Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study Keele Aches and Pains Study protocol: validity, acceptability, and feasibility of the Keele STarT MSK tool for subgrouping musculoskeletal patients in primary care Effect of pre-accession physical fitness on training injuries among US Army recruits. Risk factors of acute and overuse musculoskeletal injuries among young conscripts: a population-based cohort study Step test performance and risk of stress fractures among female army trainees. Risk factors for bone stress injuries: a follow-up study of 102,515 person-years. The relationship between health-related fitness and quality of life in postmenopausal women from Southern Taiwan Effects of Plyometric Training on Components of Physical Fitness in Prepuberal Male Soccer Athletes: The Role of Surface Instability Identifying the Physical Fitness, Anthropometric and Athletic Movement Qualities Discriminant of Developmental Level in Elite Junior Australian Football: Implications for the Development of Talent Insomnia in a post-acute brain injury sample Integrative neuromuscular training and sex-specific fitness performance in 7-year-old children: an exploratory investigation. Naproxen versus Acetaminophen for Therapy of Soft Tissue Injuries to the Ankle in Children Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study The relationship between pre-season fitness testing and injury in elite junior Australian football players. Effect of individual counseling on physical activity fitness and health: a randomized controlled trial in a workplace setting. Evaluation of an aquatics programme on fitness parameters of individuals with a brain injury Musculoskeletal injuries in British Army recruits: a prospective study of diagnosis-specific incidence and rehabilitation times Relationship of physical fitness to prevalence and incidence of overweight among schoolchildren. Volume of physical activity and injury occurrence in young basketball players. Continued Significant Effect of Physical Training as Treatment for Overuse Injury The Use of an 8-Week Mixed-Intensity Interval Endurance-Training Program Improves the Aerobic Fitness of Female Soccer Players Effect of a general fitness program on musculoskeletal symptoms, clinical status, physiological capacity, and perceived work environment among home care service personnel
Objective To identify potentially effective complementary approaches for musculoskeletal (MSK)–mental health ( MH ) comorbidity , by synthesis ing evidence on effectiveness , cost-effectiveness and safety from systematic review s ( SRs ) . Design Scoping review of SRs . Methods We search ed literature data bases , registries and reference lists , and contacted key authors and professional organisations to identify SRs of r and omised controlled trials for complementary medicine for MSK or MH . Inclusion criteria were : published after 2004 , study ing adults , in English and scoring > 50 % on Assessing the Method ological Quality of Systematic Review s ( AMSTAR ) ; quality appraisal checklist ) . SRs were synthesis ed to identify research priorities , based on moderate/good quality evidence , sample size and indication of cost-effectiveness and safety . Results We included 84 MSK SRs and 27 MH SRs . Only one focused on MSK – MH comorbidity . Meditative approaches and yoga may improve MH outcomes in MSK population s. Yoga and tai chi had moderate/good evidence for MSK and MH conditions . SRs reported moderate/good quality evidence ( any comparator ) in a moderate/large population for :  low back pain ( LBP )  ( yoga , acupuncture , spinal manipulation/mobilisation , osteopathy ) , osteoarthritis ( OA ) ( acupuncture , tai chi ) , neck pain  ( acupuncture , manipulation/manual therapy ) , myofascial trigger point pain ( acupuncture ) , depression ( mindfulness-based stress reduction ( MBSR ) , meditation , tai chi , relaxation ) , anxiety ( meditation/MBSR , moving meditation , yoga ) , sleep disorders ( meditative/mind – body movement ) and stress/distress ( mindfulness ) . The majority of these complementary approaches had some evidence of safety — only three had evidence of harm . There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP , and manual therapy/manipulation for neck pain , but few SRs review ed cost-effectiveness and many found no data . Conclusions Only one SR studied MSK – MH comorbidity . Research priorities for complementary medicine for both MSK and MH ( LBP , OA , depression , anxiety and sleep problems ) are yoga , mindfulness and tai chi . Despite the large number of SRs and the prevalence of comorbidity , more high- quality , large r and omised controlled trials in comorbid population s are needed Background Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy . Underst and ing intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness . Findings from this population may also be useful as hypothesis-generating work for particular civilian setting s such as law enforcement officers ( SWAT teams ) , firefighters ( smoke jumpers ) , or others in physically dem and ing professions . Questions / purpose sThe purpose s of this study were ( 1 ) to examine whether using baseline measures of self-report and physical performance can identify musculoskeletal injury risk ; and ( 2 ) to determine whether a combination of predictors would enhance the accuracy for determining future musculoskeletal injury risk in US Army Rangers . Methods Our study was a planned secondary analysis from a prospect i ve cohort examining how baseline factors predict musculoskeletal injury . Baseline predictors associated with musculoskeletal injury were collected using surveys and physical performance measures . Survey data included demographic variables , injury history , and biopsychosocial questions . Physical performance measures included  ankle dorsiflexion , Functional Movement Screen , lower and upper quarter Y-balance test , hop testing , pain provocation , and the Army Physical Fitness Test ( consisting of a 2-mile run and 2 minutes of sit-ups and push-ups ) . A total of 320 Rangers were invited to enroll and 211 participated ( 66 % ) . Occurrence of musculoskeletal injury was tracked for 1 year using monthly injury surveillance surveys , medical record review s , and a query of the Department of Defense healthcare utilization data base . Injury surveillance data were available on 100 % of the subjects . Receiver operator characteristic curves and accuracy statistics were calculated to identify predictors of interest . A logistic regression equation was then calculated to find the most pertinent set of predictors . Of the 188 Rangers ( age , 23.3 ± 3.7 years ; body mass index , 26.0 ± 2.4 kg/m2 ) remaining in the cohort , 85 ( 45.2 % ) sustained a musculoskeletal injury of interest .  Results Smoking , prior surgery , recurrent prior musculoskeletal injury , limited-duty days in the prior year for musculoskeletal injury , asymmetrical ankle dorsiflexion , pain with Functional Movement Screen clearing tests , and decreased performance on the 2-mile run and 2-minute sit-up test were associated with increased injury risk . Presenting with one or fewer predictors result ed in a sensitivity of 0.90 ( 95 % confidence interval [ CI ] , 0.83–0.95 ) , and having three or more predictors result ed in a specificity of 0.98 ( 95 % CI , 0.93–0.99 ) . The combined factors that contribute to the final multivariable logistic regression equation yielded an odds ratio of 4.3 ( 95 % CI , 2.0–9.2 ) , relative risk of 1.9 ( 95 % CI , 1.4–2.6 ) , and an area under the curve of 0.64 . Conclusions Multiple factors ( musculoskeletal injury history , smoking , pain provocation , movement tests , and lower scores on physical performance measures ) were associated with individuals at risk for musculoskeletal injury . The summation of the number of risk factors produced a highly sensitive ( one or less factor ) and specific ( three or more factors ) model that could potentially be used to effectively identify and intervene in those persons with elevated risk for musculoskeletal injury . Future research should establish if screening and intervening can improve musculoskeletal health and if our findings among US Army Rangers translate to other occupations or athletes . Level of Evidence Level II , prognostic study Musculoskeletal conditions represent a considerable burden worldwide , and are predominantly managed in primary care . Evidence suggests that many musculoskeletal conditions share similar prognostic factors . Systematic ally assessing patient ’s prognosis and matching treatments based on prognostic subgroups ( stratified care ) has been shown to be both clinical ly effective and cost-effective . This study ( Keele Aches and Pains Study ) aims to refine and examine the validity of a brief question naire ( Keele STarT MSK tool ) design ed to enable risk stratification of primary care patients with the five most common musculoskeletal pain presentations . We also describe the subgroups of patients , and explore the acceptability and feasibility of using the tool and how the tool is best implemented in clinical practice . The study design is mixed methods : a prospect i ve , quantitative observational cohort study with a linked qualitative focus group and interview study . Patients who have consulted their GP or health care practitioner about a relevant musculoskeletal condition will be recruited from general practice . Participating patients will complete a baseline question naire ( shortly after consultation ) , plus question naires 2 and 6 months later . A sub sample of patients , along with participating GPs and health care practitioners , will be invited to take part in qualitative focus groups and interviews . The Keele STarT MSK tool will be refined based on face , discriminant , construct , and predictive validity at baseline and 2 months , and vali date d using data from 6-month follow-up . Patient and clinician perspectives about using the tool will be explored . This study will provide a vali date d prognostic tool ( Keele STarT MSK ) with established cutoff points to stratify patients with the five most common musculoskeletal presentations into low- , medium- , and high-risk subgroups . The qualitative analysis of patient and health care perspectives will inform practitioners on how to embed the tool into clinical practice using established general practice IT systems and clinician-support packages OBJECTIVE To evaluate the association of pre-accession physical fitness , as measured by a five-minute step test , with incidence of overuse injuries and outpatient healthcare utilization among male United States ( US ) Army recruits . PARTICIPANTS US Army male trainees who met weight st and ards and took a pre-accession fitness test .  METHODS In this prospect i ve cohort study , incidence and outpatient healthcare visits for overuse injuries during the first 90 days of military service were compared between recruits who failed the pre-accession step test with those who passed . RESULTS The hazard rate ratio for injury among recruits who failed the fitness test compared to those who passed the test was 1.31 ( 95 % C.I = 1.20 - 1.44 ) . Among the subset of recruits with at least one medical encounter for an overuse injury , the utilization rate ratio for subjects who failed the fitness test versus those who passed was 1.15 ( 95 % C.I = 1.09 - 1.22 ) . Other factors associated with increased risk of injury or healthcare utilization include age , body mass index , and smoking history . CONCLUSIONS Risk of injury and utilization were associated with fitness test results . These findings may have implication s for military accession and training policy as well as for other physically dem and ing training programs such as police , fire fighters and athletes Background Military service in Finl and is compulsory for all male citizens and annually about 80 % of 19-year-old men enter into the service . The elevated risk for many chronic diseases and loss of function among those who are inactive and unfit can be often detected already in youth . On the other h and , activity-induced injuries among young are true public health issue . The purpose of the present prospect i ve cohort follow-up study was to evaluate predictive associations between acute or overuse injuries and their various intrinsic risk factors . Methods Four successive cohorts of conscripts who formed a representative sample of Finnish young men were followed for 6 months . At the beginning of the service , the risk factors of injuries were measured and recorded and then the acute and overuse injuries treated at the garrison clinic were identified . Predictive associations between injuries and their risk factors were examined by multivariate Cox ’s proportional hazard models . Results Of the 1411 participants , 27 % sustained an acute injury and 51 % suffered from overuse injury . Concerning acute injuries , highest risk for severe injuries were detected among conscripts with low fitness level in both the st and ing long-jump and push-up tests ( hazard rate , HR=5.9 ; 95 % CI : 1.6‒21.3 ) . A history of good degree in school sports was not a protective factor against acute injuries . High waist circumference and , on the other h and , being underweight according to BMI increased the HR for overuse injuries . Brisk leisure time physical activity before military entry was a protective factor against overuse injuries . Poor result in Cooper ’s test was a warning signal of elevated risk of overuse injuries . Conclusion We confirmed previous findings that low level of physical fitness is predictor for musculoskeletal injuries during intensive physical training . The U-shaped relationship between body composition and overuse injuries was noticed indicating that both obesity and underweight are risk factors for overuse injuries . Persons with excellent sports skills according to their earlier degrees in school sports had similar HR for acute injuries than those with poorer degrees . This indicates that school-age sports skills and fitness do not carry far and therefore preventive programmes are needed to prevent activity-induced injuries BACKGROUND Stress fractures and other musculoskeletal injuries are major sources of morbidity among female military trainees . Several risk factors have been postulated , particularly pre-existing fitness , usually assessed with post-entry run time for ≥ 1.0 mile . PURPOSE Physical fitness is not formally evaluated prior to Army entry . If a valid and simple test that identified women at increased risk of stress fracture were available and could be applied prior to entry , it would facilitate cost-benefit studies of deferral or interventions . These analyses were undertaken to determine if a 5-minute step test conducted before entry identified women at increased risk . METHODS A prospect i ve study was conducted of weight-qualified women entering the Army in 2005 - 2006 , with analyses completed in 2011 . At the pre-entry examination , information was collected on age , BMI , smoking , race , and activity level . Everyone took the step test . All outpatient medical encounters were captured , and stress fractures and other musculoskeletal injuries identified . Women with stress fractures and those with other musculoskeletal injuries were evaluated separately . RESULTS 1568 women were included in the study ; 109 developed stress fractures and 803 other musculoskeletal injury . Women who failed the step test had a 76 % higher stress fracture incidence and a 35 % higher incidence of other musculoskeletal injuries . There was effect modification between age and test failure for stress fracture . CONCLUSIONS A step test that can be administered before military entry identifies women with increased incidence of stress fracture and other musculoskeletal injury . This test could be used pre-entry to defer or target high-risk recruits for tailored fitness training before or after military entrance PURPOSE The aim of the present study was to assess the risk factors for magnetic resonance imaging (MRI)-detected bone stress injuries in the pelvis , hip , thigh , and knee in a large cohort of Finnish conscripts during a follow-up of 102,515 person-years . METHODS An epidemiologic prospect i ve cohort study of 152,095 conscripts , including 2345 ( 1.5 % ) females , was conducted . Localized pain in the pelvis , hip , thigh , or knee result ed in an orthopedic surgeon 's consultation and subsequent MRI examination at the Central Military Hospital , Helsinki , Finl and . Risk factors were systematic ally collected from 1998 to 2004 , including data on conscripts ' physical fitness and body composition measured at the beginning of their military service . RESULTS Altogether , 319 MRI-detected bone stress injuries of the pelvis , hip , thigh , or knee were identified in our cohort ; thus , the incidence was 311 ( 95 % CI : 277 - 345 ) per 100,000 person-years . The female : male ratio varied substantially , depending on the anatomic location of the injury ; it was highest for sacral injuries ( female : male ratio = 51.1 ) and lowest for injuries of the femoral condyle ( female : male ratio = 0.8 ) . In univariate Cox regression analysis , poor muscle strength and a poor result in a 12-min run were significantly associated with bone stress injuries . In multivariable analysis , the strongest risk factors for bone stress injuries were female gender ( hazard ratio 8.2 ; 95 % CI : 4.8 - 14.2 ) and higher age ( hazard ratio 2.1 ; 95 % CI : 1.4 - 3.1 ) . CONCLUSIONS Female military trainees have a highly increased risk of bone stress injuries of the pelvis and hip compared with male conscripts . Sacral stress fractures are typical bone stress injuries in female military recruits . Physicians should remember the possibility of bone stress injury , especially when examining stress-related pain symptoms of the pelvic area in physically active young adult females Background Health-related fitness has been reported to be associated with improved quality of life ( QoL ) in the elderly . Health-related fitness is comprised of several dimensions that could be enhanced by specific training regimens . It has remained unclear how various dimensions of health-related fitness interact with QoL in postmenopausal women . Objective The purpose of the current study was to investigate the relationship between the dimensions of health-related fitness and QoL in elderly women . Methods A cohort of 408 postmenopausal women in a rural area of Taiwan was prospect ively collected . Dimensions of health-related fitness , consisting of muscular strength , balance , cardiorespiratory endurance , flexibility , muscle endurance , and agility , were assessed .  QoL  was determined using the Short Form Health Survey ( SF-36 ) . Differences between age groups ( stratified by decades ) were calculated using a one-way analysis of variance ( ANOVA ) and multiple comparisons using a Scheffé test . A Spearman ’s correlation analysis was performed to examine differences between QoL and each dimension of fitness . Multiple linear regression with forced-entry procedure was performed to evaluate the effects of health-related fitness . A P-value of < 0.05 was considered statistically significant . Results Age-related decreases in health-related fitness were shown for sit-ups , back strength , grip strength , side steps , trunk extension , and agility ( P<0.05 ) . An age-related decrease in QoL , specifically in physical functioning , role limitation due to physical problems , and physical component score , was also demonstrated ( P<0.05 ) . Multiple linear regression analyses demonstrated that back strength significantly contributed to the physical component of QoL ( adjusted beta of 0.268 [ P<0.05 ] ) . Conclusion Back strength was positively correlated with the physical component of QoL among the examined dimensions of health-related fitness . Health-related fitness , as well as the physical component of QoL , declined with increasing age Abstract Negra , Y , Chaabene , H , Sammoud , S , Bouguezzi , R , Mkaouer , B , Hachana , Y , and Granacher , U. Effects of plyometric training on components of physical fitness in prepuberal male soccer athletes : the role of surface instability . J Strength Cond Res 31(12 ) : 3295–3304 , 2017—Previous studies contrasted the effects of plyometric training ( PT ) conducted on stable vs. unstable surfaces on components of physical fitness in child and adolescent soccer players . Depending on the training modality ( stable vs. unstable ) , specific performance improvements were found for jump ( stable PT ) and balance performances ( unstable PT ) . In an attempt to combine the effects of both training modalities , this study examined the effects of PT on stable surfaces compared with combined PT on stable and unstable surfaces on components of physical fitness in prepuberal male soccer athletes . Thirty-three boys were r and omly assigned to either a PT on stable surfaces ( PTS ; n = 17 ; age = 12.1 ± 0.5 years ; height = 151.6 ± 5.7 cm ; body mass = 39.2 ± 6.5 kg ; and maturity offset = −2.3 ± 0.5 years ) or a combined PT on stable and unstable surfaces ( PTC ; n = 16 ; age = 12.2 ± 0.6 years ; height = 154.6 ± 8.1 cm ; body mass = 38.7 ± 5.0 kg ; and maturity offset = −2.2 ± 0.6 years ) . Both intervention groups conducted 4 soccer-specific training sessions per week combined with either 2 PTS or PTC sessions . Before and after 8 weeks of training , proxies of muscle power ( e.g. , countermovement jump [ CMJ ] , st and ing long jump [ SLJ ] ) , muscle strength ( e.g. , reactive strength index [ RSI ] ) , speed ( e.g. , 20-m sprint test ) , agility ( e.g. , modified Illinois change of direction test [ MICODT ] ) , static balance ( e.g. , stable stork balance test [ SSBT ] ) , and dynamic balance ( unstable stork balance test [ USBT ] ) were tested . An analysis of covariance model was used to test between-group differences ( PTS vs. PTC ) at posttest using baseline outcomes as covariates . No significant between-group differences at posttest were observed for CMJ ( p > 0.05 , d = 0.41 ) , SLJ ( p > 0.05 , d = 0.36 ) , RSI ( p > 0.05 , d = 0.57 ) , 20-m sprint test ( p > 0.05 , d = 0.06 ) , MICODT ( p > 0.05 , d = 0.23 ) , and SSBT ( p > 0.05 , d = 0.20 ) . However , statistically significant between-group differences at posttest were noted for the USBT ( p < 0.01 , d = 1.49 ) in favor of the PTC group . For most physical fitness tests ( except RSI ) , significant pre-to-post improvements were observed for both groups ( p < 0.01 , d = 0.55–3.96 ) . Eight weeks of PTS or PTC result ed in similar performance improvements in components of physical fitness except for dynamic balance . From a performance-enhancing perspective , PTC is recommended for pediatric strength and conditioning coaches because it produced comparable training effects as PTS on proxies of muscle power , muscle strength , speed , agility , static balance , and additional effects on dynamic balance Abstract Gaudion , SL , Doma , K , Sinclair , W , Banyard , HG , and Woods , CT . Identifying the physical fitness , anthropometric and athletic movement qualities discriminant of developmental level in elite junior Australian football : implication s for the development of talent . J Strength Cond Res 31(7 ) : 1830–1839 , 2017—This study aim ed to identify the physical fitness , anthropometric and athletic movement qualities discriminant of developmental level in elite junior Australian football ( AF ) . From a total of 77 players , 2 groups were defined according to their developmental level ; under 16 ( U16 ) ( n = 40 , 15.6 to 15.9 years ) , and U18 ( n = 37 , 17.1 to 17.9 years ) . Players performed a test battery consisting of 7 physical fitness assessment s , 2 anthropometric measurements , and a fundamental athletic movement assessment . A multivariate analysis of variance tested the main effect of developmental level ( 2 levels : U16 and U18 ) on the assessment criterions , whilst binary logistic regression models and receiver operating characteristic ( ROC ) curves were built to identify the qualities most discriminant of developmental level . A significant effect of developmental level was evident on 9 of the assessment s ( d = 0.27–0.88 ; p ⩽ 0.05 ) . However , it was a combination of body mass , dynamic vertical jump height ( nondominant leg ) , repeat sprint time , and the score on the 20-m multistage fitness test that provided the greatest association with developmental level ( Akaike 's information criterion = 80.84 ) . The ROC curve was maximized with a combined score of 180.7 , successfully discriminating 89 and 60 % of the U18 and U16 players , respectively ( area under the curve = 79.3 % ) . These results indicate that there are distinctive physical fitness and anthropometric qualities discriminant of developmental level within the junior AF talent pathway . Coaches should consider these differences when design ing training interventions at the U16 level to assist with the development of prospect i ve U18 AF players Objective : The purpose was to establish the frequency of insomnia within the post-acute TBI population and compare it with insomnia rates among other rehabilitation out patients . Design : A prospect i ve study was undertaken of 50 consecutive post-acute TBI admissions and a comparison group of 50 rehabilitation out patients evenly divided between spinal cord injury ( SCI ) and musculoskeletal ( MSK ) cases . Setting : Subjects were recruited at various outpatient clinics of a major rehabilitation hospital . Patients : Among the TBI subjects , the predominant cause of injury was motor vehicle accident ; both mild and severe injuries were well represented in the sample ; and , on average , patients were almost 4 months post-injury . The comparison and TBI groups did not differ significantly with respect to education or marital status . However , the MSK group was older and a higher proportion of the SCI group was female . Measures : The Pittsburgh Sleep Quality Index ( PSQI ) , Beck Depression Inventory ( BDI ) , and sleep diaries  were administered to the TBI group . Only the PSQI and BDI were completed by the comparison group . Results : Thirty per cent of the patients were found to suffer from insomnia . Sleep initiation was a problem almost twice as often as sleep duration . An additional 12 % did not meet the DSM-IV criteria for insomnia but , nevertheless , experienced a degradation of sleep quality , as measured by the PSQI . Conversely , only slightly more than half ( 58 % ) of the TBI sample reported sleep to be relatively normal and satisfactory . Insomnia was also commonly reported by the patients in the rehabilitation comparison groups . They generated significantly higher mean PSQI Global Scores relative to the TBI group and the frequency of poor sleep quality was elevated significantly above the TBI rate . Relative to the TBI cases , twice as many comparison group patients were classified by the PSQI as insomniacs . Conclusion : Poor sleep quality and insomnia were definitely problems for the TBI group , although the magnitude of these problems was much greater for the rehabilitation comparison group . De grade d and disordered sleep may represent widespread challenges within the rehabilitation population in general CONTEXT Integrative neuromuscular training ( INT ) has successfully enhanced physical fitness and reduced abnormal biomechanics , which appear to decrease injury rates in adolescent female athletes . If not addressed at the proper time , low levels of physical fitness and abnormal mechanics may predispose female athletes to an increased risk of musculoskeletal injuries . OBJECTIVES To evaluate sex-specific effects of INT on selected measures of health- and skill-related fitness in children during physical education ( PE ) . DESIGN Cohort study . SETTING Public primary school . PATIENTS OR OTHER PARTICIPANTS Forty children ( 16 boys , 24 girls ; age = 7.6 ± 0.3 years , height = 124.5 ± 6.4 cm , mass = 29.5 ± 7.6 kg ) from 2 second- grade PE classes . INTERVENTION(S ) The classes were r and omized into the PE-plus-INT group ( 10 boys , 11 girls ) or the control group ( 6 boys , 13 girls ) that participated in traditional PE . The INT was performed 2 times per week during the first approximately 15 minutes of each PE class and consisted of body weight exercises . MAIN OUTCOME MEASURE(S ) Push-up , curl-up , st and ing long jump , single-legged hop , single-legged balance , sit- and -reach flexibility test , shuttle run , and 0.8-km run . RESULTS At baseline , the boys demonstrated higher levels of performance in most of the fitness measurements as evidence d by greater performance on the push-up , st and ing long jump , single-legged hop , shuttle run , and 0.8-km run ( P < .05 ) . In the evaluation of the training effects , we found intervention effects in the girls for  enhanced INT-induced gains in performance relative to the control group on the curl-up , long jump , single-legged hop , and 0.8-km run ( P < .05 ) after controlling for baseline . Boys did not demonstrate similar adaptations from the INT program ( P ≥ .05 ) . CONCLUSIONS These data indicate that INT is an effective and time-efficient  addition to PE for enhancing motor skills and promoting physical activity in children . Seven-year-old girls appeared to be more sensitive to the effects of INT than 7-year-old boys . Future research is warranted to confirm these effects in larger cohorts of children Background : Musculoskeletal ( MSK ) ankle injuries cause significant morbidity in ambulatory pediatric population s. No optimal pharmacotherapy is available . Objective : To conduct a r and omized , double-blind trial to compare 2 drug therapies for soft tissue injury of the ankle . Methods : Patients ( N = 77 , aged 8–14 y , 61 % male ) with ankle injuries presenting to a regional pediatric emergency department were assigned to receive either acetaminophen ( 15 mg/kg 4 times a day ) or naproxen ( 5 mg/kg 4 times a day ) in a double-blind fashion on a routine basis for a 5 day period . On days 0 and 7 , patients rated their degree of disability and pain on weight bearing using a 10 cm visual analog scale developed for this study . In addition , they were examined by a physician who rated pain , tenderness on palpation , and swelling using a 4 point scale . There were 3 follow-up telephone calls on days 3 , 14 , and 21 . Adherence was evaluated by self-report and pill count . Results : Both the acetaminophen and naproxen groups had significant improvement in degree of disability and pain from day 0 to day 7 . There was no statistically significant difference in outcome between the 2 groups by patient self-evaluation or physician assessment . There also was no significant difference in adverse event rates between the 2 groups , and the majority of patients in both groups felt that the medication was helpful . Conclusions : No significant difference in efficacy of pain control or improvement of disability between the naproxen and acetaminophen groups suggests no preferential advantage for naproxen over acetaminophen for MSK injuries when given on a regular basis , with concurrent supportive treatment . Possible differential benefit from intermittent therapy needs to be evaluated among children with ankle injury Background The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden . The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service . Methods The trial design was a population -based , r and omised study . Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospect ively for one 6-month term to determine the baseline incidence of injury . After this period , two new successive cohorts in the same four companies were r and omised into two groups and followed prospect ively for 6 months . Military service is compulsory for about 90 % of 19-year-old Finnish men annually , who comprised the cohort in this study . This r and omised , controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group .  A neuromuscular training programme was used to enhance conscripts ' motor skills and body control , and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries . The main outcome measures were acute injuries of the lower and upper limbs . Results In the intervention groups , the risk for acute ankle injury decreased significantly compared to control groups ( adjusted hazards ratio ( HR ) = 0.34 , 95 % confidence interval ( 95 % CI ) = 0.15 to 0.78 , P = 0.011 ) . This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels . In the latter group of conscripts , the risk of upper-extremity injuries also decreased significantly ( adjusted HR = 0.37 , 95 % CI 0.14 to 0.99 , P = 0.047 ) . In addition , the intervention groups tended to have less time loss due to injuries ( adjusted HR = 0.55 , 95 % CI 0.29 to 1.04 ) . Conclusions A neuromuscular training and injury prevention counselling programme was effective in preventing acute ankle and upper-extremity injuries in young male army conscripts . A similar programme could be useful for all young individuals by initiating a regular exercise routine . Trial registration Clinical Trials.gov identifier number NCT00595816 OBJECTIVES Australian Football ( AF ) is a collision sport containing high injury rates in junior competition . Successful performance at the elite junior level not only requires superior specific football knowledge and skills , but also well developed fitness qualities . However , no studies have examined the link between physical fitness qualities and injury in AF . DESIGN Prospect i ve cohort . METHODS Injury data were collected through the use of a Player Movement Record ( PMR ) and a st and ardized Injury Report Form ( IRF ) . Fitness test data was collected during the pre-season of the 2010 and 2011 seasons . RESULTS 382 players consented to participate in the study . The cohort experienced an injury incidence rate of 24.29/st and ardized club ( 40 players/club ) . A faster 5-m sprint was associated with ' injury status ' ( p=0.016 ) and a ' knee ' region ( p≤0.001 ) injury . A faster planned agility score was associated with an increased risk of a ' hip/groin/thigh ' region ( p=0.010 ) injury , and specifically a ' quadriceps strain ' ( p=0.005 ) . A lower 20-m shuttle run was associated with an increased risk of a ' shin/ankle/foot ' ( p=0.045 ) injury . Increased injury severity was associated with a higher left foot running vertical jump ( VJ ) ( p=0.040 ) , and faster 5-m sprint ( p=0.043 ) . CONCLUSIONS Lower aerobic endurance , faster 5-m acceleration and greater planned agility were associated with an increased risk of various injury types in elite junior AF players . Furthermore , a higher left foot running VJ and faster 5-m acceleration were associated with injury severity . These results may largely relate to a greater work capacity placing a higher load upon the musculoskeletal system in contact and non-contact situations BACKGROUND Physical inactivity and obesity are major public health problems . Our objective was to investigate the effectiveness of an individual counseling intervention at the workplace on physical activity fitness and health . Counseling content derived from the Patient-centered Assessment and Counseling for Exercise and Nutrition ( PACE ) program . METHODS A total of 299 employees of three municipal services in the Dutch town of Enschede were r and omly allocated into intervention ( n = 131 ) and control group ( n = 168 ) . Over a 9-month period , intervention group subjects were offered seven counseling sessions . Counseling was based on the individual 's stage of behavioral change using PACE physical activity and nutrition protocol s. Subjects in both the intervention and control group received written information about several lifestyle factors . Primary outcome measures were physical activity ( total energy expenditure , during sports activities , during physical activity leisure time other than sports , and meeting the moderate-intensity public health recommendations ) ; cardiorespiratory fitness ; and prevalence of musculoskeletal symptoms . Secondary outcome measures were body composition ( body mass index [ BMI ] , and percentage of body fat measured via skinfold thicknesses ) ; blood pressure ; and blood cholesterol . RESULTS There were significant positive effects on total energy expenditure , physical activity during sports , cardiorespiratory fitness , percentage of body fat , and blood cholesterol . No effects were found for the proportion of subjects meeting the public health recommendation of moderate-intensity physical activity , physical activity during leisure time other than sports , prevalence of musculoskeletal symptoms , body mass index , and blood pressure . CONCLUSIONS Individual face-to-face counseling at the workplace based on PACE protocol s positively influenced physical activity levels and some components of physical fitness . The implementation of workplace counseling programs for individuals should therefore be promoted The primary objective was to determine the effect of an aquatic exercise programme on the physical fitness of people with a brain injury . A pre-test – post-test r and omized-groups design was conducted . Sixteen out patients with a brain injury were included in the study . Eight participants were assigned to an aquatic exercise group and eight to a control group . The components of physical fitness measured included cardiovascular endurance , body composition , muscular strength and endurance and flexibility . Measurements were taken pre- and post-programme . Results indicated an increase in components of physical fitness for the experimental group but not the control group . Increases in fitness were reported as having a positive impact on the functional capacity of individuals in the exercise group as well as enhancing the individual 's ability to complete activities of daily living successfully . Results indicate that aquatic exercise may positively impact the primary and secondary physical injuries caused by a brain injury Background Musculoskeletal injuries during initial military training are a significant medical problem facing military organisations globally . In order to develop an injury management programme , this study aims to quantify the incidence and rehabilitation times for injury specific diagnoses . Methods This was a prospect i ve follow-up study of musculoskeletal injuries in 6608 British Army recruits during a 26-week initial military training programme over a 2-year period .  Incidence and rehabilitation times for injury specific diagnoses were recorded and analysed . Results During the study period the overall incidence of musculoskeletal injuries was 48.6 % , and the most common diagnosis was iliotibial b and syndrome ( 6.2 % ) . A significant proportion of the injuries occurred during the first 11 weeks of the programme . The longest rehabilitation times were for stress fractures of the femur , calcaneus and tibia ( 116 ± 17 days , 92 ± 12 days , and 85 ± 11 days , respectively ) . The combination of high incidence and lengthy rehabilitation indicates that medial tibial stress syndrome had the greatest impact on training , accounting for almost 20 % of all days spent in rehabilitation . Conclusion When setting prevention priorities consideration should be given to both the incidence of specific injury diagnoses and their associated time to recovery OBJECTIVES We examined the relationship between comprehensive fitness tests and overweight using a school surveillance system in a racially diverse city in the United States . RESEARCH METHODS AND PROCEDURES Trained physical education teachers  measured weight , height , and fitness annually from 2001 to 2003 . We compiled data for a cross-sectional analysis ( 11,845 measurements on 6297 students , 5 to 14 years of age ) and a 1-year prospect i ve analysis ( 4215 measurements on 2927 students not overweight at baseline , 5 to 13 years of age ) . Overweight was defined as a BMI > or = 95th percentile ( Centers for Disease Control and Prevention 2000 growth charts ) , and underfit was defined as failing at least one of five fitness tests : endurance run , abdominal strength , flexibility , upper body strength , and agility ( Amateur Athletic Union and Fitnessgram ) . Associations between fitness and overweight were examined using multivariate logistic regression models , adjusting for sociodemographic status and repeated measurements over time . RESULTS The mean number of fitness tests passed was lower among students with a BMI above the 80th percentile . Overweight incidence over 1 year was 7 % and 2 % for underfit and fit girls , respectively ( odds ratio , 3.3 ; 95 % confidence interval , 2.0 to 5.6 ) . Not passing either the endurance run or upper body strength test was associated with overweight incidence in both boys and girls . After adjusting for baseline BMI , the endurance run remained a significant predictor of incident overweight among girls ( odds ratio , 2.0 ; 95 % confidence interval , 1.1 to 3.5 ) . DISCUSSION Findings support a cross-sectional inverse relationship between physical fitness and  overweight among school-aged children . The direction of causation between fitness and overweight is not clearly established and merits further study Participation in organised , competitive physical activity by young athletes is increasing rapidly . This is concurrent with an increase in sporting injuries in the young population . This pilot study aim ed to compare the weekly volume and types of physical activity in young basketball players injured and not injured during the season . Detailed physical activity and injury data were prospect ively collected in 46 school-level basketball players aged 14 to 18 years . Participants completed physical activity logs which documented the type of physical activity undertaken , what the activity consisted of ( i.e. training , competition ) and the level at which it was played on a daily basis . Allied health staff completed a weekly injury form . Results showed that injured and uninjured athletes participated in a similar volume of total weekly physical activity over the season . However , injured athletes ( p = 0.04 ) and athletes who specifically sustained overuse injuries ( p = 0.01 ) participated in a greater amount of basketball refereeing than uninjured athletes . Based on these findings it was concluded that greater participation in running-type physical activity such as refereeing , as an addition to training and competition , may predispose the young basketball player to increased injury risk . Future research using larger sample sizes are required to further investigate the role of participation volume and type on injury occurrence in adolescent athletes . Key pointsBasketball players participating in larger amounts of running-type physical activity , in addition to regular training and competition , may be predisposed to overuse injuryFuture studies using larger sample sizes are required to investigate the precise volumes of physical activity that increase injury riskThis would assist in the development of participation guidelines to decrease the current injury rates observed in the young athletic population Background : The treatment of exercise-related injuries is often a problem , and recurrent injuries are common . Two recent systematic review s found only one high- quality paper on the treatment of long-st and ing groin pain .  In this r and omized clinical trial , a training program including strength training result ed in a return of 79 % of the athletes to the previous level of sport without any groin pain . The long-term effect of this exercise program was evaluated . Hypothesis : The effect of the exercise program for adductor-related groin pain is long lasting . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Forty-seven ( 80 % ) of the 59 original participants of the study agreed to participate in this 8- to 12-year follow-up . They were all interviewed and examined using a st and ardized and reproducible protocol , identical to the one used in the original trial . The investigating physician ( P.N. ) was not involved in the original study and was unaware of the original treatment allocation . Results : A significant effect of the active training treatment  still existed for the whole group ( P = .047 ) and even more for the subgroup of 39 ( 83 % ) soccer players ( P = .012 ) . No significant differences were found regarding age , present sports activity , reasons for activity reduction , or time to follow-up . Conclusion : The beneficial short-term effect of the exercise program used in the primary r and omized clinical trial for treating long-st and ing adductor-related groin pain in athletes was found to be lasting , both for the whole group and even more for the large subgroup of soccer players . This is the first time an exercise treatment for overuse injuries to the musculoskeletal system has been shown to have a long-lasting effect ( 8 - 12 years ) Clark , JE . The use of an 8-week mixed-intensity interval endurance-training program improves the aerobic fitness of female soccer players . J Strength Cond Res 24(7 ) : 1773 - 1781 , 2010-The purpose of this study is to examine improvements in cardiorespiratory fitness ( & OV0312;o2 ) after the use of a mixed-intensity interval endurance-training ( MI-ET ) program in female soccer players , to vali date the MI-ET program as an appropriate training regimen to improve cardiorespiratory fitness ( & OV0312;o2 ) in soccer players . 32 female soccer players ( average 18.66 ± 0.31 years ) were recruited from a group of currently conditioning local U-19 and college soccer teams and r and omly assigned to participate in an 8-week periodized training program that involved either the MI-ET program or the continuation of a current endurance-training ( ET ) program . Analysis of variance indicates no differences in & OV0312;o2 values within the group of athletes before participating in the exercise program . After the 8 weeks of training , the MI-ET group of athletes had significantly greater average & OV0312;o2 values ( 62.13 ± 0.96 ml O2·kg−1·min−1 vs. 57.27 ± 1.59 ml O2·kg−1·min−1 ) , p = 0.015 , along with a greater group average of change in & OV0312;o2 ( 12.44 ± 0.92 ml O2·kg−1·min−1 vs. 7.72 ± 0.99 ml O2·kg−1·min−1 ) , p < 0.001 . The MI-ET program is shown to be a valid means to improve aerobic fitness as indicated by the MI-ET group exhibiting significantly greater & OV0312;o2 measures after training The aim of the present controlled study was to evaluate the effect of a general fitness program , performed by an occupational health service , using pre-post assessment for a number of different outcome measures . A total of 160 employees working in the central home care service district of Umeå , Sweden were asked to participate in a program of a 1-year long exercise program . Of the 160 selected , 54 subjects declined to participate and nine subjects were rejected after a medical check up . The remaining 97 subjects participated in a schedule consisting of pre-post medical and physiotherapy examinations , question naires concerning sociodemography , musculoskeletal and general health complaints and work environment , physiological tests of cardiovascular fitness , and of strength and endurance of shoulder flexors and knee extensors , and registration of sick leave . The subjects were r and omly assigned to an exercise ( treatment ) or control group . The exercise group trained twice a week for 1 year using a mixed program including exercises for coordination , strength/endurance , and fitness . The test schedule was repeated for both groups after 1 year . The exercise intervention was associated with positive changes in prevalence and intensity of musculoskeletal and psychosomatic complaints , better physiotherapy status ( less muscle tightness , better neck mobility , and less tender points ) , increased shoulder strength and increased coordination in thigh muscles . However , the exercise group reported worse situations post-exercise concerning aspects of their physical and psychosocial work-environment ( i.e. , concerning ergonomy , influence , appreciation and communication with work manager ) , which might have been due to stress associated with the exercise situation
Primary findings indicate that there is ( a ) strong evidence that poor performance on a set distance run for time is a predictor for MSK-I risk in both genders ; ( b ) strong evidence that poor performance on timed shuttle runs is a predictor for MSK-I risk in males ; ( c ) moderate evidence in males and limited evidence in females that poor performance on a timed step test is a predictor of MSK-I risk ; and ( d ) limited or insufficient evidence that poor performance on the Cooper run test , maximal and submaximal aerobic grade d exercise tests , and the Conconi test are predictors of MSK-I risk in males or females or both .
Several measures of CRE are risk factors for training-related MSK-I in military and civilian athletic population s , indicating that CRE may be an important measure for MSK-I risk stratification
A systematic review of the association between physical fitness and musculoskeletal injury risk : part 1—cardiorespiratory endurance .
J Strength Cond Res 31(6 ) : 1744–1757 , 2017—Musculoskeletal injuries ( MSK-Is ) are a significant health problem for both military and athletic population s. Research indicates that MSK-I is associated with physical fitness ; however , the association between specific components of physical fitness and MSK-I in military and athletic population s has not been systematic ally examined .