Page 108 - JSOM Spring 2025

2) anatomical location; 3) injury nature; 4) injury mechanism; populations. 30,32,35,37,38,45,47 The prevalence of these types of in-
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and 5) risk factors. juries ranged from 17% to 30%. 30,38 One study reported pain
and tendinopathy as the major cause of injury, while another
MSK Injury Incidence in SOF Populations study reported pain, spasm, and ache as the leading nature
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Overall, 10 studies reported data on MSK injury incide of injury.
nce. 28,30,34,35,37,40–42,44–46 Four studies reported on incidence per
100 person-years 35,40,42,46 and one study per 1,000 person- Mechanism of Injury
years. One study reported injury incidence per 1,000 re- Eleven studies described in more detail mechanism of in-
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cruit days; two studies reported injury incidence relative to the jury. 29,30,32,34,35,37,40,42-44,46 Seven of these studies reported the dif-
number of jumps executed by the subjects 30,34 ; and eight stud- ferent activities that caused MSK injuries. 32,35,37,40,42,43,46 Three
ies presented data on injured personnel 32,33,36,37,39,41,44,45 with- studies investigated injuries sustained only during static line
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out a specific period of time. All the studies were of military parachuting, 30,34,44 while one study only reported injuries
SOF with most on SOF Operators except for a study including that occurred during fast-roping. The most common activity
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trainees and another on trainees only. The reported inci- at the time of the MSK injury was physical training, 32,35,40,42,43
dence of MSK injuries among SOF personnel varied from 8 to with the percentage of injuries ranging from 28% for SEAL
846 per 1,000 personnel per year. 34,42 Operators to over 80% (comprised sports) for Operators of
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32
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the 10th Special Forces Group (SFG). Lovalekar et al. re-
Anatomical Location of Injury ported the two primary injury mechanisms (both accounting
Fifteen articles reported on the bodily sites of the MSK in- for 22%) as “unknown” or “other cause.” However, physical
jury 29-31,33-35,37–44,46 although there were some differences in training and recreational/sports activities, when combined, ac-
how the data were reported. Some studies grouped injuries counted for 32% of MSK injuries. Hayhurst et al. indicated
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by body region (i.e., lower extremities, etc.), 31,38,39,42 while oth- military training was the most common cause of injury, fol-
ers 29,30,33,35,37,40–44,46 presented more specific body regions (i.e., lowed by other cause and personal training (32%, 28%, and
knee, ankle, foot). 28%, respectively).
Eleven studies 29,30,33-35,38,39,41–43,46 reported the lower extremities Five studies 35,37,40,43,46 further analyzed the mechanism of in-
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as the most injured body site, with prevalence ranging from jury for different activities. In the study by Abt et al. running
40% to 65% of all reported MSK injuries. One study re- was the most common mechanism of injury (23%), followed
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31
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ported the upper extremity and spine (combined as 50%) to be by lifting (19%). Lovalekar et al., reported “unknown” and
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the most affected body region, while another study reported “other causes” as the mechanism for the majority of MSK in-
the upper extremity to be the most commonly affected (38% juries (about 70%), followed by lifting (8%). In another study,
of all the MSK injuries). Lovalekar et al. reporting on dif- Lovalekar et al. reported lifting and running as the most
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ferences between four groups of U.S. Navy specialists, noted common mechanisms of MSK injury (excluding “unknown”
that Sea Air and Land Qualification Training (SQT), Special and “other”), with percentages varying from 15% for CQT
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Warfare Combatant-Craft Crewmen (SWCC), and Crewman to 24% for SQT. Hayhurst et al. found that weight training
Qualification Training (CQT) sailors sustained injuries to the was the most common mechanism of injury, followed by run-
lower extremities more frequently (65%, 37%, and 64%, re- ning (together accounting for 26% of total injuries). In SWCC
spectively), while Sea Air and Land (SEAL) sailors sustained Operators, Lovalekar et al. reported weightlifting as the pri-
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injuries to the upper extremity more frequently (35%). mary mechanism of MSK injuries (24%), followed by running
(16%). For CQT Operators, the representation was reversed
Further assessment of more refined injury locations indi- with running reported as the most common mechanism of in-
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cated that the foot and ankle, 29,30,41 back and neck, coccyx, jury (55%), followed by lifting (8%).
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knee, 33–35 shoulder, 35,37,42 and lumbar spine were the anatom-
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ical sites most injured. In the study by Lovalekar et al., there Injury Risk Factors
were differences between the Operator and trainee groups: Two of the studies included in this systematic review analyzed
for the SEAL and SWCC qualified personnel the most com- risk factors for MSK injuries in an SOF population. 36,39 Assess-
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mon anatomical locations of injuries were the shoulder and ing a U.S. Army Ranger cohort, Teyhen et al. found that com-
lumbopelvic region, respectively, while for the SQT and CQT prehensive and overuse injuries can be predicted by multiple
trainees the lower extremities (foot and toes, ankle, and knee) factors. Their study identified a common set of self-reported
were the most common sites of injury. These findings support data (smoking status, previous surgery, recurrent injury his-
previous literature involving SOF trainees that suggests the tory, and limited duty in the precedent year), movement-based
lower extremities sustain 64%–78% of all MSK injuries, with tests (pain during one of the Functional Movement Screen
the knee, ankle, lower leg, and foot the most commonly in- clearing tests and range of motion asymmetry in ankle dorsi-
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jured body parts. A more recent study, involving U.S. Naval flexion), and physical performance results (run time and sit up
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Special Warfare personnel, found the prevalence of lower ex- repetitions) as reliable predictors of future injuries.
tremity injuries among SWCC Operators to be higher (50%)
than in the previous studies, and more similar to CQT sail- Heebner et al. examined the correlation between physical and
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ors, for whom lower extremity injuries accounted for 66% of performance characteristics and unintentional MSK injuries
MSK injuries sustained. in U.S. Army Special Forces Operators. The authors reported
that less shoulder-retraction strength, knee extension strength,
Nature of Injury and a smaller trunk extension: flexion ratio were significant
Eleven studies reported data about the nature of in- risk factors for injuries in Operators. Having two or more risk
jury, 28,30,32,35,37,38,40,42,44,45,47 with sprains and strains identified factors resulted in greater injury risk. Their findings highlight
as the most common nature of MSK injury in seven SOF the importance of optimizing knee extension strength, trunk
106 | JSOM Volume 25, Edition 1 / Spring 2025