Page 43 - JSOM Spring 2023

TABLE 3 Type of Musculoskeletal Injuries Among 142 SWCC higher among SWCC Operators (22.1%) as compared to
Operators and 187 CQT Students During a One-Year Period CQT students (16.5%), but this difference was not statisti-
[Count (Percent)] cally significant (p = 0.163). The discrepancy in MSI inci-
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Musculoskeletal Injury Type SWCC Operators CQT Students dence between SWCC Operators and CQT students in these
Bursitis 1 (2.6) 2 (2.0) two studies may be due to the differences in the source of MSI
Capsulitis 0 (0.0) 1 (1.0) data (medical chart-review in the previous study versus self-
Chondromalacia/ 1 (2.6) 0 (0.0) reported in the current study), differences in medical care seek-
Patellofemoral Pain ing behavior, and differences in tendency to self-report MSIs
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Concussion 2 (5.3) 0 (0.0) between the two groups. Previous studies have shown that
9,17
Disc injury 1 (2.6) 0 (0.0) military trainees often are reluctant to seek medical care. In
Dislocation 4 (10.5) 1 (1.0) a study of US Army trainees undergoing initial entry training,
a large percentage (64%) of trainees with self-reported symp-
Fracture 2 (5.3) 4 (4.1) toms of MSI did not seek medical care or report the MSI to
Impingement 2 (5.3) 1 (1.0) leadership. The most common reasons for not seeking medical
Inflammation 1 (2.6) 11 (11.2) care were the desire to graduate on time and to avoid profile.
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Labral tear 1 (2.6) 0 (0.0) Although a similar study has not been conducted among NSW
Meniscal 1 (2.6) 0 (0.0) personnel, it is likely that CQT students could be reluctant to
Pain/Spasm/Ache 6 (15.8) 19 (19.4) seek medical care for insidious-onset MSIs caused by repeti-
Periostitis 0 (0.0) 3 (3.1) tive microtrauma and overtraining, such as running- associated
Sprain 7 (18.4) 14 (14.3) MSIs, especially since running is an important part of NSW
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Strain 4 (10.5) 9 (9.2) recruits’ physical training. Further investigation of the prev-
Stress Fracture 1 (2.6) 11 (11.2) alence of medical care avoidance in various trainee and ac-
tive-duty military populations is warranted.
Subluxation 0 (0.0) 2 (2.0)
Tendonitis/Tenosynovitis/ A comparison of medical chart-reviewed and self-reported
Tendinopathy 3 (7.9) 17 (17.3) MSIs during the same time period within a sample of US Army
Other 1 (2.6) 1 (1.0) 101st Airborne (Air Assault) Division soldiers showed that
Unknown 0 (0.0) 2 (2.0) there was under-counting of MSIs from both sources of data,
Total 38 98 but there also is selective under-reporting of MSIs based on
SWCC = Special Warfare Combatant-Craft Crewman, CQT = Crew- MSI anatomic location and MSI type. There is a need for
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man Qualification Training analysis of factors that influence self-reporting of MSIs and
seeking medical care for MSIs among Special Forces military
physical training. Most MSIs were caused by a non-contact populations, such as the SWCC Operators and CQT students
mechanism, and more than half of the MSIs among CQT stu- included in this analysis, as well as to identify strategies to
dents were considered overuse. encourage seeking medical care when required.

MSI Frequency Anatomic Location of MSIs
The one-year cumulative incidence reported in this study The most frequent anatomic location for self-reported MSIs
was significantly higher among CQT students as compared in both SWCC Operators (50.0% of MSIs) and CQT students
to SWCC Operators (37.4% versus 21.2%, p = 0.002). Spe- (66.3%) in the current study was the lower extremity. This
cial Warfare training is substantially different from other en- is in agreement with the analysis of medical chart-reviewed
try-level military training in terms of its nature and intensity, MSIs among SWCC Operators and CQT students, in which
but similar high rates of MSIs have been reported in other US lower extremity MSIs accounted for 36.7% and 63.6% of
military trainee populations, including 39.5% of men during MSIs in SWCC Operators and CQT students, respectively.
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eight weeks of US Army Basic Combat Training, 39.6% of men When anatomic sub-location for MSIs in SWCC Operators
during 12 weeks of US Marine Corps boot camp training, and was analyzed in the current study, the most common sub-
615.6 MSI visits/1000 men during six weeks of US Air Force locations were the knee (28.9%), shoulder (21.1%), and
Academy Basic Cadet Training. 14–16 For SWCC Operators, a lumbo-pelvic spine/low back (13.2%). This is in alignment
report published by the NHRC reported a high prevalence of with the three most common sub-locations for self-reported
self-reported MSIs (64.9%). This, however, was the prevalence MSIs reported by the NHRC (low back: 33.6%, knee: 21.5%,
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of MSIs and included any MSI sustained while the subject was shoulder: 14.1%) and the descriptive analysis of medical-chart
a SWCC Operator. In comparison, the current study included reviewed MSIs ( lumbo-pelvic spine: 21.7%, shoulder: 20.0%,
only those MSIs sustained during a period of one year prior knee: 15.0%). Though the relative ranking of the three most
5,6
to the date of survey. Therefore, direct comparisons cannot common sub- locations differed across the three studies, the
be made between the studies. Interestingly, the NHRC study consistent finding of these as the most common sub-locations
among SWCC Operators showed that the lowest rates for seek- underscores the importance of identifying modifiable risk fac-
ing medical care were for traumatic injuries (primarily minor tors and developing prevention strategies for knee, shoulder,
cuts and abrasions) as well as chronic pain. The SWCC Oper- and low back MSIs in SWCC Operators. SWCC Operators
ators who did not seek medical care for chronic pain reported are exposed to turbulent conditions when in small boats in
that they did not seek medical care because they believed that the open seas, and this is probably the cause of the high oc-
there was nothing that could be done about the pain. 6 currence of low back pain in this group of military personnel. 6
A previous study of medical chart-reviewed MSIs demon- The most frequent anatomic sub-location of MSIs among
strated that the one-year cumulative incidence of MSI was CQT students in the current study were the lower leg (20.4%),

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