Page 77 - JSOM Fall 2021

TABLE 3 Injuries Not Reported to Medical Personnel, by Body Region and Setting
In Garrison While Deployed
Total Injuries Injury Onset: Total Injuries Injury Onset:
Body Region Not Reported Gradual [vs acute] p-Value Not Reported Gradual [vs acute] p-Value
Neck 33 17 [16] .692 18 9 [9] 1.0
Back 58 31 [27] .994 31 14 [17] .885
Shoulder 59 40 [19] .014* 33 19 [14] .243
Elbow 23 16 [7] .837 9 4 [5] .853
Wrist 29 15 [14] .630 16 10 [6] .094
Hand 12 1 [11] .121 4 0 [4]
Hip 27 17 [10] .643 15 9 [6] .417
Knee 50 40 [10] .028* 23 18 [5] .215
Ankle 24 11 [13] .753 7 2 [5] .577
Foot 26 11 [15] .314 11 8 [3] .400
*Statistically significant association between injury reporting and injury onset (p < .05).

FIGURE 2 Common reasons for reporting injuries. FIGURE 3 Common reasons for not reporting injuries.

overall severity and impact of MSKIs as injuries might be ad- Recent studies analyzing MSKIs have advocated to improve
dressed (earlier) before they progress to a more debilitating a SM’s access to care to identify preventable and acute inju-
level. ries sooner. 15,16,25,26 Nye et al. discussed embedding providers
to mitigate the fear and lack of trust a SM may have to report
15
The majority of MSKIs in the current study occurred gradually, their injuries. As the current survey showed, 46% of airmen
suggesting they were likely overuse injuries. Previous studies who reported an injury to a medical provider felt the medical
with two different cohorts of soldiers revealed that 70% of the provider did not give their injury adequate attention. As such,
reported MSKIs were deemed overuse injuries. 6,23 Understand- embedding providers may only add to that lack of trust and
ing injury reporting behaviors and trends may influence and deter SMs from reporting. Similarly, 45% of the injuries not
improve the system for accessing care to treat these injuries. Of reported to medical providers were identified as having oc-
particular concern, the current study found that 38% of air- curred suddenly, which suggests they were acute, may have
men reported having a negative experience related to reporting been preventable, and might have benefited from immediate
their injuries and being placed on modified duty. Negative ex- evaluation and treatment. Previous self-reported injury data
periences associated with seeking MSKI care discourages SMs collected in a special operations cohort revealed that the ma-
from reporting and ultimately decreases readiness. jority of injuries were preventable and had occurred during
physical and tactical training. 27
Injuries that are addressed early in any environment may pos-
itively impact their severity and resulting conditions. There Research describing healthcare seeking and injury reporting
may be advantages to applying a sports medicine model to is not consistent in terms of body regions affected. Injuries to
increase access to care for the military. For example, provid- special operations USAF personnel in the current cohort were
ing medical personnel such as physical therapists or athletic most common in the back and shoulder (total; reported and
trainers to work in close-proximity to soldiers, similar to a not reported). A systematic review of MSKI in military special
sideline coverage capacity in sports, would facilitate early and operations forces found that the most common body parts af-
rapid management of injuries. 15,16 Having medical staff readily fected in these populations were the ankle, knee, and lumbar
available during prime physical training events may improve spine. The current study results differ from results described
28
patient/provider relationships and build trust for reporting ail- by Smith and colleagues, who found that unreported knee and
19
ments. Fraser et al. explained how the military culture may back injuries were most common in an Army population.
benefit from such a change in which clinicians serve as “force Cohen et al. found knee and ankle injuries to be the most com-
18
multipliers,” optimizing readiness for SMs in times of injury. 24 mon in initial entry trainees. Differing influential factors in
Musculoskeletal Injury Healthcare–Seeking Behaviors | 75