RESUMO
INTRODUCTION: Musculoskeletal injuries (MSKIs) are ubiquitous during initial entry military training, with overuse injuries the most common. A common injury mechanism is running, an activity that is integral to US Coast Guard (USCG) training and a requirement for graduation. The purpose of this study was to assess the effects of a policy that allowed for athletic footwear choice on risk of lower quarter MSKI in USCG recruits. METHODS: A retrospective cohort study was performed that included 1230 recruits (1040 men, 190 women) who trained under a policy that allowed self-selection of athletic footwear and 2951 recruits (2329 men, 622 women) who trained under a policy that mandated use of prescribed uniform athletic shoes and served as controls. Demographic data and physical performance were derived from administrative records. Injury data were abstracted from a medical tracking database. Unadjusted risk calculations and multivariable logistic regression assessing the effects of group, age, sex, height, body mass and 2.4 km run times on MSKI were performed. RESULTS: Ankle-foot, leg, knee and lumbopelvic-hip complex injuries were ubiquitous in both groups (experimental: 13.13 per 1000 person-weeks; control: 11.69 per 1000 person-weeks). Group was not a significant factor for any of the injuries assessed in either the unadjusted or adjusted analysis, despite widespread reports of pain (58.6%), perceived injury attribution (15.7%), perceived deleterious effect on performance (25.3%), general dissatisfaction (46.3%) and intended discontinuance of use following graduation (87.7%). CONCLUSION: MSKI continues to be a major source of morbidity in the recruit training population. The policy that allowed USCG recruits to self-select athletic footwear did not decrease or increase the risk of MSKI. While regulations pertaining to footwear choice did not influence injury outcomes, there was general dissatisfaction with the prescribed uniform athletic footwear conveyed by the recruits and widespread reports of discomfort, perceived deleterious effects from wear and intended discontinued use following training completion.
RESUMO
AIM: To elucidate the hormonal influences on sex differences in knee joint behavior, normal-menstruating females were compared to males on serum hormone levels and anterior knee joint laxity (displacement at 46N, 89N and 133N) and stiffness (Linear slope of deltaForce/deltaDisplacement for 46-89N and 89-133N) across the female menstrual cycle. METHODS: Twenty-two females were tested daily across one complete menstrual cycle, and 20 males were tested once per week for 4 weeks. Five days each representing the hormonal milieu for menses, the initial estrogen rise near ovulation, and the early and late luteal phases (total of 20 days) were compared to the average value obtained from males across their 4 test days. RESULTS: Sex differences in knee laxity were menstrual cycle dependent, coinciding with significant elevations in estradiol levels. Females had greater laxity than males on day 5 of menses, days 3-5 near ovulation, days 1-4 of the early luteal phase and days 1, 2, 4 and 5 of the late luteal phases. Within females, knee laxity was greater on day 5 near ovulation compared to day 3 of menses, and days 1-3 of the early luteal phase compared to all days of menses and day 1 near ovulation. On average, differences observed between sexes were greater than those within females across their cycle. There were no differences in anterior knee stiffness between sexes or within females across days of the menstrual cycle.
