Page 40 - JSOM Spring 2023

Epidemiology of Musculoskeletal Injuries
Among Naval Special Warfare Personnel

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Mita Lovalekar, MBBS, PhD, MPH *; Karen A. Keenan, PhD ; Matthew Bird ;
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Debora E. Cruz, MSc ; Kim Beals, PhD, RD ; Bradley C. Nindl, PhD, FACSM 6
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ABSTRACT
Background: Musculoskeletal injuries (MSIs) are an important platoons as well as other Special Operations Forces (SOF)
cause of morbidity in the military, especially among Special Operators. CQT students undergo arduous training in sea-
Forces. The aim of this analysis was to describe MSIs among manship, maritime navigation, patrolling, marksmanship, and
two groups of Naval Special Warfare (NSW) personnel—Spe- combat before graduating and becoming SWCC Operators.
cial Warfare Combatant-Craft Crewman (SWCC) Operators SWCC Operators as well as CQT students are susceptible
and Crewman Qualification Training (CQT) students. Meth- to MSIs due to their high operational and physical training
ods: In this cross-sectional study, we describe self-reported demands. 5,6
MSIs that occurred during a one-year period and the calcu-
lated financial costs of MSIs. Group comparisons were con- There are very few peer-reviewed manuscripts about MSIs
ducted using Fisher’s exact tests and independent samples among SWCC Operators and CQT students. In a technical re-
t tests. Results: Data were available for 142 SWCC Operators port by the Naval Health Research Center (NHRC) describing
(26.9 ± 5.9 years, 1.8 ± 0.1 meters, 85.4 ± 10.4 kilograms) and self-reported injuries among SWCC Operators, 64.9% of the
187 CQT students (22.8 ± 3.2 years, 1.8 ± 0.2 meters, 81.4 ± Operators reported at least one injury event. MSI frequen-
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8.9 kilograms). The one-year cumulative MSI incidence was cies of 31.6/100 subjects/year and 17.0/100 subjects/year have
significantly lower among SWCC Operators (21.1%) com- been reported among SWCC Operators and CQT students,
pared to CQT students (37.4%, p = 0.002). The most common respectively, using MSI data derived from medical charts. To
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anatomic location for MSIs was the lower extremity (SWCC: the best of our knowledge, there are no other published studies
50.0% of MSIs, CQT: 66.3%). Physical training was the pre- of MSIs among CQT students.
dominant activity when MSIs occurred (SWCC: 31.6%, CQT:
77.6%). The lifetime cost of all the MSIs included in the anal- An injury epidemiology study among SEAL Operators re-
ysis was approximately $580,000 among 142 SWCC Opera- ported MSI rates ranging from 0.9 to 3.2 MSIs/100 subjects/
tors and $1.2 million among 187 CQT students. Conclusion: month and 23.1 MSIs/100 subjects/year as ascertained by
MSIs, especially those affecting the lower extremity and oc- medical chart review. The rates of MSIs were even higher
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curring during physical training, cause considerable morbid- among SQT students. Linenger et al. observed MSI frequency
ity and financial burden among NSW personnel. Many of the of 29.7 cases per 100 trainee-months, while Shwayhat et al.
musculoskeletal injuries are to musculotendinous tissue, which calculated 3.4 overuse MSIs per 1,000 trainee days. 8,9
typically results from tissue overload or inadequate recovery.
Further investigation of the preventable causes of these MSIs While the incidence of MSIs among NSW personnel is con-
and development of a customized, evidence-based MSI preven- sistently reported as high across studies, the MSI frequency,
tion program is required to reduce the burden of these MSIs. anatomic location, and MSI types reported have varied. Fur-
ther, there is a scarcity of peer-reviewed literature about MSIs
Keywords: Military personnel; incidence; cross-sectional stud- among SWCC Operators and CQT students. The aim of this
ies; self-report; sprains and strains study was to describe the burden of MSIs among a sample of
SWCC Operators and CQT students.

Introduction Methods
MSIs occur frequently among physically active populations, Study Participants
including athletes and military personnel. Among military per- The volunteers in this study were participants in a compre-
sonnel, MSIs can lead to loss of tactical readiness, disability, hensive human performance optimization and MSI prevention
high financial cost, and attrition from the military. 1–3 initiative among NSW personnel conducted by the University
of Pittsburgh, Pittsburgh, PA. At the time the study was con-
The NSW Command is a component of the United States Spe- ducted, only men could qualify as SWCC Operators and CQT
cial Operations Command. SWCC are responsible for the students. Study participants were active duty and free from
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insertion and extraction of NSW Sea Air and Land (SEAL) conditions that precluded participation in laboratory testing.
*Correspondence to MitaL@pitt.edu
1 Dr Mita Lovalekar is an epidemiologist affiliated with the Neuromuscular Research Laboratory, University of Pittsburgh, Pittsburgh, PA.
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2 Dr Karen A. Keenan is affiliated with Fitchburg State University, Fitchburg, MA. Matthew Bird, Debora E. Cruz, Dr Kim Beals, and
6 COL Bradley C. Nindl are all affiliated with the University of Pittsburgh, Pittsburgh, PA.
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