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Stress Fracture Prevention: Strengthening the Lower Extremity Muscles

Maintaining strength and flexibility in the lower extremities is one of the many important steps toward decreasing the likelihood of developing the small cracks in a bone commonly known as stress fractures.

There are several risk factors for stress fracture development, but a 2011 article in Medicine and Science in Sports and Exercise found that maintaining adequate muscle strength and flexibility in the hips, legs, knees, ankles, and feet is of great importance, especially for women. Here are some exercises from the American Council on Exercise that can help you build strength and flexibility:

Ankle Flexion

Single Leg Push-off

Forward Hurdle Run

Seated Calf Stretch

Standing Dorsi-Flexion (Calf Stretch)

Supine Hamstrings Stretch

Barbell Calf Raises

Jump and Reach

Agility Ladder: Lateral Shuffle

Alternate Leg Push-off

Barbell Jammers

Before beginning any exercise program, however, make sure to consult with a medical professional, especially if you are more than 45 years old.

The lowdown on stress fractures—and how to prevent them

Stress fractures are chronic injuries that occur most often in the lower extremities. Prevention is key and can be helped through adequate attention to nutrition, training surfaces, and footwear, as well as gradual progression in training.

The American Academy of Orthopaedic Surgeons defines a stress fracture as a tiny crack in a bone that occurs when fatigued muscles lose their ability to absorb shock and then transfer stresses to the bone. Most stress fractures occur in the lower extremities, and more than half occur in the lower leg and foot.

A stress fracture is an overuse—sometimes referred to as chronic—injury, which means that it develops over a long period of time—from weeks to months. According to a 2011 systematic review published in Military Medicine, stress fracture incidence is high among U.S. military recruits, ranging anywhere from 3% for men to 9.2% for women.

Since it can take several weeks or months for a stress fracture to heal, the best approach is to avoid getting one. Here are some tips for prevention:

  1. Apply the progression principle of training—gradually increase your training intensity. Slowly incorporate higher-stress activities such as jumping and interval training into your workout. Setting incremental goals can be helpful in carrying out your training routine in a gradual way. And check out HPRC’s Physical Fitness Resources for more information on training and ways to avoid injury.
  2. Check your footwear and make sure it matches your training. Replace footwear that is old or worn.
  3. Pay attention to the surface where you train, since some are easier on the bones and joints of the lower extremities. For example, it is better to jog on softer surfaces such as rubber track or grass rather than on concrete. Also, it’s better to begin training on a flat surface and then progress to hills.
  4. Monitor your diet, specifically calcium and vitamin D intake, and read the National Institute of Health’s Dietary Supplement Fact Sheet on calcium. To learn more about nutrition take a look at HPRC’s Nutrition Resources.

It is important to recognize a stress fracture and seek medical advice early, as discussed in Clinics in Sports Medicine. The Mayo Clinic provides information on the symptoms of a stress fracture.

Marines address boot camp injuries

Reducing injuries during boot camp is a priority for the Marine Corps; athletic trainers keep watch over recruits to ensure the 13-week training is as injury-free as possible.

The Los Angeles Times is reporting on how the Marine Corps has hired 27 certified athletic trainers—most with experience tending professional and college athletes—to oversee training for enlisted recruits and officer candidates at sites throughout the United States. According to the article, this is a new direction for the Corps: Not that long ago, the drill instructors might have dismissed recruits who complained of being injured and ordered them back into action.

To learn more about military recommendations for prevention of injuries related to physical training related, visit the HPRC’s Injury Management page and click on the link to read Recommendations for Prevention of Physical Training (PT)-Related Injuries.

Progressive overload injuries

Don’t get injured by trying to do too much too soon. Ramp up your exercise regimen slowly and steadily to avoid getting hurt—and having to start over.

Overuse injuries are a common risk associated with the rigors of physical training. A healthy tip to implement into your training program is to gradually increase your training workload by just 10% each week. This will help—but not guarantee—to reduce the risk of muscle or joint injury such as tendonitis or stress fractures caused by repetitive trauma. In essence, keep the progressive changes in your activity levels gradual, listen to your body, and make incremental adjustments in time and intensity until you reach your new fitness goals.

Future Trends: DARPA looking to develop “performance underwear” for warriors

DARPA researchers envision a future of soldier technology that will improve Warfighter effectiveness by employing high-tech underwear.

The future of Warfighter technology may someday include a high-tech “performance underwear” bodysuit that will protect soldiers from injuries, monitor vitals, and help soldiers maintain body energy while on the battlefield. This, according to an article in Wired.com, is what DARPA (Defense Advanced Research Projects Agency) hopes to one day accomplish. DARPA describes this so-called performance underwear concept as being an “adaptive, compliant, nearly transparent, quasi-active joint support suit,” which can “mitigate musculoskeletal injury caused by discrete dynamic events while maintaining soldier performance.” According to the official solicitation notice, the “DARPA Warrior Web program…will develop the technologies required to prevent and reduce musculoskeletal injuries caused by dynamic events typically found in the Warfighter's environment. This will be accomplished by a system (or web) of structures, in the form of a skin-suit, that are compliant and transparent until injury-causing conditions activate appropriate changes in the web structure.”

Sounds good…except there is one catch: Right now, military technology of this caliber doesn’t exist. The Wired article indicates that DARPA plans to introduce its future performance tool this month to a meeting of potential researchers. Their goal? To find a company that might be able to create a compliant, Warfighter-wearable, quasi-passive, adaptive suit system that can reduce injuries and retain optimal warrior performance.

Injury treatment and recovery

Even minor injuries can derail performance. Follow these tips to manage the discomfort of minor injuries and prevent further damage.

A key concern for Warfighters and athletes alike is getting injured. Continuing to train through a minor injury can turn it into a major one. Even with minor injuries, it’s important to decrease inflammation and increase the range of motion at the affected joint. Two approaches to take are RICE and ISE. Start with RICE—rest, ice, compression, and elevation—to decrease inflammation. Once inflammation is minimized, ISE—ice, stretching, and exercise—helps to increase the range of motion. Using these techniques may reduce inflammation, stiffness, weakness, and/or loss of normal function. Once pain and swelling are reduced, the next step is reconditioning. Exercises that target the area of injury should promote flexibility, endurance, speed, strength, and power while progressing gradually. The main goal of reconditioning is to efficiently decrease pain and increase range of motion. Always check with your physician to rule out more serious injury before proceeding.

Chapter 12 of The US Navy Seal Guide to Fitness and Nutrition provides more detail.

Pounding the pavement or soft trails—which running surface is better?

HPRC Fitness Arena: Physical Fitness
Some experts think that soft-surface running is harder on the body than running on pavement.



Conventional wisdom suggests that running on softer surfaces is better for the body than harder surfaces. However, in a recent New York Times article, the subject of running injuries on hard versus soft surfaces was examined. Exercise physiologist Hirofumi Tanaka of the University of Texas at Austin took a deeper look at soft-surface running and said he could not find any scientific evidence that a softer surface benefits runners. Tanaka developed an interest in the topic after experiencing a running injury. When he was recovering from a knee injury, an orthopedist told him to get off the roads and hit the trails. He took that advice and twisted his ankle and aggravated the injury while running on the softer, irregular surface.

In the aftermath of his accident, Dr. Tanaka said he could not find scientific evidence supporting that a softer surface is better for runners than a hard one, nor could other experts he queried. In fact, he suggested that it makes just as much sense to reason that runners are more likely to get injured on soft surfaces, which often are irregular, than on smooth, hard ones.

 

Exercise smart to prevent injuries

HPRC Fitness Arena:
Some tips to keep you from hurting yourself while exercising

Since injuries can occur in physically active individuals, here are a few tips to help you stay injury free:

  • Warm-up and cool-down after exercise;
  • Use proper form;
  • Spread activity throughout the week, not just the weekend;
  • Wear appropriate safety gear;
  • Increase intensity and time gradually, and
  • Cross train to prevent overuse injuries.

Click here for more information: Handout on Health. Sports Injuries. National Institute of Arthritis and Musculoskeletal and Skin Disease.

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Military medical researchers develop blood for screening concussions or mild traumatic brain injury

HPRC Fitness Arena:
Can a blood test detect a concussion or TBI?

MRI of Head

CNN.com is reporting that military medical researchers have developed a blood test that can detect if someone has suffered a concussion or a mild traumatic brain injury.

Traumatic brain injury (TBI) is a big concern for the military, particularly milder forms, because unlike TBI, milder injuries cannot be seen on X-rays, CT scans or MRIs. Having this test would be useful not only for the military but for civilians as well.

Read the full article here.

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Studies look at the effect of running has on your knees

HPRC Fitness Arena:
The October 13, 2010 Health section of the New York Times has an article discussing recent research on knees, arthritis and vigorous exercise.

Man with radiating knee pain

The October 13, 2010 Health section of the New York Times has an article discussing recent research on knees, arthritis, and vigorous exercise.

There's no question that physical activity over time takes its toll; however, your body is capable of adapting to it. The question is whether this adaptation is healthy.

Read the full article here.

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