Page 99 - JSOM Winter 2017

An Ongoing Series

Optimizing Musculoskeletal Performance Through Injury Prevention

Sarah J. de la Motte, PhD, MPH, ATC*; Timothy C. Gribbin, MEd, ATC; Patricia A. Deuster, PhD, MPH

ABSTRACT
Musculoskeletal injuries (MSK-Is) are ubiquitous throughout SOF, musculoskeletal issues and MSK-I pain are just part of
the Special Operations Forces (SOF) because of the physical doing their job. Hence, MSK-I prevention in SOF communities
demands of executing missions and carrying heavy loads. Pre- remains an uphill battle, and those tasked with carrying out
venting MSK-I has been a priority among SOF but is especially injury prevention (e.g., physicians, athletic trainers, strength
challenging because most MSK-Is are chronic or recurring. For and conditioning specialists) are challenged to find ways to
many SOF, musculoskeletal issues and MSK pain are just part insert techniques into daily training. Ways to focus, target,
of doing their job. Ways to focus, target, and integrate injury and integrate injury prevention efforts across the continuum
prevention efforts across the continuum of training, active duty of training, active duty, and SOF status are critical because
and SOF status are critical because MSK-Is are a significant MSK-Is are a significant barrier to human performance opti-
barrier to human performance optimization. In this article, we mization (HPO).
describe how to incorporate these efforts at all levels of train-
ing. The need for improving valid, objective, fit-for-full-duty In this article, we describe why it is essential for MSK-I pre-
metrics after injury and sharing such information continuously vention to be focused, targeted, and integrated at all levels of
with SOF is discussed. Last, strategies for engaging all levels to training and into the SOF life cycle. We describe the need for
begin a culture shift away from the acceptance of MSK-I and improving valid, objective fit-for-full-duty metrics after injury
pain as a way of life toward embracing MSK-I prevention as a and sharing such information in a continuous fashion across
regular part of everyday training are presented. the SOF life cycle. Last, we describe strategies for engaging
all levels to begin a culture shift away from the acceptance of
Keywords: musculoskeletal injury; injury prevention; pain; MSK-I and pain as a way of life toward embracing of MSK-I
human performance optimization prevention as a regular part of everyday training.

What Does MSK-I Prevention Mean for SOF?
Introduction
Key questions about the most effective and best strategies for
Musculoskeletal injuries (MSK-Is) are ubiquitous throughout MSK-I prevention remain; however, because the single great-
the Special Operations Forces (SOF) because of the physical est predictor of MSK-I is a history of previous MSK-I, ef-
demands of executing missions and carrying heavy loads. forts to introduce MSK-I prevention strategies on entry into
They are also one of the most burdensome conditions and a the military and then ensure progressive endeavors continue
1–4
leading cause of disability. Thus, preventing MSK-I is (and throughout training are essential. For motivated SOF candi-
has been) a top priority among SOF, Special Operations Com- dates, MSK-Is are often hidden, and a cycle of not addressing
mand (SOCOM) Preservation of the Force and Family, provid- particular injuries (which could have easily been treated) may
ers, and researchers. For SOF in particular, injury prevention continue for years. Thus, knowingly or not, MSK-I preven-
is especially challenging because most MSK-Is are not primary tion efforts targeted to SOF may inherently be secondary (i.e.,
but rather are chronic or recurring injuries; some may have prevention of re-injury) and/or tertiary prevention (i.e., reha-
been present for years. More importantly, many SOF prefer bilitation from an old injury, managing a current injury and
not to seek medical help, because anything that might even preventing it from further damage) rather than addressing the
potentially keep them from their jobs is evaded. By the time root of the problem. 5
an Operator has completed the required years of training to
become a member of a SOF unit or team, he is likely to have Life Cycle of SOF and MSK-I Prevention
sustained multiple MSK-Is and not undergone the necessary
treatment and rehabilitation to adequately heal and recover, The life cycle of SOF is a subset of the Warfighter life cycle
thereby perpetually remaining in a suboptimal state. For many (Figure 1). At the start of the life cycle, a recruit or officer
*Address correspondence to sarah.delamotte@usuhs.edu
Dr de la Motte is an assistant professor and scientific director, Mr Gribbin is a research associate, and Dr Deuster is a professor and director of
the Consortium for Health and Military Performance: A Defense Center of Excellence, Department of Military and Emergency Medicine, Uni-
formed Services University, Bethesda, MD.

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