Page 109 - JSOM Spring 2025

strength, and knee position on landing for MSK injury preven- anatomical location of injury, supporting the findings of this
tion. The shoulder retraction strength and shoulder internal review. However, when comparing the results of this review
rotation deficit also contributed to higher injury occurrence. with those of law enforcement officers, some differences were
evident. For example, a review of the “general duties” of law en-
forcement officers by Lyons et al. reported that the upper ex-
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Discussion
tremity was generally observed as the most common injury site,
The aims of this systematic review were to a) profile MSK inju- accounting for 33%–43% of the total MSK injuries. It should
ries sustained by SOF personnel and b) identify evidence-based be noted, however, that the upper extremity was found to be
injury prevention strategies. Data were extracted from 20 the leading site of injury in some groups of U.S. Navy specialist
studies that met the review criteria and separated into five personnel. 37,40 With military and firefighters (>45kg and >20kg,
naturally occurring MSK injury themes: 1) incidence in SOF respectively), 59,60 generally carrying heavier loads than police of-
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populations; 2) anatomical location; 3) injury nature; 4) injury ficers (10–12kg ), the finding of lower extremity injuries being
mechanism; and 5) risk factors. more common in the former two populations is understandable.
While the two studies of specialist police in this review 45,47 did
Musculoskeletal Injury Incidence not report sites of injury, with specialist police likewise carrying
1
MSK injury incidence rates among SOF personnel identified in loads of 20 to >25kg, the lower extremity as a leading site of
this review ranged from 8 to 846 injuries per 1,000 personnel injury in this population would not be unexpected. 62,63
per year. 34,42 Differences between studies in defining injury may
have contributed to this wide range. For example, Reynolds et Nature of Injury
al. defined injury as “any injury-related clinic visit resulting The findings of this review suggest that the most common type
32
from operational or physical fitness training,” while Lovalekar of MSK injuries in SOF Operators were sprains and strains.
43
et al. defined injury as “an injury to the musculoskeletal sys- These findings are similar to those reported by Lendal and
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tem (bones, ligaments, muscles, tendons, etc.) that, if occurring Kjaer who likewise found strains, sprains and pain/spasm/
after enlistment, resulted in alteration of tactical activities, tac- ache to be the most frequent types of injuries reported among
28
tical training, or physical training for a minimum of one day, SOF Operators. Shwayhat et al., who conducted a study fo-
regardless of medical attention sought.” Notably, eight stud- cused on overuse injuries, reported stress fracture as the leading
ies did not define injury. Furthermore, some studies evaluated type of injury (16%), with a higher rate than sprains and strains
only specific activities, and others included a full spectrum of (14%). However, these results are likely due to the specific focus
activities. For example, the lowest MSK injury incidence rate of the research on injuries caused by the application of repetitive
34
reported in these studies (8.23/1,000 [0.8%]), examined only forces to the body without adequate recovery time—a known
airborne operations (low static line parachute jumps). This in- risk factor in military settings specifically for stress fractures. 64
cidence rate is notably different from three other studies that
examined all activities performed, with injury prevalence rang- In a study conducted by Lovalekar et al., there was a signifi-
38
ing from 17% in CQT sailors to 85% in Air Force Special cant difference between the leading nature of injuries reported
40
Operations Command (AFSOC) Special Tactics personnel. 42 in medical records (sprains and strains accounting for 30%
of the total MSK injuries) and injuries that were self-reported
The prevalence of injuries reported in this review (8–846 inju- (traumatic fracture with 27%). This could be partly related
ries per 1,000 personnel per year) is lower than those reported to a tendency to under-report minor injuries during self-re-
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in general Army personnel and general duties policing. porting processes. Two studies reported on overuse and trau-
However, due to the wide range of findings, there is some over- matic injuries: Teyhen et al. observed that overuse injuries
41
lap with other literature. Molloy et al. reported incidence accounted for almost three times the number of acute injuries,
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rates of approximately 1,400 injuries per 1,000 personnel per while Reynolds et al. found a balance between them (50.5%
32
year from 2009 to 2015 in U.S. Army Soldiers, while a system- and 49.5%, respectively). In the study by Reynolds et al., the
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49
atic review by Lyons et al. reported MSK injury prevalence balance situation between these two natures of injury for SOF
ranging from 240 to 2,500 injuries per 1,000 personnel per Operators was significantly different compared with values of
year in a law enforcement population. conventional soldiers, which were instead mainly from over-
use injuries (77%–83%). These differences could be related to
These differences in injury rates could exist due to numerous the more physically demanding and more dangerous activities
factors such as occupational tasks and risks, equipment used, (i.e., parachuting, carrying heavy loads, fast-roping) that the
availability of injury prevention programs or physical training Operators usually perform compared to conventional units,
education, and injury reporting processes (e.g., self-reported increasing their risk of developing acute injuries.
versus point-of-care reporting). Furthermore, with physical
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fitness, a known injury risk factor, 14,51–54 the higher fitness level Mechanism of Injury
of these personnel when compared to general duties person- Studies that assessed injury mechanisms found that injuries
nel may have influenced the lower rates in SOF Operators. occurred across a full spectrum of activities. However, the
18
most common mechanism of MSK injuries in SOF Operators
Anatomical Location of Injury was physical training, with five 32,35,40,42,43 of the included stud-
Generally, the lower extremity was the most common site of ies stating that physical training accounted for 28% to over
40
injury. 29,30,33-35,38,39,41–43,46 These findings are similar to those of 80% of total MSK injuries. These results are similar to those
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65
studies on other general military forces, which report the lower reported in a study conducted in the Australian Army, where
extremities as the leading site of injuries in both trainees 55,56 and physical training was the leading mechanism of injury in sol-
57
qualified soldiers. Furthermore, a systematic review profiling diers (66%). It is of note that physical training injuries are of
injuries sustained by firefighters, another tactical occupation, such concern to military forces that dedicated attention has
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reported the lower extremity and back as the most common been allocated to this mechanism of injury. 66
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