Fall in: What military studies reveal about injury prevention

Injury prevention goes hand in hand with rehabilitation science. Injuries cost athletes and sports teams lost time and money. While most injury prevention studies are conducted on athletes, a review of US Marine Corp recruits sheds light on one aspect of injury prevention that deserves more consideration.

The Marines offer a unique setting in that recruits undergo initial and repeated fitness testing as they go through basic training. Athletes, on the other hand, typically let their sports performance speak to their level of fitness. The repeated standardized testing in the military, however, gives benchmarks that researchers can compare with performance.

When entering basic training, recruits undergo an initial strength test (IST). This test consists of a timed 1.5-mile run, max pull-ups, and max crunches. These combine for a composite score that officials compare to subsequent testing to measure progress. A study examined the results of IST testing of 103,309 recruits at Parris Island and compared them to the number of recruits that received a medical discharge or medical recycling of basic training⁽¹⁾. They found that in both men and women, those who performed better on the IST were less likely to suffer an injury during recruit training⁽¹⁾.

A research group in California went a step further to determine at which point in the training cycle the soldiers suffered injuries, what kind of injuries were most common, and confirm the relationship between physical fitness and injury⁽²⁾. Strains, sprains, and tendinitis accounted for nearly half of the injuries suffered by recruits. Most of these occurred during a conditioning hike.

Data analysis showed that those who scored better on the IST were less likely to suffer an injury during training. This correlation remained true for subsequent testing as well. The injured soldiers scored less than the uninjured on all fitness tests conducted before their injury. However, the overall incidence of injury decreased as the training and fitness level progressed. The researchers concluded that overall fitness decreased injury risk during basic training.

Practical implications

Most people generally consider athletes to be fit. However, training time is precious for both student and amateur athletes. Therefore, general conditioning is often left for the athlete to do on their own time, while official practice consists of sport-specific drill and strategy work. Without proper guidance, athletes may neglect important aspects of conditioning. They may incorporate specific strengthening activities but ignore supporting structures, leaving a weak-link in their kinetic chain.

This military study further supports the idea that fitness is associated with injury risk. What athletes portray as fitness could be adaptation. The body finds the most efficient way to execute repetitive tasks. Therefore, sports-specific performance may improve even though an athlete may neglect certain aspects of fitness training. Though clinicians may not see an athlete until they suffer an injury, this principle is good to keep in mind when considering a return to sport. If the rehabilitation plan only includes sport-specific movements and drills without a wholistic and balanced fitness approach, the athlete could be vulnerable to reinjury.

References

1. CAN Corporation: Technical Report 2014 DRM-2014-007869-Final. Fort Belvoir, VA, Defense Technical Information Center.
2. Military Medicine. 2019 March/April;184:511