Lower Limb Musculoskeletal Injuries Research Articles

A patient-centered 'test-drive' strategy for ankle-foot orthosis prescription: Protocol for a randomized participant-blinded trial.

Ankle-foot orthoses (AFOs) are commonly used to overcome mobility limitations related to lower limb musculoskeletal injury. Despite a multitude of AFOs to choose from, there is scant evidence to guide AFO prescription and limited opportunities for AFO users to provide experiential input during the process. To address these limitations in the current prescription process, this study evaluates a novel, user-centered and personalized 'test-drive' strategy using a robotic exoskeleton ('AFO emulator') to emulate commercial AFO mechanical properties (i.e., stiffness). The study will determine if brief, in-lab trials (with emulated or actual AFOs) can predict longer term preference, satisfaction, and mobility outcomes after community trials (with the actual AFOs). Secondarily, it will compare the in-lab experience of walking between actual vs. emulated AFOs. In this participant-blinded, randomized crossover study we will recruit up to fifty-eight individuals with lower limb musculoskeletal injuries who currently use an AFO. Participants will walk on a treadmill with three actual AFOs and corresponding emulated AFOs for the "in-lab" assessments. For the community trial assessment, participants will wear each of the actual AFOs for a two-week period during activities of daily living. Performance-based and user-reported measures of preference and mobility will be compared between short- and long-term trials (i.e., in-lab vs. two-week community trials), and between in-lab trials (emulated vs. actual AFOs). The study was prospectively registered at www.clininicaltrials.gov (Clinical Trials Study ID: NCT06113159). Date: November 1st 2023. https://classic.clinicaltrials.gov/ct2/show/NCT06113159.

Changes in Heart Rate Variability During Low-Frequency Transcutaneous Electrical Nerve Stimulation in Athletes with Acute Musculoskeletal Injury

Background: Pain is a relevant clinical symptom to ask for medical management. Since pain is a subjective sensation, its intensity is difficult to precisely assess. Objectives: The present study aimed to determine whether heart rate variability (HRV) can be a potential parameter to evaluate the pain-relieving effect of low-frequency transcutaneous electrical nerve stimulation (TENS). Methods: Athletes with lower limb musculoskeletal injuries were voluntarily included in the study. Pressure pain thresholds (PPT) was measured immediately after the intervention, and 24 hours after the treatment. Heart rate variability was also determined from electrocardiography (ECG) monitoring throughout the intervention. Results: The HRV of 25 participants revealed that 30 minutes of low-frequency electrical stimulation immediately increased PPT (before = 2.67 ± 0.79; after = 2.92 ± 0.90, P = 0.011). Thirteen participants had more than a 10% increase in PPT after the intervention; nevertheless, three participants had a decrease in PPT. The PPT was returned to the baseline 24 hours after the intervention. Electrocardiography demonstrated that only the frequency domain of low frequency-high frequency (LF/HF) ratio was significantly increased after the intervention (before = 1.454 ± 0.739; after = 1.922 ± 1.378; P = 0.035) but not time-domain HRV. Time-domain HRV significantly decreased during the intervention before returning to the baseline. The correlation between the change in PPT is mostly correlated with LF/HF. Conclusions: Heart rate variability revealed the potential change in sympathovagal balance toward the sympathetic domain during low-frequency TENS intervention. The frequency-domain LF/HF ratio was the most sensitive parameter to be affected by pain.

Genome-wide association study identifying variants related to performance and injury in high-performance athletes.

A growing body of evidence exists supporting the role that genetic variation plays in athletic performance and injury. This study sought to identify genetic variants associated with performance and lower limb musculoskeletal injury in a high-level athletic cohort. A total of 126 Estonian National Team members (Olympic athletes and participants of International Championships) (104 males, 82.5%) underwent a genome-wide association analysis between 2017 and 2018, to identify single-nucleotide polymorphisms (SNPs) associated with performance and/or injury. The athletic cohort was stratified within each sport based on performance and whether they were a medalist (n = 29) or not (n = 97), whether they sustained an injury (n = 47) or not (n = 79), and the type of injury (patella tendinopathy n = 22, Achilles tendinopathy n = 17, hamstring injury n = 3, anterior cruciate ligament rupture n = 6). Three SNPs demonstrated strong genome-wide association with athletic performance (podium/medalist versus not), including DSG1 (rs10502567, OR 14.3) and DSG4 (rs73410248, OR 17.4), while 76 SNPs demonstrated suggestive significance. Overall, 37 SNPs gave genome-wide suggestive association with any type of injury, including PAPPA2 (rs11580456, OR 13.8) and MAS1 (rs220735, rs170219, OR 3.1) which demonstrated positive signal with multiple SNPs. Several genes demonstrated positive association for the specific injury types, including COL22A1 (rs3924862) and PLXNA2 (rs11799530), as well as PAPPA2 (rs11580456), DOK5 (rs73142922), GNG12 (rs28435277), and DAP (rs267959, rs2930047, rs1080440, rs267939). The current study identified genetic variants associated with high-level athletic performance and musculoskeletal injury. Further work is required to permit integration of this and future knowledge into individualized training practices, as well as injury mitigation and rehabilitation programs.

Concurrent and Convergent Validity of the Child Focused Injury Risk Screening Tool (ChildFirst) for 8-12-Year-Old Children

ABSTRACT The Child Focused Injury Risk Screening Tool (ChildFIRST) aims to measure movement competence and lower-limb-injury risk in 8–12-year-old children. Although the ChildFIRST has face and content validity evidence, stronger validity evidence is warranted. We tested the concurrent validity of the ChildFIRST using motion analysis, and the convergent validity of the ChildFIRST using the modified Star Excursion Balance Test (mSEBT) and the Test of Gross Motor Development 3 (TGMD-3). We computed correlation coefficients (0.05 alpha level). We evaluated 17 participants. We observed positive correlation values between 18 ChildFIRST evaluation criteria and peak joint angles in the frontal and sagittal planes. One movement skill (i.e. leaping) presented a negative correlation value. We observed positive correlation values between the ChildFIRST and TGMD-3 and between the ChildFIRST and the mSEBT. Nine out of ten movement skills in the ChildFIRST are valid to assess movement competence and identify risk factors associated with lower-limb musculoskeletal injuries.

Translation, Cross-Cultural Adaptation, and Validation of the Foot Posture Index (FPI-6)-Italian Version.

Since foot posture is one of the main predictors of lower limb musculoskeletal injuries, it is crucial to use appropriate tools to define the foot's posture. The Foot Posture Index is, therefore, a reliable method to measure foot posture and is widely known and used in clinics and research. This study aimed to translate the Foot Posture Index 6 (FPI6) into Italian and to assess its psychometric properties. Translation and cross-cultural adaptation were obtained using a popular guideline. Two examinators assessed 68 subjects, and data were collected to test intra/inter-rater reliability, internal consistency and cross-cultural validity. The Italian version of FPI6 showed excellent inter- and intra-rater reliability (ICC 0.96 and 0.97), and Cronbach's alpha coefficient was 0.9, thus showing excellent internal consistency. The FPI-6 version has proved to be reliable in terms of inter- and intra-rater reliability and can, therefore, be used in clinical practice and scientific research.

Effect Of Eccentric Training And Isolytic Contraction To Improve Flexibility Of Quadriceps In Recreational Marathoners.

In the field of athletics, running is one of the most popular activities having beneficial health effects as well as negative effects during sports injury. Not only elite marathoners, but recreational marathoners have various lower limb musculoskeletal injuries that occur quite frequently which produces an adverse effect over the performance of the marathoners. Studies have suggested that the most common muscles that were affected were quadriceps group of muscles as well as the hamstrings muscles. The main mechanism behind the injury to the quadriceps muscles is the strong contraction of the muscle against the forced flexion action of the knee joint which is commonly seen in runners in a downhill marathon. Some of the risk factors that are responsible for the quadriceps muscle strains are inadequate stretching, muscle imbalance of the lower extremity and inadequate warm-up before vigorous exercise. Objective of this study was to find out the effect of eccentric training and whether isolytic contraction helps to improve the flexibility of the quadriceps muscle and joint range of motion of knee as well as hip joint. A total of 30 subjects were selected for the study from Krishna College of Physiotherapy. The subjects were divided into two groups namely, group A and group B consisting of 15 subjects each. Demographic data, assent and consent was taken from the marathoners that were selected according to the inclusion criteria. Pre and post assessment was taken on the basis of both active range of motion of the hip joint, active range of motion of knee joint, Manual Muscle Test of the quadriceps and Ely’s test for quadriceps before and after 6 weeks (total 16 sessions) of the treatment respectively. The session lasted for a time period of 45 mins. After the data was collected, evaluation and interpretation of collected data was done thoroughly. The subjects under the eccentric training protocol were found to have more effect compared to the ones in the group consisting of isolytic contraction protocol. The conclusion of this study was that significant effect of eccentric training and isolytic contraction helps to improve the flexibility of the quadriceps muscle and joint range of motion.

Early Changes of Hamstrings Morphology and Contractile Properties during 10 d of Complete Inactivity.

The hamstrings (HS) muscle group plays a fundamental role in maintaining knee stability, thus contributing to the prevention and rehabilitation of lower limb musculoskeletal injuries. However, little is known about HS structural and functional adaptations after periods of prolonged inactivity. Our purpose was to investigate the HS morphological and contractile properties changes during 10 d of bed rest (BR). Ten young healthy males underwent a 10-d BR. HS cross-sectional area (CSA) (at 30%, 50%, and 70% of femur length) and biceps femoris long head (BFlh) architecture were assessed by ultrasound imaging after 0 d (BR0), 2 d (BR2), 4 d (BR4), 6 d (BR6), and 10 d (BR10) of BR, whereas BFlh contractile properties (radial twitch displacement [Dm] and contraction time [Tc]) were evaluated at the same time points by tensiomyography. HS muscle volume was assessed by magnetic resonance imaging at BR0 and BR10. A reduction in muscle volume was observed in BFlh ( P = 0.002; Δ = -3.53%), biceps femoris short head ( P = 0.002; Δ = -3.54%), semitendinosus ( P = 0.002; Δ = -2.63%), semimembranosus ( P = 0.002; Δ = -2.01%), and HS pooled together ( P < 0.001; Δ = -2.78%). Early changes in CSA were detected at 30% femur length already at BR6 for BFlh ( P = 0.009; Δ = -2.66%) and biceps femoris short head ( P = 0.049; Δ = -1.96%). We also found a reduction in fascicle length at BR6 ( P = 0.035; Δ = -2.44%) and BR10 ( P < 0.001; Δ = -2.84%). Dm and Tc increased at BR2 ( P = 0.010; Δ = 30.0%) and B10 ( P = 0.019; Δ = 19.7%), respectively. Despite being a nonpostural muscle group, HS exhibited a moderate reduction in muscle dimensions in response to a short unloading period. Small changes in BFlh fascicle length were also observed, accompanied by alterations in BFLh contractile properties. These HS modifications should not be ignored from a clinical perspective.

Lower limb risk prevention in athletes: evaluation and strategies

Risk prevention of sports-related lower limb musculoskeletal injuries in adult and youth athletes is an important topic encompassing health and economic factors. For example, muscle injuries in professional football players could expose these athletes to recurrence, creating a significant economic problem for the football club. Such observations have led to the development of prevention programs, predominantly exercise-based injury prevention strategies, which may be multi-component or single-component. These programs focus on intrinsic risk factors, such as strength deficits, lack of flexibility, poor balance, coordination, endurance, previous injury, body size, anatomical alignment issues, foot shape, age, and sex. The FIFA 11+ program is an important example of an exercise-based program. It was developed under the leadership of the Fédération Internationale de Football Association with the aim of evaluating and, where necessary, implementing preventive training routines for soccer players. Despite the program being designed for soccer players, it has shown efficacy in other sports too. Many studies also emphasize the importance of identifying and avoiding extrinsic risk factors related to type and level of activity, shoe type, bracing equipment, etc. Understanding of the incidence, the severity, and the etiology of a specific injury is required in order to provide adequate prevention measures and to reduce the need for surgery. The present study focuses explicitly on identifying and evaluating possible interventions for lower limb injuries.

Review article: DINED (Delivery-related INjuries in the Emergency Department) part 1: A scoping review of risk factors and injuries affecting food delivery riders.

This scoping review describes the current state of research about two-wheeled delivery riders who have been injured while performing commercial food delivery. The key areas of interest are the patterns of injury, associated risk factors and current gaps in knowledge. Five databases were searched to identify key papers that describe injuries to two-wheeled food delivery riders. Papers were assessed for quality and eligibility and key information was extracted relating to patterns of injury and risk factors. From an initial 264 records from PubMed, Embase, CINAHL, Scopus and SafetyLit, studies were screened by title, abstract and full text to yield 12 key papers for analysis. No papers reporting on Australian data were identified. Men comprise over 85% of workers in the food delivery industry. The average age of injured riders varies by country, but is commonly under 30 years old. Most injuries are lower limb musculoskeletal injuries, although there are no consistent data about frequency, severity or cost to the healthcare system. Twenty-three key risk factors were categorised according to rider characteristics, working conditions and environmental factors. The most common risk factors were younger age, lack of driving experience, time-pressured work and inadequate protective gear. There are very few publications describing food delivery rider injuries and risk factors. This is an emerging industry in which the worker population may be younger and more vulnerable. Given the different legal and cultural contexts across different countries, Australian-specific research is needed.

A Patient and Public Involvement Study to Explore the Need for Further Research into the Experience of Younger Patients Undergoing Total Hip Arthroplasty.

Background: Total Hip Arthroplasty (THA) is one of the most commonly performed operations in orthopaedics. It is an operation usually performed in older patients, however the need for THA in younger patients is increasing. There is a lack of literature examining whether current recovery pathways address the specific needs of younger patients. Public and Patient Involvement (PPI) is a core aspect of good research practice and is recommended throughout the research process, including the formulation and refinement of pertinent research questions. Therefore, the explicit aim of this PPI study was to collect qualitative data from patients on the feasibility and requirement for further research into the experience of younger hip arthroplasty patients. Methods: Qualitative data was collected via an online questionnaire that was advertised on social media, requesting the input of anybody who had experienced a lower limb musculoskeletal injury or condition before the age of 50. The survey asked the respondents to describe their experiences and reflect on their priorities and goals throughout their recovery. Results: There were 71 respondents, of which 90% were female, with an average age of 43. Qualitative responses identified many concerns that were issues that could be translated across all patient ages. However, other priorities were raised that are not always recognised as important when measuring successful outcomes after a THA. Furthermore, many respondents described not feeling listened to by clinicians or treatment options not being sufficiently addressed and explored. Multiple respondents reported being told they were too young to have anything serious or that nothing could be done until they were older. Conclusions: The responses to the survey indicate that current care pathways are not fulfilling the needs and priorities in younger patients. Further research is required to explore these priorities and goals in more depth in order to understand how healthcare professionals can address them.

Effectiveness of virtual reality-based gait education in enhancing the rehabilitation outcomes of injured military personnel

IntroductionCorrecting adverse biomechanics is key in rehabilitating musculoskeletal injuries. Verbal instruction remains the primary method for correcting biomechanics and therefore a patient’s understanding of these instructions is believed to directly...

Effect of pre-game photobiomodulation on muscle recovery in professional soccer players: study protocol for a randomized, cross-over, sham-controlled, triple-blind, clinical trial

Background: Photobiomodulation with low-level laser therapy (LLLT) has been widely used in clinical practice for diverse purposes, such as modulation of the inflammatory process, acceleration of the tissue repair process, pain relief and the enhancement of post-exercise recovery. Studies have demonstrated a beneficial interaction between photobiomodulation and the production of creatine kinase, with a reduction in the release of this marker of muscle damage when laser and/or LEDs is administered prior to high-intensity physical activity. Objective: The aim of the proposed study is to determine the influence of pre-exercise phototherapy on post-exercise muscle recovery. Methods: A randomized, cross-over, sham-controlled, double-blind, clinical trial is proposed. The participants will be healthy professional soccer players aged 15 to 20 years from the same team with a body mass index within the ideal range (20 to 25 kg/m2 ) and no history of lower limb musculoskeletal injuries or surgery or back surgery in the previous six months. The athletes will be allocated to two groups based on the previously calculated sample size and will be blinded to allocation. Creatine kinase will be measured and the subjective perception of fatigue will be determined for each participant. The volunteers will then be randomly allocated to Group A, which will receive active phototherapy, and Group B, which will receive sham phototherapy. The athletes will undergo reevaluations immediately after as well as 48 hours after a football match. The data will be submitted to statistical analysis and the level of significance will be set to 5%. This study is registered with Clinical Trials under protocol number: NCT03416998.

The Influence of Tobacco Use, Alcohol Consumption, and Weight Gain on Development of Secondary Musculoskeletal Injury After Lower Limb Amputation

ObjectivesTo evaluate whether tobacco use, alcohol consumption, and weight gain are associated with the diagnosis of overuse musculoskeletal injuries within the first 12 months after lower limb amputation. DesignRetrospective cohort study. SettingMilitary treatment facilities. ParticipantsService members (N=681) with a deployment-related lower limb amputation. InterventionsNot applicable. Main Outcome MeasuresClinical diagnosis codes associated with musculoskeletal overuse injuries of the lower limb, upper limb, and low back regions. ResultsIn the first three months after amputation, tobacco use and alcohol consumption were reported in 55.7% and 72.0%, respectively, of the retrospective sample. The overall mean weight change was 22.9±23.6 pounds. The prevalence of reporting at least 1 overuse injury within 4 to 12 months after amputation was 57.0% in the sample, with prevalence rates of lower limb, upper limb and low back pain diagnoses at 28.3%, 21.7%, and 21.1%, respectively. Service members reporting tobacco use in the first 3 months after amputation were nearly twice as likely to be diagnosed with a lower limb musculoskeletal injury 4 to 12 months after amputation. Similarly, service members reporting alcohol consumption within the first 3 months after amputation were more than twice as likely to be diagnosed with at least 1 overuse musculoskeletal injury 4 to 12 months after amputation. However, weight change or maximum weight after amputation were not associated with the diagnosis of an overuse musculoskeletal injury. ConclusionsDevelopment of secondary overuse musculoskeletal injury appears to be related to tobacco use and alcohol consumption, but not to weight gain. These findings warrant focused research efforts toward developing preventive interventions.

Accuracy of the Region of Limb Stability in Predicting Risk for Lower Limb Injury.

This study aimed to determine whether a measure of lower limb segment stability derived from body-worn inertial measurement units can predict risk for lower limb musculoskeletal injury in Division I Collegiate Football Players (D1CFP). The region of limb stability (ROLS) values were collected in a cohort of D1CFP during preseason. ROLS is a measure of knee joint stability, defined by thigh and shank excursion (cm) in the anterior-posterior and medial-lateral direction during single limb stance. The ROLS symmetry index (SI) (%) is the ratio between lower limb ROLS values where 100% suggests absolute symmetry. One-hundred and four D1CFP participated in this study and were divided into two groups: 1) no previous lower limb injury or no in-season injury (n = 70, "noninjured group") and 2) no previous lower limb injury, but in-season injury requiring surgery (n = 34, "injured group" group). The mean ± SD ROLS SI was 82.86% ± 14.75% and 65.58% ± 16.46% for the noninjured and injured group, respectively. Significant differences in ROLS SI were found between groups (P < 0.001). The ROLS SI demonstrated an area under the curve of 0.8 (P < 0.001; 95% confidence interval = 0.71-0.88) with an SE of 0.04, indicating that the ROLS SI has good predictive accuracy in detecting those healthy D1CFP at risk for lower limb injury resulting in surgery. The ROLS SI was found to have good predictive accuracy in detecting individuals at risk for injury that were healthy and asymptomatic during preseason testing. Increase in thigh and shank excursions and/or decrease in SI between lower limbs may be a predictor of risk for future injury.

Clinical Features and isokinetic Parameters in Assessing Injury Risk in elite Football Players.

Football players frequently face the occurrence of non-contact injuries. Although there are likely multiple factors that contribute to increased risk of non-contact injury, it remains a challenge to correlate all these factors. However, it is not clear how much of individual training abilities may interfere in these events. As such, the primary aim of the present study was to determine whether the reduction of functional performance of the thigh in the isokinetic knee tests, anthropometric and morbid history can establish risk factors for lower-limb musculoskeletal injuries throughout the season. The incidence of injuries and odds ratios were calculated for suspected risk factors. Hamstring/Quadriceps conventional ratio outside of the safety range (55-64%) may be involved in the occurrence of non-contact muscle injuries and the risk for any musculoskeletal injuries in the lower extremities is 16 times higher when extensor peak of torque exceeds 10% and 12 times higher when flexor peak of torque difference was greater than 10%. This kind of evaluation can result in intervention programs that may decrease the risk of lower-limb musculoskeletal injuries. Based on these results we can establish a specific and individualized exercise program for each athlete and thus protect them during the season.

Musculoskeletal Simulation Tools for Understanding Mechanisms of Lower-Limb Sports Injuries

Musculoskeletal simulation and dynamic modeling programs have been used to gain insight into lower-limb musculoskeletal injury mechanisms. In addition to the temporospatial, kinematic, and kinetic data obtained from motion analysis systems, musculoskeletal simulation programs also can provide information on joint contact and muscle forces, musculotendinous lengths and velocities, and muscle activation levels. Musculoskeletal simulation platforms may help in the assessment of risk factors for sports-related injuries. Using musculoskeletal simulations for injury prevention programs may help lower the incidence of sports injuries, and may allow for fast recovery from injury. In this review, injury mechanisms and risk factors of some of the most common lower-limb musculoskeletal injuries, including anterior cruciate ligament, patellofemoral, and hamstring injuries were summarized from a biomechanical perspective. Also, the efficacy of musculoskeletal modeling and dynamic simulation tools in helping our understanding of these injury mechanisms was discussed.

Kinematic and kinetic differences between military patients with patellar tendinopathy and asymptomatic controls during single leg squats

BackgroundKnee valgus alignment has been associated with lower-limb musculoskeletal injury. This case-control study aims to: assess biomechanical differences between patients with patellar tendinopathy and healthy controls. Methods43 military participants (21 cases, 22 controls) were recorded using 3D-motion capture performing progressively demanding, small knee bend, single leg and single leg decline squats. Planned a priori analysis of peak: hip adduction, knee flexion, pelvic tilt, pelvic obliquity and trunk flexion was conducted using MANOVA. Kinematic and kinetic data were graphed with bootstrapped t-tests and 95% CI's normalised to the squat cycle. ANOVA and correlations in SPSS were used for exploratory analysis. FindingsOn their symptomatic side cases squatted to less depth (−6.62°, p < 0.05) than controls with exploratory curve analysis revealing a pattern of increased knee valgus collapse throughout the squatting movement (p < 0.05). Greater patella tendon force was generated by: the eccentric than concentric phase of squatting (+30–43%, ES 0.52–1.32, p < 0.01), declined (plantarflexed) compared to horizontal surface (+36–51%, ES 1.19–1.68, p < 0.01) and deeper knee flexion angles (F ≥ 658.3, p < 0.01) with no difference between groups (F ≤ 1.380, p > 0.05). Cases experienced more pain on testing on decline board (ES = 0.69, p < 0.01). For symptomatic limbs pain (rs = 0.458–0.641, p ≤ 0.05), but not VISA-P (Victoria Institute of Sport Assessment) (rs = 0.053–0.090, p > 0.05), correlated with extensor knee moment. InterpretationKnee valgus alignment is a plausible risk factor for patellar tendinopathy. Conclusions relating to causation are limited by the cross-sectional study design. Increasing squat depth, use of a declined surface and isolating the eccentric phase enable progression of loading prescription guided by pain.

Preseason Dynamic Balance Performance in Healthy Elite Male Soccer Players.

Lower limb musculoskeletal injuries in sports are linked with balance abnormalities and altered postural control. Dynamic balance screening should be performed in order to identify athletes at risk. The purpose of the study was to evaluate the preseason dynamic balance performance and side-to-side asymmetry of healthy elite male soccer players, using modified Star Excursion Balance Test (mSEBT). Seventy-three elite soccer players (23.8 ± 5.4 years) were evaluated using the mSEBT. Normalized reach distances, side-to-side asymmetries, and composite scores were determined. The composite scores were 93.33% ± 8.99% for dominant leg and 93.36% ± 9.23% for nondominant leg. No significant differences were found between dominant and nondominant limb in any direction. The mSEBT is an easy-to-use tool to measure the dynamic balance performance in elite athletes. It can be applied successfully during preseason physical examinations. Future studies are needed to establish predictive cutoff points in order to increase mSEBT use in screening soccer players for dynamic balance abnormalities and identify those at risk for noncontact lower limb injuries.

Prevalence of musculoskeletal injuries and a proposal for neuromuscular training to prevent lower limb injuries in Brazilian Army soldiers: an observational study

BackgroundThe activities carried out by soldiers in the army involve great physical demands and require intense trainings to perform combat-specific tasks. Musculoskeletal injury is a potential threat to the health and physical integrity of the soldier. This study aimed to evaluate the prevalence of lower limb musculoskeletal injuries among soldiers and to propose a training protocol to prevent the most frequent injuries.MethodsThis observational (cross-sectional) study recruited a sample of 103 soldiers who required medical attention, from a total 202 new battalion soldiers. The medical records (paper and online) had a form of running text. All data collected were recorded by the registered physicians of the battalion medical post. The records were analyzed by the following variables: medical diagnosis, injury site, mechanism, type of treatment, time loss, existence of previous injury, and recurring injury.ResultsA total of 112 musculoskeletal injuries were diagnosed in 71 soldiers, and other types of diseases/injuries were diagnosed in the other soldiers. Joint pain accounted for 55.4% of the diagnoses. The knee was the most affected site, while trauma and overload were the most common mechanisms of injury. Drug treatment was used most frequently, accounting for 58% of the cases. The majority of the sample obtained a temporary leave of absence for 1 to 6 days or not at all. Previous injuries and recurrence were not presented as risk factors for injury. With the data received, a protocol for the prevention of injuries to the lower limbs was proposed.ConclusionThis study indicated that the most frequent site of injury is the knee, and joint pain is the most common diagnosis. These results may support the necessity to develop a neuromuscular training protocol to prevent lower limb injuries, which we suggest to be applied in future studies.

Does the amount of lower extremity movement variability differ between injured and uninjured populations? A systematic review.

Movement variability during repetitive performance of a dynamic activity (eg, running, jumping, kicking) is considered an integral characteristic of optimal movement execution; however, its relationship with musculo-skeletal injury is not known. The primary aim of this study was to review published comparison trials to determine whether movement variability differs between uninjured controls and subjects with a lower limb musculo-skeletal injury. A systematic search of online databases; MEDLINE, Sports Discus, Scopus, and Web of Science was conducted from July to November 2016. Studies were selected if they (a) included participants with a lower limb injury, (b) compared injured participants to uninjured controls, (c) examined movement variability for at least one dependent variable, and (d) provided a statistical between-group comparison when comparing measures of movement variability. Studies were excluded if they (a) investigated neurological disorders, (b) examined musculo-skeletal injury in the upper extremity or spine, and (c) used nonlinear measures to examine variability (ie, complexity). A significant difference between injured and uninjured populations was reported in 73% of the included studies, and of these, 64% reported greater movement variability in the injured group. This is the first systematic review with a best-evidence synthesis investigating the association between movement variability and musculo-skeletal injury. Findings suggest that movement variability in those with a musculo-skeletal injury differs from uninjured individuals. Interestingly, there was an overall trend toward greater movement variability being associated with the injured groups, although it should be noted that this trend was not consistent across all subcategories (eg, injury type). For a clearer insight into the clinical application of variability, greater methodological homogeneity is required and prospective research is recommended.