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One out of four recruits drops out from elite military training due to musculoskeletal injuries in the Netherlands Armed Forces
  1. Iris Dijksma1,2,
  2. WO Zimmermann3,
  3. E-J Hertenberg1,
  4. C Lucas2 and
  5. MM Stuiver2
  1. 1 Primary Health Care, Defense Health Care Organisation, Netherlands Ministry of Defense, Utrecht, Utrecht, The Netherlands
  2. 2 Master Evidence Based Practice in Health Care, Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC - Location AMC, Amsterdam, North Holland, The Netherlands
  3. 3 Department of Sports Medicine, Royal Netherlands Army, Netherlands Ministry of Defense, Utrecht, Utrecht, The Netherlands
  1. Correspondence to Drs Iris Dijksma, Defense Health Care Organisation, Netherlands Ministry of Defense, Utrecht 3584 AB, The Netherlands; i.dijksma{at}


Introduction Musculoskeletal injuries (MSIs) are among the main causes of dropout from military training. The main purpose of this study was to provide an overview of dropout rates and MSI incidence rates during elite military training. Second, this study aimed to explore restricted training days due to MSIs and to describe MSI-care by military physicians.

Methods In a retrospective observational study, we collected dropout rates and injury surveillance data from the electronic patient records of two elite units of the Netherlands Armed Forces (NAF): the Royal Netherlands Marine Corps (RNLMC) and the Airmobile Brigade (AMB), from 1 January 2015 until 31 December 2017.

Results In the RNLMC, total dropout rate was 53.9% and dropout due to MSIs was 23%. The most frequently affected locations were foot, knee and leg. In the AMB total dropout rate was 52.6% and dropout due to MSIs was 25%. In the AMB, the most frequently affected locations were back, knee and leg. Average restricted training days due to MSIs ranged between 8.3 and 20.8 days/injury. MSI-care by military physicians consisted mostly of the provision of injury-specific information and (self-)management options, imposing a specific activity restriction and referral to physiotherapy.

Conclusion Our study findings showed that one out of four recruits who dropout from elite military training in the NAF, do so due to MSIs. Redesigning training programmes with the objective to reduce MSIs should be given high priority, as this may reduce dropout substantially.

  • epidemiology
  • primary care
  • rehabilitation medicine
  • sports medicine

Data availability statement

No data are available.

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  • Contributors ID: collected and analysed the data. ID, WZ, EJH, MS and CL: conceived the study, participated in its design, interpreted data and drafted the manuscript and critically revised the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or Dutch government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.