A prospective investigation of injury incidence and injury risk factors among Army recruits in military police training

Joseph J Knapik, Bria Graham, Jacketta Cobbs, Diane Thompson, Ryan Steelman, Bruce H Jones, Joseph J Knapik, Bria Graham, Jacketta Cobbs, Diane Thompson, Ryan Steelman, Bruce H Jones

Abstract

Background: United States Army military police (MP) training is a 19-week course designed to introduce new recruits to basic soldiering skills, Army values and lifestyle, and law enforcement skills and knowledge. The present investigation examined injury rates and injury risk factors in MP training.

Methods: At the start of training, 1,838 male and 553 female MP recruits were administered a questionnaire containing items on date of birth, height, weight, tobacco use, prior physical activity, injury history, and menstrual history. Injuries during training were obtained from electronic medical records and the training units provided data on student graduation and attrition.

Results: Successfully graduating from the course were 94.3% of the men and 83.7% of the women. Experiencing at least one injury during training were 34.2% of the men and 66.7% of the women (risk ratio (women/men) = 1.95, 95% confidence interval = 1.79-2.13). Recruits were at higher injury risk if they reported that they were older, had smoked in the past, or had performed less frequent exercise or sports prior to MP training. Men were at higher injury risk if they reported a prior injury and women were at higher risk if they reported missing at least six menstrual cycles in the last year or had previously been pregnant.

Conclusion: The present investigation was the first to identify injury rates and identify specific factors increasing injury risk during MP training.

References

    1. Knapik JJ, Hauret KG SC, Marin R, Jones BH. Association between ambulatory physical activity and injuries in United States Army Basic Training. J Phys Act Health. 2011;8:496–502.
    1. Jones BH, Bovee MW, Harris JM, Cowan DN. Intrinsic risk factors for exercise-related injuries among male and female Army trainees. Am J Sports Med. 1993;21:705–710. doi: 10.1177/036354659302100512.
    1. Knapik JJ, Sharp MA, Canham-Chervak M, Hauret K, Patton JF, Jones BH. Risk factors for training-related injuries among men and women in Basic Combat Training. Med Sci Sports Exerc. 2001;33:946–954. doi: 10.1097/00005768-200106000-00014.
    1. Westphal KA, Friedl KE, Sharp MA, King N, Kramer TR, Reynolds KL, Marchitelli LJ. Health, performance and nutritional status of U.S. Army women during basic combat training. Natick, MA: U.S. Army Research Institute of Environmental Medicine, Technical Report No. T96-2; 1995.
    1. Knapik JJ, Swedler D, Grier T, Hauret KG, Bullock S, Williams K, Darakjy S, Lester M, Tobler S, Jones BH. Injury reduction effectiveness of selecting running shoes based on plantar shape. J Strength Cond Res. 2009;23:685–697. doi: 10.1519/JSC.0b013e3181a0fc63.
    1. Knapik JJ, Trone D, Swedler DI, Villasenor A, Schmied E, Bullock S, Jones BH. Injury reduction effectiveness of assigning running shoes based on foot shape in Marine Corps basic training. Aberdeen Proving Ground MD: US Army Center for Health Promotion and Preventive Medicine, No. 12-MA-05SBA-08B; 2009.
    1. Jones BH, Cowan DN, Tomlinson JP, Robinson JR, Polly DW, Frykman PN. Epidemiology of injuries associated with physical training among young men in the Army. Med Sci Sports Exerc. 1993;25:197–203.
    1. Knapik JJ, Darakjy S, Scott S, Hauret KG, Canada S, Marin R, Palkoska F, VanCamp S, Piskator E, Rieger W. Evaluation of two Army fitness programs: the TRADOC Standardized Physical Training Program for Basic Combat Training and the Fitness Assessment Program. Aberdeen Proving Ground, MD: US Army Center for Health Promotion and Preventive Medicine, Technical Report No. 12-HF-5772B-04; 2004.
    1. Haddon W. Energy damage and ten countermeasure strategies. J Trauma. 1973;13:321–331. doi: 10.1097/00005373-197304000-00011.
    1. Knapik JJ, Burse RL, Vogel JA. Height, weight, percent body fat and indices of adiposity for young men and women entering the U.S. Army. Aviat Space Environ Med. 1983;54:223–231.
    1. Open Epidemiological Calculator. ], Assessed 12 August 2012.
    1. Knapik JJ, Brosch LC, Venuto M, Swedler DI, Bullock SH, Gaines LS, Murphy RJ, Tchandja J, Jones BH. Effect on injuries of assigning shoes based on foot shape in Air Force Basic Training. Am J Prev Med. 2010;38:S197–S211. doi: 10.1016/j.amepre.2009.10.013.
    1. National Institute of Health (NIH) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda MD: NIH Publication No. 98–4083; 1998.
    1. American College of Sports Medicine. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30:975–991. doi: 10.1097/00005768-199806000-00032.
    1. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley & Sons; 1989.
    1. Knapik JJ, Hauret KG, Arnold S, Canham-Chervak M, Mansfield AJ, Hoedebecke EL, McMillian D. Injury and fitness outcomes during implementation of Physical Readiness Training. Int J Sports Med. 2003;24:372–381.
    1. Knapik JJ, Darakjy S, Scott SJ, Hauret KG, Canada S, Marin R, Rieger W, Jones BH. Evaluation of a standardized physical training program for Basic Combat Training. J Strength Cond Res. 2005;19:246–253.
    1. Heir T, Eide G. Injury proneness in infantry conscripts undergoing a physical training programme: smokeless tobacco use, higher age, and low levels of physical fitness are risk factors. Scand J Med Sci Sports. 1997;7:304–311.
    1. Knapik JJ, Spiess A, Swedler D, Grier T, Darakjy S, Amoroso P, Jones BH. Injury risk factors in parachuting and acceptability of the parachute ankle brace. Aviat Space Environ Med. 2008;79:689–694. doi: 10.3357/ASEM.2273.2008.
    1. Schmidt MD, Sulski SI, Amoroso PJ. Effectiveness of an external ankle brace in reducing parachute-related ankle injuries. Med Sci Sports Exerc. 2004;36:S312.
    1. Knapik JJ, Grier T, Spiess A, Swedler DI, Hauret KG, Graham B, Yoder J, Jones BH. Injury rates and injury risk factors among Federal Bureau of Investigation new agent trainees. BMC Public Health. 2011;11:920. 910.1186/1471-2458-1111-1920.
    1. Conboy IM, Rando TA. Aging, stem cells and tissue regeneration. Cell Cycle. 2005;4:407–410. doi: 10.4161/cc.4.3.1518.
    1. Chodzko-Zajko WJ, Proctor DN, Sing MAF, Minson CT, Nigg CR, Salem GJ, Skinner JS. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41:1510–1530. doi: 10.1249/MSS.0b013e3181a0c95c.
    1. Knapik JJ, Jones BH, Vogel JA, Banderet LE, Bahrke MS, O'Connor JS. Influence of age and body mass index on measures of physical fitness in U.S. Army Soldiers. J Aging Phys Act. 1996;4:234–250.
    1. Jones BH, Bovee MW, Knapik JJ. In: Body Composition and Physical Performance. Marriott BM, Grumstrup-Scott J, editor. Washington, D.C: National Academy Press; 1992. Associations among body composition, physical fitness, and injuries in men and women Army trainees; pp. 141–173.
    1. Knapik JJ, Cuthie J, Canham M, Hewitson W, Laurin MJ, Nee MA, Hoedebecke E, Hauret K, Carroll D, Jones BH. Injury incidence, injury risk factors, and physical fitness of U.S. Army basic trainees at Ft Jackson SC, 1997. Aberdeen Proving Ground, MD: U.S. Army Center for Health Promotion and Preventive Medicine, Epidemiological Consultation Report No. 29-HE-7513-98; 1998.
    1. Knapik JJ, Sharp MA, Canham ML, Hauret K, Cuthie J, Hewitson W, Hoedebecke E, Laurin MJ, Polyak C, Carroll D. Injury incidence and injury risk factors among US Army Basic Trainees at Ft Jackson, SC (including fitness training unit personnel, discharges, and newstarts) Aberdeen Proving Ground MD: US Army Center for Health Promotion and Preventive Medicine, Epidemiological Consultation Report No. 29-HE-8370-99; 1999.
    1. Shaffer RA, Brodine SK, Almeida SA, Williams KM, Ronaghy S. Use of simple measures of physical activity to predict stress fractures in young men undergoing a rigorous physical training program. Am J Epidemiol. 1999;149:236–242. doi: 10.1093/oxfordjournals.aje.a009797.
    1. Rauh MJ, Macera CA, Trone DW, Shaffer RA, Brodine SK. Epidemiology of stress fracture and lower-extremity overuse injuries in female recruits. Med Sci Sports Exerc. 2006;38:1571–1577. doi: 10.1249/01.mss.0000227543.51293.9d.
    1. Jones BH, Shaffer RA, Snedecor MR. Injuries treated in outpatient clinics: surveys and research data. Mil Med. 1999;164(Suppl):6–1–6–89.
    1. Knapik JJ, Brosch LC, Venuto M, Swedler DI, Bullock SH, Gaines LS, Murphy RJ, Canada SE, Hoedebecke EL, Tobler SK. Injury reduction effectiveness of prescribing running shoes based on foot shape in Air Force Basic Military Training. Aberdeen Proving Ground MD: Army Center for Health Promotion and Preventive Medicine, Technical Report No. 12-MA-05SBA-08A; 2008.
    1. Forde MS, Punnett L, Wegman DH. Prevalence of musculoskeletal symptoms in union ironworkers. J Occup Env Hyg. 2005;2:203–212. doi: 10.1080/15459620590929635.
    1. Knapik JJ, McCollam R, Canham-Chervak M, Arnold S, DuVernoy TS, Hoedebecke EL. A second investigation of injuries among officers attending the US Army War College during Academic Year 2000. Aberdeen Proving Ground, MD: US Army Center for Health Promotion and Preventive Medicine, EPICON Report No. 29-HE-2682-00; 2000.
    1. Knapik JJ, Spiess A, Darakjy S, Grier T, Manning F, Livingstone E, Swedler D, Amoroso P, Jones BH. Risk factors for parachute injuries and comments about the parachute ankle brace among airborne students. Aberdeen Proving Ground MD: US Army Center for Health Promotion and Preventive Medicine, Technical Report No. 12-MA01Q2-08B; 2008.
    1. Knowles SB, Marshall SW, Bowling JM, Loomis D, Millikan R, Yang J, Weaver NL, Kalsbeek W, Miller FO. A prospective study of injury incidence among North Carolina high school athletes. Am J Epidemiol. 2006;164:1209–1221. doi: 10.1093/aje/kwj337.
    1. Macera CA, Pate RR, Powell KE, Jackson KL, Kendrick JS, Craven TE. Predicting lower-extremity injuries among habitual runners. Arch Int Med. 1989;149:2565–2568. doi: 10.1001/archinte.1989.00390110117026.
    1. Marti B, Vader JP, Minder CE, Abelin T. On the epidemiology of running injuries. The 1984 Bern Grand-Prix study. Am J Sports Med. 1988;16:285–294. doi: 10.1177/036354658801600316.
    1. Orchard JW. Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med. 2001;29:300–303.
    1. Schneider GA, Bigelow C, Amoroso PJ. Evaluating risk of re-injury among 1,214 Army Airborne soldiers using a stratified survival model. Am J Prev Med. 2000;18(Suppl3):156–163.
    1. VanMechelen W, Twisk J, Molendijk A, Blom B, Snel J, Kemper HC. Subject-related risk factors for sports injuries: a 1-yr prospective study in young adults. Med Sci Sports Exerc. 1996;28:1171–1179. doi: 10.1097/00005768-199609000-00014.
    1. Voaklander DC, Saunders LD, Quinney HA. Personal risk factors for injury in recreational and old-timer ice hockey. Sports Med Training Rehabil. 1998;8:239–250. doi: 10.1080/15438629809512530.
    1. Walter SD, Hart LE, McIntosh JM, Sutton JR. The Ontario cohort study of running-related injuries. Arch Int Med. 1989;149:2561–2564. doi: 10.1001/archinte.1989.00390110113025.
    1. Knapik JJ, Swedler D, Grier T, Hauret KG, Bullock S, Williams K, Darakjy S, Lester M, Tobler S, Clemmons N. Injury reduction effectiveness of prescribing running shoes based on foot shape in Basic Combat Training. Aberdeen Proving Ground MD: US Army Center for Health Promotion and Preventive Medicine, Technical Report No. 12-MA-05SB-08; 2008.
    1. Altarac M, Gardner JW, Popovich RM, Potter R, Knapik JJ, Jones BH. Cigarette smoking and exercise-related injuries among young men and women. Am J Prev Med. 2000;18(Suppl 3S):96–102.
    1. Lappe JM, Stegman MR, Recker RR. The impact of lifestyle factors on stress fractures in female Army recruits. Osteoporosis Int. 2001;12:35–42. doi: 10.1007/s001980170155.
    1. Valimaki VV, Alfthan E, Lehmuskallio E, Loyttyniemi E, Sah T, Suominen H, Valimakii MJ. Risk factors for clinical stress fractures in male military recruits: a prospective cohort study. Bone. 2005;37:267–273. doi: 10.1016/j.bone.2005.04.016.
    1. Reynolds KL, Heckel HA, Witt CE, Martin JW, Pollard JA, Knapik JJ, Jones BH. Cigarette smoking, physical fitness, and injuries in infantry soldiers. Am J Prev Med. 1994;10:145–150.
    1. Cady LD, Bischoff DP, O'Connell ER, Thomas PC, Allen JH. Strength and fitness and subsequent back injuries in firefighters. J Occ Med. 1979;21:269–272.
    1. Chau N, Bourgkard E, Bhattacherjee A, Ravaud JF, Choquet M, Mur JM. Associations of job, living conditions and lifestyle with occupational injury in working population: a population-based study. Int Arch Occup Environ Health. 2008;81:379–389. doi: 10.1007/s00420-007-0223-y.
    1. McSweeney KP, Congleton JJ, Kerk CJ, Jenkins OE, Craig BN. Correlation of recorded injury and illness data with smoking, exercise, and absolute aerobic capacity. Int J Ind Ergonomics. 1999;24:193–200. doi: 10.1016/S0169-8141(98)00026-2.
    1. Jones JK, Triplett RG. The relationship of cigarette smoking to impaired intraoral wound healing. J Oral Maxillofac Surg. 1992;50:237–239. doi: 10.1016/0278-2391(92)90318-T.
    1. Mosely LH, Finseth F, Goody M. Nicotine and its effect on wound healing. Plast Reconstr Surg. 1978;61:570–575. doi: 10.1097/00006534-197804000-00013.
    1. Reus WF, Robson MC, Zachary L, Heggers JP. Acute effects of tobacco smoking in the cutaneous micro-circulation. Br J Plast Surg. 1984;37:213–215. doi: 10.1016/0007-1226(84)90011-0.
    1. Riefkohl R, Wolfe JA, Cox EB, McCarthy KS. Association between cutaneous occlusive vascular disease, cigarette smoking, and skin slough after rhytidectomy. Plast Reconstr Surg. 1986;77:592–595. doi: 10.1097/00006534-198604000-00013.
    1. Siana JE, Rex S, Gottrup F. The effect of cigarette smoking on wound healing. Scand J Plast Reconstr Surg. 1989;23:207–209. doi: 10.3109/02844318909075119.
    1. Goodson WH, Hunt TK. Wound healing in well-controlled diabetic men. Surg Forum. 1984;35:614–616.
    1. Jorgensen LN, Kallehave F, Christensen E, Siana JE, Gottrup F. Less collagen production in smokers. Surgery. 1998;123:450–455. doi: 10.1016/S0039-6060(98)70167-9.
    1. Knuutinen A, Kokkonen N, Risteli J, Vahakangas K, Kallioinen M, Salo T, Oikarinen A. Smoking affects collagen synthesis and extracellular matrix turnover in human skin. Br J Dermatol. 2002;146:588–594. doi: 10.1046/j.1365-2133.2002.04694.x.
    1. Castillo RC, Bosse MJ, MacKenzie EJ, Patterson BM. Impact of smoking of fracture healing and risk of complications in limb-threatening open tibia fractures. J Orthop Trauma. 2005;19:151–157. doi: 10.1097/00005131-200503000-00001.
    1. Riebel GD, Boden SD, Whitesides TE, Hutton WC. The effects of nicotine on incorporation of cancellous bone graft in an animal model. Spine. 1995;20:2198–2202. doi: 10.1097/00007632-199510001-00004.
    1. Raikin SM, Landsman JC, Alexander VA, Froimson MI, Plaxton NA. Effect of nicotine on the rate and strength of long bone fracture healing. Clin Orthop. 1998;353:231–237.
    1. Silcox DH, Daftari T, Boden SD, Schimandle JH, Hutton WC, Whitesides TE. The effect of nicotine on spinal fusion. Spine. 1995;14:1549–1553.
    1. Chen F, Osterman L, Mahony K. Smoking and bony union after ulna-shorting osteotomy. Am J Orthop. 2001;30:486–489.
    1. Karim A, Pandit H, Murray J, Wandless F, Thomas NP. Smoking and reconstruction of the anterior cruciate ligament. J Bone Jt Surg (Br) 2006;88:1027–1031. doi: 10.1302/0301-620X.88B8.17189.
    1. Gill CS, Sandell LJ, El-Zawawy HB, Wright RW. Effects of cigarette smoking on early medial collateral ligament healing in a mouse model. J Orth Res. 2006;24:2141–2149. doi: 10.1002/jor.20234.
    1. Wong LS, Green HM, Feugate JE, Yadav M, Nothnagel EA, Martins-Green M. Effects of "second hand" smoke on structure and function of fibroblasts, cells that are critical for tissue repair and remodeling. BMC Cell Biol. 2004;5:13. doi: 10.1186/1471-2121-5-13.
    1. Carnevali S, Nakamura Y, Mio T, Liu X, Takigawa K, Romberger DJ, Spurzem JR, Rennard SI. Cigarette smoke extract inhibits fibroblast-mediated collagen gel contraction. Am J Physiol Cell Physiol. 1998;274:L591–L598.
    1. Nakamura Y, Romberger DJ, Tate L, Ertl RF, Kawamoto M, Adachi Y, Sisson JH, Spurzem JB, Rennard SI. Cigarette smoke inhibits fibroblast proliferation and chemotaxis. Am J Respir Crit Care Med. 1995;151:1497–1503. doi: 10.1164/ajrccm.151.5.7735606.
    1. Raveendran M, Senthil D, Utama B, Shen Y, Dudley D, Wang J, Zhang Y, Wang XL. Cigarette suppresses the expression of P4Halpha and vascular collagen production. Biochem Biophys Res Commun. 2004;323:592–598. doi: 10.1016/j.bbrc.2004.08.129.
    1. Schaffer M, Barbul A. Lymphocyte function in wound healing and following injury. Br J Surg. 1998;85:444–460. doi: 10.1046/j.1365-2168.1998.00734.x.
    1. Barbul A, Regan MC. Immune involvement in wound healing. Otolaryngol Clin North Am. 1995;28:955–968.
    1. DiPietro LA. Wound healing: the role of macrophages and other immune cells. Shock. 1995;4:233–240. doi: 10.1097/00024382-199510000-00001.
    1. Park JE, Barbul A. Understanding the role of immune regulation in wound healing. Am J Surg. 2004;187(Suppl 1):11S–16S.
    1. Sopori ML, Kozak W. Immunomodulatory effects of cigarette smoke. J Neuroimmunol. 1998;83:148–156. doi: 10.1016/S0165-5728(97)00231-2.
    1. Chen H, Cowan MJ, Hasday JD, Vogel SN, Medvedev AE. Tobacco smoke inhibits expression of proinflammatory cytokines and activation of IL-1R-associated kinase, p38, and NF-kappa-B in aveolar macrophages stimulated with TLR2 and TLR4 angonists. J Immunol. 2007;179:6097–6106.
    1. McCrea KA, Ensor JE, Nall K, Bleeker ER, Hasday JD. Altered cytokine regulation in the lungs of cigarette smokers. Am J Respir Crit Care Med. 1994;150:696–703. doi: 10.1164/ajrccm.150.3.8087340.
    1. Tollerud DJ, Clarke JW, Brown LM, Neuland CY, Mann DL, Pankiw-Trost LK, Blattner WA, Hoover RN. Association of cigarette smoking with decreased numbers of circulating natural killer cells. Am Rev Resp Dis. 1989;139:194–198. doi: 10.1164/ajrccm/139.1.194.
    1. Hersey P, Prendergast D, Edwards A. Effects of cigarette smoking on the immune system. Med J Aust. 1983;2:425–429.
    1. Miller LG, Goldstein G, Murphy M, Ginns LC. Reversible alterations in immunoregulatory T Cells in smoking. Chest. 1982;82:526–529. doi: 10.1378/chest.82.5.526.
    1. Yarnell JWG, Sweetnam PM, Rogers S, Elwood PC, Bainton D, Baker IA, Esatham R, Etherington MD. Some long term effects of smoking from the Caerphilly and Speedwell Collaborative Surveys. J Clin Pathol. 1987;40:909–913. doi: 10.1136/jcp.40.8.909.
    1. Friedman GD, Siegelaub AB, Seltzer CC, Feldman R, Collen MF. Smoking habits and the leukocyte count. Arch Environ Health. 1973;26:137–143.
    1. Hughes DA, Haslam PL, Townsend PJ, Turner-Warwick M. Numerical and functional alterations in circulatory lymphocytes in cigarette smokers. Clin Exp Immunol. 1985;61:459–466.
    1. Nobel RC, Penny BB. Comparison of leukocyte count and function in smoking and nonsmoking men. Infect Immun. 1975;12:550–555.
    1. Lando HA, Haddock CK, Klesges RC, Talcott GW, Jensen J. Smokeless tobacco use in a population of young adults. Addict Behav. 1999;24:431–447. doi: 10.1016/S0306-4603(98)00058-6.
    1. DiFranza JR, Winters TH, Goldberg RJ, Cirillo L, Biliouris T. The relationship of smoking to motor vehicle accidents and traffic violations. NY State J Med. 1986;86:464–467.
    1. Eiser JR, Sutton SR. Smoking, seat belts, and beliefs about health. Addict Behav. 1979;4:331–338. doi: 10.1016/0306-4603(79)90003-0.
    1. Chiolero A, Wietlisbach V, Ruffieux C, Paccaud F, Cornuz J. Clustering of risk behaviors with cigarette consumption: a population-based survey. Prev Med. 2006;42:348–353. doi: 10.1016/j.ypmed.2006.01.011.
    1. Gardner LI, Dziados JE, Jones BH, Brundage JF, Harris JM, Sullivan R, Gill P. Prevention of lower extremity stress fractures: a controlled trial of a shock absorbent insole. Am J Public Health. 1988;78:1563–1567. doi: 10.2105/AJPH.78.12.1563.
    1. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR. Physical activity and bone health. Position stand of the American College of Sports Medicine. Med Sci Sports Exerc. 2004;36:1985–1996. doi: 10.1249/01.MSS.0000142662.21767.58.
    1. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromuscular fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–1359. doi: 10.1249/MSS.0b013e318213fefb.
    1. Knapik JJ, Darakjy S, Hauret KG, Canada S, Scott S, Rieger W, Marin R, Jones BH. Increasing the physical fitness of low fit recruits before Basic Combat Training: an evaluation of fitness, injuries and training outcomes. Mil Med. 2006;171:45–54.
    1. Knapik JJ, Trone DW, Swedler DI, Villasenor A, Bullock SH, Schmied E, Brockelman T, Han P, Jones BH. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010;38:1759–1767. doi: 10.1177/0363546510369548.
    1. Rauh MJ, Koepsell TD, Rivara FP, Margherita AJ, Rice SG. Epidemiology of musculoskeletal injuries among high school cross-country runners. Am J Epidemiol. 2006;163:151–159.
    1. Silder A, Heiderscheit BC, Thelen DG, Enright T, Tuite MJ. MR observation of long-term musculoskeletal remodeling following a hamstring strain injury. Skeletal Radiol. 2008;37:1101–1109. doi: 10.1007/s00256-008-0546-0.
    1. Silder A, Thelen DG, Heiderscheit BC. Effects of prior hanstring injury of strength, flexibility and running mechanics. Clin Biomech. 2010;25(7):681–686. doi: 10.1016/j.clinbiomech.2010.04.015.
    1. Shaffer RA, Rauh MJ, Brodine SK, Trone DW, Macera CA. Predictors of stress fractures in young female recruits. Am J Sports Med. 2006;34:108–115.
    1. Lloyd T, Triantafyllou SJ, Baker ER, Houts PS, Whiteside JA, Kalenak A, Stumpf PG. Women athletes with menstrual irregularity have increased musculoskeletal injuries. Med Sci Sports Exerc. 1986;18:374–379.
    1. Bennell KL, Malcom SA, Thomas SA, Reid SJ, Brukner PD, Ebeling PR, Ward JD. Risk factors for stress fractures in track and field athletes. A twelve-month prospective study. Am J Sports Med. 1996;24:810–818. doi: 10.1177/036354659602400617.
    1. Davis MC, Hall ML, Jacobs HS. Bone mineral loss in young women with amenorrhoea. Br Med J. 1990;301:790–793. doi: 10.1136/bmj.301.6755.790.
    1. Beckvid-Henriksson G, Schnell C, Linden-Hirschberg A. Women endurance runners with menstrual dysfunction have prolonged interruption of training due to injury. Gynecol Obstet Invest. 2000;49:41–46. doi: 10.1159/000010211.
    1. Feingold D, Hame SL. Female athletic triad and stress fractures. Orthop Clin North Am. 2006;37:575–583. doi: 10.1016/j.ocl.2006.09.005.
    1. Bennell K, Matheson G, Meeuwisse W, Brukner P. Risk factors for stress fractures. Sports Med. 1999;28:91–122. doi: 10.2165/00007256-199928020-00004.
    1. American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postpartum period. Obstet Gynecol. 2002;99:171–173. doi: 10.1016/S0029-7844(01)01749-5.
    1. Sherwood OD. Relaxin's physiological roles and other diverse actions. Endocr Rev. 2004;25:205–234. doi: 10.1210/er.2003-0013.
    1. Calguneri M, Bird HA, Wright V. Changes in joint laxity occurring during pregnancy. Ann Rheum Dis. 1982;41:126–128. doi: 10.1136/ard.41.2.126.
    1. Abramson D, Roberts SM, Wilson PD. Relaxation of the pelvic joints in pregnancy. Surg Gynecol Obstet. 1934;58:595–613.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe