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Poh PYS, Sessoms PH, Haluch KS, Trone DW. Assessing Injury Susceptibility at Marine Corps Recruit Depot, San Diego, California. J Strength Cond Res 2023; 37:1530-1536. [PMID: 36728010 DOI: 10.1519/jsc.0000000000004407] [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: 02/03/2023]
Abstract
ABSTRACT Poh, PYS, Sessoms, PH, Haluch, KS, and Trone, DW. Assessing injury susceptibility at Marine Corps Recruit Depot, San Diego, California. J Strength Cond Res 37(7): 1530-1536, 2023-Marine Corps Recruit Depot (MCRD) recruits undergo demanding training. Musculoskeletal injury (MSKI) accounts for attrition and graduation delays. Functional tests, such as Functional Movement Screen (FMS), Y-Balance Test-Lower Quarter (YBT-LQ), and ankle dorsiflexion range of motion (AD-ROM), may identify individuals at greater MSKI risk. This study tested the hypothesis that functional assessments may inform injury prediction. Male recruits ( N = 407; mean ± SD : age, 20 ± 2 years) performed baseline functional tests. Marine Corps Recruit Depot staff tracked MSKI and graduation outcomes. The chi-square test of independence (individual FMS exercises) and Mann-Whitney U (FMS composite score) test examined the relationship between FMS and MSKI incidence. One-way analysis of variance compared YBT-LQ and AD-ROM with MSKI incidence. Twelve recruits (3%) incurred a lower extremity MSKI and were dropped. Of those 12, 9 had a delayed graduation, and 3 separated from enlistment. The level of significance was set at p < 0.10 to identify between-group differences (yes-MSKI vs. no-MSKI). Functional movement screen composite score ( p = 0.064), hurdle step ( p = 0.059), and trunk stability ( p = 0.001) were lower in yes-MSKI. Y-Balance Test-Lower Quarter anterior direction difference between legs ( p = 0.011) and AD-ROM right side ( p = 0.055) was greater in yes-MSKI. Odds ratios (OR) were calculated using cut-off scores, with strong odds of sustaining MSKI with FMS trunk stability score <2 (OR: 7.56, 95% confidence interval [CI]: [2.32, 24.61]) and YBT-LQ anterior difference >6.25 cm (OR: 6.38, 95% CI: [1.98, 20.55]). Recruits who incurred MSKI had scores that indicated lesser mobility and stability of the lower extremity, providing preliminary evidence that when assessed together, FMS, YBT-LQ, and AD-ROM, may have predictive value for identifying those at MSKI risk.
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Affiliation(s)
- Paula Y S Poh
- Leidos, Inc., Reston, Virginia
- Warfighter Performance Department, Naval Health Research Center, San Diego, California
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, San Diego, California
| | - Kathrine S Haluch
- Warfighter Performance Department, Naval Health Research Center, San Diego, California
- Eagle Applied Sciences, LLC, San Antonio, Texas; and
| | - Daniel W Trone
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
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Barbeau P, Michaud A, Hamel C, Rice D, Skidmore B, Hutton B, Garritty C, da Silva DF, Semeniuk K, Adamo KB. Musculoskeletal Injuries Among Females in the Military: A Scoping Review. Mil Med 2021; 186:e903-e931. [PMID: 33367692 DOI: 10.1093/milmed/usaa555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. MATERIALS AND METHODS A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews-Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. RESULTS From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. CONCLUSIONS This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.
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Affiliation(s)
- Pauline Barbeau
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Alan Michaud
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Candyce Hamel
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danielle Rice
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Chantelle Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danilo F da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Dembowski SC, Tragord BS, Hand AF, Rohena-Quinquilla IR, Lee IE, Thoma DC, Molloy JM. Injury Surveillance and Reporting for Trainees with Bone Stress Injury: Current Practices and Recommendations. Mil Med 2018; 183:e455-e461. [PMID: 29788396 DOI: 10.1093/milmed/usy101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 01/04/2023] Open
Abstract
Background Musculoskeletal injuries, including lower extremity bone stress injuries (BSI) significantly impact initial entry training (IET) in the U.S. Army due to limited duty days, trainee attrition, early medical discharge, and related financial costs. Factors complicating trainee BSI surveillance include inconsistent BSI coding practices, attrition documentation as both administrative separations and medical discharges and the inability to code for BSI grade or severity when using International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) codes. Methods A multidisciplinary expert panel developed policy guidance to enhance clinical and administrative management of BSI, following extensive analysis of current, peer-reviewed literature. Policy guidance incorporates leading practices concerning clinical BSI management, including imaging procedures, recommended notifications, early intervention, and ICD-10 diagnostic coding procedures. Policy guidance also standardizes BSI grading criteria for magnetic resonance imaging and skeletal scintigraphy (bone scan). Findings Multidisciplinary expert opinion indicates inconsistent BSI diagnosis and management across IET due to variability in trainee BSI grading, documentation, and coding practices. Injury surveillance conducted by the United States Army Medical Command (USAMEDCOM) will benefit from routine, standardized musculoskeletal injury data base searches by BSI severity/grade and anatomical location upon implementation of BSI policy guidance. Discussion Effective injury surveillance is critical for determining trainee BSI incidence and attrition, developing anticipated return to duty (RTD) timelines, and assessing long-term outcomes. BSI RTD timelines should account for gender, BSI grade/severity, anatomical location, and type of intervention. Well-defined RTD timelines would benefit administrative decision-making purposes, including whether to grant convalescent leave or enroll in the Warrior Training and Rehabilitation Program during BSI recovery. Enhanced management procedures may improve initial enlistment completion rates for trainees sustaining at least one BSI who eventually complete IET.
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Affiliation(s)
- Scott C Dembowski
- Department of Physical Therapy, Womack Army Medical Center, Fort Bragg, NC
| | - Bradley S Tragord
- US Army-Baylor University Doctor of Physical Therapy Program, AMEDD Center and School, Joint Base San Antonio, TX
| | - Amy F Hand
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Iván R Rohena-Quinquilla
- Department of Radiology, Martin Army Community Hospital, Fort Benning, GA.,Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Ian E Lee
- Office of the Surgeon General, Medical Command Headquarters Physical Performance Service Line, Falls Church, VA
| | - David C Thoma
- Department of Radiology, Tripler Army Medical Center, Tripler Army Medical Center, Hawaii
| | - Joseph M Molloy
- ORISE Knowledge Preservation Program, Office of the Surgeon General, US Army Medical Command, Physical Performance Service Line, Falls Church, VA
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Knapik JJ, Sharp MA, Steelman RA. Secular Trends in the Physical Fitness of United States Army Recruits on Entry to Service, 1975-2013. J Strength Cond Res 2017; 31:2030-2052. [PMID: 28403029 DOI: 10.1519/jsc.0000000000001928] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Knapik, JJ, Sharp, MA, and Steelman, RA. Secular trends in the physical fitness of United States Army recruits on entry to service, 1975-2013. J Strength Cond Res 31(7): 2030-2052, 2017-A systematic literature search was conducted to identify and analyze articles that reported on physical fitness of new US Army recruits. The National Library of Medicine's PubMed and the Defense Technical Information Center were searched using the keywords (military personnel OR trainee OR recruit OR soldier) AND (physical fitness OR strength OR endurance OR flexibility OR balance OR coordination OR muscle contraction OR running OR exercise OR physical conditioning). Reference lists of obtained articles and contact with authors enhanced the search. Studies were selected if they involved recruits in Basic Combat Training or One-Station Unit Training, provided a quantitative assessment of at least one fitness measure, and the fitness measure(s) were obtained early in training. Average values for each fitness measure were obtained, plotted by the year of data collection, and fitted to linear regression models (fitness measure × year). Fifty-three articles met the review criteria. Regression analysis indicated little temporal change in height, but body weight, body mass index, body fat, and fat-free mass increased over time. Limited V[Combining Dot Above]O2max data suggested no temporal change in male recruits, but those in female recruits V[Combining Dot Above]O2max seem to have slightly improved. Apparently contradicting the V[Combining Dot Above]O2max findings, performance on endurance runs (1- and 2-mile) declined, possibly because of the increase in body weight. Muscular endurance (push-ups, sit-ups) demonstrated little systematic change over time. Limited but multiple measures of muscular strength suggest a temporal increase in strength. Specific components of US Army recruit fitness seem to have changed over time.
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Affiliation(s)
- Joseph J Knapik
- 1US Army Research Institute of Environmental Medicine, Natick, Massachusetts; 2US Army Public Health Center, Aberdeen Proving Ground, Maryland; 3Oak Ridge Institute for Science and Education, Belcamp, Maryland; and 4Defense Health Agency, Falls Church, Virginia
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Allison KF, Keenan KA, Wohleber MF, Perlsweig KA, Pletcher ER, Lovalekar M, Beals K, Coleman LC, Nindl BC. Greater ankle strength, anaerobic and aerobic capacity, and agility predict Ground Combat Military Occupational School graduation in female Marines. J Sci Med Sport 2017; 20 Suppl 4:S85-S90. [PMID: 28899656 DOI: 10.1016/j.jsams.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/03/2017] [Accepted: 08/13/2017] [Indexed: 11/16/2022]
Abstract
Women can serve in all military occupational specialties (MOS); however, musculoskeletal and physiological characteristics that predict successful completion of ground combat MOS schools by female Marines are unknown. OBJECTIVES To determine which demographic, musculoskeletal, and physiological characteristics predict graduation from infantry and vehicle ground combat MOS schools in female Marines. DESIGN Prospective cohort study. METHODS Prior to MOS school, the following were assessed in 62 female Marines (22.0±3.0yrs, 163.9±5.8cm, 63.4±7.2kg): isokinetic shoulder, trunk, and knee and isometric ankle strength; body composition; anaerobic power (AP)/capacity (AC); maximal oxygen uptake (VO2max); and field-based fitness tests (broad jump, medicine ball throw, pro-agility). Both absolute and normalized (%body mass: %BM) values were utilized for strength, AP, AC, and VO2max. Select tests from each Marine's most recent Physical Fitness Test (PFT: abdominal crunches, 3-mile run time) and Combat Fitness Test (CFT: Maneuver Under Fire, Movement to Contact) were recorded. Participants were classified as graduated (N=46) or did not graduate (N=16). Simple logistic regression was performed to determine predictors of MOS school graduation. Statistical significance was set a priori at α=0.05. RESULTS Absolute and normalized ankle inversion and eversion strength, normalized anaerobic capacity, absolute and normalized VO2max, right pro-agility, and PFT 3-mile run time significantly predicted MOS school graduation (p<0.05). CONCLUSIONS Greater ankle strength, better agility, and greater anaerobic and aerobic capacity are important for successful completion of ground combat MOS school in female Marines. Prior to entering ground combat MOS school, it is recommended that female Marines should train to optimize these mobility-centric characteristics.
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Affiliation(s)
- Katelyn Fleishman Allison
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States.
| | - Karen A Keenan
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | - Meleesa F Wohleber
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | - Katherine A Perlsweig
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | - Erin R Pletcher
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | - Mita Lovalekar
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | - Kim Beals
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | | | - Bradley C Nindl
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
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Nye NS, Covey CJ, Sheldon L, Webber B, Pawlak M, Boden B, Beutler A. Improving Diagnostic Accuracy and Efficiency of Suspected Bone Stress Injuries. Sports Health 2017; 8:278-283. [PMID: 26945021 PMCID: PMC4981068 DOI: 10.1177/1941738116635558] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Lower extremity stress fractures among athletes and military recruits cause significant morbidity, fiscal costs, and time lost from sport or training. During fiscal years (FY) 2012 to 2014, 1218 US Air Force trainees at Joint Base San Antonio-Lackland, Texas, were diagnosed with stress fracture(s). Diagnosis relied heavily on bone scans, often very early in clinical course and often in preference to magnetic resonance imaging (MRI), highlighting the need for an evidence-based algorithm for stress injury diagnosis and initial management. EVIDENCE ACQUISITION To guide creation of an evidence-based algorithm, a literature review was conducted followed by analysis of local data. Relevant articles published between 1995 and 2015 were identified and reviewed on PubMed using search terms stress fracture, stress injury, stress fracture imaging, and stress fracture treatment. Subsequently, charts were reviewed for all Air Force trainees diagnosed with 1 or more stress injury in their outpatient medical record in FY 2014. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS In FY 2014, 414 trainees received a bone scan and an eventual diagnosis of stress fracture. Of these scans, 66.4% demonstrated a stress fracture in the symptomatic location only, 21.0% revealed stress fractures in both symptomatic and asymptomatic locations, and 5.8% were negative in the symptomatic location but did reveal stress fracture(s) in asymptomatic locations. Twenty-one percent (18/85) of MRIs performed a mean 6 days (range, 0- 21 days) after a positive bone scan did not demonstrate any stress fracture. CONCLUSION Bone stress injuries in military training environments are common, costly, and challenging to diagnose. MRI should be the imaging study of choice, after plain radiography, in those individuals meeting criteria for further workup.
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Affiliation(s)
- Nathaniel S. Nye
- 559th Trainee Health Squadron, Joint Base San Antonio–Lackland, Texas
| | - Carlton J. Covey
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Lucas Sheldon
- 59th Radiology Squadron, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio–Lackland, Texas
| | - Bryant Webber
- 559th Trainee Health Squadron, Joint Base San Antonio–Lackland, Texas
| | - Mary Pawlak
- 559th Trainee Health Squadron, Joint Base San Antonio–Lackland, Texas
| | | | - Anthony Beutler
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Burgi AA, Gorham ED, Garland CF, Mohr SB, Garland FC, Zeng K, Thompson K, Lappe JM. High serum 25-hydroxyvitamin D is associated with a low incidence of stress fractures. J Bone Miner Res 2011; 26:2371-7. [PMID: 21698667 DOI: 10.1002/jbmr.451] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Low serum 25-hydroxyvitamin D [25(OH)D] concentrations are associated with hip fractures, but the dose-response relationship of serum 25(OH)D with risk of stress fractures in young women is unknown. This nested case-control study in a cohort of female Navy recruits was designed to determine whether those with low prediagnostic serum 25(OH)D concentrations had greater risk of stress fracture. Sera were drawn in 2002-2009 from 600 women who were diagnosed subsequently with stress fracture of the tibia or fibula and 600 matched controls who did not experience a stress fracture. The 25(OH)D concentration was measured using the DiaSorin radioimmunoassay method. Controls were individually matched to cases on race (white, black, or other), length of service (±30 days), and day blood was drawn (±2 days). There was approximately half the risk of stress fracture in the top compared with the bottom quintile of serum 25(OH)D concentration (odds ratio [OR] = 0.51, 95% CI 0.34-0.76, p ≤ 0.01). The range of serum 25(OH)D in the lowest quintile was 1.5 to 19.7 (mean 13.9) ng/mL, whereas in the highest it was 39.9 to 112 (mean 49.7) ng/mL. It is concluded that there was a monotonic inverse dose-response gradient between serum 25(OH)D and risk of stress fracture. There was double the risk of stress fractures of the tibia and fibula in women with serum 25(OH)D concentrations of less than 20 ng/mL compared to those with concentrations of 40 ng/mL or greater. A target for prevention of stress fractures would be a serum 25(OH)D concentration of 40 ng/mL or greater, achievable with 4000 IU/d of vitamin D(3) supplementation.
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Affiliation(s)
- Alina A Burgi
- Department of Behavioral Sciences and Epidemiology, Naval Health Research Center, San Diego, CA, USA
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Packnett ER, Niebuhr DW, Bedno SA, Cowan DN. Body mass index, medical qualification status, and discharge during the first year of US Army service. Am J Clin Nutr 2011; 93:608-14. [PMID: 21248187 DOI: 10.3945/ajcn.110.007070] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The high prevalence of overweight and obesity in military recruits and in the US population as a whole necessitates understanding the health effects of body composition and associated morbidity. OBJECTIVE In this study, we examined the effect of body mass index (BMI; in kg/m(2)) and medical status on premature discharge from the US Army in a large cohort of first-time-enlisted, active-duty soldiers. DESIGN We determined the odds ratios (ORs) associated with BMI and medical status at enlistment by using a retrospective cohort of first-time, active-duty army recruits. RESULTS ORs for BMI, calculated by using 24-24.9 as a reference, exhibited a U-shaped pattern. Soldiers with a BMI >34 had the highest ORs for all-cause (OR: 1.47; 95% CI: 1.32, 1.64) and medical (OR: 1.68; 95% CI: 1.46, 1.93) discharges. A BMI <17 was 1.35 times as likely (95% CI: 1.02, 1.80) to result in an all-cause discharge and 1.45 times as likely (95% CI: 1.01, 2.08) to result in a medical discharge. ORs for soldiers who required a medical reexamination did not vary when all-cause discharge (OR: 1.10; 95% CI: 1.06, 1.14) and medical discharge (OR: 1.10; 95% CI: 1.05, 1.15) were compared. The medical discharge OR for soldiers who required a medical waiver to enter the army (OR: 1.56; 95% CI: 1.48, 1.64) was higher than the OR for all-cause discharge (OR: 1.27; 95% CI: 1.22, 1.32). CONCLUSION Enlistment BMI and medical qualification status play an important role in early discharge and may provide a valuable tool in the development of fitness, nutrition, and injury-prevention interventions in higher-risk groups.
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Affiliation(s)
- Elizabeth R Packnett
- Division of Preventive Medicine, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
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Knapik JJ, Trone DW, Swedler DI, Villasenor A, Bullock SH, Schmied E, Bockelman T, Han P, Jones BH. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med 2010; 38:1759-67. [PMID: 20576837 DOI: 10.1177/0363546510369548] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoe manufacturers market motion control, stability, and cushioned shoes for plantar shapes defined as low, normal, and high, respectively. This assignment procedure is presumed to reduce injuries by compensating for differences in running mechanics. HYPOTHESIS Assigning running shoes based on plantar shape will not reduce injury risk in Marine Corps basic training. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 1. METHODS After foot examinations, Marine Corps recruits in an experimental group (E: 408 men, 314 women) were provided motion control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. A control group (C: 432 men, 257 women) received a stability shoe regardless of plantar shape. Injuries during the 12 weeks of training were determined from outpatient visits obtained from the Defense Medical Surveillance System. Other known injury risk factors (eg, fitness, smoking, prior physical activity) were obtained from a questionnaire, existing databases, or the training units. RESULTS Cox regression indicated little difference in injury risk between the E and C groups among men (hazard ratio [E/C] = 1.01; 95% confidence interval, 0.82-1.24) or women (hazard ratio [E/C] = 0.88; 95% confidence interval, 0.70-1.10). CONCLUSION This prospective study demonstrated that assigning shoes based on the shape of the plantar foot surface had little influence on injuries even after considering other injury risk factors.
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Affiliation(s)
- Joseph J Knapik
- Directorate of Epidemiology and Disease Surveillance, US Army Public Health Command, Aberdeen Proving Ground, MD 21010, USA.
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Friedl KE, Evans RK, Moran DS. Stress fracture and military medical readiness: bridging basic and applied research. Med Sci Sports Exerc 2009; 40:S609-22. [PMID: 18849874 DOI: 10.1249/mss.0b013e3181892d53] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE Military recruits and distance runners share a special risk of stress fracture injury. Recent efforts by US and Israeli military-sponsored researchers have uncovered important mechanisms and practical low-cost interventions. This article summarizes key findings relevant to prevention of stress fracture, including simple strategies to identify and to mitigate risk. METHODS Published research supported through the Bone Health and Military Medical Readiness research program and related military bone research was analyzed for contributions to preventing stress fracture in military recruits and optimizing bone health. RESULTS Thousands of military recruits helped test hypotheses about predictors of risk, safer exercise regimens, and rest, nutrition, gait training, and technology interventions to reduce stress fracture risk. Concurrent cellular, animal, and human laboratory studies were used to systematically investigate mechanisms of mechanical forces acting on bone and interactions through muscle, hormonal and genetic influences, and metabolism. The iterative and sometimes simultaneous process of basic discovery and field testing produced new knowledge that will provide safer science-based physical training. DISCUSSION Human training studies evaluating effects on bone require special commitment from investigators and funders due to volunteer compliance and attrition challenges. The findings from multiple studies indicate that measures of bone elasticity, fragility, and geometry are as important as bone mineral density in predicting fracture risk, with applications for new measurement technologies. Risk may be reduced by high intakes of calcium, vitamin D, and possibly protein (e.g., milk products). Prostaglandin E2, insulin-like growth factor 1, and estrogens are important mediators of osteogenesis, indicating reasons to limit the use of certain drugs (e.g., ibuprofen), to avoid excessive food restriction, and to treat hypogonadism. Abnormal gait may be a correctable risk factor. Brief daily vibration may stimulate bone mineral accretion similar to weight-bearing exercise. Genetic factors contribute importantly to bone quality, affecting fracture susceptibility and providing new insights into fracture healing and tissue reengineering.
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Affiliation(s)
- Karl E Friedl
- Telemedicine and Advanced Technology Research Center, Fort Detrick, MD 21702-5012, USA.
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