VERONIQUE HAUSCHILD
Clinical Public Health and Epidemiology Directorate
U.S. Army Public Health Center
Aberdeen Proving Ground, Maryland

Do you know what injuries are? They’re actually much more than broken bones, ruptured blood vessels and bruises. Injury is the damage to body tissues caused by an instantaneous or repeated force. Injury categories and examples include:

• Acute trauma — fractured bone, strained/torn muscle, sprained joint, open wound, animal bite, laceration, broken tooth

• Cumulative microtrauma — overuse injuries, including tendonitis, bursitis, friction blisters, stress fractures, runner’s knee, low back pain, acquired flat foot

• Environmental — heat stroke, heat exhaustion, sunburn, frostbite, hypothermia, altitude sickness, lightning strike

• Poisoning — ingestion, injection, contact or inhalation of a foreign substance (examples include cyanide, botulinum, chlorine gas)

• Non-environmental — thermal burns (fire, grease), radiation sickness, electrocution

• Other — suffocation/drowning, surgical mishap, abuse/intentional damage/neglect, a foreign body in eye/nose/ear/mouth

The severity of an injury includes the urgency and complexity of the medical treatment, costs, time hospitalized and number of follow-up medical visits and days of lost or restricted duty. Some injuries also lead to long-term or permanent effects, such as chronic knee or back conditions, while others result in medical discharge from the military.

Austere environments and physically demanding military training and occupational duties predispose Soldiers to many types of injuries. In fact, injuries as a whole are the leading cause of Army active-duty medical encounters (Figure 1). Injuries continue to have a major impact on Army readiness through lost duty time, reduced performance and medical and disability costs.

This past year alone, Army Soldiers were treated for more than 1 million incidents of new injuries (Figure 2). Surprising to some, the vast majority of these are cumulative microtraumas, otherwise known as overuse injuries. These injuries most often occur to the musculoskeletal system (bone, muscle, joint, ligament, cartilage, tendon, fascia, bursa and synovium), and the majority are caused by repetitive training activities that put too much stress on the same body part without adequate rest period for body tissue to recuperate. For example, repeated running and ruck marching, especially combined, are associated with many lower leg and back injuries. And these statistics don’t include self-treated injuries, or those which Soldiers/trainees just “tough it out.” Though these injuries don’t incur medical costs, they can significantly reduce both individual Soldier and unit performance.

For each category above, how many injuries that required medical treatment have you had during your time with the Army? Which injuries required time off work or restricted your physical abilities? Have you not sought medical care for an injury to avoid getting a profile or work restriction? If so, did the untreated injury prevent you from performing at your best?

Now that you are aware of the different types of injuries and your own injury history, consider your unique risk factors. Factors that can predispose you to a new or re-injury or increase the time of rehabilitation include individual characteristics, modifiable conditions or behaviors you can change, and external factors leaders should address to reduce injury risk.

Individual characteristics
• Prior injury, such as a sprained ankle, tendonitis or muscle strain of the back, can predispose you to future injuries at the same location or to a body region that has compensated for the injury (for example, when an altered gait puts more strain on your non-injured leg). Having a heat- and cold-related injury can increase your susceptibility to these same injuries in the future. The best means to reduce this risk factor is to avoid experiencing an initial injury.

• Some injuries, such as stress fractures, are more common among women. This injury has been associated with the female athlete triad syndrome — a combination of an eating disorder, missed or irregular menstrual cycles and low bone density. It’s seen in some women who participate in high-intensity physical training and strive for leanness or low body weight. Proper nutrition has been suggested as a means to help minimize risk.

Modifiable conditions or behaviors
• Lack of awareness, ignoring safety guidelines and/or not using recommended equipment are primary reasons for many traumatic injuries. Though referred to as “accidents,” most Army vehicle and motorcycle injuries, slips and falls, and mishaps with guns and machinery can be avoided. Many sports “accidents” can also be avoided with proper equipment such as mouthguards to prevent broken teeth, helmets and wrist guards for skiing and snowboarding, and military-recommended hearing and eye protection.

• Being in poor physical shape doesn’t just mean being overweight. Evidence shows that trainees and Soldiers at or below acceptable Army weight standards who have poor aerobic or muscular endurance are also more susceptible to musculoskeletal and heat-related injury. Though it is important to get in shape, it is critical to gradually increase time, weights and distances, and frequency of physical activity. Too much too soon will only increase the risk of injury. This includes gradual acclimatization to extreme temperatures or altitude.

• Illness and medications, such as those for colds, upper respiratory infections or allergies, can increase the risk of heat injuries. Only take medication when absolutely necessary and ensure plenty of rest and adequate hydration.

• Smoking and nicotine-containing products inhibit the body’s ability to repair itself after injury. Evidence also ties these products to higher rates of new injuries. Stop using cigarettes, e-cigarettes and smokeless tobacco to reduce your injury risk, rehabilitation time and the threat for long-term health consequences such as lung disease and cancer.

External factors
• Excessive physical strain is often a part of Army training and job tasks, but too much strain on the body or same body part too fast and/or too frequently can result in overuse injuries. Cross-training is recommended to help reduce injury rates. This means fewer long runs and marches and, instead, more speed, agility, strength and balance-building activities.

• Environmental factors include extreme temperatures, high altitudes, lightning, animals and insects, and rough terrain. The Army recognizes these hazards and requires leaders to use risk management tools to identify, assess and minimize the danger during training and operations. For example, warm, humid climates increase cases of exertional heat-related injuries, including hyponatremia (overhydration). To address this, the Army uses scientifically based heat risk categories with associated work/rest cycles and fluid consumption guidelines.

Conclusion
Now that you know your injury history and risk factors, you can make changes to reduce your injury risk and thus improve your physical performance. For additional information, visit the Army Injury Prevention website at https://phc.amedd.army.mil/topics/discond/ptsaip/Pages/default.aspx.