Reducing Musculoskeletal injuries in SF soldiers

A fairly recent article in the Journal of Special Operations Medicine (JSOM)* examined the Musculoskeletal injuries from 5th group.

The authors decided to quantify the rates and types of these injuries in SF using the records from 5th group, “who treated numerous middle-aged team sergeants with shoulder, back, and knee overuse injuries”
The authors noted “Special Forces, and Ranger units are about 10 to 12 injuries per 100 Soldier-months, which is comparable to collegiate endurance athletes. Of all the types of units studied, Special Forces has the highest incidence of injury rate at 12.1 per 100 Soldier-months.”

This study revealed that physical training caused 50% of all injuries, and 30% were linked to running. Injuries resulted in 10-times the number of profile days (lost work days) as illnesses with the leading reason for outpatient visits in our Group was for musculoskeletal disorders.

The locations of affected musculoskeletal conditions in descending order include: back/neck (31%), ankle (10%), shoulder (10%), and knee (10%).

The authors found that “…over 40% of all clinical diagnoses in the 5th Group Clinic were for musculoskeletal problems.” This translated into injured members of 5th group being put on “light duty” an average of 20 to 30 days each which has “significant” operational impact on the unit.

It was interesting to note that in other army units studied, musculoskeletal injuries are more common in the lower extremities (e.g., knees and ankles) but in SF, upper extremity injuries (e.g., lower back, upper back, shoulders, etc) are more common. The authors theorized “This may be due to the slightly older average age of our Soldiers versus conventional units, in addition to the cumulative effect of repetitive micro trauma from airborne operations, combatives training, wearing heavy body armor, and carrying heavy loads.”

This article covered a bunch of additional info about injury rates and other details interested parties (trainers, docs, etc) can look up the full article for additional details there. Of most interest to me, was their comments on prevention:
“Finally to focus more on prevention, Special Forces Groups should modify unit physical training programs to incorporate the fitness and performance fundamentals used in today’s top athletic programs. Military researchers have shown that modified physical training programs can result in lower injury rates with improvements in physical fitness. Training regimens that emphasize core strength and cross-training would likely increase physical readiness while decreasing the incidence of spine and lower extremity injuries.”

I agree with all of the above. As mentioned, training hard and training smart, are not always the same thing. The latter leading to greater performance and reduced injury rates, with improved operational readiness and (potentially) greater operational longevity for the SF soldier. The top coaches involved in “today’s top athletic programs” follow similar guidelines I mentioned regarding programs that follow a wave form pattern vs. a linear pattern I had mentioned in other blog posts here.
I’m happy to see the medical and training community within the SOF community is starting to see the benefits in both performance -and reduced rates of injuries – following more modern concepts in training already being utilized by the top athletic programs and or coaches in the field. The authors finished their report by summing it up nicely:

“By making these changes to training and resourcing, Special Forces Groups will be investing in our most lethal weapon—the individual Special Forces Soldier.”

* Clinical Diagnoses in a Special Forces Group: The Musculoskeletal Burden
James H. Lynch, MD, MS and Mark P. Pallis, DO, FAAOS. Journal of Special Operations Medicine (JSOM): Volume 8, Edition 2 / Spring 2008, 76-79