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Ladlow P, Suffield C, Greeves JP, Comfort P, Hughes J, Cassidy RP, Bennett AN, Coppack RJ. How 'STRONG' is the British Army? BMJ Mil Health 2024; 170:283-286. [PMID: 37487657 PMCID: PMC11287571 DOI: 10.1136/military-2023-002508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - C Suffield
- Physical Development Branch, Royal Army Physical Training Corps, Tidworth, UK
| | - J P Greeves
- Department of Army Health and Physical Performance Research, United Kingdom Ministry of Defence, Andover, UK
| | - P Comfort
- School of Health and Society, University of Salford, Salford, UK
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - J Hughes
- Headquarters, Royal Army Physical Training Corps, Aldershot, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
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Johnson AS, Brismée JM, Hooper TL, Hintz CN, Hando BR. Incidence and Risk Factors for Bone Stress Injuries in United States Air Force Special Warfare Trainees. Mil Med 2024; 189:e1790-e1796. [PMID: 38324749 DOI: 10.1093/milmed/usae017] [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: 11/10/2023] [Revised: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES To determine (1) the incidence rate of lower extremity (LE) bone stress injuries (BSIs) in United States Air Force Special Warfare (AFSPECWAR) trainees during the first 120 days of training, and (2) factors associated with sustaining a LE BSI. DESIGN Retrospective cohort study. METHODS AFSPECWAR Airmen (n = 2,290, mean age = 23.7 ± 3.6 years) entering an intensive 8-week preparatory course "SW-Prep" between October 2017 and May 2021. We compared anthropometric measurements, previous musculoskeletal injury (MSKI), fitness measures, and prior high-impact sports participation in those that did and did not suffer a BSI during the 120-day observation period using independent t-tests and chi-square tests. A multivariable binary logistic regression was used to determine factors associated with suffering a BSI. RESULTS A total of 124 AFSPECWAR trainees suffered a BSI during the surveillance period, yielding an incidence proportion of 5.41% and an incidence rate of 1.4 BSIs per 100 person-months. The multivariate logistic regression revealed that lower 2-minute sit-up scores, no prior history of participation in a high-impact high-school sport, and a history of prior LE MSKI were associated with suffering a BSI. A receiver operator characteristic curve analysis yielded an area under the curve (AUC) of 0.727. CONCLUSION BSI incidence proportion for our sample was similar to those seen in other military settings. Military trainees without a history of high-impact sports participation who achieve lower scores on sit-ups tests and have a history of LE MSKI have a higher risk for developing a LE BSI during the first 120 days of AFSPECWAR training.
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Affiliation(s)
- Andrew S Johnson
- Operational Medicine Squadron, USAF Special Warfare, San Antonio, TX 78245, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Troy L Hooper
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Courtney N Hintz
- Operational Medicine Squadron, USAF Special Warfare, San Antonio, TX 78245, USA
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Merrigan JJ, Stone JD, Kraemer WJ, Vatne EA, Onate J, Hagen JA. Female National Collegiate Athletic Association Division-I Athlete Injury Prediction by Vertical Countermovement Jump Force-Time Metrics. J Strength Cond Res 2024; 38:783-786. [PMID: 38513181 DOI: 10.1519/jsc.0000000000004758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
ABSTRACT Merrigan, JJ, Stone, JD, Kraemer, WJ, Vatne, EA, Onate, J, and Hagen, JA. Female National Collegiate Athletic Association Division-I athlete injury prediction by vertical countermovement jump force-time metrics. J Strength Cond Res 38(4): 783-786, 2024-Vertical countermovement jump (CMJ) assessments on force plates have been purported to screen for musculoskeletal injury risk (MSKI) but with little scientific support. Thus, this study aimed to identify associations and noncontact lower-body injury predictability with CMJ force-time metrics in female athletes. The study entailed a retrospective analysis of routine injury and performance monitoring from 155 female National Collegiate Athletics Association Division I athletes. Noncontact lower-body injuries included in analysis were confirmed by medical staff, occurred during competition or training, resulted in time loss from training, and occurred within 3 months following CMJ testing (2 maximal effort, no arm swing, jumps on dual force plates). A total of 44 injuries occurred within 3 months following CMJ baseline testing and resulted in an average of 24.5 missed days from training. Those who sustained an injury were more likely to sustain another injury (15 of 44 injuries [33.1%]; odds ratio = 3.05 [95% CI = 1.31-6.99]). For every 1-unit increase from the mean in eccentric mean power and minimum eccentric force, there was a decrease in odds of sustaining a MSKI. Despite high overall model accuracy (85.6%), the receiving operating characteristic area under the curve (65.9%) was unacceptable and the true positive rate (recall) was 0.0%. Thus, no injuries in the testing data set were correctly classified by the logistic regression model with CMJ force-time metrics as predictors. Baseline CMJ assessment may not be useful for noncontact lower-body musculoskeletal injury screening or predictability in National Collegiate Athletics Association female athletes.
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Affiliation(s)
- Justin J Merrigan
- Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, Ohio
| | | | - William J Kraemer
- Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, Ohio
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Emaly A Vatne
- Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, Ohio
| | - James Onate
- James Crane Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio; and
- Division of Athletic Training, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Josh A Hagen
- Human Performance Collaborative, Office of Research, The Ohio State University, Columbus, Ohio
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Barrett T, Faulk R, Sergeant AM, Boberg J, Bartels M, Colonel ML, Saxon LA. Force plate assessments in reconnaissance marine training company. BMC Sports Sci Med Rehabil 2024; 16:16. [PMID: 38218881 PMCID: PMC10790259 DOI: 10.1186/s13102-023-00796-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024]
Abstract
The ability to obtain dynamic movement assessments using force plate technology holds the promise of providing more detailed knowledge of the strength, balance and forces generated by active-duty military personnel. To date, there are not well-defined use cases for implementation of force plate assessments in military training environments. We sought to determine if force plate technology assessments could provide additional insights, related to the likelihood of graduation, beyond that provided by traditional physical fitness tests (PFT's), in an elite Marine training school. Serial force plate measures were also obtained on those Marines successfully completing training to determine if consistent measures reflecting the effects of training on muscle skeletal load-over-time could be accurately measured. A pre-training force plate assessment performed in 112 Marines did not predict graduation rates. For Marines who successfully completed the course, serial measures obtained throughout training were highly variable for each individual and no firm conclusions could be drawn related to load imposed or the fitness attained during training.
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Affiliation(s)
- Trevor Barrett
- University of Southern California Institute for Creative Technologies, Center for Body Computing, Los Angeles, CA, United States
| | - Robert Faulk
- University of Southern California Institute for Creative Technologies, Center for Body Computing, Los Angeles, CA, United States
| | - Army Master Sergeant
- University of Southern California Institute for Creative Technologies, Center for Body Computing, Los Angeles, CA, United States
| | - Jill Boberg
- University of Southern California Institute for Creative Technologies, Center for Body Computing, Los Angeles, CA, United States
| | - Matthew Bartels
- University of Southern California Institute for Creative Technologies, Center for Body Computing, Los Angeles, CA, United States
| | - Marine Lieutenant Colonel
- University of Southern California Institute for Creative Technologies, Center for Body Computing, Los Angeles, CA, United States
| | - Leslie A Saxon
- University of Southern California Institute for Creative Technologies, Center for Body Computing, Los Angeles, CA, United States.
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Frazer L, Templin T, Eliason TD, Butler C, Hando B, Nicolella D. Identifying special operative trainees at-risk for musculoskeletal injury using full body kinematics. Front Bioeng Biotechnol 2023; 11:1293923. [PMID: 38125303 PMCID: PMC10731296 DOI: 10.3389/fbioe.2023.1293923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction: Non-combat musculoskeletal injuries (MSKIs) during military training significantly impede the US military's functionality, with an annual cost exceeding $3.7 billion. This study aimed to investigate the effectiveness of a markerless motion capture system and full-body biomechanical movement pattern assessments to predict MSKI risk among military trainees. Methods: A total of 156 male United States Air Force (USAF) airmen were screened using a validated markerless biomechanics system. Trainees performed multiple functional movements, and the resultant data underwent Principal Component Analysis and Uniform Manifold And Projection to reduce the dimensionality of the time-dependent data. Two approaches, semi-supervised and supervised, were then used to identify at-risk trainees. Results: The semi-supervised analysis highlighted two major clusters with trainees in the high-risk cluster having a nearly five times greater risk of MSKI compared to those in the low-risk cluster. In the supervised approach, an AUC of 0.74 was produced when predicting MSKI in a leave-one-out analysis. Discussion: The application of markerless motion capture systems to measure an individual's kinematic profile shows potential in identifying MSKI risk. This approach offers a novel way to proactively address one of the largest non-combat burdens on the US military. Further refinement and wider-scale implementation of these techniques could bring about substantial reductions in MSKI occurrence and the associated economic costs.
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Affiliation(s)
- Lance Frazer
- Southwest Research Institute (SwRI), San Antonio, TX, United States
| | - Tylan Templin
- Southwest Research Institute (SwRI), San Antonio, TX, United States
| | | | - Cody Butler
- United States Air Force, Special Warfare Training Wing Research Flight, Joint Base San Antonio-Lackland, San Antonio, TX, United States
| | - Ben Hando
- United States Air Force, Special Warfare Training Wing Research Flight, Joint Base San Antonio-Lackland, San Antonio, TX, United States
- Kennell and Associates Inc, Falls Church, VA, United States
| | - Daniel Nicolella
- Southwest Research Institute (SwRI), San Antonio, TX, United States
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Smith C, Doma K, Heilbronn B, Leicht A. Reliability of Force Plate Metrics During Standard Jump, Balance, and Plank Assessments in Military Personnel. Mil Med 2023; 188:e2058-e2066. [PMID: 36524866 PMCID: PMC10363007 DOI: 10.1093/milmed/usac387] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Prevention of musculoskeletal injury is vital to the readiness, performance, and health of military personnel with the use of specialized systems (e.g., force plates) to assess risk and/or physical performance of interest. This study aimed to identify the reliability of one specialized system during standard assessments in military personnel. METHODS Sixty-two male and ten female Australian Army soldiers performed a two-leg countermovement jump (CMJ), one-leg CMJ, one-leg balance, and one-arm plank assessments using a Sparta Science force plate system across three testing sessions. Sparta Science (e.g., total Sparta, balance and plank scores, jump height, and injury risk) and biomechanical (e.g., average eccentric rate of contraction, average concentric force, and sway velocity) variables were recorded for all sessions. Mean ± SD, intraclass correlation coefficients (ICCs), coefficient of variation, and bias and limits of agreement were calculated for all variables. RESULTS Mean results were similar between sessions 2 and 3 (P > .05). The relative reliability for the Sparta Science (ICC = 0.28-0.91) and biomechanical variables (ICC = 0.03-0.85) was poor to excellent. The mean absolute reliability (coefficient of variation) for Sparta Science variables was similar to or lower than that of the biomechanical variables during the CMJ (1-10% vs. 3-7%), one-leg balance (4-6% vs. 9-14%), and one-arm plank (5-7% vs. 12-17%) assessments. The mean bias for most variables was small (<5% of the mean), while the limits of agreement varied with most unacceptable (±6-87% of the mean). CONCLUSIONS The reliability of most Sparta Science and biomechanical variables during standard assessments was moderate to good. The typical variability in metrics documented will assist practitioners with the use of emerging technology to monitor and assess injury risk and/or training interventions in military personnel.
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Affiliation(s)
- Chelsea Smith
- Royal Australian Army Medical Corps, Australian Army, Townsville, QLD 4811, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Kenji Doma
- Sport and Exercise Science, James Cook University, Townsville, QLD 4811, Australia
| | - Brian Heilbronn
- Royal Australian Army Medical Corps, Australian Army, Townsville, QLD 4811, Australia
- Sport and Exercise Science, James Cook University, Townsville, QLD 4811, Australia
| | - Anthony Leicht
- Sport and Exercise Science, James Cook University, Townsville, QLD 4811, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
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Bird MB, Koltun KJ, Mi Q, Lovalekar M, Martin BJ, Doyle TLA, Nindl BC. Predictive utility of commercial grade technologies for assessing musculoskeletal injury risk in US Marine Corps Officer candidates. Front Physiol 2023; 14:1088813. [PMID: 36733913 PMCID: PMC9887107 DOI: 10.3389/fphys.2023.1088813] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
Recently, commercial grade technologies have provided black box algorithms potentially relating to musculoskeletal injury (MSKI) risk and functional movement deficits, in which may add value to a high-performance model. Thus, the purpose of this manuscript was to evaluate composite and component scores from commercial grade technologies associations to MSKI risk in Marine Officer Candidates. 689 candidates (Male candidates = 566, Female candidates = 123) performed counter movement jumps on SPARTA™ force plates and functional movements (squats, jumps, lunges) in DARI™ markerless motion capture at the start of Officer Candidates School (OCS). De-identified MSKI data was acquired from internal OCS reports for those who presented to the Physical Therapy department for MSKI treatment during the 10 weeks of training. Logistic regression analyses were conducted to validate the utility of the composite scores and supervised machine learning algorithms were deployed to create a population specific model on the normalized component variables in SPARTA™ and DARI™. Common MSKI risk factors (cMSKI) such as older age, slower run times, and females were associated with greater MSKI risk. Composite scores were significantly associated with MSKI, although the area under the curve (AUC) demonstrated poor discrimination (AUC = .55-.57). When supervised machine learning algorithms were trained on the normalized component variables and cMSKI variables, the overall training models performed well, but when the training models were tested on the testing data the models classified MSKI "by chance" (testing AUC avg = .55-.57) across all models. Composite scores and component population specific models were poor predictors of MSKI in candidates. While cMSKI, SPARTA™, and DARI™ models performed similarly, this study does not dismiss the use of commercial technologies but questions the utility of a singular screening task to predict MSKI over 10 weeks. Further investigations should evaluate occupation specific screening, serial measurements, and/or load exposure for creating MSKI risk models.
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Affiliation(s)
- Matthew B. Bird
- Department of Sports Medicine and Nutrition, Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, United States,*Correspondence: Matthew B. Bird,
| | - Kristen J. Koltun
- Department of Sports Medicine and Nutrition, Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Qi Mi
- Department of Sports Medicine and Nutrition, Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mita Lovalekar
- Department of Sports Medicine and Nutrition, Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Brian J. Martin
- Department of Sports Medicine and Nutrition, Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tim L. A. Doyle
- Department of Health Sciences, Biomechanics, Physical Performance and Exercise Research Group, Macquarie University, Sydney, NSW, Australia
| | - Bradley C. Nindl
- Department of Sports Medicine and Nutrition, Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, United States
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Impact of a 5-Week Individualised Training Program on Physical Performance and Measures Associated with Musculoskeletal Injury Risk in Army Personnel: A Pilot Study. Sports (Basel) 2023; 11:sports11010008. [PMID: 36668712 PMCID: PMC9866469 DOI: 10.3390/sports11010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To examine the feasibility and effect of an individualised and force-plate guided training program on physical performance and musculoskeletal injury risk factors in army personnel. DESIGN Pre-post, randomised control. METHODS Fourteen male and five female Australian Army soldiers were randomised into two groups and performed 5-weeks of physical training. The control group (n = 9) completed standard, group-designed, physical training whilst the experimental group (n = 8) completed an individualised training program. Physical (push-ups, multi-stage fitness test, three repetition maximum (3RM) for squat, strict press, deadlift and floor press), occupational (weight-loaded march time), and technological assessments (two-leg and one-leg countermovement jumps (CMJ), one-leg balance, one-arm plank) were conducted prior to and following the training period. Comparisons between groups and changes within groups were conducted via Mann-Whitney U tests. RESULTS Compared to the control group, the experimental group exhibited a significantly smaller improvement for weight-loaded march time (-0.7% ± 4.0% vs. -5.1% ± 3.0%, p = 0.03) and a greater improvement for deadlift-3RM (20.6% ± 11.9% vs. 8.4% ± 6.8%, p = 0.056). All other outcomes were similar between groups. Visually favourable alterations in the two-leg CMJ profile with no reports of injuries were noted for the experimental group. CONCLUSIONS Individualised physical training was feasible within an army setting and, for the most part, produced similar physical, occupational and technological performances to that of standard, group-designed physical training. These preliminary results provide a foundation for future research to expand upon and clarify the benefits of individualised training programs on long-term physical performance and injury risk/incidence in active combat army personnel.
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Physiological biomarker monitoring during arduous military training: Maintaining readiness and performance. J Sci Med Sport 2022:S1440-2440(22)00502-3. [PMID: 36631385 DOI: 10.1016/j.jsams.2022.12.005] [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: 06/15/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Physiological and psychological stressors can degrade soldiers' readiness and performance during military training and operational environments. Integrative and holistic assessments of biomarkers across diverse human performance optimization domains during multistressor training can be leveraged to provide actionable insight to military leadership regarding service member health and readiness. DESIGN/METHOD A broad categorization of biomarkers, to include biochemical measures, bone and body composition, psychometric assessments, movement screening, and physiological load can be incorporated into robust analytical pipelines for understanding the complex factors that impact military human performance. RESULTS In this perspective commentary we overview the rationale, selection, and methodologies for monitoring biomarker domains that are relevant to military research and specifically highlight methods that have been incorporated in a research program funded by the Office of Naval Research, Code 34 Biological and Physiological Monitoring and Modeling of Warfighter Performance. CONCLUSIONS The integration of screening and continuous monitoring methodologies via robust analytical approaches will provide novel insight for military leaders regarding health, performance, and readiness outcomes during multistressor military training.
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