Risk Factors For Musculoskeletal Injuries Research Articles

Concussion history and virtual reality metrics predict core or lower extremity injury occurrence among high school athletes.

A history of concussion is recognized as a risk factor for musculoskeletal injury, which is likely associated with physiological effects that warrant better understanding. This study aimed to assess the potential of measurements obtained from an immersive virtual reality (VR) test to identify a subtle perceptual-motor impairment that may be prospectively associated with the occurrence of a core or lower extremity sprain or strain. A cohort of 68 high school athletes (41 female soccer players and 27 male football players) provided survey responses and completed an immersive VR test several days prior to the initiation of preseason practice sessions. Measurements of eye, neck, arm, and whole-body displacements were obtained during 40 successive lunging/reaching responses to visual stimuli moving horizontally across the VR headset display. Injury occurrences were electronically documented from the initial preseason practice session to the final game of the season. A statistically significant and intrinsically credible two-factor prediction model for core or lower extremity injury occurrence included an interaction between female sex and a self-reported history of two or more concussions, along with slow response time (RT) for arm reach (OR = 4.67; 95% CI, 1.51-14.43). Follow-up analyses identified sex-specific cut points for arm reach RT associated with elevated injury risk, which were ≥1.385 s for females and ≥1.257 s for males. High school female soccer players who have sustained more than one concussion appear to be highly vulnerable to core or lower extremity sprain or strain, with the risk of injury compounded by a slow arm reach RT. Male football players as a group demonstrated significantly faster arm reach RT than that of female soccer players, but slow perceptual-motor RT for arm reach was also identified as a potentially important injury risk factor for male players. Immersive VR appears to provide precise measurements of behavioral performance characteristics that depend on brain processing efficiency. Given that the speed, accuracy, and consistency of perceptual-motor responses may be modifiable, future research should explore the potential benefits of VR training for reducing the risk of sport-related injuries.

A Scoping Review: Reducing Musculoskeletal Injury Risk Factors for Adaptive Sport Athletes through Prevention Programs.

The purpose of this scoping review was to identify existing strategies to reduce modifiable risk factors for musculoskeletal injury in adaptive athletes. Medline, Embase, Web of Science, and CINAHL were searched. Inclusion criteria required studies written in English, samples of adaptive athletes, and evaluation of any injury prevention programs that would reduce risk factors associated with MSK injury. The literature search resulted in 785 unique articles. 32 full text articles were screened for inclusion. Four studies of wheelchair basketball and wheelchair rugby injury prevention programs were included in the final analysis, and these studies demonstrated increase in shoulder range of motion, decreased shoulder pain, and decreased cumulative traumatic disorders; all of which was proposed to reduce risk of shoulder injury. However, these studies were small and did not include control groups. Future research is needed to implement programs that reduce risk factors of MSK injuries and reduce health disparities for adaptive athletes.

Effects of core stability and feedback music on upper body mediolateral movements during cycling

BackgroundAsymmetry in involuntary trunk motion during voluntary movements of the lower extremities is a risk factor for musculoskeletal injuries and may be related to core stability. Core stability plays a pivotal role in maintaining postural stability during distal segment movements. Because mediolateral head motion partially represents trunk motion during rhythmic movements, controlling it can help ensure symmetric trunk motion. This study aimed to investigate the relationship between core stability and asymmetric trunk motion during rhythmic movements, and to evaluate the effects of feedback music on mediolateral head motion.MethodsWe developed a system that uses a wireless earbud and a high-resolution inertial measurement unit sensor to measure head angle and provide feedback music. When the head angle exceeds a predefined threshold, the music is muted in the earbud on the side of the head tilt. In our lab-based study, we measured head angles during cycling at 70% of maximum speed using this self-developed system, and compared them between individuals with good (Sahrmann core stability test: 2–5 level) and poor core stability (0–1 level). The amplitude of mediolateral head motion was represented by the difference between the left and right peak angles, and the symmetry in mediolateral head motion was represented by the average of left and right peak angles.ResultsIndividuals with poor core stability demonstrated significantly greater amplitude of, and less symmetry in, mediolateral head motion than those with good core stability. Additionally, feedback music significantly reduced the amplitude of mediolateral head motion in both the good- and poor-core-stability groups.ConclusionOur findings indicate that core stability is crucial for maintaining symmetric head motion during rhythmic movements like cycling. Feedback music could serve as an effective tool for promoting symmetry in head motion and thus preventing musculoskeletal injuries.

Determining the effect of environmental factors, work postures and mental workload on musculoskeletal disorders in rescue workers and accidents of one of the water and sewage companies in Iran.

Musculoskeletal disorders are one of the most important problems faced by ergonomists today. This study was conducted with the aim of investigating the effect of weather conditions, working conditions and mental workload on musculoskeletal disorders of rescuers and water and sewage company accidents in hot and cold seasons. The present study was a longitudinal study that was performed on all employees of rescue and disaster teams of Shiraz Water and Sewerage Company in Iran (184 people) by census. Demographic and Nordic questionnaires, NASA Load Index (NASA-TLX), work environment assessment with temperature screening checklist and workplace ergonomic risk factor (WERA) assessment method were performed by the researcher. The collected data were analyzed using SPSS version 23 software and parametric and non-parametric statistical tests. The results showed that the highest and lowest prevalence of musculoskeletal disorders related to knee and back in winter and thigh in summer with prevalence of 57.1, 55.4 and 6% . The comparison of exposure to heat stress factors in summer and winter seasons showed that the temperature factors and work clothes of the workers in both seasons are in worse conditions than other factors (P < 0968). The results of the mental workload of people in two seasons showed that the highest and lowest mental workload is related to physical changes in the winter season and frustration in the summer season, and this relationship was significant (P < 0.001). Using multiple logistic regression model, the potential risk factors for musculoskeletal injuries including age, height, BMI, level of education and work experience in both hot and cold seasons were compared. The results showed that in summer, work experience (OR = 1.16 (1.06-1.28.)) and height (OR = 1.03(0.98-1.08) had a direct effect on the prevalence of pain and discomfort arranged in the back areas. One year of increase in work experience significantly increases the chance of a disorder in the back by 16% and a one centimeter increase in height increases the chance of a disorder in the lumbar region by 3%, although this relationship is significant. It is recommended that suitable solutions such as using appropriate and up-to-date mechanical tools, reducing activity time, increasing rest time, increasing the number of personnel in order to reduce mental workload, using work clothes suitable for the season and type of work, and ergonomics training for workers are on the agenda of company officials. Water and sewage should be placed.

Poster 381: The Current NFL Schedule is not a Risk Factor for Musculoskeletal Injuries; Epidemiology of NFL Injuries From 2017-2022

Objectives: The National Football League, among the most popular team sports in the United States, carries an injury incidence that is higher than that of other collision sports, such as rugby and ice hockey. Considerable research has been undertaken to investigate the etiology of injuries in the NFL and has identified numerous risk factors on the level of individual games, including playing surface and gameday weather conditions; additionally, one study has found that concussion risk is not affected by scheduling variation, such as overseas games and bye week timing. However, there is currently no data that reports the effects of scheduling variation over the course of a season on musculoskeletal injury incidence. The purpose of this retrospective study was to describe the relationship between scheduling factors and injury rates among professional athletes in the NFL. It was hypothesized that higher cumulative travel distance, playing overseas games, an early season bye week, and an expansion of the regular season would be associated with higher injury rates. Methods: The current study was a descriptive epidemiological study that retrospectively reviewed all injuries that occurred in the five NFL seasons from the 2017-2018 season through the 2021-2022 season. Injury data and travel distances were extracted from publicly available sources and injury reports were cross-referenced to verify injury data. Injury rates were calculated per 1,000 athletic exposures (AEs). Results: In 1,216 regular season games in the five NFL seasons, 4,378 injuries were reported for an average injury rate per year of 34.42 injuries per 1,000 AEs. Cumulative team travel distance did not significantly predict injury rates (Figure 1). There was not a statistically significant difference in injury rates between NFL teams that did (19.3 per 1,000 AEs) versus did not play a game overseas (19.3 per 1,000 AEs) (Figure 2). There was not a statistically significant difference in injury rates or the number of players on the injured reserve list between the various bye weeks. There was not a statically significant difference in injury rates between the new 17-game regular season (18.4 per 1,000 AEs) versus the previous four 16-game regular seasons (19.7 per 1,000 AEs) (Figure 3). However, NFL teams that did not qualify for the playoffs had a significantly higher injury rate (19.9 per 1,000 AEs) versus teams that did qualify for the playoffs (18.4 per 1,000 AEs). Also, NFL teams that did not qualify for the playoffs had a significantly higher number of players on the injured reserve list (8.0 per 1,000 AEs) versus teams that qualified for the playoffs (6.8 per 1,000 AEs) (Figure 4). Conclusions: Over five NFL seasons, increased cumulative travel distance, playing a game overseas, and having an early season bye week were not associated with increased injury rates in professional football players. The addition of one regular season game, from 16 to 17 during the 2020 season, was not associated with an increased injury rate. However, not qualifying for post-season play was associated with an increased injury rate and an increase in the number of players on injured reserve. Overall, the analysis suggests that the analyzed parameters in the current NFL schedule were not risk factors for musculoskeletal injuries over the last five seasons; however, lack of regular season success may be associated with higher injury rates and more players on injured reserve.

Effects of Jumping Phase, Leading Limb, and Arena Surface Type on Forelimb Hoof Movement.

During the stance phase of equine locomotion, ground reaction forces are exerted on the hoof, leading first to rapid deceleration ("braking") and later to acceleration ("propulsion") as the hoof leaves the ground. Excessive hoof deceleration has been identified as a risk factor for musculoskeletal injury and may be influenced by arena surface properties. Therefore, our objective was to evaluate the effect of arena surface type (dirt, synthetic) on hoof translation of the leading and trailing forelimbs during jump takeoff and landing. Solar hoof angle, displacement, velocity, and deceleration were captured using kinematic markers and high-speed video for four horses jumping over a 1.1 m oxer at 12 different arenas (5 dirt, 7 synthetic). Surface vertical impact and horizontal shear properties were measured simultaneously. The effects of surface type (dirt, synthetic), jump phase (takeoff, landing), and limb (leading, trailing) on hoof movement were assessed using ANOVA (p < 0.05), while the relationships of hoof movement with surface mechanical properties were examined with correlation. Slide time (p = 0.032), horizontal velocity of the hoof (p < 0.001), and deceleration (p < 0.001) were greater in the leading limb, suggesting a higher risk of injury to the leading limb when braking. However, surface type and jump phase did not significantly affect deceleration during braking.

Proof of Concept Testing of Safe Patient Handling Intervention Using Wearable Sensor Technology

Background: Healthcare workers make up one of the occupations in the United States that experience the most musculoskeletal injuries. These injuries are often related to the movement and repositioning of patients. Despite previous injury prevention attempts, injury rates remain at an unsustainable level. The purpose of this proof-of-concept study is to provide preliminary testing of the impact of a lifting intervention on common biomechanical risk factors for injury during high-risk patient movements.; Methods: A before-and-after (quasi-experimental) design was utilized to compare biomechanical risk factors before and after a lifting intervention. Kinematic data were collected using the Xsens motion capture system, while muscle activations were collected with the Delsys Trigno EMG system. Results: Improvements were noted in the lever arm distance, trunk velocity, and muscle activations during the movements following the intervention; Conclusions: The contextual lifting intervention shows a positive impact on the biomechanical risk factors for musculoskeletal injury among healthcare workers without increasing the biomechanical risk. A larger, prospective study is needed to determine the intervention’s ability to reduce injuries among healthcare workers.

Reactive postural responses predict risk for acute musculoskeletal injury in collegiate athletes.

Examine if objective assessments of reactive postural responses, quantified using wearable inertial measurement units, are associated with the risk for acute lower extremity musculoskeletal injuries in collegiate athletes. Prospective survival analysis. 191 Division I National Collegiate Athletic Association athletes completed an instrumented version of a modified Push and Release (I-mP&R) test at the beginning of their competitive season. The I-mP&R was performed with eyes closed under single- and dual-task (concurrent cognitive task) conditions. Inertial measurement units recorded acceleration and angular velocity data that was used to calculate time-to-stability. Acute lower extremity musculoskeletal injuries were tracked from first team activity for six months. Cox proportional hazard models were used to determine if longer times to stability were associated with faster time to injury. Longer time-to-stability was associated with increased risk of injury; every 250 ms increase in dual-task median time-to-stability was associated with a 36% increased risk of acute, lower-extremity musculoskeletal injury. Tests of reactive balance, particularly under dual-task conditions, may be able to identify athletes most at risk of acute lower extremity musculoskeletal injury. Clinically-feasible, instrumented tests of reactive should be considered in assessments for prediction and mitigation of musculoskeletal injury in collegiate athletes.

Impact of a 5-Week Individualised Training Program on Physical Performance and Measures Associated with Musculoskeletal Injury Risk in Army Personnel: A Pilot Study

To examine the feasibility and effect of an individualised and force-plate guided training program on physical performance and musculoskeletal injury risk factors in army personnel. Pre-post, randomised control. Fourteen male and five female Australian Army soldiers were randomised into two groups and performed 5-weeks of physical training. The control group (n = 9) completed standard, group-designed, physical training whilst the experimental group (n = 8) completed an individualised training program. Physical (push-ups, multi-stage fitness test, three repetition maximum (3RM) for squat, strict press, deadlift and floor press), occupational (weight-loaded march time), and technological assessments (two-leg and one-leg countermovement jumps (CMJ), one-leg balance, one-arm plank) were conducted prior to and following the training period. Comparisons between groups and changes within groups were conducted via Mann-Whitney U tests. Compared to the control group, the experimental group exhibited a significantly smaller improvement for weight-loaded march time (-0.7% ± 4.0% vs. -5.1% ± 3.0%, p = 0.03) and a greater improvement for deadlift-3RM (20.6% ± 11.9% vs. 8.4% ± 6.8%, p = 0.056). All other outcomes were similar between groups. Visually favourable alterations in the two-leg CMJ profile with no reports of injuries were noted for the experimental group. Individualised physical training was feasible within an army setting and, for the most part, produced similar physical, occupational and technological performances to that of standard, group-designed physical training. These preliminary results provide a foundation for future research to expand upon and clarify the benefits of individualised training programs on long-term physical performance and injury risk/incidence in active combat army personnel.

Body asymmetries as risk factors for musculoskeletal injuries in dancesport, hip-hop and ballet dancers?

The study aimed to determine the incidence and expression of body asymmetries in dancers of three different dance styles: dancesport (n = 14), hip-hop (n = 21) and ballet (n = 20) and to examine how body asymmetries (muscle strength and power, stability and range of motion) are associated with musculoskeletal injuries occurring over the past 12 months. Cross-sectional and retrospective study. Maximal isometric voluntary contraction was measured for trunk, hip, knee and ankle movements. Participants performed a single leg stance, unilateral landing, weight bearing symmetry, squat and countermovement jump on force platforms. Passive range of motion was measured for hip, knee and ankle with two-arm goniometer or digital inclinometer (hip flexion, extension and rotations). A retrospective questionnaire was used to collect data on musculoskeletal injuries occurring in the last 12 months. Different dance styles were associated with different body asymmetries, including strength asymmetries (hip flexion and external rotation), agonist/antagonist asymmetries (trunk flexion/extension, hip abduction/adduction, ankle dorsi/plantar flexion) and hip adduction and internal rotation range of motion asymmetries. Moreover, strength asymmetries of hip flexion, adduction and abduction/adduction as well as stability asymmetries were associated with the total number of musculoskeletal injuries. The incidence of body asymmetries (> 10%) in dancesport, hip-hop and ballet dancers was confirmed, as well as the association of some asymmetries with self-reported injuries occurring over the last 12 months. The cause-effect relationship should be clarified by further studies.

No Association Between Processing Speed and Risk of Sport-Related Concussion in Youth Soccer.

To determine whether slow processing speed is associated with risk of sport-related concussion. We conducted a retrospective cohort study using computerized neurocognitive assessments (Immediate Post-concussion Assessment and Cognitive Testing [ImPACT]) from the Massachusetts Concussion Management Coalition. Slow processing speed was defined as 2 SD below the sample mean (n = 131) and fast processing speed as 2 SD above the sample mean (n = 259). We used a binary logistic regression model to determine the odds of sustaining a concussion with our main predictor being processing speed (high or low) adjusted for the effects of age, sex, and prior number of concussions. Massachusetts Concussion Management Coalition, Institutional care. Three hundred ninety junior high soccer players ages 10 to 15 with a baseline score for ImPACT. Processing Speed. Risk of sustaining a concussion. Those with slow processing speed had a visual motor composite score of ≤19.92, those with fast-processing speed had a score of ≥46.20. Athletes with slow processing speed were younger (13 vs 14 years; P < 0.001) and more likely to be male (57% vs 49%; P = 0.014). After adjusting for the effects of age, sex, and prior concussions, there was no significant difference in the odds of sustaining a concussion between groups (aOR 1.01; 95% CI, 0.99-1.04). Despite previous research showing that slow processing speed is a risk factor for musculoskeletal injuries during sports, our study suggests that processing speed is not associated with the risk of sustaining a concussion among junior high school soccer players.

Incidence and risk factors for musculoskeletal injury in female soccer athletes: systematic review.

Incidence and risk factors for musculoskeletal injury in female soccer athletes: systematic review.

Incidence and Risk Factors for Musculoskeletal Injuries among Indonesian Junior Badminton Athletes during a National Elite Championship

Objective. This study aimed to investigate the incidence and risk factors for musculoskeletal injuries among junior badminton athletes during a national championship.&#x0D; Methods. A retrospective cohort study was conducted among 128 junior badminton athletes who were members of one Indonesian badminton club and participated in the National Premier Circuit held in June 2019 in West Java, Indonesia. Data on demographic characteristics, history of previous and current injuries, physical examination, diagnosis (type, anatomical structure involved, and location), and treatment of injuries were collected along with data on the format of the game (single, double, or combination), and the number of matches for each respective athlete. Measures of injury frequency used were the incidence proportion and clinical incidence. Determinant factors for incidence were investigated.&#x0D; Results. Twenty-four injury events involving 23 athletes were recorded, with an incidence proportion of 23/128 athletes (18%) and a clinical incidence of 24/128 athletes or 18.8 per 100 athletes. Acute injuries were more frequent (13/24, 54.2%) than chronic/overuse injuries. More than half (14/24, 58.3%) of the injuries occurred in the lower extremities. Factors that increased the risk of injury were age ≥ 15 years (relative risk [RR] = 6.26, 95% confidence interval [CI] 1.96, 20.04, p &lt; 0.001), and the number of matches ≥ 3 (RR = 3.79, 95% CI 1.61, 8.92, p = 0.001).&#x0D; Conclusion. Musculoskeletal injuries occurred frequently among Indonesian junior badminton athletes during the national elite championship. An effective injury-prevention program specific to young athletes should be developed to maintain their future participation and performance in competition.

Lifting capacity prediction model using physical performance measures among construction workers

Manual materials handling is performed in many workplaces and is a significant risk factor for musculoskeletal injuries. The identification of lifting capacity is important to reduce the occurrence of musculoskeletal injuries. Lifting capacity is difficult to evaluate at the workplace. Therefore, there is a need to develop an alternate method that is easy and could be performed at the workplace. The study aimed to develop a lifting capacity prediction model for construction workers based on muscle strength and endurance. In this study, 65 construction workers were recruited; their socio-demographic and physical characteristics like core strength and endurance, grip strength, and lower limb flexibility were assessed. The lifting capacity was assessed using progressive isoinertial lifting evaluation. Stepwise multiple linear regression was carried out to develop the prediction model. The study suggested that age, BMI, grip strength, flexibility, prone plank, and trunk lateral flexor endurance tests have significantly influenced lifting capacity. Hence prediction model is developed using these variables. The regression model developed would help in easy estimation of lifting capacity among construction workers, which could be even administered with minimal skills by site supervisors or managers. It might help in the decision-making during pre-placement or return to work evaluations, thereby minimizing the incidence of low back disorders.

Mobile phone usage among Nigerians: Risk factors for musculoskeletal injuries and preventive strategies.

The increase in the usage of hand-held devices (HHDs) and smartphones (SPs), especially in Nigeria has resulted in an upsurge of musculoskeletal complaints. The aim of this study was to determine the incidence and risk factors for musculoskeletal injuries due to mobile phone usage among Nigerians and the preventive strategies. This study involved 630 male and female participants above 18 years old who were purposively recruited across designated study centres in public places. The instrument used was a questionnaire specifically designed to suit the Nigerian culture and environment and developed from previously validated questionnaires. Data were exported to Statistical Computing Programming R version 4.0.5 for analysis and Chi-square was used to compare the characteristics of those who experienced injury using SPs/HHDS and those who did not. Independent variables with a 95% confidence level and P < 0.05 in the multivariate model were considered statistically significant. The most common daily use of SPs/HHDS by the participants was phone calls (98.4%) followed closely by social networking (96.0%) while the occupation and educational level of the participants had statistically significant (P < 0.05) impact on musculoskeletal injuries. The type of mobile device and the time spent using these devices were also significant (P < 0.05) risk factors for injuries. Some self-treatment strategies adopted by the participants were all significantly (P < 0.05) associated with reduction of musculoskeletal discomfort. The occupation, educational level, the types of mobile devices and time spent using the devices were risk factors for musculoskeletal injuries.

Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model

BackgroundMusculoskeletal 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.MethodsA 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.ResultsIn 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.ConclusionsThis 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.

Survival Analysis of Training Methodologies and Other Risk Factors for Musculoskeletal Injury in 2-Year-Old Thoroughbred Racehorses in Queensland, Australia.

Musculoskeletal injuries remain a global problem for the Thoroughbred racing industry and there is conflicting evidence regarding the effect of age on the incidence of injuries. The ideal time to commence race training is strongly debated, with limited supporting literature. There is also conflicting evidence regarding the effect of high-speed exercise on musculoskeletal injuries. There is a strong interest in developing training and management strategies to reduce the frequency of injuries. The types of musculoskeletal injuries vary between 2-year-old and older horses, with dorsal metacarpal disease the most common injury in 2-year-old horses. It is likely that risk factors for injury in 2-year-old horses are different than those for older horses. It is also likely that the risk factors may vary between types of injury. This study aimed to determine the risk factors for musculoskeletal injuries and dorsal metacarpal disease. We report the findings of a large scale, prospective observational study of 2-year-old horses in Queensland, Australia. Data were collected weekly for 56-weeks, from 26 trainers, involving 535 2-year-old Thoroughbred racehorses, 1, 258 training preparations and 7, 512-weeks of exercise data. A causal approach was used to develop our statistical models, to build on the existing literature surrounding injury risk, by incorporating the previously established causal links into our analyses. Where previous data were not available, industry experts were consulted. Survival analyses were performed using Cox proportional hazards or Weibull regression models. Analysis of musculoskeletal injuries overall revealed the hazard was reduced with increased exposure to high-speed exercise [Hazard ratio (HR) 0.89, 95% Confidence Interval (CI) 0.84, 0.94, p < 0.001], increased number of training preparations (HR 0.58, 95% CI 0.50, 0.67, p < 0.001), increased rest before the training preparation (HR 0.89, 95% CI 0.83, 0.96, p = 0.003) and increased dam parity (HR 0.86, 95% CI 0.77, 0.97, p = 0.01). The hazard of injury was increased with increasing age that training commenced (HR 1.13, 95% CI 1.06, 1.19, p < 0.001). Analyses were then repeated with the outcome of interest dorsal metacarpal disease. Factors that were protective against dorsal metacarpal disease and musculoskeletal injuries overall included: increased total cumulative distance (HR 0.89, 95% CI 0.82, 0.97, p = 0.001) and total cumulative days exercised as a gallop (HR 0.96, 95% CI 0.92, 0.99, p = 0.03), the number of the training preparations (HR 0.43, 95% CI 0.30, 0.61, p < 0.001). The age that training commenced was harmful for both dorsal metacarpal disease (HR 1.17, 95% CI 1.07, 1.28, p < 0.001 and overall musculoskeletal injuries.). The use of non-ridden training modalities was protective for dorsal metacarpal disease (HR 0.89, 95% CI 0.81, 0.97, p = 0.008), but not musculoskeletal injuries overall. The male sex increased the hazard of DMD compared to females (HR 2.58, 95% CI 1.20, 5.56, p = 0.02), but not MSI overall. In summary, the hazard of musculoskeletal injury is greatest for 2-year-old horses that are born from uniparous mares, commence training at a later age, are in their first training preparation, have undertaken little high-speed exercise or had limited rest before their training preparation. The hazard of dorsal metacarpal disease is greatest for 2-year-old horses that are males, commence training at a later age, are in their first training preparation, have undertaken little high-speed exercise or had limited use of non-ridden training modalities. Close monitoring of these high-risk horses during their training program could substantially reduce the impact of MSI. Furthermore, an understanding of how training methodologies affect the hazard of MSI facilitates modification of training programs to mitigate the risk impact of injury. The strengths of this study include a large sample size, a well-defined study protocol and direct trainer interviews. The main limitation is the inherent susceptibility to survival bias.

Postural Differences between Expert Laparoscopic and Naïve Surgeons: Implications for Ergonomic Assessment in Surgical Education

<h3>Study Objective</h3> Poor ergonomics can contribute to musculoskeletal disorders and chronic pain for many surgeons which threatens career longevity. This proof-of-concept study sought to quantify upper body postural differences in expert laparoscopic surgeons and naïve surgeons using 3D motion capture during a standardized simulated surgical task. <h3>Design</h3> Observational case-control. <h3>Setting</h3> Motion capture laboratory; Surgical simulation setting. <h3>Patients or Participants</h3> Expert laparoscopic surgeons (n=6) and naïve surgeons (n=9). <h3>Interventions</h3> All participants watched an instructional video prior to data collection and completed the Fundamentals of Laparoscopic Surgery (FLS) peg transfer task three times. The box trainer's height and distance were adjusted to the participants' preference. A 3D motion capture system recorded trajectories of retroreflective markers placed on the participants at various anatomical landmarks. <h3>Measurements and Main Results</h3> Outcome variables of neck, shoulder, elbow, wrist, and trunk angles were computed using a 3D kinematic model. The mean (X) and variance (2 standard deviations from the mean (2SD)) were extracted for each trial and then averaged across trials. Independent T-tests evaluated significant between group differences in body positions in all three planes of motion at the p<0.05 level. Compared to experts, naïve surgeons exhibited significantly greater variation in lateral neck (2SD=5.43±2.35° vs. 3.91±1.72°, p=0.029) and sagittal trunk motion (2SD=3.84±2.57° vs. 1.91±0.91°, p=0.018). Naïve surgeons also performed the task with their elbows significantly more flexed than the expert surgeons (Dominant Arm=96.9±9.2° vs. 82.9±2.1°, p=0.002; Non-Dominant Arm=94.7±8.9° vs. 86.2±8.4°, p=0.043). <h3>Conclusion</h3> Musculoskeletal injury risk factors among laparoscopic surgeons include awkward body posture, static muscle loading, and long operating times. This study demonstrates postural differences of the neck, trunk, and arms between expert and naïve surgeons. Incorporating ergonomic awareness and knowledge into surgical education may help to reduce surgeons' risk of developing cumulative musculoskeletal disorders and enhance surgeon career longevity.

Musculoskeletal Injuries Among Females in the Military: A Scoping Review.

Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews-Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.

Risk factors for musculoskeletal injuries in military personnel: a systematic review with meta-analysis.

To investigate the risk factors for musculoskeletal injuries in military personnel. A systematic literature search was carried out in August 2019 and updated in July 2020 without language or time filters. The inclusion criteria were prospective studies that investigated the risk factors for injuries in military personnel. Only risk factors analyzed by at least ten studies were selected for the meta-analysis. For data analysis, the RevMan5.3 program was used to compare the number of participants with injuries between high- or low-risk groups. The measurement of dichotomous variables was one of the selected parameters for the analysis, as well as the Mantel-Haenszel statistical method, random-effects model, and analysis with a relative risk (RR) and 95% confidence interval for the included studies. A total of 2,629 studies were identified through databases. Thirty-four studies met the inclusion criteria. The groups considered at risk were the oldest [RR = 1.22; (95% CI 1.06-1.41)], with overweight or obesity [RR = 1.27; (95% CI 1.08-1, 48)], with previous injuries [RR = 1.15; (95% CI 1.01-1.30)], and with the worst performance in running tests of 1,600-3,200m [RR = 1.87; (95% CI 1.28-2.71)]. Gender, ethnicity, and smoking were not associated with injuries. However, a subgroup analysis showed that among studies with a follow-up of fewer than 12months, women presented RR = 2.44 (95% CI 1.65-3.60) more likely to develop injuries. Age, overweight or obesity, previous injuries, and performance in the 1600-3200m run are associated with an increased risk of injury in the military.