MUSCULOSKELETAL (MSK) INJURIES
Overview and Impact
Running Skill
Running skill development can reduce impact on knees by up to 50% (Arendse, 2004) and running technique is an important component of running economy and performance (Folland, 2017).
MSK injuries among Active Duty Soldiers result in over 10 million limited duty days (LDD) each year and account for over 70% of the medically non-deployable population. Most military MSK injuries are to the lower limbs (foot, ankle, lower leg, knee) and are cumulative in nature. They are attributed primarily to running and occasionally to rucking.
Running injuries are an Army-wide problem. In April 2020, Maj. Gen. Lonnie G. Hibbard, commanding general of the U.S. Army Center for Initial Military Training, U.S. Army Training Doctrine Command said $557 million are spent annually to help Soldiers recover from running-related lower extremity injuries.
Military training-related MSK injuries have been called “the single most significant medical impediment to military readiness.” MSK injuries and their long-term effects are also a leading cause for medical disability and discharge.¹
ABOUT MUSCULOSKELETAL (MSK) INJURIES
Musculoskeletal (MSK) injuries can be described as damage to tissue(s) of the musculoskeletal system – bones, joints, cartilage, muscles, fascia, tendons, ligaments, bursa and synovium, and can be grouped into two main categories:
- Acute – single traumatic incident
- Cumulative – trauma that increases in severity due to successive (constantly adding to previous) repetitive incorrect movement (misuse)
Note: Cumulative trauma is often referred to as overuse, but this perspective misrepresents the issue. When the human body is used correctly on a regular basis, it does not result in cumulative trauma. Conversely, consistent incorrect usage, or misuse, can lead to eventual breakdown and injury.
Musculoskeletal injuries are of critical concern for all military branches, but especially so for the Army due to sheer numbers. MSK injuries have a ripple effect that extends to mental health, morale and readiness. Previous MSK injury is a risk factor for future MSK injury and may negatively impact confidence to return to duty.
Learning how to move correctly (technique) and developing this skill is the most direct way to prevent and reduce musculoskeletal (MSK) injuries. A running skill gap is the reason for the high injury rate among military.
Running skill development plays a key role in optimal physical function and injury prevention. The integration of basic movement concepts can also improve the overall performance of the individual Soldier.
Injury prevention and human performance optimization start with learning how to move correctly.
As with weightlifting, technique and form in running is a decisive component of success. You are either getting it done or getting injured. The initial stages in any training program should focus on development of a fundamental skill of movement – how to run (how to ruck, how to lift, how to throw, etc).
MUSCULOSKELETAL (MSK) INJURIES PREVENTION
In line with the official recommendations for general injury prevention and guides for leaders, the following strategy is specific to musculoskeletal injury prevention related to running.
UNIT LEADERS AND DRILL SERGEANTS
- Educate soldiers about MSK injuries, how they happen, and warning signs.
- Implement running skill training by following doctrinal running training guidelines: Field Manual 7-22, chapter 7. In particular,
- implement running drills and running specific strength development into weekly training.
- Avoid replacing distance runs with long foot marches.
- Do not require distance runs or foot marches on back-to-back days.
- Monitor soldiers’ technique when they run, conduct video analysis and provide timely feedback to catch the deviations in technique early to prevent injuries from occurring. To learn how to do it get certified as a Running Technique Specialist – a credential available via Army COOL and ArmyIgnited.
- Replace extended running with running technique training and running specific strength conditioning exercises. This approach is also extremely effective for speed development.
- Do not use additional physical training activities, running or marching as disciplinary measures. This can increase a risk of injury and overtraining.
SOLDIERS
- Know the difference between muscle soreness and injury. Soreness (also known as DOMS – Delayed Onset Muscle Soreness) usually appears 12-24 hours after training that placed unaccustomed loads on muscles, and goes away within a week. An injury in the making can sometimes be felt during training, as repetitive movement is performed incorrectly, or immediately after, and is distinguished from soreness by the type and level of associated pain, and actual imposed limits on normal movement.
- Seek medical evaluation for unusual pain that is in a joint, foot, knee, shin, or hip. To prevent any pain from becoming increasingly debilitating do not continue performing any physical training without adjusting your technique.
- Replace extended running with running technique drills and running specific strength conditioning exercises.
- Follow doctrinal running training guidelines: Field Manual 7-22, chapter 7 by studying with an online self-paced running skill training course available via ArmyIgnited
Schedule running seminar on your post to follow the training schedule and protocols in Field Manual (FM) 7-22 (Holistic Health and Fitness, October 2020). 1-Day seminar provides theory and practice to improve running practice and support team building.
Recommended for everyone.
This training course is a standardized approach to running and is part of the updated US Army FM 7-22. It focuses on improving running skill and biomechanics in order to directly optimize running performance, increase speed and reduce the risk of injuries.
Recommended for everyone.
In line with injury prevention, readiness and human performance optimization initiatives, this certification enables the recipients with a critical skill to instruct in running technique and to enforce the implementation of the updated regulations.
Recommend for leadership.
Information Sources and References:
- Report to the Congressional Armed Services Committees
- H.R. 4350, the National Defense Authorization Act for Fiscal Year (FY) 2022
- Musculoskeletal Injuries: Modifiable and Non-modifiable Risks and Strategies for Prevention
- A Standardized Approach to Department of Defense Medical Surveillance of Injuries: Initial Objectives of the Military Injuries Working Group, 2019-2022
- H2F launches Thunderbolt Performance Center
- Holistic Health and Fitness System Overview. Information Paper. ATCG-H2F 23 OCT 19
- Military public health experts provide tips for leaders to improve medical readiness
- Army experts track injuries to identify risks, support prevention
- New Army leader guide offers strategies for reducing Soldier injuries
- Leader Guide: What Leaders Can Do to Increase Readiness
- U.S. Army Public Health Center Musculoskeletal Injuries Fact Sheet
- Army experts track injuries to identify risks, support prevention
- Injuries, Causes, Risk Factors, and Prevention Overview. DHA
- Health of the Force reports
- Joseph M Molloy, Timothy L Pendergrass, Ian E Lee, Michelle C Chervak, Keith G Hauret, Daniel I Rhon, Musculoskeletal Injuries and United States Army Readiness Part I: Overview of Injuries and their Strategic Impact, Military Medicine, Volume 185, Issue 9-10, September-October 2020, Pages e1461–e1471, https://doi.org/10.1093/milmed/usaa027
- Deydre S. Teyhen, Stephen L. Goffar, Scott W. Shaffer, Kyle Kiesel, Robert J. Butler, Ann-Maree Tedaldi, Jennifer C. Prye, Daniel I. Rhon and Phillip J. Plisky, Incidence of Musculoskeletal Injury in US Army Unit Types: A Prospective Cohort Study. Journal of Orthopaedic & Sports Physical TherapyVolume 48, Issue 10Oct 2018Pages736-828 https://doi.org/10.2519/jospt.2018.7979
- Bruce H. Jones a, Keith G. Hauret a, Shamola K. Dye a, Veronique D. Hauschild a, Stephen P. Rossi a, Melissa D. Richardson a, Karl E. Friedl, Impact of physical fitness and body composition on injury risk among active young adults: A study of Army trainees. Journal of Science and Medicine in Sport Volume 20, Supplement 4, November 2017, Pages S17-S22 https://doi.org/10.1016/j.jsams.2017.09.015
- George, S.Z., Childs, J.D., Teyhen, D.S. et al. Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial. BMC Med 9, 128 (2011). https://doi.org/10.1186/1741-7015-9-128