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Background: Running-related injuries are prevalent musculoskeletal complaints in the United States military. Although, run retraining is an extensively researched method for reducing pain and improving function in runners, its clinical utility remains low., Case Description: The patient had a seven-year history of recurrent right calf strains. Prior conventional physical therapy failed to resolve symptoms. A biomechanical running analysis revealed a right forefoot strike during running. The patient underwent run retraining that included real-time visual feedback and a faded feedback strategy focused on converting foot strike pattern to rearfoot. Running mechanics were reassessed post-training, and at one and six months post-training., Outcomes: Foot strike pattern was successfully converted to rearfoot strike and was maintained up to six months post-training. Reductions in peak ankle dorsiflexion moment and dorsiflexion velocity were noted up to six months post-training. Self-reported function also improved by 20-30% and no calf strains were reported up to six months post-training., Discussion: This case report details the clinical reasoning and evidence-informed interventions involved in treatment of a patient with chronic calf strains. The management strategy was intended to reduce eccentric calf demands, which allowed the patient to tolerate increased running frequency without any further episodes of calf strains up to six months post-training., (Published by Elsevier Ltd.)

Background: Severe ankle and foot injuries in the US military can result in high-level functional limitation, lost duty days, and medical discharge., Objective: To assess the effectiveness of the Return to Run Clinical Pathway (RTR) in returning patients with lower extremity fractures who utilized the Intrepid Dynamic Exoskeletal Orthosis (IDEO) to high-level mobility., Methods: Thirty servicemembers with lower extremity fractures who utilized the IDEO unilaterally and completed the RTR at Naval Medical Center San Diego were included in this retrospective operational review. The Comprehensive High-level Activity Mobility Predictor (CHAMP) and all subtests were completed prior to and after completion of the RTR as part of routine clinical care. An analysis of covariance (ANCOVA) was used to compare CHAMP scores before and after the RTR., Results: Significant improvements were found in the T test (mean change, faster by 5.3 seconds; 95% confidence interval: 3.6, 7.1 seconds; P = .03) and total CHAMP score (mean change, 4.2 points; 95% confidence interval: 3.0, 5.3 points; P <.05). No significant changes were noted in the single-legged stance subtest, the Edgren sidestep test, or the Illinois agility test., Conclusion: The RTR led to improvements in high-level, multidirectional mobility in IDEO users with a history of fractures. Applicability of the intervention used in this study requires further validation before widespread use., Level of Evidence: Therapy, level 4. J Orthop Sports Phys Ther 2019;49(7):529-535. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8763 .

Objective: To describe the incidence of overuse musculoskeletal injuries in service members with combat-related lower limb amputation., Design: Retrospective cohort study., Setting: Military treatment facilities., Participants: Service members with deployment-related lower limb injury (N=791): 496 with a major lower limb amputation and 295 with a mild lower limb injury., Interventions: Not applicable., Main Outcome Measures: The outcomes of interest were clinical diagnosis codes (International Classification of Diseases-9th Revision) associated with musculoskeletal overuse injuries of the lumbar spine, upper limb, and lower limb regions 1 year before and 1 year after injury., Results: The overall incidence of developing at least 1 musculoskeletal overuse injury within the first year after lower limb amputation was between 59% and 68%. Service members with unilateral lower limb amputation were almost twice as likely to develop an overuse lower or upper limb injury than those with mild combat-related injury. Additionally, service members with bilateral lower limb amputation were more than twice as likely to develop a lumbar spine injury and 4 times more likely to develop an upper limb overuse injury within the first year after amputation than those with mild combat-related injury., Conclusions: Incidence of secondary overuse musculoskeletal injury is elevated in service members with lower limb amputation and warrants focused research efforts toward developing preventive interventions., (Published by Elsevier Inc.)