Identifying and Mitigating Injuries in Female Soldiers

Globally, the range of military roles open to female personnel are increasing, with clear benefits for defence forces. However, injury risk management through this transition is limited and more needs to be done to ensure the wellbeing of female (and male) personnel. Overall, per capita, female military personnel are reportedly injured more frequently than male personnel in most areas of the body, particularly during basic training. As an example, a study of injuries derived from Australian Army workplace health and safety data over a two-year period found that minor injuries were reported more frequently by female soldiers than by male soldiers and that the most common locations of minor injuries were the ankle in female soldiers and the knee in male soldiers. More serious injuries were reported at similar rates in female and male soldiers and both sexes had similar distributions of injuries across body regions. It should also be noted that female personnel have been found to seek treatment sooner and are more likely to report injuries they experience than male personnel and this may account for some, but not all, of the differences in overall reported rates of injuries to specific body regions.

When specific natures of injuries are considered, a volume of research literature suggests there are some sex-specific nuances in the nature of injuries. For example, male personnel are considered to experience more traumatic knee meniscal tears, shoulder dislocations, and traumatic fractures than their female counterparts while female personnel suffer more chondromalacia patella, plantar fasciitis, shin splints, and stress fractures than their male counterparts. Differences in reported injury rates between female and male personnel are suggested to decrease after basic training, culminating in minimal sex-specific differences at later stages of the military career path. However, findings in these regards may be confounded by injury identification and reporting methods, as well as sex-related differences in physical fitness levels. With female personnel, in general, presenting with lower aerobic fitness than male personnel, and aerobic fitness associated with injury risk, lower fitness levels (as opposed to sex) may be an underpinning cause of a higher injury presentation by female personnel.

Apart from lower aerobic fitness levels, push-up performance, smoking, previous injury, no history of physical deployment, and heavy occupational tasks, appear to be risk factors for injury in military women. As such, smoking cessation, prevention of first-time injury occurrence, optimal rehabilitation following injury, enhanced risk management in relation to soldier load carriage and fatigue, enhancement of aerobic fitness, and upper limb endurance training are all strategies which may decrease injury risk in female personnel.

To address the higher rate of injury in female personnel undertaking initial training, and to concomitantly optimise outcomes for both female and male personnel, several key recommendations should be considered. First, ensuring new recruits have a history of regular physical training (including aerobic and strength training) prior to commencing initial training. Second, ensuring periodised aerobic and strength training is performed at a level which is appropriate (and not excessive) for all individuals during initial and subsequent training. Third, ensuring that equipment provided to females is suitable for them and not simply designed for males without adequate consideration of sex-related differences in morphology. This third recommendation relates to packs (e.g., pack strap widths), boots (e.g. limited size width and upper lengths), general clothing (e.g. PT shorts, fatigue shirts, etc.,) and potentially other equipment. Fourth, ensuring any previous injuries have been adequately rehabilitated prior to commencement or return to training. Fifth, ensuring optimal risk management for both soldier load carriage and fatigue during, and after, initial training.