Army Injury Prevention
Sports and Physical Training Injuries 


Extreme Conditioning Programs (ECP)
                                                                                                                                                                                                                                                         

Exercise programs that include multiple high-intensity aerobic and muscle strengthening activities have become quite popular.  While specific studies of ECPs are still limited, common injuries such as shoulder and back have been noted due to the weight-lifting components of these programs.  Although the Army has not specifically endorsed ECPs, exercise programs that include a proper balance of aerobic and muscle strengthening activities are at the core of the Army’s standardized physical readiness training (PRT) regimen.  Primary prevention strategies include ensuring use of certified trainers, the gradual increase of weights, repetitions, speed, and rest days. Technical references.

Back to Top

Physical Training
                                                                                                                                                                                                                                                         

One of the biggest problems with many exercise programs, especially in some Army units, is following a training program that relies on too much running.  Excessive running can mean running distances that are too long, too often, increasing distances too rapidly especially for newer runners, or not allowing adequate rest and periodization for individuals with existing injuries and/or other physical conditions.  To reduce chance of injuries ensure that your physical training program:

  • Balances running with other forms of aerobic activities (such as cycling or swimming) and anaerobic  exercise including muscle strengthening and agility activities
  • Gradually increases amount duration and intensity of any new activity (e.g., running, weight-lifting) or when recovering from injury
  • Includes adequate rest periods by alternating types of activities on different days, ensuring adequate rest time when injured

Key military policy and doctrine can be found in FM 7-22 external link: Army Physical Readiness Training, and TB MED 592 external link: Prevention and Control of Musculoskeletal Injuries Associated with Physical Training. Technical references.  Read our article on avoiding injury.

Back to Top

Running
                                                                                                                                                                                                                                                         

Running is one of the most popular forms of exercise, is at the heart of military physical training, and is one of the most common causes of injury in Active Duty Soldiers.  While running is an excellent form of cardiovascular (aerobic) exercise, the repetitive stresses to the body can result in injury.  Most common injuries include sprains, strains, and stress fractures to the lower extremities (knee, lower leg, ankle, foot).  Most of these injuries appear to be associated with doing too much too fast, or too much too often.  These are documented as “overtraining” or “overexertion” injuries and thus are largely considered preventable.  Contrary to some beliefs, science has not identified specific running form(s) or shoe types to address most running injuries.  Instead, ensuring a proper gradual increase to distances run, moderating overall running distance and frequency, and balancing running with muscle strengthening and agility activities are the best means to reduce chance of injuries. Technical references.

Back to Top

Stretching
                                                                                                                                                                                                                                                         

A common question asked is whether one should stretch prior working out or after working out to reduce risk of injury.

Though the American College of Sports Medicine recommends 2-3 days a week of flexibility stretching external link, the current science as to when, how much, what type of stretching might reduce injury is still inconclusive.  This is because the limited studies available have evaluated stretching differently – including different types of stretching (such as static, dynamic, ballistic, plyometric), types of exercise, durations, outcomes, and populations.  Certain kinds of stretches have been shown to increase the range of motion (ROM) of a muscle or muscle group which can improve performance.  However, stretching prior to exercise has not been proven as a means to reduce risk of injury, and may even increase risk of certain injuries.  Individual risk is also a factor, since both those persons most flexible and those least flexible have higher injury rates than those with moderate flexibility.

The current ASCM recommendation is 5-10 minutes of light to moderate cardiovascular warm up before stretching.  After exercising, some gentle stretching may help reduce soreness, but this depends on the type of stretching and exercise.  Gentle cardiovascular cool downs external link may also serve this purpose.  Future assessment of stretching benefits and disadvantages are planned to illicit clearer guidelines.  Technical references.

ACSM articles:

Back to Top

Team Sports (Basketball, Football, Softball)
                                                                                                                                                                                                                                                         

  • Basketball

    Basketball has been identified as a leading sport causing injuries to Army Soldiers – including during deployment, where basketball injuries have contributed to many medical evacuations.  Substantial literature has also investigated the types of injuries resulting from basketball and means to minimize risk of injuries. Mouthguards can reduce risk of orofacial and dental injuries; read our  Mouthguard Factsheet.  The use of a rigid ankle brace could reduce rates of ankle injuries, a leading type of basketball injury. 
    Technical references.

  • Softball

    The use of break-away bases in softball can reduce risk of injuries, as can mouthguards and batting helmets. 
    Technical references.

  • Football

    The use of mouthguards and helmets can reduce risk of injuries. Technical references.

Back to Top

Warming Up and Cooling Down
                                                                                                                                                                                                                                                         

Done properly, beginning workouts with a warm-up and ending with a cool-down can improve performance as well as reduce later soreness and possibly reduce risk of certain types of injuries.  Current American College of Sports Medicine warm up and cool down recommendations external link are to warm-up with a low intensity cardiovascular exercise (e.g., walking, jogging or biking).  After 5-10 minutes, transition to a few minutes of low intensity focus on any unique muscles or movements more specific to the exercise activity but with (e.g., dribbling a ball in soccer, lifting light weights).  Stretching and flexibility exercises are important aspects of an exercise program as they can increase range of motion (ROM) and thus may enhance performance or reduce soreness, but should be done only after initial cardiovascular warm-ups or during the cool down phase of workout.  Technical references.

Back to Top

Weight Training
                                                                                                                                                                                                                                                         

Weight training (WT) is increasing in popularity, especially as it is recognized that a balanced exercise regimen should include muscle strengthening activities.  Muscle strengthening activities are a broad category of “resistance training” exercises which include use of a wide range of resistive loads, different movement velocities, and various training modalities such as free weights, weight machines, elastic bands, medicine balls and plyometrics to increase muscle strength, muscle endurance, and/or power.  WT is a type of resistance training that relies on use of free weights and weight machines and various controlled explosive movements to increase strength and power. 

Current WT recommendations of the American College of Sports Medicine external link  for most healthy adults to increase strength/power include: 

  • 2-3 times per week for each major muscle group
  • >48 hours between sessions
  • Weights: 60-70% of maximum repeated lift capability (1RM) for novice to intermediate; 80% 1RM for experienced lifters
  • 8-12 repetitions; 2 sets, no more than 4 sets; 2-3 minutes rest of muscle groups between sets

Common injuries from WT include sprains and strains, especially to the shoulder and back.  To minimize risk of WT injury, gradually increase the amount of weights, don’t overdo number of repetitions, and ensure adequate rest breaks during a session and days between sessions.  Use of proper trainers to ensure good form is critical.  Current evaluation is ongoing; technical references can be provided at request.

Back to Top

Winter Sports
                                                                                                                                                                                                                                                         

Every year winter sports result in hundreds of thousands of injuries as well as many deaths in the U.S.  A recent study of fall-related injuries in the Active Duty Army showed that snowboarding and skiing were the leading sports causing such injuries.  Many of the injuries occurred during military-unit organized events.  For information about the most common injuries and ways to prevent them, read our article external linkTechnical references.

 Back to Top 

General Topics
                                                                                                                                                                                                                                                        

  • Mouthguards

    Mouthguards are required for many sports as a proven means to reduce the risk of serious orofacial and dental injuries.  Read our  Mouthguard Factsheet to help identify the best mouthguard to reduce these injuries. Technical references.

  • Rehabilitation and Recovery

    The Human Performance Resource Optimization Center external link supports overall military human performance optimization as a DoD the educational arm of the Consortium for Health and Military Performance (CHAMP) at the Uniformed Services University of the Health Sciences (USUHS).  One of the topics it provides information on is the RX3: Rehab, Refit, Return to Duty external link program.  The RX3 program was developed by two sports medicine doctors and an exercise physiologist and is a resource for both providers and service members for basic injury prevention and rehabilitation methods, including includes videos and printable material.  A relevant doctrine for additional guidance is TB MED 592 external link: Prevention and Control of Musculoskeletal Injuries Associated with Physical Training. Technical references.

Back to Top