Incidence and Time to Return to Training for Stress Fractures during Military Basic Training

Abstract

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.

High Incidence of Stress Fractures in Military Cadets During Training: A Point of Concern

“…The distribution of sites of SF in this study is similar to the study by Singh SC, et al, [9]. However, in contrast Alexander M Wood et al, reported metatarsals as the most common site for stress fracture [3].…”

“…It is thus likely that the incidence, we reported, could have been even higher if a bone scan or an additional scintigraphy was performed. Return to full activity has been reported at 12.2 weeks for metatarsal fractures to 21.1 weeks for tibial stress fractures [3]. In our case, all cadets returned to their full activity in an average period of nine weeks.…”

“…Treatment strategies includes early identification of the symptoms, early diagnosis, a sufficiently long training pause and in special cases consultation of experts in the field. Surgical treatment may be needed in some cases [2,3].…”

A Multicenter Randomized, Double-Blind, Split-Side, Comparative Study of Moisturizer Containing MAS064D and 1% Hydrocortisone Cream in the Treatment of Infantile Seborrheic Dermatitis

“…Recognised amongst MSKI as the cause for the greatest amount of time lost out of training and therefore representing significant impact on organisational effectiveness, stress fractures, a sub-classification of overuse MSKI, have received considerable attention across the literature. Presenting in the pelvis, spine and less frequently in the upper limb, as much as 90% of all stress fractures are lower limb with incidence rates reported to range from 0.7 to 20% across both civilian and military populations [8,9,19,41,42]. Prospective data in recruits undergoing basic training indicates stress fracture incidence of 3.3% to 8.5% in the US military, 15% among Indian Army recruits and as much as 31% in Israeli Army recruits [41,43].…”

“…Prospective data in recruits undergoing basic training indicates stress fracture incidence of 3.3% to 8.5% in the US military, 15% among Indian Army recruits and as much as 31% in Israeli Army recruits [41,43]. Incidence of 5% reported in the Royal Marines [42] compares favourably to the 6% incidence reported in United States Marine Corps (USMC) recruits [44] and to the 5-9% reported among US SEAL Trainees [45]. The insidious onset of these prevalent injuries has been attributed to sustained repetitive strenuous activity which in turn indicates the requirement to investigate the nature of training within individual environments [6].…”