Sports Medicine

, Volume 27, Issue 2, pp 111–125 | Cite as

Physical Training and Exercise-Related Injuries

Surveillance, Research and Injury Prevention in Military Populations
  • Bruce H. Jones
  • Joseph J. Knapik
Review Article

Abstract

Athletes and soldiers must both develop and maintain high levels of physical fitness for the physically demanding tasks they perform; however, the routine physical activity necessary to achieve and sustain fitness can result in training-related injuries. This article reviews data from a systematic injury 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 injuries; (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 (accidental) injuries cause about 50% of deaths, 50% of disabilities, 30% of hospitalisations and 40 to 60% of outpatient visits. Epidemiological surveys show that the cumulative incidence of injuries (requiring an outpatient visit) in the 8 weeks of US Army basic training is about 25% for men and 55% for women; incidence rates for operational infantry, special forces and ranger units are about 10 to 12 injuries/100 soldier-months. Of the limited-duty days accrued by trainees and infantry soldiers who were treated in outpatient clinics, 80 to 90% were the result of training-related injuries.

US Army studies document a number of potentially modifiable risk factors for these injuries, which include high amounts of running, low levels of physical fitness, high and low levels of flexibility, sedentary lifestyle and tobacco use, amongst others. Studies directed at interventions showed that limiting running distance can reduce the risk for stress fractures, that the use of ankle braces can reduce the likelihood of ankle sprains during airborne operations and that the use of shock-absorbing insoles does not reduce stress fractures during training.

The US Army continues to develop a comprehensive injury prevention programme encompassing surveillance, research, programme implementation and monitoring. The findings from this programme, and the general principles of injury control therein, have a wide application in civilian sports and exercise programmes.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Koplan JP, Powell KE, Sikes RK, et al. An epidemiologic study of the benefits and risks of running. JAMA 1982; 248: 3118–21PubMedCrossRefGoogle Scholar
  2. 2.
    Macera CA, Pate RR, Powell KE, et al. Predicting lower-extremity injuries among habitual runners. Arch Intern Med 1989; 49: 2565–8CrossRefGoogle Scholar
  3. 3.
    Garrick JG, Requa RK. Injuries in high school sports. Pediatrics 1978; 61: 465–9PubMedGoogle Scholar
  4. 4.
    Watson AWS. Incidence and nature of sports injuries in Ireland: analysis of four types of sports. Am J Sports Med 1993; 21: 137–43PubMedCrossRefGoogle Scholar
  5. 5.
    Tomlinson JP, Lednar WM, Jackson JD. Risk of injury in soldiers. Mil Med 1987; 152: 60–4PubMedGoogle Scholar
  6. 6.
    Knapik JJ, Ang P, Reynolds K, et al. Physical fitness, age and injury incidence in infantry soldiers. J Occup Med 1993; 35: 598–603PubMedCrossRefGoogle Scholar
  7. 7.
    Jones BH, Cowan DN, Tomlinson JP, et al. Epidemiology of injuries associated with physical training among young men in the Army. Med Sci Sports Exerc 1993; 25: 197–203PubMedGoogle Scholar
  8. 8.
    Jones BH, Bovee MW, Knapik JJ. The association between body composition, physical fitness, and injuries among male and female Army trainees. In: Marriott BM, Grumstrup-Scott J, editors. Body composition and physical performance. Washington, DC: National Academy Press, 1992: 141–73Google Scholar
  9. 9.
    Tentsch SM, Churchill RE. Principles and practices of public health surveillance. New York (NY): Oxford University Press, 1994Google Scholar
  10. 10.
    Thacker SB, Stroup DF. Future directions for comprehensive public health surveillance and health information systems in the United States. Am J Epidemiol 1994; 140: 383–97PubMedGoogle Scholar
  11. 11.
    Robertson LS. Injury epidemiology. New York (NY): Oxford University Press, 1992Google Scholar
  12. 12.
    Department of Defense Injury Surveillance and Prevention Work Group. Atlas of injuries in the United States Armed Forces. Mil Med (Suppl.). In pressGoogle Scholar
  13. 13.
    Songer TJ, LaPorte RE. Disability due to injury. In: Jones BH, Hanson BC, editors. Injuries in the military: a hidden epidemic. Falls Church (VA): Armed Forces Epidemiological Board, 1996: Tech Report USALHPPM 29 HA 4044 97, 2.1–2.12Google Scholar
  14. 14.
    Kowal DM. Nature and causes of injuries in women resulting from an endurance training program. Am J Sports Med 1980; 8: 265–9PubMedCrossRefGoogle Scholar
  15. 15.
    Bensel CK, Kish RN. Lower extremity disorders among men and women in Army basic training and effects of two types of boots. Natick (MA): US Army Natick Research and Development Laboratories Technical Report TR-83/026, 1983Google Scholar
  16. 16.
    Jones BH, Bovee MW, Harris JM, et al. Intrinsic risk factors for exercise-related injuries among male and female army trainees. Am J Sports Med 1993; 21: 705–10PubMedCrossRefGoogle Scholar
  17. 17.
    Bell NS, Mangione TW, Hemenway D, et al. High injury rates among female Army trainees: a function of gender. Natick (MA): US Army Research Institute of Environmental Medicine Technical Report MISC96–6, 1996Google Scholar
  18. 18.
    Westphal KA, Friedl KE, Sharp MA, et al. Health, performance and nutritional status of US Army women during basic combat training. Natick (MA): US Army Research Institute of Environmental Medicine Technical Report No. T96–2, 1995Google Scholar
  19. 19.
    Bensel CK. The effects of tropical and leather combat boots on lower extremity disorders among US marine Corps recruits. Natick (MA): US Army Natick Research and Development Command Technical Report 76–49-CEMEL, 1976Google Scholar
  20. 20.
    US Army. Military occupational classification and structure. Army regulations (AR) 611–201. Washington, DC: Headquarters, Department of the Army, 1994Google Scholar
  21. 21.
    Reynolds KL, Heckel HA, Witt CE, et al. Cigarette smoking, physical fitness, and injuries in infantry soldiers. Am J Prev Med 1994; 10: 145–50PubMedGoogle Scholar
  22. 22.
    Kraus JF, Conroy C. Mortality and morbidity from injuries in sports and recreation. Annu Rev Public Health 1984; 5: 163–92PubMedCrossRefGoogle Scholar
  23. 23.
    Jones BH, Manikowski R, Harris JR, et al. Incidence of and risk factors for injury and illness among male and female Army basic trainees. Natick (MA): United States Army Research Institute of Environmental Medicine Technical Report T19/88, 1988Google Scholar
  24. 24.
    Patterson HS, Woolley TW, Lednar WM. Foot blister risk factors in an ROTC summer camp population. Mil Med 1994; 159: 130–5PubMedGoogle Scholar
  25. 25.
    Neely FG. Intrinsic risk factors for exercise-related lower limb injuries. Sports Med 1998; 26 (4): 253–63PubMedCrossRefGoogle Scholar
  26. 26.
    Neely FG. Biomechanical risk factors for exercise-related lower limb injuries. Sports Med 1998; 26 (6): 395–413PubMedCrossRefGoogle Scholar
  27. 27.
    Brudvig TGS, Gudger TD, Obermeyer L. Stress fractures in 295 trainees: a one-year study of incidence as related to age, sex, and race. Mil Med 1983; 148: 666–7PubMedGoogle Scholar
  28. 28.
    Gardner LI, Dziados JE, Jones BH, et al. Prevention of lower extremity stress fractures: a controlled trial of a shock absorbent insole. Am J Public Health 1988; 78: 1563–7PubMedCrossRefGoogle Scholar
  29. 29.
    Rice DP, McKenzie EJ, et al. Cost of injuries in the United States: a report to congress. San Francisco (CA): Institute for Aging and Health, University of California, 1989Google Scholar
  30. 30.
    Wagener DK, Winn DW. Injuries in working populations: blackwhite differences. Am J Public Health 1991; 821: 1408–13CrossRefGoogle Scholar
  31. 31.
    Knapik JJ, Reynolds KL, Barson J. Influence of antiperspirants on foot blisters following road marching. Natick (MA): US Army Research Laboratory Technical Report ARL-TR-1333, 1997Google Scholar
  32. 32.
    Cowan D, Jones BH, Tomlinson JP, et al. The epidemiology of physical training injuries in the US Army infantry trainees: methodology, population and risk factors. Natick (MA): United States Army Research Institute of Environmental Medicine, Technical Report T4/89, 1988Google Scholar
  33. 33.
    Cowan DN, Jones BH, Robinson JR. Foot morphologic characteristics and risk of exercise-related injuries. Arch Fam Med 1993; 2: 773–7PubMedCrossRefGoogle Scholar
  34. 34.
    Cowan DN, Jones BH, Frykman PN, et al. Lower limb morphology and risk of overuse injury among male infantry trainees. Med Sci Sports Exerc 1996; 28: 945–52PubMedCrossRefGoogle Scholar
  35. 35.
    Giladi M, Milgrom C, Stein M, et al. The low arch, a protective factor in stress fractures. Orthop Rev 1985; 14: 81–4Google Scholar
  36. 36.
    Kelsey JL. The epidemiology of musculoskeletal disorders. New York (NY): Oxford University Press, 1982Google Scholar
  37. 37.
    Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise and physical fitness: definitions, and distinctions for health related research. Public Health Rep 1985; 100: 126–31PubMedGoogle Scholar
  38. 38.
    Pate RR. A new definition of youth fitness. Phys Sportsmed 1983; 11: 77–83Google Scholar
  39. 39.
    Wells KF, Dillon EK. The sit and reach - a test of back and leg flexibility. Res Q 1952; 23: 115–8Google Scholar
  40. 40.
    Bauman C, Knapik JJ, Jones B, et al. An approach to musculoskeletal profiling of women in sports. In: Cantu R, Gillespie R, editors. Sports medicine, sports science: bridging the gap. Lexington (MA): Franklin Press, 1982: 61–72Google Scholar
  41. 41.
    Ramos MU, Knapik JJ. Instrumentation and techniques for the measurement of muscular strength and endurance in the human body. Natick (MA): United States Army Research Institute of Environmental Medicine. Technical Report T2-80, 1979Google Scholar
  42. 42.
    Knapik JJ, Wright J, Lowal D, et al. The influence of US Army basic initial entry training on the muscular strength of men and women. Aviat Space Environ Med 1980; 51: 1086–90PubMedGoogle Scholar
  43. 43.
    Vogel JA, Kirkpatrick JW, Fitzgerald PI, et al. Derivation of anthropometry based body fat equations for the Army’s weight control program. Natick (MA): US Army Research Institute of Environmental Medicine Technical Report 17–88, 1988Google Scholar
  44. 44.
    Reynolds K, Knapik J, Hoyt R, et al. Association of training injuries and physical fitness in US Army combat engineers [abstract]. Med Sci Sports Exerc 1994; 26: S219Google Scholar
  45. 45.
    Knapik JJ, Bauman CL, Jones BH, et al. Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. Am J Sports Med 1991; 19: 76–81PubMedCrossRefGoogle Scholar
  46. 46.
    Knapik JJ, Jones BH, Bauman CL, et al. Strength, flexibility and athletic injuries. Sports Med 1992; 14: 277–88PubMedCrossRefGoogle Scholar
  47. 47.
    Morris AF. Sports medicine handbook. Dubuque (IA): WC Brown, 1984Google Scholar
  48. 48.
    Amoroso PJ, Reynolds KL, Barnes JA, et al. Tobacco and injuries: an annotated bibliography. Natick (MA): US Army Research Institute of Environmental Medicine Technical Report TN96–1, 1996Google Scholar
  49. 49.
    Jones BH, Cowan DN, Knapik JJ. Exercise, training and injuries. Sports Med 1994; 18: 202–14PubMedCrossRefGoogle Scholar
  50. 50.
    Marti B, Vader JP, Minder CE, et al. On the epidemiology of running injuries: the 1984 Bern Grand-Prix study. Am J Sports Med 1988; 16: 285–94PubMedCrossRefGoogle Scholar
  51. 51.
    Macera CA. Lower extremity injuries in runners: advances in prediction. Sports Med 1992; 13: 50–7PubMedCrossRefGoogle Scholar
  52. 52.
    Macera CA, Jackson KL, Hagenmaier GW, et al. Age, physical activity, physical fitness, body composition and incidence of orthopaedic problems. Res Q 1989; 60: 225–33Google Scholar
  53. 53.
    Shaffer RA. Musculoskeletal injury project. Colloquium on Epidemiology of Fitness Training and Execise-Related Injuries (session G-9), 43rd Annual Meeting of the American College of Sports Medicine, Cincinnati (OH); 1996 May 29-Jun 1Google Scholar
  54. 54.
    Craig SC, Morgan J. Parachuting injury surveillance: Fort Bragg (NC), May 1993 to December 1994. Mil Med 1997; 162: 162–4PubMedGoogle Scholar
  55. 55.
    Amoroso PJ, Ryan JB, Bickley BT, et al. Braced for impact: reducing military paratroopers’ ankle sprains using outsidethe- boot braces. J Trauma 1998; 45: 575–80PubMedCrossRefGoogle Scholar
  56. 56.
    Lillywhite LP. Analysis of extrinsic factors associated with 379 injuries occurring during 34,236 military parachute descents. J R Army Med Corps 1991; 137: 115–21PubMedGoogle Scholar
  57. 57.
    Rovere GD, Clarke TJ, Yates CS, et al. Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries. Am J Sports Med 1988; 16: 228–33PubMedCrossRefGoogle Scholar
  58. 58.
    Sharp S, Knapik J, Jones B. Ankle braces effectively reduce recurrence of ankle sprains in female soccer players. J Athlete Train 1997; 32: 21–4Google Scholar
  59. 59.
    Finestone A, Shlamkovitch N, Eldad A, et al. A prospective study of the appropriateness of a foot-shoe fit and training shoe type of incidence of overuse injuries among infantry recruits. Mil Med 1992; 157: 489–90PubMedGoogle Scholar
  60. 60.
    James SL, Bates BT, Osternig LR. Injuries to runners. Am J Sports Med 1978; 6: 40–50PubMedCrossRefGoogle Scholar
  61. 61.
    Brody DM. Running injuries. CIBA Clin Symp 1980; 32: 1–36Google Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  • Bruce H. Jones
    • 1
  • Joseph J. Knapik
    • 1
  1. 1.US Army Center for Health Promotion and Preventive MedicineAberdeen Proving GroundMarylandUSA
  2. 2.Division of Unintentional Injury PreventionNational Center for Injury Prevention and ControlAtlantaUSA

Personalised recommendations