific figures with certain specialties write articles to state their point of view. We know, however, that a matter that involves the human body cannot be taken into consideration only by some scientific arguments, but by all the notions capable of completing a multidisciplinary and impartial vision. The fascia, too often, becomes a destination for earning and selling, to the detriment of the entire scientific community. The second part of the article on fascial nomenclature tries to obtain a new definition of what could be considered the fascial continuum, based on the most innovative information in the literature; the ultimate goal is to give free reflections on the subject in full intellectual freedom.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Filippo Tobbi
- Osteopathy, Poliambulatorio Medico e Odontoiatrico, Varese, ITA
| | - Bruno Ducoux
- Osteopathy, FROP Formation Recherche Osteopathie Prévention, Bordeaux, FRA
| | - Serge Paoletti
- Osteopathic Medicine, Académie d'Ostéopathie de France, Paris, FRA
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