Musculoskeletal injuries in British Army recruits: a prospective study of diagnosis-specific incidence and rehabilitation times

BMC Musculoskeletal Disorders

Iain R Spears²  Alexander N Bennett⁴  Mark Byers¹  Julie P Greeves³  Jagannath Sharma² 

[1] Medical Centre Defence Primary Healthcare, Infantry Training Centre Catterick Garrison, North Yorkshire, UK;School of Social Sciences and Law, Teesside University, Middlesbrough, UK;Department of Occupational Medicine, HQ Army Recruiting and Training Division, Trenchard Lines, Wilts, SN9 6BE, UK;Academic Department of Military Rehabilitation DMRC Headley Court, Surrey, UK

关键词: Rehabilitation;    Overuse injury;    Training load;    Military training;   

Others  :  1227785
DOI  :  10.1186/s12891-015-0558-6

 received in 2014-10-12, accepted in 2015-04-17,  发布年份 2015

【 摘 要 】

Background

Musculoskeletal injuries during initial military training are a significant medical problem facing military organisations globally. In order to develop an injury management programme, this study aims to quantify the incidence and rehabilitation times for injury specific diagnoses.

Methods

This was a prospective follow-up study of musculoskeletal injuries in 6608 British Army recruits during a 26-week initial military training programme over a 2-year period. Incidence and rehabilitation times for injury specific diagnoses were recorded and analysed.

Results

During the study period the overall incidence of musculoskeletal injuries was 48.6%, and the most common diagnosis was iliotibial band syndrome (6.2%). A significant proportion of the injuries occurred during the first 11 weeks of the programme. The longest rehabilitation times were for stress fractures of the femur, calcaneus and tibia (116 ± 17 days, 92 ± 12 days, and 85 ± 11 days, respectively). The combination of high incidence and lengthy rehabilitation indicates that medial tibial stress syndrome had the greatest impact on training, accounting for almost 20% of all days spent in rehabilitation.

Conclusion

When setting prevention priorities consideration should be given to both the incidence of specific injury diagnoses and their associated time to recovery.

【 授权许可】

   
2015 Sharma et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Wilkinson D, Rayson M, Bilzon JLJ. A physical demands analysis of the 24-week British Army Parachute Regiment recruit training syllabus. Ergonomics. 2008; 51:649-62.
• [2]Greeves J. Physical training of women in the military. J Defence Science. 2001; 6:228-38.
• [3]Blacker SD, Wilkinson DM, Bilzon JLJ, Rayson MP. Risk factors for training injuries among British Army recruits. Mil Med. 2008; 173:278-86.
• [4]Cowan DN, Jones BH, Frykman PN. Lower limb morphology and risk of overuse injury among male infantry trainees. Med Sci Sports Exerc. 1996; 28:945-52.
• [5]Almeida SA. Epidemiological patterns of musculoskeletal injuries and physical training. Med Sci Sports Exerc. 1999; 31(8):1176-82.
• [6]Knapik JJ, Hauewt KG, Marin R, Jones BH. Association between ambulatory physical activity and injuries in United States Army Basic Training. J Phys Act Health. 2011; 8:496-502.
• [7]Popovich RM, Gardner JW, Potter R, Knapik JJ, Jones BH. Effect of rest from running on overuse injuries in army basic training. Am J Prev Med. 2000; 18:147-55.
• [8]Sharma J. Training related musculoskeletal overuse injury risk factors: Research summary. Director General Army Medical Services Annual Report 2007 on the health of the army. DGAMS Camberly UK, UK; 2008.
• [9]Franklyn-Miller A, Wilson C, Bilzon J, McCrory P. Foot orthoses in the prevention of injury in initial military training a randomized controlled trial. Am J Sports Med. 2011; 39:30-7.
• [10]Knapik JJ, Graham B, Cobbs J, Thompson D, Steelman R, Jones B. A prospective investigation of injury incidence and risk factors among army recruits in combat engineer training. J Occup Med Toxicol. 2013a;5;8(1):5. doi: 10.1186/1745-6673-8-5.
• [11]Knapik JJ, Graham B, Cobbs J, Thompson D, Steelman R, Jones B. A prospective investigation of injury incidence and injury risk factors among army recruits in military police training. BMC Musculoskeletal Disord. 2013; 14:32.
• [12]Linenger JM, West LA. Epidemiology of soft-tissue/musculoskeletal injury among U.S. Marine recruits undergoing basic training. Mil Med. 1992; 157:491-3.
• [13]Sharma J. The development and evaluation of a management plan for musculoskeletal injuries in British Army recruits: A series of exploratory trials on medial tibia stress syndrome. PhD Thesis, Teesside University, 2013 (http://tees.openrepository.com/tees/handle/10149/312900).
• [14]Taanila H, Suni J, Pihlajamaki H, Mattila VM, Ohrankammen O, Vuorinen P et al.. Musculoskeletal disorders in physically active conscripts: a one-year follow-up study in the Finnish Defence Forces. BMC MusculoskeletDisord. 2009; 10:89. BioMed Central Full Text
• [15]Knapik JJ, Canham-Chervak M, Hauret K, Laurin MJ, Hoedebecke E, Craig S et al.. Seasonal variations in injury rates during American Army basic combat training. AnnOccupHyg. 2002; 46:15-23.
• [16]Brushoj C, Larsen K, Albrecht-Beste E, Nielsen MB, Loye F, Holmich P. Prevention of overuse injuries by a concurrent exercise program in subjects exposed to an increase in training load - A randomized controlled trial of 1020 army recruits. Am J Sports Med. 2008; 36:663-70.
• [17]Coppack RJ, Etherington J, Wills AK. The effects of exercise for the prevention of overuse anterior knee pain: a randomized controlled trial. Am J Sports Med. 2011; 39:940-8.
• [18]Sharma J, Weston M, Batterham AM, Spears IR. Gait Retraining and Incidence of Medial Tibial Stress Syndrome in Army Recruits. Med Sci Sports Exerc. 2014; 46:1684-92.
• [19]Caine DJ, Caine CG, Lindner KJ. The epidemiologic approach to sports injuries. In: Epidemiology of Sports Injuries. Caine DJ, Caine KJ, Lindner CG, editors. Human Kinetics, Champaign, IL; 1996: p.1-13.
• [20]Heir T, Glomsaker P. Epidemiology of musculoskeletal injuries among Norwegian conscripts undergoing basic military training. Scand J Med SciSpor. 1996; 6(3):186.
• [21]Fredericson M, Wun C. Differential diagnosis of leg pain in the athlete. J Am Podiatr MedAssoc. 2003; 93:321-4.
• [22]Craig DI. Current developments concerning medial tibial stress syndrome. PhysSportsmed. 2009; 37:39-44.
• [23]Galbraith RM, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009; 2:127-33.
• [24]Diehl JJ, Best TM, Kaeding CC. Classification and return-to-play considerations for stress fractures. Clin Sports Med. 2006; 25:17-28.
• [25]Clark TG, Bradburn MJ, Love SB, Altman DG. Survival analysis part I: basic concepts and first analyses. Br J Cancer. 2003; 89:232-8.
• [26]Kaufman K, Brodine S, Shaffer R. Military training-related injuries - Surveillance, research, and prevention. Am J Prev Med. 2000; 18:54-63.
• [27]Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A prospective study of running injuries: the Vancouver Sun Run in training clinics. Br J Sports Med. 2003; 37:239-44.
• [28]Luke AC, Kinney SA, D’Hemecourt PA, Baum J, Owen M, Micheli LJ. Determinants of injuries in young dancers. Med Probl Perform Ar. 2002; 17:105-12.
• [29]Bennett JE, Reinking MF, Pluemer B, Pentel A, Seaton M, Killian C. Factors contributing to the development of medial tibial stress syndrome in high school runners. J Orthop Sports PhysTher. 2001; 31:504-10.
• [30]Sharma J, Golby J, Greeves J, Spears IR. Biomechanical and lifestyle risk factors for medial tibia stress syndrome in army recruits: A prospective study. Gait Posture. 2011; 33:361-5.
• [31]Weishaar MD, McMillian DM, Moore JH. Identification and management of 2 femoral shaft stress injuries. J Orthop Sports PhysTher. 2005; 35:665-73.
• [32]Hershman EB, Lombardo J, Bergfeld JA. NOF stress fracture most athletes are able to return to full activity in 8 to 14 weeks. Femoral shaft stress fractures in athletes. Clin Sports Med. 1990; 9:111-9.
• [33]Jacobs JM, Cameron KL, Bojescul JA. Lower extremity stress fractures in the military. Clin Sports Med. 2014; 33:591-613.
• [34]Matheson GO, Clement DB, Mckenzie DC, Taunton JE, Lloyd-Smith DR, Macintyre JG. Stress fractures in athletes: a study of 320 cases. Am J Sports Med. 1987; 15:46-58.
• [35]Kader D, Saxena A, Movin T, Maffulli N. Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med. 2002; 36:940-8.
• [36]Paavola M, Orava S, Leppilahti J. Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients. Am J Sports Med. 2000; 28:77-82.
• [37]Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med. 2007; 41:211-6.
• [38]Carter JM, Izard RM, Blacker SD, Wilkinson DM. Rayson MP. Bilzon JLJ, The physical demands of the combined infantryman's course for foot guards at ITC Catterick. Optimal Performance Limited and ARTD, UK; 2006.
• [39]Meehan HI, Bull SJ, James DVB. The role of non-training stress in the development of the overtraining syndrome. J Sports Sci. 2002; 20:69-70.
• [40]Matos NF, Winsley RJ, Williams CA. Prevalence of nonfunctional overreaching/overtraining in young English athletes. Med Sci Sports Exerc. 2011; 43:1287-94.
• [41]Crowell HP. Reducing impact loading during running with the use of real-time visual feedback. J Orthop Sports PhysTher. 2010; 40:206-13.
• [42]Larsen K, Weidich F, Leboeuf-Yde C. Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts. J Manipulative PhysiolTher. 2002; 25:326-31.
• [43]Moen MH, Holtslag L, Bakker E, Barten C, Weir A, Tol JL et al.. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. Sports Med ArthroscRehabilTherTechnol. 2012; 4:12.
• [44]Sharma J, Greeves J, Goodwin N, Golby J, Spears, I: Efficacy of a New Rehabilitation Protocol on Medial Tibial Stress Syndrome in Recruits: A Pilot Study [abstract]. InProceedings of the Chartered Society of Physiotherapy Conference:10–11 October 2014; Birmingham UK. ISBN 978 1 904400 41.
• [45]Gunter P, Schwellnus MP. Local corticosteroid injection in iliotibial band friction syndrome in runners: a randomised controlled trial. Br J Sport Med. 2004; 38:269-72.
• [46]Jones BH, Canham-Chervak M, Sleet DA. An evidence-based public health approach to injury priorities and prevention: recommendations for the U.S. military. Am J Prev Med. 2010; 38:S1-10.
• [47]Gabbett TJ, Whyte DG, Hartwig TB, Wescombe H, Naughton GA. The Relationship Between Workloads, Physical Performance, Injury and Illness in Adolescent Male Football Players. Sports Med. 2014; 44:989-1003.