Training-related Injuries Research Articles

Methodological challenges of using U.S. Army administrative data to identify a cohort of basic combat trainees and descriptive analysis of trends in characteristics that are potential risk factors for training-related injury.

Training-related injury is a threat to military health and readiness. Prevalence of potential risk factors for training-related injury can change with U.S. Army recruitment goals and may influence basic combat training (BCT) injury rates. This article describes challenges of using administrative data to identify a trainee cohort and describes demographic and training characteristics across the five BCT locations. Data from the Total Army Injury and Health Outcomes Database were used to identify a U.S. Army-wide cohort of first-time trainees from January 1, 2002 to September 30, 2007 and describe its characteristics. The cohort includes 368,102 first-time trainees. The annual number starting BCT increased from 52,187 in 2002 to 68,808 in 2004. The proportion of males increased from 81.57% in 2003 to 83.84% in 2007. Mean (SD) age increased from 20.67 (3.55) years in 2002 to 20.94 (3.65) years in 2007. Mean (SD) body mass index increased from 24.53 (3.56) kg/m(2) in 2002 to 24.94 (3.84) kg/m(2) in 2006. Other characteristics fluctuated by year, including proportions of race/ethnicity, accession waivers, and confirmed graduates. Fluctuations in trainee characteristics warrant further analysis of potential influence on BCT injury rates. For research uses, careful acquisition of administrative data is needed.

Injury during U.S. Army basic combat training: a systematic review of risk factor studies.

Approximately one quarter of men and half of women in U.S. Army basic combat training experience an injury. Preventing basic combat training-related injuries would reduce associated human and economic costs and discharges from the Army. Identification of risk factors for such injuries is a crucial step toward their prevention. Although some research has begun to address this need, prior studies of risk factors for training-related injury have not been reviewed systematically. This study systematically reviews the literature on risk factors for injury during U.S. Army basic combat training. Original studies of risk factors for injury during U.S. Army basic combat training published since 1990 in peer-reviewed journals were identified using PubMed and manual searches of reference lists. This search was last performed in May 2013. Nineteen studies met the inclusion criteria. Methodologic quality and potential for bias were assessed. The findings of 11 studies deemed to be of high or medium quality were synthesized to determine the level of evidence supporting the association between each risk factor studied and risk of injury during basic combat training. Quality assessment and evidence synthesis were performed from June to September 2013. There is strong or moderate evidence supporting association of older age, history of smoking, and self-rated low physical activity level prior to basic combat training with increased risk of training-related injury among male trainees. There is limited, mixed, or insufficient evidence to identify risk factors for injury among female trainees.

You get what you give: localized vascular changes are apparent following long‐term exercise training

You get what you give: localized vascular changes are apparent following long‐term exercise training

Home-Based Balance Training Using the Wii Balance Board

Objective. To evaluate the effectiveness of a home-based rehabilitation of balance using the Nintendo Wii Balance Board System (WBBS) in patients affected by multiple sclerosis (MS). Methods. In this 24-week, randomized, 2-period crossover pilot study, 36 patients having an objective balance disorder were randomly assigned in a 1:1 ratio to 2 counterbalanced arms. Group A started a 12-week period of home-based WBBS training followed by a 12-week period without any intervention; group B received the treatment in reverse order. As endpoints, we considered the mean difference (compared with baseline) in force platform measures (ie, the displacement of body center of pressure in 30 seconds), 4-step square test (FSST), 25-foot timed walking test (25-FWT), and 29-item MS Impact Scale (MSIS-29), as evaluated after 12 weeks and at the end of the 24-week study period. Results. The 2 groups did not differ in baseline characteristics. Repeated-measures analyses of variance showed significant time × treatment effects, indicating that WBBS was effective in ameliorating force platform measures (F = 4.608, P = .016), FSST (F = 3.745, P = .034), 25-FWT (F = 3.339, P = .048), and MSIS-29 (F = 4.282, P = .023). Five adverse events attributable to the WBSS training (knee or low back pain) were recorded, but only 1 patient had to retire from the study. Conclusion. A home-based WBBS training might potentially provide an effective, engaging, balance rehabilitation solution for people with MS. However, the risk of WBBS training-related injuries should be carefully balanced with benefits. Further studies, including cost-effectiveness analyses, are warranted to establish whether WBBS may be useful in the home setting.

Sports-Related Injuries in Nonathletic Children

Q: ARE KIDS WHO ARE LESS PHYSICALLY ACTIVE OR OVERWEIGHT AT INCREASED RISK FOR SPORTS-RELATED INJURIES? A. Yes. Last month we reviewed how pediatricians can explain to parents the benefits of physical activity for kids, beyond weight control. This month we thought it would be important to follow up with advice on addressing parents’ concerns for when their typically inactive children get involved in sports by dealing with this important question. Early data in support of a relationship between poor physical fitness and activity-related injury came from investigation of army trainees: a history of inactivity, higher body mass index (BMI), and low aerobic fitness were all believed to contribute to physical training-related injuries in this population.1 In fact, there are good data demonstrating that youth with increased BMIs have a significantly higher risk of sustaining a sports-related injury then their normal-weight peers. In a review of the available literature on obesity and injury, McHugh reported that in 11 of the 13 studies included in his analysis, a higher BMI and/or high percentage of body fat were associated with an increased risk of sports-related injury.2 The reported increases in injury risk ranged from 1.4 to 3.9 times the risk identified for the normal-weight control groups. The most common injuries reported in the overweight/poorly conditioned athletes were ankle sprains, tears of the medial collateral ligament of the knee, and dental injuries. Proposed mechanisms for an increased sports-related injury rate in overweight and obese children include: poor postural control (leading to problems with balance and coordination); poor physical fitness (associated with early muscle fatigue and subsequent injury); and low preparticipation physical activity levels (associated with impaired or delayed neuromuscular and motor learning).2 Overweight or poorly conditioned children do seem to have an increased risk for sports-related injuries than their normal-weight peers.

Physical Training Injuries and Interventions for Military Recruits

Low physical fitness levels are associated with increased musculoskeletal injury risk and attrition among military recruits. The authors review physical fitness trends, injury risk factors, and Department of the Army initiatives to address recruit fitness, injuries, and attrition. Initiatives include the Fitness Assessment Program, which reduced injury risk and attrition among low-fit trainees, and the Assessment of Recruit Motivation and Strength, which enabled the Army to enlist individuals exceeding body composition accession standards without increasing attrition. Physical Readiness Training (PRT) is the Army's primary initiative to address training-related injuries and attrition. PRT's inherent injury control and exercise progression components are designed to address low fitness levels across entry-level training. PRT has been shown to decrease injury rates, but low-fit recruits remain at increased risk regardless of program design. The authors recommend resuming pre-enlistment fitness screening and fitness programming before low-fit recruits begin entry-level training. The decision whether to screen for fitness before beginning entry-level training could be based upon the existing recruiting environment in terms of applicant supply and the demand for recruits. However, the Army should anticipate increased injury and attrition rates when discontinuing screening and/or fitness programming for low-fit recruits.

The Survey of the Causes of Eye Injury of Various Services in China

The cause of eye injury in various services may be different. Preventing the injury according to the cause would be more effective. We investigated 502 (549 eyes) cases of ocular injury in 21 military hospitals in China. Sports-related injury was the first cause of ocular injury (181/502, 36.1%), and it was more often seen in navy and air force personnel. A total of 69.1% of sports-related ocular injuries were caused by playing basketball and 18.8% by playing football. Work-related injury was the second cause (140/502). The highest ratio of work-related injury was in the surface warship force (31/67, 46.3%). The ratios of military training-related injury in the army and armed police were 21.4% and 21.3%, respectively, but it is only 4.4% in the navy. The analysis of training subjects showed that about 49.2% of injuries occured during skill training, such as parachuting and operating firearms, and 29.5% occurred during physical exercise or counter-acting exercises. We also found that the ratio of sports-related injury increased and military training-related injury decreased with the level of education.

Injury Trends and Prevention in Youth Resistance Training

Resistance training has become a popular method of conditioning for children and adolescents in schools, recreation centers, and sports training facilities. However, the growing popularity of youth resistance training and the complex nature of some training programs raise new questions and concerns about the safety of this type of training for youth. In this article, the incidence, severity, and etiology of youth resistance training injuries are reviewed, risk factors for resistance training-related injuries are identified, and injury prevention strategies for youth who perform resistance exercise are discussed

Musculoskeletal injuries among overweight army trainees: incidence and health care utilization

Musculoskeletal injuries are a major cause of morbidity in military training. They are more common among overweight/obese individuals, and the prevalence of overweight/obesity in the military has increased. During strong economic periods, the military can be challenged to recruit enough qualified personnel, and physical standards are sometimes relaxed. This study was conducted to compare the incidence of and outpatient utilization for training-related overuse injuries among men who were over body fat (OBF) standards compared with those who were weight qualified (WQ). All study subjects were men ≥18 years old, who were classified as OBF or WQ and were followed for 90 days. During this period, everyone entering through the study sites was required to take a physical fitness test (5 min step test). Only individuals passing the fitness test were included in these analyses. There were 812 OBF and 6511 WQ study participants. OBF were 47% more likely to experience a musculoskeletal injury and had 49% higher health care utilization. Other significant factors included age >19 and a history of smoking. Among this population who had passed a fitness test, those who were OBF had a substantially higher risk of injury and higher utilization for these injuries. Because the recruiting environment is much better, military entrance standards have been tightened, but should the economy improve substantially the military may again be challenged to recruit adequate numbers of personnel, and the lessons learned in this project may prove valuable.

Relationship between training load and injury in professional rugby league players

Objectives: To investigate the relationship between training load and injury in professional rugby league players; Design: Prospective cohort study; Methods: Seventy-nine professional rugby league players (mean ± SD age, 23.3 ± 3.8 years) participated in this four-year study. A periodized field, strength, and power training program was implemented, with training loads progressively increased in the general preparatory phase of the season and reduced during the competitive phase of the season. Training loads and injuries were recorded for each training session. Results: Training load was significantly related ( P < 0.05) to overall injury ( r = 0.82), non-contact field injury ( r = 0.82), and contact field injury ( r = 0.80) rates. Significant relationships were also observed between the field training load and overall field injury ( r = 0.68), non-contact field injury ( r = 0.65), and contact field injury ( r = 0.63) rates. Strength and power training loads were significantly related to the incidence of strength and power injuries ( r = 0.63). There was no significant relationship between field training loads and the incidence of strength and power injuries. However, strength and power training loads were significantly ( P < 0.01) associated with the incidence of contact ( r = 0.75) and non-contact ( r = 0.82) field training injuries. Conclusions: These findings suggest that the harder rugby league players train, the more injuries they will sustain, and that high strength and power training loads may contribute indirectly to field injuries. Monitoring of training loads and careful scheduling of field and gymnasium sessions to avoid residual fatigue is warranted to minimize the effect of training-related injuries on professional rugby league players.

Squatting Kinematics and Kinetics and Their Application to Exercise Performance

The squat is one of the most frequently used exercises in the field of strength and conditioning. Considering the complexity of the exercise and the many variables related to performance, understanding squat biomechanics is of great importance for both achieving optimal muscular development as well as reducing the prospect of a training-related injury. Therefore, the purpose of this article is 2-fold: first, to examine kinematics and kinetics of the dynamic squat with respect to the ankle, knee, hip and spinal joints and, second, to provide recommendations based on these biomechanical factors for optimizing exercise performance.

Risk factors associated with self-reported training-related injury before arrival at the US army ordnance school

This study examined risk factors for self-reported injury incurred before arrival at Ordnance School for advanced individual training (AIT). During AIT in-processing, soldiers (n=27,289 men and 3856 women) completed a questionnaire that collected demographic and lifestyle information, and asked if the soldier currently had an injury that would affect their AIT performance. Potential risk factors for self-reported injury were explored using logistic regression. For men, self-reported injury was associated with older age [odds ratio (OR) >or=30 years/17-19 years=1.9], race (OR Black/Caucasian=1.2), basic combat training (BCT) site (OR Fort Benning/Fort Jackson=1.7; OR Fort Leonard Wood/Fort Jackson=1.6, OR Fort Knox/Fort Jackson=1.3), smoking on 20 or more days in the 30 days prior to BCT (OR smoker/non-smoker=1.2) and current illness (OR ill/not ill=6.2). For women, increased self-reported injury was associated with older age (OR>or=30 years/17-19 years=2.0), BCT site (OR Fort Leonard Wood/Fort Jackson=1.5) and current illness (OR ill/not ill=5.8). Certain demographic characteristics and lifestyle behaviours may be identified as injury risk factors on arrival at Ordnance AIT.

Epidemiology of Weight Training-Related Injuries Presenting to United States Emergency Departments, 1990 to 2007

Background As participation in weight training in the United States increases, the number of persons at injury risk increases. Purpose To examine weight training-related injuries in patients presenting to US emergency departments from 1990 to 2007. Study Design Descriptive epidemiology study. Methods Weight training-related injury data were analyzed from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System. Sample weights provided by this organization calculated national estimates of weight training-related injuries from the 100-hospital sample. Results From 1990 to 2007, 25 335 weight training injuries were seen in US emergency departments, correlating to an estimated 970 801 injuries nationwide. Patients’ mean age was 27.6 years (range, 6-100 years); 82.3% were male. The upper trunk (25.3%) and lower trunk (19.7%) were the most commonly injured body parts. The most common diagnosis was sprain/strain (46.1%). The most common mechanism of injury was weights dropping on the person (65.5%). A large number of injuries occurred with free weights (90.4%). Males had a larger proportion of upper trunk injuries (26.8%; injury proportion ratio [IPR], 1.45; 95% confidence interval [CI]: 1.36-1.57; P < .001) than females (18.4%). Females had a larger proportion of foot injuries (22.9%; IPR, 2.09; 95% CI: 1.93-2.26; P < .001) than males (11.0%). Persons 12 years and younger had a larger proportion of hand (37.9%; IPR, 2.08; 95% CI: 1.76-2.46; P < .001) injuries than persons 13 years or older (18.2%). Persons 55 years and older were injured more when using machines (18.2%; IPR, 1.96; 95% CI: 1.47-2.61, P < .001) than persons 54 years and younger (9.3%). Persons using free weights sustained a greater proportion of fractures/dislocations (23.6%; IPR, 2.44; 95% CI: 1.92-3.09; P < .001) than persons using machines (9.7%). Conclusion Further research is needed to drive development of targeted, age- and gender-specific, evidence-based injury prevention strategies to decrease injury rates among weight training participants.

Prevention of Physical Training–Related Injuries: Recommendations for the Military and Other Active Populations Based on Expedited Systematic Reviews

The Military Training Task Force of the Defense Safety Oversight Council chartered a Joint Services Physical Training Injury Prevention Working Group to: (1) establish the evidence base for making recommendations to prevent injuries; (2) prioritize the recommendations for prevention programs and policies; and (3) substantiate the need for further research and evaluation on interventions and programs likely to reduce physical training-related injuries.A work group was formed to identify, evaluate, and assess the level of scientific evidence for various physical training-related injury prevention strategies through an expedited systematic review process. Of 40 physical training-related injury prevention strategies identified, education, leader support, and surveillance were determined to be essential elements of a successful injury prevention program and not independent interventions. As a result of the expedited systematic reviews, one more essential element (research) was added for a total of four. Six strategies were not reviewed. The remaining 31 interventions were categorized into three levels representing the strength of recommendation: (1) recommended; (2) not recommended; and (3) insufficient evidence to recommend or not recommend.Education, leadership support, injury surveillance, and research were determined to be critical components of any successful injury prevention program. Six interventions (i.e., prevent overtraining, agility-like training, mouthguards, semirigid ankle braces, nutrient replacement, and synthetic socks) had strong enough evidence to become working group recommendations for implementation in the military services. Two interventions (i.e., back braces and pre-exercise administration of anti-inflammatory medication) were not recommended due to evidence of ineffectiveness or harm, 23 lacked sufficient scientific evidence to support recommendations for all military services at this time, and six were not evaluated.Six interventions should be implemented in all four military services immediately to reduce physical training-related injuries. Two strategies should be discouraged by all leaders at all levels. Of particular note, 23 popular physical training-related injury prevention strategies need further scientific investigation, review, and group consensus before they can be recommended to the military services or similar civilian populations. The expedited systematic process of evaluating interventions enabled the working group to build consensus around those injury prevention strategies that had enough scientific evidence to support a recommendation.

Sex Differences in “Weightlifting” Injuries Presenting to United States Emergency Rooms

Benefits of resistance training include improved muscle strength and sports performance and may include reduced injuries. However, few studies have examined sex differences in resistance training-related injuries. The objective of this investigation was to evaluate sex differences in injuries associated with strength training in adolescents and young adults by type (sprains and strains, fractures), mechanism (accidental, nonaccidental), and location (head, trunk, arm, hand, leg, foot) of injury. We hypothesized that there would be sex differences in type, mechanism, and location of strength training injuries. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 14 and 30 years were included in the study. CPSC sampling weights were used to calculate national estimates from the sample of 3,713 patients (men = 3,102; women = 611). Weighted Chi-square analyses were used to compare differences in mechanism, type, and location of injury for men versus women. Men had significantly more sprains and strains (p = 0.004), whereas women demonstrated increased accidental injuries compared to men (p < 0.001). The trunk was the most commonly injured body part for both men (36.9%) and women (27.4%). Men had more trunk injuries than women (p < 0.001), whereas women had more foot (p < 0.001) and leg (p = 0.03) injuries than men (p < 0.001). The findings indicate that men may suffer more exertional-type resistance injuries during strength training (sprains and strains) compared to women, especially at the trunk. Conversely, women may be more susceptible to lower-extremity injuries resulting from accidents during resistance training.

Youth Versus Adult “Weightlifting” Injuries Presenting to United States Emergency Rooms: Accidental Versus Nonaccidental Injury Mechanisms

Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as "accidental" if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4,111 patients. Accidental injuries decreased (p < 0.05) with age: 8 to 13 > 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p < 0.05). Evaluation of only the nonaccidental injuries (n = 2,565) showed that the oldest categories (19-22 and 23-30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p < 0.001). Two thirds of the injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to "dropping" and "pinching" in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p < 0.001). The study findings indicate that children have lower risk of resistance training-related joint sprains and muscle strains than adults. The majority of youth resistance training injuries are the result of accidents that are potentially preventable with increased supervision and stricter safety guidelines.

Risk Of Overuse Injury And Stress Fracture Among Female U.S. Army Recruits Exceeding Body Fat Limits

PURPOSE: To compare the risk of musculoskeletal injury among female Army recruits who were over body fat (OBF) standards on accession and were able pass a pre-accession physical fitness test, to those who met body fat standards (fully qualified, FQ) and were not required to pass a fitness test. Overuse injuries (OUI) in general and stress fractures (StFx) in particular are among the most common and serious training related injuries among men and women in the military, leading to substantial morbidity, direct medical costs, and indirect personnel and administrative costs. Trainees developing OUI and StFx are more likely to receive an early discharge from the military. METHODS: Each incident OUI and StFx event was identified from electronic medical records and was defined as the first outpatient encounter with an OUI or StFx diagnosis. The risk of OUI and StFx at 90 days was compared between 319 OBF subjects who passed a pre-accession physical fitness test and the population of 1656 FQ recruits. The fitness test comprised a 5-minute step test and a 1-minute push-up test, with results on each scored as pass or fail. The association between OBF status and injury was expressed as the relative risk (RR) with the 95 percent confidence interval (95% CI). RESULTS: Within the first 90 days of service, there were 172 first OUI among OBF (54%), and 836 among FQ (50%). There were 14 first StFx among OBF (4.4%), and 132 among FQ (8.0%). For OBF the OUI relative risk was 1.07 (0.95-1.20), and for StFx the relative risk was 0.55 (0.32-0.94). CONCLUSIONS: In the first 90 days of military service we observed a slight but not statistically significant (p=0.14) increase in risk of OUI, and a significantly decreased risk of StFx among OBF females. These patterns differ somewhat from those seen among men. The decrease in risk of stress fracture among OFB women may be physiologically plausible given the association of increased risk of stress fracture among individuals with low body mass index. The findings associated with OBF women and these injuries present interesting challenges for Army accession policy makers in balancing increased accessions of females with lower stress fracture risk, while controlling for costs to include possibly more overuse injuries and weight control programs.

Safety of Strength Training in Premenopausal Women: Musculoskeletal Injuries from a Two-Year Randomized Trial

The health benefits of strength training must be weighed against risks, including injuries. A prior study observed 4.2 injuries that limited usual activities for a day per 1000 strength training sessions among men and women. The analysis herein explores the incidence rates of musculoskeletal injuries from strength training in women. Randomized controlled trial. SETTING; Free-living community. A total of 163 injury-free, overweight, sedentary, premenopausal women aged 25 to 44 years. Two years of strength training (n = 81) or standard care (n = 82). The intervention followed published guidelines (U.S. Department of Health and Human Services) with hypothesized injury prevention strategies. An injury survey was administered at years 1 and 2. Injury was defined as physical activity or strength training associated injuries that limited daily activities for 1 week or more. Denominators for rate calculation were accelerometer-measured physical activity and strength training attendance (strength training only). The between-group probability of injuries was assessed using generalized estimating equations. Injury incidence rates were higher in strength training compared with standard care. In strength training, the injury rates were 3.6 per 1000 strength training sessions (95% confidence interval: 2.5-4.8 per 1000) for physical activity-related injuries, and 2.6 per 1000 (95% confidence interval: 1.5-3.6 per 1000) for strength training-related injuries. Injury rates varied by definition and denominator. Strength training had lower injury rates than previously reported, providing preliminary support for the prevention strategies. The finding of strength training injuries underscores the need for balancing the benefits against the potential risks of this exercise modality.

Injury Patterns and Injury Rates in the Circus Arts

Background Human circus arts are gaining increasing popularity as a physical activity with more than 500 companies and 200 schools. The only injury data that currently exist are a few case reports and 1 survey. Hypothesis To describe injury patterns and injury rates among Cirque du Soleil artists between 2002 and 2006. Study Design Descriptive epidemiology study. Methods The authors defined an injury as any work-related condition recorded in an electronic injury database that required a visit to the show therapist. Analyses for treatments, missed performances, and injury rates (per 1000 artist performances) were based on a subset of data that contained appropriate denominator (exposure) information (began in 2004). Results There were 1376 artists who sustained a total of the 18 336 show- or training-related injuries. The pattern of injuries was generally similar across sex and performance versus training. Most injuries were minor. Of the 6701 injuries with exposure data, 80% required ≤7 treatments and resulted in ≤1 completely missed performance. The overall show injury rate was 9.7 (95% confidence interval, 9.4–10.0; for context, published National Collegiate Athletic Association women’s gymnastics rate was 15.2 injuries per 1000 athlete-exposures). The rate for injuries resulting in more than 15 missed performances for acrobats (highest risk group) was 0.74 (95% confidence interval, 0.65–0.83), which is much lower than the corresponding estimated National Collegiate Athletic Association women’s gymnastics rate. Conclusion Most injuries in circus performers are minor, and rates of more serious injuries are lower than for many National Collegiate Athletic Association sports.

Risk Factors Associated with Self-Reported Training-Related Injury at the U.S. Army Ordnance School

Soldiers who have completed Basic Combat Training (BCT) continue to Advanced Individual Training (AIT) where they learn their military occupational specialty. Previous studies have focused on injuries experienced during AIT. PURPOSE: This study examined risk factors for self-reported injury incurred before arrival for Ordnance School AIT training. METHODS: Upon arrival for AIT, Soldiers (n=27,289 men and 3,856 women) completed a questionnaire that asked if they had a training-related injury that would interfere with their AIT training. The questionnaire also collected demographic and lifestyle characteristics. Backward stepping logistic regression was performed to examine associations between injury and other factors on the questionnaire. Multivariate odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. RESULTS: The prevalence of training injuries on arrival for AIT was 7.6% for men and 17.4 % for women. For men, analysis showed that higher risk of injury was independently associated with older age (OR (≥ 30years/17-19 years)=1.9, 95%CI=1.5-2.3), race (OR (Black/Caucasian)=1.2, 95%CI=1.1-1.4), BCT site (OR (Fort Benning/Fort Jackson)=1.7, 95%CI=1.4-2.1; OR (Fort Leonard Wood/Fort Jackson)=1.5, 95%CI=1.2-2.0), smoking within the last 30 days before BCT (OR(smoking/not smoking)=1.2, 95%CI=1.1-1.3), and a current self-reported illness (OR (ill/not ill)=6.4, 95%CI=5.2-7.9). For women, increased risk of injury was independently associated with older age (OR (≥ 30years/17-19 years)=2.2, 95%CI=1.5-3.2), basic training site (OR (Fort Leonard Wood/Fort Jackson)=1.5, 95%CI=1.1-2.0), and a current self-reported illness (OR(ill/not ill)=5.5, 95%CI=3.6-8.2). Factors not independently associated with injury included rank and smokeless tobacco use. CONCLUSION: Men were at higher injury risk if they were older, Black (relative to Caucasians), smoked within 30 days of attending BCT, attended BCT at Fort Leonard Wood or Fort Benning, or reported a current illness. Women were at higher injury risk if they were older, attended BCT at Fort Leonard Wood, or reported a current illness.