Musculoskeletal injuries in military personnel—Descriptive epidemiology, risk factor identification, and prevention

Lovalekar, Mita; Hauret, Keith G.; Roy, Tanja C.; Taylor, Kathryn M.; Blacker, Sam D.; Newman, Phil; Yanovich, Ran; Fleischmann, Chen; Nindl, Bradley C.; Jones, Bruce H.; Canham-Chervak, Michelle

doi:10.1016/j.jsams.2021.03.016

Cited by 37 publications

(35 citation statements)

References 54 publications

(67 reference statements)

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“…Musculoskeletal injuries are one of the biggest healthcare burdens to militaries for medical visits, financial cost, days lost from work and cause of medical discharge 7–9. Accordingly, an extensive body of scientific work has examined the epidemiology of musculoskeletal injuries,10–13 risk factors for musculoskeletal injuries14–19 and interventions to reduce musculoskeletal injury risk 20–22.…”

Section: Introductionmentioning

confidence: 99%

Gender data gap in military research: a review of the participation of men and women in military musculoskeletal injury studies

O’Leary¹,

Young²,

Wardle³

et al. 2022

BMJ Mil Health

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Servicewomen are at increased risk of musculoskeletal injuries compared with their male counterparts, but women are under-represented in sports medicine research. The aim of this review was to assess the representation of women in military musculoskeletal injury studies. PubMed was searched for human original research studies using the terms Military OR Army OR Navy OR ‘Air Force’ AND ‘musculoskeletal injury’. Each study was categorised as epidemiology (basic training), epidemiology (trained personnel), risk factors, interventions and other. The number of male and female participants was retrieved from each study. A total of 262 studies were included: 98 (37%) studies only included men, 17 (6%) studies only included women and 147 (56%) studies included both men and women. A total of 8 051 778 participants were included in these studies (men: 6 711 082, 83%; women: 1 340 696, 17%). The study theme with the greatest proportion of women was musculoskeletal injury epidemiology studies in a basic training population (20% of participants) with the lowest proportion of women in intervention trials (6% of participants). These data suggest women are not under-represented in military musculoskeletal injury studies when considering the gender representation of most militaries. Our data are, however, biased by large epidemiological trials and women were under-represented in intervention trials. The under-representation of women in intervention trials could be due to difficulties in controlling for the effects of female sex steroids on musculoskeletal outcomes, or a focus on interventions in the most arduous military roles where injury risk is highest and women have been previously excluded.

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Section: Introductionmentioning

confidence: 99%

Gender data gap in military research: a review of the participation of men and women in military musculoskeletal injury studies

O’Leary¹,

Young²,

Wardle³

et al. 2022

BMJ Mil Health

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“…In this sample, there were no baseline differences in demographic or anthropometric variables between those who developed a BSI during training and those that did not. In military populations, BMI is a well-documented risk factor for musculoskeletal injury (Hruby et al, 2016;Robinson et al, 2016;Jones et al, 2017;Lovalekar et al, 2021), although several previous investigations report similar body weight and BMI between those with stress fracture and healthy control groups (Armstrong et al, 2004;Cosman et al, 2013;Jepsen et al, 2013;Davey et al, 2015). Similarly, female runners did not differ in weight or BMI (Popp et al, 2009); however, male runners with a history of stress fracture were lighter and had lower fat free mass compared to a healthy comparison group (Popp et al, 2020).…”

Section: Discussionmentioning

confidence: 93%

“…To analyze the association between pQCT variables measured at baseline and the risk for future BSI, logistic regression analyses were conducted. Due to the potential contributions of sex, age, and body size on bone parameters and injury risk (Evans et al, 2008;Popp et al, 2009Popp et al, , 2020Jepsen et al, 2013;Lovalekar et al, 2021) two statistical models were employed. The unadjusted model utilized simple logistic regression to determine whether bone parameters predicted tibial BSI.…”

Section: Study Proceduresmentioning

confidence: 99%

“…Musculoskeletal injuries are a significant health concern for the military due to resultant lost duty days, attrition from training, and economic burden (Lovalekar et al, 2021). Stress fractures, in particular, are a relatively common overuse musculoskeletal injury that develop in military personnel with an incidence rate of 5.69 per 1,000 person years (Waterman et al, 2016), and are one of the leading injury causes of lost duty days and repeated training cycles (Cowan et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

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Tibial Bone Geometry Is Associated With Bone Stress Injury During Military Training in Men and Women

et al. 2022

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Bone stress injuries (BSI) are a common musculoskeletal condition among exercising and military populations and present a major burden to military readiness. The purpose of this investigation was to determine whether baseline measures of bone density, geometry, and strength, as assessed via peripheral quantitative computed tomography (pQCT), are predictive of tibial BSI during Marine Officer Candidates School training. Tibial pQCT scans were conducted prior to the start of physical training (n = 504; Male n = 382; Female n = 122) to measure volumetric bone mineral density (vBMD), geometry, robustness, and estimates of bone strength. Bone parameters were assessed at three tibial sites including the distal metaphysis (4% of tibial length measured from the distal endplate), mid-diaphysis (38% of tibial length measured from the distal endplate), and proximal diaphysis (66% of tibial length measured from the distal endplate). Injury surveillance data was collected throughout training. Four percent (n = 21) of the sample were diagnosed with a BSI at any anatomical site during training, 10 injuries were of the tibia. Baseline bone parameters were then tested for associations with the development of a tibial BSI during training and it was determined that cortical bone measures at diaphyseal (38 and 66%) sites were significant predictors of a prospective tibial BSI. At the mid-diaphysis (38% site), in a simple model and after adjusting for sex, age, and body size, total area [Odds Ratio (OR): 0.987, 0.983], endosteal circumference (OR: 0.853, 0.857), periosteal circumference (OR: 0.863, 0.824), and estimated bending strength (SSI; OR: 0.998, 0.997) were significant predictors of a BSI during training, respectively, such that lower values were associated with an increased likelihood of injury. Similarly, at the proximal diaphysis (66% site), total area (OR: 0.989, 0.985), endosteal circumference (OR: 0.855, 0.854), periosteal circumference (OR: 0.867, 0.823), robustness (OR: 0.007, 0.003), and SSI (OR: 0.998, 0.998) were also significant predictors of BSI in the simple and adjusted models, respectively, such that lower values were associated with an increased likelihood of injury. Results from this investigation support that narrower bones, with reduced circumference, lower total area, and lower estimated strength are associated with increased risk for tibial BSI during military training.

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“…Typical injuries associated with physical training and prolonged load carriage are cumulative micro-traumatic lower extremity overuse injuries [ 4 ]. Injuries such as stress fractures, shin splints, patellofemoral pain, plantar fasciitis, and Achilles tendinopathy reduce military readiness and could even be a reason for medical discharge [ 5 , 6 ]. This study explores military boot comfort and its relationship with musculoskeletal overuse injury in detail.…”

Section: Introductionmentioning

confidence: 99%

Relationship of footwear comfort, selected size, and lower leg overuse injuries among infantry soldiers

Nesterovica

Vaivads

Stepens

2021

BMC Musculoskelet Disord

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Background High rates of musculoskeletal injuries such as plantar fasciitis and stress fractures have been observed among physically active military personnel. During service time, infantry soldiers use issued boots daily that should fit well and provide comfort to prevent injuries and decrease lower extremity pain effectively. The association of military boot comfort with overuse injuries remains unclear. This study investigates the relationship between the chosen military boot size, perceived boot comfort and lower leg overuse injury. Methods During the cross-sectional study, 227 (males, n = 213; females, n = 14) active-duty infantry soldiers at a mean age of 29.5 years old, and with an average service time of 7.2 years were assessed for a history of overuse injury, footprint length, appropriate shoe size, and footwear comfort. Males with a history of overuse injury (n = 32) and non-injured age-matched controls (n = 34) were selected for detailed testing and establishing the possible relationship between footwear comfort and lower leg overuse injury. Results No relationship was found between footwear comfort and a history of lower leg overuse injury. N = 38 (57.6%) of study subjects were wearing an inappropriate shoe size daily. Inappropriate shoe size usage affected footwear comfort ratings significantly. Conclusions Study results showed that improper boot size was significantly related to comfort ratings but was not associated with a history of lower leg overuse injury.

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Musculoskeletal injuries in military personnel—Descriptive epidemiology, risk factor identification, and prevention

Cited by 37 publications

References 54 publications

Gender data gap in military research: a review of the participation of men and women in military musculoskeletal injury studies

Gender data gap in military research: a review of the participation of men and women in military musculoskeletal injury studies

Tibial Bone Geometry Is Associated With Bone Stress Injury During Military Training in Men and Women

Relationship of footwear comfort, selected size, and lower leg overuse injuries among infantry soldiers

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