Page 44 - JSOM Spring 2023

shoulder (16.3%), and knee (15.3%). When medical chart re- higher percentage of MSIs among CQT students (77.6%) as
viewed MSIs were analyzed among CQT students, common compared to SWCC Operators (31.6%) were sustained during
anatomic sub-locations were knee (30.3%), hand and fingers physical training. It is understandable that a greater percent-
5
(15.2%), and ankle and lower leg (each 12.1%). CQT students age of MSIs would result from physical training in students
spend many hours running as a part of their physical training. as compared to Operators, as students spend most of their
In the current analysis, 31 of the 35 MSIs (88.6%) that in- time in mandatory physical training while training to become
volved the lower leg and knee were caused by running. The Operators. As Operators, they still must participate in physi-
differences in relative frequencies of anatomic sub- locations cal training to maintain operational readiness. However, they
of MSIs between the two sources of MSI data (self-reported have more flexibility when selecting activities to maintain or
in the current study and medical chart review in the medical improve their fitness levels as well as more leisure time. This
chart reviewed MSI study) could be due to propensity to seek explains the disparity in MSIs sustained during recreational
medical care for certain MSIs, but not for others. 5 activity/sports between SWCC Operators (21.1%) and CQT
students (6.1%).
Cause of MSIs and Activity
at the Time of MSI Occurrence Type of MSIs
In the current analysis, the most common cause of self- The most common MSI types reported by SWCC Operators
reported MSIs was lifting in SWCC Operators (23.7%) and in the current study were sprain (18.4%) and pain/spasm/ache
running in CQT students (55.1%). When medical chart re- (15.8%). Previous studies of MSIs derived from medical chart
viewed MSI data were analyzed for a sample of US Air Force review have shown these to be the most common MSI type
Special Tactics Operators, the predominant cause of MSIs was in SWCC Operators (21.7% and 20.0%, respectively) and
2
lifting (21.8%). An analysis of self-reported MSIs among US in the top three MSI types for SEAL Operators (29.7% and
Army SOF Operators showed that lifting was the second most 12.2%, respectively). Similarly, sprains and strains were the
5
common cause of MSIs (19.2%), while running was the most most common types of self-reported MSI types in US Army
common cause (23.1%). The difference in cause of MSIs be- SOF Operators (23.1% and 11.5%, respectively) and SWCC
10
tween various components of Special Forces could be due to Operators (49.3%, when data from these two MSI types were
differences in physical and operational demands, differences in combined). 6,10
training practices, and differences in propensity to seek medi-
cal care for certain MSIs. For CQT students, the most common MSI types were pain/
spasm/ache (19.4%) and tendonitis/tenosynovitis/tendinopathy
Although the relative frequency may differ across studies in (17.3%) in the current study. These findings are consistent
military populations, both lifting and running consistently with MSI data derived from medical charts in SEAL quali-
are among the most common causes of MSIs. The Joint Ser- fication training (SQT) students (17.0% and 21.0%, respec-
29
vices Physical Training Injury Prevention Working Group tively). Tendonitis/tenosynovitis/tendinopathy and fracture
conducted a systematic review to identify interventions with (each 15.2%) were the most common medical chart-reviewed
the strongest evidence to mitigate MSIs and reported that MSIs in CQT students, followed by sprains (12.1%). Pain
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the highest priority recommended injury prevention strategy (not otherwise specified), tendonitis, and sprains/strains also
21
was to prevent overtraining. Overtraining results from ac- were reported to be the most common MSI types in US Army
cumulated training, as well as non-training stress, that causes Special Forces Assessment and Selection Course participants. 30
long-term decrements in performance, which may result in in-
22
creased MSI risk. MSIs caused by lifting or running may be It is important to note the high prevalence of tendinous injury
prevented by appropriate application of the FITT-VP princi- across Special Forces Operators and students. It is believed
ple. In other words, the frequency, intensity, time, and type of that tendonitis/tenosynovitis/tendinopathy develops when the
exercise along with the volume and progression of the exercise volume or magnitude of loading consistently exceeds their
31
program should be appropriately manipulated to allow for ad- physiological capacity. Additionally, most strains occur at
equate overload. This is such that fitness gains are made while the musculotendinous junction, which is biomechanically the
also allowing for adequate recovery to prevent overtraining weakest point, during eccentric loading of the muscle. 32,33 Both
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and injury. Specifically for strength training, the American mechanisms of injury may be prevented through appropriate
College of Sports Medicine recommends that resistance train- progressive overload and adequate recovery of the musculo-
ing programs be adjusted (e.g., FITT-VP principle) to account tendinous tissue. 34,35
for an individual’s goals, physical capacity, and training status,
and included concentric and eccentric muscle loading. MSI Estimated Lifetime Costs
24
risk can be minimized by utilization of proper mechanics while In the current study, the lifetime cost of the 38 MSIs that oc-
lifting during military training. Previous military research has curred during a one-year period in the cohort of 142 SWCC
demonstrated that decreasing running volume significantly re- Operators was approximately $580,000, and the lifetime cost
duced the risk of MSI, while still improving aerobic fitness/run of the 98 MSIs in the cohort of 187 CQT students was about
times. Alternative aerobic exercise (e.g., swimming, cycling) $1.2 million. The cost was greater in the CQT cohort mainly
can be used to promote aerobic fitness while reducing im- due to the larger number of injuries reported in the CQT co-
pact stress on the lower extremity. Further, gradual increases hort (98 injuries) as compared to the SWCC cohort (38 inju-
in running mileage also reduces the risk of MSI in military ries). While previous studies have reported lifetime costs for
populations. 25 MSIs in military populations, direct comparisons with the
results of the current study cannot be made due to method-
Previous studies of the epidemiology of MSIs among conven- ological differences. A study of MSIs among 130 US Air Force
tional and Special Forces have shown that MSIs occur most Special Tactics Operators reported a cost of approximately
often during physical training. 8,9,15,26–28 In the current study, a $1.2 million for MSIs sustained in a one-year period. 2

42 | JSOM Volume 23, Edition 1 / Spring 2023