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Scott KM, Kreisel BR, Florkiewicz EM, Crowell MS, Morris JB, McHenry PA, Benedict TM. The Effect of Cautionary Versus Resiliency Spine Education on Maximum Deadlift Performance and Back Beliefs: A Randomized Control Trial. J Strength Cond Res 2024; 38:e341-e348. [PMID: 38900182 DOI: 10.1519/jsc.0000000000004783] [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: 06/21/2024]
Abstract
ABSTRACT Scott, KM, Kreisel, BR, Florkiewicz, EM, Crowell, MS, Morris, JB, McHenry, PA, and Benedict, TM. The effect of cautionary versus resiliency spine education on maximum deadlift performance and back beliefs: A randomized control trial. J Strength Cond Res 38(7): e341-e348, 2024-The purpose of this study was to determine the effect of cautionary information about the spine vs. a message of spine resiliency on maximum deadlift (MDL) performance and beliefs regarding the vulnerability of the spine. This cluster randomized control trial involved 903 military new cadets (n = 903) during their mandatory fitness test in cadet basic training (mean age 18.3 years, body mass index 23.8 kg·m-2, 22% female). Subjects were cluster randomized to 3 groups. The cautionary group received a message warning them to protect their backs while deadlifting, the resiliency group received a message encouraging confidence while deadlifting, and the control group received the standardized Army deadlift education only. The outcome measures were MDL weight lifted and perceived spine vulnerability. Significance was set at alpha ≤0.05. There were no between-group differences in weight lifted (p=0.40). Most subjects believed that the spine is vulnerable to injury. Three times as many subjects who received the resiliency education improved their beliefs about the vulnerability of their spines compared with those receiving the cautionary education (p<0.001). This study demonstrated the potential for brief resiliency education to positively influence beliefs about spine vulnerability, whereas cautionary education did not impair performance.
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Affiliation(s)
- Kelly M Scott
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
| | - Brian R Kreisel
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
| | - Erin M Florkiewicz
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
- Doctor of Philosophy in Health Sciences Program, Rocky Mountain University of Health Professions, Provo, Utah
| | - Michael S Crowell
- Department of Physical Therapy, University of Scranton, Scranton, Pennsylvania
| | - Jamie B Morris
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
| | - Paige A McHenry
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
| | - Timothy M Benedict
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
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Wu H, Brooke-Wavell K, Fong DTP, Paquette MR, Blagrove RC. Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners? A Systematic Review and Meta-Analysis. Sports Med 2024; 54:1249-1267. [PMID: 38261240 PMCID: PMC11127851 DOI: 10.1007/s40279-024-01993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Endurance running is a popular sport and recreational activity yet is associated with a high prevalence of injury. Running related injuries (RRIs) are a leading cause of drop-out and represent a substantial financial burden to runners and healthcare services. There is clear evidence for the use of exercise-based injury prevention programs in games-based and youth sport settings, yet the research investigating the use of exercise to reduce injury risk in endurance runners has not been adequately reviewed recently. OBJECTIVES The aim of this review and meta-analysis was to systematically summarize the current research that has investigated the effect of exercise-based prevention programs and their state of supervision on the risk of RRIs in endurance runners. METHODS Three databases were searched for relevant studies. Selection and review were completed by two independent reviewers using the following inclusion criteria: (1) study population used endurance running training for health, occupational, or performance outcome(s); (2) participants performed running as their main form of exercise (> 50% of their total training time); (3) study was a randomized controlled trial; (4) a non-running-based exercise intervention was used; (5) a running-only or placebo exercise control group was included; (6) injury rate or incidence was reported; (7) injuries were recorded prospectively alongside the exercise training. Two meta-analyses were conducted using random-effects models, one based on log risk ratio and one based on log incidence rate ratio. The Cochrane Risk of Bias Assessment Tool 2 was used to evaluate the quality of studies and the Grading of Recommendations Assessment, Development and Evaluations approach was employed to grade the certainty of evidence. RESULTS A total of nine articles containing 1904 participants were included in analysis. Overall pooled results showed no significant differences between intervention and control groups in injury risk (z = - 1.60; p = 0.110) and injury rate (z = - 0.98; p = 0.329), while a post hoc analysis evaluating supervised interventions only showed that injury risk was significantly lower in the intervention group compared to the control group (z = - 3.75, p < 0.001). Risk of bias assessment revealed that seven studies included in the analysis were of low quality. CONCLUSIONS Exercise-based interventions do not appear to reduce the risk and rate of running-related injuries. Supervision may be essential for exercise-based intervention programs to reduce risk of RRIs, possibly due to increased compliance. Studies with more robust designs that include supervised exercise interventions should be prioritized in the future. TRIAL REGISTRY Clinical Trial Registration: PROSPERO CRD42021211274.
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Affiliation(s)
- Han Wu
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Katherine Brooke-Wavell
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Max R Paquette
- College of Health Sciences, University of Memphis, Memphis, TN, USA
| | - Richard C Blagrove
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
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Hearn DW, Kerr ZY, Wikstrom EA, Goss DL, Cameron KL, Marshall SW, Padua DA. Modeling Risk for Lower Extremity Musculoskeletal Injury in U.S. Military Academy Cadet Basic Training. Mil Med 2024:usae083. [PMID: 38554261 DOI: 10.1093/milmed/usae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION Sport and tactical populations are often impacted by musculoskeletal injury. Many publications have highlighted that risk is correlated with multiple variables. There do not appear to be existing studies that have evaluated a predetermined combination of risk factors that provide a pragmatic model for application in tactical and/or sports settings. PURPOSE To develop and test the predictive capability of multivariable risk models of lower extremity musculoskeletal injury during cadet basic training at the U.S.Military Academy. MATERIALS AND METHODS Cadets from the class of 2022 served as the study population. Sex and injury history were collected by questionnaire. Body Mass Index (BMI) and aerobic fitness were calculated during testing in the first week of training. Movement screening was performed using the Landing Error Scoring System during week 1 and cadence was collected using an accelerometer worn throughout initial training. Kaplan-Meier survival curves estimated group differences in time to the first musculoskeletal injury during training. Cox regression was used to estimate hazard ratios (HRs) and Akaike Information Criterion (AIC) was used to compare model fit. RESULTS Cox modeling using HRs indicated that the following variables were associated with injury risk : Sex, history of injury, Landing Error Scoring System Score Category, and Physical Fitness Test (PT) Run Score. When controlling for sex and history of injury, amodel including aerobic fitness and BMI outperformed the model including movement screening risk and cadence (AIC: 1068.56 vs. 1074.11) and a model containing all variables that were significant in the univariable analysis was the most precise (AIC: 1063.68). CONCLUSIONS In addition to variables typically collected in this tactical setting (Injury History, BMI, and aerobic fitness), the inclusion of kinematic testing appears to enhance the precision of the risk identification model and will likely continue to be included in screening cadets at greater risk.
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Affiliation(s)
- Darren W Hearn
- Doctor of Physical Therapy Program, South College, Knoxville, TN 37909, USA
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA
- United States Army, Fort Liberty, NC 28310, USA
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7505, USA
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA
| | - Donald L Goss
- Department of Physical Therapy, High Point University, High Point, NC 27268, USA
| | - Kenneth L Cameron
- John Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY, 10996 USA
| | - Stephen W Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7505, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7505, USA
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7505, USA
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Bullock GS, Dartt CE, Ricker EA, Fallowfield JL, Arden N, Clifton D, Danelson K, Fraser JJ, Gomez C, Greenlee TA, Gregory A, Gribbin T, Losciale J, Molloy JM, Nicholson KF, Polich JG, Räisänen A, Shah K, Smuda M, Teyhen DS, Allard RJ, Collins GS, de la Motte SJ, Rhon DI. Barriers and facilitators to implementation of musculoskeletal injury mitigation programmes for military service members around the world: a scoping review. Inj Prev 2023; 29:461-473. [PMID: 37620010 DOI: 10.1136/ip-2023-044905] [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: 03/22/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Musculoskeletal injury (MSK-I) mitigation and prevention programmes (MSK-IMPPs) have been developed and implemented across militaries worldwide. Although programme efficacy is often reported, development and implementation details are often overlooked, limiting their scalability, sustainability and effectiveness. This scoping review aimed to identify the following in military populations: (1) barriers and facilitators to implementing and scaling MSK-IMPPs; (2) gaps in MSK-IMPP research and (3) future research priorities. METHODS A scoping review assessed literature from inception to April 2022 that included studies on MSK-IMPP implementation and/or effectiveness in military populations. Barriers and facilitators to implementing these programmes were identified. RESULTS From 132 articles, most were primary research studies (90; 68.2%); the remainder were review papers (42; 31.8%). Among primary studies, 3 (3.3%) investigated only women, 62 (69%) only men and 25 (27.8%) both. Barriers included limited resources, lack of stakeholder engagement, competing military priorities and equipment-related factors. Facilitators included strong stakeholder engagement, targeted programme design, involvement/proximity of MSK-I experts, providing MSK-I mitigation education, low burden on resources and emphasising end-user acceptability. Research gaps included variability in reported MSK-I outcomes and no consensus on relevant surveillance metrics and definitions. CONCLUSION Despite a robust body of literature, there is a dearth of information about programme implementation; specifically, barriers or facilitators to success. Additionally, variability in outcomes and lack of consensus on MSK-I definitions may affect the development, implementation evaluation and comparison of MSK-IMPPs. There is a need for international consensus on definitions and optimal data reporting elements when conducting injury risk mitigation research in the military.
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Affiliation(s)
- Garrett S Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Centre for Sport, Exercise, and Osteoarthritis, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Carolyn E Dartt
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Emily A Ricker
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Joanne L Fallowfield
- Environmental Medicine and Sciences Division, Institute of Naval Medicine, Gosport, UK
| | - Nigel Arden
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
- University of Southampton MRC Lifecourse Epidemiology Centre, Southampton, UK
| | - Daniel Clifton
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Kerry Danelson
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - John J Fraser
- Directorate for Operational Readiness & Health, Naval Health Research Center, San Diego, California, USA
| | - Christina Gomez
- College of Health Sciences, Western University of Health Sciences, Pomona, California, USA
| | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Alexandria Gregory
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Timothy Gribbin
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Justin Losciale
- Department of Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Joseph M Molloy
- Office of the Army Surgeon General, Falls Church, Virginia, USA
| | - Kristen F Nicholson
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Julia-Grace Polich
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anu Räisänen
- Department of Physical Therapy Education, Oregon, College of Health Sciences, Western University of Health Sciences, Lebanon, Oregon, USA
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Karishma Shah
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
| | - Michael Smuda
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Deydre S Teyhen
- Army Medical Specialist Corps Chief, Office of the Army Surgeon General, Falls Church, Virginia, USA
| | - Rhonda J Allard
- Learning Resource Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Sarah J de la Motte
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
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Musculoskeletal Injury Risk in a Military Cadet Population Participating in an Injury-Prevention Program. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020356. [PMID: 36837558 PMCID: PMC9961050 DOI: 10.3390/medicina59020356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Background and Objectives: Musculoskeletal injuries are a major health hazard among military personnel. Previous research has proposed several exercise-based strategies for prevention. The purpose of this study was to investigate the effect of an exercise-based injury-prevention program on the incidence of musculoskeletal injury, motor performance and psychosocial status. Materials and Methods: Thirty-six Estonian Military Academy cadets were randomly assigned into either an intervention or control group. The intervention group followed a neuromuscular exercise-based injury-prevention warm-up program, three times per week for 6 months. The control group continued with the usual warm-up. The main outcome measure was injury incidence during the study period. Additionally, evaluation of isokinetic lower-extremity strength, postural sway, physical fitness and psychosocial status was included pre- and post-intervention. Results: During the 6-month study period, the musculoskeletal injury incidence was 43% in the intervention group and 54% in the control group (RR = 0.8; 95% CI = 0.41 to 1.99). The noted 20% risk reduction was not statistically significant (p = 0.59). Furthermore, there were no statistically significant differences between the intervention and control group in motor performance or psychosocial status measures. Conclusions: In conclusion, no effect of the exercise-based injury-prevention program on injury risk, motor performance or psychosocial status could be detected.
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Sinnott AM, Krajewski KT, LaGoy AD, Beckner ME, Proessl F, Canino MC, Nindl BC, Turner RL, Lovalekar MT, Connaboy C, Flanagan SD. Prevention of Lower Extremity Musculoskeletal Injuries in Tactical and First Responder Populations: A Systematic Review and Meta-Analysis of Randomized Trials From 1955 to 2020. J Strength Cond Res 2023; 37:239-252. [PMID: 36026481 DOI: 10.1519/jsc.0000000000004293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Sinnott, AM, Krajewski, KT, LaGoy, AD, Beckner, ME, Proessl, F, Canino, MC, Nindl, BC, Turner, RL, Lovalekar, MT, Connaboy, C, and Flanagan, SD. Prevention of lower extremity musculoskeletal injuries in tactical and first responder populations: A systematic review and meta-analysis of randomized trials from 1955 to 2020. J Strength Cond Res 37(1): 239-252, 2023-Lower extremity musculoskeletal injuries (LEMSIs) impose a significant burden on tactical and first responder populations. To determine the effectiveness of LEMSI prevention strategies, we performed a systematic review and meta-analysis of randomized controlled trials published in English from 1955 to 2020 (PROSPERO: CRD42018081799). MEDLINE, EMBASE, Cochrane, CINAHL, ProQuest, and DTIC databases were searched for trials that assigned military service members, police, firefighters, or paramedics to LEMSI prevention interventions with a minimum surveillance period of 12 weeks. Evidence was synthesized as odds ratios (OR) for LEMSI occurrence between individuals assigned to interventions and those assigned to standard activities. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0. Random-effects meta-analyses were conducted for (a) physical training and (b) footwear modifications to reduce LEMSI and (c) footwear modifications to reduce stress fractures specifically. Certainty in the body of evidence was determined with the GRADE approach. Of 28,499 records, 18 trials comprised of more than 11,000 subjects were synthesized. Interventions included physical training (8, N = 6,838), footwear modifications (8, N = 3,792), nutritional supplementation (1, N = 324), and training modifications (1, N = 350). Overall risk of bias was generally moderate ( N = 7 of 18) or high ( N = 9 of 18). Physical training (OR = 0.87, 95% CI [0.71, 1.08], p = 0.22, I 2 = 58.4%) and footwear modification (OR = 1.13, 95% CI [0.85, 1.49], p = 0.42, I 2 = 0.0%) did not reduce LEMSI or stress fractures (OR = 0.76, 95% CI [0.45, 1.28], p = 0.30, I 2 = 70.7%). Our results indicate that there is weak evidence to support current LEMSI prevention strategies. Future efforts will benefit from longer surveillance periods, assessment of women and nonmilitary populations, improved methodological rigor, and a greater breadth of approaches.
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Affiliation(s)
- Aaron M Sinnott
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Kellen T Krajewski
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Alice D LaGoy
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Meaghan E Beckner
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Felix Proessl
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Maria C Canino
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Bradley C Nindl
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Rose L Turner
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mita T Lovalekar
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Chris Connaboy
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Shawn D Flanagan
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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Bunn PDS, Sodré RDS, Matos MI, Saliba GF, Silva GDP, Caldas R, Esteves JDS, Silva EB. Effects of prevention programmes on injury risk in military personnel: a systematic review with meta-analysis. BMJ Mil Health 2022:e002098. [PMID: 35732343 DOI: 10.1136/bmjmilitary-2022-002098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/04/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Exercise programmes have been used to prevent injuries in military personnel, as they can reduce modifiable risk factors for injuries. Our aim was to review the literature to evaluate the effects of different exercise protocols on the prevention of injuries in military personnel. METHODS A systematic literature review examined the effects of different exercise protocols on the prevention of musculoskeletal injuries in the military. Several databases were explored to find experimental studies that investigated the effects of prevention programmes on the risk of injury. We have extracted from the studies: profile of participants, sample size, study design and characteristics of the control group (CG), the type of intervention and the relative risk (RR) in the experimental group and CG, with their significance levels. For data analysis, we used the RevMan V.5.3 software. The measure of RR was investigated. The risk of publication bias was analysed with Begg's test. RESULTS A total of 13 694 titles and studies were recovered from the databases and by manual search. After the removal of duplicate titles and studies that did not meet the eligibility criteria, 17 studies were selected. The protocols were composed of neuromuscular training, stretching, agility training or combined exercises. The meta-analysis showed that injury prevention exercise programmes reduced the risk of musculoskeletal injuries in military personnel by 14% (RR=0.86; 95% CI=0.76 to 0.98). CONCLUSION Injury prevention exercise programmes promoted a slight reduction in the risk of musculoskeletal injuries in military personnel. LEVEL OF EVIDENCE Very low. TRIAL REGISTRATION NUMBER CRD 42017077946.
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Affiliation(s)
- Priscila Dos Santos Bunn
- Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - R D S Sodré
- Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - M I Matos
- Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - G F Saliba
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Rio de Janeiro, Brazil
| | - G D P Silva
- Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - R Caldas
- Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - J D S Esteves
- Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Rio de Janeiro, Rio de Janeiro, Brazil
| | - E B Silva
- Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
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Bunn PDS, Lopes TJA, Terra BDS, Costa HF, Souza MP, Braga RM, Inoue A, Ribeiro FM, Alves DDS, Bezerra da Silva E. Association between movement patterns and risk of musculoskeletal injuries in navy cadets: A cohort study. Phys Ther Sport 2021; 52:81-89. [PMID: 34438262 DOI: 10.1016/j.ptsp.2021.08.003] [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: 02/20/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the association of movement patterns evaluated by the Dynamic Movement Assessment (DMA) with the occurrence of musculoskeletal injuries in navy cadets. DESIGN Cohort study. SETTING Participants were filmed performing the six functional tests of the DMA (deep squat, step up, single-leg squat, hop, plank and side-plank tests). PARTICIPANTS 240 navy cadets. MAIN OUTCOME MEASUREMENTS Depending on the number of certain movement patterns on the Dynamic Movement Assessment (DMA), participants were classified as high, moderate, medium or low risk of developing injuries. Predictive associations between injuries and risk classification were examined using logistic regression analysis. RESULTS Considering sex, previous injuries and the type of secondary school as covariates, participants who were classified as high risk were not more likely to develop injuries. Non-military high school was an independent risk factor for any injuries (OR = 3.14, 95% CI [1.43,6.91]; OR = 4.57, 95% CI [1.92,10.83]), overuse injuries (OR = 2.58, 95% CI [1.05,6.30]; OR = 2.55, 95% CI [1.06, 6.14]) and acute injuries (OR = 4.88, 95% CI [1.19,19.99]), respectively. Previous musculoskeletal symptoms also increased the chance of AI (OR = 4.45, 95% CI [1.15,17.18]; OR = 5.91, 95% CI [1.13,30.88]). CONCLUSIONS Movement patterns evaluated by DMA are not associated with an increased risk of injuries. However, attendance of a non-military high school and previous musculoskeletal symptoms are associated with musculoskeletal injuries.
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Affiliation(s)
- Priscila Dos Santos Bunn
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Rua São Francisco Xavier, n° 524, 9° floor; Block F; Room 9122, Rio de Janeiro, RJ, Brazil; Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil; Programa de Pós-Graduação em Desempenho Humano Operacional (PPGDHO), Universidade da Força Aérea (UNIFA), Av. Marechal Fontenelle, 1200, Campo dos Afonsos, Rio de Janeiro, RJ, Brazil.
| | - Thiago Jambo Alves Lopes
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil; Programa de Pós-Graduação em Desempenho Humano Operacional (PPGDHO), Universidade da Força Aérea (UNIFA), Av. Marechal Fontenelle, 1200, Campo dos Afonsos, Rio de Janeiro, RJ, Brazil
| | - Bruno de Souza Terra
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Hélcio Figueiredo Costa
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Márcio Puglia Souza
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Roberta Mendonça Braga
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Allan Inoue
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Rua São Francisco Xavier, n° 524, 9° floor; Block F; Room 9122, Rio de Janeiro, RJ, Brazil; Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil; Programa de Pós-Graduação em Desempenho Humano Operacional (PPGDHO), Universidade da Força Aérea (UNIFA), Av. Marechal Fontenelle, 1200, Campo dos Afonsos, Rio de Janeiro, RJ, Brazil
| | - Fabrício Miranda Ribeiro
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Daniel de Souza Alves
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Elirez Bezerra da Silva
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Rua São Francisco Xavier, n° 524, 9° floor; Block F; Room 9122, Rio de Janeiro, RJ, Brazil
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9
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Risk factors for musculoskeletal injuries in military personnel: a systematic review with meta-analysis. Int Arch Occup Environ Health 2021; 94:1173-1189. [PMID: 33987772 DOI: 10.1007/s00420-021-01700-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the risk factors for musculoskeletal injuries in military personnel. METHODS A systematic literature search was carried out in August 2019 and updated in July 2020 without language or time filters. The inclusion criteria were prospective studies that investigated the risk factors for injuries in military personnel. Only risk factors analyzed by at least ten studies were selected for the meta-analysis. For data analysis, the RevMan5.3 program was used to compare the number of participants with injuries between high- or low-risk groups. The measurement of dichotomous variables was one of the selected parameters for the analysis, as well as the Mantel-Haenszel statistical method, random-effects model, and analysis with a relative risk (RR) and 95% confidence interval for the included studies. RESULTS A total of 2,629 studies were identified through databases. Thirty-four studies met the inclusion criteria. The groups considered at risk were the oldest [RR = 1.22; (95% CI 1.06-1.41)], with overweight or obesity [RR = 1.27; (95% CI 1.08-1, 48)], with previous injuries [RR = 1.15; (95% CI 1.01-1.30)], and with the worst performance in running tests of 1,600-3,200 m [RR = 1.87; (95% CI 1.28-2.71)]. Gender, ethnicity, and smoking were not associated with injuries. However, a subgroup analysis showed that among studies with a follow-up of fewer than 12 months, women presented RR = 2.44 (95% CI 1.65-3.60) more likely to develop injuries. CONCLUSION Age, overweight or obesity, previous injuries, and performance in the 1600-3200 m run are associated with an increased risk of injury in the military.
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Dijksma I, Arslan IG, van Etten-Jamaludin FS, Elbers RG, Lucas C, Stuiver MM. Exercise Programs to Reduce the Risk of Musculoskeletal Injuries in Military Personnel: A Systematic Review and Meta-Analysis. PM R 2020; 12:1028-1037. [PMID: 32162467 PMCID: PMC7586796 DOI: 10.1002/pmrj.12360] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/17/2020] [Accepted: 03/03/2020] [Indexed: 12/13/2022]
Abstract
Objective To evaluate the effect of exercise programs on reduction of musculoskeletal injury (MSI) risk in military populations. Design Systematic review and meta‐analysis. Literature Survey A database search was conducted in PubMed/MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTdiscus, WHO International Clinical Trials Registry Platform Search Portal, Open Gray, National Technical Reports Library, and reference lists of included articles up to July 2019. Randomized and cluster‐randomized controlled trials evaluating exercise programs as preventive interventions for MSIs in armed forces compared to other exercise programs or to usual practice were eligible for inclusion. Methodology Two authors independently assessed risk of bias and extracted data. Data were adjusted for clustering if necessary and pooled using the random‐effects model when appropriate. Synthesis We included 15 trials in this review, with a total number of 14 370 participants. None of the included trials appeared to be free of any risk of bias. Meta‐analysis and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment could be performed for static stretching compared to no stretching (3532 participants), showing low quality of evidence indicating no favorable effect of stretching. Gait retraining, an anterior knee‐pain targeted program, and resistance exercises showed cautious favorable effects on reducing injury risk in military personnel. Conclusion The current evidence base for exercise‐based MSI prevention strategies in the military is of low quality. Areas worthy of further exploration include the effects of gait retraining, anterior knee‐pain targeted programs, agility training, and resistance training programs, on medial tibial stress syndrome incidence, anterior knee pain incidence, attrition due to injuries and any type of MSI, respectively.
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Affiliation(s)
- Iris Dijksma
- Clinical Epidemiology, Biostatistics and Bioinformatics, Master Evidence Based Practice in Health Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Defence Healthcare Organisation, Ministry of Defence, Utrecht, The Netherlands
| | - Ilgin G Arslan
- Clinical Epidemiology, Biostatistics and Bioinformatics, Master Evidence Based Practice in Health Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Roy G Elbers
- Clinical Epidemiology, Biostatistics and Bioinformatics, Master Evidence Based Practice in Health Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cees Lucas
- Clinical Epidemiology, Biostatistics and Bioinformatics, Master Evidence Based Practice in Health Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Clinical Epidemiology, Biostatistics and Bioinformatics, Master Evidence Based Practice in Health Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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11
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Ahn J, Choi B, Lee YS, Lee KW, Lee JW, Lee BK. The mechanism and cause of anterior cruciate ligament tear in the Korean military environment. Knee Surg Relat Res 2019; 31:13. [PMID: 32660592 PMCID: PMC7219609 DOI: 10.1186/s43019-019-0015-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 11/04/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose Anterior cruciate ligament (ACL) injury is very common but few studies have analyzed the injury mechanism and cause of ACL tear in a specific environment such as a military institution. The purpose of this study was to analyze the injury mechanism and cause of ACL injury in the military environment. Additionally, this study could provide outcomes that may aid future studies on prevention of ACL injury in military personnel. Materials and methods This study retrospectively analyzed 168 patients who sustained ACL tear while in military service and underwent ACL reconstruction surgery in a military hospital. Analysis of the injury mechanism and the cause was evaluated by analyzing the medical records. Knee magnetic resonance imaging analysis was also conducted for further evaluation of associated injury. Results The majority of ACL injuries in the military environment occurred through non-contact injury. Changing direction (46.4%) was the most common lower-leg position, followed by landing with the knee in a valgus position (26.8%). The activity undertaken at the time of injury was exercise in 76.2% of cases and military training/daily activities in 23.8% of cases. The incidence of ACL injury was higher in the soldier compared to the officer group during exercise (P = 0.017). Soccer was the most common activity at the time of injury (54.1%), followed by military training/daily activities, futsal, and basketball. The most common injury time was between 30 and 60 min after the start of exercise. Commonly associated injury sites were the medial meniscus and the medial collateral ligament. Conclusions The main mechanism of ACL injury occurring in the military environment was non-contact injury, especially on changing the direction of the lower leg. Soccer was the most frequent activity at the time of the injury. These findings suggested that preventive strategies against ACL injury in the military environment could effectively reduce the incidence of ACL injury.
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Affiliation(s)
- Joosuk Ahn
- Department of Orthopaedic surgery, Armed Forces Capital Hospital, 81, Saemaeul-ro 177beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Byungseop Choi
- Department of Orthopaedic surgery, Armed Forces Capital Hospital, 81, Saemaeul-ro 177beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ki Woung Lee
- Department of Orthopaedic surgery, Armed Forces Capital Hospital, 81, Saemaeul-ro 177beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jung Woo Lee
- Department of Orthopaedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Beom Koo Lee
- Department of Orthopaedic Surgery, Gil Hospital, Gachon University of Medicine and Science, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea.
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12
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van der Heijden SMT, Prins MR, van der Wurff P. Toward more reliable stability measurements in stance: recommendations for number of measurements, foot position and feedback -- a cross-sectional study among servicemen. Mil Med Res 2019; 6:21. [PMID: 31296263 PMCID: PMC6624869 DOI: 10.1186/s40779-019-0212-y] [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: 12/11/2018] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the military, insufficient postural stability is a risk factor for developing lower extremity injuries. Postural stability training programs are effective in preventing these injuries. However, an objective method for the measurement of postural stability in servicemen is lacking. The primary objective of this study was to assess the influence of the number of repetitions, different foot positions and real-time visual feedback on postural stability, as well as their effects on the intrasession reliability of postural stability measurements in servicemen. The secondary objective was to assess the concurrent validity of the measurements. METHODS Twenty healthy servicemen between 20 and 50 years of age and in active duty were eligible for this quantitative, cross-sectional study. The measurements took place on a force plate, measuring the mean velocity of the center of pressure. The participants were asked to stand as still as possible in three different foot positions (wide stance, small stance, and on one leg), five times each for 45 s each time, and the measurements were performed with and without real-time visual feedback. RESULTS We observed a significant main effect of foot position (P < 0.001), but not of visual feedback (P = 0.119) or repetition number (P = 0.915). Postural stability decreased in the more challenging foot positions. The ICC estimates varied from 0.809 (one repetition in wide stance) to 0.985 (five repetitions on one leg). The common variance (R2) between different foot positions without feedback varied between 0.008 (wide stance) and 0.412. CONCLUSIONS To yield reliable data, wide-stance measurements should be conducted three times, and small-stance measurements and measurements on one leg should be conducted two times. The scores of a measurement in a particular foot position cannot predict the scores of measurements in other foot positions.
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Affiliation(s)
- Saskia Maria Theresia van der Heijden
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands.,Research and Development, Military Rehabilitation Center Aardenburg, Korte Molenweg 3, 3941PW, Doorn, The Netherlands
| | - Maarten Reinders Prins
- Research and Development, Military Rehabilitation Center Aardenburg, Korte Molenweg 3, 3941PW, Doorn, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam and Amsterdam Movement Sciences, 1081BT, Amsterdam, The Netherlands.,Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, 3584CS, Utrecht, The Netherlands
| | - Peter van der Wurff
- Research and Development, Military Rehabilitation Center Aardenburg, Korte Molenweg 3, 3941PW, Doorn, The Netherlands. .,Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, 3584CS, Utrecht, The Netherlands.
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13
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Peck KY, DiStefano LJ, Marshall SW, Padua DA, Beutler AI, de la Motte SJ, Frank BS, Martinez JC, Cameron KL. Effect of a Lower Extremity Preventive Training Program on Physical Performance Scores in Military Recruits. J Strength Cond Res 2017; 31:3146-3157. [PMID: 29068865 DOI: 10.1519/jsc.0000000000001792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peck, KY, DiStefano, LJ, Marshall, SW, Padua, DA, Beutler, AI, de la Motte, SJ, Frank, BS, Martinez, JC, and Cameron, KL. Effect of a lower extremity preventive training program on physical performance scores in military recruits. J Strength Cond Res 31(11): 3146-3157, 2017-Exercise-based preventive training programs are designed to improve movement patterns associated with lower extremity injury risk; however, the impact of these programs on general physical fitness has not been evaluated. The purpose of this study was to compare fitness scores between participants in a preventive training program and a control group. One thousand sixty-eight freshmen from a U.S. Service Academy were cluster-randomized into either the intervention or control group during 6 weeks of summer training. The intervention group performed a preventive training program, specifically the Dynamic Integrated Movement Enhancement (DIME), which is designed to improve lower extremity movement patterns. The control group performed the Army Preparation Drill (PD), a warm-up designed to prepare soldiers for training. Main outcome measures were the Army Physical Fitness Test (APFT) raw and scaled (for age and sex) scores. Independent t tests were used to assess between-group differences. Multivariable logistic regression models were used to control for the influence of confounding variables. Dynamic Integrated Movement Enhancement group participants completed the APFT 2-mile run 20 seconds faster compared with the PD group (p < 0.001), which corresponded with significantly higher scaled scores (p < 0.001). Army Physical Fitness Test push-up scores were significantly higher in the DIME group (p = 0.041), but there were no significant differences in APFT sit-up scores. The DIME group had significantly higher total APFT scores compared with the PD group (p < 0.001). Similar results were observed in multivariable models after controlling for sex and body mass index (BMI). Committing time to the implementation of a preventive training program does not appear to negatively affect fitness test scores.
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Affiliation(s)
- Karen Y Peck
- 1John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, West Point, New York;2Department of Kinesiology, University of Connecticut, Storrs, Connecticut;3Injury Prevention Research Center, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;4Sports Medicine Research Laboratory, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina;5Department of Family Medicine, Uniformed Services University of Health Sciences;6Injury Prevention Research Laboratory, Consortium for Health and Military Performance, Uniformed Services University of Health Sciences, Bethesda, Maryland;7Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina; and8Department of Kinesiology and Physical Education, Northern Illinois University, DeKalb, Illinois
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Wardle SL, Greeves JP. Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel. J Sci Med Sport 2017; 20 Suppl 4:S3-S10. [PMID: 29103913 DOI: 10.1016/j.jsams.2017.09.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To update the current injury prevention strategy evidence base for making recommendations to prevent physical training-related musculoskeletal injury. DESIGN We conducted a systematic review to update the evidence base on injury prevention strategies for military personnel. METHODS Literature was systematically searched and extracted from five databases, and reported according to PRISMA guidelines. Sixty one articles meeting the inclusion criteria and published during the period 2008-2015 were selected for systematic review. RESULTS The retrieved articles were broadly categorised into six injury prevention strategies; (1) conditioning, (2) footwear modifications, (3) bracing, (4) physical activity volume, (5) physical fitness, and (6) leadership/supervision/awareness. The majority of retrieved articles (n=37 (of 61) evaluated or systematically reviewed a conditioning intervention of some nature. However, the most well-supported strategies were related to reducing physical activity volume and improving leadership/supervision/awareness of injuries and injury prevention efforts. CONCLUSIONS Several injury prevention strategies effectively reduce musculoskeletal injury rates in both sexes, and many show promise for utility with military personnel. However, further evaluation, ideally with prospective randomised trials, is required to establish the most effective injury prevention strategies, and to understand any sex-specific differences in the response to these strategies.
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Affiliation(s)
- Sophie L Wardle
- Division of Applied Human Physiology, Army Personnel Research Capability, Army Headquarters, Andover, UK.
| | - Julie P Greeves
- Division of Applied Human Physiology, Army Personnel Research Capability, Army Headquarters, Andover, UK
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Cameron KL, Driban JB, Svoboda SJ. Osteoarthritis and the Tactical Athlete: A Systematic Review. J Athl Train 2016; 51:952-961. [PMID: 27115044 DOI: 10.4085/1062-6050-51.5.03] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although tactical athletes (eg, military service members, law enforcement personnel, fire fighters) are exposed to several known risk factors, it remains unclear if they are at increased risk for osteoarthritis (OA). The purpose of this systematic review was to investigate the association between serving as a tactical athlete and the incidence and prevalence of OA. DATA SOURCES We completed a comprehensive systematic literature search in November 2014 using 12 bibliographic databases (eg, PubMed, Ovid, SportDiscus) supplemented with manual searches of reference lists. STUDY SELECTION Studies were included if they met the following criteria: (1) an aim of the study was to investigate an association between tactical athletes and OA; (2) the outcome measure was radiographic OA, clinical OA, total joint replacement, self-reported diagnosis of OA, or placement on a waiting list for a total joint replacement; (3) the study design was a cohort study; and (4) the study was written in English. DATA EXTRACTION One investigator extracted data from articles that met all inclusion criteria (eg, group descriptions, measures of disease burden, source of nonexposed controls). DATA SYNTHESIS Twelve articles met the inclusion criteria and described retrospective cohort studies. Firefighters, active-duty military service members, and veteran military parachutists consistently had a higher incidence or prevalence of knee, hip, or any OA diagnosis (4 studies). Active-duty pilots and veteran military parachutists may have a higher prevalence of spine OA, but this was not statistically significant (2 studies). Occupational risk factors for OA among tactical athletes include rank and branch of military service. The risk of OA among individuals who completed mandatory national military service remains unclear (6 studies). CONCLUSIONS The incidence of OA among tactical athletes appears to be significantly higher when compared with nonexposed controls. Further research is needed to specifically identify modifiable risk factors within this high-risk population to develop and implement effective risk-reduction strategies.
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