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Human Performance Optimization Used to Prevent Common Injuries in Troops

by U.S. Medicine

March 12, 2012

By Stephen Spotswood

NATIONAL HARBOR, MD — The term “human performance optimization” (HPO) emerged from a 2006 DoD quadrennial review which identified a need to promote warrior wellness and apply emerging technologies to human performance.

The U.S. was engaged in a long war with a high operational tempo and had an ongoing need to enhance mental and physical resilience and decrease injuries among deployed servicemembers.

At the time, nobody could define exactly what HPO meant or how it was achieved because there were no metrics or ways to translate research into operational technologies.

More than five years later, while there are still many questions about what it means for the military, researchers are better equipped to incorporate HPO into training, especially in the prevention of the musculoskeletal (MSK) injuries that plague the active-duty military.

Targeting MSK Injuries

HPO is defined as the process of applying knowledge, skills and emerging technologies to improve and preserve the capabilities of DoD personnel to execute essential tasks.

It is quite different from general health and fitness. Whereas health and fitness is a way to keep the body in general working order on a day-to-day basis, HPO has a very specific outcome. It targets a full spectrum of parameters, including cardio endurance, power, speed and flexibility and lines up with the cycles of training objectives. HPO also does not deal with emotional balance but with mission mindset, which includes arousal regulation, pain tolerance and harnessing stress.

One of the clearest indicators that DoD has failed to properly train servicemembers for combat is when they suffer a preventable injury. The most common injuries on the battlefield, preventable or otherwise, are MSK.

MSK injuries are the No. 1 cause of lost duty days and account for 1.6 million medical encounters per year, most of which are noncombat related.

According to Lt. Col. Anthony Beutler, MD, USAF, an assistant professor at the Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 34% of deploying troops sustained a noncombat MSK injury during Operations Enduring Freedom and Iraqi Freedom. That is the most common reason for medical air evacuation at 24%, compared with combat injuries, which accounted for only 14%. Those also are the most common injuries during basic training, and 25% of MSK injuries during basic training lead to early medical discharges.

Long-term consequences also are significant, Beutler explained at the 2012 Military Health Services conference, held earlier this year in National Harbor, MD. “If you have an ACL injury and have no surgery, you have an 80% greater risk of getting osteoarthritis in 15 years, and this will keep you from doing the things you want to do to advance your career in the military,” he said. “If you have the best surgery with the best rehab possible, the risk is still greater than 80%. The only way to prevent OA risk is to prevent the primary injury.”

Conference attendees during the morning plenary session at the 2012 Military Health System (MHS) Conference, held at the Gaylord National Hotel and Convention Center in National Harbor, Md., Jan 31, 2012. The MHS aims to ensure the medical readiness of U.S. service members, and to provide a ready medical force. — DoD photo by Johnny Bivera

Focusing on Injury Prevention

“The line commanders that we talk to understand this problem. They know it’s true,” Beutler said. “And they all want to know how to reduce these injuries. The consequence is force depletion, and we don’t train people to go into combat with one-third less people. There’s loss of camaraderie and loss of unit cohesion.”

As a result, prevention of MSK injuries has become a growing field of research at USUHS.

Proven exercises can help train a soldier to move properly and prevent MSK injuries. “We’ve found that there are a lot of movement factors,” Beutler said. “I can train you how to jump and move safely and possibly decrease your risk for injury.”

That extra training cannot be added to every servicemember’s schedule in basic training, however, because the added cost and necessary personnel would be prohibitive, Beutler said.

This has led USUHS researchers to seek ways to identify who is most at risk for MSK injuries.

“It doesn’t have to be perfect, but it does have to be practical, and we can’t spend more time and money screening than we gain in injuries lost,” Beutler said.

One way to evaluate servicemembers in basic training is through a Functional Movement Screen (FMS), which documents their movement and identifies problem areas.

“We’re screening 800 deploying Marines using FMS, as well as a few other screening tools, to see if we can predict who’s going to be injured during deployment,” Beutler said.

Some answers are available to the question of whether injury-prevention exercises actually decrease MSK injuries. During one study, servicemembers undergoing basic training had their warm-up prior to morning PT replaced with a 10-minute injury prevention movement retraining program. The result was a fivefold decrease in injuries in that group over the year.

Another knowledge gap is just how the rigors of active-duty combat impact servicemembers when it comes to their musculoskeletal system. “What does carrying 100 pounds of body armor do to your movement patterns?” Beutler asked. “How broken are you when you come back?”

Currently, USUHS is integrating HPO into its curriculum and is activity developing ongoing clinical training for providers, as well as educational products for servicemembers. Much of this information can be found on the DoD-sponsored website www.humanperformanceresourcecenter.org.

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