Research Paper Title

Musculoskeletal Injuries and United States Army Readiness Part I: Overview of Injuries and Their Strategic Impact.

Background

Noncombat injuries (“injuries”) greatly impact soldier health and United States (U.S.) Army readiness; they are the leading cause of outpatient medical encounters (more than two million annually) among active component (AC) soldiers.

Noncombat musculoskeletal injuries (“MSKIs”) may account for nearly 60% of soldiers’ limited duty days and 65% of soldiers who cannot deploy for medical reasons.

Injuries primarily affect readiness through increased limited duty days, decreased deployability rates, and increased medical separation rates.

MSKIs are also responsible for exorbitant medical costs to the US government, including service-connected disability compensation. A significant subset of soldiers develops chronic pain or long-term disability after injury; this may increase their risk for chronic disease or secondary health deficits potentially associated with MSKIs.

The authors will review trends in US Army MSKI rates, summarise MSKI readiness-related impacts, and highlight the importance of standardising surveillance approaches, including injury definitions used in injury surveillance.

Methods

This review summaries current reports and US Department of Defence internal policy documents.

MSKI’s are defined as musculoskeletal disorders resulting from mechanical energy transfer, including traumatic and overuse injuries, which may cause pain and/or limit function.

This review focuses on various US Army populations, based on setting, sex, and age; the review excludes combat or battle injuries.

Results

More than half of all AC soldiers sustained at least one injury (MSKI or non-MSKI) in 2017.

Overuse injuries comprise at least 70% of all injuries among AC soldiers. Female soldiers are at greater risk for MSKI than men. Female soldiers’ aerobic and muscular fitness performances are typically lower than men’s performances, which could account for their higher injury rates.

Older soldiers are at greater injury risk than younger soldiers.

Soldiers in noncombat arms units tend to have higher incidences of reported MSKI’s, more limited duty days, and higher rates of limited duty days for chronic MSKI’s than soldiers in combat arms units. MSKI’s account for 65% of medically non-deployable AC soldiers. At any time, 4% of AC soldiers cannot deploy because of MSKIs.

Once deployed, non-battle injuries accounted for approximately 30% of all medical evacuations, and were the largest category of soldier evacuations from both recent major combat theatres (Iraq and Afghanistan).

More than 85% of service members medically evacuated for MSKI’s failed to return to the theatre.

MSKI’s factored into (1) nearly 70% of medical disability discharges across the Army from 2011 through 2016 and (2) more than 90% of disability discharges within enlisted soldiers’ first year of service from 2010 to 2015.

MSKI-related, service-connected (SC) disabilities account for 44% of all SC disabilities (more than any other body system) among compensated US Global War on Terrorism veterans.

Conclusions

MSKI’s significantly impact soldier health and US Army readiness.

MSKI’s also figure prominently in medical disability discharges and long-term, service-connected disability costs.

MSKI patterns and trends vary between trainees and soldiers in operational units and among military occupations and types of operational units.

Coordinated injury surveillance efforts are needed to provide standardised metrics and accurately measure temporal changes in injury rates.

Reference

Molloy, J.M., Pendergrass, T.L., Lee, I.E., Chervak, M.C., Hauret, K.G. & Rhon, D.I. (2020) Musculoskeletal Injuries and United States Army Readiness Part I: Overview of Injuries and Their Strategic Impact. Military Medicine. usaa027. doi: 10.1093/milmed/usaa027. Online ahead of print.