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Injury Prevention for Tactical Operators
Danny J. McMillian, DPT, ATC, CSCS, TSAC-F 6/5/201
Posted: Sunday, March 31, 2013 2:33 PM
Joined: 6/5/2012
Posts: 2


 The purpose of this month’s TSAC Forum is to share injury concerns and our experiences with injury prevention interventions. 

The varied and rigorous physical nature of tactical duties, combined with operations that are often conducted in harsh environments, predisposes the tactical athlete to injury risk. Injuries have been cited as the biggest health problem of the military services. In a 2006 study, there were 743,547 injuries among non-deployed military services members. To provide some context, for every 1,000 service members tracked for one year, 628 of them sustained a musculoskeletal injury. Over 80% of the injuries were considered overuse.  

To better control injuries, a 2008 Department of Defense Injury Prevention Work Group (IPWG) reviewed the medical literature and presented several recommendations to the military services. Two recommendations are particularly pertinent for tactical strength and conditioning professionals: 1) prevent overtraining, and 2) perform multi-axial, neuromuscular, proprioceptive, and agility training.  

Overtraining has been particularly prevalent in the military, often due to the overuse of distance running as a means of training endurance. Fortunately, there are several studies that have shown adequate training of endurance with minimal distance running. For individuals that want to include distance running in their program, the following limitations have been shown to reduce injury rates without compromising fitness: a) limit running to three times per week on non-consecutive days, and b) limit the duration to 30 minutes.  

The second recommendation from the DOD IPWG (perform multi-axial, neuromuscular, proprioceptive, and agility training), is essentially telling us to help tactical athletes move better. I would add that for many individuals in the tactical professions, an important component of moving better is getting stronger. Some practical interventions: 

 --Screen all members of the tactical unit for both movement proficiency and performance. Identify each individual’s weak links and prescribe corrective training.  

 --Use dynamic warm-up and cool-down sessions to not only serve their usual purpose, but to also provide an opportunity for addressing movement proficiency.  

 --Test fitness broadly. If your fitness test battery does not include movement skill and heavy resistance challenges, don’t assume tactical mobility and strength are adequate. In fact, you can assume those domains will be undertrained and likely a source of increased injury risk. 

These are just a few suggestions for addressing the injury problems that concern tactical organizations. What are your experiences and recommendations? 


Matthew D. Tentis 10/11/2012 6:10:22 PM
Posted: Thursday, April 11, 2013 9:44 PM
Joined: 10/11/2012
Posts: 5


My deployment was spent working as a medic in a battalion aid station.  My background gave me an advantage in addressing musculoskeletal injuries, which made up probably 80% of visits.  One injury we could not seem to tackle was lower back pain.  I worked with combat arms Soldiers that spent much of their time in full kit training or out on the roads of Iraq. 

 

What advice is out in terms of preventing lower back pain from carrying a heavy load over long periods of time?  The average Soldier's kit is pretty heavy, is there even an effective approach to keeping their lower back pain free? 

 

Dr. Mcmillian, great post to start this thread!  Thank you! 

 

Matt Tentis, ATC, CSCS

mtentis10@gmail.com


Danny J. McMillian, DPT, ATC, CSCS, TSAC-F 6/5/201
Posted: Saturday, April 20, 2013 11:34 PM
Joined: 6/5/2012
Posts: 2


 Matt, despite much attention from researchers and trainers, managing the back pain problem is one of our biggest challenges. When you add a soldier’s kit and the rough terrain of most deployments, the challenges are even greater. I don’t pretend to have a solution, but here is what I feel are some best practices:

  • If you have already had a problem, make sure you get full rehab. That means restoring motion, activation, 3-D motor control, strength, endurance, and confidence. Too often rehab stops when the pain is gone – not good enough.
  • Endurance is probably more protective than strength. So, once adequate functional strength is achieved, emphasize endurance.
  • Get off of the floor. Mat or floor based stability exercises are a fine place to start, but most challenging activities occur on your feet. Start with symmetrical loads and base of support, and then gradually start to challenge stability more with asymmetrical loads and stances.
  • Make sure the hips and thoracic spine are mobile. The lumbar spine is not meant to move very much in the frontal and transverse planes, so functional movement in those planes needs to come from above and below the lumbar spine.
  • Optimize aerobic and anaerobic fitness; when central fatigue sets in, it’s hard to control the spine. For soldiers that have to carry heavy loads over long distance, create a systematic progression that gradually increases one of those variables at a time.
  • Educate on habitual postures. The low-load stress of bad habitual postures can catch up with us over time.

Hope this helps.