Musculoskeletal Lower Limb Injury Risk in Army Populations

Sports Medicine - Open, Apr 2016

Injuries are common within military populations, with high incidence rates well established in the literature. Injuries cause a substantial number of working days lost, a significant cost through compensation claims and an increased risk of attrition. In an effort to address this, a considerable amount of research has gone into identifying the most prevalent types of injury and their associated risk factors. Collective evidence suggests that training and equipment contribute to a large proportion of the injuries sustained. In particular, the large loads borne by soldiers, the high intensity training programs and the influence of footwear have been identified as significant causative factors of lower limb injury in military populations. A number of preventative strategies have been developed within military bodies around the world to address these issues. The relative success of these strategies is highly variable; however, with advancements in technology, new approaches will become available and existing strategies may become more effective.

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Musculoskeletal Lower Limb Injury Risk in Army Populations

Andersen et al. Sports Medicine - Open Musculoskeletal Lower Limb Injury Risk in Army Populations Kimberley A. Andersen 0 Paul N. Grimshaw 0 Richard M. Kelso 0 David J. Bentley 1 Key Points 0 School of Mechanical Engineering, University of Adelaide , Adelaide, South Australia 5005 , Australia 1 School of Health Sciences, Flinders University , GPO Box 2100, Adelaide, South Australia 5001 , Australia Injuries are common within military populations, with high incidence rates well established in the literature. Injuries cause a substantial number of working days lost, a significant cost through compensation claims and an increased risk of attrition. In an effort to address this, a considerable amount of research has gone into identifying the most prevalent types of injury and their associated risk factors. Collective evidence suggests that training and equipment contribute to a large proportion of the injuries sustained. In particular, the large loads borne by soldiers, the high intensity training programs and the influence of footwear have been identified as significant causative factors of lower limb injury in military populations. A number of preventative strategies have been developed within military bodies around the world to address these issues. The relative success of these strategies is highly variable; however, with advancements in technology, new approaches will become available and existing strategies may become more effective. Review Introduction Military personnel serve in many capacities around the world and there are two factors of paramount importance to all efforts; that soldiers are physically capable for duty and that they return safely. The most prevalent factor that could prevent the achievement of these two criteria is musculoskeletal injury [ 1–3 ]. Soldiers injured in basic training may be unable to deploy, while soldiers injured during deployment may not be fit to return to active duty. Furthermore, once a musculoskeletal injury is incurred, the risk of sustaining another such injury increases [ 3–5 ] causing a greater risk of attrition. One study found a 13 % increase in the incidence of lower limb injury if the recruit had suffered a previous ankle sprain [ 4 ]. While certainly undesirable, some amount of catastrophic injury is unavoidable during deployment and is a direct result of the conditions in which military personnel work. There is, however, a large proportion of injuries that may result from (or be exacerbated by) controllable factors such as training [ 6–11 ] and equipment [ 8, 12, 13 ]. Substantial research has assessed the risk factors for injury in the military [ 1, 3, 4, 6, 10, 12, 14 ]; however, results are often contradictory and focus on individual factors, when in reality, a large number are inextricably linked. Load carriage and training are commonly cited as causative factors towards musculoskeletal injury within military forces, particularly army [ 1, 3, 4, 6, 8–10, 15–19 ]; however, the effect that footwear can have on injuries has received minimal attention in previous reviews of military injuries despite the research completed in this area [ 3, 7, 9, 20–22 ]. Footwear can have a significant effect on gait and performance of tasks, which in turn can lead to injury. The aim of this review is twofold; first, to review the current literature regarding injury causes in the military and second, to demonstrate the influence footwear can have on injury incidence. This review will investigate the prevalence and risk factors for musculoskeletal injury in army populations, the effects of load carriage, training and footwear and finally, schemes for injury prevention and their effectiveness. Methodology This review is a narrative review and the authors do not claim to have analysed all of the available literature; however, they are confident that an accurate snapshot of the current state of the literature has been provided. Articles were sourced from Google Scholar, Pubmed and the Defense Technical Information Center using the search terms ‘military musculoskeletal injury’, ‘load carriage’, ‘military footwear’ and ‘combat boots’. The reference lists of the articles found were then searched for other relevant articles not identified in the initial search. Injuries and Associated Factors Injury Rates and Definitions Injury can affect the combat readiness of any soldier. Therefore, it is important to consider the rates at which injuries occur and in what circumstances. There is significant variation between reported injury rates from different sources (Table 1), and this is largely attributable to the data and definitions used, the nature of the study and the injury types included in the studies. Injury definitions are highly dependent on the data source. A common definition of injury is anything resulting in a medical visit [ 1, 4, 6, 12 ]. This definition is particularly common for retrospective studies, where database information is used as t (...truncated)


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Kimberley A. Andersen, Paul N. Grimshaw, Richard M. Kelso, David J. Bentley. Musculoskeletal Lower Limb Injury Risk in Army Populations, Sports Medicine - Open, 2016, pp. 22, Volume 2, Issue 1, DOI: 10.1186/s40798-016-0046-z