Gender differences in the cause of low back pain in British soldiers

OBJECTIVES: To explore gender differences in the cause of low back pain in a population of military personnel who are expected to undertake high levels of sport, exercise and physical military training. METHODS: A prospective study of trained British soldiers, with symptomatic low back pain, referred to the Colchester Garrison Sports Injury and Rehabilitation Centre over a four year period. RESULTS: The study demonstrates that 928 (17.8%) of the 5214 referrals were for new cases of low back pain. The incidence of low back pain in female soldiers is higher than their male counterparts with an odds ratio of 3.17 (95% CI 2.31 - 4.35) There was a highly significant cross gender difference in low back pain caused by activities in the followining categories: military physical traininong (OR 2.65, 95% CI 1.70 - 4.02), work or occupation (OR 2.49, 95% CI 1.56 - 3.87) and off-duty pursuits (OR 2.91, 95% CI 1.72 - 4.72). There was no cross gender difference in low back pain caused by sport, road traffic accidents or activities pre-dating military service. CONCLUSIONS: Female soldiers are significantly more likely to suffer low back pain as a result of physical military training, their occupation, or off-duty activities. Sporting activities do not cause low back pain in women to a greater extent than men By demonstrating the scale of the problem and by determining of the cause of injury, it should now be possible to propose methods of effective intervention to reduce injury, implement those interventions and audit effectiveness.     

2005～2010年396名军人伤害住院病情分析

目的:对某区部队伤害住院患者进行流行病学特征分析,提出预防建议。方法:应用我院的病历数据库资料进行分析。结果:意外损伤、军事训练伤、运动伤是导致部队伤害住院的3大主要因素。伤害主要发生在18～24岁(占76.77%)之间,干部意外损伤、运动伤、斗殴伤和交通伤高于战士,军事训练伤则战士明显高于干部。结论:部队要重视和加强伤害的预防工作。     

Injuries presenting to Army physiotherapy in north Queensland, Australia

OBJECTIVE: To analyze archival physiotherapy records at a major military base in North Queensland, Australia, to investigate the epidemiology of injuries associated with sports and training, examining for possible risk factors for military training injury. METHODS: A retrospective study was undertaken during a 62-month period, from 1987 to 1992, at Lavarack Barracks, Townsville, Australia, which services a dynamic population base of some 5,000 uniformed staff. Sociodemographic basic data, as well as treatment-related data (treatment area, number and type, interval between onset and initial treatment, reported cause), were used. Admission records were recoded according to the Orchard Sports Injury Classification System (version 2.0) standard. RESULTS: During the 62-month period from 1987 to 1992, 4,993 personnel, 96.2% (4,803/4,993) males and 3.7% (190/4,993) females, were referred for 5,025 physiotherapy treatments. The incidence of injuries requiring physiotherapy was 80.4 new patients per 5,000 personnel per month, and the incidence rate of injury was 19.3% per year or 0.19 injuries per person per year. The mean age of patients was 25.7 +/- 6.2 (SD) years, and the median age was 24 years, with a range of 17 to 59 years. Injuries were related to military training (29.3%, 1,471/5,025), diverse causes (21.2%, 1,072/5,025), sports (13.8%, 694/5,025), insidious onset (11.8%, 589/5,025), football (11.7%, 586/5,025), manual handling (4.2%, 211/5,025), motor vehicle crashes (4.1%, 206/5,025), and surgery (3.9%, 196/5,025). The four major body areas treated by physiotherapists were the knee joint (37.0%, 1,321/3,612), lumbar spine (29.8%, 1,075/3,612), ankle (19.9%, 719/3,612), and shoulder joints (13.8%, 497/3,612), which accounted for nearly three-quarters of all admissions. Of these, most were referred without definitive diagnosis (71.1%, 2,572/3,612), with the remainder comprising joint injuries (17.5%, 634/3,612), other types of pathology such as chest infections or neurological involvement, soft-tissue injuries (3.5%, 128/3,612), and bone damage (1.0%, 38/3,612). Most injuries (59.0%, 2,959/5,019) occurred during the 6 months between April and September referred to as the winter season, during which 71.8% of all football and 66.8% of all sports-related referrals were made. Significant associations were found between gender and injury cause (p < 0.001), gender and injury type (p < 0.01), body area affected and injury type (p < 0.00001), body area affected and injury cause (p < 0.00001), injury cause and injury type (p < 0.00001), and season and injury cause (p < 0.00001). Pretreatment interval was significantly associated with cause of injury (p < 0.00001), body area affected (p < 0.0001), and type of injury (p < 0.0001). Total number of consecutive treatments provided was significantly associated with both body area affected (p < 0.05) and injury type (p < 0.001). CONCLUSIONS: This study has used archival physiotherapy records for the purpose of exploring injury reporting patterns associated with a military population. The incidence profile for injuries using physiotherapy admissions is likely to be conservative because the patients are a group of injured military personnel selected by medical officers for physiotherapy treatment. This selection process needs further study, particularly because the majority of injuries referred for physiotherapy treatment are undiagnosed. This may be attributable in part to the cumulative and diverse nature of some injuries. Injury prevention needs to focus on activities relating to military training and football and other sports. Improved systems for recording detailed and accurate physiotherapy admission, treatment, and follow-up information are needed.     

2009、2010年全军军事训练伤流行病学抽样调查

目的 随机抽样调查2009、2010年全军监控点部队军事训练伤的发生与分布情况,分析其发生的流行病学特点及趋势.方法 随机抽取全军10个军事训练伤监控点部队,以2009年度和2010年度的参训军人为研究对象,按照《军事训练伤诊断标准及防治原则》采集所有军事训练伤数据,并进行分析.结果 两年中被调查的63 132名参训军人共发生各类训练伤10 775例,其中2009年参训军人27 230人,发生军事训练伤4076例,总发生率15.0％; 2010年参训军人35 902人,发生军事训练伤6699例,总发生率18.7％,2010年军事训练伤发生率明显高于2009年(P＜0.01).军事训练伤中骨关节损伤、软组织损伤、器官损伤的构成比2009年分别为33.5％、48.4％、18.1％,2010年分别为19.7％、73.3％、7.0％,其中骨关节损伤及器官损伤的构成比明显下降,而软组织损伤的构成比显著上升.2009、2010两年度军事训练伤发生率连续出现双高峰期现象.结论 在军事训练伤中应重视相关损伤的预防.加强军事训练伤预防知识的普教育,严格贯彻《军事训练健康保护规定》是有效降低军事训练伤发生率的关键.     

Comparing sports injuries in men and women.

OBJECTIVE: To compare the pattern of injury between men and women in seven collegiate sports to determine if gender-specific factors exist which could be modified to reduce the risk of injury to female athletes. DESIGN: Retrospective cohort study of injury reports compiled by certified athletic trainers between Fall 1980 and Spring 1995. SETTING: An NCAA division III College. PARTICIPANTS: Eighteen to 22 year-old male and female college athletes competing in seven like sports (basketball, cross-country running, soccer, swimming, tennis, track and water polo) at the intercollegiate level, playing similar number of contests and using the same facilities. MAIN OUTCOME MEASURES: Analyses of injury patterns, classified by sport and anatomic location, for men and women in seven like sports. RESULTS: A total of 3,767 participants were included in the study, with 1874 sports-related injuries reported among the men and women's teams. Of these injuries, 856 (45.7%) were sustained by female and 1018 (54.3%) by male athletes. Overall, no statistically significant gender difference was found for injuries per 100 participant-years (52.5 for female athlete versus 47.7 for males). A statistically significant gender difference in injury incidence (p < 0.001) was seen for two sports: swimming and water polo. Female swimmers reported more back/neck, shoulder, hip, knee and foot injuries: and female water polo players reported more shoulder injuries. When evaluating all sports concurrently, female athletes reported a higher rate of hip, lower-leg and shoulder injuries, while male athletes reported a higher rate of thigh injuries. CONCLUSION: Except for some minor gender differences in total injuries for two sports and several differences in total injuries by anatomic location, our data suggest very little difference in the pattern of injury between men and women competing in comparable sports. The increased rate of shoulder injury among female swimmers probably resulted from the more rigorous training philosophy of their coach. Thus, no gender-specific recommendations can be suggested for decreasing the incidence of injury to female athletes competing in these sports.     

Injury occurrence and risk factors in construction engineers and combat artillery soldiers

OBJECTIVES: This 1-year prospective study compared 125 construction engineers and 188 combat artillery soldiers to determine whether there were differences in injury occurrences/ types because of their diverse occupational tasks and training requirements. Also, intrinsic factors were studied to establish any associations with a soldier's risk for injury. METHODS: Prestudy height, weight, and body mass index and fitness (3.2-km run, sit-ups, push-ups) data were collected prior to the injury medical records review. Approximately 30% of each battalion was studied. RESULTS: For engineers and artillery, 86.0% and 66.0% incurred at least one injury, respectively. Of total soldiers, 64.0% of engineers and 56.4% of artillerymen had injuries associated with limited duty profiles. Total injuries resulted in 743 days of limited duty time (5.9 days per soldier) in engineers and 1,078 days (5.7 days per soldier) in artillery. Odds ratios (OR) and 95% confidence intervals (CI) were also calculated. The odds of traumatic fractures were (OR = 6.5, 95% CI = 1.8-23.7) 6 times higher in engineers than artillery, but strains/sprains and abrasions/lacerations were (OR = 2.3, 95% CI = 1.5-3.7; OR = 2.5, 95% CI = 1.2-5.0) two times higher in artillery than engineers. The number of limited duty days associated with knee injuries was significantly higher in engineers than artillery (p < 0.0001), and number of days for low back injuries was significantly higher in the artillerymen (p < 0.0001). Greater body mass was a risk factor for lower back pain and the body mass index was > or = 25 for strains/sprains in both units. CONCLUSIONS: Significant differences in injuries were reported between the two units. It is plausible that the differences were related to the diverse training exposures of the units. However, it is beyond the scope of this study to make conclusions about the causes of the injury differences. The data also indicate that body mass and body mass index were identified as modifiable injury risk factors for both units, which suggests that these injuries are preventable.     

藏区医院住院武警官兵军事训练伤分析

 目的 分析藏区医院住院武警官兵军事训练伤的特点,探讨卫勤保障前置后军事训练伤防治效果,为搞好军事训练伤防治工作提供依据。方法 以2010 06至2016 06藏区医院因军事训练伤住院的武警官兵为研究对象,分析其军事训练伤的群体分布、受伤季节、受伤类型及受伤病程的特点。并对比“卫生资源前置”前（2010 06至2013 05）、后（2013 06至2016 06）军事训练伤住院官兵的院前时间、住院时间、致残率等。结论 驻高原山地藏区住院武警官兵军事训练伤发病季节以秋季最高发（34.7%）,软组织损伤为主（55.1%）,急性损伤所占比例最大（67.2%）。卫生资源前置后,军事训练伤住院官兵的住院时间、急性损伤的院前时间均缩短,致残率无显著变化。结论 应根据高原山地藏区武警官兵军事训练伤的特点有针对性地制定防治措施,卫生资源前置这一举措能更及时的开展救治     

Sports and training injuries in British soldiers: the Colchester Garrison Sports Injury and Rehabilitation Centre

OBJECTIVES: To record and analyse the injuries and conditions requiring referral to the Colchester Garrison Sports Injury and Rehabilitation Centre over a three year period, with special reference to type and site of injury, aetiology, and outcome. METHODS: An ongoing prospective study in which data on the diagnosis, cause of injury, and treatment of all patients referred to the Centre was coded and stored on a database. A total of seventeen variables were recorded. SUBJECTS: All patients were trained, serving soldiers in the British Army referred via their General Practitioner to the Sports Injury and Rehabilitation Centre. RESULTS: A total of 3921 referrals were made over the three-year period. The most common specific condition seen was low back pain (22.2%) followed by sprain of the ankle (15.1%). Lower limb conditions, both overuse and traumatic, accounted for over half (55.8%) of all referrals. Military training was the most common cause of all conditions (35.2%) followed by organised or personal sport (28.5%). In addition to medical treatment and physiotherapy, 30% of patients required formal rehabilitation. CONCLUSIONS: This is the first full review of the data collected by the Sports Injury and Rehabilitation Centre. It defines the injury patterns for trained soldiers rather than military recruits. Low back pain is identified as a major cause of morbidity in this population. The review serves as a benchmark in the planning of injury prevention strategies and the establishment of future rehabilitation services.     

Fitness, performance, and risk of injury in British Army officer cadets.

The objectives of this study were to investigate the effectiveness of the Commissioning Course (CC) to develop and maintain standards of fitness, to assess capability to perform military tasks, and to determine the relationship between fitness and risk of injury in 106 British Army officer cadets (OCdts). Aerobic fitness, muscular strength, endurance, and body composition were regularly assessed. Performance on four representative military tasks was measured at the end of the CC. All injuries in term 1 were documented. Over the CC, changes in fitness were generally modest and equivocal. Aerobic fitness improved by approximately 10% (p < 0.01), strength by 5 to 9% (p < 0.05 to p < 0.01), and muscular endurance by 55% (p < 0.01). Reductions in fat (p < 0.01) and gains in fat free mass (p < 0.05) averaged 3%. The females demonstrated greater improvements than the males. The majority of OCdts passed the representative military tasks, although females in some trades showed high failure rates. Forty-six percent of OCdts sustained injuries in the first term, resulting in 5% of man-days lost. No gender difference was found in injury rates. The least aerobically fit OCdts sustained more injuries than their fitter counterparts. In conclusion, there is scope for optimizing the effectiveness of the CC to enhance fitness and improve the focus of physical training on maximizing military task performance.     

Sport specialization and sport participation opportunities and their association with injury history in female high school volleyball athletes

ObjectiveDetermine the association of sport specialization in female volleyball athletes with previous injury history and determine the association of sport specialization with volleyball participation opportunities.DesignCross-sectional.SettingRecruitment occurred from 83 Wisconsin high schools during the 2018 volleyball season.ParticipantsFemale volleyball athletes (N = 1,588, grades 9–12, age = 15.6 ± 1.1 years).Main outcomesParticipants completed a pre-season questionnaire soliciting information regarding 1) demographics, 2) sport specialization, 3) sport participation, and 4) sport-related injuries in the previous 12 months. Univariable logistic regression models were used to identify associations with previous injury. Chi-square analyses were used to investigate associations between sport specialization classification and other sport participation opportunities.ResultsBoth moderately and highly specialized athletes were more likely to report a previous injury compared to low specialized athletes (moderate OR: 1.84 [1.29–2.62]; p < 0.001 and high OR: 2.30 [1.64–3.24]; p < 0.001). Highly specialized athletes were more likely to report participating in club volleyball, summer tournaments, and training camps in the past 12 months. Participants who reported participating in club volleyball, summer competitions, and training camps last year were more likely to report an injury.ConclusionsSpecialization was associated with injury history and year-round volleyball opportunities among female adolescent volleyball athletes.     

The incidence of injury in light infantry soldiers

U.S. Army soldiers lose substantial training hours as a result of musculoskeletal injuries. Most military injury data have focused on basic trainee populations. This study examines activities associated with injuries in operational infantry soldiers. We conducted a randomized, retrospective medical record review of 339 records from a total of 3,195 light infantry soldiers over 13 months. The annualized incidence of injuries was 95 per 100 soldiers per year vs. 74 per 100 for illness. There were 372 injuries, representing 56% of sick-call diagnoses. Physical training caused 50% of all injuries, and 30% of those were linked to running. Injuries caused nearly 10 times the number of limited duty days as illness. Soldiers with lower extremity running injuries spent seven times more days on profile than those with nonrunning injuries. We conclude that physical training is related to a high number of injuries in infantry soldiers. This study provides important data on activities and injuries in operational infantry soldiers.     

Incidence and nature of the most common rugby injuries sustained in Argentina (1991-1997)

OBJECTIVE: To study the incidence of the most commonly sustained injuries in Argentine rugby and analyse them according to type, position and age of the players, and phase and time of play. METHODS: A prospective registry of injuries was constructed in different provincial unions of Argentina. Data were collected during a whole weekend each year from 1991 to 1997. Chi2 with Yates correction test, contingency tables, odds ratios (OR), and 95% confidence intervals (CI) were calculated (Epi Info Version 6.04a). RESULTS: A total of 924 injuries were registered in 1296 rugby games, involving 38 933 players. The mean (SD) incidence per weekend was 2.4 (0.2)% (95% CI 2.22 to 2.53), and the number of injuries per season was 24,188. Overall, senior players suffered more injuries than those in younger divisions (OR = 1.53; 95% CI 1.34 to 1.76; p<0.0001). The most common type of injury was pulled muscles of the lower limbs (11.7%, p<0.0001). Overall, the knee was the most susceptible to injury (14.1%, p<0.0001). Senior players suffered more pulled muscles of the lower limbs (OR = 2.99; 95% CI 2.01 to 4.46; p<0.0001), ankle ligament distension (OR = 1.69; 95% CI 1.12 to 2.53; p = 0.01), knee trauma (OR = 1.69; 95% CI 1.06 to 2.68; p = 0.02), bleeding wounds on the face (OR = 3.86; 95% CI 2.24 to 6.70; p<0.0001), and knee ligament distension (OR = 2.14; 95% CI 1.16 to 3.96; p = 0.01). Younger players had a greater risk of suffering muscular or ligament injuries of the cervical column (OR = 3.0; 95% CI 1.05 to 10.08; p = 0.04). The forwards had a higher risk of injury (OR = 1.41; 95% CI 1.23 to 1.61; p<0.0001). The most commonly injured player was the flanker (15.5%, p<0.01), and the most common mechanism was in open play (33%). More injuries were sustained in the second half (OR = 1.17; 95% CI 1.03 to 1.34; p = 0.01). CONCLUSIONS: Injuries are the cause of significant morbidity among rugby players in Argentina. A more thorough investigation and a greater understanding of the mechanisms are crucial in order to update the rugby laws and reduce this high injury incidence.     

Optimising training adaptations and performance in military environment

Objectives

Worldwide decreases in physical fitness and increases in body fat among youth have set challenges for armed forces to recruit physically capable soldiers. Therefore, knowledge of optimizing physical adaptation and performance through physical training is vital. In addition, maintaining or improving physical performance among professional soldiers in various military environments is crucial for overall military readiness. The present review focuses on the effects of military training on physical performance by searching for optimal methods to do it.

The interaction between military education and health: a survey among conscripts undergoing officer training in Norway

An increasing number of soldiers are unable to finish their military training because of health problems. In the summer of 1999, 236 (96%) of 246 officer training school applicants in Harstad, Northern Norway, were enrolled in the survey. Those selected for military education estimated their physical condition better (p < 0.02), participated in athletic sport more frequently (p < 0.05), and smoked four times less (p < 0.001) than those who were dismissed. Thirty-nine percent of those accepted for further military education went to see the doctor during the 3-week introductory period compared with 20% among those who were dismissed (p < 0.002). The overall consultation rate in the introductory period was 52.5 per 100 cadet months. During the rest of the education, the consultation rate dropped significantly to 43.1 (p < 0.02). The magnitude of health-related problems during military education is a concern from a medical point of view and can, at least in part, be attributed to the level of physical activity of the military education.     

Injury pattern in youth team handball: a comparison of two prospective registration methods

The purpose of this study was to examine the injury incidence and pattern of injuries in youth female and male team handball players using two different prospective registration methods; match reports (90 teams, 1080 players) and coach reports (34 teams, 428 players). A total of 118 injuries were recorded by the coach report, of which 93 (79%) were acute injuries (incidence training: 0.9+/-0.16 injuries/1000 player hours; matches: 9.9+/-1.26; rate ratio vs training: 10.8 [95% confidence interval (CI) 7.0-16.6]; P<0.0001) and 25 (21%) were overuse injuries. Knee (26%) and ankle (24%) injuries accounted for half of the acute injuries (training: 0.5+/-0.12 injuries/1000/h; matches: 4.4+/-0.84; rate ratio vs training: 8.0 (95% CI 4.5-14.5); P<0.0001). No gender difference was found in the injury rate (rate ratio female vs male: 1.3 (95% CI 0.8-2.1); P=0.40). Most of the injuries occurred in the attacking phase by back or wing players doing a plant-and-cut, landing or turning movement, and more than half in contact situations with the opponent. Similar results were observed for acute match injuries in the match report. These results indicate that the rate of injuries in youth team handball is as high as at the senior level, and prevention should focus on knee and ankle injuries. The coach report seems to be the best method to register injuries in youth team handball to provide a full spectrum of injuries according to their type, incidence and severity.     

驻高原武警某部官兵训练伤发病状况及其与慢性疲劳综合征的关系

 目的 了解驻高原武警官兵训练伤发病状况,并探讨其与慢性疲劳综合征(chronic fatigue syndrome,CFS)之间的联系。方法 对驻高原武警某部官兵进行问卷调查,收集2020-09至2021-08的CFS与训练伤状况,分析人员类别、学历、年龄等对二者的影响,并探讨二者之间的相关性。结果 对1971名官兵的问卷调查结果显示,训练伤发病率为20.65%,CFS发病率为24.05%。通过单因素分析筛选影响因素,经二分类logistic回归分析,级别、年龄、学历的不同对CFS及训练伤的发病率有影响(P＜0.05),且患有CFS官兵训练伤的发病率为31.01%,显著高于平均水平,并易多次受伤(P＜0.05)。结论 驻高原官兵训练伤与CFS存在一定相关性,应将提高组训的科学性与防治CFS同步开展,确保官兵心理健康水平与身体素质不断提高。     

Epidemiology of medically treated sport and active recreation injuries in the Latrobe Valley, Victoria, Australia

OBJECTIVE: To quantify and describe medically treated sport and active recreation injuries in a defined region of the Latrobe Valley from 7 November 1994 to 6 November 1995. METHOD: A geographic target area was defined, restricted to the six postcodes that fell wholly within the catchment area of the Latrobe Regional Hospital. Data describing medically treated sport and active recreation injuries to Latrobe Valley residents aged over 4 years (about 70,000) were selected by postcode from three sources: the Victorian Admitted Episodes Dataset (hospital admissions), the Victorian Injury Surveillance System (presentations to hospital emergency departments), and the Extended Latrobe Valley Injury Surveillance (ELVIS) project (presentations to general practitioners). RESULTS: At least 2300 cases of medically treated sport and active recreation injury were recorded. This corresponds to a hospital admission rate of 16/10,000 population, emergency department presentation rate of 169/10,000 population, and a general practitioner presentation rate of 187/10,000 population. There were more male patients than female, and younger age groups were also overrepresented, but these data may reflect the greater participation of these groups in sport and active recreation. Australian football was associated with the highest number of injuries (accounting for 24.0% and 22.0% of presentations to emergency departments and general practitioners respectively) followed by cycling (15.7% and 12.6%) and basketball (17.5% and 13.5%). CONCLUSIONS: This study shows that routine health sector data collections in defined populations can provide useful information on the size, distribution, and characteristics of the problem of sport and active recreation injuries at the community level. However, all current health sector systems for injury data collection and surveillance require attention to improve case capture and identification and data quality.     

Mountain biking injuries in rural England

BACKGROUND: Off road mountain biking is now an extremely popular recreation and a potent cause of serious injury. AIM: To establish the morbidity associated with this sport. METHODS: Data were collected prospectively over one year on all patients presenting with an injury caused by either recreational or competitive off road mountain biking. RESULTS: Eighty four patients were identified, 70 males and 14 females, with a mean age of 22.5 years (range 8-71). Most accidents occurred during the summer months, most commonly in August. Each patient had an average of 1.6 injuries (n = 133) and these were divided into 15 categories, ranging from minor soft tissue to potentially life threatening. Operative intervention was indicated for 19 patients (23%) and several required multiple procedures. The commonest injuries were clavicle fractures (13%), shoulder injuries (12%), and distal radial fractures (11%). However, of a more sinister nature, one patient had a C2/3 dislocation requiring urgent stabilisation, one required a chest drain for a haemopneumothorax, and another required an emergency and life saving nephrectomy. CONCLUSION: This sport has recently experienced an explosion in popularity, and, as it carries a significant risk of potentially life threatening injury across all levels of participation, the use of protective equipment to reduce this significant morbidity may be advisable.     

军事训练致踝关节损伤调查分析

目的探讨在军事训练中踝关节损伤的原因和预防。方法通过某部队300名战士问卷调查方式,对他们在训练中踝关节损伤的人数,部位,程度,项目等调查数据进行统计分析。结果踝关节损伤占19.3%,损伤部位以外侧韧带受伤为主,发生于越野训练,步伐训练等项目,程度以轻伤为主。结论在踝关节的训练伤中,用力不当是首要因素。科学训练,掌握相关的训练知识和医学知识可以避免和减少踝关节损伤。