{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:06:56Z","timestamp":1792786016981,"version":"4.5.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","funder":[{"name":"Services Research"},{"name":"Department of Defense, Defense Health Agency","award":["HU0012120089"],"award-info":[{"award-number":["HU0012120089"]}],"id":[{"id":"https:\/\/ror.org\/03df8gj37","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In 2017, the United States Marine Corps (USMC) increased the pull-up requirements of the Physical Fitness Test (PFT) to improve combat readiness, raising concerns regarding potential increases in upper extremity (UE) musculoskeletal injuries (MSKIs). This study assesses the impact of this policy change on UE MSKI incidence among active-duty male Marines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Linear regressions estimated with ordinary least squares were used to perform interrupted time series analyses of UE MSKI rates among male Marines from the Military Health System Data Repository between 2014 and 2023. Upper extremity MSKI rate trends were evaluated pre- (2014-2016) and post-intervention (2017-2023), stratified by age, race\/ethnicity, body mass index (BMI), and rank. Newey-West SEs were used in linear regression analyses to adjust for violations from autocorrelation and heteroskedasticity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study population included 231,323 Marines in the pre-intervention period (2014-2016) and 313,537 in the post-intervention period (2017-2023). Cumulative UE MSKI proportions increased (9.0%-9.4%). Pre-policy, UE MSKI rates trended downward (b1 = \u22125.09, P &amp;lt; .001). Post-policy, this trend significantly reversed (b3 = 5.11, P &amp;lt; .001) but not immediately (b2 = \u22124.00, P = .431). Subgroup analysis revealed sustained increasing rates among Marines &amp;lt;20 years (b1\u2009+\u2009b3 = 0.88, P &amp;lt; .001). Conversely, decreasing rates occurred in Marines with obesity (b1\u2009+\u2009b3 = \u22121.09, P = .006), ages 40-49 (b1\u2009+\u2009b3 = \u22121.21, P = .046), and senior enlisted (b1\u2009+\u2009b3 = \u22121.10, P = .012). Warrant officers experienced a significant decrease in UE MSKI rates (b2 = \u221234.22, P = .007) as well as subsequent trend stabilization (b3 = 6.23, P &amp;lt; .001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 2017 standards were temporally associated with a plateau in previously declining UE MSKI rates. While no immediate population-level spike occurred, the heterogeneity of subgroup responses highlights specific risks for younger personnel. Future policy modifications should balance fitness objectives with targeted injury prevention strategies to optimize readiness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag464","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:27:24Z","timestamp":1790335644000},"source":"Crossref","is-referenced-by-count":0,"title":["Assessing the Impact of Increased Pull-Up Requirements on Upper Extremity Musculoskeletal Injuries Among Males in the U.S. Marine Corps: An Interrupted Time Series Analysis"],"prefix":"10.1093","author":[{"given":"Bradley","family":"McNeal","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2373-5234","authenticated-orcid":false,"given":"Hava","family":"Marneweck","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc , Bethesda, MD 20817,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6660-1229","authenticated-orcid":false,"given":"Amanda","family":"Banaag","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc , Bethesda, MD 20817,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8827-5735","authenticated-orcid":false,"given":"Vivitha","family":"Mani","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc , Bethesda, MD 20817,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mel","family":"Helgeson","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Mayo Clinic , Rochester, MN 55905,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2573-0706","authenticated-orcid":false,"given":"Christian","family":"Coles","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc , Bethesda, MD 20817,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1377-8615","authenticated-orcid":false,"given":"Tracey Perez","family":"Koehlmoos","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"2026100720375846100_usag464-B1","author":"United States Marine Corps","year":"2016"},{"key":"2026100720375846100_usag464-B2","author":"United States Marine Corps","year":"2022"},{"key":"2026100720375846100_usag464-B3","author":"United States Marine Corps","year":"2021"},{"key":"2026100720375846100_usag464-B4","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/j.jsams.2015.08.002","article-title":"Scapula kinematics of pull-up techniques: avoiding impingement risk with training changes","volume":"19","author":"Prinold","year":"2016","journal-title":"J Sci Med Sport"},{"key":"2026100720375846100_usag464-B5","first-page":"2","article-title":"Absolute and relative morbidity burdens attributable to various illnesses and injuries among active component members of the U.S. Armed Forces, 2023","volume":"31","author":"Armed Forces Health Surveillance Division","year":"2024","journal-title":"MSMR"},{"key":"2026100720375846100_usag464-B6","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1093\/occmed\/kqr028","article-title":"Musculoskeletal injuries among overweight army trainees: incidence and health care utilization","volume":"61","author":"Cowan","year":"2011","journal-title":"Occup Med (Lond)"},{"key":"2026100720375846100_usag464-B7","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1097\/JOM.0000000000000982","article-title":"The relationship between BMI and work-related musculoskeletal (MSK) injury rates is modified by job-associated level of MSK injury risk","volume":"59","author":"Schoenfisch","year":"2017","journal-title":"J Occup Environ Med"},{"key":"2026100720375846100_usag464-B8","doi-asserted-by":"publisher","first-page":"2289","DOI":"10.1186\/s12889-024-19699-w","article-title":"BMI changes among U.S. Navy and Marine Corps active-duty service members during the COVID-19 pandemic, 2019\u20132021","volume":"24","author":"Janvrin","year":"2024","journal-title":"BMC Public Health"},{"key":"2026100720375846100_usag464-B9","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1093\/ije\/dyw098","article-title":"Interrupted time series regression for the evaluation of public health interventions: a tutorial","volume":"46","author":"Bernal","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2026100720375846100_usag464-B10","author":"Armed Forces Health Surveillance Division","year":"2015"},{"key":"2026100720375846100_usag464-B11","author":"Centers for Disease Control and Prevention","year":"2026"},{"key":"2026100720375846100_usag464-B12","doi-asserted-by":"publisher","first-page":"e1817","DOI":"10.1093\/milmed\/usaf621","article-title":"Trends in upper extremity injuries in female Marines following the addition of the pull-up as a physical fitness test event","volume":"191","author":"Arnold","year":"2026","journal-title":"Mil Med"},{"key":"2026100720375846100_usag464-B13","author":"Office of People Analytics","year":"2023"},{"key":"2026100720375846100_usag464-B14","doi-asserted-by":"publisher","first-page":"e1461","DOI":"10.1093\/milmed\/usaa027","article-title":"Musculoskeletal injuries and United States Army readiness part I: overview of injuries and their strategic impact","volume":"185","author":"Molloy","year":"2020","journal-title":"Mil Med"},{"key":"2026100720375846100_usag464-B15","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1001\/jamasurg.2018.0480","article-title":"Practical guide to surgical data sets","volume":"153","author":"Schoenfeld","year":"2018","journal-title":"JAMA Surg"},{"key":"2026100720375846100_usag464-B16","author":"Centers for Disease Control and Prevention","year":"2013"},{"key":"2026100720375846100_usag464-B17","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1093\/milmed\/usab447","article-title":"Overweight BMI (25-29) in active duty military: excess fat or more lean mass? 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