1. THESIS PROGRESS REPORT
Prevention and Control of Musculoskeletal Injuries associated with physical related activities and training among soldiers of Maldives National Defense Force
THESIS PROGRESS REPORT
IKRAM HAMEED G

2. PREVIEW I – Objectives II – Overview of Study 1 III – Study 2
Introduction
Objective

3. General objective
to describe and analyses the influence of preventive intervention on, musculoskeletal injuries associated with physical activities from military service compared to earlier years and to conduct and propose a comprehensive intervention exercises and programme for Maldives National Defense Force.

4. Specific objectives
To evaluate and determine the incidence of musculoskeletal injury associated with basic fitness test in the military services in Maldives National Defense Force

5. Specific objectives
To analyze the literature on the incidence of musculoskeletal injury in military and to review the current knowledge on the possibilities for preventing knee injuries and the effectiveness of prevention programmes

6. Specific objectives
To conduct an experimental study in order to analyze the influence on musculoskeletal injuries associated with the proposed comprehensive intervention exercises and programme for Maldives National Defense Force.

7. CLARIFICATION of under- recognized musculoskeletal injuries WITH BASIC fitness test in Maldives national defense force - STUDY 1

8. Purpose
To evaluate and determine the occurrence of musculoskeletal injury with basic fitness test in Maldives National Defense Force.

10. Incidence of knee injuries in the military and the effectiveness of prevention programmes: A systemic review STUDY 2

11. introduction
Knee injuries are the predominant cause of Musculoskeletal injuries of lower extremities and the leading cause of loss of manpower in defense force

12. Military soldiers from different armed forces around the world participate in physical activities other than military physical trainings such as sports for personal interests, relaxation, health and fitness training

13. Classification of injury prevention research
1. Establishing
the extent of the military injury problem
- Incidence
- Severity
2. Establishing the aetiology and mechanism of military injury
3. Introducing a preventive measure
4. Evaluating the effectiveness of a preventive measures
The Classification of injury prevention research has been described by Van Mechelen et al. as model of four different steps

14. the extent of the military injury problem - Incidence - Severity
Step 1
1. Establishing
the extent of the military injury problem
- Incidence
- Severity
Before initiating any prevention program for military injuries, especially knee injuries, the magnitude of the problem must be identified and the extent of the injury defined in terms of the incidence and severity

15. 2. Establishing the aetiology and mechanism of military injury
STEP 2
2. Establishing the aetiology and mechanism of military injury
The second step of the sequence of injury prevention research is to establish the risk factors and mechanisms that play a role in the incidence of knee injuries in military activities.

16. 3. Introducing a preventive measure
STEP 3
3. Introducing a preventive measure
Thirdly, measures that has the prospective to reduce the future risk or severity of knee injuries should be introduced. These measures should be based on information (aetiology and injury mechanisms) gathered in the second phase.

17. 4. Evaluating the effectiveness of a preventive measures
STEP 4
4. Evaluating the effectiveness of a preventive measures
Finally, to assess the effectiveness of these preventive measures.

18. Purpose
to analyze the literature on the incidence of musculoskeletal injury in military and to review the current knowledge on the possibilities for preventing knee injuries and the effectiveness of prevention programmes

19. Relevant studies were searched using the
Data sources
Relevant studies were searched using the
PubMed database (1965 to June 2017)
MEDLINE database (1966 to June 2017).
Google scholar

20. Additionally, relevant reviews were searched and assessed from reference lists and retrieved articles for possible information on trials of interest. Keywords in this search were “military injuries”, “musculoskeletal injuries”, “knee injuries”, “incidence”, “risk factors”, “prevention”, “preventive”, and “physical training”.
All these terms were combined with each other in different ways.

21. Incidence and characteristics
Several investigation has studied the incidence causes and risk factors of knee injuries in male soldiers;
However, epidemiological data on knee injuries in female soldiers were still limited

22. Articles not written in English were excluded
Articles not available in the library in Mahidol University were requested from other sources.

23. What did the Literature tell us about injuries in 2013-2015

24. Breakdown of knee injuries

25. Ways of preventing injuries in military
Most of the programme includes
Warmup and cooldown with special emphasis on stretching
Adequate rehabilitation and time for recovery from an injury

26. Improvement in fitness with special emphasis on proprioceptive training
Protective equipment
Excellent training ground / area

27. Other programmes add further items on this list
Screening prior to the training
Nutrition and hydration
Improved technique and better injury recording

28. Studies on Preventing Military injuries
Author / year /country
Type of unit n
Intervention
Result
Pope, Rodney P./ 1999/ Australia
(50)
Army
143 female recruits
Reduced foot marching speed from 7.5 to 5km/h
Allowed women to march on their own steps length rather than marching in step
Encouraged marching and running in more widely spaced formation to aid in obstacle awareness
Conducted running on grass in preference to roads wherever possible
Substitute interval running for longer distance runs where possible
Incidence of pelvic stress fractures reduced from 11.2% pre-intervention to 0.6% post- intervention.

29. Stopped running in formation
Rudzki, Stephan J / 1999/ Australia
(51)
Army
318 females
1634 Males
Stopped running in formation
Introduce interval training of 400 and 800 meter on grassy surface
Reduced distance on the running test from 5 to 2.4km
Standardized foot marched to include control of march speed, progressive load increments and a prohibition on running
Ran in water as a cross training technique
Compared to the pre-intervention cohort, injury rates post- intervention decreased 46% for men and 35% for women
Medical discharges decreased 41% among men but unexpectedly rose 58% for women

30. Run less mileage than control group
Knapik et al, 2004, USA
(52)
Army
518 men
416 women
Wide variety of exercises such as calisthenics, movement and climbing drills, interval training and distance running compared to usual basic combat training physical training program consisting of long distance running, stretching, calisthenics, sit-ups and pushups practice
Run less mileage than control group
Highly prescriptive program with enforced progressive overload
Experimental group men and women were respectively lower risk of overuse injuries than experimental group
Overall Advanced physical fitness test pass rate higher for experimental group

31. What we learned from the review
Multi model intervention programme may result in injuries in general
However, more well designed studies were required to evaluate the effect of specific preventive intervention

32. Proprioceptive and / or coordination trainings seems to prevent severe knee injuries in military service

33. Prevention programmes probably have different effects in male and female soldiers

34. Further studies should monitor compliance of soldiers with the programme because this was found to be an essential factor for its effectiveness

35. THANK YOU