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Hayhurst D, Warner M, Stokes M, Fallowfield J. Musculoskeletal injury in military specialists: a 2-year retrospective study. BMJ Mil Health 2024; 170:242-247. [PMID: 36175032 DOI: 10.1136/military-2022-002165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/09/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Military specialists are elite personnel who are trained to work across diverse operational environments where a high level of physical conditioning is a prerequisite for their role. Anecdotally, personnel are acknowledged to be at high risk of developing musculoskeletal injuries (MSKIs). However, there are presently no published data on this UK military population to support this view. This is the first (2-year) retrospective epidemiological study to identify the MSKI sustained by this military population. METHODS All MSKI reported over a 2-year period (January 2018-December 2019) were recorded to identify the incidence, frequency, nature, onset, cause, location and reporting times. Injuries were described using injury count and relative frequency (percentage). Time at risk for each personnel day was calculated as 365 days. RESULTS A total of 199 personnel reported 229 injuries over the reporting periods. The injury incidence rates were 26.8 personnel per 100 person years (2018) and 27.7 personnel per 100 person years (2019), respectively. Military training accounted for the highest number of injuries (32%), followed by 'other injuries' (28%), personal training (28%) and sport (12%). The leading activity associated with injury was weight training (15%), followed by running (11%) and military exercise (10%). Lower extremity injuries accounted for the highest number of injuries (40%), followed by trunk (36%) and upper extremity (24%) injuries. CONCLUSION This study identifies the MSKI profile of a military specialist population over a 2-year period. Areas where modifiable risk factors may be identified to reduce risk of injury are highlighted. Recommendations for further research include investigating injury burden and the impact of injury on operational readiness.
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Affiliation(s)
| | - M Warner
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - M Stokes
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - J Fallowfield
- Head of Applied Physiology, Environmental and Science Division, Institute of Naval Medicine, Gosport, UK
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Juman L, Schneider EB, Clifton D, Koehlmoos TP. Common Data Elements and Databases Essential for the Study of Musculoskeletal Injuries in Military Personnel. Mil Med 2024:usae241. [PMID: 38771112 DOI: 10.1093/milmed/usae241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/21/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Injuries are the leading cause of medical encounters with over 2 million medical encounters for musculoskeletal (MSK) conditions and over 700,000 acute injuries per year. Musculoskeletal injuries (MSKIs) are by far the leading health and readiness problem of the U.S. Military. The Proceedings of the International Collaborative Effort on Injury Statistics published a list of 12 data elements deemed necessary for injury prevention in the civilian population; however, there are no standardized list of common data elements (CDEs) across the DoD specifically designed to study MSKIs in the Military Health System (MHS). This study aims to address this gap in knowledge by defining CDEs across the DoD for MSKIs, establishing a CDE dictionary, and compiling other necessary information to quantify MSKI disease burden in the MHS. MATERIALS AND METHODS Between November 2022 and March 2023, we conducted an environmental scan of current MSKI data metrics across the DoD. We used snowball sampling with active engagement of groups housing datasets that contained MSKI data elements to determine CDEs as well as information on readiness databases across the DoD containing up-to-date personnel information on disease, hospitalizations, limited duty days (LDDs), and deployability status for all military personnel, as well as MSKI-specific measures from the MHS Dashboard which tracks key performance measures. RESULTS We identified 8 unique databases: 5 containing demographic and diagnostic information (Defense Medical Surveillance System, Medical Assessment and Readiness Systems, Military Health System Data Repository, Person-Data Environment, and Soldier Performance, Health, and Readiness Database); and 3 containing LDD information (Aeromedical Services Information Management System, eProfile, and Limited Duty Sailor Marines Readiness Tracker). Nine CDEs were identified: DoD number, sex, race, ethnicity, branch of service, rank, diagnosis, Common Procedural Terminology coding, and cause codes, as they may be captured in any database that is a derivative of the Military Health System Data Repository. Medical Assessment and Readiness Systems contained most variables of interest, excluding injury/place of region and time in service. The Limited Duty Sailor Marines Readiness Tracker contains a variable corresponding to "days on limited duty." The Aeromedical Services Information Management System uses the "release date" and "profile date" to calculate LDDs. The eProfile system determines LDDs by the difference between the "expiration date" and "approved date." In addition, we identified 2 measures on the MHS Dashboard. One measures the percentage of service members (SMs) who are on limited duty for longer than 90 days because of an MSKI and the other tracks the percentage of SMs that are not medically ready for deployment because of a deployment-limiting medical condition. CONCLUSIONS This article identifies core data elements needed to understand and prevent MSKIs and where these data elements can be found. These elements should inform researchers and result in evidence-informed policy decisions supporting SM health to optimize military force readiness.
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Affiliation(s)
- Luke Juman
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD 20817, USA
| | | | - Dan Clifton
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Tracey Perez Koehlmoos
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Rice H, Seynnes O, Werkhausen A. Effect of increased running speed and weight carriage on peak and cumulative tibial loading. Scand J Med Sci Sports 2023; 33:2516-2523. [PMID: 37642291 DOI: 10.1111/sms.14476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/11/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Tibial stress injuries are a burdensome injury among military recruits. Military activities include running and the carriage of additional weight, and this may be related to the high risk of bone stress injuries. The aim of this study was to quantify tibial loading when running at two different speeds, with and without additional weight, and to quantify their combined influence. METHODS Fourteen male distance runners who ran at least 40 km per week ran barefoot on a force-instrumented treadmill in four conditions representing preferred running speed (mean (SD) 3.1 (0.3) m/s) and 20% increased running speed (3.8 (0.4) m/s), with and without 20% of body weight carried in a weight vest. Kinematics and kinetics were synchronously collected. Bending moments were estimated about the medial-lateral axis of the tibial centroid located 1/3rd of the length from distal to proximal. Static equilibrium was ensured at each 1% of stance. Peak bending moments were obtained in addition to cumulative-weighted loading, where weighted loading accounted for the relative importance of the magnitude of the bending moment and the quantity of loading using a bone-dependent weighting factor. RESULTS There were no interaction effects for running speed and weight carriage on peak or cumulative tibial loading. Running at a 20% faster speed increased peak and cumulative loading per kilometer by 8.0% (p < 0.001) and 4.8% (p < 0.001), respectively. Carriage of an additional 20% of body weight increased peak and cumulative loading per kilometer by 6.6% (p < 0.001) and 8.5% (p < 0.001), respectively. INTERPRETATION Increasing the physical demand of running by increasing speed or weight carriage increased peak tibial loading and cumulative tibial loading per kilometer, and this may increase the risk of tibial stress injury. Running speed and weight carriage independently influenced tibial loading.
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Affiliation(s)
- Hannah Rice
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Olivier Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Amelie Werkhausen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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Wolski L, Stannard J, Toohey L, Fogarty A, Drew M. Musculoskeletal Complaint Epidemiology in Australian Special Operation Forces Trainees. Mil Med 2023; 188:e3539-e3546. [PMID: 37311061 PMCID: PMC10629990 DOI: 10.1093/milmed/usad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Elite military trainees are burdened by high numbers of musculoskeletal (MSK) injuries and are a priority military population for injury prevention. This research aims to describe the MSK complaint epidemiology of trainees undertaking special forces (SF) training in the Australian Defence Force (ADF). One barrier to accurate injury surveillance in military populations is that traditional surveillance methods rely on personnel engaging with the military healthcare system to collect injury data. This approach is likely to underestimate the injury burden as it is known that many military personnel, particularly trainees, avoid reporting their injuries because of various motives. Subsequently, the insights from surveillance systems may underestimate the injury burden and limit the ability to inform prevention requirements. This research aims to actively seek MSK complaint information directly from trainees in a sensitive manner to mediate injury-reporting behaviors. MATERIALS AND METHODS This descriptive epidemiology study included two consecutive cohorts of ADF SF trainees from 2019 to 2021. Musculoskeletal data items and their respective recording methods were based on international sports injury surveillance guidelines and adapted to a military context. Our case definition encompassed all injuries or physical discomforts as recordable cases. A unit-embedded physiotherapist retrospectively collected MSK complaint data from selection courses and collected prospective data over the training continuum. Data collection processes were external to the military health care system to mediate reporting avoidance and encourage injury reporting. Injury proportions, complaint incidence rates, and incidence rate ratios were calculated and compared between training courses and cohorts. RESULTS In total, 334 MSK complaints were reported by 103 trainees (90.4%), with a complaint incidence rate of 58.9 per 1,000 training weeks (95% CI, 53.0-65.5). Of these MSK complaints, 6.4% (n = 22) resulted in time loss from work. The lumbar spine (20.6%, n = 71) and the knee (18.9%, n = 65) were the most frequently affected body parts. Most of the MSK complaints were reported during selection courses (41.9%), followed by field survival and team tactics (23.0%) and urban operations courses (21.9%). Physical training accounted for 16.5% of complaints. Fast-roping training was associated with more severe MSK complaints. CONCLUSIONS Musculoskeletal complaints are highly prevalent in ADF SF trainees. Complaints are more frequently reported in selection and qualification training courses than in physical training. These activities are priorities for focused research to understand injury circumstances in ADF elite training programs to inform injury prevention strategies. A strength of our study is the data collection methods which have provided greater MSK complaint information than past research; however, much work remains in conducting consistent and accurate surveillance. Another strength is the use of an embedded physiotherapist to overcome injury-reporting avoidance. Embedded health professionals are recommended as continued practice for ongoing surveillance and early intervention.
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Affiliation(s)
- Lisa Wolski
- Australian Defence Force, Australian Army, Sydney, NSW 2173, Australia
| | - Joanne Stannard
- Australian Defence Force, Australian Army, Adelaide, SA 5111, Australia
- School of Science, Edith Cowan University, Perth, WA 6027, Australia
| | - Liam Toohey
- Australian Institute of Sport, Bruce, ACT 2617, Australia
- University of Canberra, Research Institute for Sport and Exercise, Canberra, ACT 2617, Australia
| | - Alison Fogarty
- Defence Science and Technology Group, Melbourne, VIC 3207, Australia
| | - Michael Drew
- Department of Defence, Joint Health Command, Canberra, ACT 2600, Australia
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Murphy MC, Stannard J, Sutton VR, Owen PJ, Park B, Chivers PT, Hart NH. Epidemiology of musculoskeletal injury in military recruits: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:144. [PMID: 37898757 PMCID: PMC10612319 DOI: 10.1186/s13102-023-00755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Injuries are a common occurrence in military recruit training, however due to differences in the capture of training exposure, injury incidence rates are rarely reported. Our aim was to determine the musculoskeletal injury epidemiology of military recruits, including a standardised injury incidence rate. METHODS Epidemiological systematic review following the PRISMA 2020 guidelines. Five online databases were searched from database inception to 5th May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by military recruits after the year 2000 were included. We reported on the frequency, prevalence and injury incidence rate. Incidence rate per 1000 training days (Exact 95% CI) was calculated using meta-analysis to allow comparisons between studies. Observed heterogeneity (e.g., training duration) precluded pooling of results across countries. The Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies assessed study quality. RESULTS This review identified 41 studies comprising 451,782 recruits. Most studies (n = 26; 63%) reported the number of injured recruits, and the majority of studies (n = 27; 66%) reported the number of injuries to recruits. The prevalence of recruits with medical attention injuries or time-loss injuries was 22.8% and 31.4%, respectively. Meta-analysis revealed the injury incidence rate for recruits with a medical attention injury may be as high as 19.52 injuries per 1000 training days; and time-loss injury may be as high as 3.97 injuries per 1000 training days. Longer recruit training programs were associated with a reduced injury incidence rate (p = 0.003). The overall certainty of the evidence was low per a modified GRADE approach. CONCLUSION This systematic review with meta-analysis highlights a high musculoskeletal injury prevalence and injury incidence rate within military recruits undergoing basic training with minimal improvement observed over the past 20 years. Longer training program, which may decrease the degree of overload experienced by recruit, may reduce injury incidence rates. Unfortunately, reporting standards and reporting consistency remain a barrier to generalisability. TRIAL REGISTRATION PROSPERO (Registration number: CRD42021251080).
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Affiliation(s)
- Myles C Murphy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia.
| | - Joanne Stannard
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Vanessa R Sutton
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Brendon Park
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Paola T Chivers
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Hando BR, Bryant J, Pav V, Haydu L, Hogan K, Mata J, Butler C. Musculoskeletal injuries in US Air Force Tactical Air Control Party trainees: an 11-year longitudinal retrospective cohort study and presentation of a musculoskeletal injury classification matrix. BMJ Mil Health 2023:military-2023-002417. [PMID: 37220991 DOI: 10.1136/military-2023-002417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Little is known of the epidemiology of musculoskeletal injuries (MSKIs) in US Air Force Special Warfare (AFSPECWAR) Tactical Air Control Party trainees. The purpose of this longitudinal retrospective cohort study was to (1) report the incidence and type of MSKI sustained by AFSPECWAR trainees during and up to 1 year following training, (2) identify factors associated with MSKI, and (3) develop and present the MSKI classification matrix used to identify and categorise injuries in this study. METHODS Trainees in the Tactical Air Control Party Apprentice Course between fiscal years 2010-2020 were included. Diagnosis codes were classified as MSKI or non-MSKI using a classification matrix. Incidence rates and incidence proportion for injury types and regions were calculated. Measures were compared for differences between those who did and did not sustain an MSKI during training. A Cox proportional hazards model was used to identify factors associated with MSKI. RESULTS Of the 3242 trainees, 1588 (49%) sustained an MSKI during training and the cohort sustained MSKIs at a rate of 16 MSKI per 100 person-months. Overuse/non-specific lower extremity injuries predominated. Differences were seen in some baseline measures between those who did and did not sustain an MSKI. Factors retained in the final Cox regression model were age, 1.5-mile run times and prior MSKI. CONCLUSION Slower run times and higher age were associated with an increased likelihood of MSKI. Prior MSKI was the strongest predictor of MSKI during training. Trainees sustained MSKIs at a higher rate than graduates in their first year in the career field. The MSKI matrix was effective in identifying and categorising MSKI over a prolonged (12-year) surveillance period and could be useful for future injury surveillance efforts in the military or civilian settings. Findings from this study could inform future injury mitigation efforts in military training environments.
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Affiliation(s)
- Ben R Hando
- Kennell and Associates Inc, Falls Church, Virginia, USA
| | - J Bryant
- Human Performance Squadron, Special Warfare Training Wing, US Air Force, San Antonio, Texas, USA
| | - V Pav
- Kennell and Associates Inc, Falls Church, Virginia, USA
| | - L Haydu
- Special Warfare Training Wing, Human Performance Squadron, US Air Force, San Antonio, Texas, USA
| | - K Hogan
- Special Warfare Training Wing, Human Performance Squadron, US Air Force Education and Training Command, San Antonio, Texas, USA
| | - J Mata
- Special Warfare Training Wing, Human Performance Squadron, US Air Force, San Antonio, Texas, USA
| | - C Butler
- Special Warfare Training Wing, Human Performance Squadron, US Air Force Education and Training Command, San Antonio, Texas, USA
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Wallace J, Osmotherly P, Gabbett T, Spratford W, Niyonsenga T, Newman P. A Validated Injury Surveillance and Monitoring Tool for Fast Jet Aircrew: Translating Sports Medicine Paradigms to a Military Population. SPORTS MEDICINE - OPEN 2022; 8:92. [PMID: 35841441 PMCID: PMC9288569 DOI: 10.1186/s40798-022-00484-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
Background Military populations, including fast jet aircrew (FJA - aka fighter aircrew/pilots), commonly suffer from musculoskeletal complaints, which reduce performance and operational capability. Valid surveillance tools and agreed recordable injury definitions are lacking. Our objective was to develop and then evaluate the validity of a musculoskeletal complaints surveillance and monitoring tool for FJA. Methods A Delphi study with international experts sought consensus on recordable injury definitions and important content for use in a surveillance and monitoring tool for FJA. Using these results and feedback from end-users (FJA), the University of Canberra Fast Jet Aircrew Musculoskeletal Questionnaire (UC-FJAMQ) was developed. Following its use with 306 Royal Australian Air Force (RAAF) FJA over 4 × five-month reporting periods, validity of the UC-FJAMQ was evaluated via multi-level factor analysis (MFA) and compared with routine methods of injury surveillance. Results Consensus was achieved for: eight words/descriptors for defining a musculoskeletal complaint; six definitions of recordable injury; and 14 domains important for determining overall severity. The UC-FJAMQ was developed and refined. MFA identified three distinct dimensions within the 11 items used to determine severity: operational capability, symptoms, and care-seeking. MFA further highlighted that symptom severity and seeking medical attention were poor indicators of the impact musculoskeletal complaints have upon operational capability. One hundred and fifty-two episodes of time loss were identified, with the UC-FJAMQ identifying 79% of these, while routine methods identified 49%. Despite modest weekly reporting rates (61%), the UC-FJAMQ outperformed routine surveillance methods. Conclusions The UC-FJAMQ was developed to specifically address the complexities of injury surveillance with FJA, which are similar to those noted in other military and sporting populations. The results demonstrated the UC-FJAMQ to be sensitive and valid within a large group of FJA over 4 × five-month reporting periods. Adoption of consistent, sensitive, and valid surveillance methods will strengthen the FJA injury prevention literature, ultimately enhancing their health, performance, and operational capability. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00484-1.
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Scott WC, Hando BR, Butler CR, Mata JD, Bryant JF, Angadi SS. Force plate vertical jump scans are not a valid proxy for physical fitness in US special warfare trainees. Front Physiol 2022; 13:966970. [PMID: 36467678 PMCID: PMC9709481 DOI: 10.3389/fphys.2022.966970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/31/2022] [Indexed: 07/26/2023] Open
Abstract
Background: The United States Air Force Special Warfare Training Wing (SWTW) administers a comprehensive physical fitness test to active duty Airmen entering the Special Warfare training pipeline. The Sparta Science™ system utilizes proprietary software to analyze the force-time curve of a vertical jump and purports to serve as a proxy for traditional military fitness tests. The Sparta Science™ system produces four proprietary metrics, including the Sparta™ Score, which is correlated to high magnitudes of force production purportedly performance. This study investigated how Sparta™ Jump Scans correlate to components of a physical fitness test utilized within the SW training pipeline. Methods: At the entry and exit of an 8-week Special Warfare Training Wing preparatory course (SW PREP), 643 trainees completed both an initial and final Sparta™ Jump Scan and a Candidate Fitness Test (CFT). The Candidate Fitness Test consists of eight components and tests several different domains of fitness including strength, power, muscular endurance, swimming proficiency, and cardiovascular fitness. Paired t-tests were used to determine if Sparta™ Jump Scan metrics and CFT components changed during SW PREP. Sparta™ Score's correlation was assessed against every other Sparta™ Jump Scan metric and all CFT fitness measures. Results: This study found that the Sparta™ Jump Scan metrics decline slightly over SW PREP (p < 0.05; negligible-small effect size), while most CFT measures improve (p < 0.05; small-medium effect size). Changes in Sparta™ Jump Scan metrics did not reflect the changes in CFT performance over SW PREP (r 2: 0.00-0.03). Conclusion: The Sparta™ Score was not correlated to the most tactically-relevant fitness measures (rucking and swimming), and only weakly correlated with the only jumping measure on the fitness test, the standing broad jump.
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Affiliation(s)
- W Casan Scott
- US Air Force Special Warfare Training Wing, San Antonio, TX, United States
- National Council on Compensation Insurance, Boca Raton, FL, United States
| | - Ben R Hando
- US Air Force Special Warfare Training Wing, San Antonio, TX, United States
- Kennell & Associates, Inc., Fall Church, VA, United States
| | - Cody R Butler
- US Air Force Special Warfare Training Wing, San Antonio, TX, United States
| | - John D Mata
- US Air Force Special Warfare Training Wing, San Antonio, TX, United States
| | - Jacob F Bryant
- US Air Force Special Warfare Training Wing, San Antonio, TX, United States
| | - Siddhartha S Angadi
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, VA, United States
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Lisman P, Ritland BM, Burke TM, Sweeney L, Dobrosielski DA. The Association Between Sleep and Musculoskeletal Injuries in Military Personnel: A Systematic Review. Mil Med 2022; 187:1318-1329. [PMID: 35544342 DOI: 10.1093/milmed/usac118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Musculoskeletal injuries (MSKIs) are a significant health problem in the military. Accordingly, identifying risk factors associated with MSKI to develop targeted strategies that attenuate injury risk remains a top priority within the military. Insufficient sleep has garnered increased attention as a potential risk factor for MSKI in both civilians and military personnel. Yet, there are no systematic evaluations of the potential association between sleep and MSKI in the military. The purpose of this review is to examine the relationship between sleep and injury in military personnel. MATERIALS AND METHODS Literature searches were performed in multiple electronic databases using keywords relevant to sleep quantity and quality, MSKI, and military populations. Two investigators independently assessed the methodological quality of each study using the Newcastle-Ottawa Scale for cohort studies or an adapted form of this scale for cross-sectional studies. RESULTS The search yielded 2402 total citations, with 8 studies (3 cohort and 5 cross-sectional) fitting the inclusion criteria. Overall, the systematic review found 5 of the 8 reviewed studies supporting an association between sleep (quality and duration) and MSKI in military personnel. Specifically, poor sleep was associated with increased injury incidence in 2 cohort and 3 cross-sectional studies. CONCLUSION This is the first systematic review to evaluate the published literature on the association between sleep and MSKI risk in military populations. Although there is currently limited research on this topic, findings suggest that sleep is associated with MSKI and should be considered when designing strategies aimed at reducing MSKI risk in military personnel.
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Affiliation(s)
- Peter Lisman
- Department of Kinesiology, Towson University, Towson, MD 21252, USA.,Towson Research Academy of Collaborative Sport Science (TRACS), Towson University, Towson, MD 21252, USA
| | - Bradley M Ritland
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Tina M Burke
- Behavior Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Lisa Sweeney
- Department of Library Services, Towson University, Towson, MD 21252, USA
| | - Devon A Dobrosielski
- Department of Kinesiology, Towson University, Towson, MD 21252, USA.,Towson Research Academy of Collaborative Sport Science (TRACS), Towson University, Towson, MD 21252, USA
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Hando BR, Scott WC, Bryant JF, Tchandja JN, Angadi SS. The Use of Force Plate Vertical Jump Scans to Identify Special Warfare Trainees at Risk for Musculoskeletal Injury: A Large Cohort Study. Am J Sports Med 2022; 50:1687-1694. [PMID: 35384740 DOI: 10.1177/03635465221083672] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Vertical jump scans from commercially available force plate systems are increasingly used in military settings to screen for musculoskeletal injury (MSKI) risk. However, to date, no studies have determined the ability of these tools to identify tactical athletes at elevated risk for MSKI. PURPOSE To (1) determine associations between scores from a force plate vertical jump test and the likelihood of experiencing an MSKI and to (2) establish the test-retest reliability of the output scores from the force plate system used. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 823 male Air Force Special Warfare trainees underwent force plate vertical jump screenings before entering an 8-week training course at US Air Force Special Warfare Training Wing. MSKI data were collected for the 8-week surveillance period for each trainee. Logistic regression analyses were used to identify associations between baseline force plate jump scores and the likelihood of MSKI (any region) or a lower extremity MSKI (significance level, P = .05). The test-retest portion of the study collected force plate output scores from 12 trainees performing 3 trials of the standard test procedures. The reliability of 5 output scores was assessed with intraclass correlation coefficients (ICCs) using a single rater. RESULTS All force plate output scores demonstrated excellent test-retest reliability (ICC >0.90). Overall 308 (36.4%) trainees had an MSKI during the surveillance period. However, no significant associations were found between the proprietary force plate vertical jump scan output scores and the likelihood of experiencing either an MSKI or a lower extremity MSKI. CONCLUSION Output scores from this commercially available force plate system did not identify Air Force Special Warfare trainees at elevated risk of experiencing an MSKI.
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Affiliation(s)
- Ben R Hando
- US Air Force Special Warfare Training Wing, Joint Base San Antonio, Lackland, Texas, USA
| | - W Casan Scott
- US Air Force Special Warfare Training Wing, Joint Base San Antonio, Lackland, Texas, USA
| | - Jacob F Bryant
- US Air Force Special Warfare Training Wing, Joint Base San Antonio, Lackland, Texas, USA
| | - Juste N Tchandja
- US Air Force Special Warfare Training Wing, Joint Base San Antonio, Lackland, Texas, USA
| | - Siddhartha S Angadi
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, Virginia, USA
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Kierkegaard M, Tegern M, Broman L, Halvarsson A, Larsson H. Test-Retest Reliability and Translation of the Musculoskeletal Screening Protocol Questionnaire Used in the Swedish Armed Forces. Mil Med 2022; 188:usac082. [PMID: 35365829 PMCID: PMC10362998 DOI: 10.1093/milmed/usac082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Musculoskeletal disorders (MSDs) in military personnel are common, and it is important to identify those at risk so that appropriate preventive and rehabilitative strategies can be undertaken. The Musculoskeletal Screening Protocol (MSP) questionnaire is part of the implemented prevention strategy to reduce MSDs in the Swedish Armed Forces. The aims of this study were to evaluate the questionnaire's reliability and to translate it into English. MATERIALS AND METHODS One-week test-retest reliability of the questionnaire was evaluated in a sample of 35 Swedish military personnel. Reliability was evaluated by calculations of Cohen's kappa or quadratic-weighted kappa. Percent agreement was used as a parameter for measurement error. Translation into English included forward and backward translations and expert committee discussions. RESULTS Kappa values relating to physical complaints/injuries were excellent (>0.75) except for knee and lower leg MSDs and for the intensity ratings, where Kappa values were mostly interpreted as fair-to-good (0.4-0.75). Kappa values of items pertaining physical performance, physical activity and exercise, eating and tobacco habits, sleep, and perceived health ranged between 0.72 and 1. Kappa values for feeling mentally or physical prepared were 0.47 and 0.65, respectively. Most percentage agreement values ranged between 90% and 100%. The English version was found to be satisfactorily equivalent to the Swedish MSP questionnaire. CONCLUSION The Swedish MSP questionnaire was found to be highly reliable and was satisfactorily translated into English. This provides support for the questionnaire's ability to trustworthily capture the prevalence of MSDs and perceived health in military personnel. Future research is warranted on the psychometric properties of the English MSP questionnaire.
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Affiliation(s)
- Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm 141 83, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational therapy and Physiotherapy, Karolinska University Hospital, Stockholm 141 86, Sweden
- Academic Specialist Center, Center of Neurology, Stockholm Health Services, Stockholm 113 65, Sweden
| | - Matthias Tegern
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm 141 83, Sweden
- Department of Community Medicine and Rehabilitation, Unit of Physiotherapy, Umeå University, Umeå 901 87, Sweden
| | - Lisbet Broman
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm 141 83, Sweden
| | - Alexandra Halvarsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm 141 83, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational therapy and Physiotherapy, Karolinska University Hospital, Stockholm 141 86, Sweden
| | - Helena Larsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm 141 83, Sweden
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Stannard J, Finch CF, Fortington LV. Improving musculoskeletal injury surveillance methods in Special Operation Forces: A Delphi consensus study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000096. [PMID: 36962170 PMCID: PMC10021797 DOI: 10.1371/journal.pgph.0000096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
Musculoskeletal injury mitigation is a priority in military organisations to protect personnel health and sustain a capable workforce. Despite efforts to prevent injury, inconsistencies exist in the evidence used to support these activities. There are many known limitations in the injury surveillance data reported in previous Special Operation Forces (SOF) research. Such studies often lack accurate, reliable, and complete data to inform and evaluate injury prevention activities. This research aimed to achieve expert consensus on injury surveillance methods in SOF to enhance the quality of data that could be used to inform injury prevention in this population. A Delphi study was conducted with various military injury surveillance stakeholders to seek agreement on improving surveillance methods in SOF. Iterative questionnaires using close and open-ended questions were used to collect views about surveillance methods related to injury case definitions and identifying essential and optional data requirements. Consensus was predefined as 75% group agreement on an item. Sixteen participants completed two rounds of questionnaires required. Consensus was achieved for 17.9% (n = 7) of questions in the first-round and 77.5% (n = 38) of round two questions. Several challenges for surveillance were identified, including recording injury causation, SOF personnel's injury reporting behaviours influencing accurate data collection, and surveillance system infrastructure limitations. Key military injury surveillance stakeholders support the need for improved data collection to enhance the evidence that underpins injury prevention efforts. The consensus process has resulted in preliminary recommendations to support future SOF injury surveillance.
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Affiliation(s)
- Joanne Stannard
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Caroline F Finch
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Lauren V Fortington
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
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Ross JA, Winters JD, Royer SD, Hoch MC, Bergin R, Morelli N, Conley C, Sheppard RL, Heebner NR. Comparisons and Intercorrelations of Physical Performance Variables of Operational Preparedness in Special Operations Forces. Mil Med 2021; 188:e1109-e1116. [PMID: 34850087 DOI: 10.1093/milmed/usab425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Marine Forces Special Operations Command (MARSOC) deploys teams of operators (OP) and enablers (EN) to accomplish special operations missions. OP and EN are required to train and deploy together to accomplish these missions; however, they have different training and selection pipelines. Advanced strength and conditioning training strategies are applied to both OP and EN to enhance physical preparedness; however, it is unclear how the selection pipeline of these two personnel types affects overall physical preparedness and the relationships between performance variables. The purpose of this study is to gain a greater understanding of the relationships of a wide array of physical preparedness variables in OP and EN in an effort to streamline testing and training strategies. MATERIALS AND METHODS For this study, 155 male (82 OP, 73 EN) MARSOC personnel (age: 29.5 ± 4.9 years, mass: 87.9 ± 11.1 kg, height: 1.79 ± 0.07 m) completed a physical preparedness assessment that included a DEXA assessment of body composition (BF%), 27.4 m sprint (30 yd), countermovement jump (VJ), 5-10-5 pro-agility (Agility), medicine ball toss (UBP), isometric mid-thigh pull (IMTP), and a 30 second (AnC) and 5 minute (AC) non-motorized treadmill run. Independent samples t tests, Mann-Whitney U tests, and Spearman's Rank correlations were used to compare variables between OP and EN. RESULTS OP demonstrated greater VJ, UBP, IMTP, AnC, and AC (P < 0.05); and significantly lower BF% and agility time (P < 0.05). Measurements of mass, height, body mass index, and 30 yd were not significantly different (P > 0.05). Weak to moderate correlations were seen between anthropometric and performance variables. OP and EN demonstrated similar correlations for most performance and anthropometric variables. CONCLUSIONS These results suggest that MARSOC OP demonstrate better physical preparedness over EN, while similar trends are observed between performance variables. Tests with moderate to high correlations may be removed from the protocol to account for testing time constraints. Height, weight, and BF% variables are poorly correlated with performance, particularly in OP, questioning their value in physical performance assessments in this population.
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Affiliation(s)
- Jeremy A Ross
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Joshua D Winters
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Scott D Royer
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Reiley Bergin
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Nathan Morelli
- Department of Physical Therapy, High Point University, High Point, NC 27268, USA
| | - Caitlin Conley
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Ryan L Sheppard
- Marine Forces Special Operations Command, Camp Lejeune, NC 28542, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
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Lendal MS, Kjaer M. Musculoskeletal sports medicine injuries in special operations forces soldiers. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Marius Sartvin Lendal
- Department of Orthopedic Surgery Institute of Sports Medicine Copenhagen University Hospital ‐ Bispebjerg‐Frederiksberg Frederiksberg Denmark
| | - Michael Kjaer
- Department of Orthopedic Surgery Institute of Sports Medicine Copenhagen University Hospital ‐ Bispebjerg‐Frederiksberg Frederiksberg Denmark
- Department of Clinical Medicine Center for Healthy Aging University of Copenhagen Copenhagen Denmark
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Dimensionality Reduction Differentiates Sensitive Force-Time Characteristics from Loaded and Unloaded Conditions throughout Competitive Military Training. SUSTAINABILITY 2021. [DOI: 10.3390/su13116105] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose was to evaluate neuromuscular fatigue’s effect on unloaded and loaded countermovement jump (CMJ) force-time characteristics during high-intensity tactical training. Eighteen male and sixteen female Marines completed two maximal effort CMJs, in unloaded (PVC pipe) and loaded (10 kg weight vest and 20 kg barbell) conditions, prior to, and 24, 48, and 72 h after starting the 4-day event. The top three variables from three principal components (PC) were analyzed using mixed-effects modeling (PC1—concentric mean power, eccentric peak force, and modified reactive strength index; PC2—countermovement depth, eccentric mean power, and eccentric mean velocity; PC3—braking duration, jump height, peak power). Metrics from PC1 and PC3 were reduced across training and from both loading conditions. Metrics from PC2 were similarly affected by external loading but were less influenced by training-induced fatigue. Jump performances with the barbell and with shallower countermovement depths did not change throughout training. Thus, 20 kg loaded CMJs are stable neuromuscular measures suitable for tracking chronic training adaptations. Monitoring unloaded and 10 kg loaded CMJ performances, along with movement strategies (i.e., countermovement rates and depth), may help identify moments of accumulated fatigue to inform training and recovery adjustments and improve the sustainability of personnel.
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Capella S, Demoulin E, Wilkinson C, Hindle P. Longitudinal study of medical downgrades in the Royal Air Force. BMJ Mil Health 2021; 169:249-255. [PMID: 34035160 DOI: 10.1136/bmjmilitary-2021-001839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION As the focus of the Royal Air Force (RAF) shifts from sustained to contingency operations and the number of personnel is reduced, the burden of retained, medically downgraded personnel may affect operational readiness. The main aims were: to define the prevalence of morbidity leading to permanent medical downgrading; to determine at risk populations and identify areas for improvement. METHOD Database of personnel referred to the RAF Medical Board was analysed from January 2012 to October 2013 and January 2017 to December 2019. Patients were excluded if they did not require a formal medical board; incomplete and duplicate entries were also excluded. The primary reason for medical downgrade was categorised with an ICD-10 code. Further subanalysis compared musculoskeletal disease with age, individual trade groups and anatomic region. RESULTS 2% of RAF service personnel were permanently downgraded annually. Musculoskeletal disease was the leading cause for permanent downgrade across both periods: 58% and 49%. Female personnel were at a greater risk of musculoskeletal downgrade compared with males. Spinal and knee pathology were the leading cause for downgrading among 'high risk' personnel. Personnel downgraded due to musculoskeletal pathology were often retained in a limited role with 10% and 5% retained as medically fully deployable. 14% and 12% of personnel downgraded due to musculoskeletal pathology were medically discharged. CONCLUSION Musculoskeletal disease was the leading cause for permanent medical downgrades in the RAF. A greater proportion of downgraded personnel with musculoskeletal conditions were retained in service with medical limitations rather than medically discharged.
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Affiliation(s)
| | - E Demoulin
- Trauma and Orthopaedics, Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire, UK
| | - C Wilkinson
- Department of Occupational Medicine, RAF College Cranwell, Sleaford, Lincolnshire, UK
| | - P Hindle
- Trauma and Orthopaedic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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