Physical and Performance Characteristics Related to Unintentional Musculoskeletal Injury in Special Forces Operators: A Prospective Analysis

Abstract

Context: Seventy-seven percent of musculoskeletal injuries sustained by United States Army Special Forces Operators are preventable. Identification of predictive characteristics will promote the development of screening methods to augment injury-prevention programs.Objective: To determine physical and performance characteristics that predict musculoskeletal injuries.Setting: Clinical laboratory. Patients or Other Participants: A total of 95 Operators (age ¼ 32.7 6 5.1 years, height ¼ 179.8 6 6.9 cm, mass ¼ 89.9 6 12.7 kg).Main Outcome Measure(s): Laboratory testing consisted of body composition, aerobic and anaerobic capacity, upper and lower body strength and flexibility, balance, and biomechanical evaluation. Injury data were captured for 12 months after laboratory testing. Injury frequencies, cross-tabulations, and relative risks (RRs) were calculated to evaluate the relationships between physical characteristics and injury proportions. Between-groups differences (injured versus uninjured) were assessed using appropriate t tests or Mann-Whitney U tests.Results Conclusions: Knee-extension and shoulder-retraction strength were risk factors for musculoskeletal injury in Operators. Less trunk-flexion and -extension strength, higher body mass index, lower aerobic capacity, and increased ground reaction forces during landing were characteristics that may also contribute to musculoskeletal injury. Having 2 or more risk factors resulted in a greater injury proportion (v 2 ¼ 13.512, P ¼ .015); however, more research is needed. Athletic trainers working in the military or similar high-demand settings can use these data to augment screening and injury-prevention protocols.Key Words: military athletes, strength, flexibility, biomechanics Key PointsDeficits in knee and shoulder strength were risk factors for musculoskeletal injury in Operators. Having more than 1 risk factor significantly increased the Operators' risk for musculoskeletal injury. M usculoskeletal injury due to training and recreation is a serious and often underrecognized problem in military populations.1À4 These injuries place a large burden on our military personnel (operational and medical) and can directly affect the readiness of Special Operations Forces (SOF) across various branches of service.4À8 Epidemiologic data 4,5 have demonstrated that a large proportion of the musculoskeletal injuries seen in basic military forces and in the SOF community occurred during training and were preventable. These researchers 5 have defined preventable injuries as those that can be reduced through the use of injuryprevention programs by modifying the characteristics related to musculoskeletal injury. The leadership has also recognized that these high incidence and recurrence rates of injury may negatively affect the quality of life after service. Athletic trainers and other medical staff within the armed forces have a unique opportunity to combat this problem through screening and prevention initiatives.Physical training is a critical part of enhancing physical and ...

Incidence of injuries and factors related to injuries in combat soldiers

“…Interestingly, although not significant, in the pretesting the non-injured group had the ‘average’ BMI compared with participants who were injured in the first half of the course (had higher BMI) and compared with participants who were injured in the second half of the course (with lower BMI). Similar to our results, Heebner et al 23 and Teyhen et al 12 found no difference in BMI in soldiers who sustained an injury and those who did not. Looking at the army literature, there is no consistency considering the relation between high/low BMI and injuries.…”

“…It was suggested that a higher BMI may have a protective effect against injury, due to the greater absolute amounts of muscle among soldiers with higher BMI that enable those soldiers to cope better with load-carrying tasks than their lighter counterparts 11 24. In contrast, Heebner et al 23 reported that army operators who sustained a spinal injury had a significantly greater BMI than those who did not. Additionally, several studies of military trainees have demonstrated either a J-shaped or a bimodal relationship between BMI and injury risk (high injury risk at the high and low extremes of BMI, and lowest among those with ‘average’ BMI) 21.…”

Musculoskeletal injury in military Special Operations Forces: a systematic review

“…One additional text was identified by a content expert 17. Following a full-text review, 21 studies were retained for analysis 17–37. The main reason for study exclusion was due to other occupation types in the sample population, and the results were not reported separately to provide data exclusive to a SOF population.…”

“…Seventeen studies reported injury anatomical locations. Three studies grouped their analysis by body regions of which the lower extremity and spine were the most common regions affected 25 32 34. Fourteen studies analysed by specific body parts of which the ankle, knee and lumbar region were the most frequently affected sublocations.…”

Isokinetic Trunk Strength in Acute Low Back Pain Patients Compared to Healthy Subjects: A Systematic Review

“…Arms and legs can be compared with their contralateral to define deficits or imbalances but, unlike the extremities, the trunk does not have this possibility, which makes it difficult to find parameters of normality or reference. Trunk strength has been related to injury prevention [ 25 , 26 ], which is why it plays an important role in the functional evaluation of people or athletes [ 27 , 28 ].…”