Page 48 - JSOM Winter 2017

with the elite US NSW Operators (or SEALs) in southeast Af- Table 2 New Evaluations by Injured Body Region
ghanistan to support the purpose and use of PTs’ skills in iden- Injury Location No. of Patients (%)
tifying and treating musculoskeletal injuries. Lumbar/sacral spine 82 (29.08)
Shoulder 59 (20.92)
Methods Knee 28 (9.93)
Cervical spine 18 (6.38)
Data were collected about US Navy SEALs (hereafter, SEALS)
and supporting assets in southeast Afghanistan from May Ankle 17 (6.03)
2012 until September 2012. Participants consisted of deployed Thoracic spine 16 (5.67)
SEALS, support staff, and civilians. The information was ob- Wrist 14 (4.97)
tained from the personnel seen by a single PT and consists of Hip 13 (4.61)
1,251 encounters of 282 individual patients. Documentation Leg 11 (3.9)
was kept on official US Navy medical visit forms (US Navy SF Elbow 9 (3.19)
600) and completed during patient evaluation and treatment. Foot 7 (2.48)
Patient demographics, the location of injury, the initial diagno- Hand 6 (2.13)
sis, and the treatment used during that encounter were docu- Head 2 (0.71)
mented. Data were collected only on those patients seen by
the PT. The SEAL team’s deployment preceded and extended
beyond the PTs deployment window; information in this re- Table 3 Mechanisms of Injury of Evaluated Injuries
port was collected during the PT’s entire deployment window. Mechanism of Injury No.
Physical training 108
MOS 77
Results
Other 40
Patient encounters were recorded from 17 May 2012 until 25 Combat injury 32
September 2012 in various locations in southeast Afghanistan. Load 17
A total of 1,251 patient encounters were completed. Of these, Recreation/sports 6
282 encounters (23%) were first-time evaluations by the PT, Motor vehicle accident 2
and 969 (77%) were follow-up visits or continued therapy. MOS, Military Occupational Specialties (rating specific duties)
Figure 1 shows the breakdown of monthly evaluation types.
The injury incidence was two per day. The average number of The three most common treatment modalities for musculo-
new evaluations per month was 56 and the average number of skeletal injuries were therapy exercise (n = 461; 37%), mo-
follow-up evaluations was 194. bilization or manipulation (n = 394; 31%), and dry needling
(n = 176; 14%; Figure 2). The modalities used for treatment
Figure 1 Patient encounters by the physical therapist. were mobile and portable, which allowed for their use even at
isolated forward operating bases.

All members of the unit met predeployment requirements of
physical condition and medical history, as listed by Naval reg-
ulations. Because of the nature of the command under review
15
and physical conditioning of the patients, none of the patients
were issued any duty restriction. The PT used her treatment
options and followed up while she was deployed locally to
assure acute injuries were treated and the patient could return
to duty. No patient evaluated was medically evacuated from
theater or sent to a higher level medical site for their injury.

Discussion
Musculoskeletal injuries are still the primary reason for de-
creased readiness and medical visits in military commands,
The three most frequently injured body regions, in order, were especially for those deployed in high-tempo operational com-
the lumbar/sacral spine, the shoulder, and the knee, which ac- mands. There is a large database on combat and noncombat
1–6
counted for 60% of body regions injured (Table 2). The head injuries during Operation Enduring Freedom and Operation
was the least injured body region. Evaluation of injuries was Iraqi Freedom through the DNBI system. However, no previ-
1,4
based on the mechanism of injury and physical examinations. ous studies were found that examined PTs’ experiences while
Diagnostic modalities were limited and no imaging was per- deployed in support of NSW down range.
formed. All injuries evaluated were limited to musculoskeletal
complaints that did not require medical treatment, such as dis- Although SEALs and support units are considered elite ath-
location, lacerations, and penetrating trauma. letes and are at top physical fitness, our study has demon-
strated that injuries requiring attention still occur at a rate of
A unit physical training mechanism of injury (MOI) accounted 22%. None of the injuries were significant enough to mandate
for 108 individuals (38%) who reported for evaluation (Table transfer to a higher level of medical care, owing to the im-
3). The least common reported MOI was motor vehicle ac- mediate care and therapies provided by the PT. Recent war
cident (1%). data show the most common reason for evacuation was DNBI

46 | JSOM Volume 17, Edition 4/Winter 2017