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Original research
Musculoskeletal injuries in UK Service Personnel and the impact of in-theatre rehabilitation during Cold Weather Warfare training: Exercise CETUS 2020
  1. David H Ferraby1,
  2. D Hayhurst2,
  3. R Strachan3,
  4. H Knapman4,
  5. S Wood5 and
  6. J L Fallowfield6
  1. 1Commando Logistic Regiment RM, Medical Centre, Chivenor, UK
  2. 2Rehab Div, DMRC Headley Court, Epsom, UK
  3. 3Aviation Medicine Training Wing, Centre of Aviation Medicine, RAF Henlow, Bedfordshire, UK
  4. 4PCRF, Medical Reception Station, Medical Centre, Dhekelia, UK
  5. 5HDIS, Specialist Group Military Intelligence (SGMI), Hermitage, Berkshire, UK
  6. 6Environmental Medicine and Science Division, Institute of Naval Medicine, Alverstoke, Hampshire, UK
  1. Correspondence to Captain David H Ferraby, Commando Logistic Regiment RM, Medical Centre, Chivenor, Devon, UK; david.ferraby100{at}mod.gov.uk

Abstract

Introduction The Royal Marines provide the lead Service for UK Defence Mountain and Cold Weather Warfare capability. This is the first prospective study addressing musculoskeletal injury rates sustained during Cold Weather Warfare training, with the aim of informing injury mitigation interventions and assist military medical planning with respect to delivering primary care rehabilitation in theatre.

Methods All musculoskeletal injuries were surveyed by the Forward Rehabilitation Team (Nov 2019–Mar 2020) during a Cold Weather Deployment to Norway (Ex CETUS 2019/20). The frequency, nature of injury (new or recurrent), onset (sudden or gradual), cause, location and exercise/treatment outcome were recorded.

Results Eleven per cent (n=136 cases) of the deployed population (n=1179) reported a musculoskeletal injury, which were mainly ‘new’ (62%), and with a ‘sudden’ onset (64%). Injury rate was 17.8 injuries per 10 000 personnel days. The majority of injuries occurred due to military training (88%), specifically during ski-related (61%) and load carriage (10%) activities.

The average Service Person treated by the Forward Rehabilitation Team improved from ‘injured with restricted duties’ to ‘fully fit’, and with an improvement in their self-reported Musculoskeletal Health Questionnaire from 33 to 45 over an average of two rehabilitation sessions. One hundred and seventeen Service Personnel were able to continue on Ex CETUS with rehabilitation in theatre, thus negating the requirement for aeromedical evacuation for continuation of rehabilitation in the UK. Nineteen patients were unable to continue their Cold Weather Deployment due to the nature of their musculoskeletal injury and returned to the UK for continued care in firm base rehabilitation centres.

Conclusion This study identifies the nature, causation and injury location. It demonstrates the effectiveness of in-theatre rehabilitation and the ability to treat patients when deployed. Recommendations are presented to support strategies to mitigate musculoskeletal injury risk during future Cold Weather Warfare deployments to Norway.

  • musculoskeletal disorders
  • audit
  • rehabilitation medicine
  • occupational & industrial medicine

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.

http://dx.doi.org/10.1136/bmjmilitary-2021-001972

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    Data availability statement

    Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.

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    Footnotes

    • Twitter @itsDHF

    • Contributors DHF: designed study, data collection, data analysis, data interpretation, prepared manuscript and acted as guarantor. DH: designed study, data collection, data analysis, data interpretation and contributed to the preparation of the manuscript. JLF: designed study, data collection, data analysis, data interpretation and contributed to the preparation of the manuscript. RS: designed study and contributed to the preparation of the manuscript. AW: data interpretation and prepared manuscript. HK: designed study, data collection, data analysis and data interpretation.

    • Funding United Kingdom Ministry of Defence.

    • Competing interests None declared.

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

    • 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.