Massage & Bodywork

March/April 2013

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Want more treatment options? Visit www.abmp.com to see Whitney Lowe's webinars, where he explores specific treatment approaches for common pathologies. and massage in particular presents many options to prevent and ease these debilitating conditions. Musculoskeletal Injury in Soldiers An extremely large number of MSDs are noncombat related. These injuries begin showing up in basic training and extend throughout a soldier's military career. A US military report states the injury rate for Army personnel is 2,500 reported injuries for every 1,000 soldiers, with "2.1 million injury-related medical visits, affecting 900,000 service members … [adding] up to an estimated 25 million limited-duty days per year."1 The report notes that musculoskeletal injuries are the cause of 68 percent of all limited-duty orders (doctors' orders to limit or change a soldier's tasks). What is perhaps most surprising is that the report only cites statistics from noncombat garrisons and does not include the Iraq or Afghanistan operations. In the Iraq and Afghanistan military conflicts, 34 percent of deployed troops sustained a noncombat musculoskeletal injury, making it the most common reason for medical air evacuation, surpassing combat injuries.2 In addition, 25 percent of musculoskeletal injuries result in medical discharges. Lower-extremity injuries are particularly prevalent in the military because of the nature of many military activities. In training and active duty, heavy loads are often carried while running, jumping, marching, or performing other physical activity. According to the Army Times, an Army Science Board study recommended that soldiers carry no more than 50 pounds, yet soldiers on extended foot patrols routinely carry an average load ranging from 87 to 127 pounds.3 These heavy loads put tremendous stress on numerous structures of the body and lead to the high occurrence of MSDs. In addition, routine occupational tasks often require carrying and transferring heavy loads. Of the numerous MSDs which plague military personnel, injuries to the low back and lower extremities account for more than 80 percent of the injuries, with that percentage split roughly in half between the two areas.4 Three of the most commonly occurring lower-extremity injuries are tibial stress, iliotibial band friction syndrome, and anterior cruciate ligament sprains. Medial Tibial Stress Syndrome During running, the lower extremity can absorb three to four times an individual's body weight on each foot strike. If an individual is carrying very heavy equipment, this cumulative load puts even greater stress on the shock-absorbing tissues of the body. The key responsibility for shock absorption is then spread among several tissues, with the primary responsibility being taken over by bones, ligaments, muscles, and tendons. Iliotibial band Lateral epicondyle of femur 1 The iliotibial band in relation to the femoral condyle. 3D anatomy images. Copyright of Primal Pictures Ltd. www.primalpictures.com. The tibialis posterior muscle is a primary contributor to shock absorption in the lower extremity. One of its key functions is to resist excessive pronation of the foot during gait. As this muscle works eccentrically to resist excessive pronation, it is also absorbing a great deal of the impact load from repeated foot strikes. However, repeated overload on the tibialis posterior often leads to muscle fatigue. Excessive tensile force on the muscle's attachment sites can cause nearby inflammation resulting in significant pain, commonly known as shin splints. If constant overload and fatigue of the tibialis posterior muscle progresses, the muscle can no longer accomplish its primary shock-absorbing role and a greater stress load is www.abmp.com. See what benefits await you. 107

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