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Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

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  #1  
Old 26th October 2012, 04:51 PM
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Default Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

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Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan
Roy, Tanja C.; Knapik, Joseph J.; Ritland, Bradley M.; Murphy, Nicole; Sharp, Marilyn A.
Aviation, Space, and Environmental Medicine, Volume 83, Number 11, November 2012 , pp. 1060-1066(7)
Quote:
Purpose: This study determined injury incidence and examined the association between musculoskeletal injuries and potential intrinsic and extrinsic risk factors.

Methods: This retrospective cohort study involved a survey of 593 volunteers from two battalions of a Stryker Brigade Combat Team upon completion of a 12-mo deployment to Afghanistan. The survey included questions on physical characteristics, work duties, equipment worn, fitness training, and injuries experienced during the deployment.

Results: Of the surveyed soldiers, 45% sustained an injury during the deployment. Total injuries resulted in 5049 d of limited duty, an average of 8.5 d per injury. The body regions with the largest numbers of injuries were the low back (17.4%), knee (12.7%), and shoulder (10.0%). The majority (65%) of injuries occurred while working. The most frequent activities soldiers reported as the cause of injury were lifting and carrying (9.8%), dismounted patrolling (9.6%), and physical training (8.0%). Older age, higher enlisted rank, female sex, months deployed, more time spent standing, longer strength training sessions, heaviest load worn, and heavier or more frequent lifting tasks were all associated with injury.

Discussion: Tasks requiring physical energy expenditure such as load carriage, lifting, or standing resulted in an increased risk of musculoskeletal injury in this study. Lifting/carrying, dismounted patrols, and physical training were associated with 26% of musculoskeletal injuries. The weight of loads carried and lifting may be exceeding the work capacity of the soldiers, resulting in injury. These injuries in turn limit available work days for military units, reducing combat power.
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Old 26th October 2012, 05:03 PM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Related threads:
Other thread tagged with military
Military/ Police boots and tibial stress fractures- is there a link?
Military Footwear
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Old 1st November 2012, 05:46 AM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Just out of interest - I did a tour of Helmand, Afghan in 2009/10 in a non-podiatric capacity, however, my skills as a pod were called upon on more than one occasion as I worked in the Field Hospital. From a podiatric point of view the most common complaint I saw, by far, was IGTN. P,fasc was fairly common and obviously a lot of fungal skin infections. I had some real whoppers in terms of ingrowers though and always with infection. There is a physio department out there which is mixed UK and US and that was a great set-up so I'd do the odd teaching session there too.

The Operating theatre staff would let me use their bays and I do remember performing a PNA while a CAT-A patient was in the theatre having something amputated from an IED strike. All very surreal

Some experience though.
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Old 8th March 2013, 06:21 PM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

A prospective investigation of injury incidence and risk factors among army recruits in combat engineer training
Joseph J Knapik, Bria Graham, Jacketta Cobbs, Diane Thompson, Ryan Steelman and Bruce H Jones
Journal of Occupational Medicine and Toxicology 2013, 8:5
Quote:
Background
United States Army combat engineer (ENG) training is an intense 14-week course designed to introduce new recruits to basic soldiering activities, Army values and lifestyle, and engineering skills and knowledge. The present investigation examined injury rates and injury risk factors in ENG training.

Methods
At the start of their training, 1,633 male ENG recruits were administered a questionnaire containing items on date of birth, height, weight, tobacco use, prior physical activity, and injury history. Injuries during training were obtained from electronic medical records and the training units provided data on student graduation and attrition. Risk factors were identified using Cox regression.

Results
Ninety-two percent of the recruits successfully graduated from the course and 47% of the recruits experienced one or more injuries during training. Univariate Cox regression demonstrated that recruits were at higher injury risk if they reported that they were older, had a higher or lower body mass index, had smoked in the past, had performed less exercise (aerobic or muscle strength) or sports prior to ENG training, had experienced a previous time-loss lower limb injury (especially if they had not totally recovered from that injury), or had a lower educational level.

Conclusions
The present investigation was the first to identify injury rates and identify specific factors increasing injury risk during ENG training. The identified risk factors provide a basis for recommending future prevention strategies.
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Old 13th April 2013, 12:50 PM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Changes in Dynamic Plantar Pressure During Loaded Gait.
Goffar SL, Reber RJ, Christiansen BC, Miller RB, Naylor J, Rodriguez BM, Walker MJ, Teyhen DS.
Phys Ther. 2013 Apr 11.
Quote:
BACKGROUND:
Lower extremity overuse injuries are detrimental to military readiness. Extremes of arch height and heavy loads carried by military personnel are associated with increased risk for overuse injury. Little is known regarding the impact of load carriage on plantar pressure distributions during gait.

OBJECTIVE:
The objective was to determine how load carriage affects plantar pressure distributions during gait in individuals with varying arch types.

DESIGN:
A cross sectional repeated measures design.

SETTING:
Research laboratory at Fort Sam Houston, Texas.

PARTICIPANTS:
Healthy service members (n=115, 18 females, 31.3±5.6 years, 86.0±11.0 kg) weighing ≥70kg were enrolled. Participants were categorized as having high, normal, or low arched feet based on published cut-off values for the arch height index (AHI).

INTERVENTION:
Not applicable.

MEASUREMENTS:
Plantar pressure measurements were obtained using an in-shoe pressure measurement system while participants wore combat boots and walked on a treadmill under three loaded conditions (uniform, 20 kg, and 40 kg load). Maximal force (MaxF) and force-time integral (FTI) were assessed using a nine sector mask to represent regions of the foot. Analysis utilized 3×3 repeated measures ANOVA across the levels of load and arch type.

RESULTS:
A significant interaction existed between arch type and load for MaxF (p=0.001) and FTI (p≤0.001) in the medial midfoot, with greater forces in low arched feet. In the medial forefoot, MaxF (p=0.004) and FTI (p=0.002) were greatest in high arched feet across all load conditions. In the great toe region, low and normal arched feet demonstrated greater MaxF (p=0.001) and FTI (p=0.03). The relative distribution of FTI increased proportionately in all regions of the foot regardless of arch type for all load conditions.

LIMITATIONS:
The influence of fatigue, greater loads, and different walking speeds were not assessed.

CONCLUSION:
Regardless of arch type, increases in load did not alter the relative distribution of forces over the plantar foot during gait. Those with high arched feet had greater forces in the medial forefoot region, while those with normal or low arched feet had greater forces in the great toe region, regardless of load. These differences in force distributions may demonstrate different strategies to generate a rigid lever during toe-off.
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Old 11th May 2013, 03:37 PM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Impact of ballistic body armour and load carriage on walking patterns and perceived comfort.
Park H, Branson D, Petrova A, Peksoz S, Jacobson B, Warren A, Goad C, Kamenidis P.
Ergonomics. 2013 May 8
Quote:
This study investigated the impact of weight magnitude and distribution of body armour and carrying loads on military personnel's walking patterns and comfort perceptions. Spatio-temporal parameters of walking, plantar pressure and contact area were measured while seven healthy male right-handed military students wore seven different garments of varying weight (0.06, 9, 18 and 27 kg) and load distribution (balanced and unbalanced, on the front and back torso). Higher weight increased the foot contact time with the floor. In particular, weight placement on the non-dominant side of the front torso resulted in the greatest stance phase and double support. Increased plantar pressure and contact area observed during heavier loads entail increased impact forces, which can cause overuse injuries and foot blisters. Participants reported increasingly disagreeable pressure and strain in the shoulder, neck and lower back during heavier weight conditions and unnatural walking while wearing unbalanced weight distributed loads. This study shows the potentially synergistic impact of wearing body armour vest with differential loads on body movement and comfort perception. Practitioner Summary: This study found that soldiers should balance loads, avoiding load placement on the non-dominant side front torso, thus minimising mobility restriction and potential injury risk. Implications for armour vest design modifications can also be found in the results.
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Old 15th June 2013, 06:17 AM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Effects of wearing different personal equipment on force distribution at the plantar surface of the foot.
Schulze C, Lindner T, Woitge S, Finze S, Mittelmeier W, Bader R.
ScientificWorldJournal. 2013 May 16;2013:827671.
Quote:
Background. The wearing of personal equipment can cause specific changes in muscle activity and posture. In the present study, we investigated the influence of differences in equipment related weight loading and load distribution on plantar pressure. In addition, we studied functional effects of wearing different equipment with a particular focus on relevant changes in foot shape.

Methods. Static and dynamic pedobarography were performed on 31 male soldiers carrying increasing weights consisting of different items of equipment.

Results. The pressure acting on the plantar surface of the foot increased with higher loading, both under static and dynamic conditions (p < 0.05). We observed an increase in the contact area (p < 0.05) and an influence of load distribution through different ways to carry the rifle.

Conclusions. The wearing of heavier weights leads to an increase in plantar pressure and contact area. This may be caused by flattening of the transverse and longitudinal arches. The effects are more evident in subjects with flat feet deformities which seem to flatten at an earlier load condition with a greater amount compared to subjects with normal arches. Improving load distribution should be a main goal in the development of military equipment in order to prevent injuries or functional disorders of the lower extremity.
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Old 16th June 2013, 03:10 AM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Quote:
Originally Posted by Phil3600 View Post
P,fasc was fairly common and obviously a lot of fungal skin infections.
Hi Phil,
I am currently treating defence personel and Havent come across any fungal issues but I was wondering from your experience, do you have any specific "tricks" when advising management of chronic issues besides the usual-
-airing out feet/ drying well
-changing socks
-changing boots
-aluminum bases sprays
-antifungal gels,creams, alcohol wipes
- toe seperators

Thanks
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  #9  
Old 30th August 2013, 12:00 AM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Changes in Dynamic Plantar Pressure During Loaded Gait
Stephen L. Goffar, Rett J. Reber, Bryan C. Christiansen, Robert B. Miller, Jacob A. Naylor, Brittany M. Rodriguez, Michael J. Walker and Deydre S. Teyhen
Physical Therapy September 2013 vol. 93 no. 9 1175-1184
Quote:
Background Lower extremity overuse injuries are detrimental to military readiness. Extremes of arch height and heavy loads carried by military personnel are associated with increased risk for overuse injury. Little is known regarding the impact of load carriage on plantar pressure distributions during gait.

Objective The objective of this study was to determine how load carriage affects plantar pressure distributions during gait in individuals with varying arch types.

Design A cross-sectional, repeated-measures design was used for the study.

Methods The study was performed at a research laboratory at Fort Sam Houston, Texas. Service members who were healthy and weighing ≥70 kg were enrolled in the study. The participants (97 men, 18 women; mean age=31.3 years, SD=5.6; mean weight=86.0 kg, SD=11.0) were categorized as having high-, normal-, or low-arched feet on the basis of published cutoff values for the arch height index. Plantar pressure measurements were obtained with the use of an in-shoe pressure measurement system while participants wore combat boots and walked on a treadmill under 3 loaded conditions (uniform, 20-kg load, and 40-kg load). Maximal force (MaxF) and force-time integral (FTI) were assessed with the use of a 9-sector mask to represent regions of the foot. A 3 × 3 repeated-measures analysis of variance was used for analysis across the levels of load and arch type.

Results A significant interaction existed between arch type and load for MaxF and FTI in the medial midfoot, with greater force in low-arched feet. In the medial forefoot, MaxF and FTI were greatest in high-arched feet across all load conditions. In the great toe region, low-arched and normally arched feet had greater MaxF and FTI. The relative distribution of FTI increased proportionately in all regions of the foot regardless of arch type for all load conditions.

Limitations The influence of fatigue, greater loads, and different walking speeds was not assessed.

Conclusions Regardless of arch type, increases in load did not alter the relative distribution of force over the plantar foot during gait. Participants with high-arched feet had greater force in the medial forefoot region, whereas those with normally arched or low-arched feet had greater force in the great toe region, regardless of load. These differences in force distribution may demonstrate different strategies to generate a rigid lever during toe-off.
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Old 30th August 2013, 12:23 PM
Dr. Steven King Dr. Steven King is offline
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Smile Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Quote:
Originally Posted by NewsBot View Post
Changes in Dynamic Plantar Pressure During Loaded Gait
Stephen L. Goffar, Rett J. Reber, Bryan C. Christiansen, Robert B. Miller, Jacob A. Naylor, Brittany M. Rodriguez, Michael J. Walker and Deydre S. Teyhen
Physical Therapy September 2013 vol. 93 no. 9 1175-1184
Conclusions Regardless of arch type, increases in load did not alter the relative distribution of force over the plantar foot during gait. Participants with high-arched feet had greater force in the medial forefoot region, whereas those with normally arched or low-arched feet had greater force in the great toe region, regardless of load. These differences in force distribution may demonstrate different strategies to generate a rigid lever during toe-off.

Mahalo Newsbot!

You are the greatest keep up the good work keeping us informed.

If the army wants to research stategies to generate a rigid lever during toe off perhaps they could read some of their own financed research like SBIR A11-109 "Advanced Composite Insoles for the Reduction of Stress Fractures." found at www.kingetics.com under the MAREN tab.

It seems that all the current tax payer funded army research on footwear is focused on punching more holes in boots so they they can breath better and drain water better from all the holes in the boots.

http://www.bostonglobe.com/business/...lEI/story.html

http://www.washingtontimes.com/news/...ght-new-boots/

Happy Friday,
Steve
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Old 9th September 2013, 06:23 PM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Effect of armor and carrying load on body balance and leg muscle function
Huiju Park, Donna Branson, Seonyoung Kim, Aric Warren, Bert Jacobson, Adriana Petrova, Semra Peksoz, Panagiotis Kamenidis
Gait & Posture; Article in Press
Quote:
This study investigated the impact of weight and weight distribution of body armor and load carriage on static body balance and leg muscle function. A series of human performance tests were conducted with seven male, healthy, right-handed military students in seven garment conditions with varying weight and weight distributions. Static body balance was assessed by analyzing the trajectory of center of plantar pressure and symmetry of weight bearing in the feet. Leg muscle functions were assessed by analyzing the peak electromyography amplitude of four selected leg muscles during walking. Results of this study showed that uneven weight distribution of garment and load beyond an additional 9kg impaired static body balance as evidenced by increased sway of center of plantar pressure and asymmetry of weight bearing in the feet. Added weight on non-dominant side of the body created greater impediment to static balance. Increased garment weight also elevated peak EMG amplitude in the rectus femoris to maintain body balance and in the medial gastrocnemius to increase propulsive force. Negative impacts on balance and leg muscle function with increased carrying loads, particularly with an uneven weight distribution, should be stressed to soldiers, designers, and sports enthusiasts.
Quote:
Highlights
•Uneven weight distribution created a greater sway of center of plantar pressure while standing.
•Added weight on non-dominant side of the body creates greater impairment of static balance.
•Garment weight less than 10% of the body mass decreases sway of center of plantar pressure.
•Increased garment weight elevates EMG amplitude in rectus femoris and medial gastrocneminus in gait.
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Old 7th March 2014, 07:04 PM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Effects of 8 weeks of military training on lower extremity and lower back clinical findings of young Iranian male recruits: A prospective case series.
Boroujeni AM, Yousefi E, Moayednia A, Tahririan MA.
Adv Biomed Res. 2014 Jan 9;3:20
Quote:
BACKGROUND:
In this prospective case series we have assessed the clinical effects of 8 weeks military training on the lower extremity of the recruits.
MATERIALS AND METHODS:
Military recruits who met the eligibility criteria and gave informed consent were entered into the study. They were asked to fill out a self-reporting pain and functionality questionnaire before and after their training. They were also examined by a physician before and after their military training. The questionnaire and examination were concentrated on three blocs: lower back, knee, and foot.
RESULTS:
Three-hundred and seventy-three study subjects were evaluated. The study showed that there is a significant difference in reporting lower back pain after the training compared to the rate of complaints prior to the training (P < 0.001), knee pain, and foot pain also increased significantly (P < 0.1 and P < 0.0001, respectively) The difference was most prominent in foot complaints. Physical examination also showed significant increase in lower extremity findings following the training (P < 0.05).
CONCLUSION:
Our study shows that there is a need for a new approach to military training of male recruits in Iran in order to minimize the adverse health effects.
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Old 4th April 2014, 07:32 AM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Return to Duty and Disability After Combat Related Hind Foot Injury.
Sheean AJ, Krueger CA, Hsu JR.
J Orthop Trauma. 2014 Apr 1.
Quote:
OBJECTIVES::
To characterize the return to duty rates and disability outcomes for soldiers who sustained combat-related hindfoot injuries that were treated with either reconstruction or transtibial amputation (TTA).
DESIGN::
Retrospective cohort series SETTING:: Tertiary trauma center PATIENTS/ PARTICIPANTS:: All patients treated for combat related hindfoot injuries between May 2005 and July 2011.
INTERVENTION::
Transtibial amputation or hindfoot reconstruction /ankle fusion.
MAIN OUTCOME MEASUREMENTS::
Age, return to duty (RTD) rate, combined disability, associated disabling conditions RESULTS:: One hundred twenty two patients underwent treatment for combat related hindfoot injuries. Fifty-seven patients were treated with amputation and 65 patients were treated with hindfoot reconstruction or ankle fusion. The overall RTD rate was 20%. Amputees had a RTD rate of 12%, which was lower than those who had a fusion or hindfoot repair (26% (p < 0.06)). The disability ratings of amputees were significantly higher than those patients undergoing either ankle fusion or primary hindfoot repair (75% and 62% respectively (p < 0.006)).
DISCUSSION::
While RTD rates were higher for hindfoot reconstruction or ankle fusion compared to TTA, psychiatric conditions were more common among these patients. Although there were clear differences between both groups, the relationship between true functional outcomes and disability ratings remains unclear and both treatment groups appear to do poorly in terms of returning to active duty.
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Old 7th April 2014, 05:10 AM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Phil

i was in Iraq: running a med unit rather than in my Pod capacity. Also got to do lots of feet! My docs were only too happy for me to do IGTNs, etc... :-)

Ian
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Old 16th August 2014, 04:41 AM
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Default Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

Risk of Lower Extremity Injury in a Military Cadet Population After a Supervised Injury-Prevention Program.
Scott Carow, Eric Haniuk, Kenneth Cameron, Darin Padua, Steven Marshall, Lindsay DiStefano, Sarah de la Motte, Anthony Beutler, and John Gerber
Journal of Athletic Training In-Press.
Quote:
Context:  Specific movement patterns have been identified as possible risk factors for noncontact lower extremity injuries. The Dynamic Integrated Movement Enhancement (DIME) was developed to modify these movement patterns to decrease injury risk.

Objective:  To determine if the DIME is effective for preventing lower extremity injuries in US Military Academy (USMA) cadets.

Design:  Cluster-randomized controlled trial.

Setting:  Cadet Basic Training at USMA.

Patients or Other Participants:  Participants were 1313 cadets (1070 men, 243 women).

Intervention(s):  Participants were cluster randomized to 3 groups. The active warm-up (AWU) group performed standard Army warm-up exercises. The DIME groups were assigned to a DIME cadre-supervised (DCS) group or a DIME expert-supervised (DES) group; the former consisted of cadet supervision and the latter combined cadet and health professional supervision. Groups performed exercises 3 times weekly for 6 weeks.

Main Outcome Measure(s):  Cumulative risk of lower extremity injury was the primary outcome. We gathered data during Cadet Basic Training and for 9 months during the subsequent academic year. Risk ratios and 95% confidence intervals (CIs) were calculated to compare groups.

Results:  No differences were seen between the AWU and the combined DIME (DCS and DES) groups during Cadet Basic Training or the academic year. During the academic year, lower extremity injury risk in the DES group decreased 41% (relative risk [RR] = 0.59; 95% CI = 0.38, 0.93; P = .02) compared with the DCS group; a nonsignificant 25% (RR = 0.75; 95% CI = 0.49, 1.14; P = .18) decrease occurred in the DES group compared with the AWU group. Finally, there was a nonsignificant 27% (RR = 1.27; 95% CI = 0.90, 1.78; P = .17) increase in injury risk during the academic year in the DCS group compared with the AWU group.

Conclusions:  We observed no differences in lower extremity injury risk between the the AWU and combined DIME groups. However, the magnitude and direction of the risk ratios in the DES group compared with the AWU group, although not statistically significant, indicate that professional supervision may be a factor in the success of injury-prevention programs.
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