Risk factors for injuries along an infantry commanders course.

To determine the influence of prevention programme on somatosensory ability in combat soldiers during 14-weeks of an infantry commanders course, two cohorts were recruited (INT-group, n = 196; CONT-group, n = 169). Soldiers were tested pre-and post-course for anthropometric measurements, proprioceptive ability, dynamic postural balance, and filled CAIT questionnaire. The INT-group performed injury prevention exercises and the CONT-group continued with their routine physical fitness lessons. All musculoskeletal injuries were recorded along the course. In the CONT-group 24.2% and in the INT-group 19.9% suffered injury during the course. The rates of injuries were not significantly different between groups (χ2(1) = .677 p = .411). Previous injury (OR = 3.349, 95% CI = 1.283-8.740), pre-course BMI (OR = 1.216, 95% CI = 1.064-1.389), and pre-course proprioception ability (OR = .870, 95% CI = .810-.935) were factors associated with injury in the CONT-group. Pre-course proprioception ability (OR = .769, 95% CI = .699-.846) and pre-course CAIT score (OR = .087, 95% CI = .027-.276) were factors in the INT-group. Soldiers who received injury prevention exercises had a similar prevalence of total musculoskeletal injuries as those who did not receive these exercises. Risk factors for injuries were different in the two groups.

Reduced Growth Hormone Response to Anaerobic Exercise Among Children With Overweight and Obesity.

ABSTRACT: Hejla, D, Dror, N, Pantanowitz, M, Nemet, D, and Eliakim, A. Reduced growth hormone response to anaerobic exercise among children with overweight and obesity. J Strength Cond Res 36(8): 2194-2197, 2022-The aim of the present study was to examine the effect of an anaerobic exercise test on growth hormone (GH) secretion in children with overweight and obesity compared with children with normal weight. Fifteen children with overweight (body mass index percentile [BMI%ile] ≥85 < 95) and obesity (BMI%ile ≥95) and 10 children with normal weight (BMI%ile >5 < 85) participated in the study. Subjects performed a modification of the Wingate anaerobic test (WAnT), with 10 bouts of 15-second cycling separated by 1 minute of rest. Blood samples for GH and lactate were collected before and 15, 30, 45, and 60 minutes after the beginning of the exercise test. There was a significant increase in GH levels following the modified repeated WAnT in both groups, but the increase in GH levels was significantly greater among the normal weight children compared with those with overweight and obesity ( p < 0.003). Seven of the 10 subjects with normal weight had GH increase above the threshold for GH sufficiency compared with only 2 subjects with overweight and obesity. Growth hormone response to the modified repeated WAnT was significantly reduced among children with overweight and obesity compared with those with normal weight. Anaerobic interval-type training may not be a sufficient exercise alternative to stimulate appropriate GH levels among children with obesity.

Can Achilles and patellar tendon structures predict musculoskeletal injuries in combat soldiers?

Aiming to investigate whether Achilles tendon (AT) structure and patellar tendon (PT) structure are risk factors for musculoskeletal injuries in combat soldiers, 168 participants were recruited from an infantry commander's course. The AT and PT were examined pre-course using UTC to capture the structure of four echo-type fibers (I-IV). All injuries were assessed by military physicians pre-course and throughout the 14-week course. Soldiers who were injured during the course had a significantly higher pre-course prevalence of AT and PT echo-type III and echo-type IV compared to soldiers that were not injured during the course. Variables that were found to be associated with injured/non-injured participants were echo-type III + IV of the PT (OR = 1.44, 95% CI = 1.24-1.68) and echo-type III of the AT (OR = 1.69, 95% CI = 1.35-2.12). ROC analyses showed that the best model, exhibiting both high sensitivity and low specificity, was that participants with PT echo-type III + IV > 10% or AT echo-type III >8.5% had the highest risk of being injured during the course. In conclusions, the tendon structure at the beginning of high-intensity activity or physical training program might be a risk factor for subsequent injury during the course. Soldiers and high-level athletes should be aware of the cutoff points for fiber types in tendon structure that might put them at high risk for future injury. At-risk soldiers/athletes should be provided with an intervention program before they start their training program, with the aim of improving the tendon structure and preventing subsequent injury.

Generalized joint hypermobility, scoliosis, patellofemoral pain, and physical abilities in young dancers.

BACKGROUND: Many young girls with generalized joint hypermobility (GJH) choose to participate in dance because their bodies are suited for this activity. Scoliosis tends to occur often in thin girls, who also are more likely to choose dance. Both anomalies (GJH and scoliosis) may be related to reduced abilities such as diminished strength and insufficient postural balance, with increased risk for musculoskeletal conditions. The main objectives of the present study were to determine the prevalence of dancers with GJH, the prevalence of dancers with scoliosis, and the prevalence of dancers with these two anomalies; and, to determine differences in physical abilities and the presence of patellofemoral pain (PFP) between young female dancers with and without such anomalies. METHODS: One hundred thirty-two female dancers, aged 12-14 years, were assessed for anthropometric parameters, GJH, scoliosis, knee muscle strength, postural balance, proprioception ability, and PFP. RESULTS: GJH was identified in 54 dancers (40.9%) and scoliosis in 38 dancers (28.8%). Significant differences were found in the proportion of dancers with no anomalies (74 dancers, 56.1%) and dancers with both anomalies (34 dancers, 25.8%) (p < .001). Dancers with both anomalies had reduced dynamic postural balance in the anterior direction (p = .023), reduced proprioception ability (p < .001), and weaker knee extensors (p = .036) and flexors (p = .040) compared with dancers with no anomalies. Among dancers with both anomalies, 73.5% suffered bilateral PFP, 17.6% suffered unilateral PFP, and 8.8% had no PFP (p < .001). CONCLUSIONS: A high prevalence of young girls participating in dance classes had GJH, as the increased joint flexibility probably provides them with some esthetic advantages. The high prevalence of scoliosis found in these young dancers might be attributed to their relatively low body mass, their delayed maturation, and the selection process of dancers. Dancers with both GJH and scoliosis had decreased muscle strength, reduced postural balance, reduced proprioception, with higher risk of PFP. The main clinical implications are the need to reduce the risk of PFP among dancers by developing appropriate strength and stabilizing exercises combined with proprioceptive and postural balance training, to improve the correct alignment of the hyperextended and hypermobile joints, and to improve their supporting muscle strength.

The Effect of Growth Hormone Treatment on Physical Performance Indices in Children With Idiopathic Short Stature.

PURPOSE: To examine the effect of growth hormone (GH) treatment on physical performance in children with idiopathic short stature and normal GH secretion. MATERIALS AND METHODS: A total of 24 children participated in the study (13 GH-treated, 11 non-treated, aged 8-13 y, 11 males and 13 females, Tanner stage 1-2). Participants performed a battery of motor skill performance tests (Eurofit), as well as the Wingate anaerobic test. RESULTS: No statistically significant differences in any of the Eurofit physical fitness test results (eg, 20-m shuttle run 33.0 [15.1] vs 25.1 [21.0] laps in treated and nontreated participants, respectively, P = .25) or the Wingate anaerobic test were found between the groups (eg, peak power 5.0 [2.9] vs 3.9 [2.6] watts/kg in treated and nontreated participants, respectively, P = .2). CONCLUSIONS: Therapeutic usage of exogenous GH for pre and early pubertal children with idiopathic short stature and normal GH secretion was not associated with beneficial effects on physical performance indices. This suggests that the use of GH as a potential performance enhancing agent, in this age group, at least at commonly used doses, is not advantageous.

The Effect of Information Placebo on Physical Activity in Overweight and Obese Children.

PURPOSE: To assess the effect of 1 week of consuming a placebo "energy drink" compared with a week of drinking regular water on daily physical activity in obese children participating in a weight reduction multidisciplinary program. METHODS: Seventeen prepubertal (age = 128.7 [26.6] m) overweight and obese children (7 females and 10 males) participated in the study. Participants received 7 bottles of mineral water per week for 2 weeks. Different types of information were randomly provided regarding the drink consumed in each week: standard (water) versus deliberate positive information (presumed energy drink and placebo). Daily step count was measured using pedometers and compared using paired t test. RESULTS: After consuming the placebo drink, children demonstrated a significantly higher average daily step number (10,452 [4107]) compared with the days they drank water (8168 [2928], P < .005). This difference was attributed mainly to male participants. CONCLUSION: The use of placebo in the form of deliberate positive information was associated with a significant increase in real-life physical activity in overweight and obese children, especially in boys. Positive information may be used to encourage children with obesity to enhance daily physical activity and energy expenditure.

Injury Prevention Exercises for Reduced Incidence of Injuries in Combat Soldiers.

ABSTRACT: Steinberg, N, Bar-Sela, S, Moran, U, Pantanowitz, M, Waddington, G, Adams, R, Band, SS, and Funk, S. Injury prevention exercises for reduced incidence of injuries in combat soldiers. J Strength Cond Res 35(11): 3128-3138, 2021-The aim of this study was to determine the influence of an "all-cause injury" prevention program, focused on static-to-dynamic transitions, on injury prevalence in a military commanders course. Two cohorts of male infantry commanders were recruited (intervention [INT group], n = 196 and controls [CO group], n = 169) and tracked by a physiotherapist, who recorded any injuries that occurred during the 14-week course. Soldiers were tested precourse, midcourse, and postcourse for anthropometrics, proprioception ability, and dynamic postural balance (DPB). The INT group performed injury prevention exercises for 5 minutes, 3 times a week, and the CO group continued with their routine physical fitness sessions. The prevalence of injuries reported to the physiotherapist during the course was significantly lower for the INT group compared with the CO group (14.8 and 34.3%, respectively, p < 0.001). Similarly, rates of injury in the INT group were significantly lower than in the CO group (p < 0.001; hazard = 2.53, 95% confidence interval = 1.62-3.95). Precourse proprioception ability was significantly lower in those that became injured during the commanders course, irrespective of the group. Likewise, for DPB parameters, the injured subjects in both groups had significantly lower precourse scores than the noninjured subjects. From pretesting to midtesting, the injured soldiers in the INT group improved their ability up to the level of the noninjured subjects. A reduced prevalence of injuries was found for soldiers who completed the injury prevention program. Because the subjects soldiers injured on the course had reduced somatosensory abilities at the outset, and as these abilities can be improved by static-to-dynamic exercises, identifying at-risk soldiers and providing them with appropriate strategies for improvement beforehand is indicated.

The influence of a multidisciplinary intervention program on Achilles tendon structure in children with overweight and obesity.

The effects of childhood obesity on tendon structure and its relation to physical activity are barely known. We aimed to investigate the influence of a 6-month multidisciplinary childhood obesity management program (which included dietary intervention and an exercise program) on Achilles tendon structure in overweight/obese children. Twenty-five overweight/obese children (overweight group) who participated in a 6-month multidisciplinary childhood obesity program, and 27 normal-weight controls were examined for anthropometric measurements and for Achilles tendon structure (using ultrasound tissue characterization to capture a three-dimensional structure of four echo type fibers and the cross-sectional area) at baseline, 3, and 6 months. The BMI of the overweight group significantly decreased from the pre- to the post-intervention period, (p = .002, η2 = .229), yet among the control group, the BMI significantly increased (p = .002, η2 = .222). Interactions (pre-post × group) showed a significant decrease in the prevalence of echo type I and in echo type III fibers and a significant increase in the prevalence of echo type II fibers and in the cross-sectional area along the intervention. No significant changes in echo type fibers were found in the control group along the 6 months.Conclusion: At pre-intervention, the overweight group had significantly "worse" tendon structure, with a lower prevalence of echo type II fiber and a higher prevalence of echo type III fibers compared with the control group. Following the 6-month intervention, the tendon structure of the overweight group was "positively" changed, with reduced echo type III fibers and increased echo type II fibers. What is Known: • Physical activity and weight reduction programs are efficient for obese children. • Obese children tend to suffer orthopedic problems and pain during physical activity. What is New: • Pre-intervention, obese children had 'worse' tendon structure compared to controls. • Following 6-month program, tendon structure of obese children 'positively' changed.

The placebo effect on aerobic fitness test results is preserved following a multidisciplinary intervention program for treating childhood obesity.

BACKGROUND: The aim of the study was to examine the placebo effect on fitness test results in trained and untrained overweight and obese children. METHODS: Twenty pre-pubertal overweight children performed two pairs of progressive treadmill exercise tests before and 12 weeks into a multidisciplinary program for the treatment of childhood obesity. In each test pair, at random order, participants received different types of information regarding a water drink consumed prior to testing-standard information (water) vs deliberate positive information (presumed energy drink, placebo). RESULTS: The intervention led to a significant change (P < .05) in BMI%ile (95.6 ± 4.4 vs 93.6 ± 6.9), % fat (35.4 ± 6.0 vs 31.6 ± 5.8), baseline heart rate (104.2 ± 11.6 vs 94.0 ± 7.0 bpm), total leisure activity score-Godin (9.3 ± 8.8 vs 41.5 ± 15.2), total screen time (6.9 ± 5.8 vs 3.1 ± 1.4 h/d), and a significant improvement in fitness. Following the placebo drink, both groups achieved a significantly higher peak heart rate (untrained: 176.1 ± 13.7 vs 167.5 ± 16.8; trained: 170.7 ± 11.6 vs 166.2 ± 11.4 bpm) and longer running time (untrained: 559.9 ± 151.0 vs 434.4 ± 140.3 seconds; trained: 728.3 ± 177.3 vs 667.1 ± 176.1 seconds). Despite longer exercise duration and higher peak exercise heart rate, average, and peak RPE were lower after the placebo drink (untrained: 12.1 ± 2.3 vs 13.6 ± 2.1; trained:10.0 ± 1.8 vs 11.6 ± 2.1), recovery time was shorter (untrained: 119.2 ± 25.3 vs 133.2 ± 23.7 seconds; trained: 92.6 ± 18.9 vs 102.7 ± 18.3 seconds). The placebo-induced change in running time and peak RPE were significantly greater prior to training. CONCLUSION: The significant information placebo effect is preserved in trained overweight children. Information, as well as other motivating aids and fatigue distractors may be useful in enhancing physical performance in obese children.

Significant effect of information placebo on exercise test results in children with normal weight, overweight and obesity.

AIM: The aim of the study was to examine the effect of information placebo on fitness test results in normal weight, overweight and obese children. METHODS: Twenty-four pre-pubertal children with overweight or obesity and 24 age and maturity-matched normal weight children performed a progressive treadmill exercise test twice. Different types of information were randomly provided regarding a water drink consumed prior to testing; standard (water) vs deliberate positive (presumed energy drink, placebo) information. RESULTS: Following the placebo drink, both groups demonstrated significantly higher peak heart rate (overweight 165.8 ± 16.7 vs 174.2 ± 14.8 bpm and normal weight 177.9 ± 13.6 vs 189.8 ± 12.2 bpm) and longer time to exhaustion (overweight 396.9 ± 161.9 vs 521.5 ± 182.5 seconds; normal weight: 700.1 ± 155.2 vs 893.3 ± 150.1 seconds). Despite longer exercise duration and higher peak heart rate, average and peak rate of perceived exertion were significantly lower after the placebo drink (overweight 14.1 ± 2.5 vs 12.5 ± 2.5; normal weight 12.1 ± 1.4 vs 10.7 ± 1.5), with significantly shorter recovery time (overweight 132.2 ± 28.5 vs 118.4 ± 31.6; normal weight: 106.7 ± 18.6 vs 96.7 ± 17.8 seconds). CONCLUSION: Our results demonstrate a significant effect of information placebo on fitness test results that is unrelated to body weight. Children with obesity may enhance their physical activity levels and energy expenditure if properly encouraged.

Achilles Tendon Tissue Structure in Children with Overweight and Children with Obesity.

Aim: To investigate differences in Achilles tendon structure between children with overweight/obesity and children with normal weight.Methods: Twenty-two children with obesity, 10 children with overweight, and 44 children with normal weight participated in the study. BMI% was calculated. The Achilles tendon was examined using ultrasound tissue characterization (UTC) imaging to capture a three-dimensional structure of four echo-type fibers and a cross-sectional area.Results: A significantly higher percentile of echo-types II, a lower percentile of echo-types III and IV, and a lower cross-sectional area were found for children with normal weight compared with children with overweight/obesity (p < .05). Following a piecewise linear regression model according to tendon structure, a BMI percentile of 75% was found to be the most accurate cutoff point of the children into the "unaffected" (BMI% <75%) and "affected" tendon structure groups (BMI% ≥ 75%), as the children with BMI%≥75% already had an Achilles tendon structure similar to that of the children with overweight/obesity.Conclusions: Tendon integrity as examined with UTC differs between children with obesity and children with normal weight. Children with a BMI percentile of ≥75 already demonstrate a different tendon structure pattern compared with children with BMI percentile of <75. This may put children with obesity at a greater risk of injury and should be addressed when applying an exercise program for children with overweight/obesity.

The effect of placebo on endurance capacity in normal weight children - a randomized trial.

BACKGROUND: The aim of the study was to examine the influence of the placebo effect on the endurance capacity results in normal weight children. METHODS: Twenty-four pre-pubertal normal-weight children aged 6-13 years participated in the study. Subjects underwent anthropometric measurements (weight, height, BMI percentile, and fat percentage), a progressive treadmill exercise test to evaluate endurance capacity, and filled habitual activity questionnaire. The participants were examined twice, in a random order, with each child being compared to him/herself. Different types of information were provided regarding a water drink consumed prior to testing- standard information (water) vs. deliberate positive information (presumed energy drink, placebo). RESULTS: Following the placebo drink, children demonstrated significantly higher peak pulse (177.9 ± 13.6 vs. 189.8 ± 12.2 bpm), higher stage achieved and longer time of exercise to exhaustion (700.1 ± 155.2 vs. 893.3 ± 150.1 s). Although the exercise duration was longer, stage and heart rate achieved were higher, the reported average, and peak rate of perceived exertion (RPE) were significantly lower for the placebo (18.3 ± 1.4 vs 16.2 ± 1.5). Although the effort was higher while drinking placebo (longer run, higher exercise phase, higher heart rate), recovery time was significantly shorter. The reported differences were not associated with order of tests, age, gender or child activity level. CONCLUSION: Our results demonstrate a significant information placebo effect on children's endurance capacity test results. This highlights the possible role of positive information (placebo) in trying to encourage physical activity in children. Whether this effect could be applied to longer-term interventions has yet to be tested. TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT03165604 , Registered May 24, 2017.

Effects of a Program for Improving Biomechanical Characteristics During Walking and Running in Children Who Are Obese.

PURPOSE: To investigate the influence of a weight-reduction program with locomotion-emphasis on improving biomechanical characteristics of children who are obese (OW). METHODS: Ten children who are OW participated in a 6-month multidisciplinary childhood obesity management program (GRP1); another 10 children who are OW participated in the same multidisciplinary childhood obesity management program with additional locomotion-emphasis exercises for improving biomechanical characteristics (GRP2); and 10 control children who are OW with no intervention program. Outcomes were anthropometric measurements and temporal and foot pressure parameters. RESULTS: GRP2 had significantly improved foot pressure in the different walking/running speeds compared with GRP1. In the temporal parameters, pretests by speed by group interactions were significantly improved for GRP2 compared with GRP1. CONCLUSIONS: We found evidence to support beneficial effects of combined dietary and physical activity/locomotion-emphasis exercises on the movement characteristics of children who are OW.

Effect of gender on the GH-IGF-I response to anaerobic exercise in young adults.

Exercise-associated effects on the growth hormone-insulin-like growth factor-I (GH-IGF-I) axis were studied, mainly after aerobic exercise. We determined the gender effect on the GH-IGF-I axis response to a standard all-out Wingate anaerobic test (WAnT) in healthy active young adult men and women (men = 12 and women = 16; age range: 24-34 years). Blood samples for GH and IGF-I, key elements of the GH-IGF-I axis, were collected before and 20, 30, 40, and 60 minutes after the beginning of exercise. In addition, we collected postexercise blood lactate levels. Postexercise lactate levels were higher among men; however, this difference did not reach statistical significance (13.8 ± 1.3 vs. 11.1 ± 1.0 mmol·L, respectively; p = 0.1). The WAnT was associated with a significant increase in GH in both genders. However, GH peak was greater among women (10.8 ± 1.8 vs. 5.6 ± 1.4 ng·ml, in women and men, respectively; p < 0.01). In addition, postexercise GH peak occurred significantly earlier in female (20 minutes) compared with male participants (40 minutes). Exercise was associated with a significant increase in IGF only among men (from 166.8 ± 8.4 to 186.9 ± 9.3; p < 0.02); however, no significant between-gender effect was found. In summary, supramaximal anaerobic exercise was associated with a greater and earlier postexercise GH peak in women compared with men. All together, the results suggest anaerobic exercise-related anabolic-type hormonal response.

The effect of a weight management program on postural balance in obese children.

UNLABELLED: The present study aimed to investigate whether obese children improve their balance and postural performance following a 6-month-weight management program. Twenty-nine obese children aged 6-14 years were examined posturographically before and after participation in weight management program. The interactive balance system evaluated the stability index, Fourier spectral analysis, weight distribution index, and falling index. The performance was evaluated for eight positions requiring closure of eyes, standing on pillows, as well as head turns. Anthropometric measurements (e.g., weight, height, BMI, and BMI percentiles) were also determined before and after the intervention. We found significant increase in height and significant decreased in BMI percentile following the intervention program (p<.05). Pre-intervention BMI percentile was found to be correlated with stability index in most of the positions measured (e.g., normal open position=.464; p=.011). Following the intervention program, an interaction was found between BMI percentile differences (pre- versus post-interventional) and balance (stability index and F2-F4 frequencies of most standing positions). Furthermore, a correlation was found between general stability and the falling index (.446; p=.015). Regression analysis showed that only initial weight distribution index and post-intervention BMI entered the equation as predictors of post-intervention weight distribution index. CONCLUSION: Weight management program for childhood obesity improved stability, reduced potential vestibular stress/disturbances, and decreased falling probability of the participants. Further longitudinal studies are needed to verify the relationship between physical activity, weight loss, and reduction of subsequent injuries in obese children.

Long term effects of a health promotion intervention in low socioeconomic Arab- Israeli kindergartens.

BACKGROUND: Obesity is the most common chronic pediatric disease in westernized, especially low socioeconomic societies. We previously demonstrated the beneficial effects of a randomized prospective school-based health education program for low socioeconomic status Arab-Israeli kindergarten children. METHODS: To examine whether the effects of our program on nutrition and physical activity knowledge and preferences, anthropometric measures, and fitness persisted one year after the end of intervention. RESULTS: At one year following the intervention BMI and BMI percentiles approached baseline level in both the intervention (16.4 ± 0.2 kg/m2 and 61.5 ± 2.4%, respectively) and control group participants (16.5 ± 0.2 kg/m2 and 58.5 ± 3.3%, respectively). Yet, a year after the end of the intervention, the decrease in BMI%ile from baseline was significantly greater in the intervention group (-7.8 ± 1.5 vs. -1.9 ± 1.9, p<0.012). Nutritional and physical activity knowledge and preferences, and physical fitness remained significantly elevated in the intervention compared to the control group participants. CONCLUSIONS: The beneficial effects of a kindergarten dietary-physical activity intervention applied by the kindergarten teachers, on nutrition and physical activity knowledge and preferences, fitness, and BMI percentile were evident one year after the end of intervention. This promising program may play a role in health promotion, prevention and treatment of childhood obesity.

Posturography characteristics of obese children with and without associated disorders.

A group of 59 obese children ages 6-12 years were interviewed for current medical diagnoses (e.g., Attention Deficit Hyperactivity Disorder- ADHD, and clumsiness) and later were examined posturographically for balance and stability. General stability of all the obese children deviated significantly from norms. 32.2% of the obese children had a pattern of balance that could indicate orthopedic problems. Obese children with ADHD or perceived clumsiness had significantly worse balance and postural performance compared to other obese children. Balance and posture among obese children without suspicion of problems were similar to non-obese controls. In conclusion, obese children with associated disorders (such as ADHD and perceived clumsiness) manifested disturbance in balance control. Thus, physical activity interventions for these children should include safety measures to decrease the chances of falling and subsequent injury.

Achilles Tendon and Patellar Tendon Structure in Combat Soldiers Following Prevention Exercises.

INTRODUCTION: Military training that increases physical stress on musculoskeletal morphology also increases the risk of orthopedic injuries. Somatosensory prevention programs that reduce stress and improve functionality could be beneficial for better organization of tendon structure. The aim of this study was to investigate the impact of a somatosensory prevention exercise on the tendon structure (percentage of echo-type fibers; A-P and M-L diameters and cross-sectional area) of the Achilles tendon and patellar tendon among combat soldiers. MATERIALS AND METHODS: These tendons of male Infantry soldiers aged 18-21 were screened before and after a 14-week training course. The intervention group, who performed preventative exercises, included 108 soldiers (BMI = 23.85 ± 2.76), while the control group, who participated in the same military course without these exercises, included 98 soldiers (BMI = 24.26 ± 4.03). Ultrasound scanning for tendon structure included percent of echo-type I-IV fibers, A-P diameter, M-L diameter, and cross-sectional area parameters. RESULTS: Time by group interaction was found for echo-type I and II in both tendons. No significant differences were found between the two groups in the pretesting percentage of echo-type IV fibers of the Achilles tendon (P = .522), in echo-type III fibers of the Achilles tendon (P = .833), and echo-type IV fibers of the patellar tendon (P = .162). Greater pre-post differences in echo-type III and IV fibers were found in the control group compared with the intervention group for both the Achilles tendon (P = .021, P = .002) and the patellar tendon (P < .001, P < .001). CONCLUSION: Increased damaged fibers (echo-type III and IV) of both tendons were found among the control group, yet not among soldiers who performed prevention exercises.

The Influence of a 14-Week Infantry Commanders Courses on the Achilles Tendon and Patellar Tendon Structure.

INTRODUCTION: Alternated tendon structure may raise stress to the musculoskeletal structures and may increase the potential for overuse injury. Screening the tendon structure of soldiers pre- and post-participation in a strenuous combat course is essential. The aim of the present study was to investigate the influence of a 14-week infantry commanders courses on the Achilles tendon (AT) structure and patellar tendon (PT) structure in combat soldiers. MATERIALS AND METHODS: Ninety-eight participants from an infantry commanders course were screened pre- and post-course for the AT and PT structures, using ultrasonographic tissue characterizaton (UTC) imaging to capture a 3D structure of four echo-type fibers (I-IV). RESULTS: In both tendons, the mean relative frequency of echo-type I fibers significantly decreased from pre- to post-testing, with a significant increase in the relative frequency of echo-types II, III, and IV fibers. In the AT, 60.2% of the subjects showed positive differences (between pre- and post-testing in the echo-type III + IV fiber ("worsened" tendon structure), whereas in the PT, 92.2% of the subject showed an increased frequency. No significant correlation (r = 0.108; P = .324) was found between the differences of echo-type III + IV fibers of the AT and that of the PT. CONCLUSIONS: Loads to the musculoskeletal structures along the combat course increased the mean relative frequency of the "reduced" echo-type fibers (III + IV) in both the AT structure and the PT structure. Yet, whereas in the AT around 40% of the soldiers showed an improved tendon structure along the course, in the PT less than 10% of the soldiers showed that improvement. Soldiers and commanders should be aware of the different influence of the loading exercises along the course on the AT and on the PT structure, as "reduced" tendons structure might put the soldiers at higher risk for injury in the future.

Achilles and patellar tendon structure following a prevention program in male combat soldiers.

OBJECTIVES: The aims of the study were to compare the prevalence of soldiers with musculoskeletal symptoms between soldiers that participated in a prevention program (INT) and a control group (CONT); and, to assess whether 'high risk' for a symptom indicator [participants with patellar tendon (PT) echo-type III+IV >10% or Achilles tendon (AT) echo-type III >8.5%] applies when a prevention intervention is used. METHODS: Soldiers from two consecutive infantry commanders courses (year 1-CONT, n = 165; year 2-INT, n = 196) were examined pre-course for AT and PT structure using ultrasound tissue characterization (UTC), and their musculoskeletal overuse symptoms were assessed and recorded by military physicians throughout the course. A prevention program was provided to the INT group (year 2) during the 14-week course. RESULTS: No significant differences were found in the prevalence of soldiers with symptoms between the two groups [INT: 39 (19.9%), CONT: 40 (24.2%); p = .32]. Using the indicator at baseline, 20 soldiers (10.2%) were suggested to be at 'high risk.' Of those 20 soldiers, 17 actually had symptoms during the course (positive predictive value-85%). The prevalence of soldiers with a suggested 'high risk' according to our indicator who had no symptoms during the course was low (3/20, 15%). Twenty-two soldiers who had symptoms during the course had not been suggested to be at 'high risk' by our indicator. CONCLUSION: Our intervention did not reduce the prevalence of soldiers with symptoms. Our 'high risk' pre-course, AT and PT structure indicator is valid and can be used as a screening tool to reduce the prevalence of symptoms in combat soldiers; with the caution that soldiers that were not identified by the indicator, might also have symptoms along the course.