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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