Abstract
The most common reason of medical evacuation for non-combat related injuries appears to be related to the musculoskeletal system. This is reported during both military deployments as well as during basic combat training. The most common cause of non-combat musculoskeletal injuries appear to occur from overuse, generally as a result of physical training. Overuse injuries are considered an outcome of the overtraining syndrome, which is considered a continuum of negative adaptations to training. Symptoms appear when the training stimulus has reached the point where the intensity and or volume of training have become too excessive, coupled with inadequate rest and recovery. These are issues that are quite common within the military during both training and deployment. During periods of deployment additional physiological stresses such as the environment (altitude, cold and heat), and nutritional and sleep deprivation may pose significant challenges on the health and performance of the soldier. This is often manifested during sustained combat operations, in which the ability to provide rest and recovery become secondary to the mission’s objectives. This chapter will focus on the frequency, mechanism and risks associated with overuse injuries reported during both military training and deployment.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Abt, J.P., Sell, T.C., Lovalekar, M.T., Keenan, K.A., Bozich, A.J., Morgan, J.S., Kane, S.F., Benson, P.J., Lephart, S.M.: Injury epidemiology of U.S. army special operations forces. Mil. Med. 179(10), 1106–1112 (2014)
AFHSC: Medical evacuations from operation Iraqi Freedom/Operation New Dawn, active and reserve components, US Armed Forces, 2003–2011. Med. Surv. Monthly Rep. 19, 18–21 (2012)
Amos, D., Hansen, R., Lau, W.M., Michalski, J.T.: Physiological and cognitive performance of soldiers conducting routine patrol and reconnaissance operations in the tropics. Mil. Med. 165(12), 961–966 (2000)
Armstrong, L.E.: Performing in Extreme Environments. Human Kinetics, Champaign, IL (2000)
Attwells, R.L., Birrell, S.A., Hooper, R.H., Mansfield, N.J.: Influence of carrying heavy load on soldiers’ posture, movements, and gait. Ergonomics 49(14), 1527–1537 (2006)
Bell, N.S., Mangione, T.W., Hemenway, D., Amoroso, P.J., Jones, B.H.: High injury rate among female trainees; a function of gender? Am. J. Prev. Med. 18(3S), 141–146 (2000)
Belmont Jr, P.J., Goodman, G.P., Waterman, B., DeZee, K., Burks, R., Owens, B.D.: Disease and nonbattle injuries sustained by a U.S. Army Brigade Combat team during operation Iraqi Freedom. Mil. Med. 175(7), 469–476 (2010)
Bergeron, M.F., Nindl, B.C., Deuster, P.A., Baumgartner, N., Kane, S.F., Kraemer, W.J., Sexauer, L.R., Thompson, W.R., O’Connor, F.G.: Consortium for health and military performance and American College of sports medicine consensus paper on extreme conditioning programs in military personnel. Current Sports Med. Rep. 10(6), 383–389 (2011)
Bergman, B.P., Miller, S.A.S.J.: Equal opportunities, equal risks? Overuse injuries in female military recuits. J. Public Health Med. 23(1), 35–39 (2001)
Breitheupt, M.D.: Zur pathologie des menschlicen fusses. Medicinische Ztg 24, 169 (1855)
Bullock, S.H., Jones, B.H., Gilchrist, J., Marshall, S.W.: Prevention of physical training-related injuries recommendations for the military and other active populations based on expedited systematic reviews. Am. J. Prev. Med. 38(1), S156–S181 (2010)
Cawkill, P., Rogers, A., Knight, S., Spear, L.: Women in Ground Close Combat Roles: The Experiences of Other Nations and a Review of the Academic Literature. Defense Science and Technology Labroratory, Porton Down (2009)
Cheung, S.: Advanced Environmental Exercise Physiology. Human Kinetics; Champaign, IL (2009)
Cho, J.H., Lee, I., Hammamieh, R., Wang, K., Baxter, D., Scherler, K., Etheridge, A., Kulchenko, A., Gautam, A., Muhie, S., Chakraborty, N., Galas, D.J., Jett, M., Hood, L.: Molecular evidence of stress-induced acute heart injury in a mouse model simulating posttraumatic stress disorder. Proc. Natl. Acad. Sci. 111(8), 3188–3193 (2014)
Christensen, P.A., Jacobsen, O., Thorlund, J.B., Madsen, T., Møller, C., Jensen, C., Aagaard, P.: Changes in maximum muscle strength and rapid muscle force characteristics after long-term special support and reconnaissance missions: a preliminary report. Mil. Med. 173(9), 889–894 (2008)
Daniels, W.L., Kowal, D.M., Vogel, J.A., Stauffer, R.M.: Physiological effects of a military training program on male and female cadets. Aviat. Space Environ. Med. 50(6), 562–566 (1979)
Epstein, Y., Yanovich, R., Moran, D.S., Heled, Y.: Physiological employment standards IV: integration of women in combat units physiological and medical considerations. Eur. J. Appl. Physiol. 113, 2673–2690 (2013)
Evans, R.K., Antczak, A.J., Lester, M., Yanovich, R., Israeli, E., Moran, D.S.: Effects of a 4-month recruit training program on markers of bone metabolism. Med. Sci. Sports Sci. 40(11), S660–S670 (2008)
Finestone, A., Milgrom, C.: How stress fracture incidence was lowered in the Israeli army: a 25-yr struggle. Med. Sci. Sports Exerc. 40(11S), S623–S629 (2008)
Finestone, A., Milgrom, C., Evans, R., Yanovich, R., Constantini, N., Moran, D.S.: Overuse injuries in female infantry recruits during low-intensity basic training. Med. Sci. Sports Sci. 40(11), S630–S635 (2008)
Giladi, M., Milgrom, M.O.C., Danon, Y.L.: Stress fractures in military recruits; a prospective study evaluating the incidence, clincial presentation and possible risk factors. Med. Corps Int. 3, 21–26 (1988)
Gomez-Merino, D., Chennaoui, M., Burnat, P., Drogou, C., Guezennec, C.Y.: Immune and hormonal changes following intense military training. Mil. Med. 168(12), 1034–1038 (2003)
Greene, D.A., Naughton, G.A.: Adaptive skeletal responses to mechanical loading during adolescence. Sports Med. 36(9), 723–732 (2006)
Grier, T., Canham-Chervak, M., McNulty, V., Jones, B.H.: Extreme conditioning programs and injury risk in a US army brigade combat team. US Army Med Depart. J., 36–47 (2013)
Haslam, D.E.: The military performance of soldiers in sustained operations. Aviat. Space Environ. Med. 55(3), 216–221 (1984)
Hauret, K.G., Jones, B.H., Bullock, S.H., Canham-chervak, M., Canada, S.: Musculoskeletal injuries; description of an under-recognized problem among military personnel. Am. J. Prev. Med. 38(1S), S61–S70 (2001)
Headquarters Department of the Army: Technical Bulletin: Prevention and Control of Muscusloskeletal Injuries Associated with Physical Training. Headquarters, Department of the Army, Washington, DC (2011)
Heavens, K.R., Szivak, T.J., Hooper, D.H., Dunn-Lewis, C., Comstock, B.A., Flanagan, S.D., Looney, D.P., Kupchak, B.R., Maresh, C.M., Volek, J.S., Kraemer, W.J.: The effects of high intensity short rest resistance exercise on muscle damage markers in men and women. J. Strength Conditioning Res. 28(4), 1041–1049 (2014)
Hines, L.A., Sundin, J., Rona, R.J., Wessely, S., Fear, N.T.: Posttraumatic stress disorder post Iraq and Afghanistan: prevalence among military subgroups. Can. J. Psychiatry 59(9), 468–479 (2014)
Hodgdon, J.A., Hesslink, R.L., Hackney, A.C., Vickers, R.R., Hilbert, R.P.: Norwegian military field exercises in the arctic: cognitive and physical performance. Arctic Med. Res. 50(Suppl 6), 132–136 (1991)
Hoffman, J.: Physiological Aspects of Sport Training and Performance, pp. 395–412. Human Kinetics, Champaign, IL (2014)
Jepsen, K.J., Evans, R., Negus, C.H., Gagnier, J.J., Centi, A., Erlich, T., Hadid, A., Yanovich, R., Moran, D.S.: Variation in tibial functionality and fracture susceptibility among healthy, young adults arises from the acquisition of biologically distinct sets of traits. J. Bone Min. Res. 28, 1290–1300 (2013)
Jones, B.H., Bovee, M.W., Harris, J.H., Cowan, D.N.: Intrinsic risk factors for exercise-related injuries among male and female Army trainees. Am. J. Sports Med. 21, 705–710 (1993)
Jones, B.H., Cowan, D.N., Tomlinson, J.P., Robinson, J.R., Polly, D.W., Frykman, P.N.: Epidemiology of injuries assocaited with physical training among young men in the army. Med. Sci. Sports Exerc. 25(2), 197–203 (1993)
Jones, B.H., Perrotta, D.M., Canham-chervak, M.L., Nees, M.A., Brundage, J.F.: Injuries in the military; a review and commentary focused on prevention. Am. J. Prev. Med. 18(3S), 71–84 (2000)
Jordaan, G., Schwellnus, M.P.: The incidence of overuse injuries in military recruits during basic military training. Mil. Med. 159(6), 421–426 (1994)
Kaufman, K.R., Brodine, S., Shaffer, R.: Military training-related injuries; surveillance, research, and prevention. Am. J. Prev. Med. 18(3S), 54–63 (2000)
Knapik, J.J., Bullock, S.H., Canada, S., Toney, E., Wells, J.D., Hoedebecke, E., Jones, B.H.: Influence of an injury reduction program on injury and fitness outcomes among soldiers. Inj. Prev. 10(1), 37–42 (2004)
Knapik, J.J., Daniels, W., Murphy, M., Fitzgerald, P., Drews, F., Vogel, J.: Physiological factors in infantry operations. Eur. J. Appl. Physiol. 60, 233–238 (1990)
Knapik, J.J., Montain, S.J., McGraw, S., Grier, T., Ely, M., Jones, B.H.: Stress fracture risk factors in basic combat training. Int. J. Sports Med. 33, 940–946 (2012)
Knapik, J.J., Reynolds, K.L., Harman, E.: Soldier load carriage: historical, physiological, biomechanical, and medical aspects. Mil. Med. 169, 45–56 (2004)
Knapik, J.J., Rieger, W., Palkoska, F., Camp, S.V., Darakjy, S.: United States Army physical readiness training: rationale and evaluation of the physical training doctrine. J. Strength Conditioning Res. 23(4), 1353–1362 (2009)
Knapik, J.J., Sharp, M.A., Canham-Chervak, M., Hauret, K., Patton, J.F., Jones, B.H.: Risk factors for training-related injuries among men and women in basic combat training. Med. Sci. Sports Sci. 33(6), 946–954 (2001)
Knapik, J.J., Spies, A., Grier, T., Sharp, M.A., Lester, M.E., Marin, R., Jones, B.H.: Injuries before and after deployments to Afghanistan and Iraq. Public Health 126, 498–506 (2012)
Kreider, R., Fry, A.C., O’Toole, M.: Overtraining in sport: terms, definitions, and prevalence. Overtraining Sport, 309–331
Kryskow, M.A., Beidleman, B.A., Fulco, C.S., Muza, S.R.: Performance during simple and complex military psychomotor tasks at various altitudes. Aviat. Space Environ. Med. 84(11), 1147–1152 (2013)
Lauder, T.D., Baker, S.P., Smith, G.S., Lincoln, A.E.: Sports and physical training injury hospitalizations in the army. Am. J. Prev. Med. 18(3S), 118–128 (2000)
Lester, M.E., Knapik, J.J., Catrambone, D., Antczak, A., Sharp, M.A., Burrell, L., Darakjy, S.: Effect of a 13-month deployment to Iraq on physical fitness and body composition. Mil. Med. 175(6), 417–423 (2010)
Libster, D., Heled, Y., Shapiro, Y., Epstein, Y.: Physiological aspects of female in combat. Harefuah 137, 521–525 (1999)
Lieberman, H.R., Bathalon, G.P., Falco, C.M., Kramer, F.M., Morgan, C.A., Niro, P.: Severe decrements in cognition function and mood induced by sleep loss, heat, dehydration, and undernutrition during simulated combat. Biol. Psychiatry 57(4), 422–429 (2005)
Lieberman, H.R., Tharion, W.J., Shukitt-Hale, B., Speckman, K.L., Tulley, R.: Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training. Sea-air-land. Psychopharmacology 164(3), 250–261 (2002)
Lutz, L.J., Karl, J.P., Rood, J.C., Cable, S., Williams, K.W., Young, A.J., McClung, J.P.: Vitamin D status, dietary intake, and bone turnover in female soldiers during military training: a longitudinal study. J. Int. Soc. Sports Nutr. 9(38), 1–7 (2012)
Margolis, L.M., Crombie, A.P., McClung, H.L., McGraw, S.M., Rood, J.C., Montain, S.J., Young, A.J.: Energy requirements of US army special operation forces during military training. Nutrients 6, 1945–1955 (2014)
Margolis, L.M., Murphy, N.E., Martini, S., Spitz, M.G., Thrane, I., McGraw, S.M., Blatny, J.M., Castellani, J.W., Rood, J.C., Young, A.J., Montain, S.J., Gundersen, Y., Pasiakos, S.M.: Effects of winter military training on energy balance, whole-body protein balance, muscle damage, soreness, and physical performance. Appl. Physiol. Nutr. Metab. 39(12), 1395–1401 (2014)
Meeusen, R., Duclos, M., Foster, C., Fry, A., Gleeson, M., Nieman, D., Raglin, J., Rietjens, G., Steinacker, J., Urhausen, A.: Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of sport science and the American college of sports medicine. Med. Sci. Sports Exerc. 45(1), 186–205 (2013)
Meyerhoff, J.L., Hebert, M.A., Huhman, K.L., Mougey, E.H., Oleshansky, M.A., Potegal, M., et al.: Operational stress and combat stress reaction: neurobiological approaches toward improving assessment of risk and enhancing intervention. In: Friedl, K., Lieberman, H.R., Ryan, D.H., Bray, G.A. (eds.) Countermeasures for Battlefield Stressors, pp. 27–87. Louisiana State University Press, Baton Rouge, Louisiana (2000)
Moran, D.S., Israeli, E., Evans, R., Yanovich, R., Constantini, N., Shabshin, N., Finestone, A.: Prediction model for stress fractures in young female recruits during basic training. Med. Sci. Sports Sci. 40, S636–S644 (2008)
Mottern, J.A., Simutis, Z.M.: Gender integration of U.S. Army basic training. In: Proceedings of the 36th Annual Conference of the International Military Testing Association; pp. 24–29, (1994)
Mudambo, K.S., Scrimgeour, C.M., Rennie, M.J.: Adequacy of food rations in soldiers during exercise in hot, day-time conditions assessed by doubly labelled water and energy balance methods. Eur. J. Appl. Physiol. 76(4), 346–351 (1997)
Muñoz, L., Norgan, G., Rauschhuber, M., Allwein, D., Powell, B.W., Mitchell, D., Gilliland, I., Beltz, S., Mahon, M., Mikan, V., Cook, J., Lowry, J., Richardson, C., Sethness, R., Etnyre, A., Jones, M.E.: An exploratory study of cardiac health in college athletes. Appl. Nurs. Res. 22(4), 228–235 (2009)
Nindl, B.S., Castellani, J.W., Warr, B.J., Sharp, M.A., Henning, P.C., Spiering, B.A., Scofield, D.E.: Physiological employment standards III: physiological challenges and consequences encountered during international military deployments. Eur. J. Appl. Physiol. 113, 2655–2672 (2013)
Nindl, B.C., Leone, C.D., Tharion, W.J., Johnson, R.F., Castellani, J.W., Patton, J.F., Montain, S.J.: Physical performance responses during 72 h of military operational stress. Med. Sci. Sports Exerc. 34(11), 1814–1822 (2002)
Ozcivici, E., Luu, Y.K., Adler, B., Qin, Y.X., Rubin, J., Judex, S., Rubin, C.T.: Mechanical signals as anabolic agents in bone. Nat. Rev. Rheumatol. 6, 50–59 (2010)
Pandolf, K.B., Moran, D.S.: Recent heat and cold strain predictive indices. Elsevier Ergon. Book Ser. 3, 487–494 (2005)
Peake, J.B.: Reflections on injuries in the military. The hidden epidemic. Am. J. Prev. Med. 18(3S), 4–5 (2000)
Peoples, G.E., Gerlinger, T., Craig, R., Burlingame, B.: The 274th forward surgical team experience during operation enduring freedom. Mil. Med. 170(6), 451–459 (2005)
Popovich, R.M., Gardner, J.W., Potter, R., Knapik, J.J., Jones, B.H.: Effect of rest from running on overuse injuries in Army basic training. Am. J. Prev. Med. 18(3S), 147–154 (2000)
Protzman, R.R., Griffis, C.G.: Stress fractures in men and women undergoing military training. J. Bone Joint Surg. 59, 825 (1977)
Rantalainen, T., Nikander, R., Daly, R.M., Heinonen, A., Sievänen, H.: Exercise loading and cortical bone distribution at the tibial shaft. Bone 48(8), 786–791 (2011)
Reynolds, K., Cosio-Lima, L., Bovill, M., Tharion, W., Williams, J., Hodges, T.: A comparison of injuries, limited-duty days, and injury risk factors in infantry, artillery, construction engineers, and special forces soldiers. Mil. Med. 174(7), 702–708 (2009)
Reynolds, K.L., White, J.S., Knapik, J.J., Witt, C.E., Amoroso, P.J.: Injuries and risk factors in a 100-mile (161 -km) infantry road march. Prev. Med. 18, 167–173 (1999)
Ristolainen, L., Heinonen, A., Waller, B., Kujala, U.M., Kettunen, J.A.: Gender differences in sport injury risk and types of injuries: a retrospective twelve-month study on cross-country skiers, swimmers, long-distance runners and soccer players. J. Sports Sci. Med. 8, 443–451 (2009)
Robling, A.G., Castillo, A.B., Turner, C.H.: Biochemical and molecular regulation of bone remodeling. Annu. Rev. Biomed. Eng. 8, 455–498 (2006)
Rodriguez-Soto, A., Jaworski, R., Jensen, A., Niederberger, B., Hargens, A.R., Frank, L.R., Kelly, K.R., Ward, S.R.: Effect of load carriage on lumbar spine kinematics. Spine 38(13), E783–E791 (2013)
Rodway, G.W., Muza, S.R.: Fighting in thin air: operational wilderness medicine in high Asia. Wilderness Environ. Med. 22(4), 297–303 (2011)
Roy, T.C.: Diagnoses and mechanisms of musculoskeletal injuries in an infantry brigade combat team deployed to Afghanistan evaluated by the brigade physical therapist. Mil. Med. 176, 903–908 (2011)
Roy, T.C., Ritland, B.M., Knapik, J.J., Sharp, M.A.: Lifting tasks are associated with injuries during the early portion of a deployment to Afghanistan. Mil. Med. 177, 716–722 (2012)
Sale, D.G., Jacobs, I., MacDougall, J.D., Garner, S.: Comparison of two regimens of concurrent strength and endurance training. Med. Sci. Sports Exerc. 22, 348–356 (1990)
Santtila, M., Häkkinen, K., Nindl, B.C., Kyröläinen, H.: Cardiovascular and neuromuscular performance responses induced by 8 weeks of basic training followed by 8 weeks of specialized military training. J. Strength Conditioning Res. 26(3), 745–751 (2012)
Sharp, M.A., Knapik, J.J., Walker, L.A., Burrell, L., Frykman, P.N., Darakjy, S.S., Lester, M.E., Marin, R.E.: Physical fitness and body composition after a 9-month deployment to Afghanistan. Med. Sci. Sports Exerc. 40(9), 1687–1692 (2008)
Sherrard, J., Lenn, M., Cassell, E., Stokes, M., Ozanne-Smith, J.: Injury prevention during physical activity in the Australian defence force. J. Sci. Med. Sport 7(1), 106–117 (2004)
Songer, T.J., Laporte, R.E.: Disabilities due to injury in the military. Am. J. Prev. Med. 18(3S), 33–40 (2000)
Tharion, W.J., Lieberman, H.R., Montain, S.J., Young, A.J., Baker-Fulco, C.J., Delany, J.P., Hoyt, R.W.: Energy requirements of military personnel. Appetite 44(1), 47–65 (2005)
Thorlund, J.B., Jakobsen, O., Madsen, T., Christensen, P.A., Nedergaard, A., Andersen, J.L., Aagaard, P.: Changes in muscle strength and morphology after muscle unloading in special forces missions. Scand. J. Med. Sci. Sports 21(6), e56–e63 (2011)
Tzila Zwas, S., Elkanovitch, R., Frank, G.: Interpretation and classification of bone scintigraphic findings in stress fractures. J. Nucl. Med. 28, 452–457 (1987)
Unwin, C., Hotoph, M., Hull, L., Ismail, K., David, A., Wessely, S.: Women in the persian gulf; lack of gender differences in long-term health effects of service in United Kingdom armed forces in the 1991 Persian gulf war. Mil. Med. 167, 406–413 (1991)
Vileikyte, L.: Stress and wound healing. clinical. Dermatology 25, 49–55 (2007)
Welsh, T.T., Alemany, J.A., Montain, S.J., Frykman, P.N., Tuckow, A.P., Young, A.J., Nindl, B.C.: Effects of intensified military field training on jumping performance. Int. J. Sports Med. 29(1), 45–52 (2008)
Yanovich, R., Evans, R., Israeli, E., Constantini, N., Sharvit, N., Merkel, D., Epstein, Y., Moran, D.S.: Differences in physical fitness of male and females recruits in gender-integrated Army basic training. Med. Sci. Sports Exerc. 40(11), S654–S659 (2008)
Zambraski, E.J., Yancosek, K.E.: Prevention and rehabilitation of musculoskeletal injuries during military operations and training. J. Strength Conditioning Res. 26(7), S101–S106 (2012)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Hoffman, J.R., Church, D.D., Hoffman, M.W. (2015). Overuse Injuries in Military Personnel. In: Gefen, A., Epstein, Y. (eds) The Mechanobiology and Mechanophysiology of Military-Related Injuries. Studies in Mechanobiology, Tissue Engineering and Biomaterials, vol 19. Springer, Cham. https://doi.org/10.1007/8415_2015_187
Download citation
DOI: https://doi.org/10.1007/8415_2015_187
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-33010-5
Online ISBN: 978-3-319-33012-9
eBook Packages: EngineeringEngineering (R0)