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.

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

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

Purpose/hypothesis: Shoulder instability is common in active young athletes and military personnel, often requiring shoulder stabilization surgery. Acute post-operative pain is usually managed with opioid pain medications, which have adverse effects that reduce military readiness. Battlefield Acupuncture (BFA) has demonstrated promise as a non-pharmaceutical intervention for acute post-operative pain. The purpose of this randomized clinical trial was to assess the effectiveness of BFA on post-surgical pain and opioid medication usage.

i gaunaurd, m sumner, p pasquina, a symsack, j haynes, c bennett, r gailey

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

Purpose/hypothesis: Veterans with lower limb loss (LLL) are a complex population with their own unique challenges with rehabilitation but share many commonalities with the general population. This case series highlights two examples of a physical therapist and patients with LLL who participated in the Mobile Device Outcomes Based Rehabilitation Program at the Bruce W. Carter VA Medical Center, Miami, FL using a novel mobile sensor system and application called Rehabilitative Lower Limb Orthopaedic Assistive Device (ReLOAD) to augment rehabilitation.

i gaunaurd, p pasquina, a symsack, m sumner, j haynes, t fields, a munoz-boyle, l prasso, christina sole-plasa, j stevens, c bennett, b applegate, b isaacson, r gailey

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

Purpose/hypothesis: Supported by the DoD/VA Joint Incentive Fund, Mobile Device Outcomes-based Rehabilitation Program (MDORP) utilizes mobile technology, called Rehabilitative Lower Limb Orthopedic Assistive Device (RELOAD) to enhance the rehabilitation of Services Members (SMs) and Veterans with lower limb loss (LLL). The ReLOAD system assesses walking quality, provides auditory feedback to correct gait deviations, and recommends patient-speci c exercises that target their impaired function and limitations. The purpose of this study is to examine the use of the RELOAD system in the clinical practice of Physical Therapists (PTs) to optimize assessment and care of SMs and Veterans with LLL.

A Symsack, i gaunaurd, j haynes, m sumner, c bennett, b isaacson, p pasquina, r gailey

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

Purpose/hypothesis: The home-based exercise program (HEP) for patients in rehabilitation following lower limb loss (LLL) is an integral part of the continuity of care outside the clinic for the maintenance and improvement of strength, mobility, and functional goals. However, clinical evidence shows that patients have varying degrees of exercise adherence to HEPs. Evidence-based exercise prescription to improve HEP adherence has suggested dosing of 20 minutes daily, minimum of three times per week or the completion of two-thirds of the prescribed exercise routine. The purpose of this study is to determine patient adherence to their HEP among SMS and Veterans with LLL using the Rehabilitative Lower Limb Orthopaedic Assistive Device (ReLOAD).

A Symsack, i gaunaurd, j haynes, m sumner, c bennett, b isaacson, p pasquina, r gailey

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

Purpose/hypothesis: The rehabilitation for Service Members (SMS) and Veterans with lower limb loss (LLL) can involve months of prosthetic training and targeted exercises intended to improve gait quality and functional mobility. During this time, Physical Therapists (PTS) prescribe home exercise programs (HEP) as part of the plan of care, which serve to augment treatment and improve or maintain patient function while outside the clinic. The purpose of this study is to identify the targeted exercise prescription trends following initial evaluation (eval) among PTS who are participating in the Mobile Device Outcomes Based Rehabilitation Program (MDORP) for SMS and Veterans with LLL.

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

Abstract accepted for poster presentation at the 2025 American Physical Therapy Association Combined Sections Meeting- Houston, TX

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.