Epidemiology of Musculoskeletal Injury in Military Recruits: a Systematic Review and Meta-analysis

Overview

Journal BMC Sports Sci Med Rehabil

Publisher Biomed Central

Specialty Orthopedics

Date 2023 Oct 29

PMID 37898757

Authors

Myles C Murphy

Joanne Stannard

Vanessa R Sutton

Patrick J Owen

Brendon Park

Paola T Chivers

Nicolas H Hart

Affiliations

Soon will be listed here.

Abstract

Background: Injuries are a common occurrence in military recruit training, however due to differences in the capture of training exposure, injury incidence rates are rarely reported. Our aim was to determine the musculoskeletal injury epidemiology of military recruits, including a standardised injury incidence rate.

Methods: Epidemiological systematic review following the PRISMA 2020 guidelines. Five online databases were searched from database inception to 5 May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by military recruits after the year 2000 were included. We reported on the frequency, prevalence and injury incidence rate. Incidence rate per 1000 training days (Exact 95% CI) was calculated using meta-analysis to allow comparisons between studies. Observed heterogeneity (e.g., training duration) precluded pooling of results across countries. The Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies assessed study quality.

Results: This review identified 41 studies comprising 451,782 recruits. Most studies (n = 26; 63%) reported the number of injured recruits, and the majority of studies (n = 27; 66%) reported the number of injuries to recruits. The prevalence of recruits with medical attention injuries or time-loss injuries was 22.8% and 31.4%, respectively. Meta-analysis revealed the injury incidence rate for recruits with a medical attention injury may be as high as 19.52 injuries per 1000 training days; and time-loss injury may be as high as 3.97 injuries per 1000 training days. Longer recruit training programs were associated with a reduced injury incidence rate (p = 0.003). The overall certainty of the evidence was low per a modified GRADE approach.

Conclusion: This systematic review with meta-analysis highlights a high musculoskeletal injury prevalence and injury incidence rate within military recruits undergoing basic training with minimal improvement observed over the past 20 years. Longer training program, which may decrease the degree of overload experienced by recruit, may reduce injury incidence rates. Unfortunately, reporting standards and reporting consistency remain a barrier to generalisability.

Trial Registration: PROSPERO (Registration number: CRD42021251080).

References

Green B, Pizzari T . Calf muscle strain injuries in sport: a systematic review of risk factors for injury. Br J Sports Med. 2017; 51(16):1189-1194. DOI: 10.1136/bjsports-2016-097177. View

Lovalekar M, Sharp M, Billing D, Drain J, Nindl B, Zambraski E . International consensus on military research priorities and gaps - Survey results from the 4th International Congress on Soldiers' Physical Performance. J Sci Med Sport. 2018; 21(11):1125-1130. DOI: 10.1016/j.jsams.2018.05.028. View

Maffulli N, Longo U, Gougoulias N, Loppini M, Denaro V . Long-term health outcomes of youth sports injuries. Br J Sports Med. 2009; 44(1):21-5. DOI: 10.1136/bjsm.2009.069526. View

Sammito S, Hadzic V, Karakolis T, Kelly K, Proctor S, Stepens A . Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model. Mil Med Res. 2021; 8(1):66. PMC: 8662851. DOI: 10.1186/s40779-021-00357-w. View

Chasse E, Laroche M, Dufour C, Guimond R, Lalonde F . Association Between Musculoskeletal Injuries and the Canadian Armed Forces Physical Employment Standard Proxy in Canadian Military Recruits. Mil Med. 2020; 185(7-8):e1140-e1146. DOI: 10.1093/milmed/usaa011. View

Trone D, Cipriani D, Raman R, Wingard D, Shaffer R, Macera C . Self-reported smoking and musculoskeletal overuse injury among male and female U.S. Marine Corps recruits. Mil Med. 2014; 179(7):735-43. DOI: 10.7205/MILMED-D-13-00516. View

Sharma J, Golby J, Greeves J, Spears I . Biomechanical and lifestyle risk factors for medial tibia stress syndrome in army recruits: a prospective study. Gait Posture. 2011; 33(3):361-5. DOI: 10.1016/j.gaitpost.2010.12.002. View

Mohd Din F, Rampal S, Muslan M, Hoe V . Association between pain catastrophising and musculoskeletal disorders is modified by past injuries in Malaysian military recruits. Occup Environ Med. 2016; 73(7):429-34. DOI: 10.1136/oemed-2015-103140. View

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

10.

Hauschild V, Lee T, Barnes S, Forrest L, Hauret K, Jones B . The Etiology of Injuries in US Army Initial Entry Training. US Army Med Dep J. 2019; (2-18):22-29. View

11.

Hall L . Relationship between 1.5-mile run time, injury risk and training outcome in British Army recruits. J R Army Med Corps. 2017; 163(6):376-382. DOI: 10.1136/jramc-2016-000756. View

12.

Cohen B, Pacheco B, Foulis S, Canino M, Redmond J, Westrick R . Surveyed Reasons for Not Seeking Medical Care Regarding Musculoskeletal Injury Symptoms in US Army Trainees. Mil Med. 2019; 184(5-6):e431-e439. DOI: 10.1093/milmed/usy414. View

13.

Booth C, Probert B, Forbes-Ewan C, Coad R . Australian army recruits in training display symptoms of overtraining. Mil Med. 2006; 171(11):1059-64. DOI: 10.7205/milmed.171.11.1059. View

14.

Fallowfield J, Leiper R, Shaw A, Whittamore D, Lanham-New S, Allsopp A . Risk of Injury in Royal Air Force Training: Does Sex Really Matter?. Mil Med. 2018; 185(1-2):170-177. DOI: 10.1093/milmed/usy177. View

15.

Stannard J, Finch C, Fortington L . Improving musculoskeletal injury surveillance methods in Special Operation Forces: A Delphi consensus study. PLOS Glob Public Health. 2023; 2(1):e0000096. PMC: 10021797. DOI: 10.1371/journal.pgph.0000096. View

16.

Havenetidis K, Kardaris D, Paxinos T . Profiles of musculoskeletal injuries among Greek Army officer cadets during basic combat training. Mil Med. 2011; 176(3):297-303. DOI: 10.7205/milmed-d-10-00196. View

17.

Munnoch K, Bridger R . Smoking and injury in Royal Marines' training. Occup Med (Lond). 2007; 57(3):214-6. DOI: 10.1093/occmed/kql170. View

18.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

19.

Murphy M, George H, Naqi M, Owen P, Chivers P, Hart N . Musculoskeletal injury epidemiology in law enforcement and firefighter recruits during physical training: a systematic review. BMJ Open Sport Exerc Med. 2022; 8(1):e001289. PMC: 8889355. DOI: 10.1136/bmjsem-2021-001289. View

20.

Knapik J, Trone D, Swedler D, Villasenor A, Bullock S, Schmied E . Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010; 38(9):1759-67. DOI: 10.1177/0363546510369548. View