Injuries and Factors Associated with Injuries Among U.S. Army Band Musicians.

The Department of Defense is the largest employer of full-time musicians. In the U.S. military, many musicians experience unique occupational exposures such as extended periods of standing, sitting, and marching for rehearsals and performances, static and non-neutral postures, and a variety of repetitive motions while playing instruments. These exposures are in addition to physical training and fitness standards required of U.S. Army soldiers. METHODS: An electronic survey was administered to active-duty U.S. Army Band musicians. The survey collected demographics, personal characteristics, Army Physical Fitness Test performance, occupational demands, health behaviors, and injuries from October 2017 to December 2018. Survey responses were combined with medical and physical fitness performance records. Descriptive statistics were reported and factors associated with injuries were investigated. RESULTS: There were 465 Army Band members in this population, with approximately half (49%) completing the survey. Most survey respondents (81%) reported an injury in the past year, which they predominantly attributed to overuse (54%). Leading reported activities resulting in injury included running for physical training (21%), repetitive movements while playing an instrument (11%), and standing while playing (11%). A majority of survey respondents (60%) also had a medical encounter for an injury. Factors significantly associated with injury among men were lower aerobic fitness and higher body fat percentage; additional unadjusted factors associated with injury among all Army Band soldiers included female sex, older age, and longer periods of marching and standing while playing. CONCLUSIONS: Injury prevention initiatives for Army Band musicians should focus on the reduction of overuse and repetitive motion injuries. Suggested prevention strategies include balanced physical training, ergonomic adjustments, rehearsal breaks, and leadership support for injury prevention efforts.

Assessing Community-Based Public Health Plans: An Example From US Army Injury Prevention.

CONTEXT: The US Army requires community health coalitions to develop action plans for their top public health priorities. OBJECTIVE: To date, the US Army has not implemented a standardized review process for community action plans. DESIGN: This project used the Plan Quality Index (PQI), an evidence-based, standardized tool, to evaluate injury prevention action plans created by injury prevention teams (IPTs). SETTING: 17 Army installations. PARTICIPANTS: 17 IPT leads; 5 Health Promotion Program Officers. INTERVENTION: Implementation of the PQI to evaluate the strength of injury prevention action plans and make recommendations for quality improvement to drive reductions in injuries at 17 Army installations. MAIN OUTCOME MEASURE: PQI total scores for high- (≥50 points on the PQI) and low-ranking plans (<50 points on the PQI) were assessed for differences using t tests of the mean PQI score. Chi-square tests were employed to identify differences in meeting criteria between high- and low-scoring plans. RESULTS: PQI total scores ranged from 9 to 78 points out of 80. The weakest planning elements among all plans were lack of use of SMART objectives (18%), lack of identification of responsible parties (18%), absent evaluation plan (24%), and lack of timelines (35%). The mean score for the high-ranking plans (64.6 ± 9.5) was significantly higher than the mean score for the low-ranking plans (26.2 ± 12.7) ( P < .001). Mean scores for clarity, effectiveness, and quality were all significantly higher for the high-ranking plans than for the low-ranking plans ( P = .014, P = .002, and P < .001, respectively). CONCLUSIONS: The PQI tool provides a framework for objective, standardized, and evidence-based feedback and recommendations for improving community health plans. The project identified examples of high-quality action plans and provided actionable recommendations for plan improvement to facilitate sustainability of initiatives addressing injuries, which have long posed a threat to military health and readiness.

The cost of lower extremity fractures among active duty U.S. Army soldiers, 2017.

The estimated cost to the Army for lower extremity fractures in 2017 was approximately $116 million. Direct medical expenses totaled $24 million, and indirect medical costs totaled $92 million ($900 thousand lost duty; $91 million limited duty). Foot and toe fractures, along with lower leg and ankle fractures accounted for the majority of soldiers' initial visits for care (n=4,482; 91.6%), and more than $103 million (89.0%) of overall costs ($116 million). Costs varied by location of care. In outpatient settings, initial visits for foot and toe injuries accounted for the highest costs: $49 million overall. Direct medical costs totaled $1.2 million, and indirect medical costs (limited duty) were $48 million. Conversely, in inpatient settings, lower leg and ankle fractures accounted for slightly more than half of all costs (overall $9 million; $4.8 million in direct medical costs and $4.5 million in indirect medical costs). The finding that the majority of costs related to lower extremity fractures were due to estimated days of lost or limited duty and associated loss of productivity justifies the inclusion of indirect cost estimates as a part of overall injury cost calculations.

The Impacts of ICD-10-CM on U.S. Army Injury Surveillance.

INTRODUCTION: Injuries are the leading cause of medical encounters and lost work days in the U.S. Army, affecting more than half of active-duty soldiers annually. Historically, Army injury surveillance has captured both acute traumatic and cumulative microtraumatic overuse injuries. This article describes how the transition from the ICD-9-CM to ICD-10-CM impacted U.S. military injury surveillance by comparing injury rates and distributions under both systems. METHODS: Mapping ICD-9-CM codes to the expanded ICD-10-CM codes is not a straightforward endeavor; therefore, the Army Public Health Center incorporated ICD-10-CM codes into a comprehensive, systematic approach to taxonomically categorize injuries. This taxonomic methodology was applied to Army injuries under ICD-10-CM (2016-2019) and compared with the ICD-9-CM Army injury surveillance definitions (2012-2015). RESULTS: Soldier injury rates appeared to increase when surveillance with ICD-10-CM began. Soldiers experienced 1,276 incident injury medical encounters per 1,000 person-years in 2015 (ICD-9-CM), compared with 1,804 injuries per 1,000 in 2016 (ICD-10-CM), a 41% increase. Importantly, the distribution of injuries also shifted, such that the average cumulative microtraumatic injury rate increased by 42% during 2016-2019 (ICD-10-CM) compared with the 2012-2015 average (ICD-9-CM), whereas acute traumatic injuries only increased by 17%. CONCLUSIONS: The enhanced descriptions provided by ICD-10-CM codes and the applied taxonomic categorizations have improved precision in Army injury surveillance. Data unequivocally show that most injuries in this physically active population are cumulative microtraumatic injuries. The taxonomic methodology can be extended to injury surveillance in other populations and may allow a more efficient transition to ICD-11-CM.

Musculoskeletal injuries in military personnel-Descriptive epidemiology, risk factor identification, and prevention.

OBJECTIVES: To provide an overall perspective on musculoskeletal injury (MSI) epidemiology, risk factors, and preventive strategies in military personnel. DESIGN: Narrative review. METHODS: The thematic session on MSIs in military personnel at the 5th International Congress on Soldiers' Physical Performance (ICSPP) included eight presentations on the descriptive epidemiology, risk factor identification, and prevention of MSIs in military personnel. Additional topics presented were bone anabolism, machine learning analysis, and the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on MSIs. This narrative review focuses on the thematic session topics and includes identification of gaps in existing literature, as well as areas for future study. RESULTS: MSIs cause significant morbidity among military personnel. Physical training and occupational tasks are leading causes of MSI limited duty days (LDDs) for the U.S. Army. Recent studies have shown that MSIs are associated with the use of NSAIDs. Bone MSIs are very common in training; new imaging technology such as high resolution peripheral quantitative computed tomography allows visualization of bone microarchitecture and has been used to assess new bone formation during military training. Physical activity monitoring and machine learning have important applications in monitoring and informing evidence-based solutions to prevent MSIs. CONCLUSIONS: Despite many years of research, MSIs continue to have a high incidence among military personnel. Areas for future research include quantifying exposure when determining MSI risk; understanding associations between health-related components of physical fitness and MSI occurrence; and application of innovative imaging, physical activity monitoring and data analysis techniques for MSI prevention and return to duty.

Factors associated with motorcycle traffic crash fatalities among active duty U.S. Army personnel.

OBJECTIVE: Research on factors associated with motorcycle fatalities among active duty U.S. Army personnel is limited. This analysis describes motorcycle crash-related injuries from 1995 through 2014 and assesses the effect of alcohol use and helmet use on the risk of fatal injury among active duty U.S. Army motorcycle operators involved in a traffic crash, controlling for other factors shown to be potentially associated with fatality in this population. METHODS: Demographics, crash information, and injury data were obtained from safety reports maintained in the Army Safety Management Information System. Traffic crashes were defined as crashes occurring on a paved public or private roadway or parking area, including those on a U.S. Army installation. Analysis was limited to motorcycle operators. Odds ratios (ORs) and 95% confidence intervals (95% CIs) from a multivariable analysis estimated the effect of alcohol use and helmet use on the risk of a fatal injury given a crash occurred, controlling for operator and crash characteristics. RESULTS: Of the 2,852 motorcycle traffic crashes, most involved men (97%), operators aged 20-29 years of age (60%), and operators who wore helmets (95%) and did not use alcohol (92%). Two thirds of reported crashes resulted in injuries requiring a lost workday; 17% resulted in fatality. Controlling for operator and crash characteristics, motorcycle traffic crashes involving operators who had used alcohol had a 3.1 times higher odds of fatality than those who did not use alcohol (OR =3.14; 95% CI, 2.17-4.53). Operators who did not wear a helmet had 1.9 times higher odds of fatality than those who did wear a helmet (OR =1.89; 95% CI, 1.24-2.89). CONCLUSIONS: Among U.S. Army motorcycle operators, alcohol use and not wearing a helmet increased the odds of fatality, given that a crash occurred, and additional modifiable risk factors were identified. Results will help inform U.S. Army motorcycle policies and training.

Accuracy of self-reported injuries compared to medical record data.

BACKGROUND: Self-reported injury data are frequently used in epidemiologic investigations. These data provide useful information about the activities and mechanisms of injuries because injury cause-coding is often not required for outpatient medical visits. OBJECTIVES: The purpose of this evaluation is to determine the accuracy of self-reported military injuries when compared to injuries in outpatient medical records. METHOD: Injuries reported by survey were compared to diagnoses for injuries (International Classification of Diseases (ICD-9-CM 800-999)) and injury-related musculoskeletal disorders (selected ICD-9-CM 710-739) obtained from medical records. Self-reported injury responses from military personnel were matched to diagnoses by date and body part. A new methodology for including secondary matching body parts was proposed and implemented. RESULTS: Infantry Soldiers (n = 5490) completed surveys that requested details about their most recent injury. About one-quarter (24%, n = 1336) reported injuries on the survey and had an injury diagnosis in their medical record in a six month period. Seventy-five percent of the self-reported injuries (n = 996 of 1336) were confirmed by medical records with a date match within 3 months and an identical or nearby body part. Common self-reported injuries were ankle sprains (10%), knee sprains (9%), lower back strains (4%), shoulder strains (3%), and lower back pain (3%). CONCLUSIONS: A high percentage of self-reported injuries were accurate when compared with medical records, substantiating the use of survey data for the evaluation of injury outcomes. This is the first effort to validate self-reported injuries and musculoskeletal disorders with medical records in a large military population.

Musculoskeletal training injury prevention in the U.S. Army: Evolution of the science and the public health approach.

Injuries cause more morbidity among soldiers in the U.S. Army than any other health condition. Over two-thirds of U.S. soldiers' injuries occur gradually from cumulative micro-traumatic damage to the musculoskeletal system as a result of physical training activities. Paradoxically, the very physical training activities required to improve soldier performance also result in injury. Determining the amounts and types of physical training that maximize performance while minimizing injuries requires scientific evidence. This evidence must be incorporated into a framework that ensures scientific gaps are addressed and prevention efforts are evaluated. The five-step public health approach has proven to be an effective construct for Army public health to organize and build an injury prevention program. Steps include: 1) surveillance to define the magnitude of the problem, 2) research and field investigations to identify causes and risk factors, 3) intervention trials and systematic reviews to determine what works to address leading risk factors, 4) program and policy implementation to execute prevention, and 5) program evaluation to assess effectiveness. Dissemination is also needed to ensure availability of scientific lessons learned. Although the steps may not be conducted in order, the capability to perform each step is necessary to sustain a successful program and make progress toward injury control and prevention. As with many U.S. public health successes (e.g., seatbelts, smoking cessation), the full process can take decades. As described in this paper, the U.S. Army uses the public health approach to assure that, as the science evolves, it is translated into effective prevention.

Risk Factors for Sprains and Strains Among Physically Active Young Men: A US Army Study.

This investigation aimed to identify risk factors for lower extremity sprain/strain injuries in physically active men. Lower extremity (LE) sprain/strain injuries are a significant source of morbidity among physically active populations. Data on and risk factors for injuries, including personal characteristics, and physical training and fitness were obtained from male Soldiers in an operational US Army division (N=6,865) by survey. Injury risks, risk ratios (RR), odds ratios (OR), and 95% confidence intervals (95% CI) were calculated. Multivariate analysis utilized logistic regression. Self-reported injury incidence for the prior 12 months was 43% (n=2,939), with 30% (n=878) of injuries attributed to LE sprains/strains. Lower extremity sprain/strain injuries were most commonly caused by falls, jumps, trips, or slips (49.4%), occurred while running (30.6%), and often resulted in limited duty profiles (64%). Higher risk of LE sprain/strain injury was independently associated with higher body mass index (ORoverweight/normal=1.2, 95% CI: 1.0-1.5), (ORobese/normal=1.4, 95% CI: 1.1-1.9), lower aerobic endurance (from 2-mile run time) (ORQuartile 2 (Q2)/Quartile 4 (Q4)=1.4, 95% CI: 1.0-1.8), (ORQuartile 1 (Q1)/Q4=1.6, 95% CI: 1.3-2.1), and lower core strength (sit-up repetitions) (ORQ1/Q4=1.4, 95% CI: 1.1-1.8). Lower risk of LE sprain/strain injury was associated with performing unit resistance training 3 or more times per week (OR3 times/none=0.5, 95% CI: 0.3-0.8). LE sprain/strain injuries contribute a significant portion of injuries among US Army Soldiers. Emphasis on aerobic fitness, core strength, and resistance training may help reduce the risk of LE sprain/strain injury among physically active men.

Injury Mechanisms, Activities, and Limited Work Days in US Army Infantry Units.

Injuries are a leading health and readiness concern for the US Army. For effective prevention planning, details concerning circumstances associated with injuries are needed. Over 5,000 Soldiers were surveyed to collect demographic and injury details (type, body part, mechanism, activity, limited duty days); 874 reported an injury within 6 months of survey administration. The greatest proportion of limited duty time was associated with knee (19.2%), ankle (14.8%), and lower back injuries (12.9%). Overexertion was the leading injury mechanism (43.9%), followed by falls, jumps, trips, and slips (35.2%), which accounted for the highest average limited duty days per injury (42±43 days). Running was the leading activity associated overexertion injuries (39.3%) and falls (30.5%). Running also accounted for the greatest total limited duty days (5,844 days, 29.8%). For Army infantry units, results suggested a focus of prevention activities on running-related injuries resulting in overexertion or falls. Healthcare providers can facilitate injury prevention with contributions to initiatives providing details on injury mechanisms and activities associated with injuries.

Factors Associated With Injury Among Employees at a U.S. Army Hospital.

The purpose of this study was to investigate injury incidence and factors associated with injury among employees at a large U.S. Army hospital to inform injury prevention planning and health promotion education efforts. Demographics, health behaviors, and injury history were collected by survey from hospital employees between October and December 2014. Descriptive statistics were reported and factors associated with injury were determined using multiple logistic regression. Respondents (380; 56% females, 44% males; 54% active duty military, 45% civilians) reported a prevalence of unhealthy behaviors (e.g., not enough exercise [58%] and poor sleeping habits [49%]). Nearly half of respondents (47%) reported at least one occupational injury in the past 12 months. Leading mechanisms of injuries were repetitive overuse (36%), falls (15%), and single twisting movement/overexertion (14%). Leading activities at the time of injury were physical training (24%), walking/hiking (15%), and lifting or moving objects (11%). Factors associated with injury included active duty military status, less education, tobacco use, overuse of alcohol or drugs, and stress. Health education efforts and materials intended for hospital staff should incorporate identified modifiable injury risk factors (e.g., alcohol and drug use, stress, tobacco use, poor sleep). Injury prevention initiatives should focus on physical training, walking/hiking, and lifting. Establishment of surveillance and routine review of employee injury, illness, and health behavior data are recommended to monitor program effects and collect data necessary to inform future prevention priorities and planning.

Risk factors for injury associated with low, moderate, and high mileage road marching in a U.S. Army infantry brigade.

OBJECTIVES: Road marching is an important physical training activity that prepares soldiers for a common occupational task. Continued exploration of risk factors for road marching-related injuries is needed. This analysis has assessed the association between modifiable characteristics of physical training and injury risk. METHODS: Injuries in the previous 6 months were captured by survey from 831 U.S. Army infantry soldiers. Road marching-related injuries were reported as those attributed to road marching on foot for specified distances while carrying equipment. Frequencies, means, and relative risk ratios (RR) for road marching-related injury with 95% confidence intervals (CI) were calculated. Adjusted odds ratios (OR) and 95% CI were calculated for leading risk factors using multivariable logistic regression. DESIGN: Retrospective cohort study. RESULTS: Half (50%) of reported injuries were attributed to road marching or running. When miles of exposure were considered, injury risk during road marching was higher than during running (RRroad marching/running=1.8, 95% CI: 1.38-2.37). A higher product of road marching distance and weight worn (pound-miles per month) resulted in greater injury risk (RR≥1473 pound-miles/<1472=1.92, 95% CI: 1.17-2.41). Road marching-related injuries were associated with carrying a load >25% of one's body weight (OR>25%/1-20%=2.09, 95% CI: 1.08-4.05), having high occupational lifting demands (OR50-100+lbs/25-50lbs=3.43, 95% CI: 1.50-7.85), road marching ≥5 times per month (OR≥5 times/4 times=2.11, 95% CI: 1.14-3.91), and running <4 miles per week during personal physical training (OR0/≥10 miles/week=3.56, 95% CI: 1.49-8.54, OR1-4/≥10 miles/week=4.14, 95% CI: 1.85-9.25). CONCLUSIONS: Ideally, attempts should be made to decrease the percentage of body weight carried to reduce road marching-related injuries. Since this is not always operationally feasible, reducing the cumulative overloading from both physical training and occupational tasks may help prevent injury.

Functional Movement Screen: Pain versus composite score and injury risk.

OBJECTIVES: The Functional Movement Screen (FMS™) has been used as a screening tool to determine musculoskeletal injury risk using composite scores based on movement quality and/or pain. However, no direct comparisons between movement quality and pain have been quantified. DESIGN: Retrospective injury data analysis. METHODS: Male Soldiers (n=2154, 25.0±1.3years; 26.2±.7kg/m2) completed the FMS (scored from 0 points (pain) to 3 points (no pain and perfect movement quality)) with injury data over the following six months. The FMS is seven movements. Injury data were collected six months after FMS completion. Sensitivity, specificity, receiver operator characteristics and positive and negative predictive values were calculated for pain occurrence and low (≤14 points) composite score. Risk, risk ratios (RR) and 95% confidence intervals were calculated for injury risk. RESULTS: Pain was associated with slightly higher injury risk (RR=1.62) than a composite score of ≤14 points (RR=1.58). When comparing injury risk between those who scored a 1, 2 or 3 on each individual movement, no differences were found (except deep squat). However, Soldiers who experienced pain on any movement had a greater injury risk than those who scored 3 points for that movement (p<0.05). A progressive increase in the relative risk occurred as the number of movements in which pain occurrence increased, so did injury risk (p<0.01). CONCLUSIONS: Pain occurrence may be a stronger indicator of injury risk than a low composite score and provides a simpler method of evaluating injury risk compared to the full FMS.

Evaluating Injury Risk and Gender Performance on Health- and Skill-Related Fitness Assessments.

Grier, TL, Canham-Chervak, M, Bushman, TT, Anderson, MK, North, WJ, and Jones, BH. Evaluating injury risk and gender performance on health- and skill-related fitness assessments. J Strength Cond Res 31(4): 971-980, 2017-The purpose of this analysis was to investigate the association of injury risk and gender performance on health- and skill-related fitness assessments. A survey was used to collect personal characteristics and Army Physical Fitness Test scores (2-mile run, push-ups, and sit-ups). Within the same day, 9 physical fitness assessments were performed. Percent body fat was estimated using height, weight, age, and sex. All fitness assessment data were categorized into tertiles of high, moderate and low performance. To investigate potential injury risk predicted by fitness assessment performance, injury risk ratios, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated using medical record data. A total of 3,264 soldiers completed surveys and physical fitness assessments. Tertiles of fitness performance with men and women combined showed that on an average, 14% of women and 70% of men were in the moderate- and high-performance groups. Among men, higher injury risk was independently associated with low performance on a 2-mile run (ORslow/fast = 1.51, 95% CI 1.18-1.94) and low performance on a weighted 300-yard shuttle run (ORslow/fast = 1.36, 95% CI 1.06-1.74). For women, a higher risk of injury was associated with low performance on the 2-mile run (ORslow/fast = 2.38, 95% CI 1.04-5.74). Therefore, out of the 13 fitness assessments, the 2-mile run and weighted 300-yard shuttle run can also (in addition to measuring performance) be utilized to identify soldiers or athletes who are at a higher risk of experiencing an injury.

Statistical process control charts for monitoring military injuries.

BACKGROUND: An essential aspect of an injury prevention process is surveillance, which quantifies and documents injury rates in populations of interest and enables monitoring of injury frequencies, rates and trends. To drive progress towards injury reduction goals, additional tools are needed. Statistical process control charts, a methodology that has not been previously applied to Army injury monitoring, capitalise on existing medical surveillance data to provide information to leadership about injury trends necessary for prevention planning and evaluation. METHODS: Statistical process control Shewhart u-charts were created for 49 US Army installations using quarterly injury medical encounter rates, 2007-2015, for active duty soldiers obtained from the Defense Medical Surveillance System. Injuries were defined according to established military injury surveillance recommendations. Charts display control limits three standard deviations (SDs) above and below an installation-specific historical average rate determined using 28 data points, 2007-2013. Charts are available in Army strategic management dashboards. RESULTS: From 2007 to 2015, Army injury rates ranged from 1254 to 1494 unique injuries per 1000 person-years. Installation injury rates ranged from 610 to 2312 injuries per 1000 person-years. Control charts identified four installations with injury rates exceeding the upper control limits at least once during 2014-2015, rates at three installations exceeded the lower control limit at least once and 42 installations had rates that fluctuated around the historical mean. CONCLUSIONS: Control charts can be used to drive progress towards injury reduction goals by indicating statistically significant increases and decreases in injury rates. Future applications to military subpopulations, other health outcome metrics and chart enhancements are suggested.

Effect of Mandatory Unit and Individual Physical Training on Fitness in Military Men and Women.

PURPOSE: The purpose of this study was to look at the effect of additional individual physical training (PT) in addition to mandatory unit PT as well as other risk factors on physical fitness. DESIGN: A cross-sectional design. SETTING: This study was conducted on a US military installation. PARTICIPANTS: Participants were 6290 male and 558 female active duty US Army soldiers in 3 light infantry brigades. MEASURES: Participants completed self-administered questionnaires asking about individual characteristics, PT, and physical fitness. Cut points were established for soldiers scoring within the top 33% for each of the 3 Army Physical Fitness Test events (2-mile run, sit-ups, and push-ups) and top 50% in each of the tests combined for overall performance. ANALYSIS: Odds ratios and 95% confidence intervals from multivariate analyses were calculated. RESULTS: Variables impacting physical fitness performance of men and women included increased body mass index, leading unit PT sessions, and individual distance running mileage. Other variables impacting physical performance for men included increased age, smoking, and individual resistance training. CONCLUSION: Soldiers performing additional individual PT demonstrated a positive influence on fitness compared to unit PT participation alone. Increased age and being overweight/obese negatively influenced physical fitness. To enhance fitness performance through unit PT, running by ability groups and resistance training should be encouraged by leadership.

The Role of Gender and Physical Performance on Injuries: An Army Study.

INTRODUCTION: In basic combat training, women experience twice as many injuries as men; however, evidence at the operational Army level is limited. This study aims to investigate the association between gender and injury likelihood while controlling for certain confounding factors in the operational Army. METHODS: Data were analyzed in 2015 from a cross-sectional study utilizing data from a 2010-2011 survey of light infantry Army Soldiers. Gender, age, body fat, tobacco use, Army Physical Fitness Test (2-mile run, push-ups, and sit-ups), occupational physical demand, and injury data were obtained via paper survey. ORs and 95% CIs from a multivariable analysis were calculated. RESULTS: Surveys were completed by 4,384 male and 363 female Soldiers. Injury incidence was 42% for men and 53% for women. After adjusting for the aforementioned variables, injury likelihood was higher in Soldiers aged ≥27 years (OR [age 27-29/22-26 years]=1.26, 95% CI=1.07, 1.48; OR [age ≥30/22-26 years]=1.28, 95% CI=1.08, 1.51), Soldiers with body fat ≥23.38% (OR [body fat ≥23.38%/≤19.28%]=1.30, 95% CI=1.08, 1.57), and Soldiers with the slowest 2-mile run times (OR [≥15.68/≤14.13 minutes]=1.53, 95% CI=1.26, 1.85). Women were no more likely than men to sustain an injury. CONCLUSIONS: When accounting for age, body fat, physical performance, and occupational physical demand, there was no gender difference in the likelihood of injury among Soldiers. Although women, on average, have lower aerobic and muscular performance than men, results suggest men and women of similar physical performance experience similar injury likelihood.