Post-concussion Return to Shooting Progression for Military Service Members: A Scoping Review and Conceptual Framework.

INTRODUCTION: There are established protocols for staged return to physical activity in sport and military settings following concussion. Currently, there is no evidence-based staged return to shooting protocol in use by the U.S. military despite the unique challenges and stresses shooting places on the vestibular-ocular and cognitive systems often disrupted by a concussion. The primary purpose of this scoping review was to summarize available evidence and current practices on return to shooting post-concussion, with the goal of optimizing an evidence-based return to shooting protocol for military service members. Our secondary aim was to identify individuals who may benefit from a return to shooting progression. MATERIALS AND METHODS: A comprehensive search of PubMed, SPORTDiscus, and Google Scholar was performed from the earliest dates to April 2023. A gray literature (Google) search was also performed. Articles were included if they studied a population with concussion, addressed return to shooting, and were written in English. Articles were excluded if they discussed health conditions other than concussion, focused on non-shooting interventions, did not use human subjects, or were written in a language other than English. RESULTS: Our search strategy yielded 134 articles: 1 article met our inclusion and exclusion criteria, whereas the other 133 articles were rejected. The gray literature search yielded one item. CONCLUSIONS: Based on our results, there is insufficient evidence to inform current practices on return to shooting post-concussion. In the absence of a published return to shooting protocol, we offer recommendations for identifying individuals who may benefit from a return to shooting progression and a revised version of a U.S. Army Special Operations Command Return to Range Progression. This protocol follows a conceptual framework for progression for variables such as environment, weapon type/caliber, and shooter position/movement. Further research is needed on identifying individuals who may benefit from a return to shooting protocol and safely and effectively progressing these individuals through a return to shooting protocol post-concussion.

The Effect of Blood Flow Restriction Training on Muscle Atrophy Following Meniscal Repair or Chondral Restoration Surgery in Active Duty Military: A Randomized Controlled Trial.

CONTEXT: Recently, blood flow restriction (BFR) training has gained popularity as an alternative to high-load resistance training for improving muscle strength and hypertrophy. Previous BFR studies have reported positive treatment effects; however, clinical benefits to using BFR following meniscal repair or chondral surgery are unknown. The purpose of this study was to determine the effect of resistance exercises with BFR training versus exercises alone on self-reported knee function, thigh circumference, and knee flexor/extensor strength postmeniscal or cartilage surgery. DESIGN: Single-blinded randomized controlled trial in an outpatient military hospital setting. Twenty participants were randomized into 2 groups: BFR group (n = 11) and control group (n = 9). METHODS: Participants completed 12 weeks of postoperative thigh strengthening. The BFR group performed each exercise with the addition of BFR. Both groups continued with the prescribed exercises without BFR from 12 weeks until discharged from therapy. Thigh circumference and self-reported knee function were measured at 1, 6, 12, and 24 weeks postoperatively along with knee extensor and flexor strength at 12 and 24 weeks. Change scores between time points were calculated for knee function. Limb symmetry indices (LSI) were computed for thigh circumference and knee strength variables. RESULTS: Seventeen participants were included in the final analyses (BFR = 8 and control = 9) due to COVID-19 restrictions. There were no interactions or main effects for group. Time main effects were established for change in knee function scores, thigh circumference LSI, and knee extensor strength LSI. However, knee flexor strength LSI had no main effect for time. CONCLUSION: The outcomes of this trial suggest that resistance exercises with and without BFR training may result in similar changes to function, thigh atrophy, and knee extensor strength postmeniscus repair/chondral restoration, though further study with larger sample sizes is needed.

C6 Spinous Process Fracture in a Young Adult.

A 21-year-old male military academy cadet developed acute posterior neck pain after performing multiple sets of overhead shoulder presses and resting the bar on his lower neck and shoulders. He presented to a direct-access physical therapy clinic. Due to the acute onset and focal nature of pain in the setting of repetitive weightlifting, the physical therapist ordered radiographs of the cervical spine, which revealed a C6 spinous process fracture. J Orthop Sports Phys Ther 2017;47(8):578. doi:10.2519/jospt.2017.7277.

Changes in lateral abdominal muscle thickness during the abdominal drawing-in maneuver in those with lumbopelvic pain.

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To determine if changes in transversus abdominis (TrA) and internal oblique (IO) muscle thickness and side-to-side symmetry differ in individuals with and without unilateral lumbopelvic pain while at rest and during the abdominal drawing-in maneuver (ADIM). BACKGROUND: Although the ADIM has been found to produce a symmetrical change in TrA and IO muscle thickness in healthy subjects, how these muscles are activated in those with unilateral lumbopelvic pain during the ADIM remains unknown. METHODS: Fifteen subjects with lumbopelvic pain and 15 age- and gender-matched control subjects were recruited. To investigate a similar subgroup of patients with lumbopelvic pain that has been used in previous research, subjects were required to have unilateral symptoms, a positive sacroiliac provocation test, and a positive active straight-leg raise test. Ultrasound images were obtained bilaterally at 2 different points during each trial of the ADIM: (1) at rest and (2) while maintaining the ADIM. Average percent change in thickness of the TrA and IO muscles was obtained over 3 trials. RESULTS: The percent change in thickness of the TrA was 20.9% less in those with lumbopelvic pain compared to the control group (P = .035), while the percent change in IO thickness was equivalent between groups (P = .522). No differences were observed for the TrA or IO muscles between the symptomatic and asymptomatic sides in those with (TrA, P = .263; IO, P = .172) or without (TrA, P = .780; IO, P = .635) lumbopelvic pain during the ADIM. Changes in TrA muscle thickness were greater than the IO muscle during the ADIM for both groups (P<.001). Specifically, the increases in TrA muscle thickness in those with and without lumbopelvic dysfunction were 32.7% and 47.3% greater, respectively, compared to changes in the IO muscle. CONCLUSIONS: Individuals with unilateral lumbopelvic pain demonstrated a smaller increase in thickness of the TrA muscle during the ADIM. This finding provides an element of construct validity for the use of the ADIM for assessing TrA muscle thickness in those with unilateral lumbopelvic pain. However, both groups demonstrated a symmetrical side-to-side change in TrA and IO muscle thickness despite the symptomatic group having unilateral symptoms. Further, we detected a preferential change in TrA muscle thickness during the ADIM in both groups.