Energy Deficiency During Cold Weather Mountain Training in NSW SEAL Qualification Students.

Special operation forces participating in mountain warfare/cold weather (MWCW) training have higher energy demands, but adequate fueling is difficult to achieve. The purpose of the study was to determine energy expenditure relative to energy intake and examine fueling patterns during 3 days of MWCW training in Naval Special Warfare Sea, Air, Land (SEAL) Qualification Training (SQT) students. Ten SQT students (age: 23.3 ± 1.8 years, height: 182.3 ± 6.4 cm, and weight: 83.6 ± 4.5 kg) were fitted for heart rate and accelerometer monitors during MWCW training. Total daily energy expenditure was determined using a combination of direct observation and heart rate-VO2 regression. Total daily energy intake was collected using the Automated Self-Administered 24 (ASA24) assessment tool. Total daily energy expenditure for river crossing, alpine skills, and mountain patrol were 3,913 ± 293, 4,207 ± 400, and 5,457 ± 828 kcals, respectively. Reported total daily energy intakes were 2,854 ± 657 (river crossing) and 2,289 ± 680 kcals (mountain patrol), producing 1,044 ± 784 and 3,112 ± 1,420 kcal deficits, respectively. SQT students consumed 258 ± 95 g (3.1 ± 1.3 g·kg-1·day-1) of carbohydrates, 130 ± 55 g (1.6 ± 0.7 g·kg-1·day-1) of protein, and 113 ± 39 g (1.4 ± 0.5 g·kg-1·day-1) of fat. MWCW training evolutions elicited high total daily energy expenditure and inadequate energy intake, especially before and during active training sessions, which may lead to decreased work output, early onset fatigue, and increased risk of injury. Increasing total daily energy intake by providing fuel/fluids, primarily carbohydrates, during the planned breaks and "downtime" of each training evolution and focusing on provision of the balance of calories/macronutrients needed for a more complete and expedited recovery over dinner and evening snacks will help bridge the energy gap.

Poor anaerobic power/capability and static balance predicted prospective musculoskeletal injuries among Soldiers of the 101st Airborne (Air Assault) Division.

Musculoskeletal injuries have negatively impacted tactical readiness. The identification of prospective and modifiable risk factors of preventable musculoskeletal injuries can guide specific injury prevention strategies for Soldiers and health care providers. OBJECTIVES: To analyze physiological and neuromuscular characteristics as predictors of preventable musculoskeletal injuries. DESIGN: Prospective-cohort study. METHODS: A total of 491 Soldiers were enrolled and participated in the baseline laboratory testing, including body composition, aerobic capacity, anaerobic power/capacity, muscular strength, flexibility, static balance, and landing biomechanics. After reviewing their medical charts, 275 male Soldiers who met the criteria were divided into two groups: with injuries (INJ) and no injuries (NOI). Simple and multiple logistic regression analyses were used to calculate the odds ratio (OR) and significant predictors of musculoskeletal injuries (p<0.05). RESULTS: The final multiple logistic regression model included the static balance with eyes-closed and peak anaerobic power as predictors of future injuries (p<0.001). CONCLUSIONS: The current results highlighted the importance of anaerobic power/capacity and static balance. High intensity training and balance exercise should be incorporated in their physical training as countermeasures.

Greater ankle strength, anaerobic and aerobic capacity, and agility predict Ground Combat Military Occupational School graduation in female Marines.

Women can serve in all military occupational specialties (MOS); however, musculoskeletal and physiological characteristics that predict successful completion of ground combat MOS schools by female Marines are unknown. OBJECTIVES: To determine which demographic, musculoskeletal, and physiological characteristics predict graduation from infantry and vehicle ground combat MOS schools in female Marines. DESIGN: Prospective cohort study. METHODS: Prior to MOS school, the following were assessed in 62 female Marines (22.0±3.0yrs, 163.9±5.8cm, 63.4±7.2kg): isokinetic shoulder, trunk, and knee and isometric ankle strength; body composition; anaerobic power (AP)/capacity (AC); maximal oxygen uptake (VO2max); and field-based fitness tests (broad jump, medicine ball throw, pro-agility). Both absolute and normalized (%body mass: %BM) values were utilized for strength, AP, AC, and VO2max. Select tests from each Marine's most recent Physical Fitness Test (PFT: abdominal crunches, 3-mile run time) and Combat Fitness Test (CFT: Maneuver Under Fire, Movement to Contact) were recorded. Participants were classified as graduated (N=46) or did not graduate (N=16). Simple logistic regression was performed to determine predictors of MOS school graduation. Statistical significance was set a priori at α=0.05. RESULTS: Absolute and normalized ankle inversion and eversion strength, normalized anaerobic capacity, absolute and normalized VO2max, right pro-agility, and PFT 3-mile run time significantly predicted MOS school graduation (p<0.05). CONCLUSIONS: Greater ankle strength, better agility, and greater anaerobic and aerobic capacity are important for successful completion of ground combat MOS school in female Marines. Prior to entering ground combat MOS school, it is recommended that female Marines should train to optimize these mobility-centric characteristics.

Association of prospective lower extremity musculoskeletal injury and musculoskeletal, balance, and physiological characteristics in Special Operations Forces.

OBJECTIVES: Previous research has examined lower extremity (LE) musculoskeletal injury (MSI) patterns and risk factors in Special Operations Forces (SOF) trainees, conventional military personnel, and athletes; however, it is unclear if SOF have the same patterns/risk factors. This study aimed to determine the association of musculoskeletal, balance, and physiological characteristics with LE MSI in SOF. DESIGN: Cohort study. METHODS: A total of 726 Air Force (N=140), Navy Sea, Air, and Land (N=301), and Special Warfare Combatant Crewmen (N=285) SOF (age=25.72±4.77years, height=178.34±6.63cm, weight=84.28±9.03kg) participated in laboratory testing, including: LE muscular strength and flexibility; balance; body composition; anaerobic power/capacity; and aerobic capacity. Medical charts were reviewed for LE MSI 365days following laboratory testing. Participants were assigned by injury status and laboratory data stratified by tertile. Chi-square statistics were calculated to determine the frequency of LE MSI across tertiles for each characteristic. RESULTS: There was a significant association between LE MSI and: ankle inversion strength (weaker side: Χ(2)=17.703; stronger side: Χ(2)=18.911; p≤0.001); ankle eversion/inversion strength ratio (lower side: Χ(2)=13.456; higher side: Χ(2)=16.885; p≤0.001); hamstring flexibility (less flexible: Χ(2)=19.930; more flexible Χ(2)=15.185; p≤0.001); gastrocnemius-soleus flexibility (less flexible: Χ(2)=7.889, p=0.019); dynamic balance asymmetry (Χ(2)=7.444, p=0.024); Vestibular and Preference ratios (Χ(2)=9.124, p=0.010 and Χ(2)=6.572, p=0.037, respectively); and aerobic capacity (Χ(2)=13.935, p=0.001). CONCLUSIONS: Characteristics associated with LE MSI are unique in SOF. Human performance program initiatives should include efforts to optimize ankle strength and flexibility, maintain moderate hamstring flexibility, expand dynamic balance strategies, and maximize aerobic capacity to reduce LE MSI risk.

Epidemiology of musculoskeletal injuries sustained by Naval Special Forces Operators and students.

OBJECTIVES: The aim of this analysis was to describe the incidence and common types of medical chart-reviewed musculoskeletal injuries, among four distinct groups of Naval Special Warfare (NSW) personnel: Sea, Air, and Land (SEAL) Operators, SEAL Qualification Training (SQT) students, Special Warfare Combatant-craft Crewman (SWCC) Operators, and Crewman Qualification Training (CQT) students. DESIGN: Descriptive cross-sectional study. METHODS: Medical records were reviewed for 920 NSW personnel. MSI were described and classified by frequency and incidence; anatomic location; injury type and cause; activity during injury; and potential for prevention. RESULTS: The frequency of MSI was 23.1, 46.5, 31.6, and 17.0 per 100 participants per year among SEAL, SQT, SWCC, and CQT, respectively. Upper extremity MSI were the most common in SEAL, lower extremity MSI were common in the other groups. The most frequent MSI anatomic sub-locations varied across groups (SEAL: shoulder, 21.6% of MSI; SQT: foot and toes, 17.0%; SWCC: lumbopelvic spine, 21.7%; and CQT: knee, 30.3%). Pain/spasm/ache were the most common MSI type in SEAL (29.7%) and SWCC (21.7%), tendonitis/tenosynovitis/tendinopathy was the most common MSI type in SQT (21.0%), and tendonitis/tenosynovitis/tendinopathy and fracture were the most common in CQT (15.2% each). A considerable proportion of MSI were classified as potentially preventable-SEAL: 35.1%, SQT: 53.0%, SWCC: 36.7%, and CQT: 21.2%. CONCLUSIONS: MSI cause considerable morbidity among NSW Operators and students, with distinct patterns of distribution by anatomic location and injury type. Since many injuries may be preventable, targeted interventions may be able to mitigate MSI risk.

Effects of Age and Military Service on Strength and Physiological Characteristics of U.S. Army Soldiers.

Soldiers must maintain tactical performance capabilities over the course of their career. Loss in physical readiness may be a function of age and the operational demands associated with increasing years of service. The purpose of this study was to assess strength and physiological characteristics in different cohorts of U.S. Army Soldiers based on years of service and age. A total of 253 Soldiers (age: 28.1 ± 6.8 years; height: 1.76 ± 0.11 m; mass: 84.1 ± 12.2 kg) participated. Individual subject cohorts were created based on years of service (1-5 years, 6-10 years, 11-15 years) and age (20-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years). Testing included shoulder, knee, ankle, and torso strength, aerobic capacity/lactate threshold, anaerobic power/capacity, and body composition/total mass. Those with 11 to 15 years of service and between ages 30 and 34 had a higher percentage of body fat, and lower aerobic capacity and lactate threshold than younger Soldiers with fewer years of service. Physical training interventions should focus on maintenance of physiological characteristics to offset the loss of readiness at the similar time point of 11 to 15 years of service and 30 to 34 years of age.

Long-term outcomes of a dynamic ankle-foot orthosis on gait characteristics of a service member with incomplete nerve injury to the lower extremity: a case report.

This case study reports a 5-year follow-up of a 32-year-old male service member who suffered polytrauma in 2007 following a Humvee rollover in Afghanistan. The service member's injured left lower extremity was salvaged, but severe damage to the lumbosacral plexus and significant injuries to the pelvis, hip, and femur resulted in near total paralysis and foot drop of the left lower limb. Two years of multiple substandard ankle-foot orthotic devices pushed him to investigate a dynamic ankle-foot orthotic (DAFO) with energy storing capability, which allowed him to remain on active duty and deploy for a second tour while wearing the device. The anecdotal improvements described by this service member prompted a biomechanical analysis of walking and running gait, comparing a shoes only condition to the DAFO. Results of gait analysis demonstrated an improvement in spatial-temporal parameters in both walking and running, improved sagittal angles and moments at the ankle, knee, and hip, greater ankle stability through decreased dorsiflexion excursion, and a marked increase in ankle power while running. Most notably, the service member credits this device for substantial improvement in quality of life including total cessation of pain medication and return to regular vigorous activity.