Tactical Athletes and Osteoarthritis
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August 15, 2017
By Jeremy D. Howard, MS, LAT, ATC
The lights explode on blindingly in the barracks at 0400. We jump into our physical fitness uniforms and go form up to conduct a long and slow unit run for 4 miles. Once back from the run, we get cleaned and dressed in our duty uniforms and combat boots just in time to form up with our 35 pound ruck sacks on and ‘rubber duck’ fake M-16A2 rifles to ruck march a mile to the airfield, heel striking the whole way. At the airfield we get ‘smoked’ with physical fitness exercises because someone in the class violated the rules. A short while later, we pile into the UH-60 Blackhawk helicopter before it raises to 60 feet above the ground and throws out the ropes for which we are to use to rappel to the ground. At this point, I realize I left out that every time we moved, we were supposed to jog to where we were going while yelling out “Air Assault” when our left foot hit the ground. This story is a snapshot of only the 10 days of Air Assault that comprised my 15+ year military career. It does not list the physical requirements of Basic Combat Training (BCT), Advanced Individual Training (AIT) or any other physically and mentally challenging course or duty station the Army has to offer. It should come to no surprise that at the ripe-and-young age of 32, I was diagnosed by the United States Army with Osteoarthritis (OA) in my knees.
This story was no creation of M. Night Shyamalan, there was no surprise twist at the end. We all probably saw the diagnosis of OA for this Tactical Athlete coming from somewhere around the second sentence. The thing is, being a Tactical Athlete, even in the reserve component, is not easy on the body. Ever since the beginning, war hasn’t been easy; during the Civil War, General Sherman was even quoted saying, “War is hell1.” Thus, the Warfighter must train to fight and win in similar circumstances and that places them at increased risk for developing early onset OA in their third and fourth decades of life2. Due to the nature of the training and job, some Tactical Athletes have even been found to have 2.52 to 2.93 times more risk for developing OA2.
OA is a debilitating chronic disease known for its degeneration effects on the soft-tissues, articular cartilage and bones surrounding weight bearing joints2-3 that has long been thought to only effect those in their advanced years of age2. With annual costs of $187 billion, this disease is a major financial burden on public health3. We know, both anecdotally from my story and from various research articles, that Tactical Athletes are at increased risk for musculoskeletal injury2,4. In-fact, musculoskeletal injury is the leading cause of Warfighters not deploying with their units for combat or contingency operations4; further, a history of musculoskeletal injury is also a risk factor for developing OA3. This is where we start to see the perfect storm for OA forming, a hurricane of musculoskeletal injuries and a nor’easter of risk factors.
The military is doing its part and has been looking into how to overcome the storm of their musculoskeletal injury issue. After looking at the research and the current best practices for strength and conditioning, in 2010 the Army developed a new physical fitness program for their Warfighters. The Army moved away from its aerobic-based old fitness philosophy of Physical Training (PT) to a new program with dynamic warmups, more effective periodization and functional fitness patterns that mimic the combat requirements of the Warfighter. They called this Physical Readiness Training (PRT)5. This is only one prong of a major offensive effort to attack the maelstrom of OA occurring in Tactical Athletes. To play the Devil’s Advocate, the average diagnosis of OA on radiograph occurs 10-15 years post-injury; thus, these changes of PRT will be hard to gauge as effective for years.
But, what can Athletic Trainers (ATs) do to help in the lines of effort? While we have yet to establish just which occupational task or risk factor in the Tactical Athlete population is contributing to increased risk of OA2, ATs can assist in decreasing the frequency of musculoskeletal injuries through implementing injury prevention/reduction programs3. After all, having a history of knee or hip injury increases one’s risk of OA by 4-fold and 5-fold, respectively 3. Neuromuscular-based programs consisting of lower extremity and core strengthening, plyometric and proprioception/balance-based exercises appear to decrease the frequency of lower extremity injury3. ATs are also ideally suited for case management as part of the chronic management model for those who do sustain injury, offering better care to the Tactical Athlete3. Finally, ATs are very well versed in weight-management techniques and can assist in providing counseling or technical advice to those with higher BMIs to lessen their risk for OA later in life3. Through implementation of properly designed injury-reduction and weight-control protocols along with assisting in case management, ATs can help to disperse the perfect storm of OA.
- Civil War Trust. (2017). Biography: William T. Sherman. Retrieved from https://www.civilwar.org/learn/biographies/william-t-sherman.
- Cameron, K.L., Driban, J.B., & Svoboda, S.J. (2016). Osteoarthritis and the tactical athlete: A systematic review. Journal of Athletic Training, 51(11), 952-961. doi: 10.4085/1062-6050-51.5.03.
- Palmieri-Smith, R.M., Cameron, K.L., DiStefano, L.J., Driban, J.B., Pietrosimone, B., Thomas, A.C., & Tourville, T.W. (2017). The role of athletic trainers in preventing and managing posttraumatic osteoarthritis in physically active populations: A consensus statement of the Athletic Trainers’ Osteoarthritis Consortium. Journal of Athletic Training, 52(6), 610-623. doi: 10.4085/1062-6050-52.2.04.
- Teyhen, D.S., Shaffer, S.W., Butler, R.J., Goffar, S.L., Kiesel, K.B., Rhon, D.I., …, & Plisky, P.J. (2015). What risk factors are associated with musculoskeletal injury in the US Army Rangers? A prospective prognostic study. Clinical Orthopaedics and Related Research, 473(9),2948-2958.
- Headquarters, Department of the Army. (2010). Army Physical Readiness Training. Training Circular (TC) 3-22.20. Washington, DC.
About the Author
Jeremy Howard is the State Health Promotion Officer for Florida Army National Guard under the Resilience, Risk Reduction, and Suicide Prevention Program. Howard graduated with a Bachelor of Science in Athletic Training from Florida Gulf Coast University (#DunkCity) and from the University of Saint Augustine for Health Sciences’ Master of Health Science in Athletic Training programs. He is currently pursuing an Educational Doctorate in Health Sciences at the same institution. In 2002, Howard enlisted in the Florida Army National Guard and is still currently serving; he is also a veteran of Operation Enduring Freedom-Afghanistan. His professional interests include Concussion/TBI, Injury Prevention Programs and Manual Therapy.