ABERDEEN PROVING GROUND, Md. – The Defense Centers for Public Health-Aberdeen, formerly the Army Public Health Center, routinely monitors Soldiers’ medical data to identify the most common or problematic military injuries, trends and risk factors.
“The surveillance data we gather from our routine surveillance, along with findings from our investigations of specific activities, provide evidence to inform policies, procedures and equipment development,” says Army Col. Amy Blank, chief of the DCPH-A's Military Injury Prevention Division.
DCPH-A subject-matter experts evaluate injuries associated with military activities, physical training and sports. Eye damage and hearing loss injuries are investigated separately by ophthalmologists and optometrists and by audiologists, respectively.
How have data improved military readiness?
“As one success story, years of monitoring eye injuries proved that the development and Soldiers’ use of effective eye protection were a solution to a severe problem,” says Army Maj. William Garrison, chief of the DCPH-A Tri-Service Vision Conservation and Readiness Branch. “Eye injuries still occur, but use of official equipment and compliance with procedures have been shown to be good controls.”
Noise-induced hearing loss, a leading reason for veteran disability compensation, is also experienced by active-duty Soldiers whose gradual loss of auditory ability can adversely impact survivability, lethality and situational awareness. By monitoring hearing loss data among Soldiers, experts are able to determine if programs and equipment are effective.
By far, the leading category of injuries experienced by active-duty Soldiers is microtraumatic damage to the musculoskeletal system, or MSK overuse injuries. Overuse injuries occur over time due to excessive use from running, marching and other repetitive activities that stress tissues more quickly than they can heal.
“Each year, about 70 percent of the approximate 500,000 active-duty Soldiers’ initial medical visits are for MSK overuse injuries,” says Dr. Michelle Chervak, chief of the DCPH-A Injury Prevention Branch. “Overuse injuries can take weeks or months to heal and are the leading reason for Soldiers’ having a medical profile, which can require a temporary restriction from physical duty or deployment.”
DCPH-A data have supported changes in the Army’s past “run-centric” physical training because a majority of overuse injuries are often training-related knee, lower leg and foot, and back injuries associated with distance running. Today’s Army fitness training promotes a gradual increase in training distances and a broader regimen of strength, power, balance, agility, and speed drills to reduce overemphasis on long runs.
“While reduced focus on running can help, data also suggest the same injuries are associated with ruck marching,” says Chervak.
This means leaders should not plan distance marches in conjunction with other physical training activities that stress the lower body, says Chervak. Tips include avoiding back-to-back days of marching, distance running or lower-body-strength building, and reducing load weights and distances when feasible.
How does injury monitoring help the Army?
“Our data can be used by senior military decision-makers as well as personnel at the local installation level,” says Blank. “However, we encourage installation and unit medical, safety, and public health staff to further investigate their local data.”
DCPH-A injury experts contribute to the annual Health of the Force reports in addition to annual surveillance reports. The HoF reports provide snapshots of a variety of Army-wide and Command- and installation-level health statistics, including injury and noise-induced hearing loss. These annual reports allow leaders and installation personnel to understand the current status and trends of various medical metrics that are impacting force readiness.
Sometimes specific units’ injuries are also investigated. For example, past studies showed that specialized ankle braces reduced acute ankle injuries among paratroopers. Since then, a new parachute design has helped reduce ankle injuries. A more recent investigation of paratroopers suggests they may have higher rates of shoulder injuries than non-paratroopers.
An investigation of three U.S. Army Band units showed their risk of overuse injuries was increased by long periods spent standing and in repetitive or awkward body positions; higher body mass (weight); and slower fitness test run times.
Identifying risk factors and effectiveness of interventions
APHC studies show common factors that may increase a person’s chance of injury. Some factors are inherent to individuals’ physiology, such as age or gender, or to their anatomic features, such as high foot arches or knock knees. Unique injury risk considerations for military women are summarized in an APHC factsheet that can be found at https://phc.amedd.army.mil/PHC Resource Library/MiltaryWomenInjuryPrevention_FS_12-021-0319_Final.pdf.
Other risk factors are conditions or behaviors that can be modified by individuals.
For example, APHC studies have found that being above as well as below Army weight-for-height standards, or body mass index, can increase a person’s injury risk.
APHC studies sometimes use survey questions to better understand factors that contribute to Soldiers’ injuries. For example, fewer hours of sleep have been associated with higher injury risks: Soldiers who had ≤5 hours of sleep had more than twice the risk of injury compared to those who had ≥8 hours of sleep.
Other studies are designed to determine the effectiveness of specific equipment or procedures to reduce injuries.
“Unfortunately, our studies of specific methods or equipment to reduce Army injuries often don’t indicate they work,” says Dr. Bruce Jones, a DCPH-A senior science advisor, medical doctor and retired Army colonel. “However, even this evidence is useful, as it can help redirect injury prevention planning decisions.”
Jones says investigations of orthotics and insoles; specific running shoe design based on foot types; minimalist running shoes; boots versus running shoes; and back braces all failed to show they reduced injuries.
“While we have effective eye protective equipment, hearing protection, and mouthguards to reduce serious dental injuries, we don’t have evidence-based (proven) equipment solutions for preventing training-related overuse injuries,” says Jones.
Jones says because there is no set running distance or frequency that represents a “0 risk” for all Soldiers, the key to reducing injury risk is conducting a variety of training activities to decrease excessive repetitive stress on lower legs.
Weight training, including lifts such as the deadlift, bench press and squat, has recently become a more routine element of Soldier physical training. DCPH-A experts recommend proper technique and a gradual increase of amounts and intensity of these activities to reduce the chance of back, neck, arm, and shoulder injuries.
“By the nature of the military, we must conduct physical training – which itself increases injury risk,” Jones says. “This is why leaders should regularly monitor their unit’s injury profile rates to identify risks that can be modified, and to adjust training accordingly.”
Why it’s important
The DCPH-A's injury monitoring data benefit Soldiers’ immediate and long-term health, but it is up Soldiers and leaders to make use of the information to maximize the overall fighting strength of Soldiers and units and ensure their future health.
APHC injury experts recommend the following basics:
- Recognize high-risk activities, including training in hot and cold weather, ruck marching, parachuting and obstacle courses.
- Wear required approved protection equipment, and follow documented Army procedures.
- Maintain a healthy weight within the Army standards.
- Conduct well-balanced, weekly unit and individual physical training activities.
- - Aim for 75 minutes of vigorous aerobic exercise and 2 sessions of strength training each week.
- - Include exercises for agility, speed, strength, power and balance.
- - Avoid stressing the same muscle groups on back-to-back days (e.g., distance runs and ruck marches)
- - Allow your body a weekly day of rest from strenuous physical activity.
- - Use ability groups for runs to avoid forced gait changes.
- Don’t use tobacco, e-cigarettes or vaping products; they can hinder tissue recovery.
- Prioritize sleep quality to reduce injury risk.
Here is a comprehensive list of Army Injury Prevention Factsheets and Training Products.
The Defense Centers for Public Health-Aberdeen advances Joint Force health protection with agile public health enterprise solutions in support of the National Defense Strategy.
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