Military training-related injuries

Abstract

Background: Musculoskeletal physical training-related injuries are a major problem in military populations. Injuries are important in terms of loss of time from work and training and decreased military readiness. The implications of these injuries in terms of patient morbidity, attrition rates, and training costs for military personnel are staggering. This article reviews: (1) pertinent epidemiologic literature on musculoskeletal injury rates; (2) injury type and location; and (3) risk factors for military populations. Suggestions for injury surveillance and prevention are also offered.

Methods: Existing military and civilian epidemiologic studies were used to estimate and compare the size of the injury problem, identify risk factors, and test preventive measures. Most of the military research data obtained was from Marine and Army recruits, Army Infantry soldiers, and Naval Special Warfare candidates. Additional studies conducted in operational forces provided documentation of the injury problem in these populations as well.

Results: Injury rates during military training are high, ranging from 6 to 12 per 100 male recruits per month during basic training to as high as 30 per 100 per month for Naval Special Warfare training. Data collected show a wide variation in injury rates that are dependent largely on the following risk factors: low levels of current physical fitness, low levels of previous occupational and leisure time physical activity, previous injury history, high running mileage, high amount of weekly exercise, smoking, age, and biomechanical factors. (Data are contradictory with respect to age.)

Conclusion: Considering the magnitude of training injuries in military populations, there is a substantial amount of work that remains to be performed, especially in the areas of surveillance, prevention, and treatment. Modifiable risk factors have been identified suggesting that overuse and other training injuries could be decreased with proper interventions. Outpatient surveillance systems are available to capture musculoskeletal injury data but need to be refined. Given the size of the problem, a systematic process of prevention should be initiated starting with routine surveillance to identify high-risk populations for the purpose of prioritizing research and prevention. Properly planned interventions should then be implemented with the expectation of dramatically reduced lost work/training time, attrition, and medical costs, while increasing military readiness.

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.