Negri LB, Fairnelli WA, Korupolu S, Tam J, Gelfand J

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

Bacterial biofilm infections play a critical role in wound pathogenesis, enabling bacteria to defend themselves against both antibiotics and host defenses. They enhance persistence of infection, permitting spread of infection, delay of healing, and the development of antimicrobial resistance, all potentially contributing to sepsis and death from wounds. Antibiotic drugs are 10- to- 1,000-fold less effective against bacterial biofilm cultures than standard mean inhibitory concentration (MIC) reports indicate. We are developing ways to bring antimicrobial blue light (aBL) into patient care, specifically for treating wounds, with a special focus on the potential for this mode of therapy to overcome antimicrobial resistance (AMR) in biofilms. Antimicrobial blue light (herein 405nm) involves photochemical reactions with endogenous chromophores in bacteria that result in the release of reactive oxygen species (ROS), which are highly cytotoxic for bacteria. However, aBL penetrates tissue poorly, so this modality is best suited to the treatment of visible, light- accessible wounds. In this setting, aBL is a topical treatment to substantially reduce the bacterial bioburden, preventing more serious, penetrating infection. Thus, topically acting agents enhancing aBL would be useful. We have previously demonstrated that vitamin K 3/menadione could enhance aBL antimicrobial activity. A photosensitizer is a molecule that absorbs light and undergoes a photochemical reaction in which it typically donates an electron to a target substrate, generating reactive molecular species which, in turn, may have a biological effect. In this report, we have demonstrated that menadione acts as a therapeutic photosensitizer to kill bacteria upon illumination with aBL, elucidating some of the mechanisms, and additionally demonstrating this adjuvant effect in a porcine skin explant, ex vivo wound- biofilm model.

Penafiel A, Metzger E, Hager N, Wagner L, Isaacson B, Pasquina P, Werner K

Abstract accepted for a poster session at the 2023 USU Research Days

The average sleep quality in the military is so poor that the cutoff in validated subjective sleep quality complaint measures is twice as high as that in civilians. More than two-thirds of the military report sleeping less than the recommended seven hours per night. This sleep restriction (SR) can lead to reduced reaction time, verbal fluency, working and visual memory, and information processing, all of which are key functions in the completion of military activities. SR can also lead to atrophy of hippocampal subregions and other long term neurobehavioral consequences. The current mechanisms to combat SR, including caffeine, psychostimulants, and exercise, have varying effectiveness and short-lived results; therefore, an intervention with long-lasting effects is needed. 

Photobiomodulation therapy (PBMT) is a non-invasive intervention that applies non-ionizing light to the body to enhance performance, stimulate healing, moderate recovery, and improve health. Red/infrared PBMT (e.g. 600-900 nm) is known to be absorbed by cytochrome c oxidase within the mitochondria, facilitating electron transfer efficiency and doubling adenosine triphosphate production in cells. PBMT delivered via intranasal applicators, diode lasers, and/or light treatment helmet devices has been shown to penetrate the skin and skull, resulting in modulated brain activity. One study utilized electroencephalography (EEG) to measure the effects of transcranial PBMT (tPBMT) on neural oscillations. tPBMT modulated oscillatory frequencies for delta, theta, alpha, beta, and gamma bands, as well as affected the power and functional connectivity of internal brain activity. Additionally, tPBMT using near infrared light has been shown to potentially improve cognitive function, attention, and executive function, supporting its use in neurological interventions. 

Two placebo-controlled studies have examined the effect of PBMT on sleep in athletes after dosing the whole body with multiple short exposures. One study using noncoherent red light with a wavelength of 685nm dosed at 30 J/cm2 was associated with improved subjective sleep quality, increased total sleep time, and decreased sleep onset latency. They also demonstrated the PBMT group had a significant increase in morning serum melatonin. Conversely, a separate study found that PBMT dosed at 14.4 J/cm2 with an irradiance of 0.012W/cm2 decreased total sleep time but increased the percentage of N2 and N3 sleep, while improving sleep quality. The mechanisms of efficacy remain unclear. While neither study examined objective measures of brain activity during wake or sleep, we hypothesize that brain exposure to PBMT will optimize energetics for the coordinated firing involved in the deepest "slow-wave" sleep, yielding increased power in the delta band and improved sleep quality. This abstract provides the methods and expected outcomes of our study that will explore the application of PBMT in a military sample to characterize the effects of this modality on sleep. 

Galvin J, Rooney P, Tokish J, Grassbaugh J, Masini B, Free K, Bastian M, Gillette L, Colburn Z

Abstract accepted for platform presentation at the 2023 Society of Military Orthopaedic Surgeons (SOMOS) Annual Meeting

Currently the measurement of serum or synovial biomarkers does not have a role in diagnosis or monitoring of injury severity in young patients with recurrent anterior shoulder instability. The purpose of this study was to compare gene expression differences in the peripheral blood and tissue of young patients with recurrent anterior shoulder instability with and without significant glenoid bone loss (GBL). Additionally, we sought to determine a peripheral blood transcriptomic biomarker for the reliable delineation of the severity of GBL in anterior shoulder instability patients.

There are significant gene expression differences in the peripheral blood of anterior shoulder instability patients with and without significant (≥10%) GBL. The differential expression of 5 genes allowed development of an accurate predictive model and transcriptomic classifier to predict the severity of GBL. This novel peripheral blood transcriptomic biomarker may assist in tracking glenoid bone loss and injury severity and progression in young patients with recurrent anterior shoulder instability.

Smith M, Yuan X, Smith J, deal b, Nanos G, Tintle S, Reece D, Miller M

Abstract accepted for presentation at the 2023 SOMOS Annual Meeting

Carpal Tunnel Syndrome (CTS) is the most common peripheral entrapment neuropathy, impacting the health of the general population, as well as the performance and readiness of active duty service members (ADSMs) and military beneficiaries.1-2 CTS occurs when the median nerve (MN) is compressed beneath the transverse carpal ligament (TCL) within the carpal tunnel (CT). Within the general workforce, the incidence of CTS is between 1.5 and 3.5 per 1,000 person-years.3 According to Wolf et al., the raw incidence of CTS in the United States (U.S.) military is 3.98 per 1,000 person-years.4 CTS risk factors include female gender, increasing age, poor wrist posture, and occupations that involve repetitive movements, forceful grip, and exposure to vibration.3-5 Occupational risk factors are particularly relevant in the setting of the Military Health System (MHS), as different military occupational specialties may predispose ADSMs to CTS. Notably, CTS can impact operational readiness, prompting the need to improve diagnostic and treatment options for this common health condition, focusing on safety and efficiency to facilitate quicker return to duty. To this end, high-frequency ultrasound (HFUS) has demonstrated utility in CTS diagnosis and may serve as a valuable tool to improve overall safety during CTS treatment.

CTS diagnosis and treatment are typically guided by patient complaints, physical examination, and electrodiagnostic studies (EDX). The 2012 American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM)’s evidence-based guideline on the use of neuromuscular ultrasound (US) in the diagnosis of CTS concluded that US adds diagnostic value to EDX, focusing specifically on measuring the MN cross-sectional area (CSA) at the wrist as a diagnostic tool.6 Additionally, the guideline recommended that US be considered in screening for anatomic abnormalities. However, the 2016 American Academy of Orthopedic Surgeons’ clinical practice guidelines indicate limited evidence in support of routine US pre-operative exams, specifying a need for higher-level evidence regarding the utility of US, with a focus on establishing optimal measurement and cut-off values, in alignment with AANEM's guidelines for future research.7 More recently, studies have demonstrated that utilizing a cut-off CSA of 10-12 mm2 can differentiate between patients with normal versus abnormal EDX.8-9 However, Chen et al. demonstrated that US measurements were unable to differentiate levels of severity, indicating EDX remains a useful tool for grading CTS severity.9

CTR by endoscopic (ECTR) or mini-open (mOCTR) approach is the current standard of care (SOC) in the MHS for management of refractory CTS. CTR techniques have continued to evolve to further reduce post-operative symptoms and iatrogenic injury risk, while promoting quicker recovery and better functional outcomes. CTR using Ultrasound Guidance (CTR-US) is a promising treatment option for military beneficiaries with CTS, currently under rigorous study in a single-site pragmatic randomized controlled feasibility trial at a military medical center. Both ECTR and CTR-US involve smaller incisions and alternative means of visualization (i.e., endoscope or US). Although rare, intra-operative complications can occur during CTR secondary to anatomic variations. Multiple surgeons have emphasized the need for increased awareness of anatomic variations of the muscles, nerves, and vasculature within the CT region to promote procedural safety.15-17 Neurovascular injury can result in increased post-operative pain, persistent paresthesias, and/or excessive bleeding, all of which may contribute to an extended, complicated post-operative course, impacting return to work/duty and overall quality of life.

Key variations in neurovascular anatomy include a high bifurcation of the median nerve (approximately 6%), transligamentous thenar motor branch of the MN (TMB; <10%), multiple TMBs (<1% in patients with normal versus hypertrophic thenar musculature), ulnar course of the palmar cutaneous branch of the MN (PCBMN; <3%), persistent median artery (PMA; 1.2 – 23%), and superficial ulnar artery (UA; <10%).15-19 Prior studies have demonstrated that HFUS can be utilized to reliably identify these key variations that are at risk during CTR.10-14 Therefore, pre-operative US exams can identify anatomic variations and aid decision-making of the most appropriate CTR approach. This case series presents three participants in the feasibility trial of CTR-US who received pre-operative diagnostic US examinations, which detected distinct anatomic variants that were integral to subsequent treatment planning for CTR.

Galvin J, Rooney P, Tokish J, Grassbaugh J, Masini B, Free K, Bastian M, Gillette L, Colburn Z

Abstract accepted for platform presentation at the 2023 Washington State Orthopaedic Association (WSOA) Annual Meeting

Currently the measurement of serum or synovial biomarkers does not have a role in diagnosis or monitoring of injury severity in young patients with recurrent anterior shoulder instability. The purpose of this study was to compare gene expression differences in the peripheral blood and tissue of young patients with recurrent anterior shoulder instability with and without significant glenoid bone loss (GBL). Additionally, we sought to determine a peripheral blood transcriptomic biomarker for the reliable delineation of the severity of GBL in anterior shoulder instability patients.

There are significant gene expression differences in the peripheral blood of anterior shoulder instability patients with and without significant (≥10%) GBL. The differential expression of 5 genes allowed development of an accurate predictive model and transcriptomic classifier to predict the severity of GBL. This novel peripheral blood transcriptomic biomarker may assist in tracking glenoid bone loss and injury severity and progression in young patients with recurrent anterior shoulder instability.

wentz g, landry p, Reilly N, Gonnella M, Haltiwanger H, wilson v, goss d

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

Active-duty service members (ADSMs) are required to perform regular bouts of running and vigorous physical activity in accordance with the nature of their roles and responsibilities. As a result, ADSMs are at an inherently higher risk of sustaining a running-related injury compared to the general population. Prior research has identified numerous biomechanical parameters associated with an increased risk of injury, particularly regarding joint kinematics during gait. The gold standard for assessing joint kinematics of gait is three-dimensional motion capture. However, conducting three-dimensional motion capture analyses typically requires sophisticated laboratory equipment and a designated, open testing space. These conditions are often not feasible for a clinical environment, and thus populations that do not have ready access to biomechanics laboratory settings, including ADSMs. As a result, gait kinematics are often not considered when forming treatment and management plans for ADSMs following a running-related musculoskeletal injury. However, recent technological advances have strived to bring laboratory-grade motion capture technologies to clinical settings to reach patients that could benefit from the information and context that can be derived from these types of gait analyses. Therefore, the purpose of this case study was to evaluate the effectiveness of a portable, clinic-friendly three-dimensional motion capture system to supplement the treatment of and recovery from a running-related injury for an active-duty service member.

Galvin J, Rooney p, Egan a, tokish j, Grassbaugh j, Masini b, free k, bastian m, gillette l, colburn z

Abstracted accepted for a poster session at the 2023 Military Health System Research Symposium

Currently, the measurement of serum or synovial biomarkers does not have a role in diagnosis or monitoring of injury severity in young patients with recurrent anterior shoulder instability. The purpose of this study was to compare gene expression differences in the blood and tissue of young patients with anterior shoulder instability with and without significant glenoid bone loss (GBL). Additionally, we sought to identify a blood transcriptomic biomarker for the reliable delineation of the severity of GBL.

There are significant gene expression differences in the blood of anterior shoulder instability patients with and without significant (≥10%) GBL.

The differential expression of 5 genes allowed development of an accurate predictive model and transcriptomic biomarker to predict the severity of GBL.

This novel blood transcriptomic data may assist in tracking GBL and injury progression in patients with recurrent anterior shoulder instability.

Galvin J, Rooney p, Egan a, say f, Grassbaugh j, Masini b, free k, bastian m, gillette l, colburn z

Abstracted accepted for a poster session at the 2023 Military Health System Research Symposium

The purpose of this study was to compare gene expression differences in the peripheral blood and capsular tissue of young patients with recurrent anterior shoulder instability and those patients with unidirectional posterior shoulder instability.

There are significant gene expression differences in the shoulder capsule of anterior and posterior shoulder instability patients. This transcriptomic data may provide an improved understanding of the pathobiology of various forms of shoulder instability which could lead to future precision medicine approaches to prevent the development of early glenohumeral osteoarthritis.

Cin H, Mincey C, Persinger J, Hager N, Yimyam C, Metzger E, Isaacson B, Wagner L, Pasquina P

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

Physical activity limiting conditions are incompatible with maintaining a fit and ready fighting force and improving the health and wellness of those entrusted to our care. This study may produce new scientific knowledge about optimal dosing parameters of PBMT to best reduce pain and improve function for those who are limited by PF. This innovative therapy has the potential to promote a fit and ready fighting force by returning service members to duty quickly, reducing health care costs, and promoting operational readiness. The long-term goals of this research team include: 1) developing PBMT protocols for broad application to other painful and duty-limiting conditions, and 2) exploring the application of this portable device in forward-deployed environments.

Cheema N, Nazarian A, Pham L, Ghag N, Fuchs C, Tam J, Anderson R

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

Fatigue is defined by the reduction of a muscle’s strength and performance during exercise, and it is affected by different parts of the motor pathway controlling muscle contractions. Fatigue can occur in the central nervous system and affects neuronal signaling to the muscle whereas peripheral fatigue affects the site of neuromuscular junctions present on the muscle. Fatigue limits performance and unless allowed to recover, continuous activity will result in muscle dysfunction and musculoskeletal injuries that are commonly observed in military personnel. Light therapy has been shown to have several beneficial physiologic effects in a wide range of tissues. The musculoskeletal system can be irradiated with wavelengths in red and near infrared (NIR) regions which penetrate deep into the body. Application of NIR light is a noninvasive procedure and there is minimal heat generated by the light emitting diodes (LEDs), making it an appealing therapeutic strategy for muscle damage. Recent studies are suggesting that photobiomodulation therapy (PBMT) can reduce pain, inflammation and enhance physical performance. However, the mechanism(s) of cellular responses by PBM in muscle is not clearly understood. There is no standardization in parameters for PBMT, with researchers and clinicians using a wide range of wavelengths, fluences, treatment duration/frequency, etc. in PBM applications. Therefore, the goal of this study is to improve our understanding of the mechanism(s) of action of PBM effects on the musculoskeletal system, ultimately to inform the choice of clinical treatment parameters. We investigate two wavelengths in NIR light, 980 nm and 810 nm, and their effect on fatigue induced in intense exercise in cells and mice.

Metzger E, Hager N, Wagner L, Isaacson B, Pasquina P

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

Noncombat, musculoskeletal injuries account for nearly 60% of warfighters’ limited duty days and 65% of warfighters on non-deployable status. Often the treatment and the rehabilitation modalities available for common musculoskeletal conditions have little impact on the progression of the condition. A safe, patient friendly, and effective modality that could advance the treatment of these conditions would be extremely impactful. Photobiomodulation (PBM) – (formerly known as low-power laser therapy or low-level laser therapy), 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, in order to biologically modulate cellular activity to enhance healing. Current research reveals that PBM treatment can influence repair and regeneration of several tissue lines, stimulate metabolism, and most importantly for the injured warfighter - reduce inflammation and pain while recovering from injury. The PBM research portfolio is investigating the influence of this modality as it serves to enhance human performance, recovery, operational readiness, and warfighter quality of life with guided research efforts into the following areas of interest and aimed outcomes:

1. Musculoskeletal (MSK) injury: increased function and decreased pain for issues such as knee osteoarthritis, plantar fasciitis, tendinopathy, and bone stress injury.

2. Performance: improved maximum isometric voluntary contraction, sprint time, and countermovement jump measures.

3. Recovery: decreased inflammatory and oxidative stress biomarkers, and physical activity disability.

4. Self-reported behavioral health: decreased delayed-onset muscle soreness, perceived exertion, fatigue, and mental athletic energy used, and increased sense of wellbeing.

5. Sleep: increased sleep efficiency and self-reported quality of sleep.

6. Nerve: increased nerve strength post-reparative common peripheral nerve surgery and comparative use of analogous, commercially available, or manufactured sealing mechanisms.

7. Hearing: preventative protective treatment to noise exposure.

8. Wound: increased reduction in pathogens during the healing process.

Bradley M, Yuan X

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

 This study demonstrates the influence of the APDACAP on the structure of the foot, particularly on talus positioning, for the first time in a large sample of humans and elucidates previously misunderstood concepts about pronation. We determined that the current, most widely used method for categorizing foot type (CIA) is not the most accurate for diagnostic screening. Instead, the investigators propose a new, more accurate categorization system for foot type, which includes the CIA’s three categories of low, medium, and high arch heights, and further stratifies to describe the wide spectrum of flexible and rigid foot types within each arch height category, by considering the degrees of APDACAP and TDA. Although the following still needs to be verified in a prospective trial, it is expected that the most often misdiagnosed/mistreated foot types are to be (1) low arch height yet rigid midfoot (i.e., low CIA & high APDACAP/TDA), (2) high arch height yet flexible midfoot (i.e., high CIA & low APDACAP/TDA), and (3) medium arch height with APDACAP/TDA values toward the outer extremes of the flexible/rigid continuums. The implications of the new categorization system will enable better awareness and care to prevent and treat lower extremity injuries.

Smith M, Yuan X, Smith J, Deal B, Nanos G, Tintle S, Reece D, Miller M

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

CTS is the most common peripheral entrapment neuropathy, impacting the health, performance, and readiness of Active Duty service members and military beneficiaries. Military occupations often require repetitive movements, forceful grip, and exposure to vibration, which are risk factors for CTS, illustrating the importance of access to novel CTR techniques that facilitate return to functional activity. Current barriers to CTS treatment within the MHS include limited access to subspeciality care in rural areas, lack of resources, and OR procedural costs and staffing requirements. Clinic-based procedures have demonstrated utility in decreasing costs and increasing access to care within the MHS. Preliminary data from this pragmatic randomized controlled feasibility trial at WRNMMC suggest that CTR-US can be performed by non-operative physicians with advanced training within a clinic environment and yield positive outcomes that compare favorably to the current SOC mOCTR approach. Outcomes of this trial comparing CTR-US and mOCTR at WRNMMC can further expand available CTS management options within the MHS, improving access to care, practice efficiency, operational readiness, and long-term functional outcomes for service members.

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.

Gaunaurd I, Goss D, Helton M, Gonella M, Reilly N, Haltiwanger H, Mulier L, Gailey R

Musculoskeletal injuries (MSI) affect approximately 800,000 service members annually and 25 million days of limited duty. There is a need for quick screen assessments that can classify and predict the risk of lower extremity (LE) MSI prior to activity. An Injury Risk Index (IRI) could facilitate improved decision-making and reduce the negative impact associated with selected MSI. The purpose of this study is to determine the frequency and distribution of Soldiers’ risk of MSI after performing sensors-based objective LE tests for static and dynamic stability. The number of Soldiers with prior lower limb MSI who had worse static and dynamic stability symmetry could be a concern for reinjury and/or less than ideal physical performance while on duty. The ability to identify the risk of injury in Soldiers, athletes or people with previous injuries may promote preventative interventions or pre-habilitation to reduce re-injury. 

Dowe JN, Bradley MW, Dickens JF

Abstracted accepted for a poster session at the 2023 Military Health System Research Symposium

Musculoskeletal injuries are some of the most prevalent issues in the military, being a significant contributor to functional limitations, duty restrictions, and impaired military readiness. In particular, shoulder instability events, such as dislocations and subluxations, are a disproportionately burdensome condition among military Service Members (SM), with SM being 20 times more likely to experience a shoulder instability event than their civilian counterparts. Furthermore, a common consequence of instability events is bone loss to the glenohumeral joint, which increases risk of re-injury (currently around 80% re-injury rate). As the amount of bone loss increases, so do the failure rates following nonoperative and operative treatment, leading to recurrent instability that contributes to inferior long-term outcomes and impaired biomechanics. With the military population being the most at-risk population for shoulder instability injuries, understanding the unique anatomical structure of a patient’s shoulder joint is essential in advancing treatment and surgical decision making. Additionally, the high costs associated with these injuries highlights the need for enhanced management and care. Imaging modalities, such as magnetic resonance imaging (MRI) and computed tomography (CT), are used to assess the extent of injury in patients who experience shoulder instability. These assessments help guide decisions regarding the direction of care for patients. However, these imaging modalities each have certain advantages and disadvantages in analyzing a patient’s joint structure. Currently, the closest to a gold standard for assessing bone loss in the shoulder is by obtaining a three-dimensional (3D) CT scan and then utilizing a 3D reconstruction. Though valuable, the current evaluation process can be improved to provide more efficiency and ease from both a clinician and patient perspective. The process of obtaining a 3D view of the shoulder joint from an MRI, although less common, can be completed to effectively assess bone loss and determine treatment, while also solving some of the issues associated with the use of CT.

Reilly N, Velasco T, Roberts K, Hulsopple C, Wise S, Goss D, Leggit J

Abstracted accepted for a poster session at the 2023 Military Health System Research Symposium

Active-duty service members (ADSMs) regularly run and perform vigorous physical activity per their training and physical fitness requirements. As such, ADSMs are at a higher risk of developing acute and persistent running-related musculoskeletal pathologies. As such, chronic exertional compartment syndrome (CECS) presents a significant clinical problem among the ADSM population. The condition impacts the ability to run as the repetitive mechanical strains incurred during gait result in localized pain, weakness, and/or paresthesia, predominantly in the musculature of the lower legs. Troublingly, the exact pathophysiology of CECS is not thoroughly understood, and surgical interventions to treat the condition (i.e., fasciotomy) have generally seen mixed outcomes regarding clinical success. As a result, alternative, non-surgical approaches have received increased attention. Two such approaches include 1) pharmaceutical interventions via botulinum toxin A (BoNT-A) to reduce lower limb pain and symptoms and perhaps reduce intramuscular compartment pressure, and 2) structured gait retraining to modify running mechanics (i.e., transition to forefoot strike pattern) to decrease skeletal muscle activity and stresses of the lower limbs. Prior research and case series utilizing each modality have reported promising results and clinical outcomes regarding pain and overall function during running. However, the implementation of these non-surgical interventions for patients with CECS has, to date, been limited in scope due to the availability of laboratory-grade equipment and analytical expertise for corresponding biomechanical gait data. The combination of these modalities on specific biomechanical gait parameters associated with injury risk in patients with CECS is mainly unexplored.

Rhon D, Sell T, Boeth R, Foster K, Greenlee T, Young J

Abstract presented at the World Physiotherapy Congress 2023 organized by World Confederation for Physical Therapy (WCPT)

Main outcome measures of study were frequency of adjacent joint injuries in the 2-year period after initial patellofemoral pain injury, and hazard ratios (HR) with 95% confidence interval (CI) and Kaplan–Meier survival curves for risk of adjacent joint injury based on receiving therapeutic exercise for the initial injury. After initial patellofemoral pain diagnosis, 42,983 (46.6%) individuals sought care for an adjacent joint injury. Of these, 19,587 (21.2%) were subsequently diagnosed with a lumbar injury, 2837 (3.1%) a hip injury, and 10,166 (11.0%) an ankle-foot injury. One in five (19.5%; n = 17,966) received therapeutic exercise which reduced the risk of having a subsequent lumbar (HR = 0.78, 95% CI 0.76–0.81), hip (HR = 0.93, 95% CI 0.87–0.98) or ankle-foot (HR = 0.86, 95% CI 0.83–0.90) injury.

Smith m, Abboud Chalhoub c, Hogaboom n, St Laurent m, Yuan x, Nordstrom m

Abstract accepted as a poster for 2023 USU Reserach Days

Chronic neck pain is a common health condition for Active Duty military personnel across all occupational specialties. The reduction of cervical lordosis in forward head posture (FHP) can lead to muscular imbalances, degenerative spinal changes, and heightened neck pain. The efficacy of a FHP therapy collar is being explored within the military population with chronic neck pain in an ongoing randomized waitlist-controlled trial at the Walter Reed National Military Medical Center (WRNMMC).

Evaluating the treatment effect of a simple, non-invasive, wearable device for neck pain is highly relevant to the military. This ongoing trial at WRNMMC will shed further light on the potential utility of this novel device in reducing neck pain due to FHP, and thereby improve functional outcomes and operational readiness.

Wentz G, Landry P, Yang K, Reilly N, Gonnella M, Wilson V, Goss D

Abstract submitted to American College of Sports Medicine Annual Meeting & World Congresses 2023

This clinical case involved a 38-year-old male soldier presented with lateral knee instability and pain, sustained 1.5 months previously during downhill trail running. Mechanism of injury was reported valgus knee collapse while planting out of a creek. Post-injury follow-up revealed unremarkable imaging for acute pathologies. Initial subjective measures collected included Single Assessment Numeric Evaluation (SANE) of 70% and resting Numeric Pain Rating Scale (NPRS) score of 2 out of 10. Patient demonstrated minimal effusion. Squat test highlighted pain from 30 to 60 degrees of knee flexion and moderate valgus with internal rotation collapse. Pain with end range knee flexion, painful knee extension (NPRS: 5 of 10) with manual muscle test. Tenderness of lateral joint line and lateral femoral condyle was observed. Patient exhibited positive signs during Thessaly test, varus stress test at 0 and 30 degrees, and Nobles and Rennes test.