By: Alexandria Gregory, MA*
Musculoskeletal injuries (MSK-I) that occur during military
training and deployment are a leading cause of lost duty time for Military
Service Members. MSK-I also reduce combat readiness and put a big burden on the
military healthcare system. The goal of the work of the Consortium for Health
and Military Performance’s (CHAMP) Injury Prevention Research Lab (IPRL) at the
Uniformed Services University of the Health Sciences (USUHS) is to optimize Warfighters’
mission readiness by conducting and interpreting human performance research with
a focus on injury prevention.
IPRL projects explore the sources and effects of MSK-I on Military
Service Members in training and active-duty populations. MSK-I in Warfighters
typically occur in the lower back, ankles, knees, and shoulders, and are most
commonly sprains and strains (ligament and muscle stretches and tears), spasms,
tendon injuries, and inflammation. Many who sustain MSK-I will often have
continued problems throughout their military careers, even leading to early
separation or a disability discharge from service. So, the lab’s goal is to
focus on effectively preventing MSK-I within military populations and improve
outcomes after injury to boost mission readiness and reduce lost duty time for
Warfighters.
Dr. Sarah de la Motte is the Principal Investigator of the
current research projects in IPRL. These projects are also supported by the
following team members: Dr. Daniel Clifton, Dr. John Tra, Dr. Emily Southmayd,
Amelia Barrett, Carolyn Dartt, and Alexandria Gregory. The team conducts
research and informs policy with all branches of the military and at various
levels of training—from recruits to officers.
Past research studies included working with Service Academy
cadets to identify risk factors associated with anterior cruciate ligament (ACL)
injuries. Subsequently, the IPRL team assisted with implementing a MSK-I
prevention program— the Dynamic Integrated Movement Enhancement (DIME) program—at
the U.S. Military Academy (USMA) at West Point along with researchers from the
University of North Carolina at Chapel Hill, the University of Connecticut, and
the USMA. In another project, the team used new MSK-I risk screening tools to investigate
Army, Navy, Air Force, and Marine Corps recruits entering basic training at the
Baltimore Military Entrance Processing Station. The team also investigated
functional movement ability changes over training and deployment cycles working
in an active-duty population of Marines for a different project.
IPRL is currently investigating factors that contribute to
training success, as well as MSK-I, environmental injuries, and concussions in
Marine officers at The Basic School at Marine Corps Base Quantico, Virginia. For
this project, IPRL’s goal is to create predictive models for MSK-I during
officer training by evaluating measures such as functional movement,
psychosocial factors (for example, mental health, stress, and resilience), and
biochemical factors (for example, nutrition, stress, resilience, and inflammation).
In addition, the team aims to create predictive models for early career
performance including MSK-I risk, physical fitness, and promotion in Marine
Officer training. Across the country, the team is investigating MSK-I rates
during secondary training and healthcare-seeking behaviors for MSK-I with
Marines at the School of Infantry-West (SOI-W) at Camp Pendleton, California.
Part 1 of this project is to examine factors (for example, functional movement,
physical fitness, and healthcare-seeking behaviors) that are associated with
MSK-I and develop a targeted prevention curriculum. Part 2 includes examining
the effectiveness of this integrated injury-prevention curriculum on MSK-I during
secondary training. As a result of part 1 of this project, we learned that
there are many self-limiting beliefs and physical barriers that might affect
the willingness of Marines to report or seek care for their MSK-I during
secondary training. Accordingly, the team is developing another project to
investigate the healthcare-seeking behaviors for MSK-I in Marines at SOI-W and
recruits at Marine Corps Recruiting Depot-San Diego, California. This project
aims to improve early identification of MSK-I through increased MSK-I
reporting, which is the first step in preventing MSK-I in Warfighters. Finally,
IPRL is developing another research project to investigate low back pain in
Marines, which is a major burden among active-duty Marines. The goal is to
identify factors (for example, motion-based metrics and healthcare-seeking
behaviors) that improve the assessment, prediction, prevention, and management
of low back pain. In addition, this project will also evaluate the
effectiveness of a targeted low back pain prevention-and-wellness program for
at-risk Military Service Members.
Findings from IPRL projects have been published in
scientific journals and presented at various conferences. In February 2020,
several team members presented at the International Congress on Soldiers’
Physical Performance in Quebec City, Canada. Dr. de la Motte’s presentation on how
self-limiting beliefs and cultural barriers influence musculoskeletal-injury reporting
highlighted how understanding barriers to MSK-I reporting is essential for
prediction and prevention of MSK-I. Dr. Southmayd also discussed the role of mental
resilience in the biopsychosocial experience of pain in male and female officers.
She suggested that mental resilience might further impact the experience of
pain during training. In addition, Dr. Clifton presented a poster on the association
between organized physical activity or sport participation during high school
and the odds of self-reported MSK-I or pain during U.S. military entry-level training.
His poster highlighted that organized physical activity or sport participation
may not be associated with reducing MSK-I in male enlistees.
IPRL supports and collaborates with other entities outside
of the USUHS research community. These include the U.S. Coast Guard Training
Center-Cape May, U.S. Army Center for Initial Military Training with the
Training & Doctrine Command, U.S. Marine Corps Force Fitness Division, and
The Ohio State University. By working with other organizations, we can continue
to develop and promote guidance on injury prevention to Warfighters, their family members, and healthcare
providers—thus reaching our goal of reducing injuries, improving performance,
and getting Military Service Members back to duty.
About the author.
Alexandria Gregory, of
the Henry M. Jackson Foundation, is a Research Assistant for the Consortium for
Health and Military Performance (CHAMP) at the Uniformed Services University of
the Health Sciences (USUHS).
* The opinions and assertions expressed herein are those of the author and do not necessarily reflect the official policy or position of USUHS or DoD. The contents of this publication are the sole responsibility of the author and do not necessarily reflect the views, opinions, or policies of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. The author has no financial interests or relationships to disclose.
Past research studies included working with Service Academy
cadets to identify risk factors associated with anterior cruciate ligament (ACL)
injuries. Subsequently, the IPRL team assisted with implementing a MSK-I
prevention program— the Dynamic Integrated Movement Enhancement (DIME) program—at
the U.S. Military Academy (USMA) at West Point along with researchers from the
University of North Carolina at Chapel Hill, the University of Connecticut, and
the USMA. In another project, the team used new MSK-I risk screening tools to investigate
Army, Navy, Air Force, and Marine Corps recruits entering basic training at the
Baltimore Military Entrance Processing Station. The team also investigated
functional movement ability changes over training and deployment cycles working
in an active-duty population of Marines for a different project.
