{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:18Z","timestamp":1787016978800,"version":"build-2736575974"},"reference-count":46,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T00:00:00Z","timestamp":1679356800000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,2,26]]},"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Musculoskeletal injury (MSKI) risk is increased following mild traumatic brain injury (mTBI). Increased MSKI risk is present up to 2\u2009years following post-mTBI return-to-duty\/activity relative to both non-mTBI peers and to their pre-mTBI selves across a range of populations, including military service members, and professional, college and high school athletes. Despite the well documented increased post-mTBI MSKI risk, the underlying neuromuscular mechanisms contributing to this increased risk have yet to be definitively determined. A number of potential mechanisms have been suggested (eg, aberrant kinematics, dynamic balance impairments, lower voluntary muscle activation), but none have been confirmed with a comprehensive, prospective study. This study aims to: (1) elucidate the neuromuscular control mechanisms following mTBI that contribute to increased MSKI risk, and (2) prospectively track patient outcomes (up to 12 months; MSKI occurrences and patient-reported outcomes (PRO)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a multicentre prospective, case-matched control observational study to identify deficiencies in neuromuscular function following mTBI that may contribute to increased MSKI risk. Participants (aim to recruit 148, complete data collection on 124) will be classified into two cohorts; mTBI and control. All participants will undergo longitudinal (initial, 6\u2009weeks post-initial, 12\u2009weeks post-initial) comprehensive three-dimensional biomechanical (jump-landing; single leg hop; cut; gait), neuromuscular (interpolated twitch technique, muscular ramp contraction) and sensory (joint repositioning; light touch sensation) assessments to elucidate the underlying neuromuscular control mechanisms post-mTBI that may contribute to increased MSKI. Occurrences of MSKI and PROs (National Institutes of Health Patient-Reported Outcome Measurement Information System: Physical Function, Pain Interference, Depression, Anxiety; Brief Resilience Scale; Tampa Scale of Kinesiophobia), will be tracked monthly (up to 1\u2009year) via electronic data capture platforms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study received approval from the Walter Reed National Military Medical Center Institutional Review Board. Results will be made available to the associated funding agency and other researchers via conference proceedings and journal articles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT05122728\">NCT05122728<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-069404","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T07:04:19Z","timestamp":1683097459000},"page":"e069404","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Investigating post-mild traumatic brain injury neuromuscular function and musculoskeletal injury risk: A protocol for a prospective, observational, case\u2013controlled study in service members and active individuals"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct05122728","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0785-6640","authenticated-orcid":false,"given":"Robert C","family":"Lynall","sequence":"first","affiliation":[{"name":"Department of Kinesiology, University of Georgia, Athens, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph G","family":"Wasser","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA"},{"name":"Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel I","family":"Brooks","sequence":"additional","affiliation":[{"name":"Clinical Quality Management, Defense Health Agency, Falls Church, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarrod A","family":"Call","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology, University of Georgia, Athens, GA, USA"},{"name":"Regenerative Bioscience Center, University of Georgia, Athens, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad D","family":"Hendershot","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA"},{"name":"Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA, USA"},{"name":"Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R","family":"Kardouni","sequence":"additional","affiliation":[{"name":"US Army Forces Command, Fort Bragg, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianne D","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, University of Georgia, Athens, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy C","family":"Mauntel","sequence":"additional","affiliation":[{"name":"Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA, USA"},{"name":"Department of Clinical Investigations, Womack Army Medical Center, Fort Bragg, NC, USA"},{"name":"Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,22]]},"reference":[{"key":"2025121410425133000_13.3.e069404.1","unstructured":"Nindl BC , Williams TJ , Deuster PA , et al . 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