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Purpose: This study determined injury incidence and examined the association between musculoskeletal injuries and potential intrinsic and extrinsic risk factors.
Methods: This retrospective cohort study involved a survey of 593 volunteers from two battalions of a Stryker Brigade Combat Team upon completion of a 12-mo deployment to Afghanistan. The survey included questions on physical characteristics, work duties, equipment worn, fitness training, and injuries experienced during the deployment.
Results: Of the surveyed soldiers, 45% sustained an injury during the deployment. Total injuries resulted in 5049 d of limited duty, an average of 8.5 d per injury. The body regions with the largest numbers of injuries were the low back (17.4%), knee (12.7%), and shoulder (10.0%). The majority (65%) of injuries occurred while working. The most frequent activities soldiers reported as the cause of injury were lifting and carrying (9.8%), dismounted patrolling (9.6%), and physical training (8.0%). Older age, higher enlisted rank, female sex, months deployed, more time spent standing, longer strength training sessions, heaviest load worn, and heavier or more frequent lifting tasks were all associated with injury.
Discussion: Tasks requiring physical energy expenditure such as load carriage, lifting, or standing resulted in an increased risk of musculoskeletal injury in this study. Lifting/carrying, dismounted patrols, and physical training were associated with 26% of musculoskeletal injuries. The weight of loads carried and lifting may be exceeding the work capacity of the soldiers, resulting in injury. These injuries in turn limit available work days for military units, reducing combat power.
Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan
Just out of interest - I did a tour of Helmand, Afghan in 2009/10 in a non-podiatric capacity, however, my skills as a pod were called upon on more than one occasion as I worked in the Field Hospital. From a podiatric point of view the most common complaint I saw, by far, was IGTN. P,fasc was fairly common and obviously a lot of fungal skin infections. I had some real whoppers in terms of ingrowers though and always with infection. There is a physio department out there which is mixed UK and US and that was a great set-up so I'd do the odd teaching session there too.
The Operating theatre staff would let me use their bays and I do remember performing a PNA while a CAT-A patient was in the theatre having something amputated from an IED strike. All very surreal
Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan
A prospective investigation of injury incidence and risk factors among army recruits in combat engineer training
Joseph J Knapik, Bria Graham, Jacketta Cobbs, Diane Thompson, Ryan Steelman and Bruce H Jones Journal of Occupational Medicine and Toxicology 2013, 8:5
Quote:
Background
United States Army combat engineer (ENG) training is an intense 14-week course designed to introduce new recruits to basic soldiering activities, Army values and lifestyle, and engineering skills and knowledge. The present investigation examined injury rates and injury risk factors in ENG training.
Methods
At the start of their training, 1,633 male ENG recruits were administered a questionnaire containing items on date of birth, height, weight, tobacco use, prior physical activity, and injury history. Injuries during training were obtained from electronic medical records and the training units provided data on student graduation and attrition. Risk factors were identified using Cox regression.
Results
Ninety-two percent of the recruits successfully graduated from the course and 47% of the recruits experienced one or more injuries during training. Univariate Cox regression demonstrated that recruits were at higher injury risk if they reported that they were older, had a higher or lower body mass index, had smoked in the past, had performed less exercise (aerobic or muscle strength) or sports prior to ENG training, had experienced a previous time-loss lower limb injury (especially if they had not totally recovered from that injury), or had a lower educational level.
Conclusions
The present investigation was the first to identify injury rates and identify specific factors increasing injury risk during ENG training. The identified risk factors provide a basis for recommending future prevention strategies.
Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan
Changes in Dynamic Plantar Pressure During Loaded Gait.
Goffar SL, Reber RJ, Christiansen BC, Miller RB, Naylor J, Rodriguez BM, Walker MJ, Teyhen DS. Phys Ther. 2013 Apr 11.
Quote:
BACKGROUND:
Lower extremity overuse injuries are detrimental to military readiness. Extremes of arch height and heavy loads carried by military personnel are associated with increased risk for overuse injury. Little is known regarding the impact of load carriage on plantar pressure distributions during gait.
OBJECTIVE:
The objective was to determine how load carriage affects plantar pressure distributions during gait in individuals with varying arch types.
DESIGN:
A cross sectional repeated measures design.
SETTING:
Research laboratory at Fort Sam Houston, Texas.
PARTICIPANTS:
Healthy service members (n=115, 18 females, 31.3±5.6 years, 86.0±11.0 kg) weighing ≥70kg were enrolled. Participants were categorized as having high, normal, or low arched feet based on published cut-off values for the arch height index (AHI).
INTERVENTION:
Not applicable.
MEASUREMENTS:
Plantar pressure measurements were obtained using an in-shoe pressure measurement system while participants wore combat boots and walked on a treadmill under three loaded conditions (uniform, 20 kg, and 40 kg load). Maximal force (MaxF) and force-time integral (FTI) were assessed using a nine sector mask to represent regions of the foot. Analysis utilized 3×3 repeated measures ANOVA across the levels of load and arch type.
RESULTS:
A significant interaction existed between arch type and load for MaxF (p=0.001) and FTI (p≤0.001) in the medial midfoot, with greater forces in low arched feet. In the medial forefoot, MaxF (p=0.004) and FTI (p=0.002) were greatest in high arched feet across all load conditions. In the great toe region, low and normal arched feet demonstrated greater MaxF (p=0.001) and FTI (p=0.03). The relative distribution of FTI increased proportionately in all regions of the foot regardless of arch type for all load conditions.
LIMITATIONS:
The influence of fatigue, greater loads, and different walking speeds were not assessed.
CONCLUSION:
Regardless of arch type, increases in load did not alter the relative distribution of forces over the plantar foot during gait. Those with high arched feet had greater forces in the medial forefoot region, while those with normal or low arched feet had greater forces in the great toe region, regardless of load. These differences in force distributions may demonstrate different strategies to generate a rigid lever during toe-off.
Re: Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan
Impact of ballistic body armour and load carriage on walking patterns and perceived comfort.
Park H, Branson D, Petrova A, Peksoz S, Jacobson B, Warren A, Goad C, Kamenidis P. Ergonomics. 2013 May 8
Quote:
This study investigated the impact of weight magnitude and distribution of body armour and carrying loads on military personnel's walking patterns and comfort perceptions. Spatio-temporal parameters of walking, plantar pressure and contact area were measured while seven healthy male right-handed military students wore seven different garments of varying weight (0.06, 9, 18 and 27 kg) and load distribution (balanced and unbalanced, on the front and back torso). Higher weight increased the foot contact time with the floor. In particular, weight placement on the non-dominant side of the front torso resulted in the greatest stance phase and double support. Increased plantar pressure and contact area observed during heavier loads entail increased impact forces, which can cause overuse injuries and foot blisters. Participants reported increasingly disagreeable pressure and strain in the shoulder, neck and lower back during heavier weight conditions and unnatural walking while wearing unbalanced weight distributed loads. This study shows the potentially synergistic impact of wearing body armour vest with differential loads on body movement and comfort perception. Practitioner Summary: This study found that soldiers should balance loads, avoiding load placement on the non-dominant side front torso, thus minimising mobility restriction and potential injury risk. Implications for armour vest design modifications can also be found in the results.
Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan
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