Warriors Corner: Army Wellness Center Musculoskeletal Injury Reduction Program

– Ladies and gentleman welcome to the Warriors Corner for the briefing on Army Wellness Center
Musculoskeletal Injury Reduction Program. Today’s speakers will be
Brigadier General Jeff Johnson Deputy Chief of Staff for
Support United States Army Medical Command Chief of Dental Corp. Dr. Bruce Jones Army Lead
and Injury Surveillance at the Army Public Health Center. Mr. Todd Hoover Army
Wellness Center Operation Division Chief Army Public Health Center. During the question and answer section please wait until you have
the mic to ask your question. At this time lets welcome
Brigadier General Jones. (applause) – Good afternoon, its’ great to see ya. Those who have stuck it out til the end here at the Army Warriors Corner. I think everybody that’s here at this time gets 10, 000 meaningless points. So feel free to take those and if you take them over to one of the stands here they’ll give you a
meaningless gift as well. So it’s my pleasure to have an opportunity to introduce really, a couple of experts that are going to talk to you today about musculoskeletal or MSK prevention. That’s what this is really all about. The reason it’s important
is because the number one medical non-readiness factor in our formation is MSK injuries. That’s really why we need to figure out what makes it up and what
do we need to do about it? So let me just start off
by teasing you a little bit with a little bit of a story. The year before I came
into the military, 1982 the Force Com Commander
asked a question of his staff that got a lot of this started. His question to his
staff at that time was, hey I notice we’re
having a lot of injuries what if I were to mandate that everybody had to wear running shoes
instead of combat boots in order to do physical training? ‘Cause at that time everybody
was wearing combat boots. So an interventional study was set up in order to be able to
test that hypothesis. Thousands of tennis shoes were purchased and the study never happened
because that same year the chief of staff of the
Army said I don’t really care to know what the science is behind this, what I want to do is, I
just want to tell everybody they got to wear tennis shoes and that’s gonna decrease injury rates. So they did that, we
didn’t really get a chance to do the study then but then the study’s came over subsequent years. We found out that it really doesn’t matter from an injury perspective whether you’re wearing combat boots
or your wearing tennis shoes. Found out that it wasn’t
really a magic answer that Force Com Commander was looking for. So there’s also been
some additional studies over the course of time that looked at if we have a better stretching program that’s obviously gonna
change injury rates, which it doesn’t. Well what if we have a
particular manufacturer of a tennis shoe, maybe that would change what the injury rate, no. Didn’t effect it at all. Also studied, well maybe if we matched the kind of shoe with a type of foot, high arch, low arch, flat feet, pes planus, whatever it might be, guess what? No magic bullets to this problem. So that’s been kind of interesting to watch over the course of time. How it is that we’ve tried to
get after injury prevention but really haven’t had
the science behind it. Today we’re going to have an opportunity to hear some of the science behind it and to understand what
it is that can be done in order to identify those
who are in the formation that are highest risk
for injury prevention. One other quick story, just to demonstrate that you can have an impact on injury prevention. In 2003 to 2013 TRADOC directed
Army Accessions Command to conduct a standardized structured physical training program in their brigade combat training units. So they spent a lot of time decreasing the amount of total mileage that they did during basic training. They did interval training,
they decreased the mileage, they did more multi-directional
functional movements, like grass drills or gorilla drills and they found that they
were able to decrease the injury rate in
those formations by 46%. So it went from nearly 4, 000 to 2, 000 injuries per trainee per
year in those formations by changing the structure
and the intensity at which individuals worked out. So over the course of
time, and you’re gonna hear again today from the
research from our experts, that we really know that
there’s two reasons, two modifiable risk factors for getting after musculoskeletal
injuries, MSK injuries. Those are the type and the
intensity at which you work out and the level of
individual physical fitness for each person that is
inside that formation. Fortunately, we have the
Army Wellness Centers at each one of our camps posting stations across the United States
who has advanced technology that can assess what a persons
individual fitness level is and to target and to give individualized exercise prescriptions in order to be able to help them get through those
two modifiable risk factors. So really what we want to do today is to present options for
commanders to understand how they can get after
musculoskeletal injuries. How they can get up
stream of the number one medical non-readiness
action that’s taking place. Impact of that, we currently have about eight million limited duty days inside of our total Army
every year from this. That has a significant impact on training and on the readiness. So without any further
ado let me introduce the true experts here who
are going to walk you through some interesting information that I’m sure you gonna have some
questions at the end for. It’s my honor to
introduce Dr. Bruce Jones. Dr. Jones is a physician,
retired colonel as well who has spent his entire
military and civilian career researching and investigating injuries inside of our troops and our formations. Dr. Jones, great to have you here. Also have Dr. Hoover who is here with us, he’s an exercise physiologist who really was the brain child behind
the Army Wellness Centers, initially envisioned them
and then implemented them across the United States, across CONUS initially starting in Europe. So, Todd it’s great to
have you here as well. So gentleman, take it over from here. – Thank you sir. Sir is the mic on? I guess it is. So, General Johnson thank you for that very excellent introduction to the topic. As General Johnson said,
what we’re gonna talk to you about today is the
biggest medical threat to readiness of the Army and we’ll also talk to you about how we can improve readiness
through injury reduction. Next slide. So I’ll try to answer
three questions for you. The first one is why
should we be interested, how big is this problem? The next question is
what causes this problem, why do we have the problem? And then Todd Hoover
will talk to you about how we can get ahead of this problem through health promotion and
the Army Wellness Center. Next slide. So there’s a wide variety of
injuries that affect soldiers. As you can see here, these
are mostly traumatic injuries the number one health
problem as you will see, is actually overuse injuries from training related activities. Next slide. So this slide gives you
an idea of just how big the problem is, you can
see the top line here, if you can’t read it it says injuries. There were roughly in 2017 two million, a little more than two
million injury encounters in medical treatment facilities. Second leading cause was mental health at just about a million
and then everything else was much lower. If you look at the second line under the blue line you can see the number of specific injuries those
were roughly 350, 000 affecting 250 to 300 soldiers that year. That’s what we see year in and year out, so this is a big problem. Next slide. 97% of all the injuries that we see are not necessarily
musculoskeletal but their due to a transfer of energy
from an external source and 75% of all injuries are
musculoskeletal injuries due to cumulative trauma
what in sports medicine we call overuse injuries
from too much training. These injuries include
things like stress fractures, achilles tendonitis,
patellar-femoral pain syndrome, plantar fascitis and other
back and knee pain syndromes. Next slide. Another way at looking at the magnitude of the problem is to look
at days of limited duty due to injuries or profile days. What you can see across
this yellow line here is musculoskeletal injuries
and just in the first half of 2019 there were 4.1 million profiles prescribed for soldiers. The second leading cause
was actually pregnancy and post-partum recovery
at about 725, 000, 10.2% of the problem. And the third leading category of health was behavioral health at
just over 700, 000 and 10%. So musculoskeletal injuries
accounted for almost 60% of all prescribed limited duty for the Army in the
first half of this year. Next slide. So what are the main
take home lessons so far? Injuries are the number one
medical threat to readiness, musculoskeletal injuries
due mostly to training and vigorous operational activities are the biggest portion of that problem. As you saw over four million days in the first half of the year which would average out as General Johnson said to about eight million days
of limited duty annually. Next slide. So why do we have this problem? I think for most of us who have been in the military we know why. It’s the type of activities that we have to do to be prepared for our missions. This slide is a reminder that the type of activity is important. As you will see in a moment running is the leading cause of these types of industries for the Army but road marching, per hour of road marching, per mile of road marching
is twice as hazardous actually two to five times
as hazardous as running and per hour on the obstacle course it’s seven to eight times
more injurious than running. So the type of activity is important and there are trade-offs,
you can’t trade running for marching miles and expect
to reduce your injury rates. Next slide. So here we see the five leading causes of injuries for the Army. Running is number one at 43% of the total followed by MOS work related task, equipment maintenance and so forth. Falls, slips and trips
are third at about 10% followed by road marching
at about 8% and then sports. So vigorous physical activities
dominate the top five. Next slide. So over 30 years of experience, actually it’s almost 40
now, it sort of shocks me to think that’s the case. We have found that there are consistently strong relationships
between aerobic fitness as measured either on a
treadmill with a VO2 max or run times from unit records. And also between body
composition and increased risk of musculoskeletal injuries. So what have we found over that time? Next slide. These are data on Army trainees but we see that the same pattern of
association and operational units. What we see here is
along the horizontal axis we see run times from
the fastest quintal 20% to the slowest quintal 20% and injuries on the vertical axis and the next few slides it’ll
be oriented in this same way. What we see for male soldiers in blue we see risk going up from
about 10% to over 24%. So almost a two and half fold increase in injury risk as we go from
the fastest to the slowest. For women in the light
red we see risk going from 27% to 56% a more than doubling of risk as we go from fastest to slowest. This we have found consistently as I said in both Basic Training populations
and in operational units. This is a study of 185, 000 men and women, 143, 000 men, 41, 000 women, so everything you see on this chart is significant just because of the large numbers. Next slide. So what do we see when we
look at body mass index which we use as a surrogate
for percent body fat and it’s really highly
correlated with body fat in soldiers as well as civilians. What we see here is we go from low BMI’s on the left to high BMI’s on the right that there’s very little difference but one notable thing
is that the extremes, both the lowest and the highest in the BMI for women and for men are at greater risk than
those with average BMI’s. Now we know that as
BMI or body fat goes up run times get slower and
aerobic fitness goes down. So we wondered what
would happen if we looked at both fitness and body
fat at the same time or BMI at the same time. Next slide. So this is what we found,
this is the incidence of injury by 2-mile run
time and BMI for women. Just to orient you along
the horizontal axis we see run time from fastest on the left to slowest on the right and we see BMI from lowest, an indicator of low body fat to the highest coming out from the back and we see injury risk or
incidence on the vertical axis. This is kind of counterintuitive
but the highest risk was for women who had the lowest
BMI’s and ran the slowest. But interstingly, the lowest risk was for the three highest quintals of women who also were in the
fastest quintal of run time. So it appears that being
somewhat over weight but physically fit is protective against musculoskeletal injuries
and also if you’ll notice the highest risk at every fitness level is for those with the lowest BMI’s. Next slide. So this now is incidents
of injury by two mile run and body mass index for men
in basic combat training. This is roughly a 140,
000 men, same orientation, run times on the horizontal,
BMI going from low to high coming out of the page
and the vertical axis is incidence injury and we
see the same thing for men. The highest risk is in those who are in the lowest fitness
level but have the lowest BMI’s and the lowest risk are in
these upper three quintals of BMI who are also physically fit. Next slide. So key points to remember, this point, running is the leading cause
of musculoskeletal injuries in the Army and some
modifiable risk factors are poor aerobic fitness
and also body mass index that’s outside of AR 600-9 our
body composition standards, either underweight or overweight. By the way bmi comes directly from the height- weight standards. Then the biggest risk
factor is slow run times which are a behavioral
modifiable risk factor. Next slide. And with that I would like to turn it over to Todd Hoover my compatriot here to tell you about a way that
we can manage this problem. Todd. – Thank you Dr. Jones. Thank you Brigadier General Johnson. So with Dr. Jones I
think he did a good job with laying out kind of what
these data are suggesting. So next slide. And what I’ll briefly talk about are the primary and secondary risk factor that these data has
suggested and that is this is that we have a primary risk factor which is aerobic capacity
as measured in run time. So if we have males that
have a run time greater than 15 minutes and females
that have a run time greater than 18 minutes, that’s
the primary indicator that that persons at a higher
risk for MSK injury. If we add somebody out of compliance with the AR600-63, either to low or too high, that’s the secondary indicator but overall if we were
simplifying it to leaders we would just say look,
if you have soldiers that meet these run time criteria, your primary indicator,
those are the soldiers that most likely you would want to do an intervention on and try to increase that aerobic capacity. If you can do that and improve
their aerobic performance as measured in the two mile run, then we can actually
decrease the MSK risk factor. Next slide. So the Army Wellness Centers
were actually started in Germany in 2004 (speaking German). I was in Heidelberg. Yeah, yeah it was beautiful. So we started in Germany
actually in 2005 at the hospital in Heidelberg and it was
really a simple concept. What we wanted to do was actually turn how health promotion and health education was delivered at that
time which was really a secondary and tertiary model. What we wanted to do with
that Army Wellness Center is we wanted to focus
on primary prevention. What we wanted to do was to look at people with specific risk factors
before they had an issue. So in the case of MSK,
before they were injured we would want to prevent it. Before somebody had hypertension
we’d want to prevent that and as you know there
are certain lifestyle modifiable risk factors
that we can do such as modifying physical activity and diet and we can change a broad
spectrum of conditions that we see in primary care. Well when it comes with
MSK, we can actually modify performance a little bit and
decrease those risk factors. So with the Army Wellness Centers instead of going the traditional health education, health promotion, what we wanted to do was do something a little
bit more evidenced based. How we approached it was, instead of lecturing the
people, holding classes and stuff like that, what we wanted to do was assess them where they were at. So for example, if somebody came in and we were looking at aerobic capacity, we would do a VO2 Max test. Which meant that we’d
put them on a treadmill or a bike, put a mask on
them and we would measure their aerobic capacity. Then we could actually
tell them specifically what intensity they would need to train at a specific heart rate
to achieve their goal and we could give them a very targeted exercise prescription. The other thing that we wanted to do is measure exactly body composition but instead of just doing it with some anthropometric measurement
or something like that, we wanted to do something a little bit more scientifically sound. So we introduced the
BOD POD Air Displacement and then for calories instead
of just calculating out doing a manual calculation
of caloric needs, we’d actually do indirect calorimetry which meant that we would put somebody, lay them down and actually
measure the amount of oxygen of their self uptake and then
from that we can determine how many calories they needed per day in 15 minutes by just
measuring the amount of air that they consumed because
for every liter of oxygen you consume you burn five calories. So this device is extremely accurate. We would see this in research and in very heavy clinical
settings but we wanted to apply it to the general population. One of the things that the
Wellness Centers have mastered is health coaching. That is this, if we’re
going to modify a behavior we’re going to need to coach
people on how to do that. So the Wellness Center
staff are highly trained in being able to modify health behaviors by coaching, by implementing
these coaching strategies. So we took these professionals,
we trained them on coaching and the six core programs we have in an Army Wellness Center
and made them very proficient at assessing peoples health risk and then writing and exercise
plan or health plan for them and then coaching them on
what they needed to do. Next slide. So recently, we always stay abreast of new technology and the K-5 is something that we’ve recently introduced
into the Wellness Centers. This is a pretty amazing device. I feel like a commercial right now where selling like cooking
demo or something like that but this is a K-5. Mostly you would see this
in a research setting and this is a wearable metabolic analyzer. What we do know with the soldiers, we’re testing with a
protocol and we’re working with Appalachian State University at Fort Campbell and we’re
looking at MSK specifically. We can actually take this device out to the unit where the soldier is at and have them do a two mile
run wearing this device. Then from it this would
actually send a signal to a laptop that’s at
the edge of the track and they can collect the data. Then from it we can
actually measure exactly what their aerobic capacity
is, their performance, their substrate utilization which means we can tell them precisely
what fuel they were using, carbohydrates, fats, when
they were doing that activity and then precisely tell
them what they would need to do to modify their run
performance to improve it. The objective is, to take
this research grade technology and bring it to the soldier
and actually improve the outcome quite a bit. So this is one of the
things that we’ve been doing in the Wellness Centers
and with Appalachian State we’re actually running
some validation studies on a protocol using
this device specifically for the soldiers in the two mile run time. The objective is to
leverage this technology at such a precise level
that we can actually improve the performance of a
soldier in a few visits. What we’ve shown in our data analysis is that the more frequently a soldier comes into an Army Wellness Center the greater the impact or the greater the results that they have. Next slide. This is a demo I think
you have to hit play. This is a little clip we have on the K-5. (intense music) Let me emphasis this, the
reason that we wanted to go to this is to not be restricted
to just a brick and mortar. Although the Wellness
Centers are fully mobile at this point now, this
increases our capability to actually go to the units
where the soldiers are at and conduct these types
of advanced testing That was one of the innovations that we’ve been working on this to improve it. This was from a program evaluation that we had a couple years ago and it’s actually published in the American Journal of
Health Promotion in 2018. What it showed was the
effects of cardiorespiratory fitness, soldiers that came in almost 70% saw an improvement in
cardiovascular fitness. We saw improvements in body composition and we saw improvements in BMI. What was interesting in
this is those that had a specific target for
improving body composition actually saw the greatest increase. Obviously, they were
more motivated to do it. That journal article won Editor’s
Pick of the Year for 2018 and it actually looked at the effects of the Army Wellness Centers. So what we wanted to do
was implement a program to standard to, for example like using American College of
Sports Medicine standards to integrity and we wanted to make sure that we delivered this to the soldier, to their family member
and to the people of the Army community to get these services that are highly specialized and capable. Next slide. The other thing that we found in health behavior obviously is smoking. Those that smoked had
increase risk factor for MSK and also sleeping. These are areas that the
Army Wellness Centers will address with a
client if they indicate that this is one of the
issues that their doing or some of the health behaviors
that their engaging in. We can actually help
them coach through that. Next slide. So the Army Wellness Centers key points what we did show in our analysis is that those soldiers or people that did visit the Army Wellness Center, saw improvements in cardiovascular fitness
and also saw decreases in body composition. What we’re trying to educate leaders on is that if you have
soldiers in your formation that meet these run times criteria those are the soldiers
that would best benefit from a visit to an Army Wellness Center. And if you can get soldiers
that have a run time, males that have a run time
greater than 15 minutes and females with a run time
greater than 18 minutes those are the population that would most be suited to the type of
services that we provide. Next slide. So we have a network of
35 Army Wellness Centers in Europe across the
continental United States, Japan, Korea, Hawaii and the network of wellness centers are all
linked in a central database. Which means that if you go for a visit lets say at Fort Bragg
and get an assessment and three months later
you’re out at Fort Carson you can actually follow-up and do a whole series of assessments
and get the same coaching because your data is already
there and it’s web based. All the Wellness Centers are linked through this virtual network. The other thing about the
Wellness Centers too is that we designed the
assessments to be mobile so we can actually pull together teams from specific Wellness
Centers to go anywhere in the world to actually
do these assessments. As you can tell most of
our assessments are mobile, it’s a mobile capability. Laura Mitvalsky and I
actually went to Iraq and were doing anabolic test
in forward operating bases to assess soldiers in that environment. So the capability exist to provide these services anywhere in the world. Next slide. And I’ll pause for questions. So Dr. Jones and I will be more than happy to answer any questions that you may have. – Sir, I have a question. If you could go back, your soldier impact on
fitness and weight loss there was some bar graphs. – Yes, the bar graphs. – About three charts or so. It will be red, yellow and green. Could you talk a little bit about the red? Its’ kind of surprising
to me that somebody would enter into a measurement program actually execute the
program and you’d have such a high percentage getting worse. Could you just talk
about that a little bit? – Yeah, basically what we’re talking about is changing human behavior
and changing human behavior is very very complex and
it takes a lot of effort to get somebody to modify and be compliant with a prescription. So when we looked at it the effect size that we’ve seen with this type of program is that the effect size that we’ve seen in the Army Wellness Center
are at or greater than you would see for a work site
health promotion programs. So we’ve been able to validate that the question then is too, with these data and this cohort of
soldiers that had come in, this is just a general population
of everybody that came in. What we’re doing now with
MSK pilot at Fort Campbell is these are very targeted interventions with people with specific risk factors. So we anticipate the
outcomes to be much higher. So if you would look at
it to explain the data why we would see that? It’s just a general axis at this point but with very targeted interventions like the MSK at Fort Campbell. It’s gonna be a cohort of
people that are specifically motivated because their specific
identifiable risk factors. So we anticipate those
outcomes to be even higher but our outcomes like
I said are greater than or equal to what you’d see
for these types of programs. – What is also noticeable in this graph that there are 20 to 30% more soldiers who had positive outcomes
than negative outcomes. So there is innate positivity here. – [Male] I am not trying to
criticize all I’m saying is, Dr., no argument there. I’m not surprised by the green I just I would have thought that
the red would be smaller and the yellow would be bigger. I would have thought that
you’d have more people that just, they weren’t able to modify and weren’t able to take advantage. – This is like smoking cessation, it’s very hard to change the behavior but this is a pretty big success. But it’s a good question,
I’m not faulting that either. – [Male] Hello, thank you very much. I’ve used the Army Wellness Center and I think it’s a
fabulous fantastic resource and I use it in Europe actually. I just wanted to ask you, I wish I could run two
miles in 15 minutes still. I’m not able to do that anymore, so I was just wondering if
there was any correlation in between your study with
musculoskeletal injuries and age? – I could answer
– Yes. – But I know he’s the expert. – We see routinely that the older soldiers have higher risk of injuries
and it’s for obvious reasons. Fitness goes down with age
and as a former distant runner I can tell you that
that’s absolutely true. And weight also goes up and those are both combined risk factors for injuries. – For each decade after the age of 30 we see a decrease in our aerobic capacity, just physiologically as we age, it’s part of the aging process but
we can slow that down by being physically
active and physically fit. So you may not be able to
get that 15 minute time but certainly for the age
group it could be relative to have a lower risk
factor as we get older. – [Male] Thank you all for doing this. Russ Read with the Washington Examiner. I know there’s been a lot of concern about the running injuries here but with the new fitness test coming out this year, any concern that we’re
going to see more injuries related to some of the newer events? Particularly when it
comes to lifting weights and things that soldiers
may not be as familiar with? – You know we don’t have an
answer for that question yet. We suspect that with
any new training regime there maybe more injuries
from a different source. That’s something that we’re looking at right now to discover. The bottom line is, this new test is intended to actually
test and encourage soldiers to work out, to develop a wider variety of the components of physical fitness. The two that were primarily
missing in the past were muscle strength and power
which this new test gets at. So the bottom line is
we’ll have to wait and see but we’re looking at it closely
in conjunction with TRADOC. – [Male] That’s a perfect segue to a question that I had and that is, how is the research that
you’re doing being integrated with the Army Physical Fitness School and the Holistic Health
and Fitness program or H2F? – You know, we work very closely with CIMT at TRADOC with
the Center for Initial Military Training, so they’re
well aware of our research and we’re in constant
communications with them. They of course are the proponent who manages the soldier fitness school. So the doctrine is based very much on things we’ve discovered
in conjunction with them. – I wasn’t expecting
that with the microphone but I think you already
answered my question. Hello, hello, okay. What I want to know is how is this related or synchronized with H2F effect? So is its effect and H2F
an outcome of your studies? – They have been aware of our studies and incorporated much of the thinking and principles that we’ve discovered. In regards to what the effects will be we’re in the process of discovering the effects of H2F, Health
and Holistic Fitness and the ACFT, the Army
Combat readiness test. We’re looking at that data right
now, we got our first feed. – And as these other programs evolve out the Wellness Centers is
an established network that exist today with evidence
that there’s an effect that shows positive outcomes. So what will remain is
something complimentary to these types of programs, meaning that in units if they have soldiers of these specific things that
need an additional type of coaching or assessment
the Army Wellness Centers is a perfect platform
for that to occur in. Where the other ones will focus more on a larger segment of the population. The Wellness Centers will focus precisely on more precision type health promotion on people that need very
specific health coaching, the assessments and the type of work that would help improve
their performance over time. – [Male] It’s Captain Gorman
with the Defense Health Board. Dr. Hoover, with the Wellness Centers what’s their capability? Are they designed for a
certain percentage of the unit? Obviously, if everybody went there, – That’s a great question. So we’ll talk about briefly on that. So when we built the Wellness Centers we looked at ASIP data, which is Army Stationing Installation Plan. We actually looked at
that in each community where we put an Army Wellness Center in. What we projected out was
that an Army Wellness Center would see roughly 25% of the population, of the beneficiary population
which is 40 miles of the MTF, within a 40 mile radius of the MTF. Now to be more specific
what we wanted to do with the Wellness Centers is actually see the at-risk population, meaning, and that was a great question to add, is that Wellness Centers weren’t designed to see a 100% of the population. It’s not economically
efficient to build a program that everybody would utilize. But if you can identify, and this is where the work with Dr. Jones
has been very good, is when you survey the population, you’ve identified the problem and you look at the risk factors and you know exactly what these markers are. If you take those people
and then you link ’em up with the types of services that we deliver in the Army Wellness Center, that’s were the efficiency
is in these types of programs and that’s what we want to do. So we’re designed to see 25%
of the beneficiary population and the priority would
always go to the at-risk or the primary risk factors
within that population. – On the K-5 apparatus is that available at all the Army Wellness
Centers and whose using it? – That’s a great question. So we are actually are testing 30 of ’em in several different, I think there’s 22 Wellness Centers that have ’em and the biggest one that we’re working on, this is where we’re doing
a validation analysis, it’s at Fort Campbell. That’s where we actually taking soldiers within a unit that have
these MSK indicators and we’re actually referring them over to look at the effects on
how we could use this device to improve performance to the unit. Yes, sir. – [Male] What are the
implications for reducing solider load during marches and rucks? What are the implications
of that for reducing the rates of musculoskeletal injury? – That’s a great question. I know Dr. Jones can answer
but I will briefly say that one of the things with the K-5 is that we’ve got this
new added capability where we feel that we’re
going to be able to predict what somebody’s VO2 max is to determine what would be the appropriate load for them to carry using
these types of devices. – So by assessing the
residual aerobic capacity at a certain marching
pace you can determine what extra load the soldier could carry. So, I mean this is
another great capability. We can show right now
that the more you march the more you get injured, the
heavier the load you carry the more you’ll get injured. We now can show that the
more pound/miles you march. So if you multiply
miles/marched times pounds you get pound/miles. So we can begin to
discriminate between high and low pound mileage
and we can already say that those that do more
pound/miles per month at roughly about 1500 a month, which would be three 10
mile road marches, I believe with 10, 50 pounds. I would have to check the math in my head but you get the idea. Those soldiers have more injuries than those who carry less or
do fewer pound/miles. You can’t just trade
off running for marching and expect to reduce your injury rates, on a minute per minute
or hour per hour basis. So we have to balance these trade-offs but we have a much better understanding of the general principles. The main principle of
training related injuries doesn’t matter what activity you’re doing. Whether it’s running or marching or weightlifting now we can show, the more training you do, the
more injuries you will get. We also know from a handful of studies that there are levels of training above which injury risk
increase but fitness does not. The key is to identify those thresholds that which injuries go
up but fitness doesn’t. Those are two markers of over training. – And so as a special gift today for everybody attending
we got free posters and brochures that anybody wants to take and everything that we
talked about in the brief is nicely represented in these graphics. – So, I think we’re out
of time, am I right? There giving me a thumbs up, which is a thumbs down. (chuckling) – Yeah. Don’t forget your nice
posters and brochures. (applause) – [Announcer] Ladies and
gentleman, this concludes the briefings at the Warrior’s Corners. Have a wonderful Army day to all.

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