Are you injury prone?

ABERDEEN PROVING GROUND, Md. –  Do you know how many injuries you have had? Are there actions you can take to reduce your injury risk?

Injuries include many kinds of damage to body tissue caused by an external energy. Some injuries are easily recognized, like broken bones, cuts, bruises and concussions – but did you know that pain, pulled muscles, stress fractures, sunburn, animal bites, poisonings and electric shocks are all also injuries? The restriction of air or heat can also cause an injury, such as suffocation or frostbite.

Injuries are usually preventable in some way – they are rarely completely unavoidable accidents.

“Understanding the wide variety of causes and factors associated with injury can help you assess your injury risk, whether it be for acute or chronic injury-related conditions,” says Dr. Michelle Chervak, chief of the Injury Prevention Branch of the Defense Centers for Public Health-Aberdeen and co-chair of the Department of Defense Military Injuries Working Group. “For the same reason, we routinely summarize population-level military injury data in aggregated categories to help prioritize prevention efforts.”

Dr. Anna Renner, a safety engineer in the IPB who oversees the annual DCPH-A injury surveillance reports, describes the primary categories of injuries used in military injury reporting:

• Acute traumatic injuries occur when a single force causes damage to the body. Examples include fractured bones, strained or torn muscles, sprained joints, open wounds, animal bites, lacerations and broken teeth.
• Cumulative micro-traumatic injuries, often called overuse injuries, result from small but repeated stress on the same body part without adequate rest during exercising or other repetitive activities like work tasks. The damage to tissues may be repeated over hours, days or weeks before the injury is recognized. The majority of these injuries are to musculoskeletal tissues and include back pain, joint pain, tendonitis, bursitis, stress fractures and runner’s knee.
• Environmental injuries are those caused by an energy source in the natural environment. Heat stroke, heat exhaustion, sunburn, frostbite, hypothermia, altitude sickness and lightning strikes are examples.
• Poisonings can occur from ingestion, injection, contact with or inhalation of a foreign substance (drugs, toxins, chemicals) that causes chemical and biological damage to the body.
• Non-environmental injuries are caused by man-made thermal burns (fire, grease), radiation sickness and electrocution.
• Other injuries include asphyxiation and drownings, surgical complications and mishaps, abuse resulting in intentional injury and unspecified injuries.

“Injuries are the leading reason for active-duty military medical visits among all Services,” says Chervak. “They can often have a significant impact on readiness through lost duty time, reduced performance and medical and disability costs.”

The military medical data continues to show that most injuries experienced by service members are musculoskeletal injuries resulting from cumulative microtrauma or overuse injuries.

“The nature of the physically demanding military training and occupational duties required of service members increases their risk for these of injuries,” says Renner. “For example, repeated running and ruck marching, especially combined, are associated with many lower extremity and back injuries.”

Chervak emphasizes that medical record data only reflect those injuries seen by a medical provider, so the data don’t include self-treated injuries, or those which personnel or trainees just ‘tough it out.’ Though these untreated injuries don’t incur medical costs, they can detract from an individual Service member’s performance, which in turn impacts unit performance.

Assess yourself

Think about your own injury history –

• How many injuries have you had? What caused them?
• Which injuries required a medical visit?
• Which injuries required time off work or restricted your physical abilities?
• Have you avoided medical care for an injury to avoid getting a profile or work restriction? If so, did the untreated injury prevent you from performing at your best? Did it result in a more severe injury later?

Now consider your unique risk factors that can predispose you to a new injury or increase the time it takes to recover from an injury. Examples of injury risk factors include –

• Prior injury, medical conditions and medications

1. Musculoskeletal injuries such as ankle sprains, runner’s knee or back strains, may predispose you to future similar injuries, or to another body region that has compensated for the injury (for example, when an altered gait puts more strain on your non-injured leg). Some musculoskeletal injuries may also lead to long-term or permanent effects, such as chronic knee or back conditions.
2. Prior heat- or cold weather-related injuries can also increase susceptibility to future heat or cold injuries.
3. Illness and medications, such as those for colds, upper respiratory infections or allergies, can increase the risk of heat injuries and may affect thinking and reactions. Only take medications when absolutely necessary and ensure plenty of rest and adequate hydration.

• Higher-risk physical characteristics and behaviors

1. Gender. Some injuries, such as stress fractures, are more common among women. Some injuries have been associated with the female athlete triad syndrome – a combination of very low weight due to inadequate nutrients and calorie intake for an extended time, missed or irregular menstrual cycles and diagnosis of low bone density. It’s observed in some women who participate in high-intensity physical training and strive for leanness or low body weight. Proper nutrition has been suggested to minimize risk.
2. Excessive weight or poor fitness. Service members with high body mass index and/or low aerobic fitness have increased risk of musculoskeletal and heat injury.
3. Smoking and use of nicotine-containing products can inhibit the body’s ability to repair itself after injury. Evidence has tied these products to higher rates of new injuries.

• Ignoring safety guidelines and/or not using recommended equipment

1.  Stairs and flooring, vehicles, machinery and weapons. Though often referred to as “accidents,” injuries that occur from slips, trips and falls, motor vehicle and motorcycle crashes and mishaps with machinery, guns or knives can often be avoided. Awareness of the hazards and following recommended safety precautions could reduce risk of these injuries.
2. Sports. Many sports “accidents” can also be avoided with proper protective equipment such as mouthguards to prevent broken teeth, helmets and wrist guards for skiing and snowboarding and military-recommended hearing and eye protection.

• Not allowing gradual adaptation to new environments and activities.

1. Though it is important to get in shape, it is critical to gradually increase duration, distance, frequency and intensity of physical activity. Too much too soon will only increase the risk of injury. Physical stress that is too much, too fast and/or too frequent can result in overuse injuries. Cross-training is recommended for full body conditioning that may also reduce injuries. This means fewer long runs and marches and, instead, more speed, agility, strength and balance-building activities.
2. Environmental factors including extreme temperatures (hot or cold), humidity, high altitudes and rough terrain also increase risk of injury. Adequate hydration and proper nutrition can decrease weather-related injury risk. Allowing your body to slowly adapt to new environmental conditions can reduce injury risk.

When you assess your injury history and risk factors, you can make changes to reduce your injury risk and improve your physical performance. For additional information –

• Active Duty Injury Prevention website
• Consortium for Health and Military Performance – Human Performance Resources
• Operation Supplement Safety

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