Basic Initial Entry Training
Military recruits are at high risk of overuse MSKI because initial entry training (typically 10 to 16 weeks) is often a sudden substantial increase in the amount and intensity of their physical activity. Many recruits injured in initial entry training led relatively sedentary lives prior to enlistment and do not have the foundation necessary for the rigors of military training.
Common initial training MSKI injuries include bone stress injuries (BSI) and various joint pain injuries. Lower body injuries (e.g. from hip and pelvis to feet) are most common, often a result of the rigors of running and road marching activities.
Data show recruits who are more physically fit and/or had participated in sports prior to their initial military training have lower MSKI rates. Yet an estimated one-third of applicants to military entry training do not meet basic military fitness standards.
What can reduce recruit injury risk?
Leaders should follow doctrine to ensure trainees' gradual increases to physical activities (distances, weights, speed). Recruits with injuries should be treated as soon as possible and given adequate time to recover to avoid exacerbating an injury so that it becomes more difficult and costly to treat.
Data suggests increasing length of stride in runs/marches (stretching legs out further forward than a person's normal gait) can put excess or awkward pressure on the MSK structure and increase risk of injury. Smaller quicker steps may be safer. Recruits should also be encouraged to increase their resilience to injury prior to basic training:
Prior to military initial training, recruits should:
-
Physically prepare
well before initial entry training. A gradual increase of exercise and physical activity over time will encourage MSK tissues to strengthen. A stronger body will be more resilient to overuse MSKI during entry training.
- Include various exercise drills to include agility, power and balance training along with more traditional aerobic endurance (cardio) and strength exercises. Data suggest activities prior to enlistment that required multi-directional body movement, such as soccer or basketball, may especially lower MSKI risk.
During training, recruits should:
-
Avoid non-steroidal anti-inflammatory drugs (NSAIDs), for bone pain.
NSAIDs, which include products that can be purchased over the counter such as ibuprofen, may be one of the most significant and preventable risks of BSI. NSAIDS have been found to delay healing in those who have a BSI. Many orthopedic doctors are aware that NSAIDs delay healing, but this may not be well known by others in the medical field. Since NSAIDs can be effective for other kinds of pain management, many providers may prescribe NSAIDS.
-
Seek medical assessment at early signs to avoid more serious MSKI. Some injuries, such as severe stress fractures, can require surgery. Delayed muscle soreness can be a normal indication that muscles are being challenged, but
pain in a joint or bone can be a serious health condition that will likely result in lost duty or training time and possible treatment in a hospital.
Seek care before the damage is serious.
-
If injured, follow your recovery treatment plan(s). Recovery from an MSKI will likely involve a plan to gradually rebuild tissues that have been damaged. The process includes an initial reduction of training loads and the slow addition of activities. Increasing load/speed/amount of activity too quickly can slow the overall recovery time. The recovery phase may be guided by a healthcare provider (orthopedist, physical therapist, occupational therapist) or certain certified fitness instructors.
-
Maintain proper weight and eat nutritional foods with adequate calories and meet dietary standards. Data indicate that service members who are both overweight or have body mass index (BMI) standards above military standards AND service members who are below weight or have BMI below military standards are at higher risk of MSKI. Inadequate caloric intake can increase risk of injury.
-
Find ways to maximize sleep. While military operations and training conditions are not often conducive to the recommended adult 7 to 8 hours of sleep, inadequate sleep may further increase risk of injury to service members. Tips for service members to maximize the amount and quality of sleep in a 24 hour period are highlighted in these articles:
Sources:
Deployment
During deployment, MSKIs are the most common cause of ambulatory visits.
Many service members who sustain MSKIs that are treated conservatively in the theater during deployment, eventually require surgery following a combat tour.
Aside from risk of combat fire, service members' health, physical fitness, and body composition (BMI, fat %) can be impacted by nutrition, hydration, physical stressors such as carrying extremely heavy loads, poor sleep, environmental extremes (sun, heat, cold, altitude), environmental pollutants and hazards (animals, insects), infectious and noninfectious disease, and mental stressors. These factors all increase injury risk, independently as well as combined.
What can service members do to reduce injury risk when deployed?
-
Pay attention to the hazards and risks in deployment medical threat briefs (MTBs). These briefs are intended to highlight key threats/risk in that area of operation (AOR) and the procedures to reduce risk.
-
Take personal responsibility when you can. Military deployments are inherently with risk. Units leaders are responsible to consider, prioritize and manage all risks with goal of mission success. Service members can still reduce personal injury risks:
- Follow doctrinal/operational risk management guidance to reduce risks
- Don't smoke (this increases MSKI risk and delays healing), eat as healthy as possible with adequate calories, and stay hydrated
- Wear protective eye and hearing protection
- Wear eye protection, braces, if participating in intramural sports
- Use three-point touch rule when getting in or off vehicles/tall obstacles
- Avoid contact with local animals
-
Ensure rucks are properly packed and worn to reduce risk of back injuries and blisters from ribbing straps
Source:
Fitness Testing in the Military
The use of specific fitness tests, along with standards for body composition, is a long-established practice to monitor basic health and fitness of military personnel.
The basic fitness tests required by service members are not intended to predict the degree to which complex physical tasks are successfully performed. These tests provide measures of the basic fitness levels that are needed by personnel to safely conduct common job tasks for military combat. For example, the use of timed runs, ranging for 1.5 to 3 miles depending on the Service, have been useful indicators of a person's aerobic fitness (cardiovascular health). Data has indicated that service members with slow run times (poor aerobic fitness) tend to have a higher risk of injury and attrition.
Each military Service has established its own fitness test criteria to meet mission needs:
-
Army: The Army Combat Fitness Test (ACFT) is a 6-event test that provides measures of upper and lower body, core strength, and power through 5 tests (the deadlift, push-ups, plank hold, standing power throw, sprint-drag-carry) and a 2-mile run for aerobic fitness. Go to: https://www.army.mil/acft
What can service members do to reduce injury risk associated with fitness training?
The best way to avoid injuries associated with physical fitness tests is to:
- Learn proper form for the tests before conducting them
- Gradually increase speed or weight several weeks or months, and
- Maintain fitness instead of waiting to 'train for the test'. Abruptly starting to train hard can increase risk of muscle strains and joint sprains.
Additional sources:
Obstacle Courses and Combatives
Established policies and procedures are designed to ensure these essential military training activities are conducted in the safest manner possible to reduce risk of injury.
As an example, orofacial and dental injuries that occur during these activities are highly preventable with proper mouthguard use. As a result, military regulations require mouthguards (i.e., AR 600-63) during these training events.
Military personnel should wear authorized safety protection including mouthguards during to obstacle courses and combative training to prevent acute injuries.
Sources:
Parachuting
Most injuries experienced by U.S. military paratroopers are due to cumulative microtraumatic (overuse) injuries that develop over time. However, because military paratroopers may be more likely to experience acute injuries such as sprains, fractures, or brain injuries, they receive hazard duty pay once qualified and in an active paratrooper unit. The good news is that while in basic initial Airborne training to become paratroopers, they experience less injuries due to safety oversight during controlled training jumps. The use of the newest T-11 parachute in recent years has also reduced rates of ankle injuries due to a slower descent rate. Current injuries of concern include acute head, neck and shoulder injuries and overuse injuries to shoulders as well as knees. Following proper training protocol as much as possible during operational and combat activities can reduce risks.
Sources:
Road (Ruck) Marching
Military mission success often depends on the efficiency by which troops access remote or unstable environments on foot. Unfortunately, the military carried load has continued to increase due to the demands of modern warfare. Weights ranging from 75 to 125 pounds were not uncommon during recent deployments in Afghanistan.
Foot blisters, stress fractures, foot pain and tingling, knee problems, and back problems are among the most common road marching related injuries.
Using proper equipment, improving load distribution, and ensuring proper physical fitness training to include progressive increases in weight and distance during training can reduce the risk of injuries.
Sources:
What can help prevent injuries?
Certain products/items have been evaluated as to their effectiveness at reducing injuries to military populations.
-
Blister Prevention: Physical training and military operations like road marching can result in potentially serious injuries from blisters on the feet or other areas such as from the shoulder straps of a ruck sack. Some blisters need medical attention and can limit duty for many days. A review of the literature finds that the primary prevention tactic is to use synthetic moisture-wicking socks and proper fitting shoes to reduce the risk of blister formation. Other types of prevention are not as well scientific proven to be effective but may be considered. Read our Blister Prevention Factsheet or Army.mil article for more information. Also see: Technical references.
-
Mouthguards: The military requires the use of mouthguards for many sports such as combatives training since properly-fitted mouthguards are a proven means to reduce the risk of serious dental injuries. Read our Mouthguard Factsheet to help identify how to choose the best mouthguard to reduce these injuries.
-
Arch Supports and Insoles (inadequate evidence for injury prevention): Prior military studies demonstrated inconsistent findings regarding the use of arch support or insoles to reduce injuries. For more information read this report.
