21 April 2025

The Critical Role of Musculoskeletal Injury Research in Military Readiness

In the winter of 2024, Military Medicine, the International Journal of AMSUS, the Society of Federal Health Professionals, published a supplement focused solely on musculoskeletal injuries in the U.S. Military: prevalence/incidence, healthcare utilization, and cost analysis. This supplement, containing eight articles, is a collaboration between investigators from the Uniformed Services University of the Health Sciences, the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) program, The Geneva Foundation, and Kennell and Associates, Inc.  

Musculoskeletal injuries (MSKIs) are the leading medical threat to the operational effectiveness of the U.S. Armed Forces. The recent study, Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A 12-Year Study Spanning Fiscal Years 2010–2021, provides an unprecedented analysis of MSKI trends, prevalence, and associated healthcare costs. Understanding the significance of this study is essential for military leadership, healthcare providers, and policymakers striving to enhance service member readiness and resilience. 

Why Musculoskeletal Injuries Matter 

MSKIs affect the bones, muscles, ligaments, and tendons, leading to pain, decreased mobility, and long recovery times. For active-duty service members (ADSMs), these injuries can impair physical performance, limit deployability, and increase reliance on private-sector healthcare. Given the physically demanding nature of military service, even minor MSKIs can have far-reaching consequences on operational effectiveness. 

Key Findings from the Study 

The study analyzed over a decade of data, revealing critical insights into the burden of MSKIs across all four military branches: 

 

• High Prevalence and Incidence: Lower extremity (LE) injuries were the most common, affecting 24–29% of service members, followed by spine (17–20%), upper extremity (UE) (14–16%), and head/neck injuries (6–8%). 

• Branch-Specific Risk: Soldiers had a higher risk of LE injuries compared to airmen, and Marines exhibited an increasing risk of MSKIs over the study period. 

• Increased Healthcare Utilization: The need for medical intervention, particularly same-day surgeries (SDS), rose significantly, with reliance on private sector care (PC) increasing across all injury types. 

• Escalating Costs: In Fiscal Year 2021, MSKI-related private sector costs were highest for LE injuries ($132.2 million), followed by spine ($98.7 million), UE ($92.1 million), and head/neck injuries ($42.7 million). 

 

The Importance of This Research 

This study is the first of its kind to assess MSKI trends across all service branches while spanning the transition from ICD-9 to ICD-10 coding systems. The comprehensive data set highlights a pressing need for continued research and targeted prevention efforts.

 

• Enhancing Injury Prevention Strategies: By identifying high-risk populations and activities, military leaders can implement training modifications to reduce injury incidence. 

• Improving Medical Readiness: A proactive approach to MSKI management can ensure service members receive timely, effective treatment, minimizing long-term disability and attrition. 

• Optimizing Healthcare Resource Allocation: With rising reliance on private sector care, strategic investments in military healthcare infrastructure could help contain costs and improve access to care. 

• Supporting Policy Development: Evidence-based policies can be crafted to address MSKIs at both the individual and institutional levels, ensuring a fit and ready force. 

 

Looking Ahead 

The findings underscore the need for continued surveillance of MSKIs, including risk factor assessment and long-term treatment outcomes. Expanding research efforts to examine injury prevention programs and rehabilitation effectiveness could significantly reduce the MSKI burden on the military healthcare system. 

Conclusion 

Musculoskeletal injuries remain a persistent challenge for the U.S. Armed Forces, impacting readiness, healthcare costs, and overall force effectiveness. The insights from this study emphasize the urgent need for strategic interventions, increased research efforts, and policy enhancements to mitigate the impact of MSKIs on military personnel. By prioritizing injury prevention and efficient treatment strategies, the military can better safeguard the health and operational readiness of its service members. 

Disclaimer: The views expressed do not reflect the official policy of the Army, the Department of Defense, or the U.S. Government.