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Gait retraining and incidence of medial tibial stress syndrome in army recruits

Lookup NU author(s): Dr Iain SpearsORCiD


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PURPOSE: Gait retraining, comprising biofeedback and/or an exercise intervention, might reduce the risk of musculoskeletal conditions. The purpose was to examine the effect of a gait-retraining program on medial tibial stress syndrome incidence during a 26-wk basic military training regimen. METHODS: A total of 450 British Army recruits volunteered. On the basis of a baseline plantar pressure variable (mean foot balance during the first 10% of stance), participants classified as at risk of developing medial tibial stress syndrome (n = 166) were randomly allocated to an intervention (n = 83) or control (n = 83) group. The intervention involved supervised gait retraining, including exercises to increase neuromuscular control and flexibility (three sessions per week) and biofeedback enabling internalization of the foot balance variable (one session per week). Both groups continued with the usual military training regimen. Diagnoses of medial tibial stress syndrome over the 26-wk regimen were made by physicians blinded to the group assignment. Data were modeled in a survival analysis using Cox regression, adjusting for baseline foot balance and time to peak heel rotation. RESULTS: The intervention was associated with a substantially reduced instantaneous relative risk of medial tibial stress syndrome versus control, with an adjusted HR of 0.25 (95% confidence interval, 0.05-0.53). The number needed to treat to observe one additional injury-free recruit in intervention versus control at 20 wk was 14 (11 to 23) participants. Baseline foot balance was a nonspecific predictor of injury, with an HR per 2 SD increment of 5.2 (1.6 to 53.6). CONCLUSIONS: The intervention was effective in reducing incidence of medial tibial stress syndrome in an at-risk military sample. © 2014 by the American College of Sports Medicine.

Publication metadata

Author(s): Sharma J, Weston M, Batterham AM, Spears IR

Publication type: Article

Publication status: Published

Journal: Medicine and Science in Sports and Exercise

Year: 2014

Volume: 46

Issue: 9

Pages: 1684-1692

Print publication date: 01/09/2014

Acceptance date: 01/01/1900

ISSN (print): 0195-9131

ISSN (electronic): 1530-0315

Publisher: Lippincott Williams and Wilkins


DOI: 10.1249/MSS.0000000000000290

PubMed id: 24500537


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