Factores de riesgo para el Síndrome de Estrés Tibial Medial asociados a la cinética del countermovement jump en cadetes en formación

Abstract

Medial Tibial Stress Syndrome (MTSS) is one of the most frequent pathologies in military personnel. As the muscles of the lower extremity contribute to the attenuation of impact forces in activities such as running and jumping, neuromuscular performance deficiencies and asymmetries may be associated with an increased risk for musculoskeletal injuries. PURPOSE: to determine the kinetic risk factors associated with MTSS through the bilateral countermovement jump (CMJ) in army cadets. METHODS: ethical approval was granted by the General José María Córdova Military School of Cadets where the study was conducted. This observational study was executed in a cohort of 123 cadets (followed for 24 weeks) who entered to the military school in 2017. Anthropometric, demographic data and MTSS history were recorded. Jump height (cm), peak landing force (N*kg), peak landing force asymmetry (%), concentric mean force (N*kg), concentric mean force asymmetry (%), eccentric deceleration rate of force development (EDRFD [N/s*Kg]) and EDRFD asymmetry (%), were evaluated through the bilateral CMJ on a pair of uniaxial force platforms. After the follow-up, the cadets with MTSS were determined through the clinical history. RESULTS: the incidence of MTSS was 13% (n= 16). Greater EDRFD asymmetry (9,4% vs. -3,4%), female sex (RR= 2.84; 95% CI= 1.16-6.94), rural provenance (RR= 2.65; 95% CI= 1.04-6.72), and previous history of MTSSM (RR= 5.71; 95% CI= 2.23-14.62), were significantly associated with MTSS (p≤0.05). In the logistic regression, greater EDRFD asymmetry (OR= 1.03; 95% CI= 1.00-1.07), female sex (OR= 4.91; 95% CI = 1.38-13.37) and rural provenance (OR= 4.82; 95% CI= 1.04-6.72), were significantly associated with MTSS (p≤0.05). Previous history of MTSS was significant in p≤0.1 (OR= 8.95; 95% CI= 0.68-118.73). The predictive model was significant for the MTSS (p≤0.01), had a sensitivity of 31.3% and a specificity of 99.1% (overall prognosis of 90.2%). CONCLUSIONS: while we identified important non-modifiable risk factors for MTSS in cadets during basic training, we also found that greater EDRFD asymmetry was a significant risk factor. This suggests that the bilateral CMJ may be a useful tool for pre-entry screening and that high EDRFD asymmetry could be a potential target of pre-basic training risk reduction conditioning.