Related Experiment Video
Updated: Oct 23, 2025
Subject-specific Musculoskeletal Model for Studying Bone Strain During Dynamic Motion
Published on: April 11, 2018
Automated Landing Error Scoring System Performance and the Risk of Bone Stress Injury in Military Trainees
Timothy G Eckard1, Story F P Miraldi2, Karen Y Peck3
1Department of Physical Therapy, Western Carolina University, Cullowhee, NC.
Context:
Lower extremity bone stress injuries (BSIs) place a significant burden on the health and readiness of the US Armed Forces.
Objective:
To determine if preinjury baseline performance on an expanded and automated 22-item version of the Landing Error Scoring System (LESS-22) was associated with the incidence of BSIs in a military training population.
Design:
Prospective cohort study.
Setting:
US Military Academy at West Point, NY.
Patients Or Other Participants:
A total of 2235 incoming cadets (510 females [22.8%]).
Main Outcome Measure(S):
Multivariable Poisson regression models were used to produce adjusted incidence rate ratios (IRRs) to quantify the association between preinjury LESS scores and BSI incidence rate during follow-up and were adjusted for pertinent risk factors. Risk factors were included as covariates in the final model if the 95% CI for the crude IRR did not contain 1.00.
Results:
A total of 54 BSIs occurred during the study period, resulting in an overall incidence rate of 0.07 BSI per 1000 person-days (95% CI = 0.05, 0.09). The mean number of exposure days was 345.4 ± 61.12 (range = 3-368 days). The final model was adjusted for sex and body mass index and yielded an adjusted IRR for a LESS-22 score of 1.06 (95% CI = 1.002, 1.13; P = .04), indicating that each additional LESS error documented at baseline was associated with a 6.0% increase in the incidence rate of BSI during the follow-up period. In addition, 6 individual LESS-22 items, including 2 newly added items, were significantly associated with the BSI incidence.
Conclusions:
We provided evidence that performance on the expanded and automated version of the LESS was associated with the BSI incidence in a military training population. The automated LESS-22 may be a scalable solution for screening military training populations for BSI risk.
