Chapter 13

Injuries

Injuries are not an uncommon occurrence during intense physical training. It is, nonetheless, a primary responsibility of all leaders to minimize the risk of injury to soldiers. Safety is always a major concern.

Most injuries can be prevented by designing a well-balanced PT program that does not overstress any body parts, allows enough time for recovery, and includes a warm-up and cool-down. Using strengthening exercises and soft, level surfaces for stretching and running also helps prevent injuries. If, however, injuries do occur, they should be recognized and properly treated in a timely fashion. If a soldier suspects that he is injured, he should stop what he is doing, report the injury, and seek medical help.

Most injuries can be prevented by designing a well-balanced PT program.

Many common injuries are caused by overuse, that is, soldiers often exercise too much and too often and with too rapid an increase in the workload. Most overuse injuries can be treated with rest, ice, compression, and elevation (RICE). Following any required first aid, health-care personnel should evaluate the injured soldier.

Typical Injuries Associated with Physical Training

Common injuries associated with exercise are the following:

Abrasion (strawberry) - the rubbing off of skin by friction.
Dislocation - “the displacement of one or more bones of a joint from their natural positions.
Hot spot - a hot or irritated feeling of the skin which occurs just before a blister forms. These can be prevented by using petroleum jelly over friction-prone areas.
Blister - a raised spot on the skin filled with liquid. These can generally be avoided by applying lubricants such as petroleum jelly to areas of friction, keeping footwear (socks, shoes, boots) in good repair, and wearing the proper size of boot or shoe.
Shinsplints - a painful injury to the soft tissues and bone in the shin area. These are generally caused by wearing shoes with inflexible soles or inadequate shock absorption, running on the toes or on hard surfaces, and/or having calf muscles with a limited range of motion.
Sprain - a stretching or tearing of the ligament(s) at a joint.
Muscle spasm (muscle cramp) - a sudden, involuntary contraction of one or more muscles.
Contusion - a bruise with bleeding into the muscle tissue.
Strain - a stretching or tearing of the muscles.
Bursitis - an inflammation of the bursa (a sack-like structure where tendons pass over bones). This occurs at a joint and produces pain when the joint is moved or touched. Sometimes swelling occurs.
Tendonitis - an inflammation of a tendon that produces pain when the attached muscle contracts. Swelling may not occur. Stress fractures of the feet.
Tibial stress fractures - overuse injuries which seem like shinsplints except that the pain is in a specific area.
Knee injuries - caused by running on uneven surfaces or with worn out shoes, overuse, and improper body alignment. Soldiers who have problems with their knees can benefit from doing leg exercises that strengthen the front (quadriceps) and rear (hamstrings) thigh muscles.
Low back problems - caused by poor running, sitting, or lifting techniques, and by failing to stretch the back and hip-flexor muscles and to strengthen the abdominal muscles.

The most common running injuries occur in the feet, ankles, knees, and legs. Although they are hard to eliminate, much can be done to keep them to a minimum. Preventive measures include proper warm-up and cool-down along with stretching exercises. Failure to allow recovery between hard bouts of running can lead to overtraining and can also be a major cause of injuries. A well-conditioned soldier can run five to six times a week. However, to do this safely, he should do two things: gradually build up to running that frequently and vary the intensity of the running sessions to allow recovery between them.

Many running injuries can be prevented by wearing proper footwear. Soldiers should train in running shoes. These are available in a wide range of prices and styles. They should fit properly and have flexible, multi-layered soles with good arch and heel support. Shoes made with leather and nylon uppers are usually the most comfortable. See Appendix E for more information on running shoes.

Since injuries can also be caused by running on hard surfaces, soldiers should, if possible, avoid running on concrete. Soft, even surfaces are best for injury prevention. Whenever possible, soldiers should run on grass paths, dirt paths, or park trails. However, with adequate footwear and recovery periods, running on roads and other hard surfaces should pose no problem.

Common running injuries include the following:

Black toenails.
Ingrown toenails.
Stress fractures of the feet.
Ankle sprains and fractures. Achilles tendonitis (caused by improper stretching and shoes that do not fit.
Upper leg and groin injuries (which can usually be prevented by using good technique in stretching and doing strengthening exercises).

Tibial stress fractures, knee injuries, low back problems, shinsplints, and blisters, which were mentioned earlier, are also injuries which commonly occur in runners.

Other Factors

Proper clothing can also help prevent injuries. Clothes used for physical activity should be comfortable and fit loosely. A T-shirt or sleeveless undershirt and gym shorts are best in warm weather. In cold weather, clothing may be layered according to personal preference. For example, soldiers can wear a BDU, sweat suit, jogging suit, or even Army-issued long underwear. In very cold weather, soldiers may need gloves or mittens and ear-protecting caps. Rubberized or plastic suits should never be worn during exercise. They cause excessive sweating which can lead to dehydration and a dangerous increase in body temperature.

Army Regulation 385-55 (paragraph B-12, C) prohibits the use of headphones or earphones while walking, jogging, skating, or bicycling on the roads and streets of military installations. However, they may be worn on tracks and running trails.

Road safety equipment is required on administrative-type walks, marches, or runs which cross highways, roads, or tank trails or which are conducted on traffic ways. If there is reduced visibility, control personnel must use added caution to ensure the safety of their soldiers.