LANGLEY AIR FORCE BASE, Va. –
Editor's Note: This article was modified with permission from the author, Maj. (Dr.) Anthony Beutler, and was originally published in the Medical Examiner Newsletter, Fall 2008 and Combat Edge 2010. Beutler is an Assistant Professor in the Department of Family Medicine at the Uniformed Services University and is the Chief of the Injury Prevention Research Laboratory. Capt. Justin Gray is a Doctor of Physical Therapy in the Department of Physical Therapy at Langley AFB.
Injury prevention is a funny term. Like "global warming,""human performance optimization," and "political change," injury prevention has many different and sometimes completely opposite meanings to different people. But looking more narrowly at musculoskeletal injury, the statistics are frightening and clear. Too many people are too frequently hurt in the military. And as people train more frequently to meet the new twice-a-year fitness testing standards, the chances of a running or other fitness injury is even greater. Can't we do something about it?
The First Step in Prevention
Musculoskeletal injuries are extremely common and costly in the military. The statistics are staggering. In the peacetime military (i.e., pre-2001), musculoskeletal injuries accounted for 50 percent of deaths, 50 percent of disabilities, 60 percent of clinic visits, and were the leading cause of hospitalization and lost duty time. In fact, more duty days are lost to tears of the anterior cruciate ligament (ACL) than to any other single non-combat, musculoskeletal injury. Who knew that three-on-three basketball could look so much like hand-to-hand combat! But if musculoskeletal injuries are so common and costly, can they be prevented? The causes of injuries in basic training and other military environments are well documented, and offer several valuable lessons:
Lesson 1 - Don't Smoke.
Smoking is one of the two universal, independent risk factors for injury. Smoking at least doubles your risk for musculoskeletal injury and it is an entirely modifiable risk factor.
Lesson 2 - Be Fit.
Decreased fitness is the second universal, independent risk factor for injury. It's not just your heart that you hear screaming at you to get off the couch. Muscles, tendons, cartilage and bone need stressing to maintain their functions. And your abdominals just don't hold up well when your "six-pack" becomes "one-lump."
Lesson 3 - Stretching is Not for Everyone, Warming Up Is.
We have studied stretching and jumping jacks until we're blue in the face (literally). Stretching prior to working out has little effect on injury rate and no effect on muscle soreness. This is probably because people at the extremes of flexibility (too much or too little) have a higher risk of injury than people with normal flexibility. Assuming that stretching improves your flexibility--a big assumption--what happens if you make every Airman stretch regularly? People who are less flexible may become more flexible, and that will result in less injury risk. But the people who started off normal may become hyper-flexible and therefore more prone to injury, thereby cancelling out any overall injury prevention. So, stretching for the masses is out.
However, warming up before exercise does help. Proper warm-ups are associated with improved performance and less muscle soreness. Increasing literature shows that specific warm-up programs prevent injury when performed regularly and correctly. We do a lot of jumping jacks and push-ups in the military and just about any way you warm-up is probably better than no warm-up at all. But if we had a program that could warm you up, and in the same eight minute period prevent 50% of all leg injuries, squadron PT might change significantly. To review sample injury prevention warm-ups, go to the following website and click on the "Exercise Manual:" http://www.usuhs.mil/fap/iprlprojects.html#adsoccer.
Lesson 4 - There are LOTS of Proven Ways to Prevent Musculoskeletal Injury.
Of all the injury prevention data, the most widely applicable in the military is the prevention of ankle sprains. There are several simple things that can decrease injury risk: i) Ankle braces and balance training to prevent recurrent sprains, ii) Replace running shoes frequently; every six months or every 300 to 400 miles; and iii) Wear stability shoes no matter the foot type. Research shows that prescribing shoes based on foot type actually increased injuries in basic military trainees. Implementation of these and other easy interventions will go a long way toward an injury-free military.
Where can I go to learn more?
The Injury Prevention Research Lab at USUHS is working hard to understand the best ways to prevent and treat injuries. The Injury Prevention Research Lab is a part of the USUHS Consortium for Health and Military Performance (CHAMP). CHAMP is pushing the frontiers of injury prevention, nutrition, and medical treatment to the war fighter. If you have concerns about injury prevention or treatment, check out USUHS Family Medicine website: www.usuhs.mil/fap/iprl.html or the CHAMP website at http://www.usuhs.mil/mem/champ.html
Throughout the month of October, your Joint Base Langley-Eustis Physical Therapy staff will host classes and provide information workshops to acquaint our fellow armed forces personnel with the services offered by the department. For more information, contact Langley Physical Therapy at 764-6963 or Capt. Justin Gray at justin.gray@langley.af.mil.