Military training-related injuries: surveillance, research, and prevention

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.

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.

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.)

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.