Page 105 - Journal of Special Operations Medicine - Summer 2016

An Ongoing Series

Avoiding Program-Induced Cumulative Overload (PICO)

Robin Orr, PhD; Joseph J. Knapik, ScD; Rodney Pope, PhD

ABSTRACT

This article defines the concept of program-induced and other accumulating factors may lead to overtrain-
cumulative overload (PICO), provides examples, and ing and eventual injury. 2,5–8 The purpose of this article
advises ways to mitigate the adverse effects. PICO is is to define the concept of PICO, provide examples of
the excessive cumulative physical workload that can be its occurrence, consider key literature that usefully con-
imparted to military personnel by a military training tributes to our understanding of this military training
program with an embedded physical training compo- phenomenon, and suggest general principles to reduce
nent. PICO can be acute (accumulating within a single the likelihood of PICO.
day) or chronic (accumulating across the entirety of the
program) and results in adverse outcomes for affected Defining PICO
personnel, including detrimental fatigue, performance
degradation, injuries, or illness. Strategies to mitigate PICO was first described in 2006 in a report detailing
PICO include focusing administration and logistic prac- the optimization of Basic Recruit Training at the Austra-
tices during the development and ongoing management lian Army Recruit Training Centre. PICO is the exces-
9
of a trainee program and implementing known muscu- sive cumulative physical workload that can be imparted
loskeletal injury prevention strategies. More training is to military personnel by a military training program
not always better, and trainers need to consider the total with an embedded physical training component. Specifi-
amount of physical activity that military personnel ex- cally, in this context, PICO denotes excessive cumula-
perience across both operational training and physical tive physical workload that is unintentional, as opposed
training if PICO is to be mitigated. to specifically designed or identified overload occurring
across a training program in order to meet training in-
Keywords: injuries, overload; training; prevention; programming tent. PICO can be acute (accumulating within a single
day) or chronic (accumulating across the entirety of the
training program). PICO results in adverse outcomes
for affected military personnel, including detrimental
Introduction
fatigue, performance degradation, injuries, or illness.
Musculoskeletal injuries continue to affect military Physical training programs are designed to improve the
force generation and sustainment. Programs like basic physical fitness of military trainees, and operational
training or specialist courses (e.g., Special Operations, training activities are intended to introduce trainees to
Rangers, SEAL [Sea, Air, and Land]) have generally been new or somewhat familiar tasks and allow practice to
associated with high rates of injury. A potential rea- achieve or maintain the required level of competence.
1–4
son for these high injury rates is the sudden increase in However, if the total volume or sustained intensity of
training load, typical of training programs where a large physical activity programmed into the overall military
number of training priorities must be met in a short pe- training program is too high or if training events are not
riod of time. During formal military training periods, well sequenced to avoid sustained and cumulative mus-
there are often an abrupt escalation in the volume and culoskeletal stress, the trainee’s ability to recover may be
intensity of physical conditioning activities, complex compromised, regardless of whether the trainee is a new
new tasks that must be learned, and reduced opportu- recruit or an experienced operator undergoing specialist
nity to recover from physically demanding tasks. These training.

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