Musculoskeletal Injuries Among Females in the Military: A Scoping Review

Abstract

Introduction Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. Materials and Methods A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews—Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. Results From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. Conclusions This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.

Occupational and Environmental Challenges for Women

“…Given that most women in nontraditional professions are in their childbearing years, it seems pertinent to study occupational challenges faced during the peripartum period. Military data suggest that fitness declines during pregnancy and the immediate postpartum period (4,49). At 6 months postpartum, most military servicewomen have not returned to their prepregnancy fitness state (49).…”

“…These fields' available occupational and exposure risk data primarily focuses on the predominantly biologically male employee population. However, there are many anthropometric, physiologic, and biomechanical differences between men and women, including body composition and musculoskeletal, cardiorespiratory, metabolic, and thermoregulatory functions that can affect physical fitness, performance, and injury risk (4,5). Fortunately, the scientific community recognizes the importance of developing a methodology to explore biologic gender differences in physically demanding environments (6,7).…”

Characterization of Female US Marine Recruits: Workload, Caloric Expenditure, Fitness, Injury Rates, and Menstrual Cycle Disruption during Bootcamp

“…United States Marine Corps (USMC) entry-level training (e.g., bootcamp) is a 13 week period of introductory training that is split into processing and administration weeks (week 0 and weeks 11–12, respectively), with 10 weeks of tactical training, operational skills, and varying physical activities that follow gender-neutral standards (weeks 1–10). While females have excelled in many military occupational roles, injury rates among females are significantly higher than males [ 13 , 14 , 15 ]. Basic training follows a POI; however, the POI is centered on the physical activities and movements essential to train a recruit into a Marine and fails to account for total movement (work) throughout the day, such as walking to and from dining facilities, training locations, and classrooms.…”

A profile of injuries suffered by female soldiers serving in the Australian Army

“…Numerous military forces around the world are increasing the numbers of females in their armed forces, with many targeting 25–30% representation by female personnel [ 1 ]. The valued role of female soldiers is being further enhanced through direct combat roles being opened for female personnel in armies of many countries [ 2 , 3 ].…”

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