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activities performed under heavy loads, for prolonged times, (PRISMA) guidelines. The protocol was registered with the
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in highly stressful situations, and are usually beyond the scope Open Science Framework on 15 January 2023. Peer-reviewed
and ability of general duties performed by police officers or publications were identified by searching four different online
regular military personnel. 6,13,16 academic databases (Web of Science, ProQuest, Embase, and
PubMed) in March 2023. The search terms were defined in a
Considering the physical demands of their job, SOF Opera- broad way to limit search bias and to increase the number of
tors require levels of neuromuscular strength and aerobic studies included. As such, all studies reporting on MSK inju-
16
fitness similar to elite athletes. As such, they typically un- ries as part of their study were included with the definitions
17
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dertake appropriate physical training, either alone or under of MSK injury reported (see data item extraction). A polyglot
guidance from a specialist strength and conditioning coach, to search tool was used to adjust keywords to meet the require-
ensure they can perform and sustain the performance levels re- ments of different databases. 26
quired by their profession. Recently, several SOF units have
1,3
started to develop human performance optimization (HPO) The databases that were searched and the corresponding
programs, composed of strength and conditioning coaches, search terms are reported in Table 1. Once the results were
physical therapists, exercise physiologists, mental performance identified, duplicates were removed using EndNote (version
coaches, and nutritionists, all working together to support the 20, Clarivate) initially and then manually as articles that cir-
Operators in a similar way to that seen in elite professional cumvented EndNote’s identification system were identified.
sports. 19–21 Subsequently, two reviewers (E.M. and M.P.) independently
analyzed the titles and abstracts of the remaining articles, re-
The demanding tactical activities, paired with the physical moving articles that were clearly not relevant. If there were dis-
training required by their profession, put SOF Operators at agreements between the reviewers, the article was retained. All
a very high risk of suffering a musculoskeletal (MSK) injury the remaining articles then underwent a full-text review and
during their service. 19,22 Recent studies indicate that more than were screened against predefined inclusion and exclusion cri-
half of SOF Operators experience one sports-related injury per teria (Table 2). A third reviewer (M.S.) screened the reference
year. Thus, to support SOF HPO programs, an understand- lists of all the selected articles, and if a study was considered
23
ing of noncombat MSK injuries sustained by Operators is of potentially relevant, it was included for a full-text review, and
value. The aims of this systematic review were to: a) profile the same screening process applied. Two authors (E.M. and
MSK injuries sustained by SOF personnel and b) identify evi- M.P.) extracted the data into a table. During this process, key
dence-based injury prevention strategies. variables and main findings of interest were identified and ex-
tracted. The items to be extracted from the literature included
the study details (author and year), the study definition of in-
Methods
jury, study demographics (service demographics, age, and sex/
This systematic review was conducted following the Preferred gender of personnel), and any injury data of relevance (e.g.,
Reporting Items for Systematic Reviews and Meta-Analyses injury prevalence, causes, natures and mechanisms, body parts

TABLE 1 Literature Search Strategy: Databases Used and Corresponding Search Terms
Database Search Terms
Web of ((SWAT OR “special operations” OR “special weapons” OR “special response team” OR “special forces” OR ((police OR polices
Science OR “police” OR policed OR policing) AND (tactic OR tactical OR tactically OR tactics) AND (“groups” OR grouped OR
grouping OR groupings OR “population groups” OR (population AND groups) OR “population groups” OR group OR “social
group” OR (social AND group) OR “social group” OR groups)) OR “specialist police”) AND (injur* OR wound* OR inciden*))
NOT (psycholog* OR (mental OR mentalities OR mentality OR mentalization OR mentalization OR mentalizing OR mentalize
OR mentalized OR mentally))
ProQuest ((SWAT[all] OR “special operations”[all] OR “special weapons”[all] OR “special response team”[all] OR “special forces”[all]
OR ((police[Mesh] OR police[all] OR polices[all] OR “police s”[all] OR policed[all] OR policing[all]) AND (tactic[all] OR
tactical[all] OR tactically[all] OR tactics[all]) AND (“group s”[all] OR grouped[all] OR grouping[all] OR groupings[all] OR
“groups s”[all] OR “population groups”[Mesh] OR (population[all] AND groups[all]) OR “population groups”[all] OR
group[all] OR “social group”[Mesh] OR (social[all] AND group[all]) OR “social group”[all] OR groups[all])) OR “specialist
police”[all]) AND (injur*[all] OR wound*[all] OR inciden*[all])) NOT (psycholog*[all] OR (mental[all] OR mentalities[all] OR
mentality[all] OR mentalization[Mesh] OR mentalization[all] OR mentalizing[all] OR mentalize[all] OR mentalized[all] OR
mentally[all]))
Embase ((SWAT OR ‘special operations’ OR ‘special weapons’ OR ‘special response team’ OR ‘special forces’ OR ((police/exp OR
police OR polices OR ‘police s’ OR policed OR policing) AND (tactic OR tactical OR tactically OR tactics) AND (‘group s’ OR
grouped OR grouping OR groupings OR ‘groups s’ OR ‘population groups’/exp OR (population AND groups) OR ‘population
groups’ OR group OR ‘social group’/exp OR (social AND group) OR ‘social group’ OR groups)) OR ‘specialist police’) AND
(injur* OR wound* OR inciden*)) NOT (psycholog* OR (mental OR mentalities OR mentality OR mentalization/exp OR
mentalization OR mentalizing OR mentalize OR mentalized OR mentally))
PubMed ((“SWAT”[All Fields] OR “special operations”[All Fields] OR “special weapons”[All Fields] OR “special response team”[All
Fields] OR “special forces”[All Fields] OR ((“police”[MeSH Terms] OR “police”[All Fields] OR “polices”[All Fields] OR “police
s”[All Fields] OR “policed”[All Fields] OR “policing”[All Fields]) AND (“tactic”[All Fields] OR “tactical”[All Fields] OR
“tactically”[All Fields] OR “tactics”[All Fields]) AND (“group s”[All Fields] OR “grouped”[All Fields] OR “grouping”[All Fields]
OR “groupings”[All Fields] OR “groups s”[All Fields] OR “population groups”[MeSH Terms] OR (“population”[All Fields] AND
“groups”[All Fields]) OR “population groups”[All Fields] OR “group”[All Fields] OR “social group”[MeSH Terms] OR (“social”[All
Fields] AND “group”[All Fields]) OR “social group”[All Fields] OR “groups”[All Fields])) OR “specialist police”[All Fields]) AND
(“injur*”[All Fields] OR “wound*”[All Fields] OR “inciden*”[All Fields])) NOT (“psycholog*”[All Fields] OR (“mental”[All
Fields] OR “mentalities”[All Fields] OR “mentality”[All Fields] OR “mentalization”[MeSH Terms] OR “mentalization”[All Fields]
OR “mentalizing”[All Fields] OR “mentalize”[All Fields] OR “mentalized”[All Fields] OR “mentally”[All Fields]))

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