Page 82 - Journal of Special Operations Medicine - Spring 2014

Furthermore, Special Operators can be required to carry recruits’ physical activity 6 months prior to BUD/S,
heavy rucksacks for long distances and over challeng- Shwayhat et al. found that recruits who ran slower
ing terrain. For example, paratroopers within the 82nd than an 8 min/mile pace and on softer surfaces (e.g.,
1
Airborne Division in Afghanistan in 2003 carried an sand, grass, dirt, artificial track) and recruits with lower
average 46kg approach load and 60kg emergency ap- weekly running mileage and for shorter durations were
proach load. Increased combat load is associated with at greater risk for an overuse injury. Shwayhat et al.
47
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increased heart rate and respiratory rate, muscle fatigue, suggest that recruits prepare for BUD/S by running on
reduced marksmanship, knee pain, low back injuries, both hard (e.g., concrete and asphalt) and soft surfaces
stress fractures, and foot blisters. 50,52 In extreme cases, as a countermeasure to possibly reduce the incidence of
heavy rucksack carriage can lead to nerve damage of the overuse injuries.
upper body musculature, possibly resulting in rucksack
palsy. Orr et al. recommended that load carriage con- Additionally, the same group of researchers suggests
53
ditioning be conducted two to four times per month at gradual increases in speed, duration, and weekly mile-
a volume sufficient to provide a training stimulus but age as a preventive countermeasure. However, this re-
14
as to not cause a rapid overload prior to deployment. 54 search was published in 1994, and a thorough, detailed
training program with gradual increases in training in-
Aharony et al. studied the effects of 14 weeks of Navy tensity for both running and swimming, as well as an in-
SEAL preparatory training on overuse and irreversible jury prevention guide, is available for SEAL recruits on
injury to trainees’ lumbar sacral spine and right knee the official website. A further countermeasure includes
59
as indicated by magnetic resonance imaging. Prepara- the development of a durable, shock-absorbing orthotic
55
tory SEAL training has been described as “super physi- insert for military boots that also provides effective sup-
ological” in nature, and SEAL candidates train wearing port for minimizing ankle sprains. 11
ceramic vests weighing 7kg, carry 4- to 5.5kg rifles, and
carry up to 40% of their body weight while running Anterior knee pain syndrome (AKPS) is reportedly a com-
and marching for up to 90km. After the 14-week train- mon injury during strenuous military physical training
55
ing period, the volunteer trainees’ backs did not show due to temporary overexertion. A dynamic patellofem-
15
any signs of overuse injury. These findings are remark- oral brace has been suggested as a preemptive counter-
able considering that trainees in this study far exceeded measure to the development of anterior knee pain during
the U.S. National Institute for Occupational Safety and strenuous physical training. In a study by Van Tiggelen et
Health recommendations for loading limits in magni- al, military recruits were split into a brace group (n = 54)
tude and duration: the maximum acceptable lifting and control group (n = 113) before basic military train-
weight for industrial workers is 23kg under the most ing (BMT). The brace group wore two dynamic patello-
15
favorable conditions. Adams et al. stated that frequent femoral braces (as instructed by an experienced physical
56
lifting of heavy loads is a major risk factor for disc pro- therapist) during all physical activities at BMT. After 6
lapse, while Videman et al. concluded that maximal weeks of BMT, 18.5% of the brace group developed an-
57
weight lifting was associated with greater degeneration terior knee pain, compared to 37% of the control group,
throughout the entire lumbar spine. Although the find- indicating that a significantly lesser number of recruits de-
58
ings of Aharoney et al. suggest that healthy trainees can veloped anterior knee pain while wearing the braces than
safely participate in rigorous SEAL training with no with no brace (p = .020). Therefore, although the exact
acute evidence of damage to their lumbar sacral spines, mechanism of action remains unknown, these researchers
55
future research should examine the long-term effects of suggest that a patellofemoral brace is an effective preemp-
such training in the decades following a Navy SEAL’s tive countermeasure to AKPS during strenuous physical
career. Despite no evidence for acute back damage, the training. However, this research did not mention any
15
trainees’ knees showed signs of overuse injury. 55 negative effects of wearing the braces (e.g., performance
decrements, cumbersome mobility, perceived comfort,
The most common types of injuries among military per- etc.), so it may be necessary for additional research to
sonnel are musculoskeletal overuse injuries, in which be conducted. Furthermore, because the mental fortitude
the majority occur at or below the knee. For example, of Special Operators is quite different than the general
11
Kaufman et al. reported that musculoskeletal injury rates population, the acceptance of preemptive knee braces in
can range from 30 to 35 per 100 Navy special warfare this population should be studied.
candidates, and among 449 trainees, the most common
injuries were stress fractures, iliotibial band syndrome, Special Operators infiltrate target areas in a variety of
patellofemoral syndrome, Achilles tendinitis, and perios- ways, such as nighttime airborne parachute operations.
titis. These findings are analogous to a study of overuse The insertion itself poses a significant stressor in addition
11
injuries at BUD/S, with sprains, strains, and blisters as to the considerable operational stressors leading up to
additional common overuse injuries. In assessing SEAL the jump. For example, over 25% of U.S. Army Rangers
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74 Journal of Special Operations Medicine Volume 14, Edition 1/Spring 2014