Bh. Jones et Jj. Knapik, Physical training and exercise-related injuries - Surveillance, research and injury prevention in military populations, SPORT MED, 27(2), 1999, pp. 111-125
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.