Table 5

Musculoskeletal injury epidemiological data extracted from individual studies (n=21)

Author
Year (ref)		Injury numbers/rateAnatomical locationInjury typeActivity causing injuryMechanism of injurySeverity
Pirson and Pirlot
(1990)18 		Total not reported
Injuries/1000 jumps by weight:

  • (82–87 kg) 6.22

  • (76–81 kg) 4.38

  • (70–75 kg) 3.33

––Static-line parachutingLanding–
Linenger et al
(1993)19 		143 total injuries
29.7 cases/100 trainee months		Per 100 trainee months:

  • Knee 10.2

  • Ankle/foot 6.0

  • Lower leg 3.3

  • Upper limb 3.3

Per 100 trainee months

  • Iliotibial band syndrome 4.4

  • Patellofemoral syndrome 3.3

  • Lower leg stress fracture 2.3

–––
Shwayhat et al
(1994)20 		232 total injuries
94 injured soldiers
3.4 injuries per 1000 trainee days		–Per 1000 trainee days

  • Stress fractures 0.54

  • Sprains/strains 0.47

  • Iliotibial band syndrome 0.47

–––
Kragh et al
(1996)
(prospective data only)22 		163 injured soldiers
2.2% injured per 100 jumps

  • Ankle 19%

  • Foot 15%

  • Lumbosacral 14%

  • Thoracolumbar strain or sprain 17%

  • ‘Other minor injury’ 17%

  • Ankle sprain 13%

Static-line parachuting
Time

  • Day 1.4% (46/3211)

  • Night 2.7% (117/4358)

  • Drop zone

  • Landing strips (4.7%)

  • Airports (2.3%)

  • Fields (1.6%)

–Mild, <72 hours of restrictions 24%
Moderate, >72 hours of restrictions 57%
Severe, complete loss of work 19%
Miser et al (1995)21 281 total injuries
217 injured soldiers

  • Ankle 19.6% (n=55)

  • Knee 11.7% (n=33)

  • Back 10.3% (n=29)

  • Sprain/strain 37.0% (n=104)

  • Contusion 29.2% (n=82)

  • Closed fracture 10.3% (n=29)

  • Parachuting 89.7%

–No limitations 56.9% (n=160)
Limited performance 22.1 (n=62)
Out of combat 21.0% (n=59)
Ensign et al
(2000)24 		121 injury events
153 total injuries
100 injured soldiers		Reported as a proportion of injuries
Low back 33.6% (n=50)
Knee 21.5% (n=32)
Shoulder 14.1% (n=21)		Reported as a proportion of injuries
Sprain/strain 49.3% (n=69)
Disc problems 7.9% (n=11)
Trauma 7.9% (n=11)		Reported as a proportion of injuries
Special boat operations

  • Mission related 66.1% (n=76)

  • During unusual sea states or weather 18.3% (n=21)

  • Physical training 10.4% (n=12)

–145 days of hospitalisation
4223 days of limited duty
Schumacher et al (2000)23 210 total injuries
Without PAB:

  • 132 total injuries

  • 16.78 per 1000 jumps

    With PAB:

  • 78 total injuries

  • 13.16 per 1000 jumps


RR for sustaining an ankle injury without PAB 2.93:1		Injury rate per 1000 jumps
Without PAB:

  • Ankle 4.45

  • Back 3.56

  • Knee 3.31

  • With PAB:

  • Back 2.87

  • Foot 2.70

  • Knee 2.02

Only fractures reported:

  • Without PAB: 1.1/1000 (n=9)

  • With PAB: 0.5/1000 (n=3)

Static-line parachuting–Limited duty:

  • 71 days without PAB

  • 47 days with PAB

Kotwal et al
(2004)25 		83 total injuries
76 injured soldiers
12% injury proportion

  • Lower extremities 68.7% (n=57)

  • Foot>ankle, (n/% not reported)

–Static-line parachuting–Attrition 4.3% (n=27)
Surgical intervention 1.7% (n=11)
Hughes and Weinrauch
(2008)26 		31 total injuries
28 injured soldiers
5.05% injury proportion

  • Coccyx 19.4% (n=6)

  • Shoulder 16.1% (n=5)

  • Lumbar 12.9% (n=4)

  • Ankle 12.9% (n=4)

  • Contusion/soft tissue (n=16)

  • Fracture (n=8)

Static-line parachuting

  • Land descents 7.8% (24/307)

  • Water descents 1.6% (4/247)

    By weight (kg):

  • 91–100 5.4%

  • >100 12.5%

    By time:

  • Night descents (2.2%, 1 of 46)

  • Daytime descents (5.3%, 27 of 508)

–Hospitalisation 1.8% (n=10)
Lynch and Pallis
(2008)37 		1005 total injuries

  • Back/neck (31%)

  • Ankle (10%)

  • Shoulder (10%)

  • Knee (10%)

––––
Hollingsworth
(2009)28 		41 total injuries
28 injured soldiers
32% injury proportion		Reported as a count

  • Knee (n=10)

  • Low back (n=7)

  • Ankle (n=6)

–––Training days lost 6.03 average (0–60 days)
Reynolds et al
(2009)27 		297 total injuries
86 injured soldiers
3.5 injuries/100 soldier-months		–

  • Tear/rupture 21.9% (n=65)

  • Fracture 20.5% (n=61)

  • Dislocation 2% (n=6)

  • (note—blister 15%, not MSK)

No raw data presented
Narrative reports >80% physical training and sport related		–Limited duty days
Total 3179.0
Abt et al
(2014)29 		26 total injuries
24.5 injuries/100 subjects/year
20.8 injured soldiers/100 subjects/year

  • Knee 23.1% (n=6)

  • Shoulder 23.1% (n=6)

  • Ankle 11.5% (n=3)

  • Sprain 23.1% (n=6)

  • Fracture 11.5% (n=3)

  • Strain 11.5% (n=3)

  • Physical training 46.2% (n=12)

  • Tactical training 15.4% (n=4)

  • Recreational activity/sport 11.5% (n=3)

  • Running 23.1% (n=6)

  • Lifting 19.2% (n=5)

  • Cutting 11.5%(n=3)

  • Direct trauma 11.5% (n=3)

  • Unknown 11.5% (n=3)

–
Teyhen et al
(2015)30 		85 injured soldiers–––––
Lovalekar et al
(2016)31 		63 total injuries
44 injured soldiers
0.025 injuries/operator/month

  • Shoulder 23.8% (n=15)

  • Lumbopelvic region 12.7% (n=8)

  • Ankle 9.5% (n=6)

  • Strain 20.6% (n=13)

  • Pain/spasm 19.0% (n=12)

  • Fracture 11.1% (n=7)

  • Sprain 11.1% (n=7)

  • Unknown 22.2%

  • Other 22.2%

  • Physical training 19.0%

  • Recreational activities/sport 12.7%

  • Unknown 60.3% (n=38)

  • Other 9.5% (n=6)

  • Lifting 7.9% (n=5)

  • Direct trauma 6.3% (n=4)

  • Falls 6.3% (n=4)

–
Heebner et al
(2017)34 		48 injured soldiers
50.5% injury proportion
(narrative reports 47 injured)

  • Lower extremity 39.4% (n=26)

  • Spine 34.8% (n=23)

  • Upper extremity 25.8% (n=17)

––––
Lovalekar et al
(2017)32 		374 total injuries in EHS
294 total self-reported injuries		EHS

  • Lower extremity 54.5% (n=204)

  • Upper extremity 25.9% (n=97)

  • Spine 15.5% (n=58)

    Survey

  • Lower extremity 40.1% (n=118)

  • Upper extremity 39.1% (n=115)

  • Spine 10.9% (n=32)

EHS

  • Strain 16.6% (n=62)

  • Sprain 13.4% (n=50)

  • Pain 10.4% (n=39)

    Survey

  • Traumatic fracture 27.2% (n=80)

  • Sprain 11.2% (n=33)

  • Strain 8.5% (n=25)

–––
Lovalekar et al
(2017)33 		267 total injuries
Injuries/100 persons/year:

  • SEAL: 23.1

  • SQT: 46.5

  • SWCC: 31.6

  • CQT: 17.0

SEAL

  • Shoulder 21.6% (n=16)

  • Lumbopelvic 14.9 (n=11)

  • Ankle 13.5% (n=10)


SQT

  • Foot and toes 17% (n=17)

  • Ankle 13% (n=13)

  • Hip 12% (n=12)


SWCC

  • Lumbopelvic 21.7% (n=13)

  • Shoulder 20.0% (n=12)

  • Knee 15% (n=9)


CQT

  • Knee 30.3% (n=10)

  • Hand & Fingers 15.2% (n=5)

  • Ankle 12.1% (n=4)

SEAL

  • Pain/spasm 29.7% (n=22)

  • Tendinopathy 13.5% (n=10)

  • Sprain 12.2% (n=9)


SQT

  • Tendinopathy 21.0% (n=21)

  • Pain 17.0% (n=17)

  • Strain 14.0% (n=14)

  • SWCC

  • Pain 21.7% (n=13)

  • Sprain 20.0% (n=12)

  • Strain 16.7% (n=10)


CQT

  • Fracture 15.2% (n=5)

  • Tendinopathy 15.2% (n=5)

  • Sprain 12.1% (n=4)

Physical training

  • SEAL: 28.4%

  • SQT: 68.0%

  • SWCC: 35.0%

  • CQT: 39.4%


Tactical training:

  • SEAL: 10.8%

  • SQT: 10.0%

  • SWCC: 16.7%

  • CQT: 12.1%


Unknown

  • SEAL: 24.3%

  • SQT: 17.0%

  • SWCC: 25.0%

  • CQT: 42.4%

SEAL

  • Unknown 36.5% (n=27)

  • Other 21.6% (n=16)

  • Lifting 13.5% (n=10)


SQT

  • Unknown 36.0% (n=36)

  • Other 27% (n=27)

  • Running 17.0% (n=17)


SWCC

  • Unknown 31.7% (n=19)

  • Lifting 16.7% (n=10)

  • Other 15% (n=9)


CQT

  • Unknown 48.5% (n=16)

  • Direct Trauma 15.2% (n=5)

  • Running 12.1% (n=4)

–
Lovalekar et al
(2018)35

  • 110 total injuries

  • 84.6 injuries/100 soldiers/year

  • 49.2 injured soldiers/100 operators/year

  • Shoulder 20.9% (n=23)

  • Lumbopelvic spine 15.5% (n=17)

  • Knee 14.5% (n=16)

  • Pain/spasm/ache 44.5% (n=49)

  • Sprain 11.8% (n=13)

  • Strain 11.8% (n=13)

  • Tendinopathy 11.8% (n=13)

  • Physical training 38.2% (n=42)

  • Unknown 24.5% (n=27)

  • Tactical training 17.3% (n=19)

  • Recreation activity/sport

8.2% (n=9)

  • Lifting 21.8% (n=24)

  • Direct trauma 8.2% (n=9)

  • Landing 8.2% (n=9)

–
Teyhen et al
(2018)36 		141 total injuries
104 injured soldiers
50.2% injury proportion
Injury incidence:

  • 45.2% Cumulative

  • 31.8% Overuse

  • 13.4% Acute

  • Foot and ankle 24.1% (n=34)

  • Knee 19.1% (n=27)

  • Upper back, head, neck 17.0% (n=24)

–––Time loss injury index 18.9% lost workdays/1000 person-days
Dijksma et al
(2020)17 		68% injury proportionIncidence rate per 100 person-years

  • Foot 64.7

  • Knee 62.2

  • Leg/thigh 46.3

–––Dropout rate due to injury 23%
Restricted duty 47%

  • (–) indicates that data were not reported.

  • CQT, Crewman Qualification Training; EHS, electronic health system; MSK, musculoskeletal; PAB, parachuting ankle brace; RR, risk ratio; SEAL, Sea Air Land; SQT, SEAL Qualification Training; SWCC, Special Warfare Combatant Crewman.