Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

NewsBot · Feb 16, 2023

Musculoskeletal Injury Risk in a Military Cadet Population Participating in an Injury-Prevention Program
Ivar Vähi et al
Medicina 2023, 59(2), 356; https://doi.org/10.3390/medicina59020356

Background and Objectives: Musculoskeletal injuries are a major health hazard among military personnel. Previous research has proposed several exercise-based strategies for prevention. The purpose of this study was to investigate the effect of an exercise-based injury-prevention program on the incidence of musculoskeletal injury, motor performance and psychosocial status. Materials and Methods: Thirty-six Estonian Military Academy cadets were randomly assigned into either an intervention or control group. The intervention group followed a neuromuscular exercise-based injury-prevention warm-up program, three times per week for 6 months. The control group continued with the usual warm-up. The main outcome measure was injury incidence during the study period. Additionally, evaluation of isokinetic lower-extremity strength, postural sway, physical fitness and psychosocial status was included pre- and post-intervention. Results: During the 6-month study period, the musculoskeletal injury incidence was 43% in the intervention group and 54% in the control group (RR = 0.8; 95% CI = 0.41 to 1.99). The noted 20% risk reduction was not statistically significant (p = 0.59). Furthermore, there were no statistically significant differences between the intervention and control group in motor performance or psychosocial status measures. Conclusions: In conclusion, no effect of the exercise-based injury-prevention program on injury risk, motor performance or psychosocial status could be detected.
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NewsBot · Feb 22, 2023

Musculoskeletal Injuries at the Chinese Peacekeeping Level II Hospital in Wau, South Sudan, 2018-2022
Chao Sun, Chengjie Xiong, Feng Xu
Mil Med. 2023 Feb 20

Introduction: Musculoskeletal injuries (MSIs) are common among U.N. military personnel and cause a substantial toll, but little is known about the actual risks and changes of MSIs. The Chinese level II hospital (CHN L2H) was the highest-level hospital in the Western Sector of the U.N. Mission in South Sudan (UNMISS). This study reviewed and analyzed the MSIs managed by the CHN L2H in UNMISS.

Methods: Medical records of MSIs in CHN L2H from September 2018 to July 2022 were identified. We analyzed all the MSIs and treatment procedures.

Results: A total of 857 patients from more than 40 countries were included (86.8% men, average age of 37.83 years), consisting of 457 troop-contributing country, 231 U.N. local, and 169 U.N. international personnel. The most common injury was lumbar muscle strain (14.2%). Sports-related mechanism (29.2%) was the most frequent cause of MSIs. The most significant proportions of anatomical regions were the lumbar spine (22.52%), hand (13.77%), and foot (10.97%). No-steroid anti-inflammatory drugs (43.99%), physical therapy (20.54%), and immobilization (11.32%) were the most used treatments.

Conclusions: MSIs are common diseases in the CHN L2H in the Western Sector of UNMISS. The universality and complexity of MSIs demonstrate the urgent need to improve prevention, treatment, and rehabilitation.
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NewsBot · Feb 27, 2023

Association between external training loads and injury incidence during 44 weeks of military training
Steven D. Powell, Andrew G. Siddall, Sarah C. Needham-Beck, Victoria C. Edwards, Neil Light, Sarah Jackson, Julie P. Greeves, Sam D. Blacker, Stephen D. Myers
16 February 2023

Military training is physically arduous and associated with high injury incidence. Unlike in high-performance sport, the interaction between training load and injury has not been extensively researched in military personnel. Sixty-three (43 men, 20 women; age 24 ± 2 years; stature 1.76 ± 0.09 m; body mass 79.1 ± 10.8 kg) British Army Officer Cadets undergoing 44 weeks of training at the Royal Military Academy Sandhurst volunteered to participate. Weekly training load (cumulative 7-day moderate-vigorous physical activity [MVPA], vigorous PA [VPA] and the ratio between MVPA and sedentary-light PA [SLPA; MVPA:SLPA]) was monitored using a wrist-worn accelerometer (GENEActiv, UK). Self-report injury data were collected and combined with musculoskeletal injuries recorded at the Academy medical centre. Training loads were divided into quartiles with the lowest load group used as the reference to enable comparisons using Odds Ratios (OR) and 95% confidence intervals (95% CI). Overall injury incidence was 60% with the most common injury sites being the ankle (22%) and knee (18%). High (load; OR; 95% CI [>2327 mins; 3.44; 1.80–6.56]) weekly cumulative MVPA exposure significantly increased odds of injury. Similarly, likelihood of injury significantly increased when exposed to low-moderate (0.42–0.47; 2.45 [1.19–5.04]), high-moderate (0.48–0.51;2.48 [1.21–5.10]) and high MVPA:SLPA loads (>0.51; 3.60 [1.80–7.21]). High MVPA, and high-moderate MVPA:SLPA increased odds of injury by ~2.0–3.5 fold, suggesting that the ratio of workload to recovery is important for mitigating injury occurrence.
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NewsBot · Apr 3, 2023

Characterization of Female US Marine Recruits: Workload, Caloric Expenditure, Fitness, Injury Rates, and Menstrual Cycle Disruption during Bootcamp
Andrea C. Givens et al
Nutrients 2023, 15(7), 1639

Basic training is centered on developing the physical and tactical skills essential to train a recruit into a Marine. The abrupt increase in activity and energy expenditure in young recruits may contribute to high rates of musculoskeletal injuries, to which females are more susceptible. To date, the total workload of United State Marine Corps (USMC) bootcamp is unknown and should include movement around the military base (e.g., to and from dining facilities, training locations, and classrooms). Thus, the purpose of this effort was to quantify workload and caloric expenditure, as well as qualitatively assess the impact of female reproductive health and injury rates in female recruits. Female recruits (n = 79; age: 19.1 ± 0.2 years, weight: 59.6 ± 0.8 kg, height: 161.6 ± 0.7 cm) wore physiological monitors daily throughout 10 weeks of USMC bootcamp. Physical fitness test scores, physiological metrics from wearables, injury data, and menstrual cycle information were obtained. Female recruits on average expended 3096 ± 9 kcal per day, walked 11.0 ± 0.1 miles per day, and slept 5:43 ± 1:06 h:min per night throughout the 10 weeks of bootcamp. About one-third (35%) of female recruits sustained an injury. In a subset of females that were not taking birth control and had previously been menstruating, 85% experienced cycle dysfunction during boot camp. High levels of physical activity and caloric expenditure, coupled with the stress of a new environment and insufficient sleep, may lead to alterations in female reproductive cycles and musculoskeletal injuries in young USMC recruits.
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NewsBot · Aug 14, 2023

The Effect of Lightweight Shoes on Air Force Basic Training Injuries: A Randomized Controlled Trial
Kasper, Korey B.; Nye, Nathaniel S.; Casey, Theresa M.; Cockerell, Meredith G.; Trigg, Steven D.
Translational Journal of the ACSM 8(4) 1-7, Fall 2023. | DOI: 10.1249/TJX.0000000000000234

Introduction/Purpose
Bone stress injuries (BSI) are a leading medical diagnosis and cause of training disruptions and increased costs in US Air Force basic military training (BMT). Currently, as required by law, all trainees are issued athletic shoes upon arrival to BMT; however, the issued shoes are often disliked by trainees and are suspected of contributing to injury. This study investigated the effect of issuing shoes with lighter weight, lower heel-to-toe drop, and wider toe box than the standard-issue shoes to compare comfort, musculoskeletal injuries, and training outcomes.

Methods
In this blinded, randomized controlled product evaluation, trainees of a single BMT squadron were issued either the standard-issue shoes or a lighter-weight alternative; following completion of BMT, male and female cohorts were compared for differences in fitness assessment results, musculoskeletal injuries, and graduation delays using routinely collected databases. Associations between categorical variables were analyzed using a chi-square test with significance set to α ≤ 0.05.

Results
Among male trainees, issuing the lighter-weight shoe resulted in an absolute risk reduction of 6.05% (from 13.87% to 7.82%) and a relative risk reduction of 43.62% for BSI. Also, trainees who received the heavier standard-issue shoes noted the shoes to be “too uncomfortable to wear” at a significantly higher rate.

Conclusion
Issuing shoes with lighter weight, smaller heel-to-toe drop, and wider toe box appears to reduce the risk of BSI and shoe dissatisfaction among male BMT trainees; such shoe characteristics should be considered for use in populations engaging in similar physical training.
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NewsBot · Oct 31, 2023

Epidemiology of musculoskeletal injury in military recruits: a systematic review and meta-analysis
Myles C. Murphy, Joanne Stannard, Vanessa R. Sutton, Patrick J. Owen, Brendon Park, Paola T. Chivers & Nicolas H. Hart
BMC Sports Science, Medicine and Rehabilitation volume 15, Article number: 144 (2023)

Background
Injuries are a common occurrence in military recruit training, however due to differences in the capture of training exposure, injury incidence rates are rarely reported. Our aim was to determine the musculoskeletal injury epidemiology of military recruits, including a standardised injury incidence rate.

Methods
Epidemiological systematic review following the PRISMA 2020 guidelines. Five online databases were searched from database inception to 5th May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by military recruits after the year 2000 were included. We reported on the frequency, prevalence and injury incidence rate. Incidence rate per 1000 training days (Exact 95% CI) was calculated using meta-analysis to allow comparisons between studies. Observed heterogeneity (e.g., training duration) precluded pooling of results across countries. The Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies assessed study quality.

Results
This review identified 41 studies comprising 451,782 recruits. Most studies (n = 26; 63%) reported the number of injured recruits, and the majority of studies (n = 27; 66%) reported the number of injuries to recruits. The prevalence of recruits with medical attention injuries or time-loss injuries was 22.8% and 31.4%, respectively. Meta-analysis revealed the injury incidence rate for recruits with a medical attention injury may be as high as 19.52 injuries per 1000 training days; and time-loss injury may be as high as 3.97 injuries per 1000 training days. Longer recruit training programs were associated with a reduced injury incidence rate (p = 0.003). The overall certainty of the evidence was low per a modified GRADE approach.

Conclusion
This systematic review with meta-analysis highlights a high musculoskeletal injury prevalence and injury incidence rate within military recruits undergoing basic training with minimal improvement observed over the past 20 years. Longer training program, which may decrease the degree of overload experienced by recruit, may reduce injury incidence rates. Unfortunately, reporting standards and reporting consistency remain a barrier to generalisability.
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NewsBot · Nov 2, 2023

Stress fractures in the military context
Matthias Ring et al
Unfallchirurgie (Heidelb). 2023 Nov 1

Background: Soldiers, especially as recruits, are exposed to significantly elevated stress patterns of the foot due to occupation-related marching and excessive running. This can lead to military-specific stress fractures of the metatarsals, i.e., marching fractures. The treatment and prevention of stress fractures are of particular importance in the military context due to the impact on operational capability and treatment costs. A uniform classification of these fractures does not yet exist.

Objective: Review of stress fractures in the military setting with presentation of the incidence, risk factors, classification, treatment and prevention possibilities.

Material and methods: A PubMed®-based review of the current literature on stress fractures in the military context was conducted and the results were discussed with a focus on specific military medical treatment options.

Results: There are several possibilities to classify stress fractures, the most well-known being a 4-level magnetic resonance imaging (MRI)-based classification. Prevention and treatment possibilities are multifaceted but so far insufficiently validated.

Conclusion: Military-specific stress fractures should be grouped according to a 4-level and MRI-based classification. The treatment options include both conservative and surgical measures and should be implemented taking the patient's individual requirements into account. Preventive measures play a key role in the military context. They include the adaptation of screening tools, training and equipment and require continuous evaluation and development.
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NewsBot · Dec 16, 2023

Injuries and Factors Associated with Injuries Among U.S. Army Band Musicians
Schuh-Renner, Anna; Grier, Tyson L; Rappole, Catherine; Jones, Bruce H; McCoskey, Kelsey; Canham-Chervak, Michelle
Medical Problems of Performing Artists, Volume 38, Number 4, 1 December 2023, pp. 224-233(10)

The Department of Defense is the largest employer of full-time musicians. In the U.S. military, many musicians experience unique occupational exposures such as extended periods of standing, sitting, and marching for rehearsals and performances, static and non-neutral postures, and a variety of repetitive motions while playing instruments. These exposures are in addition to physical training and fitness standards required of U.S. Army soldiers. METHODS: An electronic survey was administered to active-duty U.S. Army Band musicians. The survey collected demographics, personal characteristics, Army Physical Fitness Test performance, occupational demands, health behaviors, and injuries from October 2017 to December 2018. Survey responses were combined with medical and physical fitness performance records. Descriptive statistics were reported and factors associated with injuries were investigated. RESULTS: There were 465 Army Band members in this population, with approximately half (49%) completing the survey. Most survey respondents (81%) reported an injury in the past year, which they predominantly attributed to overuse (54%). Leading reported activities resulting in injury included running for physical training (21%), repetitive movements while playing an instrument (11%), and standing while playing (11%). A majority of survey respondents (60%) also had a medical encounter for an injury. Factors significantly associated with injury among men were lower aerobic fitness and higher body fat percentage; additional unadjusted factors associated with injury among all Army Band soldiers included female sex, older age, and longer periods of marching and standing while playing. CONCLUSIONS: Injury prevention initiatives for Army Band musicians should focus on the reduction of overuse and repetitive motion injuries. Suggested prevention strategies include balanced physical training, ergonomic adjustments, rehearsal breaks, and leadership support for injury prevention efforts.
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NewsBot · Jul 7, 2024

Allostatic Load Is Associated with Overuse Musculoskeletal Injury during US Marine Corps Officer Candidates School
Feigel, Evan D. et al
Medicine & Science in Sports & Exercise ():10.1249/MSS.0000000000003507, June 27, 2024. | DOI: 10.1249/MSS.0000000000003507

Introduction
Overuse musculoskeletal injuries (MSKIs) remain a significant medical challenge in military personnel undergoing military training courses; a further understanding of the biological process leading to overuse MSKI development and biological signatures for injury risk are warranted. The purpose of this study was to determine the association between overuse MSKI occurrence and physiological characteristics of allostatic load (AL) characterized as maladaptive biological responses to chronic stress measured by wearable devices in US Marine Corps officer candidates during a 10-week training course.

Methods
Devices recorded energy expenditure (EE), daytime heart rate (HR), sleeping HR, and sleep architecture (time and percent of deep, light, REM sleep, awake time, total sleep). Flux was calculated as the raw or absolute difference in the average value for that day or night and the day or night beforehand. Linear mixed-effect model analysis accounting for cardiorespiratory fitness assessed the association between overuse MSKI occurrence and device metrics (α = 0.05).

Results
Sixty-nine participants (23 females) were included. Twenty-one participants (eight females) sustained an overuse MSKI. Overuse MSKI occurrence in male participants was positively associated with daytime HR (β = 5.316, p = 0.008), sleeping HR (β = 2.708, p = 0.032), relative EE (β = 8.968, p = 0.001), absolute flux in relative EE (β = 2.994, p = 0.002), absolute EE (β = 626.830, p = 0.001), and absolute flux in absolute EE (β = 204.062, p = 0.004). Overuse MSKI occurrence in female participants was positively associated with relative EE (β = 5.955, p = 0.026), deep sleep time (β = 0.664, p < 0.001), %deep sleep (β = 12.564, p < 0.001) and negatively associated with absolute flux in sleeping HR (β = -0.660, p = 0.009).

Conclusions
Overuse MSKI occurrences were associated with physiological characteristics of AL including chronically elevated HR and EE and greater time in restorative sleep stages, which may serve as biological signatures for overuse MSKI risk.
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NewsBot · Aug 23, 2024

Musculoskeletal Complaints Among Active Duty Service Members Seeking Treatment at a Navy Military Treatment Facility
Marco Campello et al
Mil Med. 2024 Aug 19;189(Supplement_3):624-627.

Introduction: Musculoskeletal injuries (MSIs) pose a significant problem for active duty service members (ADSMs). MSIs may compromise readiness and are one of the main reasons for separation from the Navy and long-term disability. Implementation of optimal treatment strategies rests on understanding the characteristics of MSI complaints in a given population. This study reports on the frequency and nature of MSI complaints of ADSMs seeking care at a military treatment facility (MTF).

Materials and methods: As part of a larger quasi-experimental study, data on MSIs from ADSMs reporting to an MTF were collected. Subjects completed a baseline questionnaire during an initial evaluation, including the self-reported MSIs for which participants were seeking care, time since onset, and other MSI comorbidities.

Results: Of the 289 respondents, 118 (41%) were female and 172 (59%) were male. The mean age was 33 years (SD = 8). The most frequently reported injury was low-back pain (n = 79, 27%), followed by knee pain (n = 60, 21%) and shoulder pain (n = 55, 19%). Thirty-four (12%) respondents reported injuries to the ankle or foot. The remaining respondents (21%) reported injuries to the neck, mid-back, arm or hand, hip, or other. Sixty-five (22%) reported an acute/subacute injury of less than 3 months, whereas 224 (78%) reported chronic injury >3 months. Furthermore, MSI comorbidities were reported by 233 (80%) of respondents with 128 of those reporting more than one.

Conclusions: Back and knee injuries were most prevalent in ADSMs reporting an MSI at a Navy shore-based MTF. Shoulder injuries were also common. Of interest, 80% of ADSMs reported at least one MSI comorbidity and 80% reported chronic injury in this study. These rates are higher than those found in a previous study of ADSMs deployed on a carrier. This is notable because chronicity and multiple MSIs are obstacles to readiness. Our findings suggest that ADSMs reporting to shore-based facilities may be at higher risk for disability than their deployed counterparts. This information is important to the development of targeted care to improve readiness in this population.
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NewsBot · Oct 18, 2024

Modeling Risk for Lower Extremity Musculoskeletal Injury in U.S. Military Academy Cadet Basic Training
Darren W Hearn, PT, PhD, MPH, Zachary Yukio Kerr, PhD, MPH, Erik A Wikstrom, PhD, ATC, LAT, Donald L Goss, PT, PhD, ATC, Kenneth L Cameron, PhD, MPH, ATC, Stephen W Marshall, PhD, Darin A Padua, PhD, ATC
Military Medicine, Volume 189, Issue 9-10, September/October 2024, Pages e2039–e2046, https://doi.org/10.1093/milmed/usae083

Introduction
Sport and tactical populations are often impacted by musculoskeletal injury. Many publications have highlighted that risk is correlated with multiple variables. There do not appear to be existing studies that have evaluated a predetermined combination of risk factors that provide a pragmatic model for application in tactical and/or sports settings.

Purpose
To develop and test the predictive capability of multivariable risk models of lower extremity musculoskeletal injury during cadet basic training at the U.S.Military Academy.

Materials and Methods
Cadets from the class of 2022 served as the study population. Sex and injury history were collected by questionnaire. Body Mass Index (BMI) and aerobic fitness were calculated during testing in the first week of training. Movement screening was performed using the Landing Error Scoring System during week 1 and cadence was collected using an accelerometer worn throughout initial training. Kaplan–Meier survival curves estimated group differences in time to the first musculoskeletal injury during training. Cox regression was used to estimate hazard ratios (HRs) and Akaike Information Criterion (AIC) was used to compare model fit.

Results
Cox modeling using HRs indicated that the following variables were associated with injury risk : Sex, history of injury, Landing Error Scoring System Score Category, and Physical Fitness Test (PT) Run Score. When controlling for sex and history of injury, amodel including aerobic fitness and BMI outperformed the model including movement screening risk and cadence (AIC: 1068.56 vs. 1074.11) and a model containing all variables that were significant in the univariable analysis was the most precise (AIC: 1063.68).

Conclusions
In addition to variables typically collected in this tactical setting (Injury History, BMI, and aerobic fitness), the inclusion of kinematic testing appears to enhance the precision of the risk identification model and will likely continue to be included in screening cadets at greater risk.
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NewsBot · Oct 1, 2025

Can Baseline Recruit Characteristics Predict Actual Injuries Sustained During New Zealand Army Basic Training?
Narelle Hall, PhD, MMSP, BAppSc (Phty), Suzanne Kuys, PhD, B Phty (Hons), PGDipPubHlth, BEdSt, BHMS(Ed), Mark Brown, MHSc (Sports Physio), MBA, BAppSc (Phty), GradCertHEd, Belinda Beck, PhD, MSc, BHMS(Ed), Michael Steele, PhD, BSc (Hon), BSc, Jacques Rousseau, PhD, MPhil (Sports Science), BPhysEd (Hons), Maria Constantinou, PhD, MPhtySt (Sports), BPhty, GradCertEd Author Notes
Military Medicine, usaf443, https://doi.org/10.1093/milmed/usaf443

Introduction

Certain army recruits entering basic training may be at heightened risk of injury. It is unknown if risk factors for lower limb injuries could be identified upon entry to basic training for New Zealand Army recruits. This study investigates if personal, lifestyle and physical performance characteristics reported at entry to training could identify recruits who go on to sustain a lower limb musculoskeletal injury during New Zealand Army basic training.
Materials and Methods

Recruits’ baseline personal (age, sex, and BMI), lifestyle (history of smoking and previous injury) and physical performance characteristics (2.4 km timed run outcome, ankle range of motion using the weight-bearing dorsiflexion lunge test and lower limb dynamic control using the Y Balance Test) were collected at entry to basic training. Backwards stepwise logistic regression analyses were undertaken to determine if baseline variables predicted the occurrence of an injury during basic training and to determine the optimal model of prediction. Significance was set to 0.10. This study was approved by Commander of TRADOC NZDF February 2012 and from Griffith University Human Research Ethics Committee May 2012 (PES/36/11/HREC).
Results

In total 248 recruits, 228 males and 20 females, were eligible to participate in the study. Forty-six (18.5%) recruits had missing data thus, 202 (81.5%) remained for analysis. There were 114 recruits who reported one or more injuries, and 88 recruits reported no injury. Two variables were associated with injury risk in the final model: passing the 2.4 km timed run and Y Balance Test average normalized posterolateral reach for the right limb. This model accurately predicted 60.9% of recruits with 36 correctly assigned as not injured and 87 correctly assigned as injured.
Conclusions

This study identified that 2 physical performance characteristics were associated with lower limb injury in New Zealand Army recruits commencing basic training; not passing the entry 2.4 km timed run, and low right posterolateral Y Balance Test score for lower limb dynamic neuromuscular control. These findings suggest that physical performance screening may be used to identify recruits at high risk of injury entering training so that mitigation measures could be implemented to lower future injury risk.
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NewsBot · Jan 25, 2026

Epidemiology of stress fractures among military cadets: a retrospective cohort study at a tertiary military medical center
Alkhudhayri, Abdulaziz Ibrahim et al
Annals of Medicine & Surgery ():10.1097/MS9.0000000000004697, January 22, 2026. | DOI: 10.1097/MS9.0000000000004697

Background:

Stress fractures are a common overuse injury among physically active populations, yet data on their incidence and characteristics in military trainees remain limited. This study describes epidemiology, anatomical distribution, and management of stress fractures in military students at a tertiary military medical center.
Methods:

We performed a retrospective cohort review of 109 male military students diagnosed with stress fractures between January 2020 and August 2025. Demographics, risk factors, fracture sites, and treatment modalities were extracted from electronic medical records and imaging archives; tibial stress fractures were additionally graded using the Fredericson MRI system. Descriptive statistics, including means, standard deviations, frequencies and percentages, and inferential analyses such as chi-square tests, independent-samples t-tests and Mann–Whitney U tests, were conducted using SPSS version 25.0.
Results:

The mean age of the cohort was 19.68 ± 1.33 years; 76.1% were under 20 years of age. All fractures involved the lower part of the body, with the tibia most frequently affected (69.7%), followed by the femur (11.0%), foot (8.3%), and hip (8.3%). Anatomically, the right proximal tibia (13.8%) and left proximal tibia (11%) were the most common sites; bilateral injuries accounted for 12.9% of cases. Conservative management was undertaken in 70.6% of cases; 29.4% required surgical intervention, most commonly open reduction and internal fixation. Operative management was significantly associated with fracture location, with hip and femoral fractures more frequently treated surgically than tibial fractures [χ2(5, N = 109) = 37.8, P < 0.001]. Age and body mass index did not differ significantly between operatively and non-operatively managed patients.
Conclusion:

While conservative therapy suffices for most, nearly one-third of fractures required surgical stabilization. These findings support early imaging-based diagnosis, graduated training protocols, and targeted prevention strategies to reduce injury burden and maintain operational readiness.
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NewsBot · Mar 6, 2026

Epidemiology of stress fractures among military cadets: a retrospective cohort study at a tertiary military medical center
Abdulaziz Ibrahim Alkhudhayri et al
Ann Med Surg (Lond). 2026 Jan 22;88(3):2256-2261.

Background: Stress fractures are a common overuse injury among physically active populations, yet data on their incidence and characteristics in military trainees remain limited. This study describes epidemiology, anatomical distribution, and management of stress fractures in military students at a tertiary military medical center.

Methods: We performed a retrospective cohort review of 109 male military students diagnosed with stress fractures between January 2020 and August 2025. Demographics, risk factors, fracture sites, and treatment modalities were extracted from electronic medical records and imaging archives; tibial stress fractures were additionally graded using the Fredericson MRI system. Descriptive statistics, including means, standard deviations, frequencies and percentages, and inferential analyses such as chi-square tests, independent-samples t-tests and Mann-Whitney U tests, were conducted using SPSS version 25.0.

Results: The mean age of the cohort was 19.68 ± 1.33 years; 76.1% were under 20 years of age. All fractures involved the lower part of the body, with the tibia most frequently affected (69.7%), followed by the femur (11.0%), foot (8.3%), and hip (8.3%). Anatomically, the right proximal tibia (13.8%) and left proximal tibia (11%) were the most common sites; bilateral injuries accounted for 12.9% of cases. Conservative management was undertaken in 70.6% of cases; 29.4% required surgical intervention, most commonly open reduction and internal fixation. Operative management was significantly associated with fracture location, with hip and femoral fractures more frequently treated surgically than tibial fractures [χ2(5, N = 109) = 37.8, P < 0.001]. Age and body mass index did not differ significantly between operatively and non-operatively managed patients.

Conclusion: While conservative therapy suffices for most, nearly one-third of fractures required surgical stabilization. These findings support early imaging-based diagnosis, graduated training protocols, and targeted prevention strategies to reduce injury burden and maintain operational readiness.
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Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

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Risk Factors for Musculoskeletal Injuries for Soldiers Deployed to Afghanistan

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Frequency and risk factors of musculoskeletal pain in nurses

Genetic Risk Factors for Musculoskeletal Soft Tissue Injuries.

Chronic diseases and allergies as risk factors for MTSS

Risk factors for ingrown toenails

Incidence and Risk Factors for Pin Site Infection of Exposed Kirschner Wires

The risk factors for diabetic peripheral neuropathy

Incidence and Risk Factors for Foot Fractures

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