Page 83 - Journal of Special Operations Medicine - Spring 2014

from the 2/75th Ranger Battalion during Operation Just Regardless, the use of preemptive ankle braces during
Cause did not sleep at least 24 hours prior to the jump an airborne insertion may be beneficial in reducing the
(December 1989) and only slept an average of 3 hr/day number of injured Operators prior to combat.
during the first 72 hours of combat. In addition to sleep
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deprivation, Rangers reported not eating an average of
17 hours prior to the jump. Their reports resulted in a Conclusions and Future Recommendations
35% casualty rate, and most of the injuries were mus- Special Operators are an elite military group both physi-
culoskeletal (sprains) and nonsurgical, with 90% occur- cally and mentally. They must endure extensive training
ring during the nighttime parachute insertion. The ankle for the toughest, often intricately detailed operations.
was the most frequently injured area (19.6%), in which Therefore, Special Operators often seek any opportunity
sprains constituted over 80% of these injuries. Of the to employ their skills against real enemy combatants.
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Rangers sustaining ankle injuries, 38% were physically This fearless mindset is necessary for Special Operations
unable to carry on with the mission, and 27% experi- and is further developed through rigorous training, in
enced limited mobility during the mission. However, which stressful combat scenarios are simulated to pre-
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despite little sleep and insufficient nourishment during pare Operators for real combat scenarios. Special Op-
the first few days of combat, as well as the tropical cli- erators must learn how to overcome many operational
mate (i.e., Panama), Rangers suffered no heat strokes. stressors in training, which will further develop their
skills for similarly stressful missions. As expected, high-
Also, the majority reported they had more energy than energy expenditure, underfeeding, sleep deprivation,
expected during battle, which may be attributed to their heavy equipment loads, and environmental factors dur-
high fitness levels and youth. Whether environmental ing SUSOPS can lead to changes in body composition
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variables, inadequate sleep, negative energy balance, and physical performance decrements, which may result
equipment stressors, or all concurrently were to blame in musculoskeletal injuries and mission mishaps. For ex-
for 90% of injuries occurring during the insertion, pre- ample, as a result of operational stressors, loss of lean
ventative countermeasures could be implemented to re- tissue and decrements in lower body power output has
duce the number of injured Operators prior to combat. been reported for SUSOPS lasting as little as 72 hours.
Furthermore, Kotwal et al. evaluated static-line para-
chute (T10C parachute) injuries sustained by the 75th A simple field test such as the maximal vertical jump test
Ranger Regiment during four nighttime combat airborne can be used to measure changes in lower body power
missions: two conducted in Afghanistan in 2001 and two output in Special Operators. Because these changes may
conducted in Iraq in 2003. Although the recommended negatively impact mission success, it is suggested that
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safety threshold for the T10C parachute is 360 pounds, commanders be aware of these declines when planning
the average total weight of the jumper plus equipment missions and consider implementing appropriate coun-
load ranged from 323 to 380 pounds across the four termeasures to attenuate physical changes during high-
missions. The risk of parachute injury is associated tempo missions or SSR immobilization. A nutritional
with equipment and weight: the heavier the parachutist countermeasure, the First Strike Ration, has been sug-
(jumper plus equipment), the faster the rate of descent, gested for repetitive 3- to 7-day missions. An additional
and the greater the force on impact. In total, 83 injuries 400 kcal of a high-carbohydrate supplement has been
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were sustained by 76 of 634 Rangers. Lower extremity recommended for Operators requiring higher energy,
injuries accounted for 68.7% of the injuries, and the foot although it is widely recommended that Special Opera-
was the most frequently injured (3.2%) followed by the tors optimize their nutrition, muscular strength, and
ankle (3.0%). The ankle is usually the most frequently in- power prior to missions. However, to these research-
jured anatomical region in parachuting, but Rangers in ers’ knowledge, no specific training program has been
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this study wore parachute ankle braces (PABs) mandated recommended and/or implemented as a countermeasure
as part of their uniform, which may have accounted for to attenuate decrements in lower body power output.
the lower than predicted ankle injury rates. 12 Nonetheless, Carlson and Jaenen have recommended
circuit training of specific targeted musculature from
Although this is the first published study of PAB use in a task movement analysis conducted by the Canadian
combat, the PAB ankle injury rate (3.0%) was signifi- Special Operations Regiment Assessment Center. 1
cantly lower (p <.001) than the combat non-PAB ankle
injury rate (10.8%) reported for Army Rangers in Pan- Research documenting the effectiveness of circuit train-
ama during Operation Just Cause. The use of PABs ing to prepare for the rigorous AC as a training counter-
12,
as a preventative ankle injury countermeasure requires measure for physical detriments during SUSOPS has not
additional study, as the PABs could either be beneficial been investigated. These investigators found no specific
for preventing ankle injuries or causative in the higher physical training countermeasures designed to reduce
rate of foot injuries seen in the study by Kotwal et al. expected losses of lower body power output, muscular
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Operational Stressors on Physical Performance and Countermeasures 75