t velasco, n reilly, c hulsopple, k roberts, s wise, d goss, j leggit

Abstract accepted for poster presentation at the ATAMMC Research Symposium 2025.

Background and Purpose: Chronic exertional compartment syndrome (CECS) is a debilitating condition for soldiers marked by lower-limb pain, paresthesia, and weakness1,2. While the gold standard treatment has long been fasciotomy, anecdotal data shows mixed results and limited predictive success following the procedure3,4. Alternative approaches to treating CECS have included pharmaceutical interventions (i.e., Botulinum toxin, BoTN-A)5,6 and structured gait retraining to ameliorate movement patterns7. However, the incorporation of a combination of non-surgical interventions for CECS has not been extensively studied in military personnel. Thus, the purpose of this case study was to evaluate a multimodal combination of treatment approaches for CECS in a soldier to identify an efficacious way to address running parameters and reduce pain to improve function.  

Case Description: A 27-year old female Soldier diagnosed with bilateral anterior and lateral lower leg CECS was recruited to participate in a larger cohort study.  She received saline injections and supervised gait retraining, including strengthening and flexibility exercises. The participant had their running gait assessed using pressure-sensitive insoles (LoadSol, Novel USA, St. Paul, MN) at the initial treatment, after 8-weeks, 3-months, and 6-months. Time points of 12- and 24-months running assessments were not collected as she moved out of network. Between the 3- and 6-months visit, the participant elected to cross-over treatment therapies and received BoTN-A. Clinical metrics included numeric pain rating scale (NPRS), the Single Assessment Numerical Evaluation (SANE) and University of Wisconsin Running Index (UWRI), as well as the Global Rating of Change scale (GROC). These metrics were obtained up to 24 months post initial injection.

Outcomes: From baseline to the 3-month mark, the participant showed improvement on clinical metrics including a 90.9% increase in UWRI and a GROC of 5. These metrics are accompanied by a 22.5% increase in cadence and a 10.2% decrease in peak ground reaction force (GRF). Notably, the patient still reported an NPRS of 5/10 (7/10 baseline) with running at 3-months. Following the BoTN-A injections, the participant at 6-months displayed a 17.9% decrease in average vertical loading rate (AVLR) and a 2.0% decrease in peak GRF. Clinically, she displayed improvements in UWRI of 47.6%, SANE of 20.0%, and a GROC of 6, along with NPRS of 0/10 with running. At 12-months, NPRS remained at 0/10 with running, but UWRI and GROC scores slightly decreased, likely from her reported knee injury. At 24-months, the participant reported no pain with running and perfect SANE, UWRI, and GROC scores.

Discussion: This case study demonstrates gait retraining can be beneficial for improving pain and function in soldiers with lower leg CECS.  The addition of BoTN-A injections in this case suggests it may be a useful supplemental modality in rehabilitation for long-term benefits for CECS patients. However, further research is needed to confirm these findings in a larger population.

k Foster, s wang-price, l brizzolara, m weber, r boeth, x yuan, d rhon

Abstract accepted for platform presentation at the 2025 Combined Sections Meeting- American Physical Therapy Association

Exercise is a treatment recommended in clinical practice guidelines for low back pain (LBP). The primary purpose was to determine the impact of receiving therapeutic exercise (TE) for the management of LBP on time-to-occurrence of subsequent lower extremity (LE) injury within 1 year, in beneVciaries of the Military Health System (MHS). The secondary purpose was to examine the dosing impact (number of TE sessions) on time-to-occurrence of subsequent LE injury in beneVciaries who received TE.

Participants were placed into one of two groups: those receiving TE or those not receiving TE. Cox proportional hazards regression models were used to examine the utilization of TE and the number of TE sessions along with the demographic factors of interest on the time-to-occurrence of subsequent hip, knee, and ankle injury, respectively.

There were 452,668 patients in this cohort (mean age (SD) = 35.5(12.3), 65.2% male, 62.8% active duty; 80.6% of active duty enlisted). Only 16.5% of patients received TE, but each additional TE visit signiVcantly decreased subsequent LE injury risk. In addition, several demographic factors signiVcantly increased the risk of subsequent hip, knee, or ankle/foot injury including age, being on active duty, receiving the initial diagnosis in the emergency room (ER) or urgent care (UC), and being in the Army, whereas other factors such as being in the Navy or Coast Guard, or being an ohcer signiVcantly reduced the risk of LE injury in the year following an initial LBP diagnosis.

Following LBP diagnosis, individuals who did not receive TE had an increased risk of subsequent LE injury in the year following the episode of LBP. Further, in individuals who did receive TE, the risk of subsequent LE injury signiVcantly decreased with each additional session. The results of the study highlight the potential downstream impact and health implications of LBP, as well as information to guide to treatment and return to duty decisions after LBP.

E Anies, r Waltz, S lacey

A 49-year-old man presented with repeated episodes of right posterior knee effusions 11 months following right knee medial meniscus debridement. He was referred to Physical Medicine & Rehabilitation (PM&R) by his orthopaedic surgeon for further non-operative management. He had previously undergone ipsilateral vein stripping procedures with vascular surgery 5 months following his meniscal procedure. MRI of the knee with contrast along with a subsequent ultrasound evaluation with no evident power doppler flow confirmed the presence of a right posterior-medial gastrocnemius fluid collection extending extramuscularly into the proximal 1/3rd of the medial head of the gastrocnemius muscle. These imaging findings combined with the yellow-clear aspirate consistent with synovial fluid confirmed the presence of a Baker’s cyst with unusually distal extramuscular extension and subcutaneous location just superficial to the medial head of the gastrocnemius muscle. Successful implementation of platelet rich plasma (PRP) and Doxycycline tissue sclerosis emphasised the key role that nonoperative modalities have in treating Baker’s cysts. The patient continues to respond appropriately with resolution of his symptoms noted 3 weeks after his initial sclerotherapy session and an additional treatment performed with half the initial dose of doxycycline. This case demonstrates the successful treatment of a baker’s cyst with an unusually distal location.

Anies E P, Waltz R A, Lacey S (January 15, 2025) A Baker’s Cyst with Distal Extramuscular Extension: A Case Report. Cureus 17(1): e77502. doi:10.7759/cureus.77502

a weart, l brown, e florkiewics, g fresinger, k east, n reilly, j song, d goss

Background: Running biomechanics have been linked to the development of running-related injuries in recreational and military runners.

Purpose/Hypothesis: The purpose of this study was to determine if personal characteristics or running biomechanical variables are associated with running-related injury incidence or time to injury in military cadets undergoing training. It was hypothesized that a rearfoot strike pattern, greater rate of impact, or a lower step rate would be related to a greater running-related injury incidence and a decreased time to injury.

Study Design: Cohort study; Level of evidence, 2.

Methods: Military cadets wore an on-shoe wearable sensor that analyzed biomechanical variables of foot strike pattern, rate of impact, running pace, step rate, step length, and contact time during cadet basic training (60 days). Running-related injuries during cadet basic training were determined by medical record review. Personal and running variables between the injured and uninjured cadets were compared using independent t tests and chi-square analyses. Time to injury and hazard ratios (HRs) were estimated using Kaplan-Meier survival curves and Cox proportional hazard regression models, respectively.

Results: Of the 674 cadets who completed the study, 11% sustained a running-related injury. A significantly greater proportion of the injured participants were female (χ2 = 7.95; P = .005) and had a prior history of injury (χ2 = 7.36; P = .007). Univariate Cox proportional hazard regression models revealed greater injury risk in females (HR, 1.96; 95% CI, 1.22-3.16; P = .005) and cadets with a prior injury history (HR, 1.86; 95% CI, 1.18-2.93; P = .008). After adjusting Cox models for prior injury, females were found to be at a 1.89 times (95% CI, 1.17-3.04; P = .009) greater risk of injury. Running biomechanical variables were not associated with injury risk.

Conclusion: Study results indicated that non-modifiable risk factors such as female sex and prior injury history increased the risk of running-related injury in cadets undergoing military training. Running biomechanical variables measured by the wearable sensor were not associated with injury in this study.

Weart A., Brown L., Florkiewicz E., Freisinger G., East K., Reilly N., Song J., Goss D. (2025) Using Wearable Sensor Technology to Analyze Running Technique and Prospective Running-Related Injuries During United States Military Cadet Basic Training. Orthopaedic Journal of Sports Medicine. https://doi: 10.1177/23259671241309273

e metzger, n hager, r ory, w lucio, l wagner, b isaacson, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

Photobiomodulation therapy (PBMT) involves applying non- ionizing forms of  light from various sources including lasers, light-emitting diodes (LEDs), and broadband light, in  the visible and near infrared spectrum, to biologically modulate cellular activity to enhance  healing. PBMT can enhance repair and regeneration of tissue, stimulate metabolism, and reduce  inflammation and pain during injury recovery. This program investigates the use of PBMT to treat musculoskeletal injury (MSKI) and enhance performance and recovery in United States  (US) military Service Members (SMs).

We conducted five clinical trials and one observational study at US military  installations to assess the application PBMT for MSKIs and performance and recovery.  Currently, 344 participants have enrolled. Data included objective measures and self-reports. 

When applied for plantar fasciitis (PF) and Achilles tendinopathy (AT), there were  improvements in self-reports across the injuries and treatment groups [vs. Sham for PF, and vs.  Standard of Care, extracorporeal shockwave therapy (SWT), PBMT alone, and in combination  with SWT for AT] in the Foot Functionality Captured via Foot and Ankle Ability Measure  (FAAM), Defense and Veteran Pain Rating Scale (DVPRS),Victorian Institute of Sport  Assessment-Achilles (VISA-A), University of Wisconsin Running Injury and Recovery Index  (UWRI), and Lower Extremity Functional Scale (LEFS). Objective ultrasound measures also  trended towards improvement. Further results for treating bone stress injury, general  wellness/recovery, and planned projects for performance will be available at the time of the  conference.

n hughes, b cornell, r rossi, e metzger, n hager, g gabler, l wagner, b isaacson, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

Special Operations Forces (SOF) train continually to maintain peak performance,  thus, are always in a state of recovery. Photobiomodulation therapy (PBMT) is a noninvasive  low-level laser treatment to enhance healing, recovery, and performance. Studies have shown  performance and recovery benefits with focal applications of PBMT. While less evidence exists  for psychological effects of systemic PBMT applications, self-reported fatigue was found to be  lower with focal PBMT compared with placebo. Further, PBMT research in elite warfighters is  limited. The Army Tactical Human Optimization Rapid Rehabilitation and Reconditioning  (THOR3) provides a consistent setting for strength and cardiovascular training, conditioning,  nutritional and behavioral health monitoring and is an optimal setting to assess the effect of  PBMT on performance and behavioral measures. We aim to study the physiologic and  behavioral effects of PBMT, post-exercise, on performance in SOF.

We will conduct a single-blind, randomized-control trial in healthy SOF operators, assigned to receive PBMT or sham-PBMT post- training. Treatment will be administered 3  times/week for 3 weeks to both quadriceps. Objective measures include body fat percentage,  height/weight, isokinetic/isometric leg strength, Oura ring sleep/activity data, and  countermovement jump. Subjective measures include demographics, Rating of Perceived  Exertion, Short Questionnaire of Fatigue, delayed muscle soreness scale, Defense Veterans Pain  Rating Scale, and activity logs.

PBMT shows promise in accelerating musculoskeletal repair, psychological  resilience, thereby reducing injury risk and enhancing overall performance. This study may  inform standards of training and care to maximize readiness among elite warfighting units.

R rossi, j schroeder, s grogan, n hager, e metzger, g gabler, j persinger, n karikari, s mckee, b isaacson, l wagner, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

Non-insertional Achilles Tendinopathy (AT) is a common overuse injury in athletes and United States military Service Members. Photobiomodulation therapy (PBMT)  delivers non-ionizing light to produce beneficial outcomes. Extracorporeal shockwave therapy  (SWT) delivers mechanical energy to the tendon and has been shown to be effective for AT. The  addition of PBMT to SWT is hypothesized to enhance these effects by increasing cellular  function and healing. Our primary aim was to evaluate PBMT, SWT, and Physical Therapy (PT)  on non-insertional AT.

Forty-five participants were randomized to: PT only, PBMT+PT, PBMT+SWT+PT, or SWT+PT. SWT treatment: 1x/week/3 weeks at 15hz for 3000 pulses. PBMT treatment: 2x/week/3 weeks at 10 J/cm2, 25W. Study duration was 6 months. Outcomes: activity logs,  pain/functional surveys, ultrasound tendon thickness measurements, and Range of Motion (ROM). 

At 3-months, all groups improved in Defense and Veterans Pain Rating Scale, Lower  Extremity Functional Scale, University of Wisconsin Running Injury and Recovery Index (PBMT+SWT+PT: + 7.1 units; p = 0.1), Patient-Reported Outcomes Measurement Information  System (6-week function scores: SWT+PT > PBMT+PT; p < .1), & Victorian Institute of Sport  Assessment-Achilles. PBMT+SWT+PT group had a Long Axis Maximal Circumference decrease of 3.1 mm (p = 0.1). Treatment with SWT increased Knee Flexed Passive Dorsiflexion  by 5.37° (p = .01). No significant intergroup differences in the above outcomes at 12-weeks (p > 0.1).

These results justify further investigation in the optimal dose/treatment frequency  of SWT+PBMT. Our findings can inform clinical treatment options for AT to optimize recovery  and return to activity.

l cin, j schroeder, c mincey, j persinger, n hager, r rossi, e metzger, c yimyam, l wagner, b isaacson, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

On average, two million patients receive treatment annually for Plantar Fasciitis  (PF) in the United States. Athletes and Active-Duty Service Members are more prone to PF from repetitive foot stresses and biomechanical predispositions (high arches, excessive pronation, etc.) Photobiomodulation therapy (PBMT) uses non-ionizing light forces to enhance performance,  alleviate pain/inflammation, promote healing and may be effective in treating PF. This study  assessed the clinical effectiveness of PBMT compared to sham-PBMT for PF in Active-Duty Service Members.

Blinded participants were randomized to receive PBMT or sham-PBMT 3x/week x3  weeks at 10 J/cm2, 25W output power using the LightForce XPi and home exercises x6 weeks.  Sham-PBMT participants could crossover after 6-weeks. Outcomes included Defense and  Veterans Pain Rating Scale (DVPRS), Foot Functionality Captured via Foot and Ankle Ability  Measure (FAAM), and ultrasound measured fascial thickness.

FAAM scores improved for the PBMT group (N = 33) at 6-weeks: -17.2 points (SD:16.1; p < .01); sham-PBMT group (N = 35): -11 points (SD:17.1; p = .08); no statistically  significant intergroup differences (p > .05). Both groups experienced median absolute change in  DVPRS scores at 6 weeks: -1.0 points; no significant intergroup differences (p > .05). 6-week  median absolute change in thickness: PBMT: -.01 mm; sham-PBMT: 0.3 mm.

Both groups met the threshold for a minimum clinically important difference on the FAAM (≥ 8-point decrease) and decreased DVPRS. The PBMT group experienced a small  PF thickness decrease. These findings indicate that PBMT may be an effective adjunctive  treatment for PF pain/function.

l. cin, s grogan, j persinger, j schroeder, n hager, r rossi, e metzger, c mincey, l wagner, b isaacson, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

Lower extremity injuries are common sources of disability and time loss for  athletes and military servicemembers. Microvascular flow (MVF) and shear wave elastography  (SWE) may be non-invasive, efficient, and cost effective in early diagnosis and treatment of  musculoskeletal injuries (MSKIs). This study aimed to establish normative values for routine  tendon echo-characteristics, presence/absence of plantaris tendon, MVF vs Power Doppler (PD),  and SWE measurements in the posterior lower leg and Achilles tendon.

Ultrasound was performed on asymptomatic participants using a Samsung RS-85  Prestige. Orthogonal measurements were obtained along the Achilles at the calcaneal insertion  (CI), avascular zone (AVZ), gastro-soleus junction (GSJ), medial gastrocnemius, and soleus.  Outcomes included: thickness/width 2D imaging measurements, vessel quantification in PD &  MVF, SWE analysis, plantaris tendon visualization, Body Mass Index (BMI), ankle Range of  Motion (ROM), and self-reports (demographics & activity).

MVF detected flow in 9 limbs vs 1 by PD (n = 106). Increased BMI resulted in  increased tendon/gastroc measurements: (p < .01); SWE [r(63) = 0.41] & AVZ SWE [r(63) =  .33]. Long-Axis median: GSJ height = 0.2 cm, CI = 0.4 cm, & AVZ height = 0.5 cm. Short-Axis  mean AVZ width: males = 1.5 cm (SD: 0.2), females = 1.4 cm (SD: 0.2). Plantaris tendons  identified in > 50% of study population (59 out of 106 limbs).

Our findings will inform the normal, routine, and novel ultrasound values for the  Achilles tendon complex and its related structures. This may help improve the diagnosis and  treatment of MSKIs.

r rossi, j persinger, n hager, s grogan

Abstract accepted for poster presentation at the 2025 Association for Medical Ultrasound Convention in Orlando, Florida.

The current study was initiated to help inform and validate a parallel study being conducted in the same clinical setting. This was done to elucidate the normative values for routine tendon echo-characteristics, presence/absence of plantaris tendon, microvascular flow (MVF), shear-wave elastography (SWE), Power Doppler (PD), & Young’s moduli in the posterior lower leg & Achilles tendon. Both the parallel study and the current one used the Samsung RS-85 Prestige ultrasound and TeleRay Remote for image review/remote exam observation. Additionally, an EZ Exam protocol was standardized across all users and image acquisition was done exclusively by RMSK-certified staff. Imaging was obtained from the gastroc-soleus complex to the Achilles insertion with stop points at the gastrocnemius, soleus, gastroc-soleus junction (GSJ), avascular zone (AVZ), and calcaneal insertion (CI). Our findings confirmed the sensitivity of MVF at detecting flow over PD. We were able to establish normative values for both SWE and in routine Achilles tendon architecture. Additionally, plantaris tendon prevalence in our study population was found to challenge current existing literature. These findings will inform the normal state of the Achilles tendon complex & its related structures with novel ultrasound values in order to improve the diagnosis and treatment progression of musculoskeletal injuries.

m Crowell, e florkiewicz, j morris, j mason, w pitt, t benedict, k cameron, d goss

Shoulder stabilization surgery is common among military personnel, causing severe acute postoperative pain that may contribute to the development of chronic pain, thereby reducing military readiness. Battlefield Acupuncture (BFA) has shown promise as a non-pharmaceutical intervention for acute postoperative pain. The purpose of this study was to determine the effectiveness of BFA combined with standard physical therapy on pain, self-reported mood, self-reported improvement, and medication use in patients after shoulder stabilization surgery.

The study design was a single-blind, randomized clinical trial, approved by the Naval Medical Center Portsmouth Institutional Review Board and registered with ClinicalTrials.gov (NCT04094246). Ninety-five participants were recruited after shoulder stabilization surgery. Participants were randomized via concealed allocation into a standard physical therapy (PT) group or a group receiving standard PT and BFA. Both groups received standard postoperative pain medication. The BFA intervention followed a standard protocol with the insertion of gold aiguille d’acupuncture emiermanente needles at 5 specific points in the ear. At 4 time points (baseline [24–48 hours], 72 hours, 1 week, and 4 weeks post-surgery), participants reported worst and average pain using a Visual Analog Scale (VAS), self-reported mood using the Profile of Mood States (POMS), self-recorded medication intake between study visits, and self-reported improvement in symptoms using a Global Rating of Change (GROC) Scale. Outcome assessors were blinded to treatment allocation. An alpha level of 0.05 was set a priori. For pain, a mixed-model analysis of variance was used to analyze the interaction effect between group and time. Differences in baseline data, total opioid usage, and pain change scores between groups were analyzed using independent t-tests.

Of the 95 participants enrolled, 7 failed to provide complete study visits after the baseline, leaving 88 patients (43 BFA, 45 control, mean age 21.8 (2.1) years, 23% female). There were no significant group-by-time interactions for VAS worst pain (F = 0.70, P = .54), VAS average pain (F = 0.99, P = .39), the POMS (F = 1.04, P = .37), or GROC (F = 0.43, P = 0.63). There was a significant main effect of time for VAS worst pain (F = 159.7, P < .001), VAS average pain (F = 122.4, P < .001), the POMS (F = 11.4, P < .001), and the GROC (F = 78.5, P < .001). While both groups demonstrated statistically significant and clinically meaningful improvements in pain and self-reported mood over time, BFA did not provide any additional benefit compared to standard physical therapy alone. There was no significant difference in opioid usage between groups at 4 weeks (t = 0.49, P = .63). Finally, both groups also demonstrated statistically significant and clinically meaningful self-reported improvements in function, but again, there was no additional benefit when adding BFA to standard physical therapy.

The results of this study do not support the effectiveness of BFA for postsurgical pain management as there were no significant differences in pain, self-reported mood, self-reported improvement, and medication use between participants who received BFA and those who did not. As this is the only known study of BFA in postsurgical participants, continued research is needed to determine if BFA is effective for pain reduction in that setting.

Michael S Crowell, Erin M Florkiewicz, Jamie B Morris, John S Mason, Will Pitt, Timothy Benedict, Kenneth L Cameron, Donald L Goss, Battlefield Acupuncture Does Not Provide Additional Improvement in Pain When Combined With Standard Physical Therapy After Shoulder Surgery: A Randomized Clinical Trial, Military Medicine, 2025;, usae577, https://doi.org/10.1093/milmed/usae577

d rhon, s de la motte, j fraser, t greenlee, b hando, j molloy, d teyhen, j tiede, j van wyngaarden, r westrick, g bullock

Musculoskeletal injuries enact a substantial burden in military settings, incurring high costs, long-term disability, and impacting military readiness. This has led to a prioritization of injury prevention programs. Understanding the challenges faced by those trying to implement these programs could help standardize and better inform future efforts. The purpose was to capture perceptions of barriers and facilitators to implementation of injury prevention programs in the US Armed Forces.

A cross-sectional survey with open-ended questions was circulated to relevant stakeholders; key themes were derived using conceptual content analysis. Four questions were asked concerning injury prevention programs: 1) barriers, 2) facilitators, 3) how can leadership best support, and 4) how can subject matter experts best collaborate to make these programs successful?

The survey reached at least 300 individuals working with the armed services worldwide; 91 completed the survey. The mean (SD) time working with military service members was 11.5 (8.2) years; 93 % worked with active-duty service members, 71.4 % were licensed healthcare providers, and 55 % worked in settings with established injury prevention programs. Only 45.2 % of participants believed an appropriate, clear way to measure program success currently exists. Nearly 85 % believed that lacking standardization of definitions and metrics hinders program assessment. Wide variability existed in opinions regarding who should be primarily responsible for promoting/supporting injury prevention efforts. Key themes included resources as both a facilitator (when present) and barrier (when absent), organizational culture, and leadership support. Leadership can best help by prioritizing the programs and valuing the programming through modeling the desired behavior. Program staff can collaborate by focusing on enabling change, integrating into organizational/unit culture and collaborating with leaders to change policy.

Daniel I. Rhon, Sarah J. de la Motte, John J. Fraser, Tina A. Greenlee, Benjamin R. Hando, Joseph M. Molloy, Deydre S. Teyhen, Jeffrey M. Tiede, Joshua J. Van Wyngaarden, Richard B. Westrick, Garrett S. Bullock. Perceived barriers and facilitators to implementation of injury prevention programs in the military: feedback from inside the trenches, Injury. 2024. 112029. ISSN 0020-1383, doi.org/10.1016/j.injury.2024.112029.

b hando, v pav, b isaacson, c colahan, w funk, x yuan

The U.S. Military Health System (MHS) transitioned to the ICD-10-CM coding scheme in October 2015 and began the phased rollout of a new electronic health record system, MHS GENESIS, in October 2017. Both changes have the potential to affect the observed prevalence and health care utilization associated with musculoskeletal injuries (MSKIs) in service members. The purpose of this article was to (1) determine the effect of the ICD-10-CM transition on the observed prevalence of select MSKI conditions and (2) describe MSKI-related health care utilization in four MTFs during the adoption of MHS GENESIS.

Ben Hando, Veronika Pav, Brad Isaacson, Courtney Colahan, Wendy Funk, Xiaoning Yuan, Musculoskeletal Injury Surveillance in the U.S. Military: Analysis of the ICD-10-CM Transition and Descriptive Report of Health Care Utilization at Four Sites Adopting MHS GENESIS, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 78–86, https://doi.org/10.1093/milmed/usad462

v pav, x yuan, b isaacson, w funk, b hando

Musculoskeletal injuries (MSKIs) represent the most common, costly, and impactful medical conditions affecting active duty service members (ADSMs) of the United States Armed Forces. Inconsistent, variable MSKI surveillance methods and often incompletely described criteria for cohort selection, injuries, incidence, and prevalence have limited efforts to observe longitudinal trends, identify gaps in care, or highlight specific military branches or sites that could benefit from enhanced MSKI intervention protocols. The purpose of this manuscript is to present a comprehensive, well-documented, and reproducible framework for capturing and categorizing MSKI burden, healthcare utilization, and private sector costs for ADSMs across a 12-year period spanning the International Classification of Diseases, 10th Revision, Clinical Modification transition.

Veronika Pav, Xiaoning Yuan, Brad Isaacson, Wendy Funk, Ben Hando, Capturing and Categorizing the Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A Comprehensive Methodology, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 70–77, https://doi.org/10.1093/milmed/usae245

b isaacson, b hando, p pav, l wagner, c colahan, p pasquina, x yuan

Lower Extremity musculoskeletal injuries (LE MSKIs) represent a significant portion of overuse injuries in active duty service members (ADSMs). However, variations in study methods and research gaps related to LE MSKIs have prevented Department of Defense (DoD) leaders from assessing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of LE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs.

Brad Isaacson, Ben Hando, Veronika Pav, Linzie Wagner, Courtney Colahan, Paul Pasquina, Xiaoning Yuan, Lower Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 56–69, https://doi.org/10.1093/milmed/usae046

x yuan, e stewart, c colahan, p pasquina, b isaacson, v pav

Low back pain and musculoskeletal injuries (MSKIs) of the Spine are the most common reason for U.S. active duty service members (ADSMs) to seek medical care. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Spine (thoracic, lumbar, sacral, and pelvic) MSKIs across the four major branches of service from Fiscal Years (FY) 2016 to 2021.

Xiaoning Yuan, Emma Stewart, Courtney Colahan, Paul Pasquina, Brad Isaacson, Veronika Pav, Ben Hando, Musculoskeletal Spine Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Healthcare Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 45–55, https://doi.org/10.1093/milmed/usae248

b isaacson, b hando, v pav, l wagner, c colahan, p pasquina, x yuan

Upper Extremity musculoskeletal injuries (UE MSKIs) represent a major threat to the overall health and readiness of U.S. active duty service members (U.S. ADSMs). However, a lack of prior research and inconsistent study and surveillance methodology has limited Department of Defense (DoD) leaders from assessing and addressing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of UE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs.

Brad Isaacson, Ben Hando, Veronika Pav, Linzie Wagner, Courtney Colahan, Paul Pasquina, Xiaoning Yuan, Upper Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 34–44, https://doi.org/10.1093/milmed/usae047

x yaun, e stewart, c colahan, p pasquina, b isaacson, v pav, b hando

Active duty service members (ADSMs) of the U.S. Armed Forces are uniquely at risk for musculoskeletal injuries (MSKIs) of the Head/Neck region, including the eye and face, from training with head gear, donning Kevlar, operating aircraft, and maintaining sitting or standing postures for prolonged durations. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Head/Neck MSKIs across the Services from fiscal years (FYs) 2016 to 2021.

Xiaoning Yuan, Emma Stewart, Courtney Colahan, Paul Pasquina, Brad Isaacson, Veronika Pav, Ben Hando, Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 22–33, https://doi.org/10.1093/milmed/usae045

c colahan, v pav, x yuan, b isaacson, l wagner, b hando

Musculoskeletal injuries (MSKIs) represent the most substantial and enduring threat to U.S. military readiness. Previous studies have focused on narrow surveillance periods, single branches of service, and used variable approaches for MSKI identification and classification. Therefore, the goals of this retrospective population study were to report the incidence, prevalence, and types of MSKIs sustained by active duty service members (ADSMs) across four Services in direct care (DC) and private sector care (PC) settings over fiscal years (FYs) 2010–2021, and to quantify and describe associated health care utilization and PC costs over the same period.

Courtney Colahan, Veronika Pav, Xiaoning Yuan, Brad Isaacson, Linzie Wagner, Ben Hando, Musculoskeletal Injuries in Female U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 10–21, https://doi.org/10.1093/milmed/usae308

V Pav, x yuan, b isaacson, c colahan, b hando

Musculoskeletal injuries (MSKIs) represent the most substantial and enduring threat to U.S. military readiness. Previous studies have focused on narrow surveillance periods, single branches of service, and used variable approaches for MSKI identification and classification. Therefore, the goals of this retrospective population study were to report the incidence, prevalence, and types of MSKIs sustained by active duty service members (ADSMs) across four Services in direct care (DC) and private sector care (PC) settings over fiscal years (FYs) 2010–2021, and to quantify and describe associated health care utilization and PC costs over the same period.

Veronika Pav, Xiaoning Yuan, Brad Isaacson, Courtney Colahan, Ben Hando, Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A 12-Year Study Spanning Fiscal Years 2010–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 1–9, https://doi.org/10.1093/milmed/usae357