The review of exercise programmes in military personnel concludes: “there is low quality evidence regarding preventive interventions for MSIs in armed forces”. [1] In this review, MSIs (musculoskeletal injuries) are injuries to muscles, bones, joints and associated tissues such as tendons and ligaments [1].
The authors of a review of exercise programmes in military personnel write, in their introduction, that musculoskeletal injuries (injuries to muscles, bones, joints and associated tissues such as tendons and ligaments) are most seen in recruits and military trainees, compared to “versed military personnel”, and that this is likely due to excessive and rapid increases in training loads in military trainees [1].
The statements about recruits on this page come from reviews of military recruits and military personnel. The statements about shin splints, kneecap pain, Achilles tendinitis, bone stress injury, the anterior cruciate ligament and ankle sprains come from general patient-information pages (AAOS OrthoInfo and the NHS), not from recruit studies.
- Why do recruits get injured, and what do reviews say about prevention?
- What do sources say about building up training?
- What about pain that does not settle?
- Which injuries can happen suddenly?
- When is urgent help needed?
- What should I do next?
Why do recruits get injured, and what do reviews say about prevention?
A paper on running-related injury among U.S. military recruits says: “Low aerobic fitness, prior injury, and weekly running distance are known risk factors.” [2]
The review of exercise programmes in military personnel was restricted to randomized controlled trials (RCTs) evaluating exercise programmes. Its authors write: “Summarizing, we conclude that there is low quality evidence regarding preventive interventions for MSIs in armed forces.” [1] In this review, MSIs (musculoskeletal injuries) are injuries to muscles, bones, joints and associated tissues such as tendons and ligaments [1]. The next sentence of that review reads: “More well-designed RCTs are needed to provide high-quality recommendations.” [1]
About the evidence
A review of injury in military recruits, covering injuries of all regions and injury types, reports: “Injuries are prevalent in military recruits, with up to one-in-four of recruits seeking medical assistance for injury in one training period.” [3]
The authors of that review write that “the overall certainty for the accuracy of our injury frequency results is low due to our study quality assessment findings” [3].
Owner clinical review required · not a release assetWhat do sources say about building up training?
AAOS OrthoInfo says: “The term ‘shin splints’ refers to pain along the inner edge of the shinbone (tibia).” [4]
AAOS OrthoInfo says shin splints often occur after sudden changes in physical activity [4].
AAOS OrthoInfo lists wearing shoes that are appropriate for your activities, warming up thoroughly before physical activity, and gradually increasing the intensity and duration of your training among the steps to prevent patellofemoral knee pain from coming back once you have been treated [5]. AAOS OrthoInfo describes patellofemoral pain syndrome as pain in the front of the knee and around the patella, or kneecap [5].
The NHS lists not warming up before exercising, tired muscles and playing sport among the common causes of sprains and strains [6].
More on shin splints
AAOS OrthoInfo lists changes in frequency, such as increasing the number of days you exercise each week, changes in duration, such as running longer distances, and changes in intensity, such as running on hills after running on only flat surfaces [4].
More on the Achilles tendon
AAOS OrthoInfo says Achilles tendinitis is a common condition that occurs when the large tendon that runs down the back of the lower leg becomes irritated and inflamed [7].
The Achilles tendon is the largest tendon in the body [7].
It connects the calf muscles to the heel bone and is used when you walk, run, climb stairs, jump, and stand on your tip toes [7].
For Achilles tendinitis, AAOS OrthoInfo gives this example: increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance may cause irritation and inflammation [7].
What about pain that does not settle?
AAOS OrthoInfo says that if your bone breaks down faster than your body can rebuild it, a bone stress injury will occur [8].
For a suspected bone stress injury, AAOS OrthoInfo says: “See your doctor or provider as soon as possible if you think that you have a bone stress injury. Ignoring the pain will lead to worse injury, and you may take longer to heal.” [8] The signs that should not wait are listed under “When is urgent help needed?” below.
On the same page, AAOS OrthoInfo includes this among its prevention steps for bone stress injury: “If you feel pain, stop your activity and rest for a few days. If your pain continues, do not try to play or exercise through the pain; see your doctor.” [8]
Which injuries can happen suddenly?
AAOS OrthoInfo says an anterior cruciate ligament (ACL) tear, or rupture, is one of the most common knee injuries [9]. AAOS OrthoInfo describes a sprain as a stretch and/or tear of a ligament, a strong band of connective tissue that connects the end of one bone with another [10].
AAOS OrthoInfo says anyone can tear their ACL, but the injury most often occurs when a person is pivoting, cutting, or jumping with their leg fully straightened on impact with the ground [9].
AAOS OrthoInfo says repeated ankle sprains can lead to long-term problems, including chronic ankle pain, arthritis, and instability [10].
When is urgent help needed?
The list below covers the signs that should not wait for a routine appointment.
What should I do next?
If knee pain is not settling, or you are unsure what is causing it, an assessment is a sensible next step. The assessment brings together the patient’s story, an examination and any tests that help, so that the patient and the surgeon can decide together. It looks at the structure involved, the patient as a whole person and the goal they want to return to. An appointment supports an informed decision. It is not a commitment to surgery.
- Read about the Knee Hub.
- Read about sports injuries.
- Read about ankle sprains.
- Read about knee and ankle injuries in National Service.
This page provides general information and cannot diagnose an individual condition. OrthoKinetics does not provide emergency or urgent care through this webpage or its WhatsApp contact.
References
- Dijksma I, Arslan IG, van Etten-Jamaludin FS, Elbers RG, Lucas C, Stuiver MM. Exercise Programs to Reduce the Risk of Musculoskeletal Injuries in Military Personnel: A Systematic Review and Meta-Analysis. PM R 2020;12(10):1028-1037. PMC7586796. https://pmc.ncbi.nlm.nih.gov/articles/PMC7586796
- Molloy JM. Factors Influencing Running-Related Musculoskeletal Injury Risk Among U.S. Military Recruits. Mil Med 2016. PubMed 27244060. https://pubmed.ncbi.nlm.nih.gov/27244060/
- Murphy MC, Stannard J, Sutton VR, Owen PJ, Park B, Chivers PT, Hart NH. Epidemiology of musculoskeletal injury in military recruits: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023;15:144. PMC10612319. https://pmc.ncbi.nlm.nih.gov/articles/PMC10612319/
- AAOS OrthoInfo. Shin Splints. https://orthoinfo.aaos.org/en/diseases–conditions/shin-splints/
- AAOS OrthoInfo. Patellofemoral Pain Syndrome. https://www.orthoinfo.org/diseases–conditions/patellofemoral-pain-syndrome
- NHS. Sprains and strains. https://www.nhs.uk/conditions/sprains-and-strains/
- AAOS OrthoInfo. Achilles Tendinitis. https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendinitis/
- AAOS OrthoInfo. Stress Fractures. https://orthoinfo.aaos.org/en/diseases–conditions/stress-fractures/
- AAOS OrthoInfo. Anterior Cruciate Ligament (ACL) Injuries. https://www.orthoinfo.org/diseases–conditions/anterior-cruciate-ligament-acl-injuries
- AAOS OrthoInfo. Sprained Ankle. https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle/
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