Common Contributors to High Injury Rates in The Military. Does The Army Physical Training System Mitigate These. A Critical Review.
The British Army is considered one of the most elite armies in the world. With a rich history of success throughout the years, many of the British Army’s methods have been at the forefront of military training around the world. Looking at physical training specifically, the Royal Army Physical Training Corps (RAPTC) has invested heavily in academic research and evidence-based practice. With the introduction of the new Soldier Conditioning Review (SCR) and the Role Fitness Tests (RFT), this has seen the Army move into a new era of modern physical employment standards based on research conducted at Chichester University. Additionally, the RAPTC has introduced the Army Physical Training System (APTS). A physical training system that allows unit Royal Army Physical Training Corps Instructors (RAPTCIs) to design a physical training programme using the APTS as the backbone. The APTS ensures the unit PT program is progressive, specific to the unit’s needs, mitigate junk mileage and allows each session to have clear physiological aims.
One of the reasons the above tests and system was introduced was due to the high rates of musculoskeletal injuries seen within military personnel. A great deal of the research around the specific reasons for these high injury rates highlighted a clear link between the physiological stress imposed on the soldiers and the risk of injury. Stating the external loads such as loaded marches, excessive running, circuits and military training was causing soldiers to over train. Resulting in high musculoskeletal injuries. Therefor the need for the introduction of the APTS, a progressive, measurable, specific and individualised physical training system was highlighted.
This article will now go on to assess the most common reasons for injuries within the military and although the APTS is a new physical training system, look to see if these reasons may be mitigated enough to reduce the risk of injury and over training in soldiers.
When looking at the research around military physical training there is a common theme around the high numbers of injuries within the Army. Within the military musculoskeletal injuries have been shown to be the largest contributor to loss of on duty days (Roy et al, 2012). Carriage and lifting tasks are associated with the highest incidences of injury deployments (Roy et al, 2012). Research has shown that overexertion is one of the most likely reasons why injuries happen (Mc Gill, 1997).
When analysing the current research around overexertion and injury incidences, there is two distinct contributors to why many injuries happen to soldiers. The first being, soldiers who have a lower level of fitness such as a poor Vo2 max are more likely to become injured (Injury predictions). Xxx stated that individuals who have a higher Vo2 Max are less likely to become injured due to the theory of relative intensity, similar to the method applied to strength training (Knapik, 2001). New research also reiterated this point that a higher level of Vo2 max reduced the rates of injury and illness, increased situational awareness and also cognitive decisions (Wang et al, 2015).
The second contributor that is directly linked to the first, is the greater exposure to stress. Individuals with lower fitness levels will experience greater stress than those who are of a higher fitness level (Turner, 2016). Due to the amount of stress physical training places onto an unfit individuals physical and psychological state, these individuals are at a much higher risk of overtraining. Which has a direct correlation to the increased risk of illness, injuries, mood disturbance, decreased testosterone (Brooks & Carter, 2013).
When assessing the selected studies for methods to reduce the risk of injuries, it is commonly agreed that some of the most important factors are firstly, the need for individuals to be afforded the time to rest and recover (Friedl et al, 2015). Secondly, to ensure the correct amount of physical and psychological stress is placed on individuals based off their own individual fitness levels (Turner, 2016). Nindl et al. (2007) observed increased cortisol values and decreased testosterone in soldiers after 8 weeks of arduous training. Therefore, when soldiers are finding group PT arduous, even though this may not be the aim of the physical training program, it could have a direct link to the decrease of performance across the unfit individuals. As well as ensuring training is not continuously arduous for individuals, the research has found that conducting consistent resistance training can mitigate some of the decreases in cortisol values and also testosterone (Flanagan et al, 2012; Kraemer et al, 2001; Kraemer & Szivak, 2012; Taylor et al, 2008).
Based off the above findings, the article will now look at, firstly, does the APTS allow for the need to individually ensure that each soldier has enough rest and recovery. Secondly, does the APTS ensure the correct amount of physical and psychological stress is placed on individuals based around their specific fitness levels.
The first point raised, does the APTS allow for the need to individually ensure that each soldier has enough rest and recovery. The system and program are designed to ensure adequate rest and recovery is scheduled based for the mass. For example, it would be uncommon for a lower body strength session to take place the day before a heavy loaded carry session. Or if the group has been on a three - week arduous exercise, it is unlikely they will come back to camp and conduct intensive physical training, they will be afforded the time to conduct recovery sessions and almost deload the group. However, when looking at the individual, it is common that the PT program will be conducted on set days. For example, it may be aerobic capacity – Monday, upper body strength – Tuesday, anaerobic capacity – Wednesday, lower body strength – Thursday and Commanding Officers PT – Friday. This schedule will be the set schedule for every soldier within the Battalion, regardless of individual stress. If a soldier has had a terrible night’s sleep or an intensive stressful day prior to the PT session they will still be expected to conduct the program regardless. Therefor although the APTS does look to factor in scheduled rest and recovery, it potentially does not allow for the level of individualised recovery potentially needed from soldier to soldier.
The second point raised, does the APTS ensure the correct amount of physical and psychological stress is placed on individuals based around their specific fitness levels. The training system as made every attempt to individualise each session as much as possible. For example, when conducting resistance training, soldiers are working within a percentage of their own 1RM and they are having rest times specific to them. When conducting sprint/interval training, the pace the soldier goes at is specific to them, the rest times again are individualised and they start the next interval when their own rest has taken place not the groups and where possible if the prescribed amount of intervals is not achievable at the pace required the session can quickly be adapted to individuals struggling with the load. For example, if at set 4 of 5, the individual has clearly dropped off the pace and cannot sustain near the desired pace the PTI may cut the session short for that individual as the soldier is no longer hitting the aim. Although the APTS does aim to control the stress placed onto each individual by individualising sessions such as intervals or resistance training, there is some sessions that the system struggles to control the stress placed onto the soldier. For example, during loaded marches, aerobic capacity and Commanding officers PT. Some attempts have been made on these sessions to monitor stress and ensure soldiers are working in the correct zones or desired output, but this remains difficult to manage for the AAPTI when they have up to 50/60 soldiers on a lesson. This could be mitigated by conducting PT with a much smaller group and although this is the Army’s aim, this is not always achievable. To truly ensure each soldier is working at the desired level the Army would need to introduce equipment to monitor load/stress/recovery such as heart rate monitors and wearable technology or cheaper methods such as introduce readiness questionnaires. As these options are either cost expensive or time expensive, it may prove a logistical problem to introduce this to the entire Army.
Overall the APTS does look to dramatically reduce the risk of injury by attempting to one, ensure rest and recovery is programmed into the schedule and ensure the program is progressive. Two, by attempting to individualise as many PT sessions as possible. Although the research has not been conducted on the APTS as of yet, as these two factors are amongst the most common contributors to injuries within the military, it would look like that by making the above adjustments to the way PT is conducted that this will help reduce the risk of high injury rates within the Army. However, more attempts will be needed to further individualised PT to ensure that each soldier has adequate rest and recovery. Also attempts should be made to further individualise the stress exposed to each individual soldier.
References
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