Musculoskeletal training injury prevention in the U.S. Army: Evolution of the science and the public health approach

Abstract

Injuries cause more morbidity among soldiers in the U.S. Army than any other health condition. Over two-thirds of U.S. soldiers' injuries occur gradually from cumulative micro-traumatic damage to the musculoskeletal system as a result of physical training activities. Paradoxically, the very physical training activities required to improve soldier performance also result in injury. Determining the amounts and types of physical training that maximize performance while minimizing injuries requires scientific evidence. This evidence must be incorporated into a framework that ensures scientific gaps are addressed and prevention efforts are evaluated. The five-step public health approach has proven to be an effective construct for Army public health to organize and build an injury prevention program. Steps include: 1) surveillance to define the magnitude of the problem, 2) research and field investigations to identify causes and risk factors, 3) intervention trials and systematic reviews to determine what works to address leading risk factors, 4) program and policy implementation to execute prevention, and 5) program evaluation to assess effectiveness. Dissemination is also needed to ensure availability of scientific lessons learned. Although the steps may not be conducted in order, the capability to perform each step is necessary to sustain a successful program and make progress toward injury control and prevention. As with many U.S. public health successes (e.g., seatbelts, smoking cessation), the full process can take decades. As described in this paper, the U.S. Army uses the public health approach to assure that, as the science evolves, it is translated into effective prevention.

Implications of Insulin-Like Growth Factor-1 in Skeletal Muscle and Various Diseases

“…Overall GH is known to stimulate growth in children and adolescents with various metabolic functions [112]. Musculoskeletal injuries represent a major public health problem [113], and medications improve muscle repair and restore functions. Increasing IGF-1 levels improves SM recovery after myotoxic injury and the administration of IGF-1 has the potential for accelerating healing after trauma [114].…”

Using causal energy categories to report the distribution of injuries in an active population: An approach used by the U.S. Army

“…Injuries are commonly cited as a leading health problem among civilians, [1][2][3][4] workers, 1,5 athletes, [6][7][8] and military populations. [9][10][11][12][13] Injury has conceptually been defined as bodily damage caused by transfers of energy or the absence of energy. 2,[14][15][16] In theory, this is broadly inclusive of a vast array of outcomes (types of bodily damage) and countless causal activities or events (e.g., vehicle crashes, falls, sports and exercise, occupational tasks, intentional violence, environmental or weather-related conditions, and poisonings).…”

“…[2][3][4] Yet U.S. Army medical surveillance and investigative studies have shown that these severe incidents are not representative of the entire military injury problem. [11][12][13]19 Military studies in the U.S. [19][20][21][22] and several international countries [23][24][25] have indicated that injuries with greatest adverse impact to military readiness are musculoskeletal injuries (MSKI). MSKI refers to damage to bone, muscle, tendon, ligaments, joints, cartilage, bursa, or synovium caused by either sudden trauma (e.g., fractures, dislocations, sprain, strains, etc) or by the accumulation of repeated microtrauma (e.g., stress fractures, Achilles tendinopathy, patellofemoral pain and "runner's knee," and dorsalgia).…”

“…6,9,16 The magnitude of the MSKI problem in military populations is significant, as they have been described as the leading cause of medical visits, medical discharges in basic training, and medical evacuations from deployment settings. 11,13,19 Impacts of MSKI have been described in terms of millions of dollars lost annually to direct medical costs, even greater indirect costs from lost training and restricted duty days, disrupted physical performance and non-deployability, medical discharges, and risks for subsequent injury. 21,22,26 Military reports have long indicated that most MSKI are overuse injuries.…”

Musculoskeletal Injury in Reserve Officers’ Training Corps: A Report From the Athletic Training Practice-Based Research Network

“…The impact of musculoskeletal injuries (MSKIs) on military medical costs, limited duty days, and military readiness has been well-documented. 11 , 12 , 20 Cases of MSKI were responsible for >75% of all medically nondeployable classifications in 2015. 2 In addition to the impact on active-duty military members, initial-entry training MSKIs are financially burdensome, particularly if training is prolonged or trainees are discharged due to injury.…”