What I Have Learned From AMTI: A Perspective from AMTI Recipient COL (Ret) Don Goss, DPT, PhD
September 30, 2021 | Download PDF
Many, many thanks to the TATRC leadership for championing the AMTI program! Initially managed by Mr. John Winston, and now Ms. Holly Pavliscsak, this program has had a remarkable impact on the Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship at West Point, NY, and has taught our team, and me personally, very much over the last 7+ years. First, I would like to highlight the program’s capabilities and then discuss specific research lessons learned. Over the past 7+ years, we have added research athletic trainers, physical therapists, research assistants, and research coordinators to our team. We have purchased computers, wearable device sensors, cameras, and various office supplies. We have 5 completed studies and 3 ongoing that would not have been possible without the resources provided by the AMTI program. I would like to sincerely thank LTC (Ret) Shane Koppenhaver, PT, PhD, and Irene Davis, PT, PhD for their encouragement and mentorship as we prepared that first AMTI grant proposal in 2012/2013. Without their assistance, none of this would have been possible.
With our first AMTI award, we intended to compare real time biofeedback for gait retraining (changing running form from a rearfoot strike pattern to a forefoot strike). The challenge at West Point was that Cadets must run in uniform and are not permitted to run with a phone or iPod. MAJ Jamie Morris observed poor compliance with the feedback devices, but after putting runners in partial minimalist footwear (Nike Free flyknit 3.0), we learned that rearfoot strikers are at 6 times greater risk of developing knee pain over a 12 month follow up when they remain using a rearfoot strike in these shoes with minimal cushioning (Morris et al., 2018).
Next, we tested a sock with sensors sewn in the metatarsal heads and heel. The sock was designed to give feedback to runners. Lt Col Dan Watson observed 18 - 19 previously injured runners transitioned from rearfoot strike to forefoot strike with the coaching provided from the Sensoria software application. They remained injury free at their six month follow up. Lt Col Watson won a technology award and a best poster award at the 2018 American Physical Therapy Association’s Combined Sections Meeting. After that meeting, MAJ Brian Stoltenberg published a validity of the Sensoria Smart Sock and Milestone pod paper (Stoltenberg et al., 2019; Goss et al., 2020).
MAJ John Mason was the recipient of his first AMTI award in 2016 to study blood flow restriction training and its ability to prevent atrophy following knee surgery. The funding brought a new capability to the USMA PT clinics that helped many Cadets and other DoD beneficiaries, as well as demonstrating the effectiveness with the study (Mason et al., 2021).
LTC Darren Hearn and our team received an AMTI award in 2018 to evaluate force and pressure sensing insoles combined with motion capture during a drop landing task in new Cadets during their first week at West Point. This grant supported his PhD dissertation and we confirmed that asymmetries led to increased injury risk.
Dr. Erin Miller’s Gait Retraining Enhances Athletes’ Technique funding supported her dissertation and even with COVID limitations slowing research progress, we collected enough data to observe significant asymmetries in running biomechanics after ACL reconstruction which will assist us in rehabilitation after these surgeries. Her dissertation defense was an especially proud moment for our team in late 2020 as Erin was our first hire with AMTI funding in 2014. She has provided outstanding work for this team for over 7 years and continues to add her skills and talents to our team today. Without this AMTI funding, none of the work above would have been possible.
Overall, we have learned that gait retraining is appropriate for previously injured runners. We do not try to change the way everyone runs, but if runners are sustaining injuries and having issues, we know how to help them. We have learned it is not as much about the shoes as it is how you run. Continuing to use a rearfoot strike pattern in minimalist shoes is not a good idea. Blood flow restriction is a useful tool post operatively to prevent atrophy. Finally, there are gait asymmetries that exist post-surgery that need to be addressed.
Once again, I am so thankful for this program which has taught us so much and has shaped the way we work with hundreds and thousands of active-duty Service Members. Our 15 fellowship graduates from 2015-2019 have spread the lessons learned to 13 locations across the DoD to serve as mentors to the younger PT Officers and other health care professionals in the Holistic Health and Fitness initiative. I have also shared our lessons learned with the 91 PT staff that I supervised at Womack Army Medical Center, Fort Bragg, NC in 2019-2020. We use many of these principles and lessons learned in our running class at Fort Bragg helping previously injured Soldiers to run injury free (SOMA presentation, 2021).
None of this would have been possible without AMTI!
Thank you, thank you, and thank you!
COL (Ret) Don Goss
This article was published in the April 2022 issue of the TATRC Times.