Common Mission and Training Related Injuries

Given the nature of the SEAL's occupation, it is not surprising that injuries occur during training and mission-related scenarios. Clearly, the type of injury will depend on the specific physical tasks and the environments under which the tasks are performed. Table 12-5 presents a brief summary of some of the anticipated and common injuries that may occur during mission-related platforms. Other than these platforms, many of the injuries are a result of activities all SEALs participate in, namely swimming and running.

Platform

Description of Injury

Steel Decks: Knee Cap Pain {Patellofemoral Syndrome)

Shin Splints Low Back Pain High Speed Boats: Knee Sprain with Effusion

Back Pain

Quadriceps Strain

Tendonitis below Knee Cap (Patellar)

Parachute Jumps: Fractures

Patellar Tendonitis Low Back Strain/Sprain Muscle Strain Confined Space (Submarine): Header (Head Blow)

Shin Contusions Troop Transport: Shin Splints Rappelling/Rock Climbing: Rope Burns

Elbow Tendonitis Abrasions of the Fingers Biceps Tendonitis Back Strain Shoulder Sprain Fast Roping: Deep Heel Bruises

Swimming

Swimming is a non-impact activity involving maximum tension on the muscle-tendon unit. Most injuries result from overuse and over training, rather than from one traumatic event. Consequently, once an injury occurs, healing can prove difficult.

The older, experienced operator, despite a high skill level, faces the added challenge of tendons and joint capsules that arc less resilient, muscles that take longer to warm up, and flexibility which is more difficult to maintain. All of these factors can lead to an increased risk of overuse and acute injury in this age group. The most common injuries arising from endurance swimming are sprains, strains and overuse injuries of the shoulder, knee and back.

Stroke-Associated Injuries

Freestyle, butterfly, and backstroke place a great amount of stress on the shoulder joint. Use alternate or bilateral breathing on freestyle and be sure to get plenty of roll on backstroke. Before beginning a butterfly set, be sure you are well warmed up. This will allow the shoulder to stay in a more neutral position during the activity of arm recovery and this neutral position helps prevent what is known as impingement syndrome" (described later in Table 12-8).

Freestyle swimming and kicking with a kickboard places a great amount of stress on the low back because of hyperextension; doing the backstroke relieves the stress. A pullbuoy is also helpful as it raises the hips and allows the spine to assume a more neutral posture.

Kicking with fins may aggravate the knee (especially the knee cap) and result in a degenerative condition known as patellofemoral syndrome, which commonly afflicts athletic individuals (described later in Table 12-8).

The breaststroke kick helps balance the knee joint by increasing muscular tone on the inside of the quadriceps muscle, and serves to balance the effect that running has: increasing muscular tone on the outside portion of the quadriceps muscle. However, the breaststroke may actually intensify iliotibial band syndrome (described later in Table 12-8). Swimmers may need to avoid doing breaststroke if they feel increased pain over the outside of the knee.

Running and Hiking

Running and hiking work large muscle groups and enhance cardiovascular fitness in a short period of time. Hiking transmits a force to the spine of approximately three times load-bearing weight. Running transmits an impact force to the spine of up to five times load-bearing weight. These forces are minimized with good body mechanics, shock-absorbing shoes apd cross-training for overall fitness. Table 12-6 outlines common running injuries.

Table 12-6. Common Running Injuries

Name of Injury

Description of Injury

Plantar Fasciitis

Inflammation and tightness of thick fibrous

band on sole of foot.

Achilles Tendonitis

Inflammation of calf tendon or "heel cords"

especially at insertion into heel.

lliotibial Band Rub

Pain on outside or lateral aspect of knee or

high on outside of hip.

Bursitis

Inflammation or irritation of various bursal

sacs about inner or medial portion of knee,

or behind the heel of the foot.

Shin Splints

Pain along medial aspect of lower third

of tibia, worse in morning, resolves after

warming up. Resolves with cooling down

after running.

Back Strain/Sprain

Results from impact loading of spine.

Knee Sprains

A complete discussion of knee injuries is beyond the scope of this text. Medial and lateral collateral ligament sprains can be placed in a rangc-of-motion (ROM) brace to allow early flexion and extension while protecting the damaged ligament.

A knee immobilizer brace that extends and immobilizes the knee straight out should be used with caution. Within 72 hours of using this type of brace, the thigh muscle is weakened and atrophied (muscle wasting as a result of disuse). However, this type of brace must be used with patella (knee cap) fractures and patellar dislocations. While in this brace, strengthening exercises should be started as early as possible to avoid muscle atrophy.

Ankle sprains are ideally treated in an aircast or similar splint. Ice, cross friction massage, partial weight-bearing, and early range of motion is allowed while protecting the injured ligament. Some severe sprains may require surgical intervention.

The most common physical conditioning error for the SEAL operator is overtraining. Overtraining is exactly what the word implies, a condition caused by:

Physical training for the operator differs from programs designed for elite athletes. The athlete in professional or college sports has an off-season to rest injured muscles and tendons, utilize physical therapy, maximize strength and flexibility, and finally cycle back into his sport. The SEAL team operator has no such luxury and training is a full time job. Typically he trains to peak levels year round. It is this repetitive, peak performance conditioning schedule that may lead to overtraining and overuse injuries.

The OVERTRAINING SYNDROME can present with a wide range of physiologic or psychological symptoms which vary widely among individuals (See Table 12-7). Overtraining is generally associated with endurance sports such as swimming or running.

There is no good laboratory or biochemical marker for overtraining syndrome. The BEST INDICATORS are resting heart rate in the morning and assessment of mood. Resting heart rate taken daily just before getting out of bed, and monitored over time will give some indicator of fitness as well as fatigue. Individuals who are overtrained will show a resting heart rate which is 10-15 beats per minute higher than baseline when measured over a period of several days. A day or two of abstaining from physical activity

Ankle Sprains

Too Much Physical Activity should show a return to baseline. The operator who continues endurance activities despite the baseline elevation in heart rate will only become more overtrained.

Table 12-7. Characterization and Symptoms of Overtraining Syndrome

Major Symptoms of Overtraining

Table 12-7. Characterization and Symptoms of Overtraining Syndrome

Decreased performance and

Decreased Capacity to

muscle strength

make decisions

Burn-out or stateness

Difficulty with concentration

Chronically fatigued

Angry and irritable

Lacking motivation

Muscle soreness

Disturbances in mood

Increased distractibility

Feelings of depression

Difficulty sleeping

Change in heart rate at rest,

Increased susceptibility to

exercise and recovery

colds or other illnesses

Changes in mood or mood swings may also be a signal that the individual is overtraining. Little data exist on mood assessment in the SEAL community. Typically, assessment of mood is accomplished with questionnaires. However, individuals who are overtraining and give an honest assessment of mood will consistently report feelings of frustration, anger, depression or an inability to feel anything at all.

Cross-training, rest days, monitoring of morning heart rate, mood assessment, and taking time off from certain physical activities will reduce overtraining errors.

Overtraining differs from "overwork," which is the temporary deterioration of performance capabilities due to an increase in the volume or intensity of training. Overwork is what typically happens to BUDS students. Physical and mental performance deteriorates in the most demanding parts of the training schedule, only to rebound quickly as the schedule lightens up.

Unlike overtraining, the overworked individual is able to show an increase in physical performance when faced with a greater workload or physical challenge.

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