Incidence and Time to Return to Training for Stress Fractures during Military Basic Training

Alexander M Wood, Richard Hales, Andre Keenan, Alexandra Moss, Michael Chapman, Trish Davey, Andrew Nelstrop, Alexander M Wood, Richard Hales, Andre Keenan, Alexandra Moss, Michael Chapman, Trish Davey, Andrew Nelstrop

Abstract

Currently, little is known about the length of time required to rehabilitate patients from stress fractures and their return to preinjury level of physical activity. Previous studies have looked at the return to sport in athletes, in a general population, where rehabilitation is not as controlled as within a captive military population. In this study, a longitudinal prospective epidemiological database was assessed to determine the incidence of stress fractures and the time taken to rehabilitate recruits to preinjury stage of training. Findings demonstrated a background prevalence of 5% stress fractures in Royal Marine training; femoral and tibial stress fractures take 21.1 weeks to return to training with metatarsal stress fractures being the most common injury taking 12.2 weeks. Rehabilitation from stress fractures accounts for 814 weeks of recruit rehabilitation time per annum. Stress fracture incidence is still common in military training; despite this stress fracture recovery times remain constant and represent a significant interruption in training. It takes on average 5 weeks after exercise specific training has restarted to reenter training at a preinjury level, regardless of which bone has a stress fracture. Further research into their prevention, treatment, and rehabilitation is required to help reduce these burdens.

Figures

Figure 1
Figure 1
Time of occurrence of stress fracture and anatomical distribution.
Figure 2
Figure 2
(Group A) Rehabilitation period from injury (Group B). Time in program for regaining fitness and military skills up to allow return to training at their preinjury stage.

References

    1. Lacroix H., Keeman J. N. An unusual stress fracture of the fibula in a long distance runner. Archives of Orthopaedic and Trauma. 2010;111(5):289–290. doi: 10.1007/BF00571528.
    1. Thomas R., Wood A. M., Watson J., Arthur C. H., Nicol A. M. Delay in diagnosis of neck of femur stress fracture in a female military recruit. Journal of the Royal Naval Medical Service. 2012;98(2):3–5.
    1. Protzman R. R., Griffis C. G. Stress fractures in men and women undergoing military training. The Journal of Bone and Joint Surgery. 1977;59(6):p. 825.
    1. Bennell K. L., Malcolm S. A., Thomas S. A., et al. Risk factors for stress fractures in track and field athletes: a twelve- month prospective study. The American Journal of Sports Medicine. 1996;24(6):810–818.
    1. Tornetta P I. I. I., Einhorn T. A., Schepsis A. A., Busconi B. D. Sports Medicine. Philadelphia, Pa, USA: Lippincott Williams and Wilkins; 2006. (Orthopaedic Surgery Essentials).
    1. Trone D. W., Reis J. P., Macera C. A., Rauh M. J. Factors associated with discharge during marine corps basic training. Military Medicine. 172(9):936–941.
    1. Milgrom C., Giladi M., Chisin R., Dizian R. The long-term followup of soldiers with stress fractures. The American Journal of Sports Medicine. 1985;13(6):398–400.
    1. Once A Marine, Always A Marine. What you could expect of Royal Marines Training from 1999. .
    1. Matheson G. O., Clement D. B., Mckenzie D. C. Stress fractures in athletes: a study of 320 cases. The American Journal of Sports Medicine. 1987;15(1):46–58.
    1. Reeser J. D. Stress Fracture. eMedicine from WebMD, .
    1. Chatzipapas C. N., Drosos G. I., Kazakos K. I., Tripslanis G., Iatrou C., Verettas D.-A. J. Stress fractures in military men and bone quality related factors. International Journal of Sports Medicine. 2008;29(11):922–926. doi: 10.1055/s-2008-1038690.
    1. Ross R. A., Allsopp A. Stress fractures in Royal Marines recruits. Military Medicine. 2002;167(7):560–565.
    1. Giladi M., Milgrom C., Kashtan H. Recurrent stress fractures in military recruits: one-year follow-up of 66 recruits. Journal of Bone and Joint Surgery B. 1986;68(3):439–441.
    1. Jansen M. March foot. Journal of Bone and Joint Surgery. 1926;8(2):262–272.
    1. Krause G. R., Thompson J. R., Jr. March fracture, analysis of 200 cases. The American Journal of Roentgenology. 1944;52:281–290.
    1. Leavitt D. G., Woodward H. W. March fracture: a statistical study of forty-seven patients. Journal of Bone and Joint Surgery. 1944;26:733–742.
    1. Tyner F. H., Hileman W. T. March fracture: an analysis of 166 cases. The American Journal of Roentgenology. 1944;52:165–172.
    1. Perron A. D. Metatarsal Stress Fracture. eMedicine for WebMD, .
    1. Patel R., Haddad F. Metatarsal Fractures. Sports Injury Bulletin, .
    1. Dixon S. J., Creaby M. W., Allsopp A. J. Comparison of static and dynamic biomechanical measures in military recruits with and without a history of third metatarsal stress fracture. Clinical Biomechanics. 2006;21(4):412–419. doi: 10.1016/j.clinbiomech.2005.11.009.
    1. Garcia J. E., Grabhorn L. L., Franklin K. J. Factors associated with stress fractures in military recruits. Military Medicine. 1987;152(1):45–48.
    1. Talbot J. C., Cox G., Townend M., Langham M., Parker P. J. Femoral neck stress fractures in military personnel: a case series. Journal of the Royal Army Medical Corps. 2008;154(1):47–50.
    1. Joshi A., KC B. R., Shah B. C., Chand P., Thapa B. B., Kayastha N. Femoral neck stress fractures in military personnel. Journal of the Nepal Medical Association. 2009;48(174):99–102.
    1. Evans J. T., Guyver P. M., Kassam A. M., Hubble M. J. Displaced femoral neck stress fractures in royal marine recruits: management and results of operative treatment. Journal of the Royal Naval Medical Service. 2012;98(2):3–5.
    1. Pegrum J., Crisp T., Padhiar N. Diagnosis and management of bone stress injuries of the lower limb in athletes. British Medical Journal. 2012;344(7854) doi: 10.1136/bmj.e2511.e2511
    1. Orava S., Hulkko A., Koskinen S., Taimela S. Stress fractures in athletes and military recruits: a review. Orthopade. 1995;24(5):457–466.

Source: PubMed

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