title: Risk of Lower Extremity Injury in a Military Cadet Population After a Supervised Injury-Prevention Program.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Cluster-randomized controlled trial.
  
  
  METHODS
  Cadet Basic Training at USMA.
  
  
  METHODS
  Participants were 1313 cadets (1070 men, 243 women).
  
  
  METHODS
  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.
  
  
  METHODS
  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 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.
authors.affiliation: William Beaumont Army Medical Center, El Paso, TX.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Carow
authors.affiliation: John A. Feagin Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Haniuk
authors.affiliation: John A. Feagin Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Cameron
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Darin A
authors.initials: DA
authors.lastname: Padua
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
authors.affiliation: University of Connecticut, Storrs.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: DiStefano
authors.affiliation: Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: de la Motte
authors.affiliation: Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Anthony I
authors.initials: AI
authors.lastname: Beutler
authors.affiliation: Womack Army Medical Center, Fort Bragg, NC.
authors.forename: John P
authors.initials: JP
authors.lastname: Gerber
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007869:Leg Injuries / Q000517:prevention & control; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008889:Military Personnel; D009068:Movement / Q000502:physiology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D063996:Warm-Up Exercise / Q000502:physiology*
keywords: Dynamic Integrated Movement Enhancement; exercises; warm-ups