Kinetic Metrics and Exploratory Applications of Telehealth Gait Retraining Following Musculoskeletal Injury in Military Personnel — MHSRS 2023

Goss D, Weart A, Miller E, McHenry P, Haltiwanger H, Gonnella M, Ford K, Reilly N, Crowell M

Abstract accepted for a breakout session at the 2023 Military Health System Research Symposium

By the nature of their work, active-duty service members (ADSMs) are exposed to greater risks of musculoskeletal injury in comparison to the general population. The prevalence of musculoskeletal injury presents significant financial and temporal strains on the Military Health System (MHS) as costs for treatment and collective time lost from active duty accumulate, respectively. As a result, one of every twenty-five ADSMs are unable to deploy or fulfill their duties due to injury at any given time. Despite the inherently dangerous nature of combat, the most prevalent cause of injury in the ADSM population is running. Effective treatments for running-related pain are needed that modify known risk factors for running-related knee pain (i.e., gait retraining to alter problematic movement patterns).” Previous research has identified numerous biomechanical parameters indicative of increased mechanical strain and corresponding increases in musculoskeletal injury risk.  Examples include, but are not limited to, greater peak vertical ground reaction forces (GRF), greater average vertical loading rates upon foot strike, and greater peak braking forces. Unfortunately, the ADSM population does not have ready access to the laboratory-grade facilities and analytical techniques (i.e., kinetics via force plates, kinematics via three-dimensional motion capture) often utilized to conduct traditional gait retraining assessments. As a result, gait kinetics are often not considered clinically when forming treatment plans following a running-related injury, leaving any underlying problematic mechanical patterns to persist following the resolution of the initial injury and predisposing the patient to an increased risk of a follow-up, potentially more severe injury. Recent advances in the capabilities of telehealth have expanded the spectrum of treatment modalities for a variety of pathologies. However, it has yet to be seen whether telehealth can be utilized effectively to treat running-related injuries based on targeted feedback stemming from biomechanical parameters associated with injury risk. To date, the use of telehealth to implement gait retraining to supplement clinical management plans and expedite the return-to-duty process in the ADSM population has been largely unexplored.