Nature and causes of injuries in women resulting from an endurance training program

Women entering the Army are exposed to considerable physical stress due to the intense physical training program encoun tered. At the beginning of a basic training cycle, a prospective study was initiated to identify exercise-related injuries and performance-limiting conditions that resulted from an 8-week physical training program and to identify some of the factors that may contribute to their occurrence. Four hundred women recruits (age 18 to 29 years) participated in the study. All had passed an initial physical examination and were without any limiting disabilities. An initial assessment of physical fitness was accomplished to determine the current status of body composition, strength of the major muscle groups (e.g., legs, trunk, arms, and upper torso), aerobic capacity, previous ath letic history, self-perception of physical fitness, and psychoso matic predisposition. The training and conditioning program (1 hr daily, five to six times a week) involved a series of standard warm-up calisthenics and stretching exercises fol lowed by a run, beginning at 3/4 mile at a 10 min per mile pace and increasing to 2 miles at 9½ min per mile by the end of training. Extensive road marches and military training activities were also included. At the end of training, a self-report injury questionnaire was used to collect injury data. These data were documented with the records from the unit dispensary and data provided by the installation physical therapy, orthopaedic, and podiatry clinics. Fifty-four percent (215) of the women sustained some reportable injury. These injuries resulted in an average training time loss of 13 days. Forty-one percent of these injuries prevented participation in all activity, 31% resulted in only limited participation. Early training "overuse syndrome" ac counted for 42% (92) of the reported injuries. Significant injuries were: tibial stress fracture (45), chondromalacia of the patella (21), hip or neck of femur stress fracture (20), sprains (12), Achilles tendinitis (10), calcaneous or metatarsal stress fracture (8), and fascial and anterior compartment strains (6). The injury data were correlated with prior-fitness measures. The results indicated that a major cause of injury in women can be attributed to the lack of prior conditioning, greater body weight and fat percent, and limited leg strength. These factors, coupled with some inherent physiologic characteristics of women (i.e., wide pelvis, less strength, and greater joint flexi bility), probably contributed to the increased risk of injury in these women. It is concluded that susceptibility to these poten tial orthopaedic and medical conditions can be identified before the beginning of training and minimized through proper reme dial activity before a strenuous physical training program is initiated.