{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:20:10Z","timestamp":1792023610942,"version":"4.4.0"},"reference-count":74,"publisher":"Oxford University Press (OUP)","issue":"9-10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Noncombat injuries (\u201cinjuries\u201d) threaten soldier health and United States (U.S.) Army medical readiness, accounting for more than twice as many outpatient medical encounters among active component (AC) soldiers as behavioral health conditions (the second leading cause of outpatient visits). Noncombat musculoskeletal injuries (MSKIs) account for more than 80% of soldiers\u2019 injuries and 65% of medically nondeployable AC soldiers. This review focuses on MSKI risk reduction initiatives, management, and reporting challenges within the Army. The authors will summarize MSKI risk reduction efforts and challenges affecting MSKI management and reporting within the U.S. Army.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials\/Methods<\/jats:title>\n                    <jats:p>This review focuses on (1) initiatives to reduce the impact of MSKIs and risk for chronic injury\/pain or long-term disability and (2) MSKI reporting challenges. This review excludes combat or battle injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Primary risk reduction Adherence to standardized exercise programming has reduced injury risk among trainees. Preaccession physical fitness screening may identify individuals at risk for injury or attrition during initial entry training. Forward-based strength and conditioning coaching (provided in the unit footprint) and nutritional supplementation initiatives are promising, but results are currently inconclusive concerning injury risk reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Secondary risk reduction<\/jats:title>\n                    <jats:p>Forward-based access to MSKI care provided by embedded athletic trainers and physical therapists within military units or primary care clinics holds promise for reducing MSKI-related limited duty days and nondeployability among AC soldiers. Early point-of-care screening for psychosocial risk factors affecting responsiveness to MSKI intervention may reduce risk for progression to chronic pain or long-term disability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Tertiary risk reduction<\/jats:title>\n                    <jats:p>Operational MSKI metrics enable commanders and clinicians to readily identify soldiers with nonresolving MSKIs. Monthly injury reports to Army leadership increase command focus on soldiers with nonresolving MSKIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Standardized exercise programming has reduced trainee MSKI rates. Secondary risk reduction initiatives show promise for reducing MSKI-related duty limitations and nondeployability among AC soldiers; timely identification\/evaluation and appropriate, early management of MSKIs are essential. Tertiary risk reduction initiatives show promise for identifying soldiers whose chronic musculoskeletal conditions may render them unfit for continued military service.<\/jats:p>\n                    <jats:p>Clinicians must document MSKI care with sufficient specificity (including diagnosis and external cause coding) to enable large-scale systematic MSKI surveillance and analysis informing focused MSKI risk reduction efforts. Historical changes in surveillance methods and injury definitions make it difficult to compare injury rates and trends over time. However, the U.S. Army\u2019s standardized injury taxonomy will enable consistent classification of current and future injuries by mechanism of energy transfer and diagnosis. The Army\u2019s electronic physical profiling system further enables<\/jats:p>\n                    <jats:p>standardized documentation of MSKI-related duty\/work restrictions and mechanisms of injury. These evolving surveillance tools ideally ensure continual advancement of military injury surveillance and serve as models for other military and civilian health care organizations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaa028","type":"journal-article","created":{"date-parts":[[2020,2,27]],"date-time":"2020-02-27T21:30:45Z","timestamp":1582839045000},"page":"e1472-e1480","source":"Crossref","is-referenced-by-count":54,"title":["Musculoskeletal Injuries and United States Army Readiness. Part II: Management Challenges and Risk Mitigation Initiatives"],"prefix":"10.1093","volume":"185","author":[{"given":"Joseph M","family":"Molloy","sequence":"first","affiliation":[{"name":"Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830"},{"name":"Physical Performance Service Line, G 3\/5\/7, U.S. Army Office of the Surgeon General, Falls Church, VA 22042"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy L","family":"Pendergrass","sequence":"additional","affiliation":[{"name":"Physical Performance Service Line, G 3\/5\/7, U.S. Army Office of the Surgeon General, Falls Church, VA 22042"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian E","family":"Lee","sequence":"additional","affiliation":[{"name":"Solution Delivery Division, U.S. Defense Health Agency, Falls Church, VA 22042"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith G","family":"Hauret","sequence":"additional","affiliation":[{"name":"U.S. Army Public Health Center, Injury Prevention Program, Aberdeen Proving Ground, Aberdeen, MD 21005"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle C","family":"Chervak","sequence":"additional","affiliation":[{"name":"U.S. Army Public Health Center, Injury Prevention Program, Aberdeen Proving Ground, Aberdeen, MD 21005"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel I","family":"Rhon","sequence":"additional","affiliation":[{"name":"Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830"},{"name":"Physical Performance Service Line, G 3\/5\/7, U.S. Army Office of the Surgeon General, Falls Church, VA 22042"},{"name":"Center for the Intrepid, Brooke Army Medical Center, Joint Base San Antonio Fort Sam Houston, San Antonio, TX 78234"},{"name":"Duke Clinical Research Institute, Duke University, Durham, NC 27701"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,2,27]]},"reference":[{"key":"2020092112143132900_ref1","author":"U.S. Army Public Health Center internal analysis","year":"2018","journal-title":"Defense Medical Surveillance System database"},{"key":"2020092112143132900_ref2","author":"Hauschild","year":"2017"},{"key":"2020092112143132900_ref3","author":"Hauschild"},{"key":"2020092112143132900_ref4","author":"U.S. Army Medical Command internal analysis","year":"2019"},{"key":"2020092112143132900_ref5","author":"U.S. Army Public Health Center internal analysis","year":"2019"},{"key":"2020092112143132900_ref6","author":"Institute for Work and Health","year":"2015"},{"key":"2020092112143132900_ref7","article-title":"Army implements new fitness standards for recruits and MOS transfers","author":"Vergun"},{"key":"2020092112143132900_ref8","author":"Foulis","year":"2015"},{"key":"2020092112143132900_ref9","author":"Knapik","year":"2004"},{"key":"2020092112143132900_ref10","article-title":"Injury surveillance and longitudinal studies for gender integration in the Army","author":"Hauret","year":"2017"},{"key":"2020092112143132900_ref11","doi-asserted-by":"crossref","first-page":"S57","DOI":"10.1519\/JSC.0000000000001115","article-title":"Physical training, fitness, and injuries: lessons learned from military studies","volume":"29","author":"Jones","year":"2015","journal-title":"J Strength Cond Res"},{"key":"2020092112143132900_ref12","author":"Department of the U.S. Army. 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