Much work remains to reach consensus on musculoskeletal injury risk in military service members: A systematic review with meta‐analysis

Abstract

Musculoskeletal injuries are the most common reason military service members cannot perform their military duties. Not only are they costly and associated with long-term disability, often long after completion of military service, but injuries also adversely affect the military readiness of a nation. This can be seen as a threat to national security and part of the impetus behind many efforts to better understand, predict, and mitigate injury risk in the military. A systematic review of the literature published between 1995 and October 31, 2020 was conducted to identify significant risk factors of musculoskeletal injury in military populations across the world. 74 out of 170 eligible studies addressed comprehensive injuries, providing 994 unique risk factors. 46 of these studies provided data that could be included in a meta-analysis, which was possible for 15 predictor variables. Seven predictors were significant in meta-analysis: female sex(RR=1.46;95CI 1.30,1.64), high body mass index(RR=1.36;95CI 1.21,1.53), functional movement screen pain (RR=1.70;95CI 1.55,1.87) or scores ≤ 14(RR=1.42 95CI 1.29,1.56), prior injury (RR=1.54;95CI 1.32,1.80), slower running performance(RR=1.33;95CI 1.18,1.51), and poorer pushup performance(RR=1.15;95CI 1.04,1.27). Low BMI, height, weight, smoking, physical activity scores, and sit-up and jump performance were not significant risk factors in the meta-analysis. Most studies had a high risk of bias. Lack of raw data and large heterogeneity in definitions of predictors and injury outcomes limited comparison across many studies. Highlights. Female sex, high body mass index, pain with functional movement screen or a score of ≤ 14, prior injury, slower running performance and poorer push-up performance were all significant predictors of musculoskeletal injury. . Low body mass index, height, weight, smoking, physical activity scores, and sit-up and jump performance were not significant predictors of musculoskeletal injury. . Many other predictors were present only in single studies, but large heterogeneity in definitions of both outcomes and predictors limited comparison across studies. . Overall, studies assessing risk factors to predict musculoskeletal injuries in the military were at high risk for bias, especially in regards to statistical approaches.

Improving musculoskeletal injury surveillance methods in Special Operation Forces: A Delphi consensus study

“…The inconsistent surveillance methods used made comparing injury patterns between studies difficult, and results were considered likely to have underestimated the injury burden magnitude. The review's findings [4] are similar to previously raised concerns regarding musculoskeletal injury taxonomy in military injury surveillance [5][6][7][8][9][10].…”

The Use of Force Plate Vertical Jump Scans to Identify Special Warfare Trainees at Risk for Musculoskeletal Injury: A Large Cohort Study

“…Musculoskeletal (MSK) injuries (MSKIs) represent one of the largest threats to US military readiness. 29 They account for 25 million limited duty days across all service branches and are the most common medical cause of a servicemember not being ready for duty. 9,39 MSKIs are also the leading cause of medical visits and costs in the US military, accounting for 2.4 million visits, affecting >800,000 active duty servicemembers, and costing $548 million in health care expenditures annually.…”

“…9,39 MSKIs are also the leading cause of medical visits and costs in the US military, accounting for 2.4 million visits, affecting >800,000 active duty servicemembers, and costing $548 million in health care expenditures annually. 9,29,39 Given the emphasis on physical training and the heavy loads routinely used in training, US Special Operations Forces experience MSKI at a higher rate than conventional military forces. 5,37 Furthermore, US Special Operations Forces trainees appear especially vulnerable to MSKI, as several investigators have reported higher injury rates during training as compared with outside of training.…”

Does choice of athletic footwear affect musculoskeletal injury risk in US Coast Guard recruits? A retrospective cohort study

“…27 Our findings also diverge from a recent systematic review with meta-analysis that found while sex was a factor for MSKI in female military members, it was not a significant factor for repetitive overuse injuries. 21 We observed large and significant effects for female sex in each injury type in the multivariable assessment, including specifically MTSS and bone stress injury (OR: 4.11, 95% CI: 1.34-12.62), RRI (OR: 2.30, 95% CI: 1.21-4.38), and overuse injuries (OR: 2.02, 95% CI: 1.13-3.64). These findings also agree with an increased risk of ankle-foot complex fractures observed among Navy enlisted females compared with their male counterparts.…”