Understanding the musculoskeletal injury risk of women in combat: the effect of infantry training and sex on musculoskeletal injury incidence during British Army basic training

IntroductionUntil recently, women were excluded from British combat roles. Their risk for musculoskeletal injury during basic training is two to three times higher than men. To better understand the musculoskeletal injury risk of women in British Army infantry basic training, we compared injury incidence between (1) men in standard entry training and men in infantry training, to assess the risk of infantry training; and (2) men and women in both standard entry and officer basic training, to assess the risk in women compared with men. MethodsThe incidence of musculoskeletal injury was determined from defence medical records for all men entering infantry training, and for all men and women entering standard entry and officer training, between April 2015 and March 2016. Results7390 men (standard entry, n=4229; infantry, n=2683; officer, n=478) and 696 women (standard entry, n=626; officer, n=70) entered basic training. Men in infantry training had a lower incidence of musculoskeletal injury (391 vs 417 per 1000 personnel, OR 0.90 (95% CI 0.81 to 0.99), p=0.028) and a higher incidence of stress fracture (14 vs 5 per 1000 personnel, OR 2.80 (95% CI 1.64 to 4.80), p<0.001) than men in standard entry training. Women had a higher incidence of musculoskeletal injury than men in standard entry training (522 vs 417 per 1000 personnel, OR 1.53 (95% CI 1.29 to 1.81), p<0.001) and a higher incidence of stress fracture than men in officer training (114 vs 19 per 1000 personnel, OR 6.72 (95% CI 2.50 to 18.07), p<0.001). ConclusionWomen in infantry training may be at similar risk for musculoskeletal injury, but at higher risk for stress fracture, compared with their non-infantry counterparts. Women in infantry training may be at higher risk for musculoskeletal injury and stress fracture compared with men in infantry training.