Category: Injury & Trauma

Categories : Injury & TraumaTags :

First Responders Could Soon Use a New Autoinjector to Control Severe Bleeding

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Photo by Mat Napo on Unsplash

A new study shows that a TXA autoinjector delivers lifesaving treatment for severe bleeding as effectively as traditional IV methods – but in under five minutes and without the need for medical expertise. This breakthrough could transform trauma care in emergencies, making rapid, easy-to-administer treatment available in settings ranging from battlefields to roadside accidents, where every second counts.

In a major breakthrough for emergency and trauma medicine, a group of researchers led by Prof Arik Eisenkraft and Prof David Gertz of the Institute for Research in Military Medicine (IRMM), Faculty of Medicine at The Hebrew University of Jerusalem, partnered with the IDF Medical Corps, have demonstrated that a simple autoinjector device can rapidly deliver Tranexamic Acid (TXA), an antifibrinolytic drug that helps stabilise blood clots and reduce blood loss, with the same effectiveness as traditional intravenous (IV) administration.

The study, recently published in the peer-reviewed journal Injury, highlights the potential for this technology to save lives in pre-hospital and battlefield settings, where timely intervention is critical and IV access may be delayed or impossible.

In Trauma, Every Second Counts

Severe bleeding is the leading cause of preventable death in trauma situations, from combat zones to highway accidents. TXA is already widely used in hospitals and dedicated trauma centres and by pre-hospital emergency responders. However, the standard IV method of administration can be difficult to perform in chaotic, high-stress environments, leading to dangerous delays in treatment.

Research has shown that for every 15-minute delay in administering TXA, its effectiveness drops by 10%, underscoring the need for a faster, simpler solution.

In the new study, the researchers found that TXA delivered via autoinjector reached effective therapeutic levels in less than five minutes and remained active throughout the treatment window.

Importantly, outcomes were comparable to intravenous delivery, with stable haemodynamic parameters and effective clot formation observed across all test subjects.

“When someone is bleeding heavily, every minute matters,” said Dr Eisenkraft. “With this autoinjector, even non-medical responders can administer lifesaving treatment almost instantly – and that can mean the difference between life and death.”

“This innovation could transform trauma response in the field,” added Dr Gertz. “From combat zones to roadside accidents and natural disasters, the ability to deliver a proven treatment quickly and easily has the potential to save countless lives.”

The simplicity and portability of the autoinjector device allow it to be used widely by paramedics, first responders, and military medics, ensuring that TXA can be administered within the critical early minutes following severe injury.

This research builds on ongoing efforts by Hebrew University and IDF scientists to improve emergency medical care in high-risk environments, ensuring that patients receive fast, effective interventions when and where they need them most.

Source: Hebrew University of Jerusalem

Categories : Injury & TraumaTags :

Study Sheds Light on Why Tendons Are Prone to Injury

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Achilles tendon injury. Credit: Scientific Animations CC0

Scientists at the University of Portsmouth have created the first detailed 3D map of how a crucial piece of connective tissue in our bodies responds to the stresses of movement and exercise. This tissue, called calcified fibrocartilage (CFC), acts like a biological shock absorber where tendons attach to bone.

Damage to the CFC tissue – common in sport-related injuries – does not mend well. To improve healing treatments, scientists need to better understand the structure of this tissue and how it reacts to varying types of pressure.

Research by Atousa Moayedi, a PhD student at the University of Portsmouth’s School of Electrical and Mechanical Engineering, has been able to demonstrate that the centre of the CFC tissue changes shape more than the surrounding areas, when stressed at different angles. 

In areas where the microscopic cavities within the tissue (the lacunae) were more densely packed, the distortion was greater. This means that the way the tissue layers are arranged, and how thick they are, strongly influences how stretching (strain) is dispersed where the tendon meets the bone.

The study, published in the Nature journal Communications Materials, is the first to measure how differently tiny regions inside this tissue stretch or deform when forces are applied.

Until now, scientists couldn’t see exactly how this tissue behaves when put under pressure, making it nearly impossible to design effective treatments. The research team used high resolution 3D scanning and AI powered image reconstruction to map the way in which CFC tissue behaves under pressure in a mouse model, as well as how and where it might fail. Importantly, they were also able to identify the features that would be important for healing.

Better understanding of how these attachments fail under stress could help prevent common sports injuries. Tennis champion Andy Murray has battled hip tendon problems, England cricket captain Ben Stokes has dealt with recurring knee tendon issues, and footballer Harry Kane has faced ankle tendon injuries that kept him off the pitch.

Atousa said: “Once you know which parts experience the most stress and why, you can design better treatments and implants that actually replicate how the natural attachment works.”

Overseeing the study, was Professor Gordon Blunn from the University of Portsmouth’s School of Medicine, Pharmacy and Biomedical Sciences. Professor Blunn said: “The weak link in the way that load is transferred from muscle to the skeleton is where the tendon joins with the bone. After injury this region is slow to heal and difficult to repair. Importantly, Atousa’s work identifies the way that load is naturally transferred in this region and serves as a model for the repair and regeneration of tissues at this site.”

Source: University of Portsmouth

Categories : Injury & Trauma Lab Tests and ImagingTags :

New Method Noninvasively Assesses Achilles Tendon in Dancers

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Photo by Nihal Demirci on Unsplash

A study in the Journal of Orthopaedic Research uses a noninvasive, nonradioactive imaging-based method to measure the structure and function of the Achilles tendon in professional ballet dancers. The method could potentially be developed to help prevent injuries and improve rehabilitation efforts in athletes, as well as in the general public.

The study involved what is called multi-echo ultrashort echo time (UTE) magnetic resonance imaging (MRI) to assess collagen and other components of the Achilles tendon. These structural UTE MRI assessments were combined with functional assessments of the Achilles tendon based on sheer wave elastography (SWE) ultrasound, which measures tendon stiffness.

Professional dancers tended to have more tendon stiffness compared with non-dancers, consistent with prior observations of a training effect from repeated loading with exercise. UTE MRI measures corresponded with the degree of stiffness from SWE ultrasound.

“These findings highlight the potential of integrating UTE and SWE imaging to investigate tendon structure‐function relationships and adaptations to mechanical loading,” the authors write. “Enhanced structure‐function assessment of tendon health and injury status could improve rehabilitation protocols or injury prevention strategies for athletes, including professional dancers.”

Source: Wiley

Categories : Injury & Trauma Pain ManagementTags :

Peri-neuronal Injection of Botulinum Eases Pain in Ukrainian Amputees

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Botulinum injection around neuromas may also be effective for other forms of pain

Photo by Raghavendra V Konkathi on Unsplash

Botulinum toxin injections provided greater short-term relief for phantom limb pain than standard medical and surgical care among Ukrainian war amputees, reports a new study led by Northwestern Medicine and Ukrainian physicians.

The study, which involved 160 amputees treated at two hospitals in western Ukraine between 2022 and 2024, could ultimately benefit millions worldwide, according to the research team.

Post-amputation pain affects most amputees. The condition limits prosthetic use, mobility and quality of life. In the US, more than 2 million people live with limb loss. In Ukraine, it is estimated that over 100 000 soldiers and civilians have lost limbs since Russia’s full-scale invasion, which began in 2022.

“Botulinum toxin injected into painful stumps of residual limbs and around neuromas was on some outcome measures more effective than comprehensive medical and surgical treatment at one month post-treatment,” said senior study author Dr Steven P. Cohen, a professor of anaesthesiology and the vice chair of research and pain medicine at Northwestern University Feinberg School of Medicine.

Dr. Steven Cohen is a retired U.S. Army colonel who traveled to Ukraine to collaborate with local doctors.

“Our results show that botulinum toxin potentially could be a powerful short-term tool for treating post-amputation pain when used alongside comprehensive medical and surgical care,” said co-author Dr. Roman Smolynets, an anesthesiologist and intensive care specialist at Multidisciplinary Clinical Hospital of Emergency and Intensive Care in Lviv, Ukraine.

“It could be another step toward helping amputees live with less pain and more dignity. But always as an additional point to comprehensive medical and surgical care, not as a monotherapy.”

The study was published in the journal Archives of Physical Medicine and Rehabilitation.

Assessing pain before and after treatments

All study participants were amputees treated at the First Medical Union of Lviv or Ivano-Frankivsk Regional Hospital. About one-fifth received botulinum toxin injections around painful nerve endings, called neuromas, in addition to standard medical and physical therapy. The other participants received comprehensive medical and surgical treatment, which included surgical revision, nerve blocks, physical and psychological therapy, medications and other interventional procedures.

The research team assessed pain levels at the start of treatment and after one and three months, focusing separately on phantom limb pain (pain in the missing limb) and residual limb pain (pain at the stump site).

At one month, the botulinum toxin group experienced an average reduction of four points in phantom limb pain on a 10-point scale, compared with just one point among patients in the comparison group. Also at one month, 69% of patients who received botulinum toxin achieved a meaningful improvement (defined as at least a 30% drop in pain) in phantom limb pain, versus only 43% in the other patient group.

However, the results shifted at three months: Patients who received comprehensive care showed more durable pain relief than the botulinum toxin group, consistent with previous research showing that botulinum toxin’s pain-relieving effects typically last about three months.

A novel way to inject botulinum toxin

While botulinum toxin injections, a non-surgical treatment that alleviates pain by blocking nerve signals, are most commonly known for their use in cosmetic procedures, they are also an established tool to treat chronic pain.

In the study, the substance was injected in a novel way. The research team used ultrasound guidance to inject botulinum toxin directly around painful nerve endings and surrounding soft tissues, rather than into muscle or skin. This targeted “peri-neuromal” approach, the scientists believe, may explain the strong short-term reduction in pain by quieting nerve activity and local inflammation. Previous studies have shown botulinum toxin to be effective for neuropathic pain, but none injected it around painful nerves.

The new findings suggest that botulinum toxin injections near nerves may also help relieve other types of nerve pain, such as shingles-related pain, carpal tunnel syndrome and pain following surgeries like mastectomy or thoracotomy.

Friendship with a Ukrainian anaesthesiologist

Cohen, who traveled to Ukraine in 2024 to help launch the study, is a retired U.S. Army colonel who served four overseas tours in support of military operations; his son currently serves with the infantry.

In Ukraine, he partnered with Smolynets, who has treated thousands of soldiers and civilians injured in the war by working in the country’s largest trauma and emergency center, and Dr. Nadiya Segin, who is pioneering the use of Botulinum toxin and nerve stimulation to treat war injuries.

Smolynets will visit Chicago the week of Oct. 19 with a Ukrainian delegation for an observership program, spending time with Cohen at his pain medicine clinic and at a Shirley Ryan AbilityLab in downtown Chicago. The two physicians, now close friends, are available for interviews during that week.

More research in Ukraine

Cohen and his colleagues stress the need for larger, randomized trials to confirm their findings, refine patient selection and optimize botulinum toxin dosing. Future research should also explore whether repeat botulinum toxin injections over time could produce sustained benefits for post-amputation pain, as they appear to do for migraine treatment.

Cohen and Smolynets, who published another study in February about using hydrodissection for post-amputation pain in Ukraine, are also researching more novel war treatments in Ukraine, at Walter Reed, and Northwestern, for traumatic brain injury and PTSD. These studies are underway. 

“As a retired colonel and the father of an infantry soldier who could be deployed in future conflicts and suffered from traumatic brain injury while at the U.S. Military Academy, this research carries special personal meaning for me,” Cohen said.

Source: Northwestern University

Categories : Injury & TraumaTags :

International Healthcare Workers Report on War Related Injuries Among Civilians in Gaza

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Findings suggest patterns of harm that exceed those reported in previous modern-day conflicts and provide critical insights to tailor humanitarian response

Photo by Mohammed Ibrahim on Unsplash

A British led study published by The BMJ provides detailed data on the pattern and severity of traumatic injuries and medical conditions seen by international healthcare workers deployed to Gaza during the ongoing military invasion.

Healthcare workers describe “unusually severe” traumatic injuries including complex blast injuries, firearm related injuries, and severe burns. Many respondents with previous experience of conflicts reported that the pattern and severity of injuries in Gaza were greater than those they had encountered in previous warzones.

It’s thought to be the first study to provide such detailed data from frontline clinicians during the conflict, which the authors say offers critical insights into the injuries and conditions most relevant to immediate management, rehabilitation, and long term health planning.

Since October 2023, Gaza has faced high intensity Israeli bombardment and ground military incursions. Publicly reported figures show that more than 59,000 Palestinians have been killed and over 143,000 wounded during the conflict, but other analyses suggest these figures may be higher.

To address this gap, healthcare workers were invited to take part in a survey about the nature and pattern of injuries and medical conditions they managed while in Gaza, ranging from explosive and firearm injuries to infections and chronic diseases.

A total of 78 doctors and nurses completed the survey using logbooks and shift records between August 2024 and February 2025, within 3 months of their deployment end date.

Participants represented 22 non-governmental organisations (NGOs) and were mainly from the US, Canada, the UK and European Union member states working in trauma surgery, emergency medicine, paediatrics, or critical care and anaesthesia.

Almost two thirds (65%) had prior experience working in an active conflict zone and their deployment to Gaza ranged from 2-12 weeks, contributing to a total of 322 weeks of frontline clinical care.

Overall, 23,726 trauma related injuries and 6,960 injuries related to weapons were reported. The most common traumas were burns (4,348, 18%), leg injuries (4,258, 18%), and arm injuries (3,534, 15%).

There were 742 obstetric cases reported, of which more than a third (36%) involved the death of the fetus, mother or both. Psychological trauma was also reported, with depression, acute stress reactions, and suicidal ideation being most common.

Some 70% of healthcare workers reported managing injuries across two or more anatomical regions and experiences of mass casualties were widespread, with 77% reporting exposure to 5-10 events and 18% managing more than 10 such scenarios.

Explosive injuries accounted for the majority of weapon related trauma (4,635, 67%), predominantly affecting the head (1,289, 28%) whereas firearm injuries targeted the legs (526, 23%).

The most common general medical conditions reported were malnutrition and dehydration, followed by sepsis and gastroenteritis. Healthcare workers also reported 4,188 people with chronic disease requiring long term treatment.

In free text responses, healthcare workers frequently described injuries as unusually severe, including multi-limb trauma, open skull fractures, and extensive injuries to internal organs. Severe burns were also emphasised, particularly in children.

Respondents with previous experience of deployment in other conflict zones commented that the severity and pattern of injuries encountered in Gaza were greater than those they had previously managed.

Despite the strength of this data, the authors acknowledge limitations. For instance, relying on logbooks and shift records inevitably introduces uncertainty, especially during periods of large influxes of injured people. Nor can they rule out the possibility of duplication, although further analyses indicated minimal impact on overall estimates.

However, they say the volume, distribution, and severity of injuries seem to indicate patterns of harm that exceed those reported in previous modern-day conflicts.

“These findings highlight the urgent need for resilient, context specific surveillance systems, designed to function amid sustained hostilities, resource scarcity, and intermittent telecommunications, to inform tailored surgical, medical, psychological, and rehabilitation interventions,” they conclude.

Source: BMJ Group

Categories : Dermatology Injury & TraumaTags :

“Skin in a Syringe” a Step Towards a New Way to Heal Burns

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Researchers in fields such as regenerative medicine and materials science have collaborated to develop a gel containing living cells that can be 3D-printed into a transplant. Photographer: Magnus Johansson

Finding a way to replicate the skin’s complicated dermis layer has long been a goal of healing burn wounds, as it would greatly reduce scarring and restore functionality. Researchers at Linköping University have developed a gel containing living cells that can be 3D-printed onto a transplant, which then sticks to the wound and creates a scaffold for the dermis to grow.

Large burns are often treated by transplanting a thin layer of the top part of the skin, the epidermis, which is basically composed of a single cell type. Transplanting only this part of the skin leads to severe scarring.

“Skin in a syringe”

Beneath the epidermis is the dermis, which has the blood vessels, nerves, hair follicles and other structures necessary for skin function and elasticity. However, transplanting also the dermis is rarely an option, as the procedure leaves a wound as large as the wound to be healed. The trick is to create new skin that does not become scar tissue but a functioning dermis.

“The dermis is so complicated that we can’t grow it in a lab. We don’t even know what all its components are. That’s why we, and many others, think that we could possibly transplant the building blocks and then let the body make the dermis itself,” says Johan Junker, researcher at the Swedish Center for Disaster Medicine and Traumatology and docent in plastic surgery at Linköping University, who led the study published in Advanced Healthcare Materials.

The most common cell type in the dermis, the connective tissue cell or fibroblast, is easy to remove from the body and grow in a lab. The connective tissue cell also has the advantage of being able to develop into more specialised cell types depending on what is needed. The researchers behind the study provide a scaffold by having the cells grow on tiny, porous beads of gelatine, a substance similar to skin collagen. But a liquid containing these beads poured on a wound will not stay there.

The researchers’ solution to the problem is mixing the gelatine beads with a gel consisting of another body-specific substance, hyaluronic acid. When the beads and gel are mixed, they are connected using what is known as click chemistry. The result is a gel that, somewhat simplified, can be called skin in a syringe.

“The gel has a special feature that means that it becomes liquid when exposed to light pressure. You can use a syringe to apply it to a wound, for example, and once applied it becomes gel-like again. This also makes it possible to 3D print the gel with the cells in it,” says Daniel Aili, professor of molecular physics at Linköping University, who led the study together with Johan Junker.

3D-printed transplant

In the current study, the researchers 3D-printed small pucks that were placed under the skin of mice. The results point to the potential of this technology to be used to grow the patient’s own cells from a minimal skin biopsy, which are then 3D-printed into a graft and applied to the wound.

“We see that the cells survive and it’s clear that they produce different substances that are needed to create new dermis. In addition, blood vessels are formed in the grafts, which is important for the tissue to survive in the body. We find this material very promising,” says Johan Junker.

Blood vessels are key to a variety of applications for engineered tissue-like materials. Scientists can grow cells in three-dimensional materials that can be used to build organoids. But there is a bottleneck as concerns these tissue models; they lack blood vessels to transport oxygen and nutrients to the cells. This means that there is a limit to how large the structures can get before the cells at the centre die from oxygen and nutrient deficiency.

Step towards labgrown blood vessels

The LiU researchers may be one step closer to solving the problem of blood vessel supply. In another article, also published in Advanced Healthcare Materials, the researchers describe a method for making threads from materials consisting of 98 per cent water, known as hydrogels.

“The hydrogel threads become quite elastic, so we can tie knots on them. We also show that they can be formed into mini-tubes, which we can pump fluid through or have blood vessel cells grow in,” says Daniel Aili.

The mini-tubes, or the perfusable channels as the researchers also call them, open up new possibilities for the development of blood vessels for eg, organoids.

Source: Linköping University

Categories : Emergency Medicine Injury & TraumaTags :

Unlocking Fast, Targeted Treatment for Trauma Injuries

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Photo by Mat Napo on Unsplash

A groundbreaking study by researchers at Rutgers Health has uncovered a way to precisely identify and target trauma sites in the body within minutes of injury. The findings, published in the journal Med (Cell Press), could revolutionise emergency care by enabling real-time diagnostics and site-specific treatments delivered within minutes of injury.

A team of scientists, led by Renata Pasqualini and Wadih Arap at the Rutgers Cancer Institute discovered something new about how the body reacts to injury. When cells are damaged, like in a major bone break, calcium levels shift, which causes certain proteins to change shape. These changed proteins, called the “traumome,” are only found in injured tissues and show up right after an injury happens. This discovery opens up a new way to treat injuries directly, without affecting healthy parts of the body.

“The moment trauma occurs, specific proteins undergo structural changes, creating a molecular footprint of injury,” said Arap. “This opens the door to delivering diagnostics or therapies directly to the site – without affecting healthy tissues.”

This discovery has relevance in emergency treatment because many medicines can affect healthy organs when they’re given too soon. With this new approach, doctors could deliver treatments like imaging agents, clotting factors or antibiotics directly to the injured area, which would help the body heal faster with fewer side effects.    

“Our long-term vision is a simple injection that autonomously finds and treats injury sites,” said Pasqualini. “This could be transformative for battlefield medicine and emergency trauma care, where every second matters.”

The team used advanced testing on a pig model with major injuries to find tiny protein pieces called peptides. These peptides are like guides that can find and stick to the specific proteins altered by injury. One of these peptides stands out because it can attach to a protein that changes shape when calcium levels rise after an injury. This makes it possible to use special scans, like PET or MRI, to see exactly where the injury is in the body.

The trauma-targeting peptide worked the same way in rats, which shows that this injury “signature” is similar in all mammals, including humans.

The work was supported by the Defense Advanced Research Projects Agency (DARPA), an agency of the U.S. Department of Defense, underscoring its strategic value in both civilian and military medical applications. “Non-compressible bleeding remains a leading cause of death among soldiers before they reach a hospital, and localised treatment could dramatically improve survival rates, which was the original impetus of this research,” said Jon Mogford, a study co-author and former DARPA official.

The next phase of research will involve linking therapeutic agents to the trauma site-homing peptides and testing them in animal models before moving to early human clinical trials. The team envisions translational applications ranging from battlefield medicine to civilian trauma response and possibly even sports injuries or surgical recovery.

“We are actively developing peptide-linked drugs and imaging agents based on this discovery,” said Arap. “The traumome concept may also have applications beyond trauma, including in surgery, inflammation and tissue regeneration.”

Source: Rutgers University

Categories : Emergency Medicine Injury & TraumaTags :

Adaptive Spine Board Could Revolutionise ER Transport

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ASB overlay is divided into five distinct sections—head and neck, upper trunk, buttocks and pelvis, thighs, and feet and heels

In combat zones and emergency rescues, rapid evacuation and treatment can mean the difference between life and death. But prolonged immobilisation during transport poses another life-threatening risk: pressure injuries.

A newly developed adaptive spine board (ASB) overlay aims to change that, offering an innovative solution to prevent pressure injuries and dramatically improve patient outcomes. Developed by researchers at The University of Texas at Arlington and UT Southwestern Medical School, the adaptive spine board sits atop a standard stretcher or spine board, using air-cell technology to redistribute pressure more effectively than traditional evacuation surfaces. The team’s newly published study in the Journal of Rehabilitation and Assistive Technologies Engineering shows the ASB outperforms other immobilisation options.

“The ability to dynamically adjust pressure so that no vulnerable body regions experience excessive weight is a breakthrough for medical evacuation,” said Muthu B.J. Wijesundara, principal research scientist at the University of Texas at Arlington Research Institute. “This innovation could set a new standard in casualty transport protocols.”

Also called bedsores or ulcers, pressure injuries result from prolonged pressure on the skin and underlying soft tissue, leading to cell death, tissue breakdown and open wounds. They are a constant risk for trauma patients during long-range transport, which sometimes lasts more than 16 hours. Research shows that more than 50% of casualties transported during the Iraq War developed pressure injuries before reaching a hospital.

While some existing technologies, such as vacuum spine boards, can help redistribute pressure, their effectiveness is limited. Many conventional supports fail to keep pressure below the thresholds recommended to prevent injury. Military stretchers and pads have shown to create high-pressure points on vulnerable areas of the body, including the back of the head, base of the spine, buttocks and heels.

“Beyond military use, the ASB overlay could prove valuable in civilian medical transport, particularly for spinal injury patients who are at high risk for pressure ulcers,” Dr Wijesundara said. “The research also highlights potential applications in other environments where prolonged immobilisation is necessary, such as disaster relief and space exploration.”

The ASB overlay features a multi-segmented air-cell design that target pressure-prone areas more effectively than previous solutions. It is divided into five distinct sections—head and neck, upper trunk, buttocks and pelvis, thighs, and feet and heels—each equipped with sensor-driven pressure modulation for responsive, localised support.

“One key innovation is the system’s ability to autonomously adjust the air-cell pressure to maintain optimal distribution for each patient,” Wijesundara said. “We developed an algorithm that compensates for environmental variables, such as temperature and barometric pressure changes, ensuring consistent performance across varying conditions. Testing showed that the ASB overlay outperformed typical equipment used in casualty transport.”

For critically injured patients, pressure injuries can significantly complicate treatment and recovery, leading to longer hospital stays, higher infection risks and additional surgeries. They’re also costly. The Agency for Healthcare Research and Quality (AHRQ) estimates that pressure injuries in the US can cost up to $151 700 per case, adding $11.6 billion in additional health care expenses annually. Alarmingly, the AHRQ also reports that approximately 60 000 patients die each year because of pressure injuries. The ASB overlay’s advanced pressure modulation could help mitigate these risks—especially for patients who cannot be repositioned during extended transport.

The research team is now planning additional studies to improve the device’s usability in real-world conditions. As the military increasingly relies on prolonged aeromedical evacuation, such advancements are critical for enhancing patient care in conflict zones.

Categories : Exercise Injury & TraumaTags :

Everything We Thought About Running Injury Development Was Wrong, Study Shows

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Photo by Barbara Olsen on Pexels

A new study from Aarhus University turns our understanding of how running injuries occur upside down. The research project, published in The BMJ, is the largest of its kind ever conducted and involves over 5000 participants. It shows that running-related overuse injuries do not develop gradually over time, as previously assumed, but rather suddenly – often during a single training session.

“Our study marks a paradigm shift in understanding the causes of running-related overuse injuries. We previously believed that injuries develop gradually over time, but it turns out that many injuries occur because runners make training errors in a single training session,” explains Associate Professor Rasmus Ø. Nielsen from the Department of Public Health at Aarhus University, who is the lead author of the study.

The study followed 5205 runners from 87 countries over 18 months and shows that injury risk increases exponentially when runners increase their distance in a single training session compared to their longest run in the past 30 days. The longer the run becomes, the higher the injury risk.

Incorrect guidance for millions of runners

According to Rasmus Ø. Nielsen, the results cast critical light on how the tech industry has implemented so-called “evidence.” Millions of sports watches worldwide are equipped with software that guides runners about their training – both for training optimisation and injury prevention.

However, the algorithm used for injury prevention is built on very thin scientific grounds, according to Rasmus Ø. Nielsen.

“This concretely means that millions of runners receive incorrect guidance from their sports watches every day. They think they are following a scientific method to avoid injuries, but in reality they are using an algorithm that cannot predict injury risk at all,” he says.

Non-existing evidence behind guidance

The current algorithm, called “Acute:Chronic Workload Ratio” (ACWR), was introduced in 2016 and is now implemented in equipment from companies that produce sports watches, while organisations and clinicians, such as physiotherapists, also use the algorithm.

The ACWR algorithm calculates the ratio between acute load (last week’s training) and chronic load (average of the past 3 weeks). The algorithm recommends a maximum 20% increase in training load to minimise injury risk.

According to Rasmus Ø. Nielsen, the algorithm was originally developed for team sports and was based on a study with 28 participants. Due to the few participants in the study combined with data manipulation, the evidence base for using the algorithm to prevent running injuries is therefore “non-existent.”

Realtime guidance

The research team has therefore worked for the past eight years to develop a new algorithm that will be much better at preventing injuries for runners.

Rasmus Ø. Nielsen emphasises that he and the other researchers behind the study have no commercial interests in launching a new algorithm as a potential replacement for a method he himself criticises.

The algorithm will be made freely available to runners, companies, clinicians and organisations who can use it actively to guide training and injury prevention.

Rasmus Ø. Nielsen hopes that the new insights will be implemented in existing technology.

“I imagine, for example, that sports watches with our algorithm will be able to guide runners in real-time during a run and give an alarm if they run a distance where injury risk is high. Like a traffic light that gives green light if injury risk is low; yellow light if injury risk increases and red light when injury risk becomes high,” explains Rasmus Ø. Nielsen.

Source: Aarhus University

Categories : Ageing Injury & TraumaTags :

Slower Arm Movements Linked to Greater Fall Risk for Older Adults

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Photo by Mikhail Nilov

When a person starts to lose their balance on a slippery surface, the natural reaction is to raise the arms to restore balance. Adults age 65 and older may move their arms more slowly when slipping, which could increase their risk of falling, according to a University of Arizona Health Sciences-led study.

The paper, published in Scientific Reports, marked the first analysis of balance-correcting arm movements that may assist in reducing the incidence of hip fractures, said senior author Jonathan Lee-Confer, PhD, an assistant professor of physical therapy at the U of A Mel and Enid Zuckerman College of Public Health. He and his collaborators studied older adults walking in everyday conditions. 

“We know older adults lose mass in the shoulder muscles used for these types of arm movements,” Lee-Confer said. “This research fills a gap by looking at how older adults move and revealing those detriments to functional performance during a slip.” 

The research team gathered data from two groups of people, the first with an average age of 26 and the second with an average age of 72. They found that all participants achieved comparable peak arm abduction during slips of similar severity; however, the older group were on average 58% slower than the younger group.

Additionally, they found that faster, more explosive arm corrections helped limit whole-body movement during a slip, quantifying the difference just 1/25 of a second made in how much participants’ bodies shifted sideways.

“It’s actually quite a bit – about an inch [2.5cm] to the side. So if someone is delayed with their arm movement, they are going to fall more toward the side than if they were able to react quickly,” said Lee-Confer, adding that until about seven years ago, the physical therapy community’s prevailing belief was that slips caused people to fall backward. 

Lee-Confer’s prior research found that many people instead fall to the side. The distinction is important in preventing injury, as slip-induced falls are strongly associated with hip fractures. 

“When an older adult fractures their hip, it can only be from a sideways fall, not purely backward,” he said.

Lee-Confer’s new study establishes a foundation for further research into interventions that could strengthen arms to improve balance reactions to slips. He plans to investigate whether strengthening targeted muscles by employing quick dumbbell raises to the side makes subjects’ arms move more rapidly when a slip occurs.

The balance-correcting arm movements happen almost as quickly as an automatic reflex and having existing strength to draw on may speed the process, he said.

If future findings support the approach, adding arm exercises to existing fall prevention programs that condition legs could make physical therapy protocols more effective, thus saving lives and prolonging healthspans. 

“This is about using physical therapy to extend someone’s quality of life,” he said. “I like the idea of being able to give somebody more years of protection from these debilitating injuries.”

According to the Centers for Disease Control and Prevention, falls are the leading cause of nonfatal and fatal injury for Americans age 65 and older. 

Source: University of Arizona