Physical training injury prevention

The Air Force will begin official scoring under the new standards of the Physical Fitness Readiness Program on July 1.

Airmen will be assessed on the following physical fitness readiness components:

1. Cardiorespiratory Fitness: 2.0-Mile Run, 20-meter High Aerobic Multi-shuttle Run (HAMR) or the 2-kilometer walk (if not medically cleared to run).
2. Muscular Strength: 1-minute push-ups, or 2-minute hand release push-ups.
3. Core Endurance: 1-minute sit-ups, 2-minute cross leg reverse crunch, or timed forearm plank.
4. Body Composition: Waist-to-Height Ratio.

The goal of the PFRP is to ensure members safely and consistently meet the physical demands of routine duties and contingency operations.

Physical training is necessary to develop and maintain the fitness required to accomplish military missions, but it is also known to cause injury.

Physical training and sports activity are the leading cause of injuries across all U.S. military Services, according to the Defense Health Agency MSMR. Historically, almost half of all Service members experience an injury annually, accounting for over five million medical encounters and 25 million days of limited duty days per year, according to the DHA 2023 Health of the Force Report.

Over 95% of military injuries are musculoskeletal injuries or MSKIs. MSKIs affect the bones, muscles, joints, ligaments and tendons.

Both microtraumatic overuse and acute traumatic injuries contribute to limited duty days.

Out of all new military injuries, more than two-thirds are caused by cumulative microtrauma (known as ‘overuse’ injuries). Overuse injuries occur from a repeated, low-intensity force over time. Lower body overuse MSKIs are most common, often due to excessive running.

The repeated stress on the lower body from running causes microscopic tears to tissues that the body repairs to rebuild and become stronger. This is referred to as adaptation. If the body does not have time to repair accumulated tears, the damage can become an overuse injury.

Back, knee and joint pain, stress fractures, shin splints, Achilles tendinitis, and bursitis are common overuse injuries.

Traumatic (acute) injuries may happen during sports activity and occur instantaneously from a high-intensity force or an abrupt movement such as a fall, a blow to the body, an awkward twist when lifting, or a sharp pivot.

Muscle strains, ligament sprains, dislocated joints, contusions (bruises), and fractured bones are examples of traumatic injuries.

When implementing PFRP training, there is a fine line between the balance of pushing the right amount to prepare yourself for any physical goal and either overdoing or underdoing it. The challenge for Airmen is how to enhance fitness while minimizing injuries.

Fortunately, most MSKIs are usually preventable.

Brandon Powers, Operational Support Team strength and conditioning specialist at Wright-Patterson Air Force Base, offers the following tips on how to reduce your risk of MSKIs during physical training.

1) Avoid too much physical activity too soon. “Avoid over-exercising by gradually working toward your goals, taking small steps to ensure you’re progressing without overdoing it,” states Powers.

Most overuse injuries occur in individual preparation if the goal is to improve quickly before an unrealistic deadline. He recommends keeping a fitness journal and making notes about your progress.

For an Airman returning to running after being off more than eight weeks, Powers recommends beginning with a walking program to allow your body to safely adapt to the progressive physical demands. The goal is to build up to 30 minutes of non-stop walking.

2) Take time to warm up and cool down. “The purpose of a warm-up is to increase blood flow to working muscles and wake up the nervous system to prepare for exercise,” says Powers.

Easing into your workouts with a warm-up will prep your muscles for activity and reduce the risk of muscle tears and injuries.

Powers recommends starting your training session with dynamic stretches and mobility where you move through a range of motion rather than holding stretches. You can then follow the warm-up with some low-effort activity specific to your training session.

Key exercises include:

• Walking knee hug.
• Walking lunge and twist.
• World’s greatest stretch.
• Open/close the gate.
• Vertical side hops.

Cooldown after a workout by gradually reducing intensity for 5-10 minutes through light activity (walking, slow cycling) followed by static stretching to lower heart rate and prevent muscle stiffness. Stretching can help improve your flexibility at the end of the workout when your muscles are warm.

Powers suggests the following static stretching exercises to finish your cooldown:

• Hamstring stretch.
• 90/90 stretch.
• Quad stretch.
• Shoulder stretch.
• Chest stretch.
• Hold each stretch for 20 - 30 seconds.

3) Add active recovery to your workouts. There are two types of recovery after exercise: active and passive. Active recovery involves doing something such as light exercise, stretching, foam rolling, or massage. Passive recovery is purely rest as when you’re sitting, lying down, or sleeping. Active recovery can help reduce delayed muscle soreness and aid with the repair process as your muscles rebuild.

Active recovery works because it increases blood flow to the muscles and joints. This improved blood supply takes away toxins and brings in fresh nutrients for healing.

Powers offers a few different types of active recovery methods to add to your exercise plan.

• Foam rolling. “Foam rolling can help reduce muscle soreness and improve your flexibility and mobility,” states Powers.

Foam rolling is like a massage. It uses compression to help release a knot or tender spot that has developed within the muscle. The compression causes the nerve to relax and loosens muscle, gets the blood flowing, and helps the body recover.

• Light activity. “Light activity on rest days can aid in the recovery process by increasing blood flow, reducing muscle stiffness, maintaining fitness consistency, and providing necessary mental breaks from high-intensity training,” states Powers.

Effective low-intensity activities include walking, light jogging, and leisurely cycling.

• Cross Train. “Cross-training for the cardio portion of the PFRP builds cardiovascular endurance without the high-impact pounding and strain on muscles and joints,” states Powers.

Cross training means adding in another form of activity like cycling, elliptical machine, rucking or rowing to work the heart and lungs without the impact of daily running. This type of training will help reduce the risk of developing a typical repetitive injury from running (shin splints, tendinitis, stress fracture).

4) Sleep your way to better physical performance. “Good, quality sleep is one of the most effective ways to recover and recharge after training and exercise,” states Powers.

Sleep is particularly important after physical exertion, as it enables the body to transition from a catabolic (breakdown) state to an anabolic (build-up) state. During deep sleep, the body produces higher levels of growth hormone that stimulates the repair of muscle fibers that may have been broken down during physical conditioning. Also, during sleep the body repairs cartilage and other connective tissues, ensuring that the joints remain lubricated and functional.

Sleep needs are variable from person to person. Most adults need seven or more hours of sleep each night.

Powers offers the following tips for improving your sleep quality for enhanced performance and recovery:

• Establish a consistent sleep schedule. Try to go to bed and wake up at the same time every day, even on weekends.
• Optimize your sleep environment. Make your bedroom conducive to sleep by keeping it cool, dark, and quiet.
• Avoid large meals and beverages late at night. Discomfort might keep you up.
• Create a relaxing bedtime routine. Set aside at least 20-30 minutes before bedtime to wind down.

When it comes to physical training, more is not always better. Your body will have a natural way of telling you when you have done too much. You will likely need a break from physical training if you experience:

• Physical fatigue and extreme muscle soreness. Intense, lingering muscle soreness (lasting days) and general exhaustion that doesn’t go away after a good night’s sleep.
• Diminished performance. Struggling with weights or paces that are usually easy, indicating a plateau.
• Mood changes. Unexplained irritability, low motivation, or feeling emotionally “spent”.
• Increased illness. Overtraining can weaken your immune system and make you more susceptible to picking up whatever bugs are going around.
• Injuries. Developing overuse injuries like tendonitis or shin splints often occur when you don’t give your body enough recovery time.
• Sleep disruption. Difficulty falling or staying asleep, even if you are tired.

Do not be worried about taking time off to allow your body to recover. Perform active recovery (walking, stretching, foam rolling), prioritize sleep (7-9 hours), and focus on high-quality nutrition to replenish.

The Warfighter’s Fitness Playbook offers detailed guidance on workouts, recovery strategies, sleep optimization, and nutrition-all interconnected elements essential for sustained performance.