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ABSTRACT: BACKGROUND: Low vitamin D status increases the risk of stress fractures. As ultraviolet (UV) light is required for vitamin D synthesis, low UV light availability is thought to increase the risk of vitamin D insufficiency and poor bone health. The purpose of this investigation was to determine if individuals with low UV intensity at their home of record (HOR) or those with darker complexions are at increased risk of developing stress fractures and lower limb fractures during U.S. Army Basic Combat Training (BCT). METHODS: This was a retrospective cohort study using the Armed Forces Health Surveillance Center data repository. All Basic trainees were identified from January 1997 to January 2007. Cases were recruits diagnosed with stress fractures and lower limb fractures during BCT. The recruit's home of record (HOR) was identified from the Defense Manpower Data Center database. The average annual UV intensity at the recruits' HOR was determined using a U.S National Weather Service database and recruits were stratified into low (<=3.9); moderate (4.0-5.4), and high (>=5.5) UV index regions. Race was determined from self-reports. RESULTS: The dataset had 421,461 men and 90,141women. Compared to men, women had greater risk of developing stress fractures (odds ratio (OR) = 4.5, 95% confidence interval (95%CI) = 4.4-4.7, p < 0.01). Contrary to the hypothesized effect, male and female recruits from low UV index areas had a slightly lower risk of stress fractures (male OR (low UV/high UV) = 0.92, 95%CI = 0.87-0.97; females OR = 0.89, 95%CI = 0.84-0.95, p < 0.01) and were at similar risk for lower limb fractures (male OR = 0.98, 95%CI = 0.89-1.07; female OR = 0.93, 95%CI = 0.80-1.09) than recruits from high UV index areas. Blacks had lower risk of stress and lower limb fractures than non-blacks, and there was no indication that Blacks from low UV areas were at increased risk for bone injuries. CONCLUSIONS: The UV index at home of record is not associated with stress or lower limb fractures in BCT. These data suggest that UV intensity is not a risk factor for poor bone health in younger American adults.
BMC Musculoskeletal Disorders 04/2013; 14(1):135. · 1.58 Impact Factor
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The Journal of Strength and Conditioning Research 03/2013; 27(3):E1-2. · 1.83 Impact Factor
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ABSTRACT: BACKGROUND: United States Army military police (MP) training is a 19-week course designed to introduce new recruits to basic soldiering skills, Army values and lifestyle, and law enforcement skills and knowledge. The present investigation examined injury rates and injury risk factors in MP training. METHODS: At the start of training, 1,838 male and 553 female MP recruits were administered a questionnaire containing items on date of birth, height, weight, tobacco use, prior physical activity, injury history, and menstrual history. Injuries during training were obtained from electronic medical records and the training units provided data on student graduation and attrition. RESULTS: Successfully graduating from the course were 94.3% of the men and 83.7% of the women. Experiencing at least one injury during training were 34.2% of the men and 66.7% of the women (risk ratio (women/men) = 1.95, 95% confidence interval = 1.79-2.13). Recruits were at higher injury risk if they reported that they were older, had smoked in the past, or had performed less frequent exercise or sports prior to MP training. Men were at higher injury risk if they reported a prior injury and women were at higher risk if they reported missing at least six menstrual cycles in the last year or had previously been pregnant. CONCLUSION: The present investigation was the first to identify injury rates and identify specific factors increasing injury risk during MP training.
BMC Musculoskeletal Disorders 01/2013; 14(1):32. · 1.58 Impact Factor
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ABSTRACT: United States Army combat engineer (ENG) training is an intense 14-week course designed to introduce new recruits to basic soldiering activities, Army values and lifestyle, and engineering skills and knowledge. The present investigation examined injury rates and injury risk factors in ENG training.
At the start of their training, 1,633 male ENG recruits were administered a questionnaire containing items on date of birth, height, weight, tobacco use, prior physical activity, and injury history. Injuries during training were obtained from electronic medical records and the training units provided data on student graduation and attrition. Risk factors were identified using Cox regression.
Ninety-two percent of the recruits successfully graduated from the course and 47% of the recruits experienced one or more injuries during training. Univariate Cox regression demonstrated that recruits were at higher injury risk if they reported that they were older, had a higher or lower body mass index, had smoked in the past, had performed less exercise (aerobic or muscle strength) or sports prior to ENG training, had experienced a previous time-loss lower limb injury (especially if they had not totally recovered from that injury), or had a lower educational level.
The present investigation was the first to identify injury rates and identify specific factors increasing injury risk during ENG training. The identified risk factors provide a basis for recommending future prevention strategies.
Journal of Occupational Medicine and Toxicology 01/2013; 8(1):5.
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ABSTRACT: LTG Dennis Cavin, Commander of Accessions Command, tasked the U.S. Army Physical Fitness School (USAPFS) and the Center for Accession Research (CAR) to develop and test the ability of a standardized physical training (PT) program to improve fitness and reduce injuries and attrition during BCT. The program developed by the USAPFS followed the principles in Army Field manual 21-20 plus incorporated injury reduction principles involving reduced running mileage and a greater variety of exercises. LTG Cavin also wanted to determine if the new fitness program coupled with an administrative change might eliminate the necessity for the Fitness Assessment Program (FAP) or reduce the number of trainees who enter the FAP. New recruits who fail a basic fitness test at the Reception Station enter the FAP and train until they can pass the test and enter BCT. The proposed administrative change was to conduct the basic fitness test at Week 2 of BCT rather than in the Reception Station. This report examines attrition, fitness and injuries 1) during implementation of the standardized physical training program, and 2) among low-fit trainees who did and did not enter the FAP prior to BCT.
11/2012;
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ABSTRACT: This study determined injury incidence and examined the association between musculoskeletal injuries and potential intrinsic and extrinsic risk factors.
This retrospective cohort study involved a survey of 593 volunteers from two battalions of a Stryker Brigade Combat Team upon completion of a 12-mo deployment to Afghanistan. The survey included questions on physical characteristics, work duties, equipment worn, fitness training, and injuries experienced during the deployment.
Of the surveyed soldiers, 45% sustained an injury during the deployment. Total injuries resulted in 5049 d of limited duty, an average of 8.5 d per injury. The body regions with the largest numbers of injuries were the low back (17.4%), knee (12.7%), and shoulder (10.0%). The majority (65%) of injuries occurred while working. The most frequent activities soldiers reported as the cause of injury were lifting and carrying (9.8%), dismounted patrolling (9.6%), and physical training (8.0%). Older age, higher enlisted rank, female sex, months deployed, more time spent standing, longer strength training sessions, heaviest load worn, and heavier or more frequent lifting tasks were all associated with injury.
Tasks requiring physical energy expenditure such as load carriage, lifting, or standing resulted in an increased risk of musculoskeletal injury in this study. Lifting/carrying, dismounted patrols, and physical training were associated with 26% of musculoskeletal injuries. The weight of loads carried and lifting may be exceeding the work capacity of the soldiers, resulting in injury. These injuries in turn limit available work days for military units, reducing combat power.
Aviation Space and Environmental Medicine 11/2012; 83(11):1060-6. · 0.88 Impact Factor
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ABSTRACT: We hypothesized that the use of evidence based injury prevention strategies would lead to a reduction in the incidence of femoral neck stress injuries (FNSIs) and other serious overuse injuries in U.S. Army Basic Combat Training (BCT). An injury prevention strategy began in late 2008 that included: (1) leadership education, (2) leadership enforcement of proven methods, and (3) injury surveillance and reporting. Data on FNSI and removal from training for injury were analyzed based on the fiscal year 2006 through 2010 (n = 210,002). For men, FNSI were reduced from 13 to 20 cases/10,000 recruits per year (2006-2008) to 8 cases/10,000 recruits in 2010 (p < 0.01); for women, FNSI were reduced from 35 to 41 cases/10,000 recruits per year (2006-2008) to 18 cases/10,000 recruits per year in 2010 (p < 0.01). For men, removals from training for injury were reduced from 0.8 to 1.1 cases/100 recruits per year (2006-2008) to 0.5 cases/100 recruits in 2010 (p < 0.01); for women removal from training for injury was reduced from 2.3 to 2.4 cases/100 recruits (2006-2008) to 1.0 case/100 recruits per years in 2010 (p < 0.01). The time course of the changes suggests that following specific injury prevention methods was effective in reducing injuries.
Military medicine 09/2012; 177(9):1081-9. · 0.92 Impact Factor
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ABSTRACT: U.S. Army soldiers spend months at a time working in austere environments during deployments. The numerous physical demands placed on them during deployment can lead to musculoskeletal injuries. These injuries account for the majority of medical evacuations and lost duty days, seriously affecting mission readiness. Because of limited electronic injury data, little research has been done on physical demands associated with injury in deployed environments. To this end, this study conducted a survey on 263 soldiers in a Stryker Brigade Combat Team during their third month of deployment to Afghanistan. In the third month, 23% sustained an injury and 43% of injuries affected the low-back, shoulder, or knee. Dismounted patrolling and lifting were reported to account for 36% of injuries. Wearing heavy loads and lifting tasks were identified as injury risk factors. Wearing heavier equipment and lifting objects higher may increase physical demands and may result in injury.
Military medicine 06/2012; 177(6):716-22. · 0.92 Impact Factor
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ABSTRACT: A one-year prospective examination of injury rates and injury risk factors was conducted in Federal Bureau of Investigation (FBI) new agent training.
Injury incidents were obtained from medical records and injury compensation forms. Potential injury risk factors were acquired from a lifestyle questionnaire and existing data at the FBI Academy.
A total of 426 men and 105 women participated in the project. Thirty-five percent of men and 42% of women experienced one or more injuries during training. The injury incidence rate was 2.5 and 3.2 injuries/1,000 person-days for men and women, respectively (risk ratio (women/men) = 1.3, 95% confidence interval = 0.9-1.7). The activities most commonly associated with injuries (% of total) were defensive tactics training (58%), physical fitness training (20%), physical fitness testing (5%), and firearms training (3%). Among the men, higher injury risk was associated with older age, slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the physical fitness test (PFT), lower self-rated physical activity, lower frequency of aerobic exercise, a prior upper or lower limb injury, and prior foot or knee pain that limited activity. Among the women higher injury risk was associated with slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the PFT, and prior back pain that limited activity.
The results of this investigation supported those of a previous retrospective investigation emphasizing that lower fitness and self-reported pain limiting activity were associated with higher injury risk among FBI new agents.
BMC Public Health 12/2011; 11:920. · 2.00 Impact Factor
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ABSTRACT: Soldiers are often required to carry heavy loads during military operations. This article reports on a systematic literature review examining the influence of physical training on load carriage performance. Several literature databases, reference lists, and other sources were explored to find studies that quantitatively examined the effects of physical training on the time taken for individuals to complete a set distance carrying an external load, with the majority of the load contained in a backpack. Effect sizes (Cohen's d statistic) were used in meta-analyses to examine the changes in load carriage performance after various modes of physical training. Effect sizes quantified training-related changes in terms of SD units. Ten original research studies met the review criteria. Meta-analysis indicated that large training effects (≥0.8SD units) were apparent when progressive resistance training was combined with aerobic training and when that training was conducted at least 3 times per week, over at least 4 weeks. When progressive load-carriage exercise was part of the training program, much larger training effects were evident (summary effect size [SES] = 1.7SD units). Field-based training that combined a wide variety of training modes and included progressive load-carriage exercise was also very effective in improving load carriage performance (SES = 1.1SD units). Aerobic training alone or resistance training alone had smaller and more variable effects, depending on the study. This review indicates that combinations of specific modes of physical training can substantially improve load carriage performance.
The Journal of Strength and Conditioning Research 11/2011; 26(2):585-97. · 1.83 Impact Factor
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ABSTRACT: To investigate risk factors for time-loss injuries among soldiers attending U.S. Army Ordnance School Advanced Individual Training.
Injuries were obtained from an injury surveillance system. A health questionnaire provided data on age, race, rank, current self-reported injury and illness, and tobacco use. Fitness data was obtained from operations office.
Cumulative time-loss injury incidence was 31% for men and 54% for women. For men, higher risk of injury was associated with race, a current self-reported injury, smoking before entering the Army, lower sit-up performance, and slower 2-mile run times. For women, higher risk of injury was associated with race, a current self-reported injury, and slower 2-mile run times.
Smoking cessation and fitness training before entry are potential strategies to reduce injuries among soldiers in the Ordnance School.
Military medicine 11/2011; 176(11):1292-9. · 0.92 Impact Factor
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ABSTRACT: Past studies indicated that overall Basic Combat Training (BCT) attrition (discharge) was associated with various risk factors. BCT has changed considerably since many of these studies were conducted. This study examined Soldiers medically attrited from BCT. Potential attrition risk factor data on recruits (n = 4,005) were collected from medical records, BCT unit records, and questionnaires. Attrition data from Fort Jackson, South Carolina, showed 203 medical discharges. Cox regression (univariate and multivariate) obtained hazard ratios and 95% confidence intervals for attrition risk factors. Higher attrition risk was associated with female gender. Higher attrition risk for men was associated with cigarette smoking, injury during BCT, and less exercise before BCT. Higher attrition risk for both genders was associated with failure on the initial 2-mile run test and separated or divorced marital status. Attrition risk factors found in this study were similar to those previously identified despite changes in BCT.
Military medicine 10/2011; 176(10):1104-10. · 0.92 Impact Factor
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ABSTRACT: Since the 1950s, the standard U.S. military troop parachute system has been the T-10. TheT-10 is currently being replaced by the newer T-11 system.
This investigation compared injury incidence between the T-10 and T-11 military parachute systems.
Participants were students in basic parachute training at the U.S. Army Airborne School (USAAS). Students performed their first parachute jumps with the T-11 and subsequent jumps with the T-10. Injury data were collected from routine reports produced by the USAAS. Combat loaded jumps and night jumps were excluded from the analysis since these were only conducted with the T-10.
There were a total of 76 injuries in 30,755 jumps for an overall cumulative injury incidence of 2.5/1000 jumps. With the T-10 parachute, there were 61 injuries in 21,404 jumps for a cumulative injury incidence of 2.9/1000 jumps; with the T-11 parachute there were 15 injuries in 9351 jumps for a cumulative injury incidence of 1.6/1000 jumps [risk ratio (T10/T11) = 1.78, 95% confidence interval = 1.01-3.12, P = 0.04].
Limitations to this analysis included the fact that the T-11 was only used on the first jumps among students who had likely never previously performed a parachute jump and that aircraft exit procedures differed very slightly for the two parachutes. Nonetheless, the data suggest that injury incidence is lower with the T-11 parachute than with the T-10 parachute when airborne training operations are conducted during the day without combat loads.
Aviation Space and Environmental Medicine 10/2011; 82(10):935-40. · 0.88 Impact Factor
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ABSTRACT: The purpose of this investigation was to examine injury incidence, events associated with injury, and injury risk factors during parachuting in an Army airborne infantry unit.
Injury data were obtained by the investigators on the drop zone and confirmed by a physician. Operational data (potential injury risk factors) were obtained from routine reports published by the infantry unit. Weather data were obtained using a Kestrel Model 4500 pocket weather tracker.
There were a total of 23,031 jumps resulting in 242 injured soldiers for a crude injury incidence of 10.5 per 1000 jumps. Parachute entanglement incidence was 0.5 per 1000 jumps. Where an event associated with the injury could be determined (67% of cases), these included ground impact (75%), static line problems (11%), tree landings (4%), entanglements (4%), and aircraft exits (3%). Univariate analysis showed that higher injury risk was associated with night jumps (versus day jumps), combat loads (versus unloaded jumps), higher wind speeds, higher dry bulb temperatures, higher humidity, C17 Globemaster or C130 Hercules aircrafts (compared to the other aircraft), exits through aircraft side doors (versus tailgates), and entanglements. Multivariate analysis indicated that independent risk factors for injuries included night jumps, combat loads, higher wind speeds, higher dry bulb temperatures, and entanglements.
This investigation provided injury incidence, events associated with injury, and quantitative assessments of injury risk factors and their interactions during military parachuting. An appreciation of these subjects can assist medical and operational planners in further reducing the incidence of injury during airborne operations.
Aviation Space and Environmental Medicine 08/2011; 82(8):797-804. · 0.88 Impact Factor
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ABSTRACT: Associations between physical activity and injuries have been previously examined using self-reports. The present investigation examined this association using objective measures of activity and injury.
To quantify ambulatory activity, pedometers were worn daily by recruits in 10 Army Basic Combat Training companies during the 9-week training cycle. Injuries were obtained from a medical surveillance system, defined as traumatic or overuse events resulting in a medical care provider visit. A daily questionnaire documented whether or not recruits wore the pedometers and trained with their companies for the entire day.
Training companies were categorized by activity level into 3 groups with higher activity (HA, 17,948±550 steps/day), 4 with moderate activity (MA, 16,346±768 steps/day) and 3 with lower activity (LA, 14,772±400 steps/day). Among men, the MA and HA groups were at 1.52 (95% confidence interval [95% CI]=1.15-2.01) and 1.94 (95% CI=1.46-2.61) times higher injury risk, respectively, compared with the LA group. Among women, the MA and HA groups were at 1.36 (95% CI=1.07-1.73) and 1.53 (95% CI=1.24-1.89) times higher injury risk, respectively, compared with low LA group. The relationships remained significant after considering physical characteristics and physical fitness.
In consonance with previous self-report studies, higher physical activity was associated with higher injury risk.
Journal of physical activity & health 05/2011; 8(4):496-502. · 1.95 Impact Factor
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ABSTRACT: This prospective cohort study examined injuries and injury risk factors in 660 British Army infantry soldiers during a predeployment training cycle.
Soldiers completed a questionnaire concerning physical characteristics, occupational factors, lifestyle characteristics (including physical training time) and previous injury. Direct measurements included height, body mass, sit-ups, push-ups and run time. Electronic medical records were screened for injuries over a 1-year period before operational deployment. Backward-stepping Cox regression calculated HR and 95% CI to quantify independent injury risk factors.
One or more injuries were experienced by 58.5% of soldiers. The new injury diagnosis rate was 88 injuries/100 person-years. Most injuries involved the lower body (71%), especially the lower back (14%), knee (19%) and ankle (15%). Activities associated with injury included sports (22%), physical training (30%) and military training/work (26%). Traumatic injuries accounted for 83% of all injury diagnoses. Independent risk factors for any injury were younger age (17-19 years (HR 1.0), 20-24 years (HR 0.71, 95% CI 0.55 to 0.93), 25-29 years (HR 0.89, 95% CI 0.66 to 1.19) and 30-43 years (HR 0.41, 95% CI 0.27 to 0.63), previous lower limb injury (yes/no HR 1.49, 95% CI 1.19 to 1.87) and previous lower back injury (yes/no HR 1.30, 95% CI 1.03 to 1.63).
British infantry injury rates were lower than those reported for US infantry (range 101-223 injuries/100 soldier-years), and younger age and previous injury were identified as independent risk factors. Future efforts should target reducing the incidence of traumatic injuries, especially those related to physical training and/or sports.
Injury Prevention 04/2011; 17(6):381-7. · 1.39 Impact Factor
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ABSTRACT: Footwear characteristics can influence, fatigue, comfort, injuries and energy cost. Members of the United States Army Band have hundreds of performances a year and these performances often include prolonged standing and marching in footwear.
The purposes of this paper are to: (1) determine injury rates before and after wearing a shoe with presumed greater cushioning and ventilation among US Army Band members, and (2) identify risk factors associated with foot pain/discomfort.
To potentially reduce injuries and improve comfort, 112 band members received shoes with an advertised increase in cushioning and ventilation.
Injury incidence determined from medical records was 55% in the year before and 57% in the year during which band members wore the new shoes (p = 0.78). Higher risk of foot pain was associated with band unit (odds ratio (OR(Ceremonial unit/other units) = 8.6), 95% confidence interval (CI): 1.2-60.2), shoe cushioning rating (OR(poor/good) = 11.8, 95% CI: 1.5-89.7), orthotic use (OR(yes/no) = 18.5, 95% CI: 2.9-120.3), and how often band members replaced their shoes (OR(≤1 year/>2 years) = 11.5, 95% CI: 1.4-95.4).
The new shoes did not lower injury incidence, although specific risk factors associated with foot pain/discomfort were identified. To potentially increase the cushioning and comfort, insoles may be considered.
The Foot 01/2011; 21(2):60-5.
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ABSTRACT: ABSTRACT:
A retrospective examination was conducted of injuries, physical fitness, and their association among Federal Bureau of Investigation (FBI) new agent trainees.
Injuries and activities associated with injuries were obtained from a review of medical records in the medical clinic that served the new agents. A physical fitness test (PFT) was administered at Weeks 1, 7 and 14 of the 17-week new agent training course. The PFT consisted of push-ups, sit-ups, pull-ups, a 300-meter sprint, and a 1.5-mile run. Injury data were available from 2000 to 2008 and fitness data were available from 2004 to early 2009.
During the survey period, 37% of men and 44% of women experienced one or more injuries during the new agent training course (risk ratio (women/men) = 1.18, 95% confidence interval = 1.07-1.31). The most common injury diagnoses were musculoskeletal pain (not otherwise specified) (27%), strains (11%), sprains (10%), contusions (9%), and abrasions/lacerations (9%). Activities associated with injury included defensive tactics training (48%), physical fitness training (26%), physical fitness testing (6%), and firearms training (6%). Over a 6-year period, there was little difference in performance of push-ups, sit-ups, pull-ups, or the 300-meter sprint; 1.5-mile run performance was higher in recent years. Among both men and women, higher injury incidence was associated with lower performance on any of the physical fitness measures.
This investigation documented injury diagnoses, activities associated with injury, and changes in physical fitness, and demonstrated that higher levels of physical fitness were associated with lower injury risk.
Journal of Occupational Medicine and Toxicology 01/2011; 6:26.
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ABSTRACT: The Military Training Task Force of the Defense Safety Oversight Council funded a project to compare injury rates between the older T-10 parachute and the newer T-11 parachute. This is a preliminary report on injury incidence and injury risk factors with the T-10 parachute. From 17 June to 3 December 2010, injury and operational data were systematically collected on all jump operations performed by the 82nd Airborne Division (Fort Bragg, North Carolina) while using T-10D parachutes. Data on injured jumpers included injury diagnosis, anatomical location of the injury, and how the injury occurred. Operational data from flight manifests and flash reports included the date and time of the jump, type of jump (administrative/non-tactical (Hollywood) or combat load), unit involved, drop zone, entanglements, Soldiers? rank, jump order (order in which the Soldiers exited the aircraft), door side (right, left, tailgate), aircraft type, and time from redeployment to jump operation. Dry bulb temperature, humidity, and wind speed were obtained using a Kestrel(registered) Model 4500 pocket weather tracker. There were a total of 23,031 jumps resulting in 242 injured Soldiers for a crude injury incidence of 10.5/1,000 jumps. There were 12 entanglements for an entanglement incidence of 0.52/1,000 jumps. In 2/3 of the injury cases (n=160) an event associated with the injury was determined and these included ground impact (n=120), static line problems (n=17), tree landings (n=6), entanglements (n=6), aircraft exits (n=4), landing on equipment (n=2), dragging by parachute on ground (n=2), parachute risers (n=2), and lowering line (n=1). The incidence of static line injuries evacuated to the hospital (more serious) was 0.30/1,000 jumps, twice as high as the incidence of 0.15/1,000 jumps reported from 1994 to 1996 at Fort Bragg.
12/2010;
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ABSTRACT: 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.
Assigning running shoes based on plantar shape will not reduce injury risk in Marine Corps basic training.
Randomized controlled clinical trial; Level of evidence, 1.
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.
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).
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.
The American journal of sports medicine 09/2010; 38(9):1759-67. · 3.61 Impact Factor
