Orthopedics This Week | February 14, 2017 - Page 10

ORTHOPEDICS THIS WEEK VOLUME 13 , ISSUE 5 | FEBRUARY 14 , 2017 10

Trainers ( ATs ) in each of the ‘ spokes ,” he said .
“ These ATs are literally embedded in training squadrons with the mission to prevent injuries through running gait training and self-care training ( e . g ., foam rolling , stretching ), as well as to diagnose and treat injuries early in their course .”
More Embedded Musculoskeletal Care Needed
Nye discussed the need for more embedded musculoskeletal care in Air Force training and operational units in an accompanying editorial he wrote with Sarah J . de la Motte , Ph . D ., MPH , ATC , assistant professor and scientific director of the Injury Prevention Research Laboratory , Consortium for Health and Military Performance , Uniformed Services University , Bethesda , Maryland .
In August 2014 , a primary care sports medicine physician was brought in to address the concern over musculoskeletal injuries at Joint Base San Antonio-Lackland , Texas ( JBSA-Lackland ) and in November 2015 , six certified athletic trainers and a physical therapist and an occupational therapist were also hired to form the first embedded sports medicine team for the 350th Training Unit . Data collected from this unit will be used to potentially guide placement of more embedded sports medicine teams within other training units .
Nye and de la Motte wrote , “ The argument for providing more robust sports medicine services ( including personnel , facilities , and equipment ) to training units at JBSA-Lackland is compelling . Physical training and rehabilitative facilities for the 350th currently include a 60-year-old offsite swimming pool , makeshift weight room , and part-time physical / occupational therapy space tucked into an old , repurposed dining facility ( where barbells have been known to break the floor ). Although great sports medicine can be delivered in almost any facility or any environment , there is a case for providing higher-level equipment and facilities to the tactical athletes who defend our Constitution on the front line each and every day . The time savings alone from offering on-site specialized care instead of appointmentbased , referral-based , remote clinic care is just a start .”
“ Many trainees ( especially special operators ) hide their injuries for fear of being removed from operational status . This fear is the result of a lack of trust and understanding between the trainee and the health care provider . Embedding health care providers into operational organizations to ensure that they understand the mission and know the people will significantly bridge this gap .”
Link Between Lower Extremity Strength and Knee Injury
Roger Kollock , Jr ., Ph . D ., ATC , CSCS , assistant professor of athletic training , exercise sports science , department of kinesiology and rehabilitative sciences at The University of Tulsa in Tulsa , Oklahoma , and colleagues through a meta-analysis of 25 studies ( January 1 , 2000-January 1 , 2013 ) discovered that knee overuse injuries like patellofemoral pain syndrome and iliotibial band syndrome are the most common overuse injury in training , active-duty and reserve military personnel , and that this type of injury is associated with less normalized hip strength and absolute knee strength . Compared with study participants without injury , they had lower absolute hip external-rotator , knee-extensor , and knee-flexor strength , as well as lower normalized hip external-rotator , hip extensor and hip-abductor strength .
“ This weakness at the hip and knee in those with knee overuse injuries were found in all three major planes of motion ( frontal , sagittal and transverse ),” Kollock , Jr ., told OTW . “ This may point to a more global weakness in the involved lower extremity among those reporting knee overuse injuries . Thus , rehabilitation programs for those suffering from knee overuse injuries should include appropriate functional activities that integrate multiple muscle groups across the activity .”
While the results of the meta-analysis did offer evidence that patients with knee overuse injuries had less muscular strength , Kollock , Jr ., explained that causality still cannot be inferred .
“ The majority of the studies included in the meta-analysis were cross-sectional designs ; thus , we were unable to determine cause and effect . It is therefore unclear if knee overuse injuries resulted from muscular weakness or muscular weakness resulted from the injury ,” he said .
“ Investigators need to conduct more studies using longitudinal designs to help determine muscular weakness at the hip and knee as causal factors . This , along with research on other contributing factors , will help further the development of effective screening programs to identify those most at risk for knee overuse injuries .”
Check out the full special issue of The Journal of Athletic Training here .
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