The effect of pregnancy and the duration of postpartum convalescence on the physical fitness of healthy women: A cohort study of active duty servicewomen receiving 6 weeks versus 12 weeks convalescence.

INTRODUCTION: Pregnancy profoundly affects cardiovascular and musculoskeletal performance requiring up to 12 months for recovery in healthy individuals. OBJECTIVE: To assess the effects of extending postpartum convalescence from 6 to 12 weeks on the physical fitness of Active Duty (AD) soldiers as measured by the Army Physical Fitness Test (APFT) and Body Mass Index (BMI). METHODS: We conducted a retrospective study of AD soldiers who delivered their singleton pregnancy of ≥ 32weeks gestation at a tertiary medical center. Pre- and post-pregnancy APFT results as well as demographic, pregnancy, and postpartum data were collected. Changes in APFT raw scores, body composition measures, and failure rates across the 6-week and 12-week convalescent cohorts were assessed. Multivariable regressions were utilized to associate risk factors with failure. RESULTS: Four hundred sixty women met inclusion criteria; N = 358 in the 6 week cohort and N = 102 in the 12 week cohort. Demographic variables were similar between the cohorts. APFT failure rates across pregnancy increased more than 3-fold in both groups, but no significant differences were found between groups in the decrement of performance or weight gain. With the combined cohort, multivariable regression analysis showed failure on the postpartum APFT to be independently associated with failure on the pre-pregnancy APFT (OR = 16.92, 95% CI 4.96-57.77), failure on pre-pregnancy BMI (OR = 8.44, 95% CI 2.23-31.92), elevated BMI at 6-8 weeks postpartum (OR = 4.02, 95% CI 1.42-11.35) and not breastfeeding at 2 months (OR = 3.23, 95% CI 1.48-7.02). Within 36 months of delivery date, 75% of women had achieved pre-pregnancy levels of fitness. CONCLUSION: An additional 6 weeks of convalescence did not adversely affect physical performance or BMI measures in AD Army women following pregnancy. Modifiable factors such as pre- and post-pregnancy conditioning and weight, weight gain in pregnancy and always breastfeeding were found to be significant in recovery of physical fitness postpartum.

Musculoskeletal Injuries and United States Army Readiness Part I: Overview of Injuries and their Strategic Impact.

INTRODUCTION: Noncombat injuries ("injuries") greatly impact soldier health and United States (U.S.) Army readiness; they are the leading cause of outpatient medical encounters (more than two million annually) among active component (AC) soldiers. Noncombat musculoskeletal injuries ("MSKIs") may account for nearly 60% of soldiers' limited duty days and 65% of soldiers who cannot deploy for medical reasons. Injuries primarily affect readiness through increased limited duty days, decreased deployability rates, and increased medical separation rates. MSKIs are also responsible for exorbitant medical costs to the U.S. government, including service-connected disability compensation. A significant subset of soldiers develops chronic pain or long-term disability after injury; this may increase their risk for chronic disease or secondary health deficits potentially associated with MSKIs. The authors will review trends in U.S. Army MSKI rates, summarize MSKI readiness-related impacts, and highlight the importance of standardizing surveillance approaches, including injury definitions used in injury surveillance. MATERIALS/METHODS: This review summarizes current reports and U.S. Department of Defense internal policy documents. MSKIs are defined as musculoskeletal disorders resulting from mechanical energy transfer, including traumatic and overuse injuries, which may cause pain and/or limit function. This review focuses on various U.S. Army populations, based on setting, sex, and age; the review excludes combat or battle injuries. RESULTS: More than half of all AC soldiers sustained at least one injury (MSKI or non-MSKI) in 2017. Overuse injuries comprise at least 70% of all injuries among AC soldiers. Female soldiers are at greater risk for MSKI than men. Female soldiers' aerobic and muscular fitness performances are typically lower than men's performances, which could account for their higher injury rates. Older soldiers are at greater injury risk than younger soldiers. Soldiers in noncombat arms units tend to have higher incidences of reported MSKIs, more limited duty days, and higher rates of limited duty days for chronic MSKIs than soldiers in combat arms units. MSKIs account for 65% of medically nondeployable AC soldiers. At any time, 4% of AC soldiers cannot deploy because of MSKIs. Once deployed, nonbattle injuries accounted for approximately 30% of all medical evacuations, and were the largest category of soldier evacuations from both recent major combat theaters (Iraq and Afghanistan). More than 85% of service members medically evacuated for MSKIs failed to return to the theater. MSKIs factored into (1) nearly 70% of medical disability discharges across the Army from 2011 through 2016 and (2) more than 90% of disability discharges within enlisted soldiers' first year of service from 2010 to 2015. MSKI-related, service-connected (SC) disabilities account for 44% of all SC disabilities (more than any other body system) among compensated U.S. Global War on Terrorism veterans. CONCLUSIONS: MSKIs significantly impact soldier health and U.S. Army readiness. MSKIs also figure prominently in medical disability discharges and long-term, service-connected disability costs. MSKI patterns and trends vary between trainees and soldiers in operational units and among military occupations and types of operational units. Coordinated injury surveillance efforts are needed to provide standardized metrics and accurately measure temporal changes in injury rates.

Musculoskeletal Injuries and United States Army Readiness. Part II: Management Challenges and Risk Mitigation Initiatives.

INTRODUCTION: Noncombat injuries ("injuries") threaten soldier health and United States (U.S.) Army medical readiness, accounting for more than twice as many outpatient medical encounters among active component (AC) soldiers as behavioral health conditions (the second leading cause of outpatient visits). Noncombat musculoskeletal injuries (MSKIs) account for more than 80% of soldiers' injuries and 65% of medically nondeployable AC soldiers. This review focuses on MSKI risk reduction initiatives, management, and reporting challenges within the Army. The authors will summarize MSKI risk reduction efforts and challenges affecting MSKI management and reporting within the U.S. Army. MATERIALS/METHODS: This review focuses on (1) initiatives to reduce the impact of MSKIs and risk for chronic injury/pain or long-term disability and (2) MSKI reporting challenges. This review excludes combat or battle injuries. RESULTS: Primary risk reduction Adherence to standardized exercise programming has reduced injury risk among trainees. Preaccession physical fitness screening may identify individuals at risk for injury or attrition during initial entry training. Forward-based strength and conditioning coaching (provided in the unit footprint) and nutritional supplementation initiatives are promising, but results are currently inconclusive concerning injury risk reduction. SECONDARY RISK REDUCTION: Forward-based access to MSKI care provided by embedded athletic trainers and physical therapists within military units or primary care clinics holds promise for reducing MSKI-related limited duty days and nondeployability among AC soldiers. Early point-of-care screening for psychosocial risk factors affecting responsiveness to MSKI intervention may reduce risk for progression to chronic pain or long-term disability. TERTIARY RISK REDUCTION: Operational MSKI metrics enable commanders and clinicians to readily identify soldiers with nonresolving MSKIs. Monthly injury reports to Army leadership increase command focus on soldiers with nonresolving MSKIs. CONCLUSIONS: Standardized exercise programming has reduced trainee MSKI rates. Secondary risk reduction initiatives show promise for reducing MSKI-related duty limitations and nondeployability among AC soldiers; timely identification/evaluation and appropriate, early management of MSKIs are essential. Tertiary risk reduction initiatives show promise for identifying soldiers whose chronic musculoskeletal conditions may render them unfit for continued military service.Clinicians must document MSKI care with sufficient specificity (including diagnosis and external cause coding) to enable large-scale systematic MSKI surveillance and analysis informing focused MSKI risk reduction efforts. Historical changes in surveillance methods and injury definitions make it difficult to compare injury rates and trends over time. However, the U.S. Army's standardized injury taxonomy will enable consistent classification of current and future injuries by mechanism of energy transfer and diagnosis. The Army's electronic physical profiling system further enablesstandardized documentation of MSKI-related duty/work restrictions and mechanisms of injury. These evolving surveillance tools ideally ensure continual advancement of military injury surveillance and serve as models for other military and civilian health care organizations.

A prospective field study of U.S. Army trainees to identify the physiological bases and key factors influencing musculoskeletal injuries: a study protocol.

BACKGROUND: Musculoskeletal injuries (MSKIs) are common in military trainees and present a considerable threat to occupational fitness, deployability, and overall military readiness. Despite the negative effects of MSKIs on military readiness, comprehensive evaluations of the key known and possible risk factors for MSKIs are lacking. The U.S. Army Research Institute of Environmental Medicine (ARIEM) is initiating a large-scale research effort, the ARIEM Reduction in Musculoskeletal Injury (ARMI) Study, to better understand the interrelationships among a wide range of potential MSKI risk factors in U.S. Army trainees in order to identify those risk factors that most contribute to MSKI and may be best targeted for effective mitigation strategies. METHODS: This prospective study aims to enroll approximately 4000 (2000 male and 2000 female) U.S. Army trainees undergoing Basic Combat Training (BCT). Comprehensive in-person assessments will be completed at both the beginning and end of BCT. Participants will be asked to complete surveys of personal background information, medical history, physical activity, sleep behaviors, and personality traits. Physical measurements will be performed to assess anthropometrics, tibial microarchitecture and whole body bone mineral density, muscle cross-sectional area, body composition, and muscle function. Blood sampling will be also be conducted to assess musculoskeletal, genetic, and nutritional biomarkers of risk. In addition, participants will complete weekly surveys during BCT that examine MSKI events, lost training time, and discrete risk factors for injury. Participants' medical records will be tracked for the 2 years following graduation from training to identify MSKI events and related information. Research hypotheses focus on the development of a multivariate prediction model for MSKI. DISCUSSION: Results from this study are expected to inform current understanding of known and potential risk factors for MSKIs that can be incorporated into solutions that optimize Soldier health and enhance military readiness.

Surveyed Reasons for Not Seeking Medical Care Regarding Musculoskeletal Injury Symptoms in US Army Trainees.

INTRODUCTION: Musculoskeletal injuries (MSKIs) pose a significant threat to military readiness and are difficult to monitor due to Soldiers' reluctance to seek medical treatment. There is high risk of developing MSKIs while going through initial entry training (IET), many of which go unreported. The purposes of this study were to identify the contributing factors that influence US Army trainees to not seek medical care for self-reported symptoms of musculoskeletal injury (SMSKI) and establish how those factors may differ by sex, training school, and installation site. MATERIALS AND METHODS: Data were collected from 739 trainees (607 males, 132 females) completing IET at either Fort Benning, GA, Fort Sill, OK or Fort Leonard-Wood, MO, USA. Male trainees were in combat arms jobs while female trainees were from both combat arms and other physically demanding jobs. All surveys were completed within 5 weeks of graduation from Advanced Individual Training and One Station Unit Training. Trainees answered a series of questions about SMSKIs sustained during IET that lasted seven or more days. Using a Likert-type scale (1-strongly disagree through 5-strongly agree), trainees rated the influence that each of the following seven statements contributed to their decision not to seek medical care: "graduating on time," "avoiding negative perceptions associated with injuries," "avoiding profile," "inconvenience in seeing a provider," "self-managing the injury based on past experience," "severity of the injury," and "prior negative experiences seeking medical care in the military." Pearson's Chi-square test was used to assess significant relationships among SMSKI reporting across sex, training school and training installation. RESULTS: Overall, SMSKI incidence was 36.1% and 58.3% among IET male and female trainees, respectively (40% overall). Nearly two-thirds (64%) of all trainees injured during IET had a SMSKI that they did not report to leadership or a medical provider. Across sex, female trainees were more likely to report SMSKIs than male trainees (p < 0.01), but there was no difference in SMSKI reporting rates by sex (p = 0.48). There was a difference in SMSKI rates by training school (p < 0.01), where infantry had higher SMSKI rates than field artillery (p < 0.01). There were no differences across training schools in how often trainees sought medical care (p = 0.58). The most common reasons selected for not reporting SMSKIs (i.e., not seeking medical care) included "I wanted to graduate on time" and "I wanted to avoid a profile." "I had prior negative experiences seeking medical care in the military" was consistently rated as the least important reason. Female trainees were more likely to not report SMSKIs in order "to avoid a profile" than male trainees (p < 0.05). CONCLUSION: Over 64% of trainees' did not seek medical care for their SMSKI during IET. As early detection, better reporting and timely treatment may result in reductions in SMSKI severity, reduced IET attrition, and lower medical expenses, trainees should be encouraged to report SMSKIs for proper early stage treatment. These study findings could be used to assist military leadership to create a positive environment for reporting and seeking care for SMSKIs.

Which US States Pose the Greatest Threats to Military Readiness and Public Health? Public Health Policy Implications for a Cross-sectional Investigation of Cardiorespiratory Fitness, Body Mass Index, and Injuries Among US Army Recruits.

OBJECTIVE: Many states in the southern region of the United States are recognized for higher rates of obesity, physical inactivity, and chronic disease. These states are therefore recognized for their disproportionate public health burden. The purpose of this study was to investigate state-level distributions of cardiorespiratory fitness, body mass index (BMI), and injuries among US Army recruits in order to determine whether or not certain states may also pose disproportionate threats to military readiness and national security. METHODS: Sex-specific state-level values for injuries and fitness among 165 584 Army recruits were determined. Next, the relationship between median cardiorespiratory fitness and injury incidence at the state level was examined using Spearman correlations. Finally, multivariable Poisson regression models stratified by sex examined state-level associations between fitness and injury incidence, while controlling for BMI, and other covariates. MAIN OUTCOME MEASURES: Cardiorespiratory fitness and training-related injury incidence. RESULTS: A cluster of 10 states from the south and southeastern regions (Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas) produced male or female recruits who were significantly less fit and/or more likely to become injured than recruits from other US states. Compared with the "most fit states," the incidence of injuries increased by 22% (95% CI, 17-28; P < .001) and 28% (95% CI, 19-36; P < .001) in male and female recruits from the "least fit states," respectively. CONCLUSIONS: The impact of policies, systems, and environments on physical activity behavior, and subsequently fitness and health, has been clearly established. Advocacy efforts aimed at active living policies, systems, and environmental changes to improve population health often fail. However, advocating for active living policies to improve national security may prove more promising, particularly with legislators. Results from this study demonstrate how certain states, previously identified for their disproportionate public health burden, are also disproportionately burdensome for military readiness and national security.

U.S. Army Physical Demands Study: Differences in Physical Fitness and Occupational Task Performance Between Trainees and Active Duty Soldiers.

Canino, MC, Foulis, SA, Zambraski, EJ, Cohen, BS, Redmond, JE, Hauret, KG, Frykman, PN, and Sharp, MA. U.S. Army Physical Demands Study: Differences in physical fitness and occupational task performance between trainees and active duty soldiers. J Strength Cond Res 33(7): 1864-1870, 2019-U.S. Army initial entry training (IET) is designed to prepare trainees for the military environment and subsequent training, including specific programs to increase physical fitness to perform job-specific tasks to the minimal acceptable performance standard (MAPS). The aim of this study was to compare physical fitness and occupational task performance of trainees at the end of IET to that of active duty soldiers. One hundred seventy-nine male combat arms trainees at the end of IET and 337 male combat arms active duty soldiers performed a sandbag carry (SBC), casualty drag (CD), and move under direct fire (MUF). Physical fitness was assessed using Army Physical Fitness Test scores. A questionnaire was administered to determine frequency of task performance. Active duty soldiers compared with trainees were older (p < 0.01) and performed more push-ups (p < 0.01) and sit-ups (p < 0.01). Trainees performed the 2-mile run faster (p < 0.01). Ninety-four percent of trainees and 99% of active duty soldiers performed the 3 tasks to the MAPSs. Active duty soldiers performed significantly faster on both the SBC (p < 0.01) and CD (p < 0.01) and reported a higher task frequency on the SBC (p = 0.03) and CD (p < 0.01). No difference in MUF performance (p = 0.16) and task frequency (p = 0.13) was detected. Initial entry training seems to provide sufficient physical training as most trainees were able to meet the MAPSs; however, performance differences were still apparent between trainees and active duty soldiers. Additional practice performing the physically demanding tasks may help maximize performance on the physically demanding job requirements.

Impact of physical fitness and body composition on injury risk among active young adults: A study of Army trainees.

OBJECTIVES: To determine the combined effects of physical fitness and body composition on risk of training-related musculoskeletal injuries among Army trainees. DESIGN: Retrospective cohort study. METHODS: Rosters of soldiers entering Army basic combat training (BCT) from 2010 to 2012 were linked with data from multiple sources for age, sex, physical fitness (heights, weights (mass), body mass index (BMI), 2 mile run times, push-ups), and medical injury diagnoses. Analyses included descriptive means and standard deviations, comparative t-tests, risks of injury, and relative risks (RR) and 95% confidence intervals (CI). Fitness and BMI were divided into quintiles (groups of 20%) and stratified for chi-square (χ2) comparisons and to determine trends. RESULTS: Data were obtained for 143,398 men and 41,727 women. As run times became slower, injury risks increased steadily (men=9.8-24.3%, women=26.5-56.0%; χ2 trends (p<0.00001)). For both genders, the relationship of BMI to injury risk was bimodal, with the lowest risk in the average BMI group (middle quintile). Injury risks were highest in the slowest groups with lowest BMIs (male trainees=26.5%; female trainees=63.1%). Compared to lowest risk group (average BMI with fastest run-times), RRs were significant (male trainees=8.5%; RR 3.1, CI: 2.8-3.4; female trainees=24.6%; RR 2.6, CI: 2.3-2.8). Trainees with the lowest BMIs exhibited highest injury risks for both genders and across all fitness levels. CONCLUSIONS: While the most aerobically fit Army trainees experience lower risk of training-related injury, at any given aerobic fitness level those with the lowest BMIs are at highest risk. This has implications for recruitment and retention fitness standards.

Body mass index predicts selected physical fitness attributes but is not associated with performance on military relevant tasks in U.S. Army Soldiers.

OBJECTIVES: Army body composition standards are based upon validated criteria; however, certain field-expedient methodologies (e.g., weight-for-height, body mass index [BMI]) may disqualify individuals from service who may otherwise excel on physical performance and military-relevant tasks. The purpose was to assess soldier physical performance and military-specific task/fitness performance stratified by BMI. DESIGN: Cross-sectional observational study. METHODS: Male (n=275) and female (n=46) soldiers performed a wide-array of physical fitness tests and military-specific tasks, including the Army physical fitness test (APFT). Within-sex performance data were analyzed by BMI tertile stratification or by Army Body Composition Program (ABCP) weight-for-height (calculated BMI) screening standards using ANOVA/Tukey post-hoc or independent t-tests, respectively. RESULTS: BMI stratification (higher vs. lower BMI) was associated with significant improvements in muscular strength and power, but also with decrements in speed/agility in male and female soldiers. Within the military specific tasks, a higher BMI was associated with an increased APFT 2-Mile Run time; however, performance on a 1600-m Loaded March or a Warrior Task and Battle Drill obstacle course was not related to BMI in either sex. Male and Female soldiers who did not meet ABCP screening standards demonstrated a slower 2-Mile Run time; however, not meeting the ABCP BMI standard only affected a minimal number (∼6%) of soldiers' ability to pass the APFT. CONCLUSIONS: Military body composition standards require a careful balance between physical performance, health, and military readiness. Allowances should be considered where tradeoffs exist between body composition classifications and performance on physical tasks with high military relevance.

Non-battle injuries among U.S. Army soldiers deployed to Afghanistan and Iraq, 2001-2013.

INTRODUCTION: Many non-battle injuries among deployed soldiers are due to occupational-related tasks. Given that non-battle injuries are a significant cause of morbidity and mortality, occupational safety and health are of great concern to the military. Some of the leading causes of non-battle injuries in the military are also common in non-military occupational settings. Nationally, falls and motor-vehicle accidents are leading causes of non-fatal occupational injuries in the civilian workforce. The objective of this research is to identify the leading causes, types, and anatomic locations of non-fatal non-battle injuries in Afghanistan and Iraq. METHODS: Non-battle injuries were identified from medical air evacuation records. Causes of air evacuated injuries were identified and coded using the diagnosis and narrative patient history in the air evacuation records. Descriptive statistics were used to report the air evacuated non-battle injury rates, causes, injury types, and anatomic locations. RESULTS: Between 2001 and 2013, there were 68,349 medical air evacuations from Afghanistan and Iraq. Non-battle injuries accounted for 31% of air evacuations from Afghanistan and 34% from Iraq. These injuries were the leading diagnosis category for air evacuations. The three leading causes of injury for Afghanistan and Iraq, respectively, were sports/physical training (23% and 24%), falls/jumps (19% and 16%), and military vehicle-related accidents (8% and 11%). The leading injury types were fractures (21%), overuse pain and inflammation (16%), and dislocations (11%). PRACTICAL APPLICATIONS: Given that over 30% of medical evacuations of soldiers result from non-battle injuries, prevention of such conditions would substantially enhance military readiness during combat.

Fitness tests and occupational tasks of military interest: a systematic review of correlations.

: Physically demanding occupations (ie, military, firefighter, law enforcement) often use fitness tests for job selection or retention. Despite numerous individual studies, the relationship of these tests to job performance is not always clear. : This review examined the relationship by aggregating previously reported correlations between different fitness tests and common occupational tasks. : Search criteria were applied to PUBMED, EBSCO, EMBASE and military sources; scoring yielded 27 original studies providing 533 Pearson correlation coefficients (r) between fitness tests and 12 common physical job task categories. Fitness tests were grouped into predominant health-related fitness components and body regions: cardiorespiratory endurance (CRe); upper body, lower body and trunk muscular strength and muscular endurance (UBs, LBs, TRs, UBe, LBe, TRe) and flexibility (FLX). Meta-analyses provided pooled r's between each fitness component and task category. : The CRe tests had the strongest pooled correlations with most tasks (eight pooled r values 0.80-0.52). Next were LBs (six pooled r values >0.50) and UBe (four pooled r values >0.50). UBs and LBe correlated strongly to three tasks. TRs, TRe and FLX did not strongly correlate to tasks. : Employers can maximise the relevancy of assessing workforce health by using fitness tests with strong correlations between fitness components and job performance, especially those that are also indicators for injury risk. Potentially useful field-expedient tests include timed-runs (CRe), jump tests (LBs) and push-ups (UBe). Impacts of gender and physiological characteristics (eg, lean body mass) should be considered in future study and when implementing tests.

Surveillance of Disease and Nonbattle Injuries During US Army Operations in Afghanistan and Iraq.

Disease and nonbattle injury (DNBI) are the leading causes of morbidity during wars and military operations. However, adequate medical data were never before available to service public health centers to conduct DNBI surveillance during deployments. This article describes the process, results and lessons learned from centralized DNBI surveillance by the US Army Center for Health Promotion and Preventive Medicine, predecessor of the US Army Public Health Command, during operations in Afghanistan and Iraq (2001-2013).The surveillance relied primarily on medical evacuation records and in-theater hospitalization records. Medical evacuation rates (per 1,000 person-years) for DNBI were higher (Afghanistan: 56.7; Iraq: 40.2) than battle injury rates (Afghanistan: 12.0; Iraq: 7.7). In Afghanistan and Iraq, respectively, the leading diagnostic categories for medical evacuations were nonbattle injury (31% and 34%), battle injury (20% and 16%), and behavioral health (12% and 10%). Leading causes of medically evacuated nonbattle injuries were sports/physical training (22% and 24%), falls (23% and 26%) and military vehicle accidents (8% and 11%). This surveillance demonstrated the feasibility, utility, and benefits of centralized DNBI surveillance during military operations.

Epidemiology of Exercise- and Sports-Related Injuries in a Population of Young, Physically Active Adults: A Survey of Military Servicemembers.

BACKGROUND: Numerous studies document the health benefits of a physically active lifestyle, but relatively few document the hazards of physical activity. Because of the requirement for physical fitness to complete their mission, the United States military services have a vested interest in understanding the benefits and risks of physical activity including exercise and sports. One of these risks is injury. Rates and proportion of injuries caused by exercise- and sports-related (ESR) activities have not been reported previously across the services. PURPOSE: The purposes of this population survey were to (1) document the rates and proportion of all injuries caused by ESR activities among military personnel, (2) compare rates across the military services, and (3) describe the causes and types of ESR injuries as well as associated days of limited activity. STUDY DESIGN: Descriptive epidemiology study. METHODS: The Defense Manpower Data Center administered the web-based 2008 Status of Forces Survey of Active Duty Service Members to a random sample of active-duty personnel. In all, 10,692 servicemembers completed the survey, which included questions about injuries from any cause and from exercise and sports during the previous year. Responses were weighted to produce population estimates for injury rates (any injury and ESR injury). Percentage distributions were used to describe activities, injury types, days of limited activity, and contributing factors for ESR injuries. RESULTS: There were 49% of servicemembers who sustained an injury from any cause in the previous year; 25% had an ESR injury. Thus, 52% of all injuries were ESR injuries. ESR injury rates ranged from 20% for the Navy to 33% for the Marine Corps. Running accounted for 45% of ESR injuries. Forty percent of ESR injuries were sprains and strains. As an indicator of injury severity, 35% of ESR injuries required more than 2 weeks of limited activity. CONCLUSION: This study quantified the overall incidence of injuries and the large proportion that are caused by exercise and sports among military personnel, a population of healthy, physically active adults. Prevention strategies should focus on running, weight training, basketball, and football. Recommendations include adherence to evidence-based practices to reduce the occurrence of ESR injuries.

Incidence of admission to the Physical Training and Rehabilitation Programs in Initial Entry Training during fiscal year 2011.

The Physical Training and Rehabilitation Program (PTRP) is a recovery and reintegration program for recruits in Initial Entry Training (IET) who are unable to continue training because of serious injury. This investigation examined PTRP admission incidence among recruits in IET at Forts Jackson, Leonard Wood, Benning, and Sill during Fiscal Year 2011 (FY11). PTRP admission data were collected from a spreadsheet completed monthly by PTRP commanders. Total number of recruits was obtained from each post's Directorate of Programs, Training, and Management. In FY11, 368 men and 268 women were admitted into PTRPs at all installations. For Forts Jackson, Leonard Wood, Benning, and Sill, male admission incidences (cases/1,000 recruits) were 2.6, 3.0, 6.2, and 5.4, respectively; female admission incidences for Forts Jackson, Leonard Wood, and Sill, were 11.1, 10.1, and 22.6, respectively. Most injuries sent to PTRP were bone stress injuries (65%) or fractures (21%). 76% of recruits were returned to duty. Differences in admission incidence between posts appear primarily related to different local policies regarding convalescent leave and admission criteria. PTRP admission rates are lower than in the past, presumably related to policy changes and injury-reduction efforts. A cost-benefit analysis would assist in determining the value of the PTRP.

A multiple intervention strategy for reducing femoral neck stress injuries and other serious overuse injuries in U.S. Army Basic Combat Training.

We hypothesized that the use of evidence based injury prevention strategies would lead to a reduction in the incidence of femoral neck stress injuries (FNSIs) and other serious overuse injuries in U.S. Army Basic Combat Training (BCT). An injury prevention strategy began in late 2008 that included: (1) leadership education, (2) leadership enforcement of proven methods, and (3) injury surveillance and reporting. Data on FNSI and removal from training for injury were analyzed based on the fiscal year 2006 through 2010 (n = 210,002). For men, FNSI were reduced from 13 to 20 cases/10,000 recruits per year (2006-2008) to 8 cases/10,000 recruits in 2010 (p < 0.01); for women, FNSI were reduced from 35 to 41 cases/10,000 recruits per year (2006-2008) to 18 cases/10,000 recruits per year in 2010 (p < 0.01). For men, removals from training for injury were reduced from 0.8 to 1.1 cases/100 recruits per year (2006-2008) to 0.5 cases/100 recruits in 2010 (p < 0.01); for women removal from training for injury was reduced from 2.3 to 2.4 cases/100 recruits (2006-2008) to 1.0 case/100 recruits per years in 2010 (p < 0.01). The time course of the changes suggests that following specific injury prevention methods was effective in reducing injuries.

Injuries to deployed U.S. Army soldiers involved in HMMWV crashes, 2002-2006.

Highly mobile multipurpose wheeled vehicle (HMMWV or Humvee) crashes present an important issue for the U.S. military. The aim of this study was to provide a descriptive analysis of occupants of military motor vehicle (MMV) crashes involving HMMWVs that occurred among deployed U.S. Army Soldiers. Crash-related data were collected from the U.S. Army Combat Readiness/Safety Center on MMV crashes among active duty Army personnel between 1999 and 2006. Records for 964 occupants with injuries from HMMWV crashes were analyzed, which represented 52% of the total occupants of MMV crashes. A significant association was observed between injury and engagement in combat, odds ratio 1.49 (1.03, 2.16). The risk of injury was greatest for gunners, odds ratio 2.37 (1.43, 3.92), and injury cost related to the crash was significantly related to prior deployment status (p < 0.001) and role of Soldier in the vehicle (Operator p = 0.005, Gunner p = 0.003). There was also a decrease over time in the number of crashes resulting in injury (p < 0.001). These data support the development of interventions that address the specific risks detailed, including the use of combat simulation training, increased protection for vulnerable positions, and enforcement of safety regulations.

Injury rates and injury risk factors among Federal Bureau of Investigation new agent trainees.

BACKGROUND: A one-year prospective examination of injury rates and injury risk factors was conducted in Federal Bureau of Investigation (FBI) new agent training. METHODS: Injury incidents were obtained from medical records and injury compensation forms. Potential injury risk factors were acquired from a lifestyle questionnaire and existing data at the FBI Academy. RESULTS: A total of 426 men and 105 women participated in the project. Thirty-five percent of men and 42% of women experienced one or more injuries during training. The injury incidence rate was 2.5 and 3.2 injuries/1,000 person-days for men and women, respectively (risk ratio (women/men) = 1.3, 95% confidence interval = 0.9-1.7). The activities most commonly associated with injuries (% of total) were defensive tactics training (58%), physical fitness training (20%), physical fitness testing (5%), and firearms training (3%). Among the men, higher injury risk was associated with older age, slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the physical fitness test (PFT), lower self-rated physical activity, lower frequency of aerobic exercise, a prior upper or lower limb injury, and prior foot or knee pain that limited activity. Among the women higher injury risk was associated with slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the PFT, and prior back pain that limited activity. CONCLUSION: The results of this investigation supported those of a previous retrospective investigation emphasizing that lower fitness and self-reported pain limiting activity were associated with higher injury risk among FBI new agents.

Association between ambulatory physical activity and injuries during United States Army Basic Combat Training.

BACKGROUND: Associations between physical activity and injuries have been previously examined using self-reports. The present investigation examined this association using objective measures of activity and injury. METHODS: To quantify ambulatory activity, pedometers were worn daily by recruits in 10 Army Basic Combat Training companies during the 9-week training cycle. Injuries were obtained from a medical surveillance system, defined as traumatic or overuse events resulting in a medical care provider visit. A daily questionnaire documented whether or not recruits wore the pedometers and trained with their companies for the entire day. RESULTS: Training companies were categorized by activity level into 3 groups with higher activity (HA, 17,948±550 steps/day), 4 with moderate activity (MA, 16,346±768 steps/day) and 3 with lower activity (LA, 14,772±400 steps/day). Among men, the MA and HA groups were at 1.52 (95% confidence interval [95% CI]=1.15-2.01) and 1.94 (95% CI=1.46-2.61) times higher injury risk, respectively, compared with the LA group. Among women, the MA and HA groups were at 1.36 (95% CI=1.07-1.73) and 1.53 (95% CI=1.24-1.89) times higher injury risk, respectively, compared with low LA group. The relationships remained significant after considering physical characteristics and physical fitness. CONCLUSIONS: In consonance with previous self-report studies, higher physical activity was associated with higher injury risk.

Musculoskeletal injuries description of an under-recognized injury problem among military personnel.

INTRODUCTION: Although injuries are recognized as a leading health problem in the military, the size of the problem is underestimated when only acute traumatic injuries are considered. Injury-related musculoskeletal conditions are common in this young, active population. Many of these involve physical damage caused by micro-trauma (overuse) in recreation, sports, training, and job performance. The purpose of this analysis was to determine the incidence of injury-related musculoskeletal conditions in the military services (2006) and describe a standardized format in which to categorize and report them. METHODS: The subset of musculoskeletal diagnoses found to be injury-related in previous military investigations was identified. Musculoskeletal injuries among nondeployed, active duty service members in 2006 were identified from military medical surveillance data. A matrix was used to report and categorize these conditions by injury type and body region. RESULTS: There were 743,547 injury-related musculoskeletal conditions in 2006 (outpatient and inpatient, combined), including primary and nonprimary diagnoses. In the matrix, 82% of injury-related musculoskeletal conditions were classified as inflammation/pain (overuse), followed by joint derangements (15%) and stress fractures (2%). The knee/lower leg (22%), lumbar spine (20%), and ankle/foot (13%) were leading body region categories. CONCLUSIONS: When assessing the magnitude of the injury problem in the military services, injury-related musculoskeletal conditions should be included. When these injuries are combined with acute traumatic injuries, there are almost 1.6 million injury-related medical encounters each year. The matrix provides a standardized format to categorize these injuries, make comparisons over time, and focus prevention efforts on leading injury types and/or body regions.