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 DI, Anderson DN, Konitzer LN, Pickens BB, Szymanek EB, Mayhew RJ, Laugesen MC, Greenlee TA

Physical therapy services delivered remotely are becoming more common. The purpose of this study was to summarize the acceptability and patient-centeredness of remotely delivered physical therapy. This was a survey study. Patients and clinicians from physical therapy clinics in the US Military Health System were asked to provide feedback at the conclusion of each remote visit. Platform, reason for care, components of physical therapy delivered and received, satisfaction, and perception of patient-centeredness were collected. Results were summarized as proportions and frequencies. Feedback was provided by physical therapists for 250 visits and from patients for 61 visits. Most visits were completed using audio only (n=172; 68.8%) while the rest integrated video capability (n=78; 31.2%). Overall patients perceived their care was patient-centered either completely or very much. Over 90% of visits were perceived by physical therapists as being highly patient centered. For 53.2% of visits, patients thought that same visit would have been even more impactful in person and for 52.4% of visits, physical therapists thought the visit would have been more impactful in person. In conclusion even though remotely provided physical therapy care was rated by patients to be patient-centered, approximately half of the patients responding felt the same physical therapy visit would have been more impactful in person. Similarly, physical therapists felt that their intervention would have been more impactful in person for approximately half of all visits. Physical therapy care delivered remotely was patient-centered and an acceptable alternative to in-person care for both patients and physical therapists.

Rhon, D.I., Anderson, D.N., Konitzer, L.N. et al. Patient-centeredness and acceptability of remotely delivered physical therapy care for musculoskeletal disorders in four large hospitals within the Military Health System. BMC Digit Health 1, 21 (2023). https://doi.org/10.1186/s44247-023-00017-0

Cohen SP, Doshi TL, Dolomisiewicz E, Reece DE, Zhao Z, Anderson- White M, Kasuske A, Wang EJ, Hsu A, Davis SA, Yoo Y, Pasquina PF, Youn Moon J

Non-organic signs have gained traction for identifying patients who may benefit from psychotherapy, decreasing the risk of treatment failure. In conjunction with other clinical factors, these signs may refine patient selection, but their association with clinical outcomes has not been studied for neck pain. Seventy-eight patients with cervical radiculopathy who received epidural steroid injection (ESI) were followed to determine the effects non-organic signs and other factors have on treatment outcome. A positive outcome was a > 2-point decrease in average arm pain, coupled with a score of 5 on a 7-point patient global impression of change scale. Nine tests in 5 categories (abnormal tenderness, regional disturbances deviating from normal anatomy, overreaction, discrepancies in exam findings with distraction, and pain during sham stimulation) were modified from previous studies and standardized. Other variables examined for their association with non-organic signs and outcomes included measures of disease burden, psychopathology, co-existing pain conditions, sleep dysfunction, imaging, and somatization.

Cohen, S. P., Doshi, T. L., Dolomisiewicz, E., Reece, D. E., Zhao, Z., Anderson-Whitle, M., Kasuke, A., Wang, E. J., Hsu, A., Davis, S. A., Yoo, Y., Pasquina, P. F., & Youn Moon, J. (2022). What is the Incidence of Subsequent Adjacent Joint Injury After Patellofemoral Pain? Mayo Clinical Proceedings, 98(6), 868-882. https://doi.org/10.1016/j.mayocp.2022.11.022

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.

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

This retrospective cohort study was designed to investigate the incidence of subsequent lumbar spine, hip, and ankle-foot injuries after a diagnosis of patellofemoral pain. The results suggest that a high number of individuals with patellofemoral pain will sustain an adjacent joint injury within 2 years although causal relationships cannot be determined. Receiving therapeutic exercise for the initial knee injury reduced the risk of sustaining an adjacent joint injury. This study helps provide normative data for subsequent injury rates in this population and guide development of future studies designed to understand causal factors.

Young, J. L., Sell, T. C., Boeth, R., Foster, K., Greenlee, T. A., & Rhon, D. I. (2023). What is the Incidence of Subsequent Adjacent Joint Injury After Patellofemoral Pain? Clinical Rehabilitation. https://doi.org/10.1177/02692155231157177

Cohen SP, Doshi TL, Dolomisiewicz E, Reece DE, Zhao Z, Anderson- White M, Kasuske A, Wang EJ, Hsu A, Davis SA, Yoo Y, Pasquina PF, Youn Moon J

Neck pain is one of the top five leading causes of disability, with more than one-third being neuropathic in nature. Since 2000, the use of cervical epidural steroid injections has more than tripled, leading to increased scrutinization. The presence of nonorganic (Waddell) signs has been shown to be associated with treatment failure for back pain but has never been validated for neck pain. In a multicenter study, Waddell signs were adapted for cervical pain, with nine signs in five categories validated in a small pilot. Seventy-eight patients with cervical radiculopathy scheduled for epidural steroid injection were then evaluated with these signs for their association with outcome, with a positive outcome defined as a greater-than 2-point decrease in arm pain and a score greater than 5 on a 7-point improvement scale. Seventy-one percent had at least one nonorganic sign and 40% had at least one sign in three categories, with noncorrelative tenderness being most common (51%). Mean number of positive nonorganic categories was higher in individuals with negative outcomes (2.5 ± 1.8; 95% CI, 2.0 to 3.1) versus those with positive outcomes (1.1 ± 1.3; 95% CI, 0.7 to 1.5; P = 0.0002). Positive associations were noted between nonorganic signs and multiple pain (P = 0.011) and multiple psychiatric (P = 0.028) conditions.

Cohen, S. P., Doshi, T. L., Dolomisiewicz, E., Reece, D. E., Zhao, Z., Anderson-Whitle, M., Kasuke, A., Wang, E. J., Hsu, A., Davis, S. A., Yoo, Y., Pasquina, P. F., & Youn Moon, J. Science, Medicine, and the Anesthesiologist. Anesthesiology 2023; 138:A12–A15 doi: https://doi.org/10.1097/ALN.0000000000004586

Ong J, Godfrey R, Nazarian A, Tam J, Isaacson B, Pasquina P, Williams D

Bacterial biofilms readily develop on all medical implants, including percutaneous osseointegrated (OI) implants. With the growing rate of antibiotic resistance, exploring alternative options for managing biofilm-related infections is necessary. Antimicrobial blue light (aBL) is a unique therapy that can potentially manage biofilm-related infections at the skin-implant interface of OI implants. Antibiotics are known to have antimicrobial efficacy disparities between the planktonic and biofilm bacterial phenotypes, but it is unknown if this characteristic also pertains to aBL. In response, we developed experiments to explore this aspect of aBL therapy.

aBL had the most significant efficacy disparity between the planktonic and biofilm phenotypes (a 2.5 log10 unit difference). However, further testing against biofilms revealed that aBL had a positive correlation between increasing efficacy and exposure time, while levofloxacin encountered a plateau. While aBL efficacy was affected the most by the biofilm phenotype, its antimicrobial efficacy did not reach a maximum.

We determined that phenotype is an important characteristic to consider when determining aBL parameters for treating OI implant infections. Future research would benefit from expanding these findings against clinical S. aureus isolates and other bacterial strains, as well as the safety of long aBL exposures on human cells.

Ong J, Godfrey R, Nazarian A, Tam J, Isaacson BM, Pasquina PF and Williams DL (2023) Comparison of Staphylococcus aureus tolerance between antimicrobial blue light, levofloxacin, and rifampin. Front. Microbiol. 14:1158558. doi: 10.3389/fmicb.2023.1158558

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.

Nowak A, Kennelley G, Hager N, Metzger E, Isaacson B, hoenig T, Hollander K, Tenforde A

We enjoyed reading the articles by Abbott, et al. that cover the important topic of stress fractures in female military personnel “Part I: Background and Clinical Considerations for Stress Fractures in Female Military Recruits” and “Part II: Risk Factors for Stress Fractures in Female Military Recruits.” Both reviews identify that female military personnel are at a greater risk for stress fractures during training than their male counterparts and detail unique risk factors that are a necessary consideration in optimizing management. While we congratulate the authors for this detailed work, it is important to highlight additional research that adds to our understanding of this injury and the approach for management and prevention of these injuries.

Andrew S Nowak, Gabrielle E Kennelley, Nelson Hager, Elizabeth C Metzger, Brad Isaacson, Tim Hoenig, Karsten Hollander, Adam S Tenforde, Stress Fractures in the Military: Opportunities to Advance Recognition, Treatment, and Prevention, Military Medicine, Volume 188, Issue 9-10, September/October 2023, Pages 244–245, https://doi.org/10.1093/milmed/usad067

Negri LB, mannaa y, Korupolu S, farinelli w, anderson r, Gelfand J

Cutaneous bacterial wound infections typically involve gram-positive cocci such as Staphylococcus aureus (SA) and usually become biofilm infections. Bacteria in biofilms may be 100–1000-fold more resistant to an antibiotic than the clinical laboratory minimal inhibitory concentration (MIC) for that antibiotic, contributing to antimicrobial resistance (AMR). AMR is a growing global threat to humanity. One pathogen–antibiotic resistant combination, methicillin–resistant SA (MRSA) caused more deaths globally than any other such combination in a recent worldwide statistical review. Many wound infections are accessible to light. Antimicrobial phototherapy, and particularly antimicrobial blue light therapy (aBL) is an innovative non-antibiotic approach often overlooked as a possible alternative or adjunctive therapy to reduce antibiotic use. We therefore focused on aBL treatment of biofilm infections, especially MRSA, focusing on in vitro and ex vivo porcine skin models of bacterial biofilm infections. Since aBL is microbicidal through the generation of reactive oxygen species (ROS), we hypothesized that menadione (Vitamin K3), a multifunctional ROS generator, might enhance aBL. Our studies suggest that menadione can synergize with aBL to increase both ROS and microbicidal effects, acting as a photosensitizer as well as an ROS recycler in the treatment of biofilm infections. Vitamin K3/menadione has been given orally and intravenously worldwide to thousands of patients. We conclude that menadione/Vitamin K3 can be used as an adjunct to antimicrobial blue light therapy, increasing the effectiveness of this modality in the treatment of biofilm infections, thereby presenting a potential alternative to antibiotic therapy, to which biofilm infections are so resistant.

Yan M, Wu M

Exercise, especially anaerobic one, can gradually increase muscle mass over time as a result of adaptive responses of muscle cells to ensure metabolic homeostasis in the tissue. Low-level light therapy (LLLT) or photobiomodulation exhibits beneficial effects on promoting muscular functions, regeneration, and recovery from exhausting exercise, although the underlying cellular mechanisms remain poorly understood. We found that hypoxia, a condition following anaerobic exercise, significantly impeded myotube differentiation from myoblasts. However, this adverse effect was blunted greatly by pre-exposure of myoblast cells to a 980 nm laser at 0.1 J/cm2 , resulting in almost nearly normal myotube differentiation. LLL pre-treatment enhanced myotube formation by 80%, with a tubular diameter of 4.28 ± 0.11 μm on average, representative of a 53.4% increase over sham light treatment. The normalized myoblast differentiation concurred with 68% more mitochondrial mass and myogenin expression over controls. Moreover, LLL pre-treatment appeared to enhance glucose uptake, prevent energy metabolic switch from oxidative phosphorylation to glycolysis, and diminish lactate production under hypoxic conditions. The observation provides valuable guidance with respect to the timing of LLLT and its potential effects on muscle strengths in concert with anaerobic exercise.

Yan, M., & Wu, M. X. (2023). Low-Level Light Pre-Conditioning Promotes C2C12 Myoblast Differentiation Under Hypoxic Conditions. Journal of Biophotonics. https://doi.org/10.1002/jbio.202100246

Ong J, Godfrey R, Nazarian A, Tam J, Drake L, Isaacson B, Pasquina P, Williams D

Biofilm contamination is often present at the skin-implant interface of transfemoral osseointegrated implants leading to frequent infection, irritation, and discomfort. New biofilm management regimens are needed as the current standard of washing the site with soap and water is inadequate to manage infection rates. We have investigated the potential of antimicrobial blue light which has reduced risk of resistance development and broad antimicrobial mechanisms. Our lab has developed an aBL device uniquely designed for an ex vivo system based on an established ovine OI implant model with Staphylococcus aureus ATCC 6538 biofilms as initial inocula. Samples were irradiated with aBL or washed for three consecutive days after which they were quantified. Colony forming unit (CFU) counts were compared to a control group (bacterial inocula without treatment). After one day, aBL administered as a single 6 h dose or two 1 h doses spaced 6 h apart both reduced the CFU count by 1.63 log10 ± .02 CFU. Over three days of treatment, a positive aBL trend was observed with a maximum reduction of ~2.7 log10 CFU following 6 h of treatment, indicating a relation between multiple days of irradiation and greater CFU reductions. aBL was more effective at reducing the biofilm burden at the skin-implant interface compared to the wash group, demonstrating the potential of aBL as a biofilm management option.

Ong, J., Godfrey, R., Nazarian, A., Tam, J., Drake, L., Isaacson, B., Pasquina, P., & Williams, D. (2023). Antimicrobial Blue Light as a Biofilm Management Therapy at the Skin-Implant Interface in an Ex Vivo Percutaneous Osseointegrated Implant Model. Journal of Orthopaedic Research. https://doi.org/10.1002/jor.25535

Yuan X, Pav V, Colahan C, Miller M, Nelson H, Pasquina P, Cohen S, Isaacson B

Low back pain (LBP) has accounted for the most medical encounters every year for the past decade among Active-Duty Service Members (ADSMs) of the U.S. Armed Forces. The objectives of this retrospective, descriptive study was to classify LBP by clinical category (Axial, Radicular, and Other) and duration (Acute, Subacute, and Chronic) and examine the LBP-related health care utilization, access to care, and private sector costs for ADSMs over a 2-year follow-up period. The Military Health System Data Repository was queried in fiscal year 2017 for all ADSMs (ages 18-62) with outpatient encounters documented with any of 67 ICD-10 diagnosis codes indicative of LBP. A 1-year clean period before the first (index) outpatient LBP encounter date was used to ensure no recent history of LBP care. Patients were eligible if continuously enrolled and on active duty for 1 year before and 2 years following the index visit. Patients were excluded for non-musculoskeletal causes for LBP, red flags, or acute trauma within 4 weeks of the index visit and/or systemic illness or pregnancy anytime during the clean or follow-up period.

Yuan, X., Pav, V., Colahan, C., Miller, M. E., Hager, N. A., Pasquina, P. F., Cohen, S. P., & Isaacson, B. M. (2022). Active-Duty Service Members Newly Presenting with Low Back Pain in Fiscal Year 2017: Health Care Utilization, Access to Care, and Private Sector Costs Over 2-year Follow-up. Military Medicine. https://doi.org/10.1093/milmed/usac363

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.

Eliason A, Weart A, Miller E, Reilly N, Haltiwanger H, Gonnella M, Crowell M, Goss D

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

Despite the inherently dangerous nature of combat, the most prevalent cause of injury observed in military servicemembers (MSMs) stems from running, possibly due to the large cumulative mechanical stresses incurred. Running-related injuries in the military have primarily been addressed by in-person rehabilitation, but limitations exist inequipment and clinician availability. Recently, telehealth has emerged as a method to reach and provide rehabilitative care to a greater number of patients as well as populations without ready access to laboratory-grade assessment tools. However, applications of telehealth for targeting biomechanical parameters associated with running-related injury in the armed services to improve clinical outcomes have not been explored. The purpose is to evaluate the viability of telehealth gait retraining as a modality to identify and modify gait-related kinetic parameters conducive to running-related injury risk in MSMs.

Yang K, Weart A, Miller E, Reilly N, Crowell M, Ford K, Mulier L, Goss D

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

Running is the primary cause of musculoskeletal injury and lost or limited duty days in military service members (MSMs). Telehealth gait retraining is an accessible healthcare intervention showing promise in altering foot strike patterns that influences kinetic and spatiotemporal parameters, reducing mechanical strain and potentially reducing injury risk. However, it is inconclusive whether biomechanical changes resulting from telehealth gait retraining persist after the intervention is completed. The purpose is to determine the long-term efficacy of an 8-week telehealth gait retraining program to target and modify gait-related kinematic parameters.

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

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

Running is the most common mechanism of injury in the military service member (MSM) population. Specifically, cumulative stresses incurred using suboptimal kinematic patterns continuously predispose MSMs to increased risks of running-related injury. The gold-standard laboratory-grade equipment and time requirements necessary for biomechanical analyses of gait are unavailable for the MSM population. Recently, the advent of telehealth has diversified options and access to clinical treatment for a variety of pathologies. However, the effectiveness of telehealth to address risk factors contributing to running-related injury for MSMs is, to date, largely unexplored. The purpose is to evaluate the efficacy of telehealth gait retraining in addressing kinematic risk factors associated with running-related musculoskeletal injury in military personnel.