Risk of Lower Extremity Injury in a Military Cadet Population After a Supervised Injury-Prevention Program

Abstract

Context: Specific movement patterns have been identified as possible risk factors for noncontact lower extremity injuries. The Dynamic Integrated Movement Enhancement (DIME) was developed to modify these movement patterns to decrease injury risk.Objective: To determine if the DIME is effective for preventing lower extremity injuries in US Military Academy (USMA) cadets.Design: Cluster-randomized controlled trial. Setting: Cadet Basic Training at USMA. Patients or Other Participants: Participants were 1313 cadets (1070 men, 243 women).Intervention(s): Participants were cluster randomized to 3 groups. The active warm-up (AWU) group performed standard Army warm-up exercises. The DIME groups were assigned to a DIME cadre-supervised (DCS) group or a DIME expertsupervised (DES) group; the former consisted of cadet supervision and the latter combined cadet and health professional supervision. Groups performed exercises 3 times weekly for 6 weeks.Main Outcome Measure(s): Cumulative risk of lower extremity injury was the primary outcome. We gathered data during Cadet Basic Training and for 9 months during the subsequent academic year. Risk ratios and 95% confidence intervals (CIs) were calculated to compare groups.Results: No differences were seen between the AWU and the combined DIME (DCS and DES) groups during Cadet Basic Training or the academic year. During the academic year, lower extremity injury risk in the DES group decreased 41% (relative risk [RR] ¼ 0.59; 95% CI ¼ 0.38, 0.93; P ¼ .02) compared with the DCS group; a nonsignificant 25% (RR ¼ 0.75; 95% CI ¼ 0.49, 1.14; P ¼ .18) decrease occurred in the DES group compared with the AWU group. Finally, there was a nonsignificant 27% (RR ¼ 1.27; 95% CI ¼ 0.90, 1.78; P ¼ .17) increase in injury risk during the academic year in the DCS group compared with the AWU group.Conclusions: We observed no differences in lower extremity injury risk between the AWU and combined DIME groups. However, the magnitude and direction of the risk ratios in the DES group compared with the AWU group, although not statistically significant, indicate that professional supervision may be a factor in the success of injury-prevention programs.

Exercise Programs to Reduce the Risk of Musculoskeletal Injuries in Military Personnel: A Systematic Review and Meta‐Analysis

“…Most studies involved only male participants, but four studies also included female participants (ranging from 10% to 40% female). [38][39][40][41] Two studies did not report on gender. 42,43 Study details are presented in detail in online Appendix C.…”

“…One trial 38 explored the effects of a dynamic integrated movement enhancement warm-up, compared to an active warm-up, before engaging in sports or other intense physical training on the incidence of lower extremity injuries. This study found no difference between the groups (RR = 1.02, 95% CI 0.85-1.22).…”

Benefits and Barriers Associated with Intention to Participate in Injury Prevention Programs in ROTC Cadets

“…There was a signi cant association between the attitudes subscale, comprised of questions related to barriers and bene ts of participation, and intention to participate (15). There are multiple bene ts to participating in ERIPPs within military personnel including reduction in the risk of lower extremity injury (24) and improvements in functional performance (11,25).…”

Osteoarthritis and the Tactical Athlete: A Systematic Review

“…Emerging evidence suggests that injury-prevention programs targeting high-risk biomechanical movement patterns may be effective in the primary prevention of acute traumatic knee-joint injury, 50,51 and these programs may be applicable to military training populations. 52 Information on effective acute traumatic injury-prevention strategies for other joints is currently limited in the literature.…”