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Musculoskeletal injuries are a problem in military personnel as they detract from force readiness and may prevent deployment. Injuries occur during basic training at three times the rate observed in post-training military service and more commonly in part time (PT) when compared to full time (FT) army personnel. The purpose of this study was to examine differences in rates and patterns of reported injuries between full time (FT) and part time (PT) personnel undertaking army basic training.
Musculoskeletal injuries are a major problem in military personnel as they detract from force readiness, may prevent soldiers from deploying and create a high financial burden [1, 2]. Injury rates during military basic training have been estimated to range between 6 and 30 per 100 personnel per month in full-time personnel, contributing to attrition and increased training costs [3,4,5]. These injury rates in basic training are around three times those experienced at other times during a military career [4, 6]. Therefore, prevention of injuries during military training is a priority, with injuries occurring during basic training of particular interest [7].
Given that basic training constitutes a high risk period for injury amongst army personnel, that there is currently a difference in training duration between full-time and part-time personnel, and that injury rates appear higher overall for part-time army personnel, the aim of this investigation was to investigate and compare the rates and patterns of injuries suffered by both full-time Australian Regular Army (ARA) and part-time Australian Army Reserve (ARES) personnel during basic training.
A retrospective cohort study was conducted to determine and compare the patterns and rates of injuries which occurred during basic training in both ARA and ARES personnel. Injury data from the period 01 July 2012 to 30 June 2014 was obtained in a non-identifiable format from the Workplace Health, Safety, Compensation and Reporting (WHSCAR) database of the Australian Department of Defence. This database constitutes the record of all occupational health and safety incidents, including those leading to injuries, experienced by army personnel [19]. This database contained information on service type, type of occurrence, date of incident, nature of resulting injury, body site affected by resulting injury, mechanism of resulting injury, activity at the time of the incident (including specific event, e.g. field exercise, if applicable), duty status and an incident description.
Injury records were included in the study if they related to army basic training and if they represented a minor or serious personal injury, as per the Department of Defence definitions [19]. It was planned that injury records would be excluded if they contained missing or incomplete data, however no records were missing data and so none were excluded on this basis. Outcomes of interest included nature of injury, injury mechanisms, activity being performed at the time of injury and body location of injury.
Descriptive analyses, including analysis of frequencies and proportions, were then undertaken using SPSS [21] to establish and enable visual and narrative comparisons of the numbers and patterns of injuries reported by full-time and part-time personnel to have occurred during army basic training.
The aim of this study was to determine and compare the rates, types, source activities, body locations, natures and mechanisms of injuries reported to have occurred in full-time and part-time army recruits during basic training. In ARA and ARES recruits, injury rates were similar, with soft tissue injuries, injuries to the knee and injuries occurring during physical training most commonly reported in both cohorts. These results are in agreement with other published studies which have found that injuries during military training are most commonly at or below the knee [3, 23], that physical training is most commonly the activity in which injury occurs [24] and that injuries to soft tissues are most common and mostly overuse in nature [23]. These, and the broader findings from this study, suggest that injury patterns are very similar between full-time and part-time recruits undertaking army basic training. Given that the types and causes of injuries are similar, it is also reasonable to expect that similar approaches to injury prevention would be effective in both full-time and part-time army recruit populations.
Minimising injuries during basic training should therefore be a focus for both ARA and ARES alike, with close attention paid in both populations to known risk factors for injury. In basic training specifically, Knapik and colleagues have found that low aerobic capacity in army recruits leads to a greater physiological stress during endurance based training tasks such as marching, obstacle courses, drill and running [23]. Addressing this problem is a dilemma for defence forces, as despite the reported benefits of physical fitness to protect against injury, increasing physical training can cause higher injury rates, requiring a balance between the need for fitness and the increases in risk of injury associated with increases in training volume [1]. However, it should be noted that research has shown that greater improvements in strength, endurance, and balance can be achieved with the same training volume when it is delivered by more experienced instructors [11]. While this benefit is known, defence forces must make an active effort to provide opportunity to its instructors to be able to become more experienced and qualified. It is thought that more experienced, tertiary qualified physical training instructors may be better able to adapt the training contents and loads to individual needs. For example, they may be able to implement high intensity intermittent training in place of some aspects of long duration endurance training, replace individual, machine based strength training with strength circuit training, and employ balance and agility training, though the latter with care to ensure overall training load does not increase, in order to prevent an increase in injury rates [13].
Previous research has shown that part-time army recruits tend to be significantly older, heavier and possess lower relative aerobic fitness than full-time recruits [17]. In addition, the differences in training dose in army basic training for full-time and part-time personnel can lead to a significantly greater increase in aerobic fitness by the end of basic training in full-time personnel when compared to part-time personnel [17]. Although it was not measured in this study, the shorter duration of basic training for ARES recruits may result in lower aerobic fitness gains than those made by recruits undertaking the longer ARA basic training course. This would mean that part-time personnel must improve their fitness after basic training or experience a greater level of injury risk if they are to be expected to work alongside full-time forces, completing the same tasks, in later years [29]. Recent research suggests that this heightened injury risk in part-time army personnel, per unit of time served, may in fact be a reality [5]. Further research is needed to confirm this possibility and test whether interventions designed to enhance fitness of part-time personnel are effective in reducing injury risk.
Types and causes of injuries reported by army recruits as having occurred during basic training are similar between full-time and part-time elements of the army. Both service types are injured at a similar rate, and at a higher rate than in the rest of their careers. Both full-time and part-time personnel undertaking basic training are most commonly injured during physical training. Their injuries tend to be soft-tissue in nature and the knee is the body site most affected by injuries in this context, with a large proportion of injuries stemming from overuse. Proposed interventions for both full-time and part-time army recruits should consider these findings and key points raised in the preceding discussion. 2ff7e9595c
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