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Overuse Injuries in the IDF's Combat Training Units: Rates, Types, and Mechanisms of Injury.

Introduction
Overuse injuries are responsible for most lost training days and attrition from combat training in the Israeli Defense Forces (IDF) as in armies around the world. The purpose of this study is to understand the rates, types, and mechanism of occurrence of overuse injuries in the IDF in order to provide the IDF's commanders a detailed updated situation report in order to enable commanders decision-making, prevention policy, and further research of this highly significant military public health issue.


Methods
A cross-sectional study including 20,000 soldiers recruited to combat units during the year of 2013 was performed. Most of the data were collected from the IDF's computerized medical consultation records package. Descriptive statistics (percent, mean, standard deviation, and median) were used in order to express results. The study was approved by the IDF's institutional review board.


Results
The overall injury rate was 24.5%. The total number of injuries was 6,393 with an average of 1.32 ± 0.22 injuries per injured soldier. The injury rate was 18.4% in the infantry units and 36.1% in non-infantry units. Of all injuries, 87% occurred in the lower back and lower limb regions. The most frequent injury sites were the calf and ankle (34%), the knee region (22%), and the lower back (19%). Of all injuries, 74% occurred during running (45%) or long-distance walking (29%). The average lost training days due to injuries was 9 d per soldier and 6.5 d per injury. The total number of stress fractures was 494-2.5% of all soldiers (four fractures per 100 person years). The calf and ankle region was the most frequent site of stress fractures and accounted for 84% of all stress fractures, the vast majority of them (95%) were fractures of the distal tibia. The average number of lost training days due to stress fractures was 16 ± 6.1 per fracture.


Conclusions
As in other armies around the world, overuse injuries in the IDF are a major public health problem and poses a significant challenge to the IDF's commanders and the medical corps policy leaders. Further studies should be performed in order to identify the risk factors for these injuries especially in the lower back and the lower limb regions as part of the effort to try and reduce the rates of these injuries as much as possible. This study emphasizes the need for a continuous surveillance and monitoring system for overuse injuries as a significant and integral component of any intervention plan in the domain of overuse injuries.