Trends in Upper Extremity Injuries in Female Marines following the Addition of the Pull-up as a Physical Fitness Test...

In November 2012, the U.S. Marine Corps announced a policy change to the female Physical Fitness Test (PFT), replacing the flexed arm hang with pull-ups. This change, which became effective on January 1, 2017, aimed to standardize fitness requirements and facilitate gender integration into combat roles. Musculoskeletal injuries (MSKIs) are a leading cause of medical encounters and non-deployability among service members. Upper extremity (UE) injuries are particularly relevant given the physical demands of pull-ups.

A retrospective open cohort study was conducted using data from the Military Health System Data Repository (MDR) from fiscal years 2010-2023. International Classification of Diseases (ICD)-9 and ICD-10 codes identified UE injuries in female Marines. Single and multigroup interrupted time series analyses were used to assess changes in injury rates surrounding the PFT policy change.

A total of 49,910 female Marines were included in this study, of whom 6,125 (12.3%) had at least one UE MSKI. The overall trend of UE MSKIs decreased both before and after the PFT policy change. The immediate change post-policy showed no significant changes in UE MSKIs at the time of intervention. However, specific groups experienced significant decreases in MSKI rates at the intervention: Marines ages 20-29 years, those of Black race, junior enlisted ranks, and those with overweight body mass index.

The findings highlight positive impacts of the PFT policy change on reducing MSKI rates among specific subgroups of female Marines. These results inform future policy adjustments aimed at mitigating injury risks while promoting operational readiness across diverse demographics.