21st Century Military Warfighter Reference: Physical Training Injury Prevention - U.S. Army Report with Practical Ways to Avoid Training Injuries and Harmful Exercises, Detailed Injury Cause Review

This is a print replica reproduction of the important military report, Recommendations for Prevention of Physical Training (PT) - Related Injuries: Results of a Systematic Evidence-Based Review by the Joint Services Physical Training Injury Prevention Work Group by the U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground.

There are discussions of the pros and cons of practical issues, such as: avoidance of "harmful" exercises (e.g., deep knee bends, mule kicks, sit-ups); would injury rates and performance be affected if body weight was assessed at a time other than a maximal effort physical fitness test?; replace running shoes every 400-600 miles; shock-absorbing insoles; socks and antiperspirants to prevent blisters; individual prescription of running shoe based on foot type; joint Support Joint bracing (especially with history of previous injury - ankle, knee, etc); joint Support Ankle taping; mouthguards, helmets, pads, reflective material; running surfaces that minimize injury; obstacle course landing areas and serial review of same; adjustment of training load by seasonal variations (when environmental temperatures are high); incorporate safe lifting technique training into PT; train Service members in special awareness and core body movement and management skills (how to run, jump, land, cut, and decelerate); pre- and post-PT nutrition, supplementation, and hydration; reinitiating exercise at lower intensity levels for the detrained (at what point of detraining should one revert to lighter training loads?); no PT on days when exhaustive military training occurs; increase marching while decreasing running; run in ability groups by time, not distance; targeted muscle strengthening; and more.

The Military Training Task Force (MTTF) of the Defense Safety Oversight Council chartered a Joint Services Physical Training Injury Prevention Work Group (JSPTIPWG) to 1) establish the evidence base for making recommendations to prevent injuries, 2) prioritize the recommendations for prevention programs and policies, and 3) substantiate the need for further research and evaluation on interventions and programs likely to reduce PT-related injuries. Of the 40 PT-related injury prevention strategies reviewed in the scientific literature, 3 were determined to be essential elements of a successful injury prevention program and not interventions in and of themselves. As a result of the work group process, one more essential element was added for a total of four. The remaining 37 interventions were categorized into 3 levels representing the strength of recommendation: recommended, not recommended, and insufficient evidence to recommend or not recommend. Six interventions had strong enough evidence to become JSPTIPWG recommendations for implementation in all four military Services immediately. Two interventions were not recommended due to evidence of ineffectiveness or harm and should be discouraged by leaders at all levels. This technical report identifies 29 injury prevention strategies that have yet to be evaluated or that lack sufficient scientific evidence to support Quad-Service recommendations at this time. Injury researchers interested in studying the prevention of PT-related injuries in the military should start with this list. The systematic process of evaluating interventions enabled the JSPTIPWG to build Quad-Service consensus around those injury prevention strategies that had enough scientific evidence to support a recommendation. The use of guidelines that required a sufficient level of scientific evidence before making any recommendation was key to prioritizing the recommendations. Preventing physical training-related injuries will have a significant effect on military operational readiness by decreasing entry-level attrition and separation due to injury.