Page 98 - JSOM Spring 2025

An Ongoing Series

Profiling “Noncombat” Musculoskeletal Injuries
in Special Operations Forces

A Systematic Review

Stefano Dresti *; Efisio Mellino ; Mario Palazzo ; Mattia Solidoro ; Robin Orr 5
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ABSTRACT
Background: Special Operations Forces (SOF) personnel are at occupational tasks, and deployments. While military SOF
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a high risk of musculoskeletal (MSK) injury. The aims of this are usually defined more strictly by using doctrinal stan-
systematic review were to a) profile MSK injuries sustained dards, police SOF include units ranging from local specialist
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by SOF personnel and b) identify evidence-based injury pre- units, commonly referred to as police tactical units or special
vention strategies. Methods: Registered with the Open Science weapons and tactics (SWAT) teams, to units famous world-
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Framework, the protocol followed the Preferred Reporting wide like the Grenzschuztgruppe 9 (GSG-9) of the German
Items for Systematic Reviews and Meta-Analyses guidelines. Bundespolizei and FBI’s Hostage Rescue Team. Moreover,
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Of the 3,773 studies identified, 14 met the eligibility criteria, several SOF units are simultaneously part of the armed forces
with 6 additional studies identified following screening of the and law enforcement, like the Italian Carabinieri Gruppo
reference lists of the included studies. Extracted data were d’Inter vento Speciale (GIS) or the Groupe d’intervention
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summated in five naturally occurring MSK injury themes: de la gendarmerie nationale (GIGN) of the French Gendar-
1) incidence in SOF populations; 2) anatomical location; merie. Specialist police and military special forces can also be
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3) nature; 4) mechanism; and 5) risk factors. Results: Injury deployed together both nationally and internationally. Like-
incidence ranged from 8 to 846 injuries per 1,000 personnel wise, they can form joint units. As an example, the Australian
per year with the lower extremities as the most reported site “Tactical Assault Groups” consist of both Australian Army
of injury. The leading nature of MSK injuries were strains and and Specialist state and federal police personnel. SOF duties
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sprains, while the most common mechanism of injury was vary and can range from special reconnaissance missions and
physical training. Smoking, physical performance, movement hostage-rescue operations to close protection for military or
limitations, muscular asymmetries, and imbalances were re- civilian authorities, high-risk arrests, and direct actions against
ported as factors that can increase MSK injury risk. Conclu- a threat. The personnel (or ‘Operators’) that compose these
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sion: This review informs injury prevention strategies within units usually undergo extremely demanding selection phases
SOF populations, notably, reducing run mileage and alternat- and must complete long qualification processes to be selected
ing running with weight load walking, educating Operators on following which they must attend and pass required special-
proper lifting technique, and analyzing force plate testing data ization courses (e.g., parachuting, close quarter battle). These
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to guide program design and implementation. selection processes usually come with a high candidate attri-
tion rate. For example, in a study by Hunt et al., of 104
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Keywords: Special Operations Forces; SOF; injury; military; candidates who attempted selection, only 39 completed the
police; human performance; occupational injuries first phase of the process.
SOF units are constantly preparing to move and operate in
all environmental conditions, ranging from aquatic, desert,
Introduction
and jungle to arctic and mountainous terrains. To success-
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Special Operations Forces (SOF) are specialist military and po- fully complete missions in this diverse range of theaters, SOF
lice units specifically created internationally and organized Operators need to have the capability to perform a wide range
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to solve the most tactically and strategically challenging mis- of insertion and extraction methods, like rucking (carrying
sions within and beyond their national borders. This review heavy loads and moving on foot), free fall parachuting, subma-
comprised SOF drawn from both military and police research. rine exfil/infil, operating all-terrain vehicles or snow mobiles,
This inclusion of both populations is due to the overlaps they long-distance swimming, and fast-roping or rappelling from
share including historical development, selection and training, helicopters. Daily duties of these Operators often include
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*Correspondence to stefano.dresti@hotmail.it
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1 Stefano Dresti, Efisio Mellino, Mario Palazzo, and Mattia Solidoro are affiliated with College of Medicine and Health, University College
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Cork, Cork, Ireland. Robin Orr is Director of the Tactical Research Unit, Bond University, Gold Coast, Australia.
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