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Musculoskeletal complaints in military recruits during their basic training
  1. Noel L W Keijsers1,
  2. M ter Stal1,
  3. N Jonkergouw2 and
  4. P H Helmhout3
  1. 1 Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
  2. 2 Department of research and development, Military Rehabilitation Center Aardenburg, Doorn, The Netherlands
  3. 3 Department of Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, The Netherlands
  1. Correspondence to Dr Noel L W Keijsers, Department of Research, Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands; n.keijsers{at}


Introduction Overuse injuries often start with a musculoskeletal complaint, which can progress over time to an injury. Little or no information is known about the development and severity of overuse injuries in military recruits. This study describes the musculoskeletal complaints in Dutch military recruits during their basic training and examines potential predictive factors for dropout due to injury.

Methods In this prospective cohort study, Dutch military recruits reported complaints of the lower body weekly using a Numeric Rating Scale (NRS) pain score chart during their basic training. Number, location and severity of complaints during each of the first 12 weeks of basic training were analysed.

Results Of the 930 recruits, 61% reported an NRS pain score of 3 or higher and 34% reported an NRS pain score of 5 or higher at least once. Complaints were mostly reported in the foot and ankle region and least reported in the upper leg region. Injury dropouts (11%) showed significantly higher proportions of complaints and higher maximal pain scores throughout most weeks of basic training. The maximal NRS pain score of the first two weeks was the strongest predictor of dropping out due to injury.

Conclusions Recruits who drop out due to injury report more severe complaints throughout basic training. Focusing on musculoskeletal complaints in the first phase of training seems helpful to identify recruits who are at risk of developing an injury.

  • rehabilitation medicine
  • sports medicine
  • musculoskeletal disorders
  • foot & ankle

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors NK and PHH conceived the study design. NK, PHH and NJ collected data. NK and MTS performed the data analysis and all authors analysed and interpreted the findings. NK and MTS wrote the draft manuscript. All authors read, critically reviewed and approved the final version.

  • Funding NK and MTS received a small grant from the Netherlands Armed Forces for analysis of data in this study. PHH and NJ have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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