No pain, no gain: The military overtraining hypothesis of musculoskeletal stress and injury

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1 Scopus citations


The purpose of this manuscript is to present a model of military overtraining and subsequent injury, discharge, and disability. Military training and combat operations are physically and physiologically demanding, placing great strain on the musculoskeletal system of warfighters. Non-battle musculoskeletal injuries (MSKI) are common and present a serious threat to operational readiness in today’s military. MSKI risk stratification and prevention are an active area of research and is steeped in the background of sports science. Here, a model is proposed that incorporates the theory of General Adaptation Syndrome to describe how military training stressors may exceed that of training in traditional athletics and may induce sub-optimal training stressors. Positive feedback loops are discussed to explain how military overtraining (MOT) creates a system of ever-increasing stressors that can only be fully understood in the greater context of all environmental factors leading to overtraining. The Military Overtraining Hypothesis (MOTH) is proposed as a model that encapsulates the elevated MSKI risk in combat arms and other operational military personnel as an effort to broaden understanding of multifactorial military MSKI etiologies and as a tool for researchers and commanders to contextualize MSKI research and risk mitigation interventions.

Original languageEnglish
Pages (from-to)2289-2299
Number of pages11
JournalPhysiotherapy Theory and Practice
Issue number11
StatePublished - 2023

Bibliographical note

Publisher Copyright:
© 2022 Taylor & Francis Group, LLC.


  • Military
  • general adaptation syndrome
  • injury
  • musculoskeletal
  • nutrition
  • overtraining

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation


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