Retrospective and Cross-sectional Analysis of Physical Training-Related Musculoskeletal Injuries in Slovenian Armed Forces.

Introduction: Injury registration is an important first step of the musculoskeletal injury (MSI) prevention process that helps establish the magnitude of the problem and focus prevention on the body parts that are most frequently injured. However, an injury definition used in that process may influence the reported prevalence of MSI, causing some injuries to be under-reported which in turn alters the prevention efforts. The primary goal of our study was to identify the 10-year prevalence of MSI in members of the Slovenian Armed Forces (SAF), to help plan and implement preventive measures for the reduction of MSI. Our secondary goal was to compare MSI data collected using two different approaches. The first one was prospective approach where only time-loss injuries were collected during a 10-year period, and the second one was a cross-sectional approach where at one point in time soldiers were asked about any musculoskeletal complaint.

Materials and Methods: The study was an introductory part of trial that was registered in the U.S. Clinical Trials Registry (clinical.trials.gov) under the identifier number NCT03415464. For the retrospective analysis, injury data from the Department of Safety and Occupational Safety of the SAF were used for a 10-year period (2006-2015) where only injuries that cause a soldier to be absent from duty for three or more working days are registered. For cross-sectional analysis, 129 members (N = 129) of an infantry SAF regiment (118 males, 11 females) volunteered to participate in the study. A modified Oslo Sports Trauma Research Centre (OSTRC) injury report form was used to collect injury data about current musculoskeletal complaints.

Results: The 10-year prevalence of MSI in SAF was 4.9%, with significantly (p = 0.0004) lower prevalence in females (3.1%) than males (5.4%). The most frequently injured body parts were ankles (23%) and knees (21%). The cross-sectional analysis has shown a much higher MSI prevalence of 48.8% (50.8% in males and 27.7% in females), demonstrating that some MSIs are probably under-reported. For all reported injuries in a cross-sectional analysis, a previous injury was a strong and significant injury risk factor (p < 0.001 for all instances).

Conclusions: To the best of our knowledge, this is the first comprehensive analysis of MSI among SAF members showing that the currently used injury surveillance system in SAF, that reports only the prevalence of time-loss injuries (4.9%), is probably underestimating the true and overall MSI prevalence (48.8%) in SAF members, suggesting a need for a better injury registration process. Based on the most frequent injury locations, preventive measures in SAF should focus on knee and ankle injuries in males with previous lower limb injuries. A best preventive approach would probably be to train smarter and harder to develop the physical capability to better protect against those injuries.