Ankle Injuries and Disorders, Knee Injuries and Disorders, Low Back Pain
Conditions
Brief summary
Physical readiness of military personnel is a cornerstone of any army, as soldiers are expected to meet high physical demands on a daily basis, and soldiers must complete one hour of physical conditioning each day. Participation in physical conditioning increases the risk of musculoskeletal injuries, and our 10-year retrospective analysis shows that 5% of soldiers sustain a sports injury during physical conditioning each year, and that ankle and knee injuries have the highest incidence rates of 25% and 20%, respectively. The primary objective of our study is to decrease the rate of ankle and knee injuries by implementing a preventive training program. The study is designed as a prospective randomized controlled trial with two arms (experimental and control).
Detailed description
Members of Slovenian Armed Forces - SAF (age range 18-51 years) are expected to participate in the study. Prior to recruitment the whole project will be explained to soldiers in a form of briefing during which they have the opportunity to ask and have answers to any questions concerning the nature of subsequent research. Following that explanation each participant will sign a consent form to voluntarily participate. No compensation will be given or promised for participation in a study that was approved by the Ethical board of the Faculty of Sport in Ljubljana (No. 454/2017). At the time of testing all soldiers must be free of acute injuries and should not reported any pain in musculo-skeletal system. Prior to the implementation of the preventive program all participants will underwent the set of functional testing that includes counterMovement jump (CMJ) testing, stork balANce test, pUll-ups, single leg hAmstrings bridge test, and loaded prone pLank test - MANUAL. Following initial testing a 15-week preventive training program will be implemented in experimental group, while control group will be training as usual. Following the intervention final testing will be performed to check for effectiveness of the intervention. After that a follow-up period will start during which injuries will be registered in both groups and later compared between groups (control and experimental) and within (2016-2017 injuries) groups to see if incidence rate of ankle and knee injuries has fallen.
Interventions
neuromuscular training
Sponsors
Study design
Eligibility
Inclusion criteria
* no major injuries that would require more than 4 weeks to recover upon entry into the study * age \>18 y * finished initial Army training
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Soldiers With Ankle and Knee Injuries | 1 year | Percentage of soldiers with ankle and knee injuries during the study period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Vertical Jump Performance | 15 weeks | jump height in countermovement jump |
| Pull-ups Performance | 15 weeks | number of overhand pull-ups in one minute |
| Hamstring Repetitive Strength | 15 weeks | Number of single leg raises on the 60 cm box |
Countries
Slovenia
Participant flow
Recruitment details
Recruitment was from January to February 2017.
Pre-assignment details
Initially, there were 160 soldier who approved to participate in initial testing, but prior to assignment of participants to groups 55 of them has declined further participation for different reasons, so only 105 soldiers was later randomised into groups, but the completion rate after this point was 100%.
Participants by arm
| Arm | Count |
|---|---|
| Functional Training 15 weeks of structured exercise intervention in the form of functional training. We have divided 15 weeks into 5 cycles each cycle lasting 3 weeks. Intervention was administered twice per week, and each session lasted 45 minutes. Each 45 minutes was further divided into 10 minutes of functional warm-up, 30 minutes of neuromuscular training (strength, agility, balance, coordination) and 5 minutes of cool down. During the 3 week period the intensity of exercise was increased with different form of same exercise, different number of repetitions and exercise duration.
Exercise: neuromuscular training | 64 |
| Regular Army Training Regular military training. | 41 |
| Total | 105 |
Baseline characteristics
| Characteristic | Functional Training | Total | Regular Army Training |
|---|---|---|---|
| Age, Continuous | 30 years STANDARD_DEVIATION 6 | 32 years STANDARD_DEVIATION 6 | 34 years STANDARD_DEVIATION 6 |
| Countermovement jump height | 28.3 centimeters STANDARD_DEVIATION 3.9 | 27.4 centimeters STANDARD_DEVIATION 4.5 | 26.0 centimeters STANDARD_DEVIATION 4.9 |
| Loaded countermovement jump height | 25.2 centimeters STANDARD_DEVIATION 3.3 | 24.6 centimeters STANDARD_DEVIATION 4.2 | 23.5 centimeters STANDARD_DEVIATION 5.1 |
| Loaded prone plank | 119 time in seconds STANDARD_DEVIATION 48 | 117 time in seconds STANDARD_DEVIATION 49 | 115 time in seconds STANDARD_DEVIATION 50 |
| Pull ups | 4 number of repetitions STANDARD_DEVIATION 4 | 4 number of repetitions STANDARD_DEVIATION 4 | 4 number of repetitions STANDARD_DEVIATION 4 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 64 Participants | 105 Participants | 41 Participants |
| Sex: Female, Male Female | 1 Participants | 5 Participants | 4 Participants |
| Sex: Female, Male Male | 63 Participants | 100 Participants | 37 Participants |
| Single leg bridge test (left leg) | 25 number of repetitions STANDARD_DEVIATION 8 | 25 number of repetitions STANDARD_DEVIATION 8 | 25 number of repetitions STANDARD_DEVIATION 7 |
| Single leg bridge test (right leg) | 26 number of repetitions STANDARD_DEVIATION 9 | 27 number of repetitions STANDARD_DEVIATION 8 | 27 number of repetitions STANDARD_DEVIATION 7 |
| Stork balance test (left leg) | 14 time seconds STANDARD_DEVIATION 13 | 14 time seconds STANDARD_DEVIATION 13 | 13 time seconds STANDARD_DEVIATION 13 |
| Stork balance test (right leg) | 14 time in seconds STANDARD_DEVIATION 13 | 14 time in seconds STANDARD_DEVIATION 13 | 13 time in seconds STANDARD_DEVIATION 14 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 64 | 0 / 41 |
| other Total, other adverse events | 0 / 64 | 0 / 41 |
| serious Total, serious adverse events | 0 / 64 | 0 / 41 |
Outcome results
Number of Soldiers With Ankle and Knee Injuries
Percentage of soldiers with ankle and knee injuries during the study period.
Time frame: 1 year
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Functional Training | Number of Soldiers With Ankle and Knee Injuries | 1 Participants |
| Regular Army Training | Number of Soldiers With Ankle and Knee Injuries | 3 Participants |
Hamstring Repetitive Strength
Number of single leg raises on the 60 cm box
Time frame: 15 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Functional Training | Hamstring Repetitive Strength | 25 repeitions | Standard Deviation 8 |
| Regular Army Training | Hamstring Repetitive Strength | 25 repeitions | Standard Deviation 7 |
Pull-ups Performance
number of overhand pull-ups in one minute
Time frame: 15 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Functional Training | Pull-ups Performance | 6 repetitions | Standard Deviation 4 |
| Regular Army Training | Pull-ups Performance | 4 repetitions | Standard Deviation 4 |
Vertical Jump Performance
jump height in countermovement jump
Time frame: 15 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Functional Training | Vertical Jump Performance | 35.4 centimeters | Standard Deviation 10.3 |
| Regular Army Training | Vertical Jump Performance | 29.9 centimeters | Standard Deviation 10.8 |