Identification of Risk Factors Prospectively Associated With Musculoskeletal Injury in a Warrior Athlete Population

Sports Health. Nov/Dec 2020;12(6):564-572. doi: 10.1177/1941738120902991. Epub 2020 Mar 5.


Background: Musculoskeletal injuries are a primary source of disability. Understanding how risk factors predict injury is necessary to individualize and enhance injury reduction programs.

Hypothesis: Because of the multifactorial nature of musculoskeletal injuries, multiple risk factors will provide a useful method of categorizing warrior athletes based on injury risk.

Study design: Prospective observational cohort study.

Level of evidence: Level 2.

Methods: Baseline data were collected on 922 US Army soldiers/warrior athletes (mean age, 24.7 ± 5.2 years; mean body mass index, 26.8 ± 3.4 kg/m2) using surveys and physical measures. Injury occurrence and health care utilization were collected for 1 year. Variables were compared in healthy versus injured participants using independent t tests or chi-square analysis. Significantly different factors between each group were entered into a logistic regression equation. Receiver operating characteristic curve and accuracy statistics were calculated for regression variables.

Results: Of the 922 warrior athletes, 38.8% suffered a time-loss injury (TLI). Overall, 35 variables had a significant relationship with TLIs. The logistic regression equation, consisting of 11 variables of interest, was significant (adjusted R2 = 0.21; odds ratio, 5.7 [95% CI, 4.1-7.9]; relative risk, 2.5 [95% CI, 2.1-2.9]; area under the curve, 0.73). Individuals with 2 variables had a sensitivity of 0.89, those with 7 or more variables had a specificity of 0.94.

Conclusion: The sum of individual risk factors (prior injury, prior work restrictions, lower perceived recovery from injury, asymmetrical ankle dorsiflexion, decreased or asymmetrical performance on the Lower and Upper Quarter Y-Balance test, pain with movement, slower 2-mile run times, age, and sex) produced a highly sensitive and specific multivariate model for TLI in military servicemembers.

Clinical relevance: A better understanding of characteristics associated with future injury risk can provide a foundation for prevention programs designed to reduce medical costs and time lost.

Keywords: injury prediction; intrinsic risk factors; movement tests; musculoskeletal injury.

MeSH terms

  • Adult
  • Age Factors
  • Athletic Injuries / epidemiology
  • Cumulative Trauma Disorders / epidemiology
  • Exercise Test
  • Humans
  • Military Personnel*
  • Musculoskeletal System / injuries*
  • Physical Conditioning, Human / adverse effects
  • Physical Fitness
  • Prospective Studies
  • Recurrence
  • Return to Work
  • Risk Factors
  • Sex Factors
  • Time Factors
  • Young Adult