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)