What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study

Abstract

Background Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy. Understanding intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness. Findings from this population may also be useful as hypothesis-generating work for particular civilian settings such as law enforcement officers (SWAT teams), firefighters (smoke jumpers), or others in physically demanding professions.Questions/purposes The purposes of this study were (1) to examine whether using baseline measures of self-report and physical performance can identify musculoskeletal injury risk; and (2) to determine whether a combination of predictors would enhance the accuracy for determining future musculoskeletal injury risk in US Army Rangers. Methods Our study was a planned secondary analysis from a prospective cohort examining how baseline factors predict musculoskeletal injury. Baseline predictors associated with musculoskeletal injury were collected using surveys and physical performance measures. Army Physical Fitness Test (consisting of a 2-mile run and 2 minutes of sit-ups and push-ups). A total of 320 Rangers were invited to enroll and 211 participated (66%). Occurrence of musculoskeletal injury was tracked for 1 year using monthly injury surveillance surveys, medical record reviews, and a query of the Department of Defense healthcare utilization database. Injury surveillance data were available on 100% of the subjects. Receiver operator characteristic curves and accuracy statistics were calculated to identify predictors of interest. A logistic regression equation was then calculated to find the most pertinent set of predictors. Of the 188 Rangers (age, 23.3 ± 3.7 years; body mass index, 26.0 ± 2.4 kg/m 2 ) remaining in the cohort, 85 (45.2%) sustained a musculoskeletal injury of interest. Results Smoking, prior surgery, recurrent prior musculoskeletal injury, limited-duty days in the prior year for musculoskeletal injury, asymmetrical ankle dorsiflexion, pain with Functional Movement Screen clearing tests, and decreased performance on the 2-mile run and 2-minute situp test were associated with increased injury risk. Presenting with one or fewer predictors resulted in a sensitivity of 0.90 (95% confidence interval [CI], 0.83-0.95), and having three or more predictors resulted in a specificity of 0.98 (95% CI, 0.93-0.99). The combined factors that contribute to the final multivariable logistic regression equation yielded an odds ratio of 4.3 (95% CI, 2.0-9.2), relative risk of 1.9 (95% CI, 1.4-2.6), and an area under the curve of 0.64. Conclusions Multiple factors (musculoskeletal injury history, smoking, pain provocation, movement tests, and lower scores on physical performance measures) were associated with individuals at risk for musculoskeletal injury. The summation of the number of risk factors produced a highly sensitive (one or less factor) and specific (three o...

Physical and Performance Characteristics Related to Unintentional Musculoskeletal Injury in Special Forces Operators: A Prospective Analysis

“…This finding suggests that Operators who fell in the bottom 25th percentile in multiple characteristics were at greater risk of sustaining an injury. A previous study 39 in US Army Rangers also determined that multiple risk factors increased the likelihood of sustaining an injury. Dvorak et al 38 found a similar relationship in elite-level football players: the greater the number of risk factors, the greater the proportion of injured players.…”

“…However, we did not find that body fat percentage was a risk factor for injury and only observed a BMI difference in the spine-injury group. Teyhen et al 39 performed a similar prospective risk factor analysis using BMI in US Army Rangers and demonstrated no difference between soldiers who sustained an injury and those who did not. This discrepancy may be due to the observed population.…”

Knee problems and its associated factors among active cyclists in Eastern Province, Saudi Arabia

“…[28] Though it was not associated with higher rate of knee pain in this study, it is well documented that smoking increased the risk for musculoskeletal injuries. [2930]…”

Reliability and Association with Injury of Movement Screens: A Critical Review

“…A total of 18 articles were included that investigated the link between FMS score and injury risk (Table 7) [17,19,27,[63][64][65][66][67][68][69][70][71][72][73][74][75][76][77]. Ten [19, 27, 64, 70-74, 76, 77] of the 18 studies reported an association between the FMS composite score and injury.…”

“…Differences in the number of participants, length of follow-up period, and sport/occupation of participants may have contributed to the inconsistencies in strength of relationship between FMS score and injury likelihood. In contrast, eight of the identified studies found no link between FMS composite score and injury risk [17,63,[65][66][67][68][69]75]. However, three of these studies [68,69,75] utilized very small sample sizes and this may explain the lack of association between FMS score and injury.…”