Prevention of Lower Extremity Musculoskeletal Injuries in Tactical and First Responder Populations: A Systematic Review and Meta-Analysis of Randomized Trials From 1955 to 2020.
Journal
Journal of strength and conditioning research
ISSN: 1533-4287
Titre abrégé: J Strength Cond Res
Pays: United States
ID NLM: 9415084
Informations de publication
Date de publication:
01 01 2023
01 01 2023
Historique:
pubmed:
27
8
2022
medline:
17
12
2022
entrez:
26
8
2022
Statut:
ppublish
Résumé
Sinnott, AM, Krajewski, KT, LaGoy, AD, Beckner, ME, Proessl, F, Canino, MC, Nindl, BC, Turner, RL, Lovalekar, MT, Connaboy, C, and Flanagan, SD. Prevention of lower extremity musculoskeletal injuries in tactical and first responder populations: A systematic review and meta-analysis of randomized trials from 1955 to 2020. J Strength Cond Res 37(1): 239-252, 2023-Lower extremity musculoskeletal injuries (LEMSIs) impose a significant burden on tactical and first responder populations. To determine the effectiveness of LEMSI prevention strategies, we performed a systematic review and meta-analysis of randomized controlled trials published in English from 1955 to 2020 (PROSPERO: CRD42018081799). MEDLINE, EMBASE, Cochrane, CINAHL, ProQuest, and DTIC databases were searched for trials that assigned military service members, police, firefighters, or paramedics to LEMSI prevention interventions with a minimum surveillance period of 12 weeks. Evidence was synthesized as odds ratios (OR) for LEMSI occurrence between individuals assigned to interventions and those assigned to standard activities. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0. Random-effects meta-analyses were conducted for (a) physical training and (b) footwear modifications to reduce LEMSI and (c) footwear modifications to reduce stress fractures specifically. Certainty in the body of evidence was determined with the GRADE approach. Of 28,499 records, 18 trials comprised of more than 11,000 subjects were synthesized. Interventions included physical training (8, N = 6,838), footwear modifications (8, N = 3,792), nutritional supplementation (1, N = 324), and training modifications (1, N = 350). Overall risk of bias was generally moderate ( N = 7 of 18) or high ( N = 9 of 18). Physical training (OR = 0.87, 95% CI [0.71, 1.08], p = 0.22, I 2 = 58.4%) and footwear modification (OR = 1.13, 95% CI [0.85, 1.49], p = 0.42, I 2 = 0.0%) did not reduce LEMSI or stress fractures (OR = 0.76, 95% CI [0.45, 1.28], p = 0.30, I 2 = 70.7%). Our results indicate that there is weak evidence to support current LEMSI prevention strategies. Future efforts will benefit from longer surveillance periods, assessment of women and nonmilitary populations, improved methodological rigor, and a greater breadth of approaches.
Identifiants
pubmed: 36026481
doi: 10.1519/JSC.0000000000004293
pii: 00124278-202301000-00035
doi:
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
239-252Informations de copyright
Copyright © 2022 National Strength and Conditioning Association.
Références
Anderson MK, Grier T, Canham-Chervak M, Bushman TT, Jones BH. Physical training, smoking, and injury during deployment: A comparison of men and women in the US army. US Army Med Dep J: 42–48, 2015.
Arslan IG, Dijksma I, van Etten-Jamaludin FS, Lucas C, Stuiver MM. Nonexercise interventions for prevention of musculoskeletal injuries in armed forces: A systematic review and meta-analysis. Am J Prev Med 60: e73–e84, 2021.
Arya S, Schwartz TA, Ghaferi AA. Practical guide to meta-analysis. JAMA Surg 155: 430–431, 2020.
Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ 328: 1490‐1494, 2004.
Baxter ML, Baycroft C, Baxter GD. Lower limb injuries in soldiers: Feasibility of reduction through implementation of a novel orthotic screening protocol. Mil Med 176: 291–296, 2011.
Bedno S, Hauret K, Loringer K, et al. Effects of personal and occupational stress on injuries in a young, physically active population: A survey of military personnel. Mil Med 179: 1311–1318, 2014.
Bender JA, Pierson JK, Kaplan HM, Johnson AJ. Factors affecting the occurrence of knee injuries. J Assoc Phys Ment Rehabil 18: 130–134, 1964.
Brown KL, Seale KB, El Khoury LY, et al. Polymorphisms within the COL5A1 gene and regulators of the extracellular matrix modify the risk of Achilles tendon pathology in a British case-control study. J Sports Sci 35: 1475–1483, 2017.
Brushoj C, Larsen K, Albrecht B E, et al. Prevention of overuse injuries by a concurrent exercise program in subjects exposed to an increase in training load: A randomized controlled trial of 1020 army recruits. Am J Sports Med 36: 663–670, 2008.
Bullock SH, Jones BH, Gilchrist J, Marshall SW. Prevention of physical training-related injuries recommendations for the military and other active populations based on expedited systematic reviews. Am J Prev Med 38(1 suppl): S156-81.
Carow SD, Haniuk EM, Cameron KL, et al. Risk of lower extremity injury in a military cadet population after a supervised injury-prevention program. J Athl Train 51: 905–918, 2016.
Childs JD, Teyhen DS, Casey PR, et al. Effects of traditional sit-up training versus core stabilization exercises on short-term musculoskeletal injuries in US army soldiers: A cluster randomized trial. Phys Ther 90: 1404–1412, 2010.
Cotterill S, Knowles S, Martindale AM, et al. Getting messier with TIDieR: Embracing context and complexity in intervention reporting. BMC Med Res Methodol 18: 1‐10, 2018.
Cowan DN, Jones BH, Robinson JR. Foot morphologic characteristics and risk of exercise-related injury. Arch Fam Med 2: 773–777, 1993.
Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for systematic reviews of interventions. Cochrane Database Syst Rev 10: 1‐2, 2019.
Cuthbert M, Ripley N, McMahon JJ, et al. The effect of Nordic hamstring exercise intervention volume on eccentric strength and muscle architecture adaptations: A systematic review and meta-analyses. Sports Med 50: 83–99, 2020.
Dijksma I, Arslan IG, van Etten-Jamaludin FS, et al. Exercise programs to reduce the risk of musculoskeletal injuries in military personnel: A systematic review and meta-analysis. PM R 12: 1028–1037, 2020.
Eldridge S, Campbell M, Campbell M, et al. Revised cochrane risk of bias tool for randomized trials (RoB 2.0): Additional considerations for cluster-randomized trials. Cochrane Methods Cochrane Database Syst Rev 10: 1‐17, 2016.
Eldridge S, Campbell M, Campbell M, et al. Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2.0): Additional Considerations for Cluster-Randomized Trials, 2016.
Emery CA, Roy TO, Whittaker JL, Nettel-Aguirre A, van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: A systematic review and meta-analysis. Br J Sports Med 49: 865–870, 2015.
Fanchini M, Steendahl IB, Impellizzeri FM, et al. Exercise-based strategies to prevent muscle injury in elite footballers: A systematic review and best evidence synthesis. Sports Med 360, 2020.
Finestone A, Giladi M, Elad H, et al. Prevention of stress fractures using custom biomechanical shoe orthoses. Clin Orthopaedics Related Res: 182–190, 1999.
Finestone A, Shlamkovitch N, Eldad A, Karp A, Milgrom C. A prospective study of the effect of the appropriateness of foot-shoe fit and training shoe type on the incidence of overuse injuries among infantry recruits. Mil Med 157: 489–490, 1992.
Finestone A, Novack V, Farfel A, et al. A prospective study of the effect of foot orthoses composition and fabrication on comfort and the incidence of overuse injuries. Foot Ankle Int 25: 462–466, 2004.
Flanagan SD, Sinnott AM, Krajewski KT, et al. Prevention of exertional lower body musculoskeletal injury in tactical populations: Protocol for a systematic review and planned meta-analysis of prospective studies from 1955 to 2018. Syst Reviews 7: 1–8, 2018.
Fonseca H, Moreira-Goncalves D, Coriolano HJ, Duarte JA. Bone quality: The determinants of bone strength and fragility. Sports Med 44: 37–53, 2014.
Frost D, Beach TA, Crosby I, McGill SM. The cost and distribution of firefighter injuries in a larger Canadian Fire Department. Work 55: 497–504, 2016.
Gardner LI Jr, Dziados JE, Jones BH, et al. Prevention of lower extremity stress fractures: A controlled trial of a shock absorbent insole. Am J Public Health 78: 1563–1567, 1988.
Goodall RL, Pope RP, Coyle JA, Neumayer R. Balance and agility training does not always decrease lower limb injury risks: A cluster-randomised controlled trial. Int J Inj Contr Saf Promot 20: 271–281, 2013.
Gray S, Collie A. The nature and burden of occupational injury among first responder occupations: A retrospective co-hort study in Australian workers. Injury 48: 2470–2477, 2017.
Grier TL, Knapik JJ, Swedler D, Jones BH. Footwear in the United States army band: Injury incidence and risk factors associated with foot pain. Foot 21: 60–65, 2011.
Grimm PD, Mauntel TC, Potter BK. Combat and noncombat musculoskeletal injuries in the US military. Sports Med Arthrosc Rev 27: 84–91, 2019.
Gwet K. Computing inter-rater reliability and its variance in the presence of high agreement. BR J Math Stat Psychol 61: 29–48, 2008.
Gwet K. Agreement coefficients for nominal ratings: A review. In: Handbook of Inter-rater Reliability. Gaithersburgh, MD: Advanced Analytics, LLC, 2014. pp. 27‐69
Hartig DE, Henderson JM. Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees. Am J Sports Med 27: 173–176, 1999.
Hauschild VD, Lee T, Barnes S, et al. The etiology of injuries in US army initial entry training. US Army Med Dep J 2: 22–29, 2018.
Higgins J, Savović J, Page M, Sterne J. Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2.0). London-UK: British Medical Association, 2016.
Higgins JPA D, Curtin F, Li T, Senn S. Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2.0): Additional Considerations for Cross-Over Trials, 2016.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 327: 557–560, 2003.
Hilyer JC, Brown KC, Sirles AT, Peoples, and L. A flexibility intervention to reduce the incidence and severity of joint injuries among municipal firefighters. J Occup Med 32: 631–637, 1990.
Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. BMJ 348: 1–12, 2014.
Hoffmann TC, Oxman AD, Ioannidis JP, et al. Enhancing the usability of systematic reviews by improving the consideration and description of interventions. BMJ 358: 1‐8, 2017.
Jensen A, Laird M, Jameson JT, Kelly KR. Prevalence of musculoskeletal injuries sustained during marine corps recruit trianing. Mil Med 184: 511–520, 2019.
Jones BH, Canham-Chervak M, Canada S, Mitchener TA, Moore S. Medical surveillance of injuries in the u.s. Military descriptive epidemiology and recommendations for improvement. Am J Prev Med 38: S42–S60, 2010.
Kim SK, Roos TR, Roos AK, et al. Genome-wide association screens for Achilles tendon and ACL tears and tendinopathy. PLoS One 12: 1‐16, 2017.
Knapik JJ, Trone DW, Swedler DI, et al. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med 38: 1759–1767, 2010.
Knapik J, Graham B, Cobbs J, et al. A prospective investigation of injury incidence and injury risk factors among Army recruits in military police training. BMC Musculoskelet Disord 14: 1–11, 2013.
Landis J, Koch GG. The measurement of observer agreement for categorical data. Biometrics 33: 159–174, 1977.
Larsen K, Weidich F, Leboeuf YC. Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts. J Manipulative Physiol Ther 25: 326–331, 2002.
Lentz L, Voaklander D, Gross DP, Guptill CA, Senthilselvan A. A description of musculoskeletal injuries in a Canadian police service. Int J Occup Med Environ Health 33: 1–8, 2019.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine 6: 1‐28, 2009.
Lovalekar M, Keenan KA, Beals K, et al. Incidence and pattern of musculoskeletal injuries among women and men during marine corps training in sex-integrated units. J Sci Med Sport 19: S1440–S2440, 2020.
Lovalekar M, Perlsweig KA, Keenan KA, et al. Epidemiology of musculoskeletal injuries sustained by naval special forces operators and students. J Sci Med Sport 6: 932‐936, 2017.
Lyons K, Radburn C, Orr R, Pope R. A profile of injuries sustained by law enforcement officers: A critical review. Int J Environ Res Public Health 14: 1‐21, 2017.
Mattila VM, Sillanpaa PJ, Salo T, et al. Can orthotic insoles prevent lower limb overuse injuries? A randomized-controlled trial of 228 subjects. Scand J Med Sci Sports 21: 804–808, 2011.
Milgrom C, Finestone A, Novack V, et al. The effect of prophylactic treatment with risedronate on stress fracture incidence among infantry recruits. Bone 35: 418–424, 2004.
Milgrom C, Finestone A, Shlamkovitch N, et al. Prevention of overuse injuries of the foot by improved shoe shock attenuation. A randomized prospective study. Clin Orthop Relat Res 281: 189–192, 1992.
Milgrom C, Giladi M, Kashtan H, et al. A prospective study of the effect of a schock-absorbing orthotic device on the incidence of stress fractures in military recruits. Foot and Ankle 6: 101–104, 1985.
Minozzi S, Cinquini M, Gianola S, Gonzalez-Lorenzo M, Banzi R. The revised cochrane risk of bias tool for randomized trials (RoB 2) showed low interrater reliability and challenges in its application. J Clinical Epidemiol 126: 37–44, 2020.
Molloy JM, Pendergrass TL, Lee IE, et al. Musculoskeletal injuries and United States army readiness Part I: Overview of injuries and their strategic impact. Mil Med: 1–11, 2020.
Molloy JM, Pendergrass TL, Lee IE, Hauret KG, Chervak MC, Rhon DI. Musculoskeletal injuries and United States army readiness. Part II: Management challenges and risk mitigation initiatives. Mil Med: 1–9, 2020.
Myer GD, Sugimoto D, Thomas S, Hewett TE. The influence of age on the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: A meta-analysis. Am J Sports Med 41: 203–215, 2012.
Naval Health Research Center San Diego CA). (U) injury reduction effectiveness of assigning running shoes based on plantar shape. In: Marine Corps Basic Training. (Vol 13): SAGE publications, United Kingdom.
Nindl BC, Eagle SR, Frykman PN, et al. Functional physical training improves women's military occupational performance. J Sci Med Sport 20(Suppl 4): S91–S97, 2017.
Nindl BC, Williams TJ, Deuster PA, Butler NL, Jones BH. Strategies for optimizing military physical readiness and preventing musculoskeletal injuries in the 21st century. US Army Med Dep J: 5–23, 2013.
Nyman JS, Granke M, Singleton RC, Pharr GM. Tissue-level mechanical properties of bone contributing to fracture risk. Curr Osteoporos Rep 14: 138–150, 2016.
Orr R, Simas V, Canetti E, Schram B. A profile of injuries sustained by firefighters: A critical review. Int J Environ Res Public Health 16: 1–20, 2019.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 372: 1‐9, 2021.
Page MJ, McKenzie JE, Higgins JPT. Tools for assessing risk of reporting biases in studies and syntheses of studies: A systematic review. BMJ Open 8: 1‐16, 2018.
Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ 372: 1‐36, 2021.
Parkkari J, Taanila H, Suni J, et al. Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: A population-based, randomised study. BMC Med 9: 1‐12, 2011.
Peck KY, DiStefano LJ, Marshall SW, et al. Effect of a lower extremity preventive training program on physical performance scores in military recruits. J Strength Cond Res 31: 3146‐3157, 2017.
Pihlajamäki H, Parviainen M, Kyröläinen H, Kautiainen H, Kiviranta I. Regular physical exercise before entering military service may protect young adult men from fatigue fractures. BMC Musculoskelet Disord 20: 1‐7, 2019.
Pope R, Herbert R, Kirwan J. Effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in Army recruits. Aust J Physiother 44: 165–172, 1998.
Pope RP, Herbert RD, Kirwan JD, Graham BJ. A randomized trial of preexercise stretching for prevention of lower-limb injury. Med Sci Sports Exerc 32: 271–277, 2000.
Poplin GS, Harris RB, Pollack KM, Peate WF, Burgess JL. Beyond the fireground: Injuries in the fire service. Inj Prev 18: 228–233, 2012.
Reynolds KL, White JS, Knapik JJ, Witt CE, Amoroso PJ. Injuries and risk factors in a 100-mile (161-km) infantry road march. Prev Med 28: 167–173, 1999.
Rudzki and SJ. Injuries in Australian Army recruits. Part I: Decreased incidence and severity of injury seen with reduced running distance. Mil Med 162: 472–476, 1997.
Rudzki SJ. Injuries in Australian Army recruits. Part II: Location and cause of injuries seen in recruits. Mil Med 162: 477–480, 1997.
Sarla G. Stress fracture in military recruits: A one year study. Eurasian J Med Invest 2, 2018.
Scott A, Backman LJ, Speed C. Tendinopathy: Update on pathophysiology. J Orthop Sports Phys Ther 45: 833–841, 2015.
Sell TC, Abt JP, Crawford K, et al. Warrior model for human performance and injury prevention: Eagle tactical athlete program (ETAP) Part I. J Spec Oper Med 10: 2–21, 2010.
Sell TC, Abt JP, Nagai T, et al. The eagle tactical athlete program reduces musculoskeletal injuries in the 101st airborne division (air assault). Mil Med 181: 250–257, 2016.
Sharma J. The Development and Evaluation of a Management Plan for Musculoskeletal Injuries in British Army Recruits: A Series of Exploratory Trials on Medial Tibial Stress Syndrome. Middlesbrough, England: Teesside University, 2013.
Simkin A, Leichter I, Giladi M, Stein M, Milgrom C. Combined effect of foot arch structure and an orthotic device on stress fractures. Foot Ankle 10: 25–29, 1989.
Steinberg N, Bar-Sela S, Moran U, et al. Injury prevention exercises for reduced incidence of injuries in combat soldiers. J Strength Cond Res 35, 2021.
Steinberg N, Dar G, Dunlop M, Gaida JE. The relationship of hip muscle performance to leg, ankle and foot injuries: A systematic review. Phys Sportsmed 45: 49–63, 2017.
Suyama J, Rittenberger JC, Patterson PD, Hostler D. Comparison of public safety provider injury rates. Prehosp Emerg Care 13: 451–455, 2009.
Szubert Z, Sobala W. Work-related injuries among firefighters: Sites and circumstances of their occurrence. Int J Occup Med Environ Health 15: 49–55, 2002.
Taanila H, Suni JH, Kannus P, et al. Risk factors of acute and overuse musculoskeletal injuries among young conscripts: A population-based cohort study. BMC Musculoskelet Disord 16: 1‐19, 2015.
Taylor JB, Ford KR, Nguyen A-D, Terry LN, Hegedus EJ. Prevention of lower extremity injuries in basketball: A systematic review and meta-analysis. Sports Health 7: 392–398, 2015.
Varley I, Hughes DC, Greeves JP, et al. The association of novel polymorphisms with stress fracture injury in Elite Athletes: Further insights from the SFEA cohort. J Sci Med Sport 21, 2017.
Wardle SL, Greeves JP. Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel. J Sci Med Sport 20(Suppl 4): S3–S10, 2017.
Watrous JR, McCabe CT, Dougherty AL, et al. Long-term outcomes of service women injured on combat deployment. Int J Environ Res Public Health 18: 1‐14, 2020.
Wood AM, Hales R, Keenan A, et al. Incidence and time to return to training for stress fractures during military basic training. J Sports Med 2014: 1‐6, 2014.
Yamato T, Maher C, Saragiotto B, et al. The TIDieR checklist will benefit the physical therapy profession. J Orthop Sports Phys Ther 46: 402–404, 2016.