Reducing Musculoskeletal injuries in SF soldiers

A fairly recent article in the Journal of Special Operations Medicine (JSOM)* examined the Musculoskeletal injuries from 5th group.

The authors decided to quantify the rates and types of these injuries in SF using the records from 5th group, “who treated numerous middle-aged team sergeants with shoulder, back, and knee overuse injuries”
The authors noted “Special Forces, and Ranger units are about 10 to 12 injuries per 100 Soldier-months, which is comparable to collegiate endurance athletes. Of all the types of units studied, Special Forces has the highest incidence of injury rate at 12.1 per 100 Soldier-months.”

This study revealed that physical training caused 50% of all injuries, and 30% were linked to running. Injuries resulted in 10-times the number of profile days (lost work days) as illnesses with the leading reason for outpatient visits in our Group was for musculoskeletal disorders.

The locations of affected musculoskeletal conditions in descending order include: back/neck (31%), ankle (10%), shoulder (10%), and knee (10%).

The authors found that “…over 40% of all clinical diagnoses in the 5th Group Clinic were for musculoskeletal problems.” This translated into injured members of 5th group being put on “light duty” an average of 20 to 30 days each which has “significant” operational impact on the unit.

It was interesting to note that in other army units studied, musculoskeletal injuries are more common in the lower extremities (e.g., knees and ankles) but in SF, upper extremity injuries (e.g., lower back, upper back, shoulders, etc) are more common. The authors theorized “This may be due to the slightly older average age of our Soldiers versus conventional units, in addition to the cumulative effect of repetitive micro trauma from airborne operations, combatives training, wearing heavy body armor, and carrying heavy loads.”

This article covered a bunch of additional info about injury rates and other details interested parties (trainers, docs, etc) can look up the full article for additional details there. Of most interest to me, was their comments on prevention:
“Finally to focus more on prevention, Special Forces Groups should modify unit physical training programs to incorporate the fitness and performance fundamentals used in today’s top athletic programs. Military researchers have shown that modified physical training programs can result in lower injury rates with improvements in physical fitness. Training regimens that emphasize core strength and cross-training would likely increase physical readiness while decreasing the incidence of spine and lower extremity injuries.”

I agree with all of the above. As mentioned, training hard and training smart, are not always the same thing. The latter leading to greater performance and reduced injury rates, with improved operational readiness and (potentially) greater operational longevity for the SF soldier. The top coaches involved in “today’s top athletic programs” follow similar guidelines I mentioned regarding programs that follow a wave form pattern vs. a linear pattern I had mentioned in other blog posts here.
I’m happy to see the medical and training community within the SOF community is starting to see the benefits in both performance -and reduced rates of injuries – following more modern concepts in training already being utilized by the top athletic programs and or coaches in the field. The authors finished their report by summing it up nicely:

“By making these changes to training and resourcing, Special Forces Groups will be investing in our most lethal weapon—the individual Special Forces Soldier.”

* Clinical Diagnoses in a Special Forces Group: The Musculoskeletal Burden
James H. Lynch, MD, MS and Mark P. Pallis, DO, FAAOS. Journal of Special Operations Medicine (JSOM): Volume 8, Edition 2 / Spring 2008, 76-79

  1. Jim Wood 15 years ago

    I am in need of advise on the best way to rehab my left ankle after having a subtalor fusion June 1st. I was told by my surgeon that I could run again, however, others have indicated different. I am a trained Tactical Medic and desire to return to duty. Please advise.

  2. Author
    Will Brink 15 years ago

    Jim, my best advice to you would be to seek out/get a referral to a physiatrist.
    One of the mods on my forums is a rehab physician. He’s a physiatrist to be exact. Many people don’t know about this specialty, and it can be a real life saver for those with various injuries, etc. His name is Dr. Peck. He’s a wealth of knowledge about all things rehab, training, etc. He posted the info below on my forums and it’s of great value to the mil/SOF population also, who are no strangers to injuries and aches and pains of all kind. His write up:
    By Evan Peck MD:
    Have a disabling medical problem that is affecting your participation in the sports or activities you enjoy?
    Is your primary care doctor either unhelpful or unwilling to understand why you don’t want to “just rest it” for the rest of your life?
    Is the surgeon you were referred to only interested in cutting on your problem?
    Even worse, was the problem already cut on, but you are not any better?
    Is there any alternative, or do you have to resort to chiropractors or naturopaths or quacks to find a health care provider who can help?
    Stop right here. You may or may not be aware of it, but there is a medical specialty specifically dedicated to non-surgical restoration and optimization of function in people with disability, ranging across the entire spectrum of disability – from a sprained ankle to a spinal cord injury, from carpal tunnel syndrome to a stroke. That specialty is Physical Medicine and Rehabilitation (PM&R).
    PM&R is a small medical specialty that has only had a medical board since 1947, but is rapidly growing as more and more people want to stay active and are unable to find physicians willing or able to help them overcome (primarily) neuromusculoskeletal injury and disability to maximize their activity and function. Many more people are also becoming weary of some of the pitfalls of only treating injuries with surgeries that “treat the MRI” and/or long-term drug use to cover up the pain rather than seek and fix the underlying cause.
    PM&R doctors are fully licensed allopathic and osteopathic physicians that go to the same medical schools as family doctors, obstetricians, neurologists, surgeons, pediatricians, radiologists, and all other medical specialties.
    A PM&R physician may be just who you need to maximize your function and performance, and to overcome injuries and ailments to resume doing the things you like to do at the level you like to do them. To find a PM&R physician in your area, please see the following website:

  3. Ray 14 years ago

    I have two tears in my left rotator, this has been a nagging injury for over the last 2 years. My Dr. told me that if rehab did'nt work that I may need to prepare for surgery. SInce the MRI diagnosis, I have continued training for fat loss quite successfully, but now have sever pain in my left forearm. This initially started as a slightly irritating problem that I begum to treat immediately but no luck. This pain then abruptly became rather severe almost over night.This pain has even prevented me from simple tasks such as turning the key in my front door. I know this is "Tennis Elbow" but this pain is riducolous. I know I must halt my upper body training, but several layoffs have not been helpful for my elbow.I am scheduling another MRI to include my elbow and shoulder. The previous was over a year ago. I guess ultimately my question would be, and I'm sure I know the answer, but do I halt my upper body training altogether for now other then ABS and continue with legs and lower my calorie intake? What recomendations would you possibly have that can help me continue some form of training to continue my journey of reaching my 9% BF goal?

    • Author
      willbrink 14 years ago

      Ray, best advice I would give you is what I gave Jim above regarding getting a referral to a physiatrist. MRI is well and good, but it diagnosis, it does not actually alter the patterns that lead to the problem to start with.

  4. knee pain treatment 14 years ago

    Hi mate would it be ok if we took some info from here to use on one of our blogs? all the best

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  6. Scott Menzies 10 years ago

    Hi Will, very interesting article. Over the last few years I have had 4 hip arthroscopies (two on each hip) for tears, reshaping etc. Recovery is going ok and my recent surgeon is best in the business and I am hoping to try out for swat selection again. I’m fearful of re-injury through explosive leg training, pack marches, runs etc. Any ideas would be greatly appreciated.

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