Previous Musculoskeletal Injuries Research Articles

Musculoskeletal Injuries, Exercise Behaviors, and Reproductive Health Are Related to Physical Fitness of Female First-Responders and Health Care Providers.

Musculoskeletal injuries (MSKi) are the most common injury type experienced by first-responders and health care providers (HCPs), making them a significant threat to physical and mental well-being. Female reproductive health and injury history has been related to physical fitness in female members of the Canadian Armed Forces. This relationship has not been explored in Canadian protective services personnel (first-responders) or HCPs. Fifty-seven females employed as firefighters, paramedics, law enforcements, or HCPs completed a physical fitness protocol to assess the following: (1) muscular power (standing long jump and medicine ball throw), (2) muscular strength (4 repetition maximum (4RM) back squats and bench press), (3) muscular endurance (Biering-Sorenson test, single-leg wall sit, and push-ups), (4) flexibility (sit-and-reach), and (5) aerobic capacity (graded treadmill VO2max test). Spearman rho correlation analyses were applied to descriptive analysis, independent-samples t-test, one-way ANCOVA (adjusted by age), and chi-square test. Spearman rho correlation analyses were used to compare physical fitness results for female reproductive health history (e.g., parity status), previous MSKi, and physical activity behaviors (e.g., sports participation). A p value of <0.05 is considered significant. History of childbirth, body composition, and exercise behaviors were related to physical fitness (i.e., standing long jump, Biering-Sorenson test, bench press, and back squat) in law enforcement, firefighting, paramedicine, and health care personnel. Physical training programs aimed at supporting parous first-responders or HCPs should emphasize lower body power, lower body strength, and upper body strength.

Incidence and Risk Factors for Bone Stress Injuries in United States Air Force Special Warfare Trainees.

To determine (1) the incidence rate of lower extremity (LE) bone stress injuries (BSIs) in United States Air Force Special Warfare (AFSPECWAR) trainees during the first 120 days of training, and (2) factors associated with sustaining a LE BSI. Retrospective cohort study. AFSPECWAR Airmen (n = 2,290, mean age = 23.7 ± 3.6 years) entering an intensive 8-week preparatory course "SW-Prep" between October 2017 and May 2021. We compared anthropometric measurements, previous musculoskeletal injury (MSKI), fitness measures, and prior high-impact sports participation in those that did and did not suffer a BSI during the 120-day observation period using independent t-tests and chi-square tests. A multivariable binary logistic regression was used to determine factors associated with suffering a BSI. A total of 124 AFSPECWAR trainees suffered a BSI during the surveillance period, yielding an incidence proportion of 5.41% and an incidence rate of 1.4 BSIs per 100 person-months. The multivariate logistic regression revealed that lower 2-minute sit-up scores, no prior history of participation in a high-impact high-school sport, and a history of prior LE MSKI were associated with suffering a BSI. A receiver operator characteristic curve analysis yielded an area under the curve (AUC) of 0.727. BSI incidence proportion for our sample was similar to those seen in other military settings. Military trainees without a history of high-impact sports participation who achieve lower scores on sit-ups tests and have a history of LE MSKI have a higher risk for developing a LE BSI during the first 120 days of AFSPECWAR training.

Incidence of shoulder disorders in a cohort of healthcare workers from 2009 to 2020

PurposeTo estimate the incidence of shoulder disorders in a cohort of Health Care Workers (HCWs).Methods4406 workers employed from 2009 to 2020, were included in the study. Occupational risk factors and jobs were assessed according to working history. Incident cases were defined in case of shoulder pain associated with functional limitations during the medical examination. The Cox regression model was used to calculate the Hazard Ratio (HR) for different work activities, adjusted for age, sex, body mass index, and previous musculoskeletal injuries, using clerks as the reference category.ResultsThe incidence rates of shoulder musculoskeletal disorder for men and women were 13.1 for 1000 person-years (CI 95% 10.6–16.3) and 20.1 for 1000 person-years (CI 95% 17.8–22.6) respectively. The adjusted HR was significantly increased with age (1.06, CI 95% 1.05–1.07), outpatient health activities (2.82, CI 95% 1.89–4.219), and wards health activity (2.37, CI 95% 1.68–3.33).ConclusionHCWs with high biomechanical risk such as nurses and healthcare assistants had a higher incidence of shoulder disorders. Actions are needed for better prevention in health care assistance.

Lower Extremity Musculoskeletal Injury in US Military Academy Cadet Basic Training: A Survival Analysis Evaluating Sex, History of Injury, and Body Mass Index.

Background:Injury incidence for physically active populations with a high volume of physical load can exceed 79%. There is little existing research focused on timing of injury and how that timing differs based on certain risk factors.Purpose/Hypothesis:The purpose of this study was to report both the incidence and timing of lower extremity injuries during cadet basic training. We hypothesized that women, those with a history of injury, and those in underweight and obese body mass index (BMI) categories would sustain lower extremity musculoskeletal injury earlier in the training period than men, those without injury history, and those in the normal-weight BMI category.Study Design:Cohort study; Level of evidence, 2.Methods:Cadets from the class of 2022, arriving in 2018, served as the study population. Baseline information on sex and injury history was collected via questionnaire, and BMI was calculated from height and weight taken during week 1 at the United States Military Academy. Categories were underweight (BMI <20), middleweight (20-29.99), and obese (≥30). Injury surveillance was performed over the first 60 days of training via electronic medical record review and monitoring. Kaplan-Meier survival curves were used to estimate group differences in time to the first musculoskeletal injury. Cox proportional hazard regression was used to estimate hazard ratios (HRs).Results:A total of 595 cadets participated. The cohort was 76.8% male, with 29.9% reporting previous injury history and 93.3% having a BMI between 20 and 30. Overall, 16.3% of cadets (12.3% of male cadets and 29.7% of female cadets) experienced an injury during the follow-up period. Women experienced significantly greater incident injury than did men (P < .001). Separation of survival curves comparing the sexes and injury history occurred at weeks 3 and 4, respectively. Hazards for first musculoskeletal injury were significantly greater for women versus men (HR, 2.63; 95% CI, 1.76-3.94) and for those who reported a history of injury versus no injury history (HR, 1.76; 95% CI, 1.18-2.64). No differences were observed between BMI categories.Conclusion:Female cadets and those reporting previous musculoskeletal injury demonstrated a greater hazard of musculoskeletal injury during cadet basic training. This study did not observe an association between BMI and injury.

Factors Associated with the Willingness to Perform a Physical Employment Standard in Probation Officers.

This study examined worker characteristics and behaviors and the perceived importance of job-related tasks associated with the willingness to perform a proposed probation officer physical ability test (PROPAT). North Carolina probation officers (N = 1213, 46.2% female, 39.8 ± 10.1 yr, 30.7 ± 6.6 kg·m-2) completed a survey including demographics, health history, and job-related tasks. A multivariable logistic regression model estimated the odds of being willing to perform the PROPAT. Adjusted odds ratios (ORadjusted) with 95% confidence intervals (CI) were calculated, with those excluding 1.00 deemed statistically significant. The majority (72%) of probation officers were willing to perform the PROPAT. Being male (compared with female) (ORadjusted = 1.50, 95% CI = 1.12-2.02) and having moderate (ORadjusted = 1.51, 95% CI = 1.10-2.08) and high physical activity status (ORadjusted = 2.89, 95% CI = 1.97-4.28) (compared with low) increased the odds of being willing to perform the PROPAT. Additionally, reporting a greater importance of tasks, including running to pursue a suspect (TASKRUN, 1-unit increase, ORadjusted = 1.25, 95% CI = 1.10-1.43) and dragging an unresisting person (TASKDRAG, 1-unit increase, ORadjusted = 1.16, 95% CI = 1.01-1.32), increased the odds of being willing to perform the PROPAT. Increasing age (1-yr increase, ORadjusted = 0.96, 95% CI = 0.94-0.98), class II (ORadjusted = 0.45, 95% CI = 0.28-0.71) and class III obesity (compared with normal weight, ORadjusted = 0.55, 95% CI = 0.32-0.93), and a previous musculoskeletal injury (ORadjusted = 0.57, 95% CI = 0.35-0.93) all decreased the odds of being willing to perform the PROPAT. These results suggest being older, previously injured, obese (body mass index ≥ 35 kg·m-2), and less active is associated with being less willing to participate in the PROPAT, whereas males and reporting a higher importance of the TASKRUN and TASKDRAG activities is associated with being more willing to participate in the PROPAT. Departments can use these findings to identify feasible strategies (e.g., education and physical training) to improve the implementation of physical employment standards.

The Incidence and Risk Factors for Injuries in Girls Volleyball: A Prospective Study of 2072 Players.

Girls high school volleyball is very popular across the United States. There is limited prospective data regarding the incidence and risk factors of time loss (TL) and non-time loss (NTL) injuries sustained in this population. To estimate the incidence and describe the characteristics of injuries (TL and NTL) sustained in a girls' high school volleyball season. Descriptive epidemiology study. Convenience sample of 78 high school interscholastic volleyball programs. High school volleyball players participating during the 2018 interscholastic season. TL and NTL injury rates, proportions, rate ratios, and with 95%CI. A total of 2,072 girls enrolled in the study with 468 subjects (22.5%) sustaining 549 injuries (NTL=28.4%, TL=71.6%) for an overall injury rate of 5.31 [4.89, 5.79] per 1000 AEs. The competition injury rate was greater than the practice injury rate for all injuries (IRR: 1.19, [1.00, 1.41]) and TL injuries (IRR: 1.31, [1.07, 1.60]). Players with a previous musculoskeletal injury had a higher rate of TL than NTL injuries (IRR; 1.36 [1.12, 1.65]). Ankle injuries accounted for the greatest proportion of TL injuries (n=110, 28%), while the greatest proportion of NTL injuries occurred in the hand/fingers (n=34, 22%). Moreover, ligament sprains accounted for 40% of TL injuries (n=156), whereas muscle/tendon strains (n=79, 51%) accounted for over half of all NTL injuries. While the majority of injuries sustained by adolescent girls' volleyball athletes were TL in nature, nearly a third of all injuries were NTL injuries. Injury characteristics differed widely between TL and NTL injuries. Understanding the most common types and characteristics of injury among high school volleyball players is critical for the development of effective injury prevention programs.

Concussion History and Neuromechanical Responsiveness Asymmetry.

Detection of subtle changes in brain sensorimotor processes may enable clinicians to identify athletes who would derive the greatest benefit from interventions designed to reduce the risk for future injury and progressive neurologic or musculoskeletal dysfunction. To develop a generalizable statistical model for identifying athletes who possess subtle alterations in sensorimotor processes that may be due to previous concussion. Cross-sectional study. Residential Olympic Training Center sports medicine clinic. A primary cohort of 35 elite athletes and a secondary cohort of 40 elite athletes who performed identical tests the preceding year. Two upper extremity tests of visual-motor reaction time and 2 tests of whole-body reactive agility were administered. The whole-body tests required lateral or diagonal responses to virtual-reality targets, which provided measures of reaction time, speed, acceleration, and deceleration. Sport-related concussion history, which was reported by 54% (n = 19) of the athletes in the primary cohort and 45% (n = 18) of the athletes in the secondary cohort. Univariable analyses identified 12 strong predictors of sport-related concussion history, which we combined to create a composite metric with maximum predictive value. Composite lateral asymmetry for whole-body reactive movements and persisting effects of previous musculoskeletal injury yielded a logistic regression model with exceptionally good discrimination (area under the curve = 0.845) and calibration (predicted-observed probabilities within 7 subgroups: r = 0.959, P = .001). Application of the derived model to compatible data acquired from another cohort of elite athletes demonstrated very good discrimination (area under the curve = 0.772) and calibration (within 8 subgroups: r = 0.849, P = .008). Asymmetry in whole-body reactive movement capabilities may be a manifestation of a subtle abnormality in the functional connectivity of brain networks that might be relevant to previously reported associations between sport-related concussion history and musculoskeletal injury occurrence.

ASSOCIATION BETWEEN INJURY AND SPORTS SPECIALIZATION AMONG FEMALE HIGH SCHOOL VOLLEYBALL PLAYERS

Background:Volleyball participation has increased and unlike other team sports, its popularity among high school girls continues to grow. With its rise in popularity, the number of girls playing club volleyball outside of school has also grown. Sports specialization in youth athletes, or year-round intensive training in a single sport at the exclusion of others has become a concern. Overuse injuries are common among female volleyball players and specialization may be one factor that puts girls at risk of injury.Hypothesis/ Purpose:Evaluate the level of sports specialization among female high school volleyball players and examine its association with injury history.Design:Retrospective cohort study.Methods:Female students in grades 9-12 at 78 high schools who were committed to trying out for their high school volleyball team were recruited to participate in this study prior to the 2018 fall high school season. Athletes completed baseline assessments of sport related injuries within the previous 12 months. The athletes were asked to report their participation in interscholastic and club volleyball, including training volume and self-reported specialization. Finally, specialization of the athletes was determined using Jayanthi’s 3-point specialization scale. Athletes who had an injury that kept them out of the first day of tryouts were excluded. Univariate and multivariate analysis was performed.Results:2216 female high school volleyball players completed baseline evaluations (Age=15.6 ± 1.1 years old, BMI= 22.5± 3.5 kgs/m2) of whom 1588 identified volleyball as their primary sport (72%). Both moderately and highly specialized volleyball athletes were about twice as likely to report a musculoskeletal injury in the previous 12 months (Moderate: OR=1.84, 95%CI=1.29-2.62; High: OR=2.30, 95%CI=1.64-3.24). Similarly, those who played club volleyball were two times more likely to report a musculoskeletal injury in the past year (OR=2.00, 95%CI=1.48-2.71). Multisport athletes were also more likely to report a previous musculoskeletal injury (OR=1.69, 85%CI=1.24-2.32). Highly specialized volleyball players were more likely to participate in club volleyball (p<0.001), summer camps (p<0.001), and participate in both club and summer camps in the same year (p<0.001).Conclusions:High school girls’ volleyball players who are highly specialized were more likely to report a musculoskeletal injury in the past 12 months. Similarly, those who played club volleyball were more likely to report an injury in the past year. While sports specialization seems to be associated with increased risk of injury, it may be at least partially related to increased training volume.

Immediate Effect of Non Ballistic Active Knee Extension in Neural Slump Position Versus Muscle Energy Technique on Hamstring Flexiblity in Young Adults-Comparitive Study

Background and purpose: Amongst all of the bi-articular muscles of the human body hamstring have a greater tendency to shorten. Tightness of hamstrings produces decreased range of motion and reduce flexibility of the pelvis, hip and knee joints which can lead to musculoskeletal injuries. Muscle energy technique (MET) also known as active muscular relaxation technique is effective for lengthening a shortened muscles and increasing the range of motion. It is found that neuro dynamic tension technique also affects muscle flexibility and stretch tolerance. The purpose of this study is to evaluate the immediate effect of muscle energy technique verses non ballistic active knee extension in neural slump position on hamstring flexibility in young adults. Materials and Method : 60 healthy individuals between the age group of 18-35 years with bilateral hamstring tightness without any previous musculoskeletal injuries were allocated into 2 groups by means of quasi random sampling. Hamstring tightness was measured using active knee extension (AKE) test. Group A was given neural slump stretch and group B was given muscle energy technique. Results: For within group data analysis Wilcoxon test was applied where Group A and Group B showed statistically significant difference (p<0.001) in pre and post hamstring flexibility. Mann Whitney U test was used for between group analysis in which Group A(mean rank 35.22) showed a greater improvement than Group B (mean rank 25.78). Conclusion: Both the techniques showed statistical as well as clinical significance in improving hamstring flexibility, however non ballistic active knee extension in neural slump position showed greater improvement than MET.

Functional Movement Screen (FMS™) Scores and Demographics of US Army Pre-Ranger Candidates.

The United States Army Rangers are a unique population whose training requirements are intensive, and physically and mentally demanding. The Functional Movement Screen (FMS) is a movement screening tool designed to assess movement quality and asymmetries in movement with the potential to identify injury risk. This study was a descriptive, cross-sectional investigation examining associations between FMS scores and the various measures of health and performance of active duty soldiers in light infantry units who were involved in the U.S. Army Pre-Ranger Course (PRC). Before the PRC, 491 male soldiers (mean age=24.0±3.8years; mean height=176.6±7.2cm; mean body mass=80.2±9.8kg) completed a questionnaire which included items on self-assessed physical fitness, last Army physical fitness test (APFT) score, tobacco use, and injury history. The soldiers then completed the FMS, which consisted of seven movements and three clearing tests. From the FMS results, a determination of asymmetries (i.e., differences in FMS scores between the right and left side of the body) was made. Differences between groups were analyzed via an independent sample t-test, a one-way analysis of variance, or a chi-square as appropriate. Significance was set at 0.05 a priori. The average composite FMS score was 16.4 (±1.9) points. Soldiers reporting ≥290 APFT points achieved a higher FMS score than those reporting lower APFT scores (16.5±2.0 vs 16.1±2.0 points, P=0.03). Soldiers reporting either tobacco use or a previous musculoskeletal injury had lower FMS scores than those not reporting these (tobacco: 16.1±2.1 vs 16.5±1.8 points, P=0.02; injury: 16.0±2.2 vs 16.6±1.8 points, P<0.01). FMS asymmetries were not related to APFT scores, tobacco use, or self-rated fitness. As self-rated fitness increased so did APFT scores. Active duty soldiers of a light infantry division achieved FMS scores similar to other military populations tested, and the composite FMS score was related to higher APFT scores, absence of tobacco use, and absence of previous musculoskeletal injuries. Improving PRC candidate healthy habits through highlighting the negative associations between poorer fitness, cigarette tobacco use and movement quality, may reduce injury risk and increase PRC completion potential.

Examining re-injury worry, confidence and attention after a sport musculoskeletal injury.

Sport injury is an unfortunate event which can have a major impact on the injured athletes' psychology. Athletes may experience re-injury worry and low levels of attention and confidence getting back to competition following a sport injury. The aim of the study was to examine re-injury worry, confidence and attention of previously injured athletes, before they returned to competition. Cross-sectional research design. A total of 52 athletes volunteered for this study, aged 23.1±4.8 years old with a previous musculoskeletal injury during the last year. Participants completed the Causes of Re-Injury Worry Questionnaire, the Sport Confidence Questionnaire of Rehabilitated Athletes Returning to Competition and the Attention Questionnaire of Rehabilitated Athletes Returning to Competition, on their first competitive game after rehabilitation program. The athletes experienced average levels of re-injury worry and distraction attention and high levels of confidence and functional attention. The duration of injury, the medical and physiotherapy treatment and the absence from sport were significantly correlated with the questionnaire factors "Re-injury worry due to opponent's ability", "Functional attention" and "Distraction attention". Psychological characteristics of previously injured athletes may be influenced from the duration of: 1) medical treatment; 2) injury; 3) physiotherapy treatment; and 4) absence from sport, when they return to competition. More research needs to be conducted to confirm the present results.

The Prevalence of Obesity and its Association with Previous Musculoskeletal Injury in Probation Officers

The Prevalence of Obesity and its Association with Previous Musculoskeletal Injury in Probation Officers

The Epidemiology of Injuries Identified at the National Football League Scouting Combine and their Impact on Professional Sport Performance: 2203 athletes, 2009-2015

Objectives:Normal At the annual National Football League (NFL) Scouting Combine, the medical staff of each NFL franchise performs a comprehensive medical evaluation of all athletes potentially entering the NFL. Currently, little is known regarding the overall epidemiology of injuries identified at the Combine and their impact on NFL performance. The purpose of this study is to determine the epidemiology of injuries identified at the Combine and their impact on future NFL performance.Methods:All previous musculoskeletal injuries identified at the NFL combine (2009-2015) were retrospectively reviewed. Medical records and imaging reports were examined. Game statistics for the first two seasons of NFL play were obtained for all players from 2009 to 2013. Analysis of injury prevalence and overall impact on draft status and position-specific performance metrics of each injury was performed and compared versus a position-matched control group with no history of injury and surgery.Results:A total of 2,203 athletes over seven years were evaluated, including 1,490 (67.6%) drafted athletes and 1,040 (47.2%) who ultimately played at least two years in the NFL. The most common sites of injury were the ankle (1160, 52.7%), shoulder (1143, 51.9%), knee (1128, 51.2%), spine (785, 35.6%), and hand (739, 33.5%). Odds ratios (OR) demonstrated quarterbacks were most at risk of shoulder injury (OR 2.78, p=0.001) while running backs most commonly sustained ankle (OR 1.49, p=0.038) and shoulder injuries (OR 1.55, p=0.022). Ultimately, defensive players demonstrated a more negative impact than offensive players following injury with multiple performance metrics impacted for each defensive position analyzed whereas skilled offensive players (i.e. quarterbacks, running backs) demonstrated only one metric affected at each position.Conclusion:The most common sites of injury identified at the Combine were: (1) ankle, (2) shoulder, (3) knee, (4) spine, and (5) hand. Overall, performance in the NFL was significantly impacted by previous injuries. NFL performance was directly dependent on position played as well as anatomic location of injury. Defensive players were more negatively impacted than offensive players. Additional work is necessary to determine longer-term impact of these injuries on NFL career and post-NFL quality of life.

Epidemiology of Injuries Identified at the NFL Scouting Combine and Their Impact on Performance in the National Football League: Evaluation of 2203 Athletes From 2009 to 2015.

Background:At the annual National Football League (NFL) Scouting Combine, the medical staff of each NFL franchise performs a comprehensive medical evaluation of all athletes potentially entering the NFL. Currently, little is known regarding the overall epidemiology of injuries identified at the combine and their impact on NFL performance.Purpose:To determine the epidemiology of injuries identified at the combine and their impact on initial NFL performance.Study Design:Cohort study; Level of evidence, 3.Methods:All previous musculoskeletal injuries identified at the NFL Combine from 2009 to 2015 were retrospectively reviewed. Medical records and imaging reports were examined. Game statistics for the first 2 seasons of NFL play were obtained for all players from 2009 to 2013. Analysis of injury prevalence and overall impact on the draft status and position-specific performance metrics of each injury was performed and compared with a position-matched control group with no history of injury or surgery.Results:A total of 2203 athletes over 7 years were evaluated, including 1490 (67.6%) drafted athletes and 1040 (47.2%) who ultimately played at least 2 years in the NFL. The most common sites of injury were the ankle (1160, 52.7%), shoulder (1143, 51.9%), knee (1128, 51.2%), spine (785, 35.6%), and hand (739, 33.5%). Odds ratios (ORs) demonstrated that quarterbacks were most at risk of shoulder injury (OR, 2.78; P = .001), while running backs most commonly sustained ankle (OR, 1.39; P = .040) and shoulder injuries (OR, 1.55; P = .020) when compared with all other players. Ultimately, defensive players demonstrated a greater negative impact due to injury than offensive players, with multiple performance metrics significantly affected for each defensive position analyzed, whereas skilled offensive players (eg, quarterbacks, running backs) demonstrated only 1 metric significantly affected at each position.Conclusion:The most common sites of injury identified at the combine were (1) ankle, (2) shoulder, (3) knee, (4) spine, and (5) hand. Overall, performance in the NFL tended to worsen with injury history, with a direct correlation found between injury at a certain anatomic location and position of play. Defensive players tended to perform worse compared with offensive players if injury history was present.

The Relationship Between Functional Movement, Balance Deficits, and Previous Injury History in Deploying Marine Warfighters.

Screening for primary musculoskeletal injury (MSK-I) is costly and time-consuming. Both the Functional Movement Screen (FMS) and the Y-Balance Test (YBT) have been shown to predict future MSK-I. With a goal of optimizing the efficiency of primary MSK-I screening, we studied associations between performance on the FMS and YBT and whether history of MSK-I influenced FMS and YBT scores. In total, 365 deploying Marines performed the FMS and YBT as prescribed. Composite and individual scores were each categorized as high risk or low risk using published injury thresholds: High-risk FMS included composite scores ≤14 and right-to-left (R/L) asymmetry for Shoulder Mobility, In-Line Lunge, Straight Leg Raise, Hurdle Step, or Rotary Stability. High-risk YBT consisted of anterior, posteromedial, and/or posterolateral R/L differences >4 cm and/or composite differences ≥12 cm. Pearson's χ tests evaluated associations between: (a) all FMS and YBT risk groups and (b) previous MSK-I and all FMS and YBT risk groups. Marines with high-risk FMS were twice as likely to have high-risk YBT posteromedial scores (χ = 10.2, p = 0.001; odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.3-3.2). History of any MSK-I was not associated with high-risk FMS or high-risk YBT. However, previous lower extremity MSK-I was associated with In-Line Lunge asymmetries (χ = 9.8, p = 0.002, OR = 2.2, 95% CI = 1.3-3.6). Overall, we found limited overlap in FMS and YBT risk. Because both methods seem to assess different risk factors for injury, we recommend FMS and YBT continue to be used together in combination with a thorough injury history until their predictive capacities are further established.

Systematic review: risk factors for musculoskeletal disorders in musicians.

Although many musicians suffer from musculoskeletal disorders, aetiological factors are unclear. To systematically search for and synthesize the best available evidence on risk factors for musculoskeletal disorders in musicians. A database search was performed in PubMed, EMBASE, CINAHL, Pedro, OTseeker and Psychinfo. A manual search was conducted in the journals Medical Problems of Performing Artists and Psychology of Music. Studies with an objective to investigate determinants associated with playing-related musculoskeletal disorders were included. Papers were selected based on adequacy of statistical methods for the purpose of the study. Search, first screening and selection were performed by one author. Two reviewers independently performed the final selection using full-text reports. Methodological quality assessment was performed by two reviewers independently. One case-control and 14 cross-sectional studies were included. Methodological quality was in general low. Large heterogeneity existed in study design, population, measurement of determinant and outcome and analysis techniques. Data were presented descriptively. Consistent results were found indicating that previous musculoskeletal injury, music performance anxiety, high levels of stress and being a female playing a stringed instrument seemed to be associated with more musculoskeletal disorders. Influence over or support at work, orchestra category/status, exercise behaviour and cigarette smoking seemed to be unrelated with musculoskeletal disorders. No conclusions could be made on causality, as the current data only represent cross-sectional associations. Because of lack of prospective studies, no causal relations could be identified in the aetiology of (playing-related) musculoskeletal disorders in instrumental musicians.

Factors Influencing Musculoskeletal Symptoms in Military Personnel during Basic Combat Training

This study was done to examine physical, psycho-social, and individual factors influencing musculoskeletal symptoms among Korean military trainees. Using a correlation study design, military trainees who had completed almost of all the basic combat training (BCT) days were recruited from two military training units selected by convenience sampling. Data from 415 participants were analyzed. Prevalence of musculoskeletal symptoms was 29.6% defined as a participant having pain or discomfort in one or more body parts during training hours for more than seven consecutive days. Back/pelvic (10.8%), knees (10.1%), shoulders (7.7%), feet/toes (5.6%), ankles (4.8%) were prone to musculoskeletal symptoms. Musculoskeletal symptoms appeared to be related to physical exertion during BCT, stress during BCT, social support from fellow trainees, or previous musculoskeletal injuries. In the logistic regression model, physical exertion during BCT (OR=2.27, 95% CI: 1.42~3.65), stress during BCT (OR=1.79, 95% CI: 1.15~2.78), and previous musculoskeletal injuries (OR=1.58, 95% CI: 1.01~2.47) were the significant factors affecting prevalence of musculoskeletal symptoms. Findings indicate that physical exertion and psycho-social stress should be managed to prevent musculoskeletal symptoms in military trainees with more attention being given to trainees having a history of musculoskeletal injuries.

A description of training characteristics and its association with previous musculoskeletal injuries in recreational runners: a cross-sectional study

BACKGROUND: Running is one of the most popular physical activities in the world and the number of runners has increased over the past 40 years. One of the consequences of the growing running popularity is the increase of musculoskeletal injuries. OBJECTIVES: To describe the routines, training characteristics and history of injury in recreational runners and to evaluate possible associations between the routines and training characteristics with previous musculoskeletal running-related injuries. METHODS: A total of 200 runners participated in this study. The participants completed an electronic form containing questions about personal characteristics, running experience, training characteristics, type of running shoes, foot type and previous injuries history over the last 12 months. The data were analyzed descriptively as well as by using logistic regression models. RESULTS: The majority of the runners was male, aged 43.0 (SD=10.5) years-old, have a body mass index of 24.2 (IQR=4.3) kg/m2, and had training volume of 35.0 (IQR=28.0) kilometers per week. Fifty-five percent of runners had injuries over the last 12 months. The most prevalent injuries observed were tendinopathies and muscle injuries. The variable that showed an association with previous running-related injuries was running experience from 5 to 15 years (Odds Ratio (OR)=0.2; 95%CI=0.1 to 0.9). CONCLUSIONS: The prevalence of running-related injuries over the last 12 months was 55%. The variable running experience was associated with the absence of previous musculoskeletal running-related injuries.

Are Lower Limb Muscle Strength and Flexibility Deficits Predictive of Musculoskeletal Injury? The WIN Study

The 2008 Physical Activity (PA) Guidelines for Americans (PAGA) include aerobic and muscle strengthening activities (MSA). The PAGA make no recommendations for stretching. PURPOSE: Relate muscle strength and flexibility with musculoskeletal injuries (MSI) incurred while participating in PA. METHODS: An orthopedic examination was conducted on 918 community-dwelling women in the WIN Study. Lower limb muscle strength (hip abductors/external rotators, knee flexors/extensors) and flexibility (lumbar spine, hamstrings, gastrocnemius) were assessed with a hand-held dynamometer and electronic inclinometer, respectively. MSI and weekly minutes of moderate and vigorous physical activity (MVPA) were self-reported for up to 3 years. MSI was reported if it interrupted daily routine for ≥2 days or if seen by a health care provider. Logistic regression related MSI to muscle strength and flexibility using the lowest quintile as the referent and controlling for previous injury, age, and MVPA. RESULTS: Data on 900 women were analyzed (M age = 52.6 ±12.5; M wt = 73.8 ±17.3 kg; M BMI=27.5 ±6.2). 242 (26.9%) of 900 women reported a MSI during PA and 694 (77.1%) reported a previous injury. Univariate regression models suggest hamstring flexibility (OR=1.6; 95% CI=1.1 to 2.3) and previous history of MSI (OR=2.6; 95% CI = 1.7 to 3.9) relate to increased risk of MSI. The lowest quintile for strength in any individual muscle did not predict MSI but being in the bottom quintile for both hip abductors and external rotators increased risk of MSI (OR=1.7; 95% CI=1.0 to 2.8). Being in the bottom quintile for both knee flexors and extensors did not increase risk of MSI (OR=1.3; 95% CI=0.8 to 2.0). A multivariate model for hamstring flexibility and hip abductor/external rotator strength controlling for age, previous MSI, and MVPA min/week reveals that women with low hamstring flexibility (OR=1.6; 95% CI=1.1 to 2.3) or hip abductor and external rotator strength (OR=1.9; 95% CI=1.1 to 3.3) were at increased MSI risk. CONCLUSION: Women with low hip muscle strength or hamstring flexibility are more likely to report a MSI but increased risk is most highly related to having had a previous MSI. Hamstring stretching may be advisable for women even though there are no recommendations for flexibility activities in the PAGA. Supported by NIH Grant R01 AR052459-05

Mood Profile of an America's Cup Team

To describe the mood profile of an America's Cup sailing team during competition and to evaluate the influence of previous injuries occurrence and intensity of physical work on the boat upon mood state. Relationships between mood domains and metabolic markers of muscle damage were also investigated. A descriptive study was conducted on an America's Cup yachting race crew comprising 21 male sailors (mean +/- SD; age = 27.6 +/- 8.5 yr, weight = 89.3 +/- 24.9 kg, BMI = 26.5 +/- 6.9 kg x m(-2)). All measurements were collected during the Louis Vuitton Cup 2007 in Valencia, Spain. The POMS test and creatine kinase (CK) serum activity were measured and correlated. Sailors were grouped according to their presence or absence of previous musculoskeletal injuries (MI) and the intensity of physical work related to boat position: high intensity (HI) and low intensity (LI). According to normative data, pre- and postracing POMS scores were constantly high with prominent anger (24.2 +/- 9 before and 24.9 +/- 10.1 after the race) and depression (22.7 +/- 8.9 before and 20.6 +/- 7.3 after the race). The HI group displayed unchanged anger scores but showed significant differences compared with the LI group (z = -2.07, P = 0.038, mu2 = 0.22) at the end of the competition. The occurrence of a previous injury did not correlate with any interference with mood. Only the fatigue domain before racing had a significant negative correlation with CK levels (r = -0.509, P < 0.05). The emotional profile of this America's Cup yachting crew showed stable mood scores with high values in anger and depression compared with normative data. Mood was dependent on physical work intensity related to boat position but not on injury occurrence. Enzyme markers of muscle damage had no bearing on most POMS domains, except for fatigue before racing.