Safety first

March 14, 2002

Maj Marty McKone, halfback for the ACSC XV in its rugby match against the VCDF's XV, takes off from behind a ruck.
The fitness and sport safety strategy is aimed at making participation in sport safer.
Photo by Cmdr Adam Grunsell

THE ADF should implement a physical fitness and sport safety strategy to increase health and reduce related injuries in personnel, according to a report commissioned by Defence.

The report, by Monash University's Accident Research Centre, says the expected benefits of personnel increasing safe participation in fitness include " a realistic estimate of reduction of injuries of 25 per cent per annum" or a decrease by 51.6 injuries for every 10,000 personnel each week.

The Defence Health Service commissioned the report, Strategic Direction and Advice For Increasing Safe Participation In Physical Activity In The Australian Defence Force, last year as a result of substantial increases in the cost of invalidity retirement and compensation claims caused by injuries.

It says it is essential to establish "which particular sporting and physical activities are associated with the greatest health benefits and the least health costs for the ADF".

"Promotion of vigorous exercise needs to be accompanied by explicit, evidence-based strategies to promote safe participation."

Navy Capt Jenny Firman, Director Preventive Health, said the study was commissioned to see where the ADF could make the best interventions to prevent sport and physical training injury.

"For some time now we've been collecting data about rates of injuries from sport and physical training that made us realise that we needed to make some changes in that area," she said.

"The most obvious way to reduce injuries from those two areas is not to do them - but that is fundamentally incompatible with lots of good things that come from exercise and sport."

The report says the major cause of injury associated with physical activity in ADF personnel is "Physical Training, which accounts for more than three times the number of casualties than other specific activities".

PT accounted for 14.3 per cent of total casualties among full-time ADF personnel with four sports - rugby union, rugby league, touch football and soccer - ranked among the 10 leading causes of casualties and Work Days Lost (WDL).

Other sports prominent in the ranked list of casualty-producing physical activities associated with significant proportions of WDL were:
Running and jogging (2 per cent of all casualties).
Australian football (1.9 per cent).
Basketball and netball (1.8 per cent).
Volleyball, which was ranked among the top 15 physical activities associated with WDL.

It found that the most common injuries were strains and sprains followed by muscle, tendon and soft tissue injuries, except for rugby and soccer where fractures were more common. The major injury sites were the knee, ankle and shoulder.

Injuries during PT accounted for the highest loss of working days, days of hospitalisation, sick days and light duty days. Most moderate or severe injuries tended to occur during the first two weeks of training.

"The ADF culture of strong competitiveness in sport results in a substantial loss of personnel working capacity due to injury," the report says.

The report recommended three overall strategies to prevent injury and increase participation in physical activity through implementation in a nine-step ADF Action Plan:

Injury surveillance. Collect data on activity-specific participation rates and exposure levels for physical activities with high-injury frequency and high WDL to identify priorities for injury prevention.
Current injury surveillance systems should also be refined to improve information on cause and circumstances of injuries.
Strategic research. This would focus on high-risk groups and environments with the largest impact on readiness. It would include more than basic training, infantry and special forces.

Other research would study risk and protective factors and the incidence of injury, the maintenance of fitness after basic training and the cost effectiveness of injury prevention.

Injury prevention implementation and evaluation. A trial of modified military (basic) training incorporating a smooth progression in intensity, duration and frequency should be conducted.

This could include: trials of pre-selection screening of recruits for injury-risk factors; interval training versus continuous training; modified risk factors for female recruit training; equipment design and use; strength training and effects on injury reduction; and deep water running as a substitute for running.

Capt Firman said the most important finding was that all the work the ADF had done up until the time of the report indicated that it was on the right path.

"The other is that, rather than stopping sport to prevent injuries, we actually need to do more physical activity because there are many benefits to be gained from doing more than we do now," she said.

"We just have to do it smarter and take heed of some of the interventions that exist to make it a safer activity."

The full report is available through the Defence Health Service web page at www.defence.gov.au/dpe/dhs by following links through info centre/publications/reports.

The Accident Research Centre report made specific recommendations for injury prevention in physical training and sports activities:
Pre-season assessment six weeks before a new season to ensure only fully fit and rehabilitated players participate. This would be linked to tailored training regimes.
Players should not be released to participate after injury unless they have completed a full rehabilitation regime.
Pre-season and in-season conditioning under trained supervision, including specific training to prevent ankle and knee injuries. Players with unstable knees should not compete. This would include special weights training for frail players and physical impact drills before the season to match-harden players.
Mandatory wearing of ankle braces by players with previously injured or unstable ankles and the taping of ankles by players at high risk because of the position they play.
Mandatory wearing of shin guards and mouth guards for football codes; facial grease, chest, thigh and shoulder pads for rugby players.
Institute accredited referee training so that all ADF matches are under the control of an accredited referee with additional training in injury prevention and first aid.
Ban informal or scratch touch games or establish strict conditions to govern ADF touch games, such as rules, materials, footwear, teams, playing surface, behaviour, umpiring, warm-ups and cool-downs, and first aid.
Limit or ban ADF personnel from informal/scratch rugby matches.
Consider reducing the exposure of ADF personnel to organised competition rugby.
Increase the number of allowable substitutes in rugby and soccer matches and encourage player substitution (but players should not be played out of position).
Mandatory warm-ups and cool-downs.
Mandatory accreditation of coaches in touch, rugby and soccer to the National Coaching Accreditation Scheme to at least Level 2.
Monitor training hours players are involved in to prevent over-training and institute individual training, injury and rehabilitation log books.
Supply shoes appropriate to ground surface conditions.
Conduct research into injuries related to tackles in rugby to help preventive measures, such as changes to techniques, refereeing, rules and personal equipment.
Conduct research into why senior rugby players choose not to wear headgear and whether wearing headgear alters behaviour.
Capt Firman said the ADF wanted to assess all the available evidence to see what modifications to PT and sport would reduce injuries.

"There's no point in doing something if it isn't going to make any difference - we want to do things that actually work, so we need to gather accurate data," she said.

By David Sibley and Cpl Jonathan Garland