Musculoskeletal and Medical Morbidity Associated with Rigorous Physical Training

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Abstract
In a prospective, epidemiological study, we describe the distribution and rates of medical conditions and musculoskeletal injuries suffered during training by U.S. Navy SEAL (Sea-Air-Land) Special Warfare trainees. The subjects were consecutive classes of candidates, healthy males, aged 18 to 31, contributing 482 trainee-months at risk. They were undergoing a physically demanding 25-week Naval Special Warfare Center indoctrination training during 1991 in Coronado, California. The main outcome measures were training-related medical conditions and musculoskeletal injuries resulting in a visit to the outpatient medical clinic. Combined medical conditions and musculoskeletal injuries occurred at a rate of 61.4 cases per 100 trainee-months at risk. Visits were nearly evenly split between medical conditions and musculoskeletal injuries. Respiratory complaints accounted for almost half of the medical conditions; overuse injuries (primarily, iliotibial band syndrome, patellofemoral syndrome, and stress fracture) accounted for 90% of the musculoskeletal injuries. We conclude that strenuous, sustained physical training results in a high incidence of medical conditions and musculoskeletal injury in trainees. Given this high morbidity, recommending limits on the amount and intensity of exercise seems prudent. Further research should examine the etiology, predisposing factors, therapy, and prevention of exercise-induced medical conditions and injuries.

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