Document Detail

Exercise training to prevent anterior knee pain in military recruits.
MedLine Citation:
PMID:  22544060     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: : To investigate the incidence of anterior knee pain among new recruits participating in a targeted exercise intervention, as an addition to army basic training, compared with recruits in an unmodified training program.
DESIGN: : Single-blind, cluster (by troop) randomized, controlled trial, during the 14-week period of basic military training.
SETTING: : The Army Training Centre (Pirbright, United Kingdom) between July 2006 and February 2007.
PARTICIPANTS: : Army recruits, who enlisted at the Army Training Centre and passed the entry medical examination, participated in the study (n = 1502). The participants were divided into 50 single-sex troops (mean n = 41; range, 22-48).
INTERVENTION: : All participants trained for 3 to 4 hours per day in endurance marching, military field exercises, running, weapons and foot drill, strength and conditioning, and classroom lessons. At the beginning of physical training sessions, the troops assigned to prevention of anterior knee pain (n = 759 persons) did 4 closed kinetic chain quadriceps and gluteal strengthening exercises and finished with 4 static stretches of the quadriceps, iliotibial band, hamstring, and gastrocnemius muscles. Position of the hip and knee in relation to the foot was emphasized. The 15-minute daily sessions were supervised by specially trained army instructors. The control group participants (n = 743) were assigned to existing military warm-up and warm-down exercises, including slow running, upper-body and lower-body stretching, abdominal curls, and push-up drills. Attendance at the physical training sessions was 91%.
MAIN OUTCOME MEASURES: : The primary outcome was the incidence of overuse anterior knee pain during the training period. Recruits with knee pain were examined by a medical officer and diagnosed by experienced physiotherapists. Criteria for the diagnosis were anterior or retropatellar knee pain from ≥2 of prolonged sitting, stair climbing, squatting, running, kneeling, and hopping; insidious onset unrelated to trauma; and presence of pain on palpation of the patellar facets, on step down, or during a double-legged squat. Exclusion criteria were signs and symptoms of intraarticular pathology or other pathologic conditions or a history of patellar dislocation, surgery, or structural damage to the knee. Secondary outcomes were related to the successful completion of training and medical or other discharges from training.
MAIN RESULTS: : The cumulative number of new cases of anterior knee pain in the intervention group was lower (10 cases; incidence, 1.3%; 95% confidence interval [CI], 0.7%-2.4%) than that in the control group (36 cases; incidence, 4.8%; 95% CI, 3.5%-6.7%). The incidence per recruit-month was lower in the intervention group compared with the control group (0.005 vs 0.020; P < 0.01). Adjustment for sex, clustering, and other risk factors did not modify the results. Overall, there was a 75% reduction in risk of anterior knee pain in the intervention group (unadjusted hazard ratio = 0.25; 95% CI, 0.13-0.48; P < 0.001). More of the intervention group than the control group successfully completed training (79.7% vs 67.8%); fewer were medically discharged (0.4% vs 3.4%); and fewer were discharged as "unfit for army service" (0.8% vs 3.1%). A greater proportion of the intervention group who were diagnosed with anterior knee pain during the study, compared with the control group, completed training (90% vs 44.4%).
CONCLUSIONS: : Daily preventative exercises during a military basic training camp successfully reduced the incidence of anterior knee pain in recruits. More of the intervention group avoided medical discharges and completed their basic training.
Jon Divine
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine     Volume:  22     ISSN:  1536-3724     ISO Abbreviation:  Clin J Sport Med     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9103300     Medline TA:  Clin J Sport Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  288-9     Citation Subset:  IM    
University of Cincinnati, Cincinnati, Ohio.
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