How to prevent injuries

Musculoskeletal injuries are an enormous problem for the U.S. military. They’re a top cause of lost duty time and the number one reason for medical evacuation from theater during Operations Iraqi and Enduring Freedom. One might think they happen most during military training or operations, but after basic training, most injuries to active-duty Military Service Members actually happen during physical training and recreational activity. If you’ve already experienced a sprained ankle, stress fracture, or similar injury, you’re at increased risk of getting injured again, so it’s important to know how to prevent it from happening.

Quality over quantity

Successful injury prevention programs—or “risk mitigation programs” as they’re starting to be known as—all share one common theme. They train what’s called neuromuscular control, or how to perform an exercise like a body squat slowly and with control. The name of the game in injury prevention is quality of exercise, not quantity. It’s more important to squat well than squat 500 pounds poorly. There isn’t a “best” injury prevention program that’s more effective than others, but there are a few exercises that are included in most because they efficiently and effectively train neuromuscular control.

  • Squats. Doing proper body squats is much harder than it looks. It requires you to maintain control over your hips, knees, and ankles, all while having the upper-body mobility to keep your chest upright. See HPRC’s guide to foundational movement for tips on how to perform a body- or air-squat correctly.
  • Lunges. They’re similar in form to a squat, but lunges require balance because you’re moving and your base of support is smaller (in line, rather than squarely under your hips). You can include them as either stationary lunges or walking lunges as shown in HPRC's video series on lunges.
  • Balance exercises. It doesn’t really matter what you do for balance exercises as long as you challenge yourself. Standing on one leg while brushing your teeth usually isn’t good enough to really improve your balance. However, exercises such as hopping forward or to the side, sticking the landing, and holding it for a couple of seconds can go a long way to improving your balance and helping prevent an ankle sprain. If those are too easy, add in a balance pad or other unstable surface to increase the difficulty.
  • Core stability exercises. Like the balance exercises, it doesn’t really matter what you do. You need a strong core to maintain control over your body as you move. That control helps maintain proper technique, and it helps you brace for unexpected movements such as when you’re changing direction playing defense in basketball.

Any risk reduction is better than no risk reduction.


How much is enough?

Experts don’t know exactly how much neuromuscular control exercise is needed to prevent injury. Some studies show you don’t need to dedicate a full workout to it though! Most injury prevention programs are designed to include a 5–10 minute warm-up before your workout, and doing that about 3 days per week seems to be effective. You also can help reduce your risk of injury by doing a set or two each of squats, lunges, balance exercises, and some core stability exercises every time you work out, run, or play sports.

Is it guaranteed to work?

In short, no. The reason injury prevention programs are now better described as “risk mitigation programs” is because they’re actually designed to reduce the injury risk for a group of people, rather than prevent injury in an individual. Basically, the way it works is that experts know implementing an injury risk mitigation program in a group, such as a football team, can prevent some injuries each year. But they don’t know whose injuries because there’s no way to predict who will get hurt.

So that means when you do the program correctly and with good form, you can’t say for sure you won’t get injured—only that you’re reducing your risk of injury. Still, any risk reduction is better than no risk reduction.

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References

Carow, S. D., Haniuk, E. M., Cameron, K. L., Padua, D. A., Marshall, S. W., DiStefano, L. J., . . . Gerber, J. P. (2016). Risk of lower extremity injury in a military cadet population after a supervised injury-prevention program. Journal of Athletic Training, 51(11), 905–918. doi:10.4085/1062-6050-49.5.22

Gribbin, T., Beutler, K., & de la Motte, S. J. (2019). Musculoskeletal Injury Prevention. In P. Duester & J. Scott (Eds.), Fundamentals of Military Medicine (pp. 393–403). Fort Sam Houston, TX: Bordon Institute.

Hauret, K. G., Taylor, B. J., Clemmons, N. S., Block, S. R., & Jones, B. H. (2010). Frequency and causes of nonbattle injuries air evacuated from Operations Iraqi Freedom and Enduring Freedom, U.S. Army, 2001–2006. American Journal of Preventive Medicine, 38(1), S94–S107. doi:10.1016/j.amepre.2009.10.022

Thorborg, K., Krommes, K. K., Esteve, E., Clausen, M. B., Bartels, E. M., & Rathleff, M. S. (2017). Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: A systematic review and meta-analysis of the FIFA 11 and 11+ programmes. British Journal of Sports Medicine, 51(7), 562–571. doi:10.1136/bjsports-2016-097066

U.S. Army. (2011). TB MED 592: Prevention and control of musculoskeletal injuries associated with physical training. Retrieved from https://www.usariem.army.mil/assets/docs/publications/guidance/tbmed592_musculoskeletal_injuries.pdf