Inclusion criteria |
1. Male |
2. 18 to 50Â years of age |
3. Serving regular UK Armed Forces personnel |
4. Lower limb injury (e.g. patellofemoral pain, ACL reconstruction, ankle injury, projectile/blast related injury) |
5. Referred to Defence Medical Rehabilitation Centre (DMRC), Headley Court for treatment. |
6. Present with a level of function enabling engagement in conventional load bearing exercise rehabilitation confirmed by clinical assessment findings and recent training history. |
7. Unable to return to active duty due to physical impairment and occupational limitations (e.g. medical downgrading). |
Exclusion Criteria |
1. Female |
2. History of cardiovascular disease (hypertension, peripheral vascular disease, thrombosis/embolism, ischaemic heart disease, myocardial infarction) |
3. History of the following musculoskeletal disorders: rheumatoid arthritis, avascular necrosis or osteonecrosis, severe osteoarthritis |
4. History of the following neurological disorders: Peripheral neuropathy, Alzheimer’s disease, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease, stroke, mild or severe traumatic brain injury |
5. Chronic or relapsing/remitting gastrointestinal disorders such as inflammatory bowel diseases, irritable bowel syndrome or gastrointestinal infections within 28Â days of screening. |
6. Acute viral or bacterial upper or lower respiratory infection at screening |
7. Moderate or severe chronic obstructive pulmonary disease (COPD) |
8. Amputation to the lower or upper extremity |
9. Known or suspected lower limb chronic exertional compartment syndrome (CECS) (tourniquet raises intra-compartmental muscle pressure) |
10. Achilles or patella tendinopathy (slow heavy resistance or eccentric exercise programme prescribed as evidence-based for confirmed tendinopathy diagnosis) |
11. ACL surgery within the last 4Â weeks |
12. Surgical insertion of metal components in lower limbs (may affect MRI results) |
13. History of any of the following conditions or disorders not previously listed: diabetes, fibromyalgia, active cancer, severe obesity (i.e., body mass index greater than 35Â kg/m2), diagnosed mental illness (e.g. PTSD, depression, anxiety) |
14. Current or previous use of any drugs known to influence muscle mass or performance within previous 6Â months |
15. Elevated risk of unexplained fainting or dizzy spells during physical activity/exercise that causes loss of balance |