{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T03:25:35Z","timestamp":1787282735735,"version":"build-2736575974"},"reference-count":36,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"The U.S. Army Medical Research Acquisition Activity, 808 Schreider Street, Fort Detrick MD","award":["21702-5014"],"award-info":[{"award-number":["21702-5014"]}]},{"name":"Department of Defense\/United States Army Medical Research Acquisition Activity","award":["W81XWH2020003"],"award-info":[{"award-number":["W81XWH2020003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Special operations combat soldiers (SOCS) are susceptible to cervical spine (CS) injuries as they undergo tactical training and perform missions in demanding environments with head-supported mass (HSM). This HSM, which includes the baseline protective helmet, communications, specialized night vision technology, and other attachments, can weigh more than 3 kg. The purpose of this study was to describe the injury epidemiology of CS injuries in SOCS including the effect that HSM may have on both CS injuries and pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>The study population included 284 SOCS and 91 age-matched nonmilitary control subjects. A self-report of CS injury history, which included a description of the cause of the injury and information regarding the HSM relative to the injury was collected from all participants. Participants were asked questions about their military experience, the number of parachute jumps, and HSM exposure. All participants completed a CS pain questionnaire (covering the previous 12 months) and the Neck Disability Index survey. All participants also underwent musculoskeletal testing (strength and range of motion) of the CS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The SOCS reported 1,090 injuries of which 91% occurred while wearing HSM during military activities. Most of these injuries (74.7%) were characterized as sprain or strain and 81.4% were acute (sudden onset). Whiplash (28.5%), followed by parachute opening shock (23.1%), and landing (parachute operations) (23.1%) were the most common injury mechanisms. Treatment was sought in 50% of cases. Eighty-eight percent reported CS pain related to military operational activity during the previous 12 months with parachute opening (69%) listed as the most common task that aggravated neck pain. SOCS with 2 or more injuries, chronic neck pain, or pain in the previous 12 months were typically weaker, had worse range of motion, and worse neck disability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SOCS experience a considerable incidence of CS injuries and frequently report neck pain. Most of these conditions are associated with exposure to HSM and correlate with chronic pain, headaches, difficulties with concentration, and sleep disturbances. Such complications often necessitate medical intervention, may limit duty performance, and could increase susceptibility to further CS injuries. Opportunities for injury prevention exist through policy evaluation and recommendations, equipment assessments, and targeted physical training regimens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag165","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T11:40:32Z","timestamp":1775302832000},"source":"Crossref","is-referenced-by-count":1,"title":["Cervical Spine Injuries and Head-Supported Mass: A Descriptive Epidemiology Study in Special Operations Combat Soldiers"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2909-9310","authenticated-orcid":false,"given":"Timothy C","family":"Sell","sequence":"first","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Atrium Health, Musculoskeletal Institute , Charlotte, NC 28207,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Zerega","sequence":"additional","affiliation":[{"name":"Atrium 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