Injury Prevention Exercises for Reduced Incidence of Injuries in Combat Soldiers

The aim of this study was to determine the influence of an "All-Cause Injury” prevention program, focused on static to dynamic transitions, on injury prevalence in a military commanders course. Two cohorts of male infantry commanders were recruited (intervention group, n=196; controls, n=169) and tracked by a physiotherapist, who recorded any injuries that occurred during the 14-week course. Soldiers were tested pre-, mid-, and post-course for anthropometrics, proprioception ability, and dynamic postural balance. The intervention group performed injury prevention exercises for five minutes, 3-times/week, and the control group continued with their routine physical fitness sessions. The prevalence of injuries reported to the physiotherapist during the course was significantly lower for the intervention group compared to the controls (14.8% and 34.3%, respectively, p.001). Similarly, rates of injury in the intervention group were significantly lower than in the control group (p=0.001; Hazard=2.53, 95% CI= 1.62-3.95). Pre-course proprioception ability was significantly lower in those that became injured during the commanders course, irrespective of group. Likewise, for dynamic postural balance parameters, the injured participants in both groups had significantly lower pre-course scores than the non-injured participants. From pre- to mid-testing, the injured soldiers in the intervention group improved their ability up to the level of the non-injured participants. A reduced prevalence of injuries was found for soldiers who completed the injury prevention program. Because the participant soldiers injured on the course had reduced somatosensory abilities at the outset, and as these abilities can be improved by static-to-dynamic exercises, identifying at-risk soldiers and providing them with appropriate strategies for improvement beforehand is indicated.

Practical applications: This study demonstrated the practical importance of "All-Cause Injury” prevention exercises for reduced prevalence of musculoskeletal injuries in soldiers during an infantry commanders course. The results indicated that the suggested static-to-dynamic somatosensory exercises enabled the injured soldiers who started the course with very low abilities to improve their scores up to the level of the non-injured soldiers. The findings have practical importance for military commanders, combat fitness officers, and military strength and conditioning professionals. Future guidelines should explain that in order to prevent injuries, recover quickly from injury, and fight effectively, combat soldiers should develop "injury readiness and resilience" strategies. The military forces should ensure that a multidisciplinary team (sports medicine physicians, physical therapists, and others) is accessible to all soldiers, since these professionals are instrumental to their military preparedness. Follow-up studies that examine the short-term and long-term effects of similar intervention programs are warranted, exploring different types of exercises, different doses of repetitions, and different exercise times per day. In addition, it is recommended that pre-service rehabilitation be implemented for participants with low dynamic postural balance and ankle proprioception scores who are about to undertake challenging physical training.