Rucking-Related Assessment of Muscular, Psychological, and Biomechanical Contributors to Hip Pain and Cartilage Integrity in Females (RAMP)

Abstract Musculoskeletal (MSK) injuries within the military population account for over 2 million medical visits, 25 lost duty days and over $700 million in healthcare costs annually. Approximately 55% of medical encounters that occur during basic combat training are MSK injuries. Over 60% of these MSK injury-related medical encounters occur in female recruits and suggests that females are at a higher risk of MSK injury during basic combat training compared to male recruits. Regardless of the specific branch of service, the risk of lower extremity MSK injury is significantly higher in females (39 - 41%) compared to males (18 - 19%). In addition, the average injury-related medical costs incurred during basic combat training were significantly higher in females compared males. It is evident that female service members are at a higher risk of injury, particularly during basic combat training, and suggests that the underlying mechanisms related to these injuries differ between male and female cadets. If not treated properly, these injuries incurred by female recruits during basic training will lead to the development of various medical conditions including chronic joint pain and osteoarthritis (OA). Military service members perform various high demand activities, including loaded rucking, which may negatively impact the loading patterns across the entire lower extremity. Heavy rucksack loads account for approximately 20% of documented injuries in military personnel. The hip joint is the most common site of injury (24%) in female service members while the foot/toes (26%) is the most common site of injury within male service members. Females exhibit a higher incidence rate of hip-related injuries during basic combat training compared to male recruits and may be due to the extensive amounts of loaded rucking performed during basic combat training. If not treated properly, these hip joint injuries may predispose female service members to a higher risk of developing chronic hip joint pain, hip joint cartilage degeneration and eventual development of hip OA. Regardless of age, service, rank and race, female service members exhibit a significantly higher incidence rate of hip OA compared to male service members. The development of hip OA at an earlier age in female service members with a prior hip-related injury will result in a higher economic- and clinical-burden on the military healthcare system as well as a larger amount of lost duty days. Therefore, targeted multi-disciplinary interventions that can be implemented in female cadets during basic combat training should be developed to reduce the risk of hip injury and the correspondingly high risk of developing hip OA in female service members.