Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model

Table 7 Summary of studies that focused on bone (mineral) density, external rotation of the hip, flexibility, and foot type as risk factors for MskIs

Study	Publication year	Country	Branches	Unit/training	Study type	n	Risk factor^*
Bone (mineral) density (low)
Cosman [64]	2013	USA	Army	Military Academy	P	755 M, 136 F	Yes
Knapik [85]	2001	USA	Army	Recruits	P	182 M, 168 F	No
Lauder[90]	2000	USA	Army	Active duty	P	230 F	Yes (F)
External rotation of the hip (higher)
Burne [170]	2004	Australia	Military Academy		P	122 M, 25 F	No
Finestone [112]	2011	Israel	Army	Elite infantry soldier	P	77 M	No (M)
Garnock [113]	2018	Australia	Navy	Recruits	P	95 M, 39 F	Yes
Rauh [171]	2010	USA	Marines	Recruits BCT	P	748 F	Yes (F)
Sobhani [155]	2015	Iran	n/a	Recruits	R	181 M	Yes (M)
Flexibility (lower)
Heebner [157]	2017	USA	Army	Special Operations Forces	P	95	No
Keenan [172]	2017	USA	Multiple	Special Forces	P	726	Yes^#,##
Knapik [85]	2001	USA	Army	Recruits	P	182 M, 168 F	No^#
Nagai [92]	2017	USA	Army	Airborne Div	P	275	No^###
Wang [106]	2003	China	n/a	Military Police Forces Training	R	805 M	No (M)
Foot type
Esterman [173]	2005	Australia	Air Force	Recruits	P	230	No
Hetsroni [174]	2006	Israel	Army	Recruits	P	405 M	No^&
Levy [175]	2006	USA	n/a	Military Academy Cadets	R	431 M, 73 F	Yes^&&
Nunns [150]	2016	UK	Marines	Recruits	P	160 M	Yes (M)^&&&,&&&&
Psaila [94]	2017	Malta	n/a	Recruits BCT	P	114 M, 13 F	No
Reynolds [98]	2000	USA	Marines	Winter mountain training	P	356	Yes^&&&&&
Rice [120]	2017	UK	Marines	Recruits	P	147 M	Yes (M)^&&&
Yates [176]	2004	UK	Navy	Recruits	P	84 M, 40 F	Yes

BCT basis combat training; n/a not available; R retrospective study; P prospective study; M male; F female; (M) risk factor only for males; (F) risk factor only for females
*Risk factor for musculoskeletal injuries (MSkI); ^#Hamstring-flexibility; ^##Gastrocnemius-soleus flexibility; ^###Several muscle groups (shoulder, trunk rotation, hip extension, active knee extension, ankle dorsiflexion, ankle plantarflexion); ^&For any type for foot pronation; ^&&Pes planus; ^&&&Width malleolar; ^&&&&Arch index, corrected calf girth; ^&&&&&Forefoot varus

ISSN: 2054-9369