Author: Mokhtar

Financial impact of embedded injury prevention experts in US Army initial entry training

Daniel R. Clifton, D. Alan Nelson, Y. Sammy Choi, Daniel Edgeworth, Donald Shell, Patricia A. Deuster. J Athl train 2022; doi: https://doi.org/10.4085/1062-6050-0353.22

Full text freely available

Take home message

By using athletic trainers and certified strength and conditioning specialists in initial entry-level training for the Army, the Army saved at least three times the cost of contracting these professionals, saving $11 to 20 million annually.

Background

More than 1 in 4 men and women suffer a musculoskeletal injury during initial training for the US military. The U.S. Army began deploying teams of athletic trainers and strength and conditioning specialists in 2010 to address the problem of early-career musculoskeletal discharges. The military could demonstrate the need for these teams if we knew how much money they saved by preventing injuries and treating them quickly.

Study objectives

The author’s purpose was to assess whether built-in injury prevention experts were associated with reduced training costs for soldiers discharged early from service.

Methods

The authors conducted a retrospective analysis of 198,166 active-duty soldiers who began training from January 2014 through May 2017. Soldiers who began training at two locations between April 2015 and November 2015 did not have athletic trainers and strength and conditioning specialists on hand. on site due to a lapse in contracts. The authors categorized these soldiers as not coming into contact with injury prevention experts. All other soldiers were categorized as having been exposed to injury prevention experts. The authors estimate soldier training costs based on average basic and advanced training costs from 2014-2017 for an average of six months of training. To be eligible for discharge from active duty, the discharge had to occur within six months of the start of training and due to a musculoskeletal condition.

Results

A total of 14,094 soldiers had no contact with injury prevention experts. 2.8% of these soldiers were discharged early due to musculoskeletal injuries. Of the 184,072 soldiers exposed to injury prevention experts, 1.0% were discharged early due to musculoskeletal injuries. The authors calculated that the injury prevention experts saved the Army $11 to $20 million per year in lost training costs due to early career discharges (net of contract costs for the experts).

Viewpoints

At a relatively small financial cost (approximately $900,000 per location or $4 million total), the Army reduced the likelihood of early discharge by ~64%. There were also significant savings on lost training costs due to early career medical layoffs. We should also keep in mind that these costs do not include other long-term savings. For example, preventing injuries or treating an injury promptly can reduce the risk of medical discharge later in a person’s life due to chronic pain (e.g., osteoarthritis) or save healthcare costs associated with chronic pain or functional limitations. Furthermore, while the costs help justify hiring these experts, we cannot ignore the other benefits that may accrue, including improved soldier quality of life and function and improved military readiness.

Clinical implications

Clinicians and administrators can use this data to advocate for athletic trainers and strength and conditioning specialists in the military and possibly industrial or performing arts fields to demonstrate a 3 to 5x return on investment.

Written by Mitchell Barnhart
Reviewed by Jeffrey Driban

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Most military service members don’t have to worry about CTE

CTE became national news in the United States in 2007, but it was not until 2016 that the National Institute of Neurological Disorders and Stroke/National Institute of Biomedical Imaging and Bioengineering (NINDS-NIBIB) criteria for the neuropathological diagnosis of CTE were published. and they were refined in 2021. Rare, isolated case studies that reported abnormal findings or used unaccepted diagnostic criteria have been disproportionately emphasized to cast doubt on the link between RHI and CTE.

In a review article in the magazine Acta NeuropathologicaAnn McKee, MD, chief of neuropathology at VA Boston Healthcare System and director of the BU CTE Center, emphasizes that more than 600 CTE cases have now been published in the literature from multiple international research groups. And of the more than 600 cases, 97 percent have confirmed exposure to RHI, mainly through contact and collision sports. CTE has been diagnosed in amateur and professional athletes, including athletes from American, Canadian and Australian football, rugby union, rugby league, soccer, ice hockey, bull riding, wrestling, mixed martial arts and boxing.

Additionally, the study authors revealed that in 82 percent (14 of 17) of alleged CTE cases that occurred without RHI, using current criteria, families were never asked what sports the deceased played.

According to the researchers, despite global efforts to find CTE in the absence of contact sports participation or exposure to RHI, it appears to be exceedingly rare, if it exists at all. “In community brain bank studies, CTE was seen in 0 to 3 percent of cases, and where information is available, positive cases were exposed to brain injury or RHI. In contrast, CTE is the most common diagnosis of neurodegenerative diseases in contact and collision athletes in brain banks around the world. A strong dose-response relationship is perhaps the strongest evidence that RHI causes CTE in athletes,” she added.

“The review presents the timeline for the development of neuropathological criteria for the diagnosis of CTE, begun nearly 100 years ago by pathologist Harrison Martland, who introduced the term ‘punch-drunk’ to describe a neurological condition in low-cost carriers, ” explains McKee. author of the study. The review chronologically describes the multiple studies conducted by independent, international groups examining diverse populations that have found CTE pathology from various sources in individuals with a history of RHI.”

CTE is characterized by a distinctive molecular structural configuration of p-tau fibrils that is different from the changes seen in aging, Alzheimer’s disease, or any other disease caused by tau protein.

Funding for this study was provided by the National Institute of Neurological Disorders and Stroke (U54NS115266; R01NS119651; U01 NS 086659), National Institute on Aging (P30AG13846; U19AG06875; R01AG062348; RF1AG057902; K01AG070326), Department of Veterans Affairs (10 1 BX002466, 101BX004613, BX004349), the Nick and Lynn Buoniconti Foundation, Andlinger Foundation, National Football League (NFL) and World Wrestling Entertainment (WWE) through unrestricted gifts, the Mac Parkman Foundation and the National Operating Committee on Safety for Sports Equipment (NOCSEA).

Effects of cold water immersion compared to other recovery modalities on athletic performance after acute strenuous exercise in physically active participants: a systematic review, meta-analysis and meta-regression.

Moore E, Fuller JT, Bellenger CR, Saunders S, Halson SL, Broatch JR, Buckley JD. Sports Med. December 17, 2022. doi: 10.1007/s40279-022-01800-1. E-publishing prior to printing. PMID: 36527593.

Full text freely available

Take home message

During post-exercise recovery, cold water immersion (CWI) provides similar benefits to other recovery methods, including active recovery.

Background

Cold water immersion (CWI) is one of several methods intended to speed recovery after training and competition. However, it is unclear whether CWI performs better than other commonly used recovery modalities.

Study aim

The researchers conducted a systematic review and meta-analysis to compare CWI with other modalities regarding athletes’ perceptions, physiological changes, and exercise performance outcomes.

Methods

The authors identified 28 articles through a comprehensive literature search for articles that met specific criteria: (1) peer-reviewed randomized controlled trials, (2) included physically active participants, (3) used CWI after acute physical activity, (4) included a other recovery intervention, and (5) outcomes include recovery of exercise performance, muscle strength, or physiological or perceptual markers of recovery. They excluded articles if participants received CWI in combination with another intervention or if participants completed more than one exercise session. The authors extracted data from the included articles: publication information, study methodology, participant information, CWI protocol, comparator recovery protocol, and assessment measures. They then assessed the quality of each study using the SIGN Checklist for Randomized Clinical Trials. During analyses, the authors examined follow-up assessments at 1, 24, 48, and 72 hours after treatment. Alternative treatments typically include active recovery, massage, contrast water therapy, warm water immersion, and cryotherapy.

Results

Overall, the quality of the included studies was low, with only one considered ‘high quality’ and 24 ‘acceptable quality’. Compared to other recovery methods, the authors found that CWI generally had limited or no effect on the perception of recovery and recovery from 1) delayed-onset muscle soreness, 2) strength performance, 3) strength, 4) flexibility, or 5) physiological problems. markers of muscle damage. Water temperature and treatment duration were not related to the outcomes after KWI.

Viewpoints

Cold water immersion is comparable to other recovery modalities, if not slightly better. The exception, however, was aerial cryotherapy, which may outperform CWI, but future studies need to confirm this. Ultimately, CWI is more clinically accessible than air cryotherapy and should be acceptable because it is comparable to other recovery methods. In fact, there was virtually no difference between active recovery and CWI, providing a more practical and easily accessible recovery method for recreationally active people and those without access to CWI. It would have been interesting to know if the results for CWI differed if the person did partial or full body immersion.

Clinical implications

Clinicians should be aware that CWI provides no or minimal improvement in recovery compared to alternative recovery methods. They need to communicate these findings to patients so they can make informed treatment decisions about whether to perform CWI, air cryotherapy, or active recovery.

Questions for discussion

Under what circumstances do you, as a doctor, prefer CWI over other recovery methods? What feedback have you received from your patients?

Written by Kyle Harris
Reviewed by Jeffrey Driban

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“While I understand the excitement, we must consider how to prevent injuries as athletes adopt this new footwear,” said lead author Adam Tenforde, MD, physician in Mass General Brigham’s Sports Medicine program and medical director of the Spaulding National Running Center. “We hope this current opinion will help better recognize potential medical problems associated with CFP shoes, the appropriate use of this new technology, and how to develop methods to use these shoes safely.”

In their publication, Tenforde and colleagues describe five patient cases, including junior elite track and field athletes in Europe and two athletes in their mid-30s who participated in endurance sports events in North America. All five experienced foot pain after wearing shoes with carbon fiber plates and were later diagnosed with navicular stress injury (BSI).

“Recognizing possible associations with navicular disease in runners with vague metatarsal or ankle pain wearing CFP shoes may be important to identify this high-risk injury,” the authors write.

Who doesn’t respond to warm-up programs for injury prevention? A secondary analysis of pilot data from neuromuscular training programs in youth basketball, football, and physical education.

Anu M. Raisänen, Jean-Michel Galarneau, Carla Van Den Berg, Paul Eliason, Lauren C. Benson, Oluwatoyosi BA Owoeye, Kati Pasanen, Brent Hagel and Carolyn A. Emery. Journal of orthopedic and sports physiotherapy 0 0:0, 1-28

Full article available for free

Take home message

Although neuromuscular training warm-up programs for injury prevention are effective in reducing one’s risk of injury, not everyone reaps the same benefits. Women and youth with a history of injury in the previous year are more likely to not respond to these programs.

Background

Preventive neuromuscular training programs can effectively reduce an active person’s risk of injury. However, these programs can be more effective if they are tailored to a person’s physical capabilities and characteristics.

Study aim

Räisänen and colleagues conducted a secondary analysis of data from young active individuals (11–18 years old) who performed a neuromuscular training warm-up program during one of four previous clinical trials. They examined whether differences in adherence were associated with non-response to the program (injury) and which factors were associated with non-response.

Methods

The authors used data collected across four studies (1793 participants), including high school basketball (18-week intervention), community football (20 weeks), and two separate high school physical education studies (12-14 weeks). The authors examined age, gender, body mass index (BMI), height, weight, lower limb dominance and balance. They also monitored participants throughout the season for injuries, number of warm-up sessions completed, number of weeks of warm-up completed, and sports participation or exposure. The warm-up programs all lasted 15 minutes and were tailored to the sport or class. All warm-ups include an aerobic and balance component. However, basketball included static and dynamic stretches, while the other two used only dynamic stretches. In addition, the soccer and gym classes included various strengthening exercises, and soccer was the only warm-up that included agility.

Results

The authors found that women and participants with a history of injury in the previous 12 months were more likely to fail to respond to a neuromuscular training warm-up. Furthermore, greater weekly compliance with warm-up reduced the risk of injury, only in football.

Viewpoints

Fifteen-minute neuromuscular training warm-up programs reduce the risk of injury in organized sports activities and general physical education courses. Consistent with existing literature, the authors demonstrated the importance of adherence (performing the program more times per week) in reducing the risk of injury in football players. However, adherence may be less relevant in high school physical education and basketball classes. The authors also found that women and people with a previous injury were more likely to be non-responders than men and people without a previous injury, respectively. We should avoid suggesting that women or people with a history of injury won’t benefit from these programs, because they could – just less so than their peers. Instead, we must find ways to optimize these programs for these populations. We should also note that the authors examined all injuries, not just lower extremity injuries, as these programs are typically designed. So it is possible that a ‘non-responder’ in the study was a ‘lower extremity responder’ if he or she had suffered an upper extremity or other injury.

Clinical implications

Clinicians should encourage the use of neuromuscular training programs and consider how these can be better tailored to women or those with a history of injury.

Questions for discussion

Would an ‘a la carte’ approach work for those identified as high risk? This means that a general warm-up can be created with a few additional movements added specifically to the participants and considered high risk?

Written by Shelly Fetchen DiCesaro
Reviewed by Jeffrey Driban

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“We found that high non-contact real-time heart rate is associated with poor performance,” Lu and Zhong said in an interview. “This suggests that even the best professional athletes are negatively affected by psychological stress, even though they are generally well trained to deal with pressure.”

Olympic archery includes several types of individual and team-based competitions, but for this study, Lu and Zhong focused on individual competitions within the gender for which heart rate data was available. During these competitions, the heartbeats of 122 male and female archers were broadcast as they completed 2,247 shots. The World Archery Federation, in collaboration with Panasonic, measured athletes’ heart rates using high frame rate cameras designed to detect skin reflection and can determine a person’s heart rate 96% as accurately as a pulse oximeter or electrocardiogram.

During each competition, individual archers shot a certain number of arrows at a target, with a time limit of 20 seconds for each shot. Archers could earn a maximum of 10 points for a perfect bull’s-eye, with the number of points decreasing the further an arrow landed from the center of the target.

Lu and Zhong found that athletes whose heart rates were higher before taking a shot consistently scored lower on those shots. Although the age and gender of the archers did not appear to significantly influence the relationship between stress and performance, a number of factors related to the nature of the competition did.

Higher heart rates are more likely to reduce the performance of lower-ranked archers and of any archers who shot second in a match or who had a lower score than their opponent at that point in the match. There was also a stronger relationship between stress and performance closer to the end of each competition, possibly due to the increase in pressure as athletes progressed through the competition, the authors wrote.

“Elite athletes typically receive training to cope with psychological stress, but our results suggest that they are still subject to the influence of psychological stress,” Lu and Zhong wrote.

This study not only provides evidence for the link between stress and real-world performance, but also shows that heart rate captured by high frame rate cameras can serve as a reliable source of biometric data, Lu and Zhong said. in situations such as the COVID-19 pandemic where researchers and participants may not be able to meet in person.

“This method could become increasingly important in diverse settings ranging from sports and business to mental health and medicine,” the researchers wrote. “In this regard, our study can be seen as a proof of concept by showing that non-contact real-time heart rate induced psychological stress.”

In future work, this technology could be used to observe how psychological stress affects athletic performance in different sports, Lu and Zhong said. The researchers also want to further investigate how contactless real-time heart rate can be incorporated into behavioral studies in laboratory and field settings.