Article

Effect on Injuries of Assigning Shoes Based on Foot Shape in Air Force Basic Training

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Abstract

This study examined whether assigning running shoes based on the shape of the bottom of the foot (plantar surface) influenced injury risk in Air Force Basic Military Training (BMT) and examined risk factors for injury in BMT. Data were collected from BMT recruits during 2007; analysis took place during 2008. After foot examinations, recruits were randomly consigned to either an experimental group (E, n=1042 men, 375 women) or a control group (C, n=913 men, 346 women). Experimental group recruits were assigned motion control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. Control group recruits received a stability shoe regardless of plantar shape. Injuries during BMT were determined from outpatient visits provided from the Defense Medical Surveillance System. Other injury risk factors (fitness, smoking, physical activity, prior injury, menstrual history, and demographics) were obtained from a questionnaire, existing databases, or BMT units. Multivariate Cox regression controlling for other risk factors showed little difference in injury risk between the groups among men (hazard ratio [E/C]=1.11, 95% CI=0.89-1.38) or women (hazard ratio [E/C]=1.20, 95% CI= 0.90-1.60). Independent injury risk factors among both men and women included low aerobic fitness and cigarette smoking. This prospective study demonstrated that assigning running shoes based on the shape of the plantar surface had little influence on injury risk in BMT even after controlling for other injury risk factors.

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... Human foot morphology is an important subject for physical anatomical analysis in several biomedical disciplines, including orthopedics, orthotic design and sports sciences [1][2][3][4][5][6][7][8][9][10][11][12][13]. Different environments and everyday habits (e.g., frequency of sport activity, shoe wearing habits), as well as personal characteristics such as sex, body mass index, and age, have been shown to have a significant influence on adult foot morphology [1][2][3][4][5][6][7][8][9]. ...
... Human foot shape also differs among ethnic groups [2] and changes in the course of postnatal development [10]. As a result, footprint shape has been used in a variety of disciplines such as orthopedics [11,12], and footwear research [13]. ...
... Our statistical analyses on healthy individuals could possibly aid in further standardizing and automating clinical evaluation. A recent study by Knapik on injury risk based on the plantar surface shape came to a similar conclusion [13]. In the study of Knapik, there tended to be a bimodal relationship between BMI and injury risk among the men. ...
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Background Foot morphology has received increasing attention from both biomechanics researches and footwear manufacturers. Usually, the morphology of the foot is quantified by 2D footprints. However, footprint quantification ignores the foot’s vertical dimension and hence, does not allow accurate quantification of complex 3D foot shape. Methods The shape variation of healthy 3D feet in a population of 31 adult women and 31 adult men who live in Belgium was studied using geometric morphometric methods. The effect of different factors such as sex, age, shoe size, frequency of sport activity, Body Mass Index (BMI), foot asymmetry, and foot loading on foot shape was investigated. Correlation between these factors and foot shape was examined using multivariate linear regression. Results The complex nature of a foot’s 3D shape leads to high variability in healthy populations. After normalizing for scale, the major axes of variation in foot morphology are (in order of decreasing variance): arch height, combined ball width and inter-toe distance, global foot width, hallux bone orientation (valgus-varus), foot type (e.g. Egyptian, Greek), and midfoot width. These first six modes of variation capture 92.59% of the total shape variation. Higher BMI results in increased ankle width, Achilles tendon width, heel width and a thicker forefoot along the dorsoplantar axis. Age was found to be associated with heel width, Achilles tendon width, toe height and hallux orientation. A bigger shoe size was found to be associated with a narrow Achilles tendon, a hallux varus, a narrow heel, heel expansion along the posterior direction, and a lower arch compared to smaller shoe size. Sex was found to be associated with differences in ankle width, Achilles tendon width, and heel width. Frequency of sport activity was associated with Achilles tendon width and toe height. Conclusion A detailed analysis of the 3D foot shape, allowed by geometric morphometrics, provides insights in foot variations in three dimensions that can not be obtained from 2D footprints. These insights could be applied in various scientific disciplines, including orthotics and shoe design.
... While certainly undesirable, some amount of catastrophic injury is unavoidable during deployment and is a direct result of the conditions in which military personnel work. There is, however, a large proportion of injuries that may result from (or be exacerbated by) controllable factors such as training [6][7][8][9][10][11] and equipment [8,12,13]. ...
... Substantial research has assessed the risk factors for injury in the military [1,3,4,6,10,12,14]; however, results are often contradictory and focus on individual factors, when in reality, a large number are inextricably linked. Load carriage and training are commonly cited as causative factors towards musculoskeletal injury within military forces, particularly army [1,3,4,6,[8][9][10][15][16][17][18][19]; however, the effect that footwear can have on injuries has received minimal attention in previous reviews of military injuries despite the research completed in this area [3,7,9,[20][21][22]. Footwear can have a significant effect on gait and performance of tasks, which in turn can lead to injury. ...
... Substantial research has assessed the risk factors for injury in the military [1,3,4,6,10,12,14]; however, results are often contradictory and focus on individual factors, when in reality, a large number are inextricably linked. Load carriage and training are commonly cited as causative factors towards musculoskeletal injury within military forces, particularly army [1,3,4,6,[8][9][10][15][16][17][18][19]; however, the effect that footwear can have on injuries has received minimal attention in previous reviews of military injuries despite the research completed in this area [3,7,9,[20][21][22]. Footwear can have a significant effect on gait and performance of tasks, which in turn can lead to injury. ...
Article
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Injuries are common within military populations, with high incidence rates well established in the literature. Injuries cause a substantial number of working days lost, a significant cost through compensation claims and an increased risk of attrition. In an effort to address this, a considerable amount of research has gone into identifying the most prevalent types of injury and their associated risk factors. Collective evidence suggests that training and equipment contribute to a large proportion of the injuries sustained. In particular, the large loads borne by soldiers, the high intensity training programs and the influence of footwear have been identified as significant causative factors of lower limb injury in military populations. A number of preventative strategies have been developed within military bodies around the world to address these issues. The relative success of these strategies is highly variable; however, with advancements in technology, new approaches will become available and existing strategies may become more effective.
... 9 10 34 40 Studies included predominantly male participants (range: 56%-100%), a finding attributed to conscription practices 37 38 or training site demographics. 44 Trials typically occurred over the course of an initial recruit training course or initial period of service which ranged from six weeks 45 to six months. 38 Andrish et al 23 specified only that training occurred over the summer. ...
... Studies of prescribed athletic footwear by arch height in military recruits reported no significant effects. [43][44][45] However, our calculations of RR using extracted data suggest that the prescribed footwear may have actually have had a significant, but small, increase in injury risk in Air Force recruits (RR: 1.11, NNT harm: 29). 45 In a study assessing prescribed tropical combat boots compared with standard issue leather boot controls in Marine recruits, the intervention group was reported to have significantly higher occurrence of retrocalcaneal bursitis, but not other overuse injuries. ...
... Among these studies, only the synthesis conducted by Knapik et al 46 employed a military-only study population in the aggregation of their previous three studies of Army, Marine Corps and Air Force recruits. [43][44][45] While our findings pertaining to prescribed shock-absorbing insoles agree with those found in the meta-analysis conducted by Bonanno et al, 13 our findings pertaining to the lack of prophylactic effects of foot orthoses diverge. 14 Their analysis found that orthoses were effective in preventing overall MSKI. ...
Article
Introduction Military members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review with meta-analysis was to assess if prescribed prophylactic footwear or foot orthoses reduced the risk of lower extremity injury in military tactical athletes. Methods MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Defense Technical Information Center databases were searched for randomised controlled trials published at any time that compared foot orthoses or prescribed footwear (to include shock-absorbing insoles and socks) with a placebo intervention or a no-treatment control. Methodological quality was assessed and the number of injuries, population at risk and duration of the study epoch were extracted and relative risk (RR) calculated. An omnibus meta-analysis was performed assessing all prescribed footwear and orthoses intervention studies, with subgroup analyses conducted on studies with similar interventions (ie, basketball athletic shoes, athletic shoes (prescribed by foot type), foot orthoses, shock-absorbing insoles, socks, tropical combat boots). Results Of 1673 studies identified, 22 were included. Three of eight studies that employed orthoses demonstrated significantly reduced overuse injuries compared with no-treatment controls (RR range: 0.34–0.68); one study showed neoprene insoles significantly decreased overuse injuries (RR: 0.75). There were no other significant effects in the individual studies and no protective effects observed in the omnibus meta-analysis or in the component subanalyses. Conclusions Prescribed footwear and orthoses do not appear to have a prophylactic effect on lower quarter musculoskeletal injuries in military members and cannot be recommended at this time.
... A total of 24 articles were included for qualitative synthesis in this review ( Figure 1). Of the included studies, twelve were randomised controlled trials (RCT) (Dubois, Esculier, Frémont, Moore, & Richards, 2015, Fuller et al., 2017Gardner et al., 1988;Knapik et al., 2009Knapik et al., , 2010aKnapik et al., , 2010bMalisoux et al., 2016aMalisoux et al., , 2016bRyan, Elashi, Newsham-West, & Taunton, 2014, Ryan, Valiant, McDonald, & Taunton, 2011, Theisen et al., 2013, five were prospective (Altman & Davis, 2016;Di Caprio, Buda, Mosca, Calabro', & Giannini, 2010, Grier et al., 2016Nielsen et al., 2014;Salzler et al., 2016), four were retrospective (Goss & Gross, 2012;Ostermann, Ridpath, & Hanna, 2016;Salzler, Bluman, Noonan, Chiodo, & de Asla, 2012, Schwellnus & Stubbs, 2006, and three were case studies (Cauthon, Langer, & Coniglione, 2013;Giuliani, Masini, Alitz, & Owens, 2011;Salzler et al., 2012). One study evaluated only females (Ryan et al., 2011) and four studies evaluated only males (Fuller et al., 2017;Giuliani et al., 2011;Grier et al., 2016;Wilk, Fisher, & Gutierrez, 2000). ...
... All studies, except five (Gardner et al., 1988;Malisoux et al., 2015;Schwellnus & Stubbs, 2006;Wilk et al., 2000;Withnall, Eastaugh, & Freemantle, 2006), reported at least one type of footwear included in the study. The following terms were used to describe running style footwear: "traditional" (Cauthon et al., 2013;Goss & Gross, 2012;Grier et al., 2016;Ostermann et al., 2016;Salzler et al., 2016Salzler et al., , 2012, "neutral" (Ryan et al., 2011(Ryan et al., , 2014, "stability" (Cauthon et al., 2013;Grier et al., 2016;Knapik et al., 2009Knapik et al., , 2010aKnapik et al., , 2010bRyan et al., 2011), "cushioned" (Grier et al., 2016;Knapik et al., 2009Knapik et al., , 2010aKnapik et al., , 2010b, "motion-control" (Grier et al., 2016;Knapik et al., 2009Knapik et al., , 2010aKnapik et al., , 2010bMalisoux et al., 2016a;Ryan et al., 2011) and "minimalist" (Altman & Davis, 2016;Cauthon et al., 2013;Dubois et al., 2015;Fuller et al., 2017;Goss & Gross, 2012;Grier et al., 2016;Ostermann et al., 2016;Ryan et al., 2014;Salzler et al., 2012Salzler et al., , 2016. Other footwear descriptions included: "modern day shoes" (Altman & Davis, 2016), "neutral plus" (Cauthon et al., 2013), "conventional" (Fuller et al., 2017), "barefoot simulating" (Giuliani et al., 2011), "standard" (Malisoux et al., 2016a), "standard cushioned" (Theisen et al., 2013), and "partial minimalist" (Ryan et al., 2014). ...
... All studies, except five (Gardner et al., 1988;Malisoux et al., 2015;Schwellnus & Stubbs, 2006;Wilk et al., 2000;Withnall, Eastaugh, & Freemantle, 2006), reported at least one type of footwear included in the study. The following terms were used to describe running style footwear: "traditional" (Cauthon et al., 2013;Goss & Gross, 2012;Grier et al., 2016;Ostermann et al., 2016;Salzler et al., 2016Salzler et al., , 2012, "neutral" (Ryan et al., 2011(Ryan et al., , 2014, "stability" (Cauthon et al., 2013;Grier et al., 2016;Knapik et al., 2009Knapik et al., , 2010aKnapik et al., , 2010bRyan et al., 2011), "cushioned" (Grier et al., 2016;Knapik et al., 2009Knapik et al., , 2010aKnapik et al., , 2010b, "motion-control" (Grier et al., 2016;Knapik et al., 2009Knapik et al., , 2010aKnapik et al., , 2010bMalisoux et al., 2016a;Ryan et al., 2011) and "minimalist" (Altman & Davis, 2016;Cauthon et al., 2013;Dubois et al., 2015;Fuller et al., 2017;Goss & Gross, 2012;Grier et al., 2016;Ostermann et al., 2016;Ryan et al., 2014;Salzler et al., 2012Salzler et al., , 2016. Other footwear descriptions included: "modern day shoes" (Altman & Davis, 2016), "neutral plus" (Cauthon et al., 2013), "conventional" (Fuller et al., 2017), "barefoot simulating" (Giuliani et al., 2011), "standard" (Malisoux et al., 2016a), "standard cushioned" (Theisen et al., 2013), and "partial minimalist" (Ryan et al., 2014). ...
Article
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Background: Many footwear characteristics are argued as risk factors for running related injuries (RRI). Several footwear assessment tools are available; however, their use in studies of RRI is unknown. Objective: This systematic review evaluated the characteristics and methods of assessing footwear in studies of RRI. Design: Five online databases were searched for studies on adult runners, in running style footwear, who experienced running-related pain or injury. The methodological quality of included articles was independently assessed by two raters using a modified Downs and Black checklist. Study and participant characteristics, footwear assessment tools used, and footwear characteristics reported were extracted for qualitative synthesis. Results: Twenty-four articles were included in the review. Low risk of bias was determined for 11 (44%) of the included studies. Twenty-eight different footwear characteristics were grouped into four categories: nomenclature, measurements, qualitative features, and subjective features. Fifteen different methods for assessing the 28 footwear characteristics were reported among the included studies. Only three methods were described previously, as valid and reliable. Conclusion: Differences in assessing footwear may mask the link between footwear characteristics and injury risk. Systematic footwear assessments and nomenclature are needed to evaluate the effects of footwear characteristics on RRI.
... Several military studies have shown bimodal or J-shaped patterns of risk for injury, where the highest and lowest extremes of BMI are at greatest risk. 18,[22][23][24] Other studies suggest highest risk occurs among those running average run times or slower and who exhibit the lowest BMIs. 1,7 These data suggest a need to further evaluate the extremes of current U.S. Army BMI standards. ...
... The study findings are consistent with the general body of evidence that shows the most aerobically fit U.S. Army male and female trainees are protected from training injuries. 14,[16][17][18][19]23,26,27 This finding has also been reported by researchers from Great Britain 28 Quintile (Q) = group containing one fifth of subjects. RR = relative risk; CI = 95% confidence interval; n = sub-population group size. ...
Article
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Objectives: To determine the combined effects of physical fitness and body composition on risk of training-related musculoskeletal injuries among Army trainees. Design: Retrospective cohort study. Methods: Rosters of soldiers entering Army basic combat training (BCT) from 2010 to 2012 were linked with data from multiple sources for age, sex, physical fitness (heights, weights (mass), body mass index (BMI), 2 mile run times, push-ups), and medical injury diagnoses. Analyses included descriptive means and standard deviations, comparative t-tests, risks of injury, and relative risks (RR) and 95% confidence intervals (CI). Fitness and BMI were divided into quintiles (groups of 20%) and stratified for chi-square (χ(2)) comparisons and to determine trends. Results: Data were obtained for 143,398 men and 41,727 women. As run times became slower, injury risks increased steadily (men=9.8-24.3%, women=26.5-56.0%; χ(2) trends (p<0.00001)). For both genders, the relationship of BMI to injury risk was bimodal, with the lowest risk in the average BMI group (middle quintile). Injury risks were highest in the slowest groups with lowest BMIs (male trainees=26.5%; female trainees=63.1%). Compared to lowest risk group (average BMI with fastest run-times), RRs were significant (male trainees=8.5%; RR 3.1, CI: 2.8-3.4; female trainees=24.6%; RR 2.6, CI: 2.3-2.8). Trainees with the lowest BMIs exhibited highest injury risks for both genders and across all fitness levels. Conclusions: While the most aerobically fit Army trainees experience lower risk of training-related injury, at any given aerobic fitness level those with the lowest BMIs are at highest risk. This has implications for recruitment and retention fitness standards.
... Namun begitu, jika tersalah pilih pastinya padah yang menimpa kerana tanpa keselesaan ketika memakai but akan menyebabkan rasa sakit dan jika dibiarkan akan menyebabkan kesan yang berpanjangan. Justeru, beberapa penyelidik telah melakukan pelbagai kajian agar dapat memberi keselesaan kepada pengguna (Hansen et al. 1998;Windle et al. 1999;Knapik et al. 2010;Larsen et al. 2002;Bogerd et al. 2012). ...
... Mereka telah mengkaji pembuatan lapik dalam kasut untuk membantu mengurangkan tekanan pada kaki. Antara penyelidik yang membuat kajian mengenai lapik dalam kasut adalah Knapik et al. (2010), Larsen et al. (2002), serta Windle et al. (1999). Walau bagaimanapun, kajian berkaitan EMG semasa kegiatan berkawad tiada dilaporkan. ...
Article
Full-text available
ABSTRAK But kawad merupakan suatu kelengkapan penting yang digunakan dalam kegiatan berkawad. Namun, penggunaan but kawad ini semasa kegiatan berkawad secara berulang kali boleh menyebabkan kecederaan pada kaki. Oleh itu, kajian ini bertujuan untuk melihat kesan tindakan otot apabila berkawad menggunakan but, kasut sukan dan tanpa berkasut. Ujian elektromiografi (EMG) digunakan untuk mengesan kelakuan otot pinggiran bawah badan, iaitu otot peroneus longus, ekstensor digitorum longus, gastroknemius kepala sisi dan gastroknemius kepala tengah. Soal selidik dijalankan untuk mengumpul data laporan kecederaan kesan memakai but ketika berkawad dan kajian EMG dilakukan untuk mendapatkan daya tindakan otot apabila berkawad. Subjek bagi soal selidik dipilih daripada kadet PALAPES. Keputusan menunjukkan 52% responden melaporkan mengalami kesakitan kaki apabila berkawad dan otot gastroknemius kepala tengah menghasilkan nilai daya yang lebih besar, iaitu dua kali ganda berbanding dengan otot lain semasa kegiatan berkawad dengan memakai but berbanding memakai kasut sukan. Oleh itu dapat disimpulkan bahawa apabila beban yang lebih besar dikenakan, otot akan bekerja lebih atau menghasilkan daya yang lebih besar untuk memastikan sistem berada dalam keseimbangan. Kata kunci: kawad; elektromiografi (EMG); but kawad; daya otot ABSTRACT Boots are important gears used in a marching activity. However, the use of these boots when marching repeatedly would cause injuries to the foot. Therefore, this study aims to study the effects of muscles' actions during marching when using boots, sports shoes and without shoes. The electromyography (EMG) test was used to track the behaviour of lower limb muscles which are peroneus longus, extensor digitorum longus, gastrocnemius medial head and gastrocnemius lateral head muscles. A survey was conducted to collect injury reported data affected from wearing boots and EMG investigation was performed to collect muscles activity during marching. Subjects for survey and experiment conducted were recruited from PALAPES cadets. Results show that 52% of respondent reported foot pain during marching activity and gastrocnemius medial head muscle produced higher value of force compared to that of other muscles when marching using boots than that of wearing sports shoes. It is concluded that when a greater load is exerted, muscle will produce a higher value of forces to ensure system equilibrium is achieved.
... In 2007, coordinated studies were conducted in Army, Air Force, and Marine Corps basic training. [29][30][31] Foot arch height was determined by expert evaluators using the template in Figure 2. Recruits in all three Services were randomized into either an experimental (E) group or control (C) group. The E group was provided a running shoe based on arch height: E group recruits with arch heights judged to represent low, medium, or high foot arches received motion control, stability, or cushioned shoes, respectively. ...
Article
This article traces the history of the athletic shoe, examines whether selecting running shoes based on foot arch height influences injuries, and examines historical data on injury rates when physical training (PT) is performed in boots versus running shoes. In the 1980s and into the 2000s, running shoe companies were advertising specialized shoes with "motion control," "stability," and "cushioning," designed for individuals with low, normal, and high arches, respectively. Despite marketing claims that these shoes would reduce injury rates, coordinated studies in Army, Air Force, and Marine Corps basic training showed that assigning or selecting shoes on this basis had no effect on injury rates. Consistent with this finding, biomechanical studies have shown that the relationships between arch height, foot joint mobility, and rear-foot motion are complex, variable, and frequently not as strong as often assumed. In 1982, the US Army switched from PT in boots to PT in running shoes because of the belief that boots were causing injuries and that running shoes would reduce injury rates. However, a historical comparison of injury rates before and after the switch to running shoes showed virtually no difference in injury risk between the two periods. It is not clear at this point if the type of footwear effects injury incidence. 2015.
... Intrinsic factors, such as cigarette smoking 9,29,30,32 and menstrual abnormalities, 31 and extrinsic factors, such as total mileage and training intensity, 18,33 have also been shown to contribute to injury risk but were not evaluated in this study. Shoe prescriptions based on plantar shape or modifications to the training environment (eg, rubberized tracks) have been instituted at Air Force BMT as a means of preventing injury, but previous investigations [34][35][36] did not support their effectiveness. ...
Article
Context: Musculoskeletal injuries are common in military trainees and have significant medical and operational effects. Objective: To provide current musculoskeletal injury epidemiology data for US Air Force basic military trainees. Design: Descriptive epidemiologic study with cross-sectional features. Setting: US Air Force Basic Military Training, Joint Base San Antonio-Lackland, Texas. Patients or other participants: All recruits who entered training between July 1, 2012, and June 30, 2014. Main outcome measure(s): Incidence density rate of all musculoskeletal injuries (stratified by body region and type) and factors and costs associated with injuries. Results: Of the 67 525 trainees, 12.5% sustained 1 or more musculoskeletal injuries. The overall incidence density rate was 18.3 injuries per 1000 person-weeks (15.1 for men and 29.4 for women). The most common diagnosis (n = 2984) was Pain in joint, lower leg, as described in the International Classification of Diseases, Ninth Revision, Clinical Modification, code 719.46. Injuries were more common among those with lower levels of baseline aerobic and muscular fitness. Injured trainees were 3.01 times (95% confidence interval = 2.85, 3.18) as likely to be discharged, and injured trainees who did graduate were 2.88 times (95% confidence interval = 2.72, 3.04) as likely to graduate late. During the surveillance period, injuries resulted in more than $43.7 million in medical ($8.7 million) and nonmedical ($35 million) costs. Conclusions: Musculoskeletal injuries, predominantly of the lower extremities, have significant fiscal and operational effects on Air Force Basic Military Training. Further research into prevention and early rehabilitation of these injuries in military trainees is warranted.
... Notwithstanding these facts, the application of the 'shoe-shop theory' with the aim of reducing excessive stress on the musculoskeletal system does not necessarily imply a reduction in RRI. This was convincingly demonstrated by a series of publications by Knapik and coworkers on a total of over 7000 army recruits [12,14,15]. In all 3 studies, matching footgear to foot type did not have any influence on injury risk, which seems to question the usefulness of cushioning and motion control technology in running shoes. ...
The aim of this contribution is to present and discuss recent research findings on the relationship between shoe technology, running biomechanics and running-related injury risk. This association has long been inferred based on biomechanical studies, but this inference is not always scientifically sound, given that the study outcome is seldom injury itself. Epidemiological studies such as prospective cohort or intervention studies focusing on running-related injuries provide more conclusive evidence. However, the underlying mechanisms in the relationship between shoe design features and injury can generally not be established. Comparisons of healthy and injured runners have revealed subtle differences in their running mechanics, especially when certain injury types are considered. However, there is no evidence today that a particular footgear is able to induce a less injury-prone running style in general.
... In cases where results were stratified and analysed by sex, the general outcome tended to reflect higher injury rates in women but with comparable injury reduction rates between men and women. 32,33,42 However, one study by Franklyn-Miller et al. 37 investigating orthotic use in Naval Officers did reveal different risk-reduction values between men and women, and indicated that orthotic use may be more effective for women over men. Some of the observed discrepancies in study outcomes may reflect the lack of sex stratification or use of single-sex cohorts. ...
Article
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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.
... Thirteen studies reported footwear type based on the manufacturer discretion. Footwear was reported as: minimalist 3 21 24 30 , traditional 21 24 , barefoot-simulating 20 , motion-control 8 26 32 33 35 , stability 8 32 33 35 , cushioned 32 33 35 , standard 26 , standard-cushioned 9 27 , and neutral 7 8 . ...
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Background: Many footwear characteristics are argued as risk factors for running related injuries (RRI). Several footwear assessment tools are available; however, their use in studies of RRI is unknown. Objective: This systematic review evaluated the characteristics and methods of assessing footwear in studies of RRI. Results: Twenty-five articles were included in the review. Low risk of bias was determined for 11 (44%) of the included studies. Twenty-nine different footwear characteristics were grouped into four categories: nomenclature, measurements, qualitative features, and subjective features. Fifteen different methods for assessing the 29 footwear characteristics were reported among the included studies. Only three methods were described previously, as valid and reliable. Conclusion: Differences in assessing footwear may lead to incomplete data and systematic bias between studies of footwear characteristics. Systematic footwear assessments and nomenclature are needed to evaluate the effects of footwear characteristics on RRI.
... Yet, traditional shoe prescription has not prevented RRIs-consider five quality randomised controlled trials (RCT) and observational cohort studies. [1][2][3][4][5] In contrast, a recent investigation 6 found that motion control shoes protected against injury in experienced runners who had pronated feet. There are likely important methodological reasons for the discrepancies between these studies, such as differing definitions of RRI and various experience levels among runners. ...
... At first sight, this seems to be illogical since wearing prescribed footwear is supposed to lower the injury risk. However, other studies in military populations investigating the effectiveness of matching running shoes according to foot shape showed no influence on injury risk [23][24][25]. A meta-analysis that pooled results of 3 investigations showed little difference between the group with matching running shoes and the control groups in the injury rate (injuries per 1000 person-days) for either men (summary rate ratio = 0.97; 95% CI: 0.88, 1.06) or women (summary rate ratio = 0.97; 95% CI: 0.85, 1.08). ...
Article
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Background: Runners and walkers often suffer from lower extremity injuries. Little is known about the relationship between their consumer behaviour towards footwear and the development of those injuries. Therefore, the aim of this study was to investigate if consumer behaviour towards footwear is a risk factor for lower extremity injuries. Methods: A prospective cohort study was set-up in leisure-time walkers and runners. Potential risk factors in consumer behaviour were obtained by means of a baseline questionnaire related to the acquisition of current walking or running shoes. Information on injuries sustained during a 24 week period after the baseline questionnaire was obtained in 104 runners and 104 walkers using a 2-weekly questionnaire. Binary logistic regression analysis was used to identify risk factors for lower extremity injuries in the consumer behaviour. Results: Forty- nine (24%) subjects suffered a self-reported lower extremity injury. 35 injuries occurred in runners and 14 among walkers.Undergoing a gait analysis before buying shoes was associated with an increased occurrence of lower extremity injuries (odds ratio (OR) 4.76). A protective factor was caring a lot about the right fitting of the shoes (OR 0.11). Conclusion: Runners and walkers should pay attention to the correct size when buying footwear to diminish the risk of lower extremity injury. Buying footwear after a gait analysis increased the risk of a lower extremity injury in runners and walkers, however, this might be associated with the increased risk that was already present because of previous injury. Trial registration: This trial was not registered since this was an observational study and no intervention took place.
... Questions assessing beliefs regarding running shoes, foot pronation, and RRI were formulated based on (1) current literature regarding biomechanical and shoe-related risk factors for RRI (Knapik et al., 2009(Knapik et al., , 2010a(Knapik et al., , 2010bMalisoux et al., 2015Nielsen et al., 2014;Ryan, Valiant, McDonald, & Taunton, 2011;Theisen et al., 2014); and (2) typical beliefs or statements within the running community regarding the influence of running shoes and foot pronation on RRI, such as the importance of matching shoe type with foot type (Ramskov, Rasmussen, & Nielsen, 2018;Saragiotto, Yamato, & Lopes, 2014). Prior to the recruitment of study participants, the questionnaire underwent a two-step refinement process: (a) reviewed for face-validity by 11 researchers (all with doctoral degrees) and 1 clinician with expertise in the field of footwear science, biomechanics, physiotherapy, and/or RRI; and (b) Pilot-tested on 4 running shoe salespersons and 9 physiotherapy students resulting in further grammatical and content modifications. ...
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Current frameworks on running-related injury (RRI) aetiology emphasise the relation between exposure to training load, internal tissue loads, and tissue capacity; with tissue load exceeding its capacity being the key biological mechanism in the development of RRI. Despite this, runners and clinicians commonly attribute improper prescription of running shoes as a primary causative factor for RRI. A likely contributor to this belief may be the marketing produced by the footwear industry, which often is not supported by scientific evidence. The purpose of this study was to examine the beliefs of running shoe salespersons and physiotherapy students regarding the influence of running shoes and foot pronation on RRI. A questionnaire was distributed to 275 physiotherapy students at three different Swedish universities and to 219 running shoe salespersons of 35 different running shoe stores. A total of 270 students and 89 salespersons responded to the questionnaire. Salespersons rated their knowledge of running shoes (r = −0.56), foot pronation (r = −0.55) and RRI (r = −0.34) higher than students did (p < .001). A minority of students (32.4%) and salespersons (14.1%) reported training errors to be the main contributing cause of RRI. A majority of salespersons (52.5%), but not students (15.3%), reported more expensive shoes to be better at preventing RRI than cheaper shoes. Most salespersons (51.9%), but not students (39.0%), would recommend uninjured runners to change their current running shoe type despite runners being satisfied with their current shoes. Despite salespersons being more confident in their knowledge of running shoes and foot pronation with relation to RRI development than students, both populations hold beliefs that do not align well with current frameworks on RRI aetiology.
... [1][2][3] The main recognized factors influencing overuse injuries are the type and frequency * Motion Analysis Laboratory, IRCCS-Istituto Ortopedico Rizzoli, Via di Barbiano of the activity, the nature and the intensity of the exercise, the footwear, Body Mass Index (BMI), smoking habit, lower limb anatomy, and psychological stressors. [4][5][6] Above all, altered gait biomechanics is recognized as a major risk factor. [7][8][9] The most frequently affected anatomical sites by overuse injuries are the calf and ankle joints (34%), during running (45%), and long-distance walking activities (29%). ...
Article
Objective Soldiers’ lower limbs and feet are frequently affected by overload- and overuse-related injuries. In order to prevent or limit the incidence of these injuries, the use of foot orthoses is often recommended. The aim of this study is to assess the effects of shock-absorbing insoles on in-shoe plantar pressure magnitude and distribution in a group of professional infantry soldiers wearing military boots during standard indoor military training. Methods Twenty male professional soldiers of the Italian Army (age 35.1 ± 6.1 years; BMI 25.2 ± 2.3 kg/m2) were recruited for this study. Each subject underwent clinical examination to assess possible overuse-related diseases of the lower limb and trunk. Subjects with altered foot morphology according to the Foot Posture Index (FPI) were excluded from this study. Twelve subjects were considered eligible and therefore underwent an indoor training routine comprised of marching, running, jumping inside parallel bars and jumping from different heights. Soldiers repeated the training session twice wearing standard military boots along with two types of insoles: the standard prefabricated insole within the boots (STI), and a special shock-absorbing insole (SAI) featuring an elastic medial arch support. A 99-capacitive sensor insole system was used to record plantar pressure distribution in both feet. Analysis of in-shoe pressure parameters at rearfoot, midfoot and forefoot and in the total foot was performed via a custom-software application developed in MATLAB. Perceived foot comfort (VAS 0–15) was also assessed. Results Pressure parameters recorded during walking and running were considered suitable for statistical analysis. In the whole foot region, pressure parameters were 18–22% lower in military boots fitted with the SAI during walking and 14–18% lower during running. SAI resulted in better comfort (+25%) with respect to the prefabricated boot orthotics (median comfort: SAI = 15/15; STI = 12/15; p = 0.0039) both during walking and running. Conclusions Shock-absorbing insoles can be an effective solution when fitted inside military boots. The present functional evaluation shows that wearing a prefabricated shock-absorbing insole can provide a significant amelioration of perceived foot comfort and plantar pressure parameters. Further studies are now needed with a larger population and more demanding exercises.
... It is known that incorporating extra rest, 54 incorporating extra stretching exercises [55][56][57] or assigning running shoes based on plantar shape [58][59][60] do not reduce the number of overuse leg injuries in military settings. In addition, daily supplementation of calcium or prophylactic treatment with bisphosphonate (risedronate) do not reduce the risk of bone stress injuries to the leg. ...
Article
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Overuse injuries of the leg are a common problem for young soldiers. This article reviews the literature concerning the prevention and treatment of exercise related leg pain in military settings and presents the latest developments in proposed mechanisms and treatments. Current practice and treatment protocols from the Dutch Armed Forces are reviewed, with an emphasis on the most prevalent conditions of medial tibial stress syndrome and chronic exertional compartment syndrome. The conclusion is that exercise related leg pain in the military is an occupational problem that deserves further study.
... Despite previous injuries being considered as the main risk factor of RRI (Hespanhol Junior, Costa, & Lopes, 2013), a recent systematic review also found that a high Q-angle was associated with RRI in two out of three prospective studies that analysed this variable (Saragiotto et al., 2014). In addition, it has been hypothesized that lower limb alignment characteristics, such as lower limb length discrepancy, right-left Q-angle difference, height of the medial longitudinal arch and subtalar angle may be associated with running injuries (Knapik et al., 2009;Knapik, Brosch, et al., 2010;Knapik, Trone, et al., 2010;Lun, Meeuwisse, Stergiou, & Stefanyshyn, 2004;Raissi, Cherati, Mansoori, & Razi, 2009;Rauh, Koepsell, Rivara, Margherita, & Rice, 2006;Rauh, Koepsell, Rivara, Rice, & Margherita, 2007;Wen, Puffer, & Schmalzried, 1998). The examination of the lower limb alignment characteristics assessed by common measurements is often used by physiotherapists, trainers and physicians in clinical practice. ...
Article
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There is conflicting evidence on the association between lower limb alignment characteristics and the incidence of running-related injury (RRI). Therefore, the primary aim of this study was to investigate the association between lower limb alignment characteristics and the incidence proportion of RRI in a convenience sample of recreational runners. A total of 89 recreational runners were included in this prospective cohort study. These participants had been running for at least six months and were injury-free at baseline. Lower limb alignment measurements were conducted in order to calculate lower limb discrepancy, Q-angle, subtalar angle and plantar index. All participants also answered a baseline and biweekly online surveys about their running routine, history of RRI and newly developed RRI over a period of 12 weeks. The prevalence of previous RRI and the 12-week incidence proportion of new RRI were calculated. Logistic regression analysis was performed to estimate the association between lower limb length discrepancy, Q-angle, subtalar angle and plantar ach index with the incidence proportion of RRI. The prevalence of previous RRI was 55.1% (n = 49). The 12-week incidence proportion of new RRI was 27.0% (n = 24). Muscle injuries and tendinopathies were the main types of RRI identified. The lower leg and the knee were the main anatomical regions affected. We did not find significant associations between lower limb length discrepancy, Q-angle, subtalar angle and plantar arch index and injury occurrence.
... A second important question concerns the effectiveness of assigning specific running shoes based on the runner's foot posture to prevent running-related injury. This was tested in the US army (Knapik, Brosch, et al., 2010;Knapik et al., 2009;Knapik, Trone, et al., 2010;Knapik, Trone, Tchandja, & Jones, 2014). In the experimental group, the new recruits received a pair of shoes "adapted" to their plantar shape according to the "shoe shop theory". ...
Chapter
Physical ergonomics of distance running footwear is a hotly debated topic of discussion. This chapter focuses on recreational distance running and the role of footwear on performance and, especially, protection against injury. Running economy is the surrogate measure of choice to evaluate distance running performance. Shoes with a mass lower than 220g induce the lowest oxygen cost per kilometre and may thus optimise performance. The role of shoe technology on injury prevention is scientifically controversial, in contrast to popular belief. Recommendations based on solid evidence are sparse and include avoiding radical changes in footwear type used and having some degree of motion control in cushioned shoes (as with most “standard” models). Shoes with low heel-to-toe drop are safe for occasional runners, while the role of cushioning is still unclear. Athlete education for optimal self-management is key for performance and injury prevention.
... It reduces the ability to absorb the impact on the foot while walking or running and can increase the risk of foot injury and lead to plantar fasciitis, metatarsal pain, knee pain, lower back pain, hindfoot deformity such as osteoarthritis of the subtalar and Chopart joints because of the high impact forces [6][7][8]. Therefore, there is increasing interest in foot shape evaluations for flat feet [9,10]. ...
Article
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Background Flat feet increase the risk of knee osteoarthritis and contribute to frailty, which may lead to worse life prognoses. The influence of the foot skeletal structure on flat feet is not yet entirely understood. Footprints are often used to evaluate feet. However, footprint-based measurements do not reflect the underlying structures of feet and are easily confounded by soft tissue. Three-dimensional evaluation of the foot shape can reveal the characteristics of flat feet. Therefore, foot shape evaluations have garnered increasing research interest. This study aimed to determine the correlation between the three-dimensional (3D) features of the foot and the measurement results of footprint and to predict the evaluation results of flat feet from the footprint based on the 3D features. Finally, the three-dimensional characteristics of flat feet, which cannot be revealed by footprint, were determined. Methods A total of 403 individuals (40–89 years) participated in this study. The proposed system was developed to identify seven skeletal features that were expected to be associated with flat feet. The loads on the soles of the feet were measured in a static standing position and with a digital footprint device. Specifically, two footprint indices were calculated: the Chippaux–Smirak index (CSI) and the Staheli index (SI). In the analysis, comparisons between male and female measurement variables were performed using the Student’s t test. The relationships between the 3D foot features and footprint index parameters were determined by employing the Pearson correlation coefficient. Multiple linear regression was utilized to identify 3D foot features that were strongly associated with the CSI and SI. Foot features identified as significant in the multivariate regression analysis were compared based on a one-way analysis of variance (ANOVA) with Tukey’s post hoc test. Results The CSI and SI were highly correlated with the instep height (IH) and navicular height (NH) of the 3D foot scanning system and were also derived from multiple regression analysis. In addition to the NH and IH, the indicators of the forefoot, transverse arch width, and transverse arch height were considered. In the flat foot group with CSI values above 62.7%, NH was 13.5% ( p < 0.001) for males and 14.9% ( p = 0.01) for females, and the axis of the bone distance was 5.3% ( p = 0.05) for males and 4.9% ( p = 0.10) for females. In particular, for CSI values above 62.7% and NH values below 13%, the axis of the bone distance was large and the foot skeleton was deformed. Conclusions Decreased navicular bone height could be evaluated with the 3D foot scanning system even when flat feet were not detected from the footprint. The results indicate that the use of quantitative indices for 3D foot measurements is important when evaluating the flattening of the foot. Trial registration number UMIN000037694. Name of the registry: University Hospital Medical Information Network Registry. Date of registration: August 15, 2019.
... While certainly undesirable, some amount of catastrophic injury is unavoidable during deployment and is a direct result of the conditions in which military personnel work. There is, however, a large proportion of injuries that may result from (or be exacerbated by) controllable factors such as training [6][7][8][9][10][11] and equipment 8, 12, 13 . In the Armed Forces context, the injuries can be classified as either due to enemy action (EA) or non-enemy action (NEA). ...
... Air Force (Knapik et al., 2010). Recruits underwent a nine week training programme but no difference was found for injury rates between groups. ...
... For example, the weekly distance run, the runners' history of previous injuries (2,3,11,12,15,29), and type of running surface (6,9,(26)(27)(28) are the major risk factors. Evidence is limited for age, gender, the body mass index (BMI), and the type of footwear as possible risk factors in the development of musculoskeletal injuries in runners (2,3,10,12,24,29). ...
Article
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Novaes J. Association of Different Factors with the Prevalence of Injuries in Runners of Rio de Janeiro's Half Marathon. JEPonline 2015;18(2):58-65. The aim of this study was to analyze the association of different surface types, types of hills, types of footstep, and body mass index (BMI) with the prevalence of injuries in of the Rio de Janeiro half marathon runners. One hundred and twenty-one healthy men participated in this study. The subjects were between 22 and 52 yrs of age and regularly practiced endurance training. A questionnaire was given with open and closed questions regarding the time of the run, the type of uphill and soil on which the training is performed and the type of footstep. Age, height, body mass, and BMI were also included. The results demonstrate a significant reduction in the prevalence of injury when the running was performed on the treadmill (P = 0.043). There were no significant differences for asphalt (P = 0.661), track (P = 0.288), soil (P = 0.053), and sand (P = 0.407). No significant differences were observed between the prevalence of injuries in uphill and downhill (P = 0.073) running, the prevalence of injuries vs. the types of footsteps (P = 0.148), the prevalence of injuries for different durations of running (P = 0.336), prevalence of injuries for different ages (P = 0.134), and the prevalence of injuries for different BMI values (P>0.05). There is a tendency for a decrease in the risk of injury when the subjects used a treadmill for training. However, it appears that uphill and downhill training, types of footstep, duration of running, age, and BMI are not related to the prevalence of injuries in half marathon runners.
... Therefore, runners could benefit from RRI prevention programs [11,13,14]. There are several RRI prevention programs [15][16][17][18][19][20][21]. However, a Cochrane review [22] has shown that the evidence from the existing prevention programs is limited and scarce. ...
Article
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Background: Running is one of the most popular and accessible physical activities in the world. However, running-related injuries are unfortunately very common. Scientific evidence is limited and scarce regarding (cost-)effectiveness and implementation process of interventions for running-related injuries prevention. Thus, the objective of this study will be to investigate the effectiveness, cost-effectiveness and implementation process of a running-related injury prevention program (RunIn3). Methods: This is the protocol of a pragmatic hybrid type 1 randomized controlled trial. There will be 530 runners over 18 years old, without running-related injuries in the last 3 months from São Paulo, Brazil. This program will be delivered online with two broad actions: (1) to provide feedback on individual training characteristics and running-related injury risk; and (2) providing/enhancing knowledge, skills and self-efficacy on running-related injury preventive behaviors. The primary outcome will be the proportion of runners reporting running-related injuries. The secondary outcomes will be preventive behaviors, direct and indirect costs, and implementation outcomes. The main effectiveness analysis on the primary outcome will be performed using linear probability mixed models in order to allow outcome changes over time and to yield the absolute risk reduction between-groups. Discussion: The main hypothesis of this study is that the RunIn3 program will be effective in reducing the running-related injury risk and in promoting preventive behavior, either by increasing the frequency of healthy behaviors or by reducing the frequency of risk behaviors. Moreover, if the RunIn3 program is effective in reducing the running-related injuries risk, we believe that this effect would go alongside with a reduction of societal costs. Trail registration: Clinicaltrials.gov (NCT03892239) Registered 5 February 2019 - Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03892239.
... Los defensores de las zapatillas modernas creen que se necesitan estas características de amortiguación y control de movimiento con el fin de protegernos de una lesión. Sin embargo no se observan cambios en la incidencia de lesiones cuando el corredor escoge el calzado en base a la estructura de su pie(Knapik, Brosch, et al., 2010;Knapik et al., 2009;Knapik, Trone, et al., 2010;Richter, Austin, & Reinking, 2011). I ...
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Introduction: Running injury prevention efforts have led to the development of various running shoe technologies. However, four studies have failed to show a reduction in injury incidence if traditional shoe types (neutral, stability or motion control) are selected based on plantar shape or foot posture. It is hoped that newer minimalist shoes (MS) designs will be more successful in reducing injuries but their effectiveness remains untested. Objective: To investigate the feasibility of a randomized controlled trial comparing the effect of MS and Traditional Shoes (TS) on the incidence of running injuries among recreational runners training for a half-marathon. Methods: Twenty-four (24) runners aged 18-45 were randomized to receive either MS or TS prior to undertaking a standardized 16-week training protocol (Figure 1). According to specific criteria (Table 1), a choice of 6 pre-determined shoe models was selected for each group. The primary outcome was the incidence of injuries defined as 3 or more consecutive days of training missed or decreased by >50% because of pain. An online training log was used for data collection. Subjects who modified or missed training were evaluated by a blinded sports physician to determine a diagnosis and disability. A treatment plan was defined by consensus with a blinded physiotherapist. The cumulative incidence of injuries and 95% CI for the whole sample, MS and TS groups were calculated. A bilateral Chi-squared test with α=0.05 and 1-β=0.8 was used for sample size estimation. Results: With minimal study advertisement, 24 eligible subjects were recruited. Twenty (80%) were followed up to injury or the end of the study period. Baseline risk factors including demographic and biomechanical variables were similar across intervention groups. Out of 24 runners, 3 (12.5%, 95% CI: 2.7%-32.4%) met the injury criteria during the study period (2 in the MS group, 1 in the TS group) and 6 (25%, 95% CI: 9.8% - 46.7%) received a diagnosis of running related injury following medical evaluation (3 in the MS group, 3 in the TS group). Conclusion: This pilot study demonstrates the feasibility of the proposed RCT with good recruitment and follow-up rates. The observed incidence of injuries and loss during follow-up suggest that, to detect a clinically significant difference of 20% in injury incidence between the MS and TS groups, a total of 105 subjects would be required using the training log criteria and 183 subjects would be required using the medical diagnosis criteria. Acknowledgments: This study was supported by the Canadian Academy of Sport and Exercise Medicine (CASEM).
Chapter
The selection of the appropriate type of design is also essential in gathering the optimal information that correctly reflects the truth. As is true in all fields of medicine, for sports injury studies independent of the type of the design, the appropriate statistical analysis of each study is the final necessary step in drawing correct inferences from the observed data. Determining the extent of the role of chance on whether the study findings represent the life situation is the main focus of the statistical analysis. Before deciding which statistical method would be proper to use in the study, one has to determine the scales or the variables, their distribution, the relatedness of the data and the specific aims of the analysis. This chapter explains these important issues necessary to understand the selection process of appropriate methods for analysis, as well as statistical concepts important in the design of the study and the reporting of the results.
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Background/aim: This randomised controlled trial investigated if the usage of running shoes with a motion control system modifies injury risk in regular leisure-time runners compared to standard shoes, and if this influence depends on foot morphology. Methods: Recreational runners (n=372) were given either the motion control or the standard version of a regular running shoe model and were followed up for 6 months regarding running activity and injury. Foot morphology was analysed using the Foot Posture Index method. Cox regression analyses were used to compare injury risk between the two groups, based on HRs and their 95% CIs, controlling for potential confounders. Stratified analyses were conducted to evaluate the effect of motion control system in runners with supinated, neutral and pronated feet. Results: The overall injury risk was lower among the participants who had received motion control shoes (HR=0.55; 95% CI 0.36 to 0.85) compared to those receiving standard shoes. This positive effect was only observed in the stratum of runners with pronated feet (n=94; HR=0.34; 95% CI 0.13 to 0.84); there was no difference in runners with neutral (n=218; HR=0.78; 95% CI 0.44 to 1.37) or supinated feet (n=60; HR=0.59; 95% CI 0.20 to 1.73). Runners with pronated feet using standard shoes had a higher injury risk compared to those with neutral feet (HR=1.80; 95% CI 1.01 to 3.22). Conclusions: The overall injury risk was lower in participants who had received motion control shoes. Based on secondary analysis, those with pronated feet may benefit most from this shoe type.
Conference Paper
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Introduction Lately, the minimalist trend has completely shaken up the running shoe market. However, no prescription guide based on scientific evidence has been used to support the promotion of minimalist or traditional (Pronation control Elevated Cushioned Heel – PECH) shoes. Objective Draft clinical guides relative to the prescription of running shoes based on an extensive literature review. Methods A total of seven databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, ERIC, Current Contents and SPORTDiscus) were systematically reviewed in the preparation of clinical guidelines that were to be used for the prescription of running shoes. Results No randomized controlled trial that could have contributed to a better understanding in the field of running shoe prescriptions was found. The only relevant articles that were gathered concluded that it was not possible to prescribe shoes solely based upon a static analysis of the foot (the wet test) or its biomechanics (degree of pronation). Two additional reviews led to similar conclusions. In 2008, Richards5 stated that the prescription of PECH shoes, traditionally found on the market and prescribed by professionals, was not evidence-based. However, it is important to note that general knowledge with respect to running shoes has been developed by taking into account their effect on spatiotemporal parameters, kinematics, biomechanics, applied forces, muscle activity, tissue stress and oxygen demand. Interestingly, for both children and adults, PECH shoes have been found to influence the following biomechanical parameters while running: decreased step frequency, increased heel strike, reduced stress on the feet as well as greater stress on the knees. Such fundamental knowledge, combined with tissue adaptation principles, have allowed establishing a therapeutic prescription flow chart whereby a shoe will be seen either as a protection and tissue unloading tool or, conversely, as a tool to stimulate the human body's adaptation process by applying stress on tissues. Conclusion More clinical trials are needed in order to recommend running shoes based on solid evidence. Nevertheless, based on current advances in the field of running shoe effects on biomechanics and tissue stress, we have produced and included information displays for patients as well as for health professionals.
Lower extremity injuries are common among military recruits and leads to poor military outcome. Orthotics are shown to reduce injuries in runners. Effect of orthotics on military recruit foot injuries have not been adequately studied. We aimed to assess orthotics' effect on ankle sprains, foot pain, tenderness and injury intensity in military recruits. 610 recruits entered this randomized, non-blinded, single centered controlled trial, 300 recruits were given a semi-rigid orthotic to put in their boots and 310 recruits who were not given anything were assigned as the control group. They were asked about history of foot pain in seven distinct parts of the lower limb and ankle sprains and their severity and were examined regarding tenderness in those foot parts for 2 times: at the beginning and the end of the two-month military trainings. Ankle sprain frequency did not differ significantly in trials (0.27±1.2) compared with controls (0.12±0.55) while ankle tenderness was significantly more common (p=0.02) and heel, foot arc and metatarsal pain and tenderness were significantly less common among trials. Pain induced inability to march or walk was less common in trials (p<0.00). Orthotics reduce foot sole pain and injury intensity and help to reduce pain induced training inability in military recruits. Further studies should assess their effect on ankle and leg pain.
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Introduction La mode des chaussures minimalistes bouleverse présentement le marché des chaussures de course à pied. À ce jour, par contre, aucun guide de prescription basé sur des données probantes accompagne la promotion des chaussures minimalistes ou traditionnelles (Talon Absorbant avec ou sans technologie antiPronateur – TAP). Objectif Élaborer des guides cliniques sur la prescription de la chaussure de course à pied à partir d’une revue de littérature. Méthode et Résultats Dans l’objectif d’élaborer des guides cliniques sur la prescription de la chaussure de course à pied, un total de 7 banques de données ont été systématiquement explorées. Aucun RCT n’a été identifié pour nous orienter sur la prescription des chaussures de course. Les seuls articles pertinents trouvés concluent que nous ne pouvons pas faire une prescription basée sur l’analyse statique des pieds1-3 (the wet test) ni de sa dynamique de mouvement (degré de pronation).4 Deux autres revues systématiques sont arrivées aux mêmes conclusions. En 2008, Richards5 montrent que la prescription des chaussures TAP traditionnellement vendues et prescrites par les professionnels, n’est pas basée sur des données probantes. Plus récemment, une revue Cochrane de Yeung6 sur les interventions dans la prévention des blessures en course à pied arrive à des conclusions similaires. L’état actuel des connaissances relatives à la chaussure est par contre élaboré sur l’effet du port d’une chaussure sur les paramètres spatio-temporels, la biomécanique, les forces appliquées, l’activité musculaire, le stress tissulaire et le coût oxydatif. Autant chez les enfants7 que chez l’adulte8-10, les chaussures TAP influencent les paramètres biomécaniques : la cadence ralentit, l’attaque talon augmente, le stress sur le pied diminue et celui sur le genou a tendance à augmenter. Ces connaissances fondamentales combinées aux principes d’adaptation tissulaire, nous permettent d’établir un organigramme de prescription thérapeutique qui utilisera la chaussure soit comme outil de protection et de décharge tissulaire soit au contraire, comme outil de stress tissulaire pour créer de l’adaptation. Conclusion De la compréhension des effets biomécaniques et tissulaires qu’ont différents types de chaussures, des posters vulgarisés explicatifs pour les patients (posters de gauche) et un poster élaboré pour professionnels de la santé (poster de droite) ont été produits.
Article
Introduction Studies have demonstrated that there is an excessive number of foot problems among personnel entering the military, which leads to disruption to training resulting in an increase in both costs and wastage. Days are lost in training due to foot problems, most commonly blisters, causing a loss of working/training days with a resultant low morale and a financial loss to the army. Methods A cohort of Phase One British Army recruits completed a questionnaire in week 3 of training to identify previous and current foot problems and assess what education on the topic they received during their training. Also, 43 foot risk assessment tools were used by the medical staff to identify incidence, severity and working days lost. Questionnaires were completed by 31 instructors to gain data on prevention and management of foot problems. Focus groups were conducted among instructors to investigate their knowledge of prevention and management, and problems identified among recruits. Results A lack of formal training on foot care exists among recruits and instructors. Blisters were reported to be the main foot problem, and army-issue boots were reported to be the main cause of problems. Sizing of boots was inconsistent, and manufacturers can vary in their sizings. There were no policies available, and only one lesson on foot care was given. Conclusions Currently, no policies exist on foot care at the Army Training Regiment (ATR). Foot clinics were available daily, and blisters and foot problems were already present; therefore, foot education is required in the early stages of training. The field craft exercise resulted in half of the recruits reporting blisters. Poor foot hygiene remained a problem when recruits arrived at the ATR for their training. Foot care instruction included in the training would reduce days and hours lost in training.
Thesis
INTRODUCTION : In the military environment, the function of the foot is constrained by the daily wearing of combat boots, a veritable orthopedic brace. A significant segment of the military population reports shoe-related foot disorders and pain, but there is little research evaluating the effects of military footwear on the development of these disorders, both internationally and in the Algerian context. The main objective of this work was to evaluate the effects of regular wearing of Rangers type military footwear on the soldier's foot, by studying the incidence of musculoskeletal and skin disorders affecting the ankle-foot complex during a 12-month follow-up period, and by comparing foot health status before and after wearing military footwear. SUBJECTS AND METHODS : This is a prospective study of the longitudinal type on a population of young male adults following their training in a military school in the south-east of Algeria. These new recruits were observed for a period of twelve months with regular wearing of Rangers type military footwear. This follow-up period extends from T0 to T12 knowing that T0 corresponds to the date of incorporation, and T12 corresponds to twelve months after the start of military training. During this period, we recorded all the cases consulting for a problem of the foot or the ankle, on a register created especially for this purpose. Foot status was analyzed at T0 and at T12 using three evaluation methods : clinical, podoscopic and functional. The footprint taken by the electronic podoscope was analyzed by calculating the Chippaux Smirak Index (CSI) and measuring the Alpha angle (α) of hallux valgus and the Beta angle (ß) of quintus varus of the two feet. To assess the functional impact, we opted for the use of the scale "Lower Extremity Functional Scale" in its Arabic version (LEFS-Ar). Furthermore, a comparative analysis before after wearing the shoe was carried out for the different parameters studied. RESULTS : 426 soldiers are participating in this study, of which 384 have completed all stages of the protocol. In this young adult population (mean age = 19.5 ± 0.89 years), the cumulative incidence of all foot and ankle disorders was estimated at 80.5%. The incidence of musculoskeletal disorders is higher than that of dermatological disorders (64.6% versus 38.5%). The main risk factors retained are footwear mismatch, obesity, lower limb misalignments, lower limb previous injuries, and anatomical shape of the foot. Abstract The comparison of foot statue before and after wearing combat boots (T0/T12) showed a significant upward trend in the prevalence of the majority of foot disorders. This difference concerns the musculoskeletal disorders such as hallux valgus, quintus varus, claw toes and overlapping toes, and the dermatological disorders such as corns, calluses, blisters, wounds, and onychodystrophies. Comparative analysis of the T0/T12 footprint indicates a significant increase in the CSI (p < 0.001), the Alpha angle (α) of hallux valgus on the left foot (p < 0.005), and the Beta angle (ß) quintus varus on both feet (p < 0.001). Regarding the evolution of the functional state from T0 to T12, we observe a very significant regression (p < 0.005) in the LEFS-Ar score. DISCUSSION & CONCLUSION: These results confirm that podiatric disorders remain fairly common among military personnel. Its frequency seems to worsen with the wearing of Rangers type military footwear. These epidemiological data, obtained in a completely original way, can help in the planning of future prevention interventions. Keywords: Military footwear, foot deformities, musculoskeletal disorders, footprint, Chippaux Smirak Index, Lower Extremity Functional Scale, Algeria
Article
Purpose: Tobacco use is common among military personnel, as is musculoskeletal injury during training. In a review of the literature on musculoskeletal injuries there was mixed evidence on the role of smoking as a risk factor. The purpose of this study is to review and analyze the literature on the impact of cigarette smoking on lower extremity overuse injuries in military training. Methods: We performed a literature search on articles published through October 2016. Search terms focused on lower extremity overuse musculoskeletal injuries and cigarette smoking in military populations. We conducted a meta-analysis overall and by sex, including smoking intensity. Results: We identified 129 potential studies and selected 18 based on quality. The overall rate ratio for smoking was 1.31, 1.31 for men, and 1.23 for women. Overall and for each sex, rate ratios were significantly greater than 1.0 for each intensity level of smoking. Conclusions: Smoking is a moderate risk factor for musculoskeletal injury, and may account for a meaningful proportion of injuries among men and women due to the high prevalence of smoking and injury in this population. Although enlistees are not allowed to smoke during basic training, their risk of injury remains high, indicating that smokers may remain at increased risk for medium to long term duration.
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Background: Lower-limb running injuries are common. Running shoes have been proposed as one means of reducing injury risk. However, there is uncertainty as to how effective running shoes are for the prevention of injury. It is also unclear how the effects of different characteristics of running shoes prevent injury. Objectives: To assess the effects (benefits and harms) of running shoes for preventing lower-limb running injuries in adult runners. Search methods: We searched the following databases: CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus and SPORTDiscus plus trial registers WHO ICTRP and ClinicalTrials.gov. We also searched additional sources for published and unpublished trials. The date of the search was June 2021. Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs involving runners or military personnel in basic training that either compared a) a running shoe with a non-running shoe; b) different types of running shoes (minimalist, neutral/cushioned, motion control, stability, soft midsole, hard midsole); or c) footwear recommended and selected on foot posture versus footwear not recommended and not selected on foot posture for preventing lower-limb running injuries. Our primary outcomes were number of people sustaining a lower-limb running injury and number of lower-limb running injuries. Our secondary outcomes were number of runners who failed to return to running or their previous level of running, runner satisfaction with footwear, adverse events other than musculoskeletal injuries, and number of runners requiring hospital admission or surgery, or both, for musculoskeletal injury or adverse event. Data collection and analysis: Two review authors independently assessed study eligibility and performed data extraction and risk of bias assessment. The certainty of the included evidence was assessed using GRADE methodology. Main results: We included 12 trials in the analysis which included a total of 11,240 participants, in trials that lasted from 6 to 26 weeks and were carried out in North America, Europe, Australia and South Africa. Most of the evidence was low or very low certainty as it was not possible to blind runners to their allocated running shoe, there was variation in the definition of an injury and characteristics of footwear, and there were too few studies for most comparisons. We did not find any trials that compared running shoes with non-running shoes. Neutral/cushioned versus minimalist (5 studies, 766 participants) Neutral/cushioned shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with minimalist shoes (low-certainty evidence) (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.59 to 1.01). One trial reported that 67% and 92% of runners were satisfied with their neutral/cushioned or minimalist running shoes, respectively (RR 0.73, 95% CI 0.47 to 1.12). Another trial reported mean satisfaction scores ranged from 4.0 to 4.3 in the neutral/ cushioned group and 3.6 to 3.9 in the minimalist running shoe group out of a total of 5. Hence neutral/cushioned running shoes may make little or no difference to runner satisfaction with footwear (low-certainty evidence). Motion control versus neutral / cushioned (2 studies, 421 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral / cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.92, 95% CI 0.30 to 2.81). Soft midsole versus hard midsole (2 studies, 1095 participants) Soft midsole shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with hard midsole shoes (low-certainty of evidence) (RR 0.82, 95% CI 0.61 to 1.10). Stability versus neutral / cushioned (1 study, 57 participants) It is uncertain whether or not stability shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral/cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.49, 95% CI 0.18 to 1.31). Motion control versus stability (1 study, 56 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with stability shoes because the quality of the evidence has been assessed as very low certainty (RR 3.47, 95% CI 1.43 to 8.40). Running shoes prescribed and selected on foot posture (3 studies, 7203 participants) There was no evidence that running shoes prescribed based on static foot posture reduced the number of injuries compared with those who received a shoe not prescribed based on foot posture in military recruits (Rate Ratio 1.03, 95% CI 0.94 to 1.13). Subgroup analysis confirmed these findings were consistent between males and females. Therefore, prescribing running shoes and selecting on foot posture probably makes little or no difference to lower-limb running injuries (moderate-certainty evidence). Data were not available for all other review outcomes. Authors' conclusions: Most evidence demonstrates no reduction in lower-limb running injuries in adults when comparing different types of running shoes. Overall, the certainty of the evidence determining whether different types of running shoes influence running injury rates was very low to low, and as such we are uncertain as to the true effects of different types of running shoes upon injury rates. There is no evidence that prescribing footwear based on foot type reduces running-related lower-limb injures in adults. The evidence for this comparison was rated as moderate and as such we can have more certainty when interpreting these findings. However, all three trials included in this comparison used military populations and as such the findings may differ in recreational runners. Future researchers should develop a consensus definition of running shoe design to help standardise classification. The definition of a running injury should also be used consistently and confirmed via health practitioners. More researchers should consider a RCT design to increase the evidence in this area. Lastly, future work should look to explore the influence of different types or running shoes upon injury rates in specific subgroups.
Thesis
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Exercise related leg pain in the military. Treatment of MTSS and CECS, with an emphasis on gait retraining.
Article
Objectives To gain insight into perceived factors related to bone health and stress fracture (SF) prevention for female runners and to understand their experiences within the medical community. Design Cohort qualitative study. Setting University health system. Participants Forty female runners, 20 who had SF histories and 20 age-and-running-distance matched women without SF. Main outcome measures Women participated in audiotaped qualitative semi-structured interviews. For women with a SF history, questions sought their perspectives on factors that they felt contributed to SF, experiences with the medical community, and changes made post SF. For women without a SF history, questions sought perspectives on factors felt important to perceived running-related bone health. Results Six themes emerged; 1) Previous/Recurrent Musculoskeletal Injuries, 2) Activity Patterns and Training Regimens, 3) Nutrition, 4) Prevention and Intervention, 5) Pain, and 6) Mindset. Within these themes, between group differences are characterized by differences in knowledge and/or application of knowledge for health and wellness. Compared to women without SF, women with SF histories increased training load more quickly, had poorer nutrition, performed less cross-training, and kept running despite pain. Conclusions More education is needed for female runners to decrease risks for SF.
Article
Introduction: The purpose of this study was to compare leg, sagittal plane knee and ankle and and frontal plane ankle stiffness over the course of a prolonged treadmill run in neutral and stability footwear. Methods: Thirteen male habitual rearfoot runners completed two biomechanical testing sessions in which they ran for 21 minutes at their preferred running speed in a neutral shoe, then changed either into the same neutral shoe or a stability shoe and ran a further 21 minutes on a force instrumented treadmill. Three-dimensional kinematics and kinetics were recorded at the beginning and end of each 21-minute interval. Results: No differences were observed in leg stiffness between footwear conditions throughout the run (p > 0.05). Knee stiffness increased during the first 21 minutes (p = 0.009), while ankle stiffness reduced at minute 21 (p = 0.004) and minute 44 (p = 0.006). These changes were modulated by an increase in ankle joint compliance and knee joint moments. No differences were observed between footwear conditions for leg and sagittal plane lower extremity joint stiffness (p > 0.05). During the second half of the run, frontal plane ankle stiffness increased in the stability shoe but decreased in the neutral shoe (p = 0.019), attributed to reduced eversion range of motion caused by the added medial post. Conclusion: These results suggest that over the course of a prolonged treadmill run, shock attenuation strategies change which may affect the knee joint.
Article
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Training civilians to be soldiers is a challenging task often resulting in musculoskeletal injuries, especially bone stress injuries. This study evaluated bone health biomarkers (P1NP/CTX) and whey protein or carbohydrate supplementations before and after Army initial entry training (IET). Ninety male IET soldiers participated in this placebo-controlled, double-blind study assessing carbohydrate and whey protein supplementations. Age and fat mass predicted bone formation when controlling for ethnicity, explaining 44% (p < 0.01) of bone formation variations. Age was the only significant predictor of bone resorption (p = 0.02) when controlling for run, fat, and ethnicity, and these factors together explained 32% of the variance in bone resorption during week one (p < 0.01). Vitamin D increased across training (p < 0.01). There was no group by time interaction for supplementation and bone formation (p = 0.75), resorption (p = 0.73), Vitamin D (p = 0.36), or calcium (p = 0.64), indicating no influence of a supplementation on bone biomarkers across training. Age, fitness, fat mass, and ethnicity were important predictors of bone metabolism. The bone resorption/formation ratio suggests IET soldiers are at risk of stress injuries. Male IET soldiers are mildly to moderately deficient in vitamin D and slightly deficient in calcium throughout training. Whey protein or carbohydrate supplementations did not affect the markers of bone metabolism.
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Appropriate padding and materials for feet should be selected on the basis of indications and functional needs of the patient. Foot wear, such as protection and foot covering, needs to be compatible with the foot and the patient's functional requirements. What are the kinematic and the kinetic pattern of shoes? What are the characteristics of foot wear, including flexibility, high heeled shoes, and shoe wearing in the elderly? What are the types of shoes? What are the characteristics of children's foot wear? What are the clinical presentations of shoe wearing? Are there any adverse side effects related to shoes? The Biblical verses related to shoes were examined from a contemporary perspective.
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In the United States, African American women are not only more likely to have experiences of childhood sexual abuse (CSA) but experience some of the severest forms of it. The presence of Afro-cultural values can play a significant role in the therapeutic outcomes of women who do seek out treatment after their experiences of CSA. That is, Afro-cultural values such as spirituality, communalism, utilization of the Black Church, and adherence to the Strong Black Women archetype (SBWA) can impact the efficacy of treatment for Black female survivors of CSA. The purpose of this study is to assess the separate relationships that these values have on Black women’s engagement in therapy, whether they experienced symptom relief, and whether they continued therapy. Results indicated that both spirituality and the Strong Black Women archetype were significantly related to therapeutic outcomes. These findings broaden clinical understanding of values that impact the treatment of Black women and has the potential to enhance multicultural competencies among mental health professionals.
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Context: This study evaluates the effect of nonexercise interventions on the reduction of risk for musculoskeletal injuries in armed forces. Evidence acquisition: A database search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, CINAHL, SPORTdiscus, Greylit, Open Grey, the WHO trial registry, and the reference lists of included articles up to July 2019. RCTs and cluster RCTs evaluating nonexercise interventions for the prevention of musculoskeletal injuries in armed forces compared with any other intervention(s) or no intervention were eligible for inclusion. Data extraction and risk of bias assessment were done by 2 authors independently, followed by meta-analysis and Grading of Recommendations Assessment, Development, and Evaluation assessment, if appropriate. Evidence synthesis: This study included 27 articles with a total number of 25,593 participants, examining nutritional supplementation, prophylactic medication, and equipment modifications with mostly high or unclear risk of bias. Meta-analysis and Grading of Recommendations Assessment, Development, and Evaluation assessment could be performed for 3 comparisons: custom-made insoles versus no insoles, tropical/hot-weather boots versus leather boots, and shock-absorbing insoles versus nonshock-absorbing insoles interventions, all showing the very low quality of evidence. Some evidence was found to support the preventive effect of shock-absorbing insoles, basketball shoes, padded polyester socks, calcium with vitamin D supplementation, only calcium supplementation, protein supplementation, and dynamic patellofemoral braces. Conclusions: Although an evidence base for the efficacy of preventive interventions for musculoskeletal injuries in armed forces is weak, there are some indications for the preventive effect of shock-absorbing insoles, basketball shoes, padded polyester socks, supplementation of calcium alone or combined with vitamin D, protein supplementation, and dynamic patellofemoral braces on the incidence of musculoskeletal injuries.
Preprint
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Introduction: Military members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review with meta-analysis was to assess if prescribed prophylactic footwear or foot orthoses reduced lower extremity injury risk in military tactical athletes. Methods: MEDLINE, Embase, Web of Science, CINAHL, SportDiscus, and DTIC databases were searched for randomized controlled trials published at any time that compared foot orthoses or prescribed footwear (to include shock-absorbing insoles and socks) to a placebo intervention or a no-treatment control. Methodological quality was assessed and numbers of injuries, population at risk, and the duration of the study epoch were extracted and relative risk (RR) calculated. An omnibus meta-analysis was performed assessing all prescribed footwear and orthoses intervention studies, with subgroup analyses conducted on studies with similar interventions [i.e., basketball athletic shoes; athletic shoes (prescribed by foot type); foot orthoses; shock-absorbing insoles; socks; tropical combat boots]. Results: Of 1,673 studies identified, 22 studies were included. Three of eight studies that employed orthoses demonstrated significantly reduced overuse injuries compared to no treatment controls (RR range: 0.34-0.68); one study showed neoprene insoles significantly decreased overuse injuries (RR: 0.75). There were no other significant effects in the individual studies, and no protective effects observed in the omnibus meta-analysis or in the component sub analyses. Conclusions: Prescribed footwear and orthoses do not appear to have a prophylactic effect on lower quarter MSKI in military members and cannot be recommended at this time.
Preprint
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Background Foot pronation is generally linked to musculoskeletal injuries, especially in relation to joint deviation caused by pronation during dynamic activities. However, no consensus appeared in the methodological way to determine foot function, and several tests propose to identify foot pronation under different conditions, from static testing to running. The aim of this study was to determine the level of agreement between different foot function classification measures. Methods One hundred and six subjects completed 5-foot function tests at standing position, walking and running. Foot Posture Index (FPI) was undertaken to determine foot function during static posture. The Center of Pressure Excursion Index (CPEI) and 3 Foot Balance tests (FBs) were realized during walking and running trials to assess pronation during dynamic activities. Agreement between the measures was determined using the Cohen’s Kappa coefficient (K) between 2 measures and the Fleiss Kappa (FK) between 3 or more measures. Results Overall agreement between the measures reported a fair agreement (Kf = 0.2). Static and walking foot tests determination agreement was moderate (K = 0.5), while agreement between FPI and FBs tests were fair (K < 0.4). Fair results were also reported between walking and running tests (K < 0.4). The concordance between running tests classification was fair (Kf = 0.2). Conclusions The lack of agreement between tests confirms the need for a consensus on an appropriate measurement of the foot function. Static foot tests are mainly used to determine foot function during dynamic activities. However, the lack of agreement between tests could question the relevance of the static foot function assessments. The FPI reported a moderate agreement with the walking classification test, but it should be accompanied by a dynamic test in order to limit the risk of misinterpretation.
Article
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Modern footwear has changed in its role over the years from providing protection to controlling foot motion and stabilisation. However, Running Related Injuries (RRIs) continue to increase despite technological innovations in fabrication and design. As we evolve in our understanding of barefoot running, examining this pattern of running is worth giving attention to. Barefoot running changes the foot strike pattern to forefoot strike with reduction in stride length and impact loading. Also, barefoot form of running provides a greater proprioceptive challenge to plantar surface of the foot and increased energy conservation at the arches. The advent of new footwear trend in form of minimalist shoe is slowly gaining attention but it is presumptive to appreciate its benefits over barefoot running. The purpose of this review was to study the evidence regarding differences between shod and barefoot mechanics and how different footwear affords mechanical changes between them. Future directions on barefoot running mechanics and its progression are also suggested.
Article
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Background Musculoskeletal injuries (MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training, operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available. Methods A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed (using the “snowball method”). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made. Results In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the “order of importance” and including concepts that are modifiable/non-modifiable, as well as extrinsic/intrinsic risk factors. Conclusions This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.
Article
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Introduction to the Logistic Regression Model Multiple Logistic Regression Interpretation of the Fitted Logistic Regression Model Model-Building Strategies and Methods for Logistic Regression Assessing the Fit of the Model Application of Logistic Regression with Different Sampling Models Logistic Regression for Matched Case-Control Studies Special Topics References Index.
Article
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This study was undertaken to examine the relationship(s) between health, nutrition, body composition, and physical performance in female soldiers during the B weeks of basic combat training (BCT). The study investigated female soldiers assigned to three platoons within a single all-female basic training company over the period of 22 March 1993 to 20 May 1993 at Fort Jackson, South Carolina. Volunteer soldiers participated in pre-training (pre-BCT; 174 original volunteers with a mean age of 21.4 yrs) and post-training (post-BCT; 158 successful BCT graduates) performance and body composition testing, as well as three separate blood draws (pre-BCT, midpoint of BCT, and.post-BCT). Additionally, a 7-day dining facility dietary assessment survey was performed on a subset of 49 randomly selected - soldiers during the second week of training. Questionnaires were utilized to acquire demographic information, as well as to assess nutrition knowledge and beliefs and food attitudes.
Article
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In Basic Combat Training (BCT) running shoes are prescribed based on plantar foot shape (reflecting longitudinal arch height). In response to a request from the Military Training Task Force of the Defense Safety Oversight Council this study examined whether or not this prescription technique influenced injury risk. After foot examinations BCT recruits in an experimental group (E, n=1,079 men, 456 women) were prescribed motion control stability or cushioned shoes for foot shapes judged to represent low medium or high arches respectively. A control group (C, n=1,068 men, 464 women) received a stability shoe regardless of plantar foot shape. Injuries during BCT were determined from outpatient visits provided by the Army Medical Surveillance Activity. Other previously known injury risk factors (e.g. age fitness smoking) were obtained from a questionnaire and existing databases. Multivariate Cox regression controlling for other injury risk factors showed little difference between the E and C groups among men (risk ratio (CIE) = 1.1195% confidence interval = 0.91- 1.34) or women (risk ratio (CIE)=1.14 95% confidence interval = 0.91-1.44). This prospective study demonstrated that prescribing shoes on the basis of the shape of the plantar foot surface had little influence on injury risk even after control of known injury risk factors.
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ACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including aerobic and resistance training, and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that aerobic endurance training of fewer than 2 d·wk-1, at less than 40-50% of V˙O2R, and for less than 10 min-1 is generally not a sufficient stimulus for developing and maintaining fitness in healthy adults. Even so, many health benefits from physical activity can be achieved at lower intensities of exercise if frequency and duration of training are increased appropriately. In this regard, physical activity can be accumulated through the day in shorter bouts of 10-min durations. In the interpretation of this position stand, it must be recognized that the recommendations should be used in the context of participant's needs, goals, and initial abilities. In this regard, a sliding scale as to the amount of time allotted and intensity of effort should be carefully gauged for the cardiorespiratory, muscular strength and endurance, and flexibility components of the program. An appropriate warm-up and cool-down period, which would include flexibility exercises, is also recommended. The important factor is to design a program for the individual to provide the proper amount of physical activity to attain maximal benefit at the lowest risk. Emphasis should be placed on factors that result in permanent lifestyle change and encourage a lifetime of physical activity.
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The purpose of this article is to provide information that will assist the physical therapist in recommending appropriate shoewear for patients with foot disorders. The discussion is divided into the following areas: 1) purposes of footwear, 2) shoe anatomy, 3) the last, 4) shoe construction, and 5) shoe sizing and fitting. Throughout the discussion, variations are noted between the terminology used to describe nonathletic and athletic footwear. Recommendations for both nonathletic and athletic footwear are provided.
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Physical training-related injuries are common among army recruits and other vigorously active populations, but little is known about their causation. To identify intrinsic risk factors, we prospectively measured 391 army trainees. For 8 weeks of basic training, 124 men and 186 women (79.3%) were studied. They answered questionnaires on past activities and sports participation, and were measured for height, weight, and body fat percentage; 71% of the subjects took an initial army physical training test. Women had a significantly higher incidence of time-loss injuries than men, 44.6% compared with 29.0%. During training, more time-loss injuries occurred among the 50% of the men who were slower on the mile run, 29.0% versus 0.0%. Slower women were likewise at greater risk than faster ones, 38.2% versus 18.5%. Men with histories of inactivity and with higher body mass index were at greater injury risk than other men, as were the shortest women. We conclude that female gender and low aerobic fitness measured by run times are risk factors for training injuries in army trainees, and that other factors such as prior activity levels and stature may affect men and women differently.
Article
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Musculoskeletal injuries represent an adverse event of strenuous physical activity. The aim of the present study was to identify pretraining factors that may predispose to such injuries. Risks of injury according to age, body composition, previous physical activity, physical fitness, use of smokeless tobacco (moist snuff) and smoking habits were determined in a population of 480 male conscripts in the army. Data were obtained by questionnaire, height and weight measurements, and from a 3000-metre run test prior to a 10-week period of basic military and physical training. Injuries were registered by doctors attached to the training camp. Every fourth conscript sustained one or more musculoskeletal injuries during the training period. Low back pain, overuse knee injuries, Achilles tendinitis, and sprains of joint capsules or ligaments were the most frequent diagnosis groups. Subjects aged 22 years and more, the least active persons before call-up, those who thought they were less fit than the average, the slowest one-third in the 3000-metre run test, smokers of more than 10 cigarettes a day, and snuff-takers suffered more injuries according to univariate analyses. Multiple logistic regression analysis showed that age, self-assessed physical fitness and snuff-taking were mutually independent risk factors of high statistical significance.
Article
In brief: Most information about running injuries comes from case reports. Although useful, the case series does not take into consideration the population from which the injuries arose and is therefore an inappropriate method on which to base causal inference. The epidemiological method is a more powerful approach because, by definition, it takes into account the population from which the injuries arose. A review of three epidemiological studies shows that the only reasonably well-established cause of running injuries is the number of miles run per week. More information is needed to establish the relationship between injury and characteristics of the runner, characteristics of running, and characteristics of the running environment. More research on the causes of running injuries is needed and should be directed to those factors over which the runner has control.
Article
The authors report the frequency of behaviors which relate to intentional and unintentional injuries in the undergraduate population in Florida (N= 1150). Comparisons of risk behavior are made for men versus women and married versus unmarried students. The findings suggest that college students frequently participate in behaviors which can lead to injury.
Article
A retrospective case-control study into the risk factors for injury during basic military training was conducted at the Recruit Training Unit, Royal Australian Air Force Base Edinburgh, South Australia. Case subjects were recruits suffering a musculoskeletal injury during the course, severe enough to result in backcoursing (being delayed and joining a later course) and usually requiring the loss of 5 days of training. Control subjects were 629 recruits selected randomly from recruits who were not case subjects from the same period of Jan 1, 1985 to Dec 31, 1990. Two hundred thirty-eight cases were identified (2.7% of the recruit population), of which 123 were overuse-type injuries and 115 acute-type injuries. Most injuries occurred in the first 2 weeks of training. Bivariate and logistic regression analysis of possible risk factors for injury was conducted, both for all case subjects and for the subgroup of case subjects with overuse injuries. Statistically significant associations were identified for female gender, body mass index >26.9, winter training, a history of lower limb injury, and the presence of a lower limb deformity. All these associations were stronger for overuse injury, and preenlistment physical activity was also significantly associated with overuse injury. No significant association was found for height, weight, age, smoking, or gender makeup of courses. Most striking was a large rise in overuse injury incidence in women over the period of study, from 0.2% in 1985 to 8.8% in 1990. Reasons for this increase may include "social pathogenesis." (C)1994 The American College of Occupational and Environmental Medicine
Article
Weight-bearing physical activity has beneficial effects on bone health across the age spectrum. Physical activities that generate relatively high-intensity loading forces, such as plyometrics, gymnastics, and high-intensity resistance training, augment bone mineral accrual in children and adolescents. Further, there is some evidence that exercise-induced gains in bone mass in children are maintained into adulthood, suggesting that physical activity habits during childhood may have long-lasting benefits on bone health. It is not yet possible to describe in detail an exercise program for children and adolescents that will optimize peak bone mass, because quantitative dose-response studies are lacking. However, evidence from multiple small randomized, controlled trials suggests that the following exercise prescription will augment bone mineral accrual in children and adolescents: Mode: impact activities, such as gymnastics, plyometrics, and jumping, and moderate intensity resistance training; participation in sports that involve running and jumping (soccer, basketball) is likely to be of benefit, but scientific evidence is lacking Intensity: high, in terms of bone-loading forces; for safety reasons, resistance training should be <60% of 1-repetition maximum (IRM) Frequency: at least 3 d·wk-1 Duration: 10-20 min (2 times per day or more may be more effective) During adulthood, the primary goal of physical activity should be to maintain bone mass. Whether adults can increase bone mineral density (BMD) through exercise training remains equivocal. When increases have been reported, it has been in response to relatively high intensity weight-bearing endurance or resistance exercise; gains in BMD do not appear to be preserved when the exercise is discontinued. Observational studies suggest that the age-related decline in BMD is attenuated, and the relative risk for fracture is reduced, in people who are physically active, even when the activity is not particularly vigorous. However, there have been no large randomized, controlled trials to confirm these observations, nor have there been adequate dose-response studies to determine the volume of physical activity required for such benefits. It is important to note that, although physical activity may counteract to some extent the aging-related decline in bone mass, there is currently no strong evidence that even vigorous physical activity attenuates the menopause-related loss of bone mineral in women. Thus, pharmacologic therapy for the prevention of osteoporosis may be indicated even for those postmenopausal women who are habitually physically active. Given the current state of knowledge from multiple small randomized, controlled trials and large observational studies, the following exercise prescription is recommended to help preserve bone health during adulthood: Mode: weight-bearing endurance activities (tennis; stair climbing; jogging, at least intermittently during walking), activities that involve jumping (volleyball, basketball), and resistance exercise (weight lifting) Intensity: moderate to high, in terms of bone-loading forces Frequency: weight-bearing endurance activities 3-5 times per week; resistance exercise 2-3 times per week Duration: 30-60 min·d -1 of a combination of weight-bearing endurance activities, activities that involve jumping, and resistance exercise that targets all major muscle groups It is not currently possible to easily quantify exercise intensity in terms of bone-loading forces, particularly for weight-bearing endurance activities. However, in general, the magnitude of bone-loading forces increases in parallel with increasing exercise intensity quantified by conventional methods (e.g., percent of maximal heart rate or percent of 1RM). The general recommendation that adults maintain a relatively high level of weight-bearing physical activity for bone health does not have an upper age limit, but as age increases so, too, does the need for ensuring that physical activities can be performed safely. In light of the rapid and profound effects of immobilization and bed rest on bone loss, and the poor prognosis for recovery of mineral after remobilization, even the frailest elderly should remain as physically active as their health permits to preserve skeletal integrity. Exercise programs for elderly women and men should include not only weight-bearing endurance and resistance activities aimed at preserving bone mass, but also activities designed to improve balance and prevent falls. Maintaining a vigorous level of physical activity across the lifespan should be viewed as an essential component of the prescription for achieving and maintaining good bone health.
Article
To better estimate rates of certain benefits and risks of recreational running, we sent questionnaires to 1,250 randomly selected male and 1,250 female registrants for a 10-km road race. The response rate was 55% for men and 58% for women. Telephone interviews of a randomly selected group of nonrespondents indicated that the only significant differences between respondents and nonrespondents were that (1) respondents were older than nonrespondents, (2) more male nonrespondents had stopped running during the year after the race, and (3) more male nonrespondents had been hit by thrown objects. One year after the race; 89% of male and 79% of female respondents were still running regularly. Eighty-one percent of men and 75% of women who smoked cigarettes when they began running had stopped smoking after beginning recreational running. Giving up smoking was significantly more common for current runners than for "retired" runners. Weight loss was commonly associated with runningand was greater in those persons who were overweight when they began running. More than a third of respondents had a musculoskeletal injury attributed to running in the year after the race and about one seventh of all respondents sought medical consultation for their injury. The risk of injury increased with increasing weekly mileage. This study uses epidemiologic methods to quantify some of the benefits and risks of running. (JAMA 1982;248:3118-3121)
Book
From the reviews of the First Edition."An interesting, useful, and well-written book on logistic regression models . . . Hosmer and Lemeshow have used very little mathematics, have presented difficult concepts heuristically and through illustrative examples, and have included references."—Choice"Well written, clearly organized, and comprehensive . . . the authors carefully walk the reader through the estimation of interpretation of coefficients from a wide variety of logistic regression models . . . their careful explication of the quantitative re-expression of coefficients from these various models is excellent."—Contemporary Sociology"An extremely well-written book that will certainly prove an invaluable acquisition to the practicing statistician who finds other literature on analysis of discrete data hard to follow or heavily theoretical."—The StatisticianIn this revised and updated edition of their popular book, David Hosmer and Stanley Lemeshow continue to provide an amazingly accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets. Hosmer and Lemeshow extend the discussion from biostatistics and epidemiology to cutting-edge applications in data mining and machine learning, guiding readers step-by-step through the use of modeling techniques for dichotomous data in diverse fields. Ample new topics and expanded discussions of existing material are accompanied by a wealth of real-world examples-with extensive data sets available over the Internet.
Article
Using a survey questionnaire design, we investigated the incidence, site, and nature of jogging injuries among all participants of a popular 16 km race. The response rate was 83.6%. Of 4,358 male joggers, 45.8% had sustained jogging injuries during the 1 year study period, 14.2% had required medical care, and 2.3% had missed work because of jogging injuries. Occur rence of jogging injuries was independently associated with higher weekly mileage (P < 0.001), history of previous running injuries (P < 0.001), and competitive training motivation (P = 0.03). Higher mileage was also associated with more frequent medical consultations due entirely to jogging-related injuries. In 33 to 44 year olds (N = 1,757), the number of years of running was inversely related to incidence of injuries (P = 0.02). Injuries were not significantly related to race running speed, training surface, characteristics of running shoes, or relative weight. Achillodynia and calf muscle symptoms were the two most common overuse injuries and occurred significantly more often among older run ners with increased weekly mileage. We conclude that jogging injuries are frequent, that the number of firmly established etiologic factors is low, and that, in recom mending jogging, moderation should be the watchword.
Article
SHARP, M. A., J. F. PATTON, J. J. KNAPIK, K. HAURET, R. P. MELLO, M. ITO, and P. N. FRYKMAN. Comparison of the physical fitness of men and women entering the U.S. Army: 1978 -1998. Med. Sci. Sports Exerc., Vol. 34, No. 2, pp. 356 -363, 2002. Purpose: To compare the physical fitness levels of recruits entering the U.S. Army in 1998 to those entering in 1978 and 1983. Methods: In 1998, 182 men and 168 women were tested before beginning basic training at Fort Jackson, SC. The measurements were 1) skin-fold estimation of percent body fat (%BF); 2) maximum oxygen uptake by treadmill running (V ú O2max); and 3) upper-body (UB), lower-body (LB), and upright pulling (UP) isometric strength. These data were compared to data from basic trainees at Fort Jackson in 1978 (skin folds, V ú O2max, UB, and LB) and 1983 (skin folds and UP). Results: Body weight (BW) of 1998 recruits was greater (P 0.05) than 1978 recruits (men, 12%; women, 6%) and 1983 recruits (men, 8%; women, 7%). %BF of 1998 recruits was greater (P 0.05) than 1978 recruits (men, 15%; women, 5%) and 1983 recruits (men, 15%; women, 17%). The 1998 men had more fat-free mass (FFM) (P 0.05) than men in 1978 (8%) or 1983 (5%), whereas 1998 women were only different from those measured in 1978 (4%, P 0.05). The V ú O2max of men (50.6 6.2 mL·kg 1 ·min1) was equivalent to men in 1978, whereas that of women (39.7 5.2 mL·kg1·min1) was 6% greater (P 0.05). The 1998 recruits were stronger (P 0.05) on all measures of muscle strength than recruits measured in 1978 (men, UB 16%, LB 12%; women, UB 18%, LB 6%) and 1983 (men, UP 7%; women, UP 6%). Conclusion: The aerobic capacity, muscle strength, and FFM of 1998 recruits is comparable to or greater than that of 1978 and 1983 recruits; however, 1998 recruits tended to have more BW and a greater %BF. Key Words: EXERCISE, V ú O2max, STRENGTH,
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The goal of this book is multidimensional: a) to help reviving Statistics education in many parts in the world where it is in crisis. For the first time authors from many developing countries have an opportunity to write together with the most prominent world authorities. The editor has spent several years searching for the most reputable statisticians all over the world. International contributors are either presidents of the local statistical societies, or head of the Statistics department at the main university, or the most distinguished statisticians in their countries. b) to enable any non-statistician to obtain quick and yet comprehensive and highly understandable view on certain statistical term, method or application c) to enable all the researchers, managers and practicioners to refresh their knowledge in Statistics, especially in certain controversial fields. d) to revive interest in statistics among students, since they will see its usefulness and relevance in almost all branches of Science.
Article
The Ft Drum Running Shoe Injury Prevention Program was initiated in November 1999 and consists of three parts: (1) a foot evaluation where medical personnel determined the soldier's foot arch height, ankle flexibility, and body weight, (2) a running shoe recommendation based on the foot evaluation, and (3) the actual shoe purchase by the soldier. This epidemiological consultation (EPICON) examined the effectiveness of the program by examining injury rates before and during the program. A historical cohort design was used. International Classification of Diseases, Version 9 (ICD-9) codes representing overuse-related injuries in the lower extremity or low back regions were downloaded from the local Ambulatory Data System (ADS). All visits to the Physical Therapy Clinic between 1 August 1998 and 31 January 2001 by active duty soldiers were considered in the analysis. Denominator data (soldiers on post) were obtained from the 10th Mountain Division S-1 Office (Personnel Section). Average +/- standard deviation total injury rates were 36.8 +/- 7.1 cases/1000 soldiers/month in the Pre-Intervention period (August 1998 through October 1999) and 18.6 +/- 4.4 cases/1000 soldiers/month in the Intervention period (July 2000 through January 2001) (relative risk = 2.0, p < 0.01). Thus, a decline in injury rates corresponded in time to the implementation of the program suggesting an association between this program and the lower injury rates. However, a major potential confounder was the switch from the use of the Ambulatory Data System (ADS) to the KG-ADS system during February to March 2000. KG-ADS required medical care providers to scroll through a list of diagnoses on their computer screens and was considered cumbersome and time-consuming, possibly resulting in provider impatience and miscoding.
Article
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.
Article
An epidemiological consultation was requested by the Commander, U.S. Army Training Center, Ft. Jackson SC, to assist in the establishment of an Army Center of Excellence for the Study of Training-Related Injuries. A preliminary investigation of basic trainees was conducted to determine injury incidence, risk factors for injuries, physical fitness, and directions for a more comprehensive investigation. Data obtained on a battalion of basic trainees (n=799) included information from medical records, platoon manning rosters, Army Physical Fitness Test (APFT) scores, discharge packets, and newstart rosters. Cumulative injury incidence (one or more visits to a health care provider for overuse or traumatic events) was 15.4% for men and 38.0% for women.
Article
An epidemiological consultation (EPICON) was requested by the Commander, U.S. Army Training Center, Ft Jackson, SC, to assist in the development of an Army Center for the Study of Training-Related Injuries. This EPICON (1) compared injury rates with a previous investigation, (2) examined injuries in special Basic Combat Training (BCT) subgroups, and (3) explored injury risk factors. Cumulative incidence of one or more injuries in the present study (men and women, respectively), was 37% and 63%, much higher than the 15% and 38% found previously at Ft Jackson in the fall of 1997. Men coming from the Fitness Training Unit (FTU) were more likely to get injured (57% vs 36%, p=0.01) and less likely to graduate (55% vs 82%, p <0.01), compared to men who went directly to BCT. On the other hand, women coming from the FTU had similar injury incidence (62% vs 63%, p=O.78) and first-time graduation success (60% vs 68%, p=O. 14) compared to women who directly entered BCT. Men who were discharged were more likely to be injured than those who were not discharged (p <0.01) while female discharges were equally likely to be injured compared to women who were not discharged (p=0.38). Injury incidence was high among the newstart-outs (recycles), 65 % for men and 97% for women, primarily accounted for by individuals sent to the Physical Training and Rehabilitation Program (PTRP) for injury recovery. Risk factors for time-loss injuries (i.e., injuries with one or more days of limited duty) among the men included training company; older age; lower performance on diagnostic push-ups, sit-ups, or the 2-mile run; cigarette smoking prior to BCT; no prior sports participation; less walking or hiking in the last month; lower peak VO2; low upper body static strength; and lower or higher levels of hamstring flexibility. Risk factors for time-loss injuries among women included training company; low performance on the diagnostic push-ups, sit-ups, or the 2-mile run.
Article
Clinical measurement is a fundamental component of podiatric biomechanics. However, recent research has seriously questioned the reliability and validity of the commonly used approaches to clinical measurement of foot posture. A reevaluation of foot-morphology measurement is therefore warranted. This article discusses alternative clinical techniques of measuring foot type reported in the literature (arch height, footprint indices, the valgus index, and navicular drop) that may prove to be superior to the commonly used podiatric measurement system. On the basis of a critical evaluation of the literature, it would appear that arch height and footprint indices are invalid as means of categorizing foot morphology, while the valgus index and navicular drop offer a number of benefits over traditional frontal-plane measurements. An additional clinical measurement suggested by the author, navicular "drift," is also introduced. The advantages, disadvantages, and clinical application of each of these approaches are discussed in detail.
Article
Popular running magazines and running shoe companies suggest that imprints of the bottom of the feet (plantar shape) can be used as an indication of the height of the medial longitudinal foot arch and that this can be used to select individually appropriate types of running shoes. This study examined whether or not this selection technique influenced injury risk during United States Army Basic Combat Training (BCT). After foot examinations, BCT recruits in an experimental group (E: n = 1,079 men and 451 women) selected motion control, stability, or cushioned shoes for plantar shapes judged to represent low, medium, or high foot arches, respectively. A control group (C: n = 1,068 men and 464 women) received a stability shoe regardless of plantar shape. Injuries during BCT were determined from outpatient medical records. Other previously known injury risk factors (e.g., age, fitness, and smoking) were obtained from a questionnaire and existing databases. Multivariate Cox regression controlling for other injury risk factors showed little difference in injury risk between the E and C groups among men (risk ratio (E/C) = 1.01; 95% confidence interval = 0.88-1.16; p = 0.87) or women (risk ratio (E/C) = 1.07; 95% confidence interval = 0.91-1.25; p = 0.44). In practical application, this prospective study demonstrated that selecting shoes based on plantar shape had little influence on injury risk in BCT. Thus, if the goal is injury prevention, this selection technique is not necessary in BCT.
Article
Two sets of concepts for sport shoe construction are discussed, based on anatomical, orthopedic, and epidemiological considerations: one for the prevention of excessive load and related injuries, and one for the improvement of performance. The proposed concepts for prevention of excessive load and related injuries in the foot and the lower extremities are cushioning, support, and guidance. The goals outlined in the concepts can be achieved by altering the material properties or the construction of the shoe. It is suggested that the concept "cushioning" is not well understood yet and needs further research. The discussed concepts for improving performance are first, that energy should be returned at the right location, at the right time, with the right frequency, and second, that loss of energy should be minimized. Reduction of energy loss is an important concept for performance. The concept "return of energy" seems inappropriate for sport shoes.
Article
Sporting activities impose on the skeletal system forces of a high intensity and frequency. Ligaments, bone and tendons behave in a time-dependent load-extension fashion, and it is important for both scientists and clinicians to consider, for example, the alterations in failure properties shown by ligaments, tendons and bone at different rates of deformation. Whether the ability of the skeletal system to withstand stress can be improved with appropriate training is still controversial. The effects of physical exercise depend on the modality, intensity and duration with which the exercise itself is performed. Moreover, genetic factors, also influencing growth and hormonal status, may exert a significant influence on the response of a given tissue to an external load. Overloading may cause a lesion, and this may decrease or annihilate performance capability. The skeletal system may not be resistant enough, and so it may prove limiting to intensive physical activity. In vitro studies on resistance of a single tissue have not taken into consideration the specific resistance of that structure in vivo, and the results so obtained cannot be readily extrapolated to sporting activities, as in vivo muscles, joints, tendons, ligaments and cartilage act as one. This article reviews some of the possible beneficial and detrimental effects of intense exercise on various components of the skeletal system, focusing on its ability to withstand and adapt to stresses and allow maximal performance.
Article
A prospective controlled trial was carried out to determine the usefulness of a viscoelastic polymer insole in prevention of stress fractures and stress reactions of the lower extremities. The subjects were 3,025 US Marine recruits who were followed for 12 weeks of training at Parris Island, South Carolina. Polymer and standard mesh insoles were systematically distributed in boots that were issued to members of odd and even numbered platoons. The most important finding was that an elastic polymer insole with good shock absorbency properties did not prevent stress reactions of bone during a 12-week period of vigorous physical training. To control for the confounding effects of running in running shoes, which occurred for about one and one-half hours per week for the first five weeks, we also examined the association of age of shoes and cost of shoes with injury incidence. A slight trend of increasing stress injuries by increasing age of shoes was observed. However, this trend did not account for the similarity of rates in the two insole groups. In addition, we observed a strong trend of decreasing stress injury rate by history of increasing physical activity, as well as a higher stress injury rate in White compared to Black recruits. The results of the trial were not altered after controlling for these factors. This prospective study confirms previous clinical reports of the association of stress fractures with physical activity history. The clinical application of a shock absorbing insole as a preventive for lower extremity stress reactions is not supported in these uniformly trained recruits. The findings are relevant to civilian populations.
Article
Using a survey questionnaire design, we investigated the incidence, site, and nature of jogging injuries among all participants of a popular 16 km race. The response rate was 83.6%. Of 4,358 male joggers, 45.8% had sustained jogging injuries during the 1 year study period, 14.2% had required medical care, and 2.3% had missed work because of jogging injuries. Occurrence of jogging injuries was independently associated with higher weekly mileage (P less than 0.001), history of previous running injuries (P less than 0.001), and competitive training motivation (P = 0.03). Higher mileage was also associated with more frequent medical consultations due entirely to jogging-related injuries. In 33 to 44 year olds (N = 1,757), the number of years of running was inversely related to incidence of injuries (P = 0.02). Injuries were not significantly related to race running speed, training surface, characteristics of running shoes, or relative weight. Achillodynia and calf muscle symptoms were the two most common overuse injuries and occurred significantly more often among older runners with increased weekly mileage. We conclude that jogging injuries are frequent, that the number of firmly established etiologic factors is low, and that, in recommending jogging, moderation should be the watchword.
Article
The purpose of this investigation was to describe the height (H), weight (W), and percent body fat (%BF) of young men and women (ages 17-35 years) entering the U.S. Army and to determine an index of adiposity that fit criteria described in the literature. H and W were measured with a digital scale and anthropometer, respectively. %BF was calculated from four skinfolds thickness. Men and women were both separated into four age categories. Very little difference in H was found with increasing age. W and %BF increased progressively with age in the males but no increase in either parameter was seen within the three youngest age groups of women. For males, W/H2 was found to be the most appropriate index of adiposity of those studied, having a correlation with %BF of 0.75 and a standard error of estimate of +/- 3.4 %BF. W/H1.5 was the most appropriate index for females, having a correlation with %BF of 0.69 and a standard error of estimate of +/- 3.2 %BF. It was suggested that these indices could be used to replace or supplement the current H-W charts used in the Army. A table for predicting %BF from these indices has been provided.