Editorial Comment
Service members are at risk for musculoskeletal injuries due to the physical nature of their training, occupations, and deployments. Specific injuries associated with combat sports are discussed in this report. This report likely underestimates the true number of injuries associated with combat sports and does not distinguish between injuries occurring during training, competition, or while on or off duty. The surveillance case definition relied on E-codes and STANAG codes. E-codes are supplementary codes that are not required and their use depends on the detail of notes taken by the clinician and their interpretation by the coder. STANAG codes are used exclusively by the military health system for hospitalizations; they are also not required. Therefore, many injuries that may have been the direct result of combat sports may not have been captured by this report.
Despite the limitations of the codes used to ascertain all cases, valuable surveillance information can be gleaned from the cases in which the codes were documented. Cases were more common among younger males in the Army and service members in combat-specific occupations. The incidence rate among recruits was also dramatically higher compared to non-recruits. These findings are not surprising given the increase in physical training during the recruit period and the extensive training continually performed by combat-specific occupations in all services.
A majority of the primary diagnoses associated with combat sports injuries were relatively minor (i.e., sprains/strains and contusions). However, combat-related sports, particularly boxing, do carry a risk of severe injuries (e.g., head injuries, fractures, and dislocations), which can cause significant morbidity or long-term sequelae (e.g., hospitalizations, surgical intervention), loss of duty time, and decreased operational effectiveness.
Combat-related sports, specifically hand-to-hand combat training, encourage confidence, mental discipline, and physical fighting skills that service members may need in battlefield situations. However, there are costs inherent to learning and enhancing hand-to-hand combat skills and cultivating the fighting spirit essential to the warrior ethos. Leaders, developers, and instructors of hand-to-hand combat training programs should identify preventable threats to the health and safety of participants; in particular, they should select and enforce practices and equipment to reduce the most frequent and serious injuries. Although the training provides many physical and mental benefits to the individual, it should be conducted in as safe a manner as possible.
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