Article Text

Download PDFPDF
Musculoskeletal injury in military Special Operations Forces: a systematic review
  1. Joanne Stannard and
  2. L Fortington
  1. School of Medical and Health Science, Edith Cowan University, Joondalup, Western Australia, Australia
  1. Correspondence to Joanne Stannard, Edith Cowan University, Joondalup, WA 6027, Australia; j.stannard{at}


Introduction Special Operations Forces conduct military activities using specialised and unconventional techniques that offer a unique and complementary capability to conventional forces. These activities expose Special Operations Forces personnel to different injury risks in comparison with personnel in the conventional forces. Consequently, different injury patterns are expected in this population. The purpose of this research is to establish high-level evidence informing what is known about musculoskeletal injury epidemiology in Special Operations Forces.

Methods A systematic review was conducted using three online databases to identify original studies reporting musculoskeletal injury data in Special Operations Forces. A critical appraisal tool was applied to all included studies. Descriptive data were extracted for demographics, study design details and injuries (eg, injury frequency, injury type, body part injured, activity, mechanism, severity). Results were narratively synthesised.

Results Twenty-one studies were included. Trainees conducting qualification training had the highest injury frequency, up to 68% injured in a training period. The ankle, knee and lumbar spine were the most common body parts affected. Parachuting caused the most severe injuries. Physical training was the most common activity causing injury, accounting for up to 80% of injuries. Running and lifting were common injury mechanisms. Injury causation information was frequently not reported. Partially validated surveillance methods limited many studies.

Conclusions Injuries are prevalent in Special Operation Forces. Future research should prioritise identifying injury causation information that supports prevention. Focus on improving surveillance methods to enhance the accuracy and comparison of results across cohorts is also recommended.

  • epidemiology
  • musculoskeletal disorders
  • occupational & industrial medicine
  • preventive medicine

Statistics from


  • Twitter @lfortington

  • Contributors JS and LF jointly designed the project. JS led the data extraction, analysis and interpretation, and drafting of the manuscript, with ongoing review and input on each section by LF. Both authors approve the submitted version and are accountable for the accuracy and integrity of the work.

  • Funding This research was partially funded by the Defence Science Centre Western Australia (no grant number). This research was supported by an Australian Government Research Training Program (RTP) Fee-Offset Scholarship through Edith Cowan University (no award number).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.