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Little data exist regarding the long-term impact of excess weight on lower extremity musculoskeletal injury/disorder (MID) in U.S. Army Soldiers. This prospective analysis examines the association between BMI of Soldiers at accession and risk of MID.
A total of 736,608 Soldiers were followed from accession into the Army, 2001–2011. Data were analyzed January through March 2015. MID was categorized as any first incident lower extremity musculoskeletal injury/disorder, and secondarily, as first incident injury/disorder at a specific site (i.e., hips, upper legs/thighs, knees, lower legs/ankles, feet/toes). Multivariable-adjusted proportional hazards models estimated associations between BMI category at accession and MID risk.
During 15,678,743 person-months of follow-up, 411,413 cases of any first MID were documented (70,578 hip, 77,050 upper leg, 162,041 knee, 338,080 lower leg, and 100,935 foot injuries in secondary analyses). The overall MID rate was 2.62 per 100 person-months. Relative to Soldiers with normal BMI (18.5 to <25 kg/m2) at accession, those who were underweight (<18.5); overweight (25 to <30); or obese (≥30) had 7%, 11%, and 33% higher risk of MID, respectively, after adjustment. Risks were highest in Soldiers who were obese at accession, and lowest in those with a BMI of 21–23 kg/m2.
Soldier BMI at accession has important implications for MID. A BMI of 21–23 kg/m2 in newly accessing Soldiers was associated with the lowest risk of incident MID, suggesting that accession be limited to people within this range to reduce overall incidence of MID among service personnel.
Purpose: To determine the association between injury history at enrollment and incident lower extremity (LE) injury during cadet basic training among first-year military cadets.
Methods: Medically treated LE injuries during cadet basic training documented in the Defense Medical Surveillance System (DMSS) were ascertained in a prospective cohort study of three large U.S. military academies from 2005-2008. Both acute injuries (ICD-9 codes in the 800-900s, including fracture, dislocations, sprains/strains) and injury-related musculoskeletal injuries (ICD-9 codes in the 700s, including inflammation and pain, joint derangement, stress fracture, sprain/strain/rupture, and dislocation) were included. Risk ratios (RR) and 95% confidence intervals (CI) were computed using multivariate log-binomial models stratified by gender.
Results: During basic training there were 1,438 medically treated acute and 1,719 musculoskeletal-related LE injuries in the 9,811 cadets. The most frequent LE injuries were sprains/strains (73.6% of acute) and inflammation and pain (89.6% of musculoskeletal-related). The overall risk of incident LE injury was 23.2% [95%CI: 22.3%, 24.0%]. Cadets with a previous history of LE injury were at increased risk for incident LE injury. This association was identical in males (RR=1.74 [1.55, 1.94]) and females (RR=1.74 [1.52, 1.99]). In site-specific analyses, strong associations between injury history and incident injury were observed for hip, knee ligament, stress fracture, and ankle sprain. Injury risk was greater (p<0.01) for females (39.1%) compared to males (18.0%). The elevated injury risk in females (RR=2.19 [2.04, 2.36]) was independent of injury history (adjusted RR=2.09 [1.95, 2.24]).
Conclusion: Injury history upon entry to the military is associated with incidence of LE injuries sustained during cadet basic training. Prevention programs targeted at modifiable factors in cadets with a prior history of LE injury should be considered.
Injuries are common within military populations, with high incidence rates well established in the literature. Injuries cause a substantial number of working days lost, a significant cost through compensation claims and an increased risk of attrition. In an effort to address this, a considerable amount of research has gone into identifying the most prevalent types of injury and their associated risk factors. Collective evidence suggests that training and equipment contribute to a large proportion of the injuries sustained. In particular, the large loads borne by soldiers, the high intensity training programs and the influence of footwear have been identified as significant causative factors of lower limb injury in military populations. A number of preventative strategies have been developed within military bodies around the world to address these issues. The relative success of these strategies is highly variable; however, with advancements in technology, new approaches will become available and existing strategies may become more effective
Female Soldiers have a significantly higher rate of injury, specifically low back and lower extremity (LB/LE) injuries, compared to male Soldiers. Despite return to full activity following an injury, LE biomechanical asymmetries may persist, likely leading to an increased risk for recurrent injuries.PURPOSE: To assess musculoskeletal and biomechanical asymmetries that may relate to the development of injury in female Soldiers. METHODS:Female 101st Airborne Division (Air Assault) Soldiers’ (n=77; age=27.1?5.9) LE strength (% body weight) and LE biomechanics were collected with 3D motion analysis during a drop landing task. Paired samples t-tests compared bilateral strength and landing biomechanics in female Soldiers. SPSS v.23 was utilized for analysis (p<0.05).RESULTS:Among all female Soldiers, 15.6% (12/77) reported at least one LB/LE injury within the last year, with half of those with injuries reporting a knee injury. The majority of all injuries and specifically knee injuries occurred on the right side. Significant asymmetries were found in knee extension strength (R:186.8?39.0 %BW vs L:171.9 ? 39.5 %BW, p<0.001), knee flexion strength (R:90.9.8?22.3 %BW vs L:86.5?21.1 %BW, p=0.001), knee flexion at initial contact (IC) (R:19.9?6.9? vs L:21.2?6.7?, p=0.33), knee flexion excursion (R:69.5?11.8? vs L:67.5?12.0?, p=0.004) and peak vertical ground reaction force (PvGRF) (R:350.3?88.6 %BW vs L:327.2?84.8 %BW, p<0.001).CONCLUSION:Female Soldiers demonstrated asymmetrical landing strategies, including decreased right knee flexion at IC and increased right PvGRF, potentially placing an increased load on the right limb, which was also the most injured limb. This stiffened landing position and greater PvGRF were found despite greater knee strength and increased knee flexion excursion on the right. These results suggest that in female Soldiers, shock absorption strategies at the knee may be influenced by mechanisms other than maximal knee strength. Further research is needed to determine the interaction between sagittal and frontal plane mechanics during landing in female Soldiers. With the expanded role of women in the military, understanding the mechanisms associated with these asymmetrical movement patterns and increased risk of injury should be a priority in military medicine.
The study objective was to determine whether spatiotemporal gait parameters could predict lower-limb overuse injuries in cohort of combat soldiers during first year of military service. Newly recruited infantry soldiers walked on a treadmill at a 15? incline with a fixed speed of 1.67 m/sec while wearing a standard military vest with a 10 kg load. Stride time variability, stride length variability, step length asymmetry, and the duration of the loading response phase of the gait cycle were measured. Injury data on 76 soldiers who did not report musculoskeletal complaints at initial screening were collected one year after recruitment. Multiple logistic regression analyses were conducted to determine the predictive effect of the gait parameters on lower-limb injuries. Twenty-four soldiers (31.6%) had overuse injuries during the first year after recruitment. Duration of the loading response was a significant predictor of general lower-limb injury (), as well as of foot/ankle and knee injuries (, , resp.). A cutoff value of less than 12.15% for loading response duration predicted knee injuries with 83% sensitivity and 67% specificity. This study demonstrates the utility of spatiotemporal gait evaluation, a simple screening tool before military training, which may help to identify individuals at risk of lower-limb overuse injuries.
Overuse injuries of the leg are a common problem for young soldiers. This article reviews the literature concerning the prevention and treatment of exercise related leg pain in military settings and presents the latest developments in proposed mechanisms and treatments. Current practice and treatment protocols from the Dutch Armed Forces are reviewed, with an emphasis on the most prevalent conditions of medial tibial stress syndrome and chronic exertional compartment syndrome. The conclusion is that exercise related leg pain in the military is an occupational problem that deserves further study.
Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan
When i was attending Officer Advanced Camp one of my fellow cadets had a bad blister on his little toe. He did not seek medical assistance because it would take him out of the training regimen which could reflect badly on his final rating and position in the army.
The toe got bad and infected and the cadet got in trouble for not reporting the injury.
Injury rates in military units may be under estimated for this reason.
If the two most common blisters in the army are 5th toe and posterior heel blisters why don't the boot makers adapt to overcome this problem??