The number one injury in the U.S. military is musculoskeletal injury. One study, published in Military Medicine, estimates that these injuries cost the U.S. government about $20 billion dollars per year. This number accounts for compensation and benefits for those who exit the military with persisting injuries. Moreover, approximately 72% of MSKI’s are preventable, according to recent data published in the health of the force report from the U.S. Army and multiple other sources. This is not a recent discovery. The military has data dating back to the 1980’s demonstrating that disability claims were on the rise. It is only recently that they did some introspection to research possible causes. What they discovered was that the physical training protocols in place were failing to prepare soldiers for the physical demands of their duties (i.e. soldiers lacked the physical foundation to be loaded with heavy equipment and move quickly). The solution to this problem is rapidly being adapted across the United States Army in the form of holistic health and fitness, also known as H2F. The idea is to dump the old model of group PT, where everyone is prescribed the same exercises and instead, personalize the approach to training. This model encompasses the soldier’s biopsychosocial and physical components. The model is set to be completely implemented by 2024. While this program is extremely inclusive and covers a wide range of health areas, it is going to take more than just getting a group of diverse health providers in one place for access.
As of 2020, we are still seeing soldiers return to duty with persisting injuries that impair their ability to accomplish their duties. Emerging evidence suggest that up to 50% of soldiers may be returning to duty before fully recovering from injuries. Additionally, research has demonstrated that more than 50% of soldiers avoid medical treatment due to the negative associations tied to seeking help. Is it really a surprise that injury and disability rates are so high? It appears the system is set up to allow for this; poor training protocols, fear of asking for help, and releasing those who do ask for help before they fully recover. How can we optimize soldier health and prevent this issue from persisting in the future?
Physical therapists at the unit level would greatly enhance access to preventative and acute trauma care for soldiers. There is evidence that 91% of all MSKI work in the US military is provided by physical therapists and 45% of total outpatient work is associated with physical therapy. At some posts, direct access is occurring. However, in some cases, it may take up to 28 days to see a physical therapist after incurring a MSKI. This can exacerbate the injury of soldiers and increase long term disability. Something as simple as a grade 2 ankle sprain could lead to chronic ankle instability and even greater risk of strains, tears, or breaks in the future. Placing physical therapists at the battalion level within the military allows soldiers to gain early access and begin rehabilitation quickly.
Physical therapists are the most suitable medical expert for this position for many reasons. Many physical therapists are dual credentialed; meaning they have experience and training in multiple fields such as strength and conditioning or athletic training. This allows them to cover the spectrum of needs most likely to affect the tactical population: musculoskeletal deficits, such as joint mobility, motor control deficits, and some neurological issues. Those with dual credentials in strength & conditioning can help develop training protocols and work in conjunction with MFTs or unit strength coaches. When cases of acute trauma (i.e. sprains or strains) arise, those with AT certifications have the ability to treat immediately on the field when an acute injury occurs. Additionally, therapists can determine if fractures are present, determine if imagery is necessary, and treat both chronic and acute issues, saving both time and money. Moreover, they are trained to know which medical providers to refer out to if PT is not the correct treatment. Unlike Physician’s Assistants (PA) or Medical Doctors (MD), therapists work with patients over longer periods. This allows them to develop stronger relationships and earn the trust and confidence of their patients. If we want to develop a culture in the tactical community where asking for help is not seen as a weakness than physical therapists can help develop that culture by being present at the units. Having a therapist at every unit could greatly enhance the effects of the developing H2F model.
While I understand that this is a lot to ask of our leaders, it does not compare to the long-term costs and damage that occurs within the tactical community. As stated earlier, the financial costs alone are exorbitant, but even more so, this population experiences a dramatic loss in quality-of-life due to simple negligence and disregard of easily preventable issues. The U.S. Army currently has about 10 active duty divisions. This amounts to approximately 40 brigades and 200 battalions. At the median rate of pay for a physical therapist, it would only cost the us government about $18.2 million to accomplish this mission. That is significantly less than 1% of the entire cost that it takes to pay for one year of current long term disability rates and is far less than 1% of the current defense budget. Over three-million lost duty days annually, $20 billion in long term disability annually, and easily over 70% of it could be prevented. Why not try something different?