“Rehabilitation has long been recognised as an essential part of the clinical treatment pathway for service personnel and it is in this area that many consider the Armed Forces provide the ‘gold standard’.” (Braithwaite et al., 2009, p.532)

Introduction

During the past 20 years the military medical services, both primary and secondary, have undergone structural changes due to Strategic Defence Reviews. This is a result of research (Braithwaite et al., 2009; Burgess, 2010; Sharma et al., 2011) that places an emphasis on preventative and rehabilitation interventions in order to reduce injuries and facilitate recovery respectively.

However, military training by its very nature is arduous and, unfortunately, injuries may occur despite the best efforts and designs of military training programmes. Research suggests that prior physical activity and aerobic fitness are indicators of remedial intervention and medical discharge (Blacker et al., 2008; Blacker et al., 2009; Sharma et al., 2011), with “Recruits often join[ing] the armed forces unfit, overweight or poorly nourished, despite encouragement to get fit before joining up.” (ALI, 2005, p.40).

The Adult Learning Inspectorate (ALI, 2005, p.40) suggests that although “Some medical discharge is inevitable…” it can be reduced through three measures:

  1. Better pre-entry screening;
  2. More flexibility in tailoring the training regime to each person; and
  3. Closer management of the processes involved.

The cost of medical discharge, both to the armed forces and the recruit, is high. Stopping a physical training programme through injury also exacts a cost for both the training provider (e.g. loss of revenue and reputation) and the individual (loss of training and potential work-time).

Gender, low aerobic fitness (as determined by the 1.5 mile run), low strength, low body mass and cigarette smoking are all considered significant risk factors for overuse MSIs (muscular skeletal injuries) during basic military training (Gemmell, 2000; Noon, 2003). Braithwaite et al. (2009) suggest that fewer physical performance or lifestyle characteristics are associated with injury risk in recruits and the only significant risk factor was slower 1.5 mile run time in males and oral contraceptive use in females. Subsequently, two training initiatives were evaluated during basic training:

  1. Gender-fair training in single-sex platoons (Bilzon & Griggs, 2007); and
  2. Soldier pre-conditioning (providing additional aerobic and strength training to the lowest quintile of fitness ‘passes’ (Bilzon & Griggs, 2008).

Analysis indicated that these initiatives improved pass-out rates in both sexes and medical discharge due to training injuries was decreased in female recruits. However, Braithwaite et al. (2009) state that a knowledge gap remains on the impact of training injuries in recruits who are not medically discharged and research should be conducted to obtain this information.

As discussed in the Calories, Eenrgy & Response section, physical activity and exercise are defined differently, with physical inactivity being a contraindication [1] for individuals who want to participate in moderate or vigorous exercise. In the world of boot camps, the red (beginner) ability group level is intended to act as the crossover – i.e. low intensity activities to condition an individual – between daily physical activities and moderate intensity activities. Further, many training providers have also adopted the concept of gender-fair training by offering female only boot camps.

Definition

  1. A contraindication is sign that someone should not continue with a particular exercise prescription because it might be harmful.

References

Braithwaite, M., Nicholson, G., Thornton, R., Jones, D., Simpson, R., McLoughin, G. & Jenkins, D. (2009) Armed Forces Occupational Health – A Review. Occupational Medicine. 59, pp.528-538.

Burgess, J. (2010) The Army Primary Health Care Service: From Foundation to Future. Journal of the Royal Army Medical Corps. 156(3), pp.185-188.

Sharma, J., Golby, J., Greeves, J. & Spears, I.R. (2011) Biomechanical and Lifestyle Risk Factors for Medial Tibial Stress Syndrome in Army Recruits: A Prospective Study. Gait Posture. 33(3), pp.361-365.

Blacker, S.D., Wilkinson, D.M., Bilzon, J.L. & Rayson, M.P. (2008) Risk Factors for Training Injuries Among British Army Recruits. Military Medicine. 173(3), pp.278-286.

Blacker, S.D., Wilkinson, D.M. & Rayson, M.P. (2009) Gender Differences in the Physical Demands of British Army Recruit Training. Military Medicine. 174(8), pp.811-816.

Adult Learning Inspectorate (2005) Safer Training: Managing Risks to the Welfare of Recruits in the British Armed Services. Available from World Wide Web: <http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/21_03_05_ali.pdf&gt; [Accessed: 13 November, 2012].

Gemmell, I.M.M. (2000) Overuse Injury in British Army Recruits Following Changes to Selection and Training Techniques. Dissertation, Membership of the Faculty of Occupational Medicine.

Noon, N.J. (2003) An Analysis of Musculoskeletal Injuries in Army Recruits. Dissertation, Membership of the Faculty of Occupational Medicine.

Bilzon, J.L.J. & Griggs, K.E. (2007) The Efficacy of Training Female Phase 1 British Army Recruits in Single-sex Platoons. HQ ARTD. Internal Report No. 2007.02.01.

Bilzon, J.L.J. & Griggs, K.E. (2008) Soldier Preconditioning Course (SPC)—CSE 1-5 ATR (P) Females: Interim Audit. HQ ARTD. Internal Report No. 2008.05.28.

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