Military training-related injuries: Surveillance, research, and prevention
Introduction
Musculoskeletal injuries are a major problem in military populations. This category of injuries is treated primarily on an outpatient basis. Unfortunately, Department of Defense (DoD) service-wide outpatient surveillance data have only recently become available. Therefore, we must rely on existing epidemiologic studies to estimate the size of the problem, identify risk factors, and begin to propose and test preventive measures. Most of the research has been conducted on Marine and Army trainees. Army infantry soldiers, Navy special forces, and some others have also been studied. Risk factors have been identified that are amenable to intervention. However, few intervention trials have been undertaken. Outpatient surveillance systems capable of capturing cause-of-injury data have been recently developed to obtain a research-based musculoskeletal injury database in select military populations. The success of these systems suggests that simple surveillance tools can provide important data.
This paper reviews the pertinent epidemiologic literature on musculoskeletal injury rates, injury type, and location and risk factors for military populations. It also provides suggestions for injury prevention.
Section snippets
Methods
Information presented to the Armed Forces Epidemiological Board’s (AFEB) Injury Control Work Group by scientists from the Navy and Army research organizations was evaluated. In addition, existing published military and civilian epidemiologic studies were used to estimate and compare the size of the problem, identify risk factors, and identify tested preventive measures. The research reviewed pertained primarily to Marine and Army recruits, Army infantry soldiers, and Naval Special Warfare
Prevention strategies
Preventive strategies should be directed at the primary factors contributing to risks for musculoskeletal injuries, such as the amount and level of intensity of the training, levels of physical fitness, and possibly equipment (e.g., footwear).
The specific approach to achieving higher levels of physical fitness while minimizing injury rates depends on the particular populations being considered. For example, with military recruits there is limited access prior to arrival to boot camp. Therefore,
Outpatient surveillance systems
Unlike inpatient clinical events that have been maintained in standardized tri-service databases for almost a decade, comprehensive outpatient surveillance systems such as the Sports Medicine Research Team System (SMARTS) or the DoD Ambulatory Data System (ADS) are a more recent development.
The Naval Health Research Center has developed SMARTS, a PC-based software application for the purpose of supporting epidemiologic research in musculoskeletal injuries.59 The system has features of both
Summary
Research suggests that musculoskeletal injuries are a significant problem in the military. Although the majority of studies have been conducted in military recruit training populations, studies conducted in operational forces provide documentation that there is a large problem in these populations as well. Data reviewed show a wide variation in injury rates between military units studied, probably varying according to the types and amounts of training performed. Military research has identified
Suggested readings
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Bensel CK, Kish RN. Lower extremity disorders among men and women in Army basic training and effects of two types of boots. Natick, MA: U.S. Army Research Institute of Environmental Medicine, 1983 (NATICK/TR-83/026).
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Hoeberigs JH. Factors related to the incidence of running injuries: a review. Sports Med 1992;13:408–22.
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Jones BH. Overuse injuries of the lower extremities associated with marching, jogging, and running: a review. Mil Med 1983;148:783–7.
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Jones BH, Harris JM, Vinh TN, Rubin C.
Acknowledgements
The views, opinions, and findings contained in this report are those of the authors and should not be construed as official Department of the Navy or DoD position, policy, or decision, unless so designated by other official documentation. The authors thank Barbara Iverson-Literski for careful manuscript preparation.
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