Physical training and exercise-related injuries - Surveillance, research and injury prevention in military populations

Athletes and soldiers must both develop and maintain high levels of physica l fitness for the physically demanding tasks they perform; however, the rou tine physical activity necessary to achieve and sustain fitness can result in training-related injuries. This article reviews data from a systematic i njury control programme developed by the US Army. Injury control requires 5 major steps: (i) surveillance to determine the size of the injury problem; (ii) studies to determine causes and risk factors for these injuries; (iii ) studies to ascertain whether proposed interventions actually reduce injur ies; (iv) implementation of effective interventions; and (v) monitoring to see whether interventions retain their effectiveness. Medical surveillance data from the US Army indicate that unintentional (acc idental) injuries cause about 50% of deaths, 50% of disabilities, 30% of ho spitalisations and 40 to 60% of outpatient visits. Epidemiological surveys show that the cumulative incidence of injuries (requiring an outpatient vis it) in the 8 weeks of US Army basic training is about 25% for men and 55% f or women; incidence rates for operational infantry, special forces and rang er units an about 10 to 12 injuries/100 soldier-months. Of the limited-duty days accrued by trainees and infantry soldiers who were treated in outpati ent clinics, 80 to 90% were the result of training-related injuries. US Army studies document a number of potentially modifiable risk factors fo r these injuries, which include high amounts of running, low levels of phys ical fitness, high and law levels of flexibility, sedentary lifestyle and t obacco use, amongst others. Studies directed at interventions showed that l imiting running distance can reduce the risk for stress fractures, that the use of ankle braces can reduce the likelihood of ankle sprains during airb orne operations and that the use of shuck-absorbing insoles does not reduce stress fractures during training. The US Army continues to develop a comprehensive injury prevention programm e encompassing surveillance, research, programme implementation and monitor ing. The findings from this programme, and the general principles of injury control therein, have a wide application in civilian sports and exercise p rogrammes.