approach was adopted, the lower fit subgroups would include disproportionately high percentages of women.

In addition to physical fitness, some of the neuromuscular, biomechanical, and anatomical differences between men and women may also play a role in injury causation in basic training. The higher risk of injury observed in women may be due to an independent contribution of these factors; they may also interact with low physical fitness to elevate the risk of injury in women. There is a need for studies that comprehensively compare risk factors for injury in military men and women.

SUMMARY

Research clearly indicates that low levels of physical fitness are closely linked to musculoskeletal injuries, and that musculoskeletal injuries are a significant problem in first-term military enlistees. These injuries impose devastating consequences to the Services in terms of monetary costs, military readiness, and attrition. However, none of the Services systematically assesses individual physical fitness levels prior to the shipping of recruits to basic training. In an effort to minimize the consequences of injury, previous studies have identified several modifiable risk factors that may synergistically affect injury causality. Some of these promising modifiable factors include the physical demands of unit training, individual physical fitness levels prior to the start of basic military training, and psychosocial stress. However, since musculoskeletal injury causality is multifactorial, it is essential to focus on the interactions of multiple factors in order to better understand the process of injury and disorder. In addition, it is clear that female recruits have a high risk of injury in basic training that is due, at least in part, to their lower physical fitness. Fundamental musculoskeletal, biomechanical, and neuromuscular differences in men and women may also play a role. There is currently limited information on how the training environment could be modified to ameliorate the high risk of injury in women (other than accommodating their differential fitness levels). Finally, military interventions aimed at modifying some of these factors have shown some success and provide a positive direction for future prevention and treatment of musculoskeletal injuries in the military.

CONCLUSIONS AND RECOMMENDATIONS

Recruitment

Currently, none of the Services systematically conducts comprehensive standardized physical fitness testing at the time of recruitment.



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