Currently, little is known about the length of time required to rehabilitate patients from stress fractures and their return to preinjury level of physical activity. Previous studies have looked at the return to sport in athletes, in a general population, where rehabilitation is not as controlled as within a captive military population. In this study, a longitudinal prospective epidemiological database was assessed to determine the incidence of stress fractures and the time taken to rehabilitate recruits to preinjury stage of training. Findings demonstrated a background prevalence of 5% stress fractures in Royal Marine training; femoral and tibial stress fractures take 21.1 weeks to return to training with metatarsal stress fractures being the most common injury taking 12.2 weeks. Rehabilitation from stress fractures accounts for 814 weeks of recruit rehabilitation time per annum. Stress fracture incidence is still common in military training; despite this stress fracture recovery times remain constant and represent a significant interruption in training. It takes on average 5 weeks after exercise specific training has restarted to reenter training at a preinjury level, regardless of which bone has a stress fracture. Further research into their prevention, treatment, and rehabilitation is required to help reduce these burdens.

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IntroductionPeripheral nerve injury secondary to load carrying is a rare condition most often described in military personnel secondary to heavy load carrying for prolonged periods. A series of patients is described presenting with compression neuropathy secondary to load carrying, and their disease characteristics are compared to those described in the literature.MethodsOur rehabilitation database was searched for all cases of shoulder neuropraxia reported between 2008-2016 during initial military training of 8790 Royal Marine (RM) recruits. Incidence, median rehabilitation period required to return to mainstream training, affected nerve distribution, and investigations performed were identified. Also described was the long-term outcome in terms of recovery from neuropathy and onward fitness for RM service.ResultsThe incidence of shoulder neuropraxia in RM recruits during training was 330 per 100,000. Of the 29 patients identified, 66% made a full recovery over a median period of 20 weeks. Median follow-up time was 2.3 years. The most common nerve affected was the axillary nerve.ConclusionShoulder neuropraxia is more common in the RM recruit population than in other previously studied groups. This could be explained by the arduous nature of the loaded marches during RM recruit training, the load including heavy packs, irregular terrain and long distances. Emphasis should be placed on prevention, by providing good recruit education on appropriate kit adjustment during load carries and early identification of symptoms.

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