This article was originally published in The Raider Patch: Magazine of the U.S. Marine Raider Association

“It’s not the years, honey. It’s the mileage.” – Indiana Jones 

Relatively young men and women in the military seem to sustain more injuries than their non-service peers. Ask a Marine which knee hurts, and they’re likely to tell you “the worse one” rather than label right or left! There’s no doubt that physical injuries like overuse take a toll on the body. But they also disrupt a leader’s operational planning when a team member is sidelined due to a seemingly benign injury. 

Leaders, take note: overuse injuries can be reduced on a meaningful scale. Many are entirely preventable. All will require your awareness and action to mitigate the risks and keep your team up and running.

This article will go over military injury trends, how the body breaks down, injury risk factors, and action steps for leaders.

MSKIs and the Military

MSKIs cost high-performance military teams serious time, money, and misery. Take a look at some of the statistics:

• MSKIs accounted for 73% of all disability cases from 1997 to 2002
• MSKIs are the single most common reason (53%) for discharge from service. 
• Physical training and sports-related activities account for up to 90% of all injuries; 80% of these injuries are considered overuse in nature.
• MSKIs comprise the greatest percentage of primary care and physical therapy visits in the deployed environment. During OEF/OIF, there were more MEDEVACs for MSKIs than combat-related injuries – the majority caused by sports or physical training.

How the Body Breaks Down

Take a look at the jobs of the body – notice that moving your brain from place to place is not its primary duty!

Effective MSKI prevention requires awareness of how the body breaks down from moving too much or not moving enough. Here are the top three ways the body breaks down and what you can do to minimize the damage.

1. Tissue overload 

• Problem: Demand exceeds capacity. Either there is a weakness of the involved body tissues or a workload imbalance where certain body parts are doing the wrong job (aka, those dreaded compensations).

• Solution: Quantify the mechanical stress the body endures over days, weeks, or months, and look for trends. Identify muscle imbalances that cause body parts to perform the wrong job and take steps to eliminate them. 

2. Repetitive motions

• Problem: A lack of work variety. In caveman days, the human body required movement in three dimensions all day long. Fast forward to today, and it’s common to barely move in one. 

• Solution: Be deliberate about work variety. When possible, vary your work throughout the day. Focused bouts of 25 to 30 minutes at the computer alternated with more physical tasks is a more effective way to maintain task attention and output performance than riding your desk for hours.

3. Sustained Positions 

• Problem: Tissues under constant tension break down without an opportunity to recover.
• Solution: Reverse your postures and positions after extended use. For the neck, straighten up and think, “be an inch taller.” For the lower back, stretch the opposite way you’ve been working (bent forward or bent backward). If you’ve been sedentary, “Get Off Your Butt!”

Let’s look at the blood supply issue, using the neck as an example. In the anatomy diagram below, notice how the blood vessels and nerves are situated between muscles and run from the neck and under the collar bone. When the arms are working, the muscles squeeze the blood vessels, reducing blood supply. Muscles and nerves lacking blood flow become malnourished – losing oxygen and building up acid. Interestingly, this inflammatory condition also causes chemical changes that chew up tendons. Suppose you’ve ever been diagnosed with “tendinitis” but weren’t doing any strenuous workouts to drive it. In that case, a blood supply issue may be the culprit!

Adding insult to injury is posture. When the head is off-center, the neck joints experience 300% more weight-bearing forces, and the muscles work 300% harder. This recipe for neck pain and headaches doesn’t account for the additional stress of wearing a helmet and NVGs. A similar situation happens in the low back with sustained bent or hyperextended positions, particularly when the spine is also under body armor and rucksack loads.

Know the Risk Factors

Here are the current factors most strongly associated with time-loss MSK injuries: 

1. Age
2. Gender
3. History of prior injury
4. Lower perceived recovery from injury 
5. On profile/limited duty within the past year 
6. Poor ankle mobility 
7. Poor performance on limb reaching tests
8. Pain reported with movement 
9. Slower 2-mile run times 

Service members with 7 or more risk factors had a high risk of sustaining a time-loss injury over the next year; those with only 1 or 2 risk factors were well-protected with little to no increased risk. While several factors are fixed – such as age and prior injury history – note the factors in bold that can be eliminated with targeted interventions.

Action Steps for Leaders: Plan Ahead

1. Be aware of physical risk factors and mitigate them when possible

Know the leading causes of MSKIs (tissue overload, repetitive motions, sustained positions) and risk factors for time-loss (7/9 factors = high risk). 

Consider the previous day’s physical training and mission requirements and what’s planned for the following day. Then, make small, immediate changes where practical, and explore incremental adjustments that you can implement across training cycles. 

2. Encourage personnel to seek care if there is a concern for injury

Being injured does not equal no training. For example, someone with a sprained wrist can still train upper body strength with modified exercises and implements. A 20-minute modified workout is better than a 60-minute session that they can’t do. Something is always better than nothing. 

3. Encourage a culture of fitness

While you can’t control outcomes, you can influence your behaviors and your team’s. A fitter workforce is more injury-resistant AND more resilient. Both professional athletes and Marines are paid to be fit. And just like pro athletes, some degree of responsibility for physical training accountability falls on the shoulders of management. So make physical training a priority and a built-in component of weekly planning. 

4. Ask a Pro

Utilize Human Performance resources for program design. While the HP team may involve many different resources, start with the following professionals if injury prevention is the objective: 

• Strength Coaches can help design plans to improve strength, stamina, and body composition and provide mission-specific training preparation. 

• Performance Dietitians can help Marines lose or gain weight, manage food sensitivities, and provide specific hydration and fuel plans to support missions and special events. 

• Cognitive Performance Specialists can help improve concentration and focus, enhance leadership and decision-making, and regulate arousal, anxiety, and stress. 

• Physical Therapists and Athletic Trainers can help identify and treat pain with movement, provide rehab and return to readiness programs after injury, and help restore lost spine or joint motion. 

References: 

Teyhen DS, Shaffer SW, Goffar SL, et al. Identification of risk factors prospectively associated with musculoskeletal injury in a warrior athlete population. Sports Health. 2020;12(6):564-572. doi:10.1177/1941738120902991.

Cohen SP, Brown C, Kurihara C, Plunkett A, Nguyen C, Strassels SA. Diagnoses and factors associated with medical evacuation and return to duty for service members participating in Operation Iraqi Freedom or Operation Enduring Freedom: a prospective cohort study. Lancet. 2010;375(9711):301-9.

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