Peter N. Frykman

Epidemiology of injuries associated with physical training among young men in the army

It is widely acknowledged that musculoskeletal injuries occur as a result of vigorous physical activity and exercise, but little quantitative documentation exists on the incidence of or risk factors for these injuries. This study was conducted to assess the incidence, types, and risk factors for training-related injuries among young men undergoing Army infantry basic training. Prior to training we evaluated 303 men (median age 19 yr), utilizing questionnaires and measurements of physical fitness. Subjects were followed over 12 wk of training. Physical training was documented on a daily basis, and injuries were ascertained by review of medical records for every trainee. We performed univariate and multivariate analyses of the data. Cumulative incidence of subjects with one or more lower extremity training-related injury was 37% (80% of all injuries). The most common injuries were muscle strains, sprains, and overuse knee conditions. A number of risk factors were identified, including: older age, smoking, previous injury (sprained ankles), low levels of previous occupational and physical activity, low frequency of running before entry into the Army, flexibility (both high and low), low physical fitness on entry, and unit training (high running mileage).

The effects of arms and countermovement on vertical jumping.

Countermovement and arm-swing characterize most jumping. For determination of their effects and interaction, 18 males jumped for maximal height from a force platform in all four combinations of arm-swing/no-arm-swing and countermovement/no-countermovement. For all jumps, vertical velocity peaked 0.03 s before and dropped 6-7% by takeoff. Peak positive power averaged over 3,000 W, and occurred about 0.07 s before takeoff, shortly after peak vertical ground reaction force (VGRF) and just before peak vertical velocity. Both countermovement and arm-swing significantly (P less than 0.05) improved jump height, but arm-swings effect was greater, enhancing peak total body center of mass (TBCM) rise both pre and posttakeoff. Countermovement only affected the post-takeoff rise. The arm-swing resulted in higher peak VGRF and peak positive power. During countermovement, the use of arms resulted in less unweighting, slower and less extensive TBCM drop, and less negative power. Countermovement increased pretakeoff jump duration by 71-76%, increased average positive power, and yielded large positive and negative impulses. High test-retest reliability was shown for jump descriptive variables. Body weight together with peak posttakeoff TBCM rise effectively predicted peak power (multiple R2 = 0.89, standard error of estimate = 243 W). The results lend insight into which jumping techniques are most appropriate for given sports situations and indicate that a jump test can effectively be used to estimate peak power output.

Cross-validation of three jump power equations

UNLABELLED The vertical jump-and-reach score is used as a component in the estimation of peak mechanical power in two equations put forth by Lewis and Harman et al. PURPOSE The purpose of the present study was to: 1) cross-validate the two equations using the vertical jump-and-reach test, 2) develop a more accurate equation from a large heterogeneous population, 3) analyze gender differences and jump protocols, and 4) assess Predicted Residual Sum of Squares (PRESS) as a cross-validation procedure. METHODS One hundred eight college-age male and female athletes and nonathletes were tested on a force platform. They performed three maximal effort vertical jumps each of the squat jump (SJ) and countermovement jump (CMJ) while simultaneously performing the vertical jump-and-reach test. Regression analysis was used to predict peak power from body mass and vertical jump height. RESULTS SJ data yielded a better power prediction equation than did CMJ data because of the greater variability in CMJ technique. The following equation was derived from SJ data: Peak Power (W) = 60.7x (jump height cm]) +45.3x(body mass [kg])-2055. This equation revealed greater accuracy than either the Lewis or previous Harman et al. equations and underestimated peak power by less than 1%, with a SEE of 355.0 W using SJ protocol. The use of one equation for both males and females resulted in only a slight (5% of power output) difference between genders. Using CMJ data in the SJ-derived equation resulted in only a 2.7% overestimation of peak power. Cross-validation of regression equations using PRESS reveals accurate and reliable R2 and SEE values. CONCLUSIONS The SJ equation is a slightly more accurate equation than that derived from CMJ data. This equation should be used in the determination of peak power in place of the formulas developed by both Harman et al. and Lewis. Separate equations for males and females are unnecessary.

Lower limb morphology and risk of overuse injury among male infantry trainees.

The effect of anatomic variation on the risk of overuse injuries has not been adequately evaluated. To determine the association of several common anatomic characteristics (genu varum, genu valgum, genu recurvatum, and lower limb length differences) with risk of overuse injury, we made prospective morphologic measurements of young men prior to beginning 12 week of Army infantry training. The training included frequent running, marching, calisthenics, and other vigorous activities. Lower extremity anatomic landmarks were high-lighted, and front- and side-view photographic slides were taken of the 294 study volunteers. The slides were compute digitized, and the following measures calculated: pelvic width to knee width ratio (to assess genu valgum/varum), quadriceps angle (Q-angle), knee angle at full extension, and lower limb length differences. The cumulative incidence of lower limb overuse injury was 30%. Relative risk of (RR) of overuse injury was significantly higher among participants with the most valgus knees (RR = 1.9). Those with Q-angle of more than 15 degrees had significantly increased risk specifically for stress fractures (RR = 5.4). Anatomic characteristics were associated with several other types of injuries, including pain and nonacute muscle strain due to overuse. This pilot study provides evidence that some lower limb morphologic characteristics may place individuals at increased risk of overuse injuries.

Comparison of the physical fitness of men and women entering the U.S. Army: 1978-1998.

PURPOSE To compare the physical fitness levels of recruits entering the U.S. Army in 1998 to those entering in 1978 and 1983. METHODS In 1998, 182 men and 168 women were tested before beginning basic training at Fort Jackson, SC. The measurements were 1) skin-fold estimation of percent body fat (%BF); 2) maximum oxygen uptake by treadmill running (VO2max); and 3) upper-body (UB), lower-body (LB), and upright pulling (UP) isometric strength. These data were compared to data from basic trainees at Fort Jackson in 1978 (skin folds, VO2max, UB, and LB) and 1983 (skin folds and UP). RESULTS Body weight (BW) of 1998 recruits was greater (P < 0.05) than 1978 recruits (men, 12%; women, 6%) and 1983 recruits (men, 8%; women, 7%). %BF of 1998 recruits was greater (P < 0.05) than 1978 recruits (men, 15%; women, 5%) and 1983 recruits (men, 15%; women, 17%). The 1998 men had more fat-free mass (FFM) (P < 0.05) than men in 1978 (8%) or 1983 (5%), whereas 1998 women were only different from those measured in 1978 (4%, P < 0.05). The VO2max of men (50.6 +/- 6.2 mL x kg(-1) x min(-1)) was equivalent to men in 1978, whereas that of women (39.7 +/- 5.2 mL x kg(-1) x min(-1)) was 6% greater (P < 0.05). The 1998 recruits were stronger (P < 0.05) on all measures of muscle strength than recruits measured in 1978 (men, UB = 16%, LB = 12%; women, UB = 18%, LB = 6%) and 1983 (men, UP = 7%; women, UP = 6%). CONCLUSION The aerobic capacity, muscle strength, and FFM of 1998 recruits is comparable to or greater than that of 1978 and 1983 recruits; however, 1998 recruits tended to have more BW and a greater %BF.

Effects of a Belt on Intra-Abdominal Pressure during Weight Lifting

Intra-abdominal pressure (IAP) has been widely hypothesized to reduce potentially injurious compressive forces on spinal discs during lifting. To investigate the effects of a standard lifting belt on IAP and lifting mechanics, IAP and vertical ground reaction force (GRF) were monitored by computer using a catheter transducer and force platform while nine subjects aged 28.2 +/- 6.6 yr dead-lifted a barbell both with and without a lifting belt at 90% of maximum. Both IAP and GRF rose sharply from the time force was first exerted on the bar until shortly after it left the floor, after which GRF usually plateaued while IAP either plateaued or declined. IAP rose significantly (P less than 0.05) earlier with than without the belt. When the belt was worn, IAP rose significantly earlier than did GRF. Both with and without the belt, IAP ended its initial surge significantly earlier than did GRF. Variables significantly greater with than without a belt included peak IAP, area under the IAP vs time curve from start of initial IAP surge to lift-off, peak rate of IAP increase after the end of its initial surge, and average IAP from lift-off to life completion. In contrast, average rate of IAP increase during its initial surge was significantly lower with the belt. Correlations are presented which provide additional information about relationships among the variables. Results suggest that the use of a lifting belt increases IAP, which may reduce disc compressive force and improve lifting safety.

Effects of two different eight - week training programs on military physical performance

Various physical demands are placed on soldiers, whose effectiveness and survivability depend on their combat-specific physical fitness. Because sport training programs involving weight-based training have proven effective, this study examined the value of such a program for short-term military training using combat-relevant tests. A male weight-based training (WBT) group (n = 15; mean ± SD: 27.0 ± 4.7 years, 173.8 ± 5.8 cm, 80.9 ± 12.7 kg) performed full-body weight-based training workouts, 3.2-km runs, interval training, agility training, and progressively loaded 8-km backpack hikes. A male Army Standardized Physical Training (SPT) group (n = 17; mean ± SD: 29.0 ± 4.6 years, 179.7 ± 8.2 cm, 84.5 ± 10.4 kg) followed the new Army Standardized Physical Training program of stretching, varied calisthenics, movement drills, sprint intervals, shuttle running, and distance runs. Both groups exercised for 1.5 hours a day, 5 days a week for 8 weeks. The following training-induced changes were statistically significant (P < 0.05) for both training groups: 3.2-km run or walk with 32-kg load (minutes), 24.5 ± 3.2 to 21.0 ± 2.8 (SPT) and 24.9 ± 2.8 to 21.1 ± 2.2 (WBT); 400-m run with 18-kg load (seconds), 94.5 ± 14.2 to 84.4 ± 11.9 (SPT) and 100.1 ± 16.1 to 84.0 ± 8.4 (WBT); obstacle course with 18-kg load (seconds), 73.3 ± 10.1 to 61.6 ± 7.7 (SPT) and 66.8 ± 10.0 to 60.1 ± 8.7 (WBT); 5 30-m sprints to prone (seconds), 63.5 ± 4.8 to 59.8 ± 4.1 (SPT) and 60.4 ± 4.2 to 58.9 ± 2.7 (WBT); and 80-kg casualty rescue from 50 m (seconds), 65.8 ± 40.0 to 42.1 ± 9.9 (SPT) and 57.6 ± 22.0 to 44.2 ± 8.8 (WBT). Of these tests, only the obstacle course showed significant difference in improvement between the two training groups. Thus, for short-term (i.e., 8-week) training of relatively untrained men, the Armys new Standardized Physical Training program and a weight-based training experimental program can produce similar, significant, and meaningful improvements in military physical performance. Further research would be needed to determine whether weight-based training provides an advantage over a longer training period.

Prediction of Simulated Battlefield Physical Performance from Field-Expedient Tests

Predictive models of battlefield physical performance can benefit the military. To develop models, 32 physically trained men (mean +/- SD: 28.0 +/- 4.7 years, 82.1 +/- 11.3 kg, 176.3 +/- 7.5 cm) underwent (1) anthropometric measures: height and body mass; (2) fitness tests: push-ups, sit-ups, 3.2-km run, vertical jump, horizontal jump; (3) simulated battlefield physical performance in fighting load: five 30-m sprints prone to prone, 400-m run, obstacle course, and casualty recovery. Although greater body mass was positively associated with better casualty recovery performance, it showed trends toward poorer performance on all the other fitness and military performance tests. Regression equations well predicted the simulated battlefield performance from the anthropometric measures and physical fitness tests (r = 0.77-0.82). The vertical jump entered all four prediction equations and the horizontal jump entered one of them. The equations, using input from easy to administer tests, effectively predict simulated battlefield physical performance.

Physical Fitness and Body Composition After a 9-Month Deployment to Afghanistan

PURPOSE To examine change in physical fitness and body composition after a military deployment to Afghanistan. METHODS One hundred and ten infantry soldiers were measured before and after a 9-month deployment to Afghanistan for Operation Enduring Freedom. Measurements included treadmill peak oxygen uptake (peak VO2), lifting strength, medicine ball put, vertical jump, and body composition estimated via dual-energy x-ray absorptiometry (percent body fat, absolute body fat, fat-free mass, bone mineral content, and bone mineral density). RESULTS There were significant decreases (P < 0.01) in peak VO2 (-4.5%), medicine ball put (-4.9%), body mass (-1.9%), and fat-free mass (-3.5%), whereas percent body fat increased from 17.7% to 19.6%. Lifting strength and vertical jump performance did not change predeployment to postdeployment. CONCLUSIONS Nine months deployment to Afghanistan negatively affected aerobic capacity, upper body power, and body composition. The predeployment to postdeployment changes were not large and unlikely to present a major health or fitness concern. If deployments continue to be extended and time between deployments decreased, the effects may be magnified and further study warranted.

Intra-Abdominal and Intra-Thoracic Pressures during Lifting and Jumping,

In order to investigate intra-thoracic pressure (ITP) and intra-abdominal pressure (IAP) during lifting and jumping, 11 males were monitored as they performed the dead lift (DL), slide row (SR), leg press (LP), bench press (BP), and box lift (BL) at 50, 75 and 100% of each subjects four-repetition maxima, the vertical jump (VJ), drop jump (DJ) from 0.5 and 1.0 m heights, and Valsalva maneuver (VM). Measurements were made of peak pressure, time from pressure rise to switch-marked initiation of body movement, and time from the movement to peak pressure. The highest ITP and IAP occurred during VM (22.2 +/- 6.0 and 26.6 +/- 6.7 kPa, respectively) with one individual reaching 36.9 kPa (277 mm Hg) IAP. In ascending order of peak ITP during the highest resistance sets, the activities were SR, BP, VJ, DJ, DL, BL, LP, and VM, while the order for IAP was BP, VJ, DJ, BL, DL, LP, SR, and VM. Pressures significantly (P less than 0.05) increased with amount of weight lifted, rising before and peaking after the weight moved. IAP generally rose earlier and was of greater magnitude than ITP. For the jumps, pressure rose and diminished before the feet lost contact with the ground. Drop-jump height did not affect pressure. Correlation of pressure with weight lifted was fair to good for most activities.