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Epidemiology of Physical Injuries in Iranian Soldiers During Military Training Course 

Ramadan Rahmani �, Seyyed Yaser Mousavi Tabar *�, Maziar Karamali �
1. PhD, Sport Physiology Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
2. MSc, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
3. MSc, Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
*Corresponding Author: HYPERLINK "mailto:Mousaviyaser41@yahoo.com"Mousaviyaser41@yahoo.com















Epidemiology of Physical Injuries in Iranian Soldiers During Military Training Course

Physical injuries are one of the main issues for military recruits specifically during the military training course. The aim of this study was to determine  the epidemiology of physical injuries during a military training course and its risks in Iranian soldiers. This cross sectional study   was implemented on a soldier population in military training garrisons of the army in one of the Iranian armed forces. Five garrisons were chosen randomly and the injured soldiers during the military training course were studied using a questionnaire and checklist. According to results, . 14.8% of the subjects suffered from trauma occurring during the military training course. 72.3%  complained of pain. Injuries in the lower parts of the body having a bruise,  cracked foot skin and pain had the most frequency among other parts.  A majority of the traumas with the frequency of 54.2% had occurred in the course of military training. There was a significant relationship between the incidence of a blister and the variables of body mass index and soldiers� athletic background. The incidence of more injuries in the course of military training is of crucial importance requiring more care. Through proper planning and implementing military training  courses can be reduced to a minimum.
Keywords:  Assessment, Military Training, Physical Injuries, Epidemiology, Accident





Introduction 
All around the world in the army, military training is a necessity and is aimed at creating physical preparedness and building up military strength. Considering that, the authors have defined some of the military training aims and their positive and negative consequences as follows: military training course is aimed at physical preparedness and the reinforcement of the individual�s strength in order that they can fulfill their assigned duty in wartime and perform an acceptable maneuver. The soldiers�  physical preparedness has a crucial effect on their victory or failure  ADDIN EN.CITE <EndNote><Cite><Author>Najafi Mehri</Author><Year>2010</Year><RecNum>120</RecNum><record><rec-number>120</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">120</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Najafi Mehri, S</author><author>Sadeghian, MAJID</author><author>Tayyebi, A</author><author>AA, Karimi Zarchi</author><author>Asgari, AR</author></authors></contributors><titles><title>Epidemiology of physical injuries resulted from military training course</title><secondary-title>MilMed Journal</secondary-title></titles><periodical><full-title>MilMed Journal</full-title></periodical><pages>89-92</pages><volume>12</volume><number>2</number><dates><year>2010</year></dates><publisher>MilMed Journal</publisher><urls></urls></record></Cite></EndNote>[1] . Physical fitness programs improve soldier�s preparedness and increase their physical strength, tolerance and agility. There is a direct relationship between soldiers� physical fitness and their military competence  ADDIN EN.CITE <EndNote><Cite><Author>Pandolf</Author><Year>2011</Year><RecNum>176</RecNum><record><rec-number>176</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">176</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pandolf, Kent B</author><author>Francesconi, Ralph</author><author>Sawka, Michael N</author><author>Cymerman, Allen</author><author>Hoyt, Reed W</author><author>Young, Andrew J</author><author>Zambraski, Edward J</author></authors></contributors><titles><title>United States Army Research Institute of Environmental Medicine: Warfighter research focusing on the past 25 years</title><secondary-title>Advances in Physiology Education</secondary-title></titles><periodical><full-title>Advances in Physiology Education</full-title></periodical><pages>353-360</pages><volume>35</volume><number>4</number><dates><year>2011</year></dates><publisher>Am Physiological Soc</publisher><isbn>1043-4046</isbn><urls></urls></record></Cite></EndNote>[2]. Primary military training effectively improves soldiers� tolerance but can be harmful while they are practicing jumping activities  ADDIN EN.CITE <EndNote><Cite><Author>Rosendal</Author><Year>2003</Year><RecNum>80</RecNum><record><rec-number>80</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">80</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rosendal, Lars</author><author>Langberg, Henning</author><author>Skov-Jensen, Arne</author><author>Kj�r, Michael</author></authors></contributors><titles><title>Incidence of injury and physical performance adaptations during military training</title><secondary-title>Clinical Journal of Sport Medicine</secondary-title></titles><periodical><full-title>Clinical Journal of Sport Medicine</full-title></periodical><pages>157-163</pages><volume>13</volume><number>3</number><dates><year>2003</year></dates><publisher>LWW</publisher><isbn>1050-642X</isbn><urls><related-urls><url>http://journals.lww.com/cjsportsmed/Abstract/2003/05000/Incidence_of_Injury_and_Physical_Performance.6.aspx</url></related-urls></urls></record></Cite></EndNote>[3]. Performing difficult physical exercises can enhance the required features and capabilities in military forces. During military training, all the soldiers reach a desired level of preparedness proportionate to the training situations. However, thoughtless pursuit of these aims can endanger military capabilities of the forces such as their physical efficiency and health  ADDIN EN.CITE <EndNote><Cite><Author>Billings</Author><Year>2004</Year><RecNum>166</RecNum><record><rec-number>166</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">166</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Billings, Christine E</author></authors></contributors><titles><title>Epidemiology of Injuries and Illnesses during the United States Air Force Academy 2002 Basic Cadet Training Program-Documenting the Need for Prevention</title><secondary-title>Military medicine</secondary-title></titles><periodical><full-title>Military medicine</full-title></periodical><pages>664-670</pages><volume>169</volume><number>8</number><dates><year>2004</year></dates><publisher>AMSUS-Association of Military Surgeons of the US</publisher><isbn>0026-4075</isbn><urls></urls></record></Cite></EndNote>[4].
Trauma and musculoskeletal injuries are among common problems for soldiers during military training and for athletes during doing exercises. Thus knowing the different aspects of these problems such as their frequency and risk factors are of crucial importance.  The term �trauma� means acute physiological or structural change in the body. This change occurs when the amount of input energy can not keep pace with the speed at which the body burns or tolerates it  ADDIN EN.CITE <EndNote><Cite><Author>Linda</Author><Year>2010</Year><RecNum>172</RecNum><record><rec-number>172</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">172</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>DU Linda </author><author>MS Kathleen </author><author>EL Mary </author></authors></contributors><titles><title>Critical Care Nursing</title></titles><volume>38</volume><section>938</section><dates><year>2010</year></dates><publisher>mosby elsevier</publisher><urls></urls></record></Cite></EndNote>[5]. Trauma refers to a physical injury caused when directly or indirectly the individual is subjected toanexternal forceful energy which is out of physiological tolerance of the body. Trauma indicates injuries affecting one or several systems of the body and is caused by several mechanisms such as driving accidents, falling, being crushed, and being buried under the rubband  ADDIN EN.CITE <EndNote><Cite><Author>Nikravanmofrad</Author><Year>1385</Year><RecNum>173</RecNum><record><rec-number>173</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">173</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author> Malahat Nikravanmofrad</author></authors></contributors><titles><title>Management of trauma victims</title></titles><dates><year>1385</year></dates><pub-location>Tehran</pub-location><publisher>Nour e Danesh</publisher><urls></urls></record></Cite></EndNote>[6]. Military training for soldiers is considered a tough physical activity and there is a direct relationship between physical injuries and  physical activities. It has  shown that primary military trainings have just one positive effect and that is enhancing soldiers� stamina. Of course, low preparedness will heighten the risk of injuries during training  ADDIN EN.CITE <EndNote><Cite><Author>Rosendal</Author><Year>2003</Year><RecNum>80</RecNum><record><rec-number>80</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">80</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rosendal, Lars</author><author>Langberg, Henning</author><author>Skov-Jensen, Arne</author><author>Kj�r, Michael</author></authors></contributors><titles><title>Incidence of injury and physical performance adaptations during military training</title><secondary-title>Clinical Journal of Sport Medicine</secondary-title></titles><periodical><full-title>Clinical Journal of Sport Medicine</full-title></periodical><pages>157-163</pages><volume>13</volume><number>3</number><dates><year>2003</year></dates><publisher>LWW</publisher><isbn>1050-642X</isbn><urls><related-urls><url>http://journals.lww.com/cjsportsmed/Abstract/2003/05000/Incidence_of_Injury_and_Physical_Performance.6.aspx</url></related-urls></urls></record></Cite><Cite><Author>Rosendal</Author><Year>2003</Year><RecNum>80</RecNum><record><rec-number>80</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">80</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rosendal, Lars</author><author>Langberg, Henning</author><author>Skov-Jensen, Arne</author><author>Kj�r, Michael</author></authors></contributors><titles><title>Incidence of injury and physical performance adaptations during military training</title><secondary-title>Clinical Journal of Sport Medicine</secondary-title></titles><periodical><full-title>Clinical Journal of Sport Medicine</full-title></periodical><pages>157-163</pages><volume>13</volume><number>3</number><dates><year>2003</year></dates><publisher>LWW</publisher><isbn>1050-642X</isbn><urls><related-urls><url>http://journals.lww.com/cjsportsmed/Abstract/2003/05000/Incidence_of_Injury_and_Physical_Performance.6.aspx</url></related-urls></urls></record></Cite></EndNote>[3]. Education has an important role in preventing and reducing physical injuries in soldiers and usually those gone through training have experienced less musculoskeletal injuries  ADDIN EN.CITE <EndNote><Cite><Author>Larsson</Author><Year>2012</Year><RecNum>151</RecNum><record><rec-number>151</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">151</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Larsson, Helena</author><author>Tegern, Matthias</author><author>Harms-Ringdahl, Karin</author></authors></contributors><titles><title>Influence of the implementation of a comprehensive intervention programme on premature discharge outcomes from military training</title><secondary-title>Work: A Journal of Prevention, Assessment and Rehabilitation</secondary-title></titles><periodical><full-title>Work: A Journal of Prevention, Assessment and Rehabilitation</full-title></periodical><pages>241-251</pages><volume>42</volume><number>2</number><dates><year>2012</year></dates><publisher>IOS Press</publisher><isbn>1051-9815</isbn><urls></urls></record></Cite></EndNote>[7]. A formulatedProgrammeto impede soldiers� injuries can protect parts of the body angaist injuries. Parkkari et al. (2011) argued the above mentioned issue while conducting a research on two groups of control and intervention. During this research, training could considerably reduce the injuries in upper parts of the body and ankles in the intervention group  ADDIN EN.CITE <EndNote><Cite><Author>Parkkari</Author><Year>2011</Year><RecNum>130</RecNum><record><rec-number>130</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">130</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Parkkari, Jari</author><author>Taanila, Henri</author><author>Suni, Jaana</author><author>Mattila, Ville M</author><author>Ohrank�mmen, Olli</author><author>Vuorinen, Petteri</author><author>Kannus, Pekka</author><author>Pihlajam�ki, Harri</author></authors></contributors><titles><title>Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study</title><secondary-title>BMC medicine</secondary-title></titles><periodical><full-title>BMC medicine</full-title></periodical><pages>35</pages><volume>9</volume><number>1</number><dates><year>2011</year></dates><publisher>BioMed Central Ltd</publisher><isbn>1741-7015</isbn><urls></urls></record></Cite></EndNote>[8]. 
Physical injuries are the most widespread reason for military recruits especially soldiers to see a doctor during military training in Iran and other parts of the world. Zambraski (2012), regarding the injury causes in military recruits and their consequences, contends that the injuries in military recruits may be the result of the direct war incidents, non- military incidents, transfer, other military operations, or even the accidents occurring during training course. These injuries can lead to loss of physical strength, hinder fulfilling one�s duty, incur remedial expenses and affect the individual�s quality of life  ADDIN EN.CITE <EndNote><Cite><Author>Zambraski</Author><Year>2012</Year><RecNum>167</RecNum><record><rec-number>167</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">167</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Zambraski, Edward J</author><author>Yancosek, Kathleen E</author></authors></contributors><titles><title>Prevention and rehabilitation of musculoskeletal injuries during military operations and training</title><secondary-title>The Journal of Strength &amp; Conditioning Research</secondary-title></titles><periodical><full-title>The Journal of Strength &amp; Conditioning Research</full-title></periodical><pages>S101-S106</pages><volume>26</volume><dates><year>2012</year></dates><publisher>LWW</publisher><isbn>1064-8011</isbn><urls></urls></record></Cite></EndNote>[9]. 
Najafi et al (2010) write the most common reason for coming to the clinic in commission-traininggarrisons in Iranarephysical injuries  ADDIN EN.CITE <EndNote><Cite><Author>Najafi Mehri</Author><Year>2010</Year><RecNum>120</RecNum><record><rec-number>120</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">120</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Najafi Mehri, S</author><author>Sadeghian, MAJID</author><author>Tayyebi, A</author><author>AA, Karimi Zarchi</author><author>Asgari, AR</author></authors></contributors><titles><title>Epidemiology of physical injuries resulted from military training course</title><secondary-title>MilMed Journal</secondary-title></titles><periodical><full-title>MilMed Journal</full-title></periodical><pages>89-92</pages><volume>12</volume><number>2</number><dates><year>2010</year></dates><publisher>MilMed Journal</publisher><urls></urls></record></Cite></EndNote>[1]. The incidence rate of trauma in the US soldiers (in 2002) during a two-month military training course was %29 in men and %53 in women. The risk factors of injuries in military recruits during military practices included female sex, too low physical flexibility, insufficient physical activities, smoking, scarcely or extremely curved legs, Knee Q Angle more than 15 degrees, Genoa Valgus, low level of muscular tolerance, old age, BMI, and  light skin  ADDIN EN.CITE <EndNote><Cite><Author>Pandolf</Author><Year>2011</Year><RecNum>176</RecNum><record><rec-number>176</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">176</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pandolf, Kent B</author><author>Francesconi, Ralph</author><author>Sawka, Michael N</author><author>Cymerman, Allen</author><author>Hoyt, Reed W</author><author>Young, Andrew J</author><author>Zambraski, Edward J</author></authors></contributors><titles><title>United States Army Research Institute of Environmental Medicine: Warfighter research focusing on the past 25 years</title><secondary-title>Advances in Physiology Education</secondary-title></titles><periodical><full-title>Advances in Physiology Education</full-title></periodical><pages>353-360</pages><volume>35</volume><number>4</number><dates><year>2011</year></dates><publisher>Am Physiological Soc</publisher><isbn>1043-4046</isbn><urls></urls></record></Cite></EndNote>[2].. In fact, risk factors of physical injuries in soldiers during military training are related to two categories of personal and impersonal. These are various factors some of which the researchers have referred in their studies.
Kaufman et al., (2000) state that physical injuries occurring during military training is considered to be one of the main problems. They leads to the waste of training and practicing time and decrease in soldiers� military preparedness and also eventually results in spending enormous expenses on training. The results of their researches show that the incurred injuries in individuals have a direct relationship to factors such as weak physical condition, lack of physical preparedness background, prior experience of injury, too much exhausting training during the course, smoking and biomechanical factors  ADDIN EN.CITE <EndNote><Cite><Author>Kaufman</Author><Year>2000</Year><RecNum>168</RecNum><record><rec-number>168</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">168</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kaufman, Kenton R</author><author>Brodine, Stephanie</author><author>Shaffer, Richard</author></authors></contributors><titles><title>Military training-related injuries: surveillance, research, and prevention</title><secondary-title>American journal of preventive medicine</secondary-title></titles><periodical><full-title>American journal of preventive medicine</full-title></periodical><pages>54</pages><volume>18</volume><number>3 Suppl</number><dates><year>2000</year></dates><isbn>0749-3797</isbn><urls></urls></record></Cite></EndNote>[10]. The studies have proved that the less educated the soldiers are, the more they experience the incidence of backache. Similarly the lower their physical preparedness is, the more they suffer from backache  ADDIN EN.CITE <EndNote><Cite><Author>Taanila</Author><Year>2012</Year><RecNum>140</RecNum><record><rec-number>140</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">140</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Taanila, Henri P</author><author>Suni, Jaana H</author><author>Pihlajam�ki, Harri K</author><author>Mattila, Ville M</author><author>Ohrank�mmen, Olli</author><author>Vuorinen, Petteri</author><author>Parkkari, Jari P</author></authors></contributors><titles><title>Predictors of low back pain in physically active conscripts with special emphasis on muscular fitness</title><secondary-title>The Spine Journal</secondary-title></titles><periodical><full-title>The Spine Journal</full-title></periodical><pages>737-748</pages><volume>12</volume><number>9</number><dates><year>2012</year></dates><publisher>Elsevier</publisher><isbn>1529-9430</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/22297262</url></related-urls></urls></record></Cite></EndNote>[11]. One of the other problems the soldiers encounter is doing their military service in warm regions. The injuries caused by the hot temperature usually affect those non-native soldiers whose physiological conditions cannot adapt to this climate. Preventing heatstroke involves educating and making use of preventive and adaptive methods  ADDIN EN.CITE <EndNote><Cite><Author>Epstein</Author><Year>2012</Year><RecNum>138</RecNum><record><rec-number>138</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">138</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Epstein, Yoram</author><author>Druyan, Amit</author><author>Heled, Yuval</author></authors></contributors><titles><title>Heat injury prevention�a military perspective</title><secondary-title>The Journal of Strength &amp; Conditioning Research</secondary-title></titles><periodical><full-title>The Journal of Strength &amp; Conditioning Research</full-title></periodical><pages>S82-S86</pages><volume>26</volume><dates><year>2012</year></dates><publisher>LWW</publisher><isbn>1064-8011</isbn><urls><related-urls><url>http://journals.lww.com/nsca-jscr/Abstract/2012/07002/Heat_Injury_Prevention_A_Military_Perspective.11.aspx</url></related-urls></urls></record></Cite></EndNote>[12]. The results of another study implemented on 2391 male and female soldiers in the US revealed that at the end of a 19-weeks training course, those who were older were more susceptible to injuries than others. This indicates the low stamina and physical strength of the older soldiers  ADDIN EN.CITE <EndNote><Cite><Author>Knapik</Author><Year>2013</Year><RecNum>147</RecNum><record><rec-number>147</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">147</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Knapik, Joseph J</author><author>Graham, Bria</author><author>Cobbs, Jacketta</author><author>Thompson, Diane</author><author>Steelman, Ryan</author><author>Jones, Bruce H</author></authors></contributors><titles><title>A prospective investigation of injury incidence and injury risk factors among Army recruits in military police training</title><secondary-title>BMC Musculoskel Disord</secondary-title></titles><periodical><full-title>BMC Musculoskel Disord</full-title></periodical><pages>32</pages><volume>14</volume><number>1</number><dates><year>2013</year></dates><urls><related-urls><url>http://www.biomedcentral.com/1471-2474/14/32</url></related-urls></urls></record></Cite></EndNote>[13]. Of other harmful activities one can refer to carrying unnecessary, heavy equipments during hiking and military trainings, which can have undesirable effects on soldiers� health. In the study carried out by Qu (2012) on 12 healthy volunteer soldiers, it was revealed that a heavy backpack can hinder soldiers� walking and also bring about incidents like falling. He divided the soldiers into three groups: one with 0 Kg backpacks, the other with 8.5 Kg backpacks and the last with 20 Kg backpacks. He had them walk on the treadmill with the same speed and came to the above conclusion  ADDIN EN.CITE <EndNote><Cite><Author>Qu</Author><Year>2012</Year><RecNum>141</RecNum><record><rec-number>141</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">141</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Qu, Xingda</author></authors></contributors><titles><title>Effects of cognitive and physical loads on local dynamic stability during gait</title><secondary-title>Applied ergonomics</secondary-title></titles><periodical><full-title>Applied ergonomics</full-title></periodical><dates><year>2012</year></dates><publisher>Elsevier</publisher><isbn>0003-6870</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/23176787</url></related-urls></urls></record></Cite></EndNote>[14].
Considering the necessity and significance of recognizing the trauma frequency during the military training course as well as the dangers regarding that in Iranian soldiers, this study is aimed at determining the epidemiology of physical trauma during a military training course in selected garrisons of Iran.
Method
This research is a Cross Sectional type in which the target population was all the military training garrisons of the land force, accounting for 14 garrisons in total, in one of the Iranian armed forces in 1391. In this study five garrisons were selected based on stratified random sampling. The samples included military training garrisons number 3, 5, 6, 8, and 12. After selecting these five garrisons, the soldiers referring to the doctor complaining of musculoskeletal injuries were studied as the available samples in each of them.
In this study, verified demographic questionnaire (the questionnaire consisted of 18 questions including the variables of age, marital status, education, weight, height, the time when the trauma occurred, the place where the trauma occurred, the previous address, the previous job, trauma mechanism) as well as a checklist to survey the trauma were employed. This checklist is specifically used for the primary and secondary survey for trauma ( this tool includes surveying life- threatening issues in traumas and examining body systems regarding trauma). These instruments were checked and approved by experts in terms of their validity and their reliability was confirmed by means of re-test (Cronbach�s alpha : r = 0.89).
In each garrison and during one military training course, the data regarding each soldier coming to the garrison clinic and recognized with injury was collected by means of these instruments. This data were described and analyzed employing software SPSS, version 18.

Results
In this study, the individuals coming to the doctor due to the trauma occurring in the course of military training came to a total of 705 comprising %14. 86 of the soldiers in total. 229 (%32. 5) Of the injured soldiers, with the most frequency, did not have a high school diploma. 607 (%86. 1) Of them were single. The mean and standard deviation of the body mass index of the individuals under study was 23.26� 4.1. (Table 1) The most frequent places where traumas happened where morning practice field and training field (%37) while soldiers were doing military practices. (Table 2) 510 (%72) of the soldiers, with the most frequency, had come to see a doctor complaining of musculoskeletal injuries. (Diagram 1) The results also indicated that most of the traumas with a frequency of %54. 2 had occurred due to the military practices mechanism. (Diagram 2) This research revealed that a majority of the injuries, with the frequency of 90.9, are of non-penetrating type. (Diagram 3)
Analyzing the anatomic distribution of the injuries in 170 (%23. 6) Patients revealed that the lower parts of the body bearing problems such as bruising, tear in the soft tissue of the foot, cracked foot skin and pain in this part had the most frequency accounting for %65. 5. Similarly, the pain in the knee in 138 (%19. 6) Cases were the second most frequent. The most common parts of the body suffering from trauma were lower parts with %64 frequency (bruise, tear, and cracked foot skin %23. 6, knee pain %19. 1,  twisted ankle %9. 3, foot blister %8. 7)  (Table 3)
Comparing body  mass index with the incidence of blister in lower parts indicated that according to the Chi-Square statistical test there is a significant relationship between these two variables (p=. 009). The results showed that according to the Chi-Square statistical test there is a significant relationship between the two variables of blister incidence in the lower parts and patients� athletic background (p=. 051). It means that less injuries occur for the soldiers with professional athletic background and high physical preparedness.
Discussion and conclusion
The rampant spread of physical injuries in soldiers during the military training course threatens their health. Furthermore these injures incur military, economic and social consequences for the military institution and the family. According to the researchers in this study, factors such as improper physical preparedness, lack of physical fitness, climate inadaptability, soldiers� lack of knowledge on the one hand and discrepant management policies and sometimes improper execution of educational plans, lack of safety equipments for the soldiers on the other hand can bring about physical injuries.
Regarding the results achieved through this research, the researcher holds that the frequency of the injuries and trauma in the soldiers during a military training course in the investigated garrisons has fortunately decreased. Furthermore the injuries are usually insignificant, superficial, and non-penetrating. At the same time the frequency of the soldiers seeing a doctor due to trauma and its problems is still a high figure and involves better consideration and preventive measures regarding the trauma and its facilitating factors in order to minimize the injuries. The results of the present study agree with those of the study by Kaufman et a.m. terms of the incidence rate and some risk factors. They have reported the figure % 6-12 for an injury rate among male soldiers during their military training within one month. Furthermore, in this study factors such as: low physical preparedness, the kind of job the individual has, the extent to which one exercises per week, previous injuries, long distance running� have been reported as  issues of concerns regarding injuries to soldiers  ADDIN EN.CITE <EndNote><Cite><Author>Kaufman</Author><Year>2000</Year><RecNum>79</RecNum><record><rec-number>79</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">79</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kaufman, Kenton R</author><author>Brodine, Stephanie</author><author>Shaffer, Richard</author></authors></contributors><titles><title>Military training-related injuries: surveillance, research, and prevention</title><secondary-title>American journal of preventive medicine</secondary-title></titles><periodical><full-title>American journal of preventive medicine</full-title></periodical><pages>54</pages><volume>18</volume><number>3 Suppl</number><dates><year>2000</year></dates><isbn>0749-3797</isbn><urls></urls></record></Cite></EndNote>[10].
In the study conducted by Rosendal et al. (2003) the incidence of injuries to soldiers during their military training course within 12 weeks has been reported %28. He holds that there is a significant relationship between the incidence of injuries and the soldiers� physical fitness (p<0.0001). The comparison between the result of the Rosendal�s study and that of this research reveals that they are different in terms of the injury incidence rate, the reason of which seems to be the inequality of the training period. However there is a significant relationship between physical fitness and the incidence of injuries  ADDIN EN.CITE <EndNote><Cite><Author>Rosendal</Author><Year>2003</Year><RecNum>80</RecNum><record><rec-number>80</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">80</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rosendal, Lars</author><author>Langberg, Henning</author><author>Skov-Jensen, Arne</author><author>Kj�r, Michael</author></authors></contributors><titles><title>Incidence of injury and physical performance adaptations during military training</title><secondary-title>Clinical Journal of Sport Medicine</secondary-title></titles><periodical><full-title>Clinical Journal of Sport Medicine</full-title></periodical><pages>157-163</pages><volume>13</volume><number>3</number><dates><year>2003</year></dates><publisher>LWW</publisher><isbn>1050-642X</isbn><urls><related-urls><url>http://journals.lww.com/cjsportsmed/Abstract/2003/05000/Incidence_of_Injury_and_Physical_Performance.6.aspx</url></related-urls></urls></record></Cite></EndNote>[3]. 
The results of the present study showed that more than half of the injuries occurred due to the military practices mechanism and that the most injuries in terms of the type and anatomic location had affected lower parts of the body. This result demands careful examination to clarify why military practices mechanism and lower parts injuries had more frequency. Why did trauma with this mechanism have a higher frequency in garrison 8? In garrison 8, trauma with mechanism of military practices had a frequency of 68.93 while in garrison 12, the frequency of trauma incidence was 27.27 which indicates a significant difference between them (p<0.05). According to the researcher, various factors are involved here including the difference in training methods and exercises of the trainers, non- native soldiers in this course in garrison. The higher frequency of injuries in lower parts can also result from factors such as incorrect exercises such as running for a long time on hard surfaces, jumping, moving ahead while sitting on your feet, not observing safety principles, not having physical fitness, and having problems in lower parts of the body and wearing inappropriate shoes. This matter necessitates giving more consideration to these factors and conditions.
The results of this study revealed that the most common cause of soldiers� complaints and seeing a doctor was musculoskeletal pains resulting from physical injuries with a frequency of 510 cases (%72. 3), which agrees with those of Jannesari�s study (1382). Studying three training garrisons of Iranian land force, they have reported that, in 821 cases (% 71.6), the main reason for soldiers� coming to the garrisons clinic is physical injury  ADDIN EN.CITE <EndNote><Cite><Author>Jannesari</Author><Year>1384</Year><RecNum>174</RecNum><record><rec-number>174</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">174</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Morteza Jannesari </author><author>Shervin Asari</author><author>Mohammad Sadeghi</author></authors></contributors><titles><title>Cause of recourse in to clinic during military traning</title><secondary-title>Military Medicine</secondary-title></titles><periodical><full-title>Military medicine</full-title></periodical><pages>187</pages><volume>7</volume><number>3</number><dates><year>1384</year></dates><urls></urls></record></Cite></EndNote>[15] . This is also in agreement with the study carried out by Njafi et al (1389). They hold that the most common injuries are musculoskeletal ones of the superficial type (%42. 1) And the parts mostly hurt were lower parts around the ankles (%27. 6)  ADDIN EN.CITE <EndNote><Cite><Author>Najafi Mehri</Author><Year>2010</Year><RecNum>120</RecNum><record><rec-number>120</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">120</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Najafi Mehri, S</author><author>Sadeghian, MAJID</author><author>Tayyebi, A</author><author>AA, Karimi Zarchi</author><author>Asgari, AR</author></authors></contributors><titles><title>Epidemiology of physical injuries resulted from military training course</title><secondary-title>MilMed Journal</secondary-title></titles><periodical><full-title>MilMed Journal</full-title></periodical><pages>89-92</pages><volume>12</volume><number>2</number><dates><year>2010</year></dates><publisher>MilMed Journal</publisher><urls></urls></record></Cite></EndNote>[1].
The findings of the research clarified that there is a direct and significant relationship between the body mass index and the incidence of blister in lower parts of the body (p<0.05). On the other hand, with the increase in weight, the incidence rate of the injuries rises respectively. This agrees with the results of the study carried out by Cowan (2011). Based on a study, they concluded that those who were extremely fat experienced musculoskeletal injuries %47 more  ADDIN EN.CITE <EndNote><Cite><Author>Cowan</Author><Year>2011</Year><RecNum>162</RecNum><record><rec-number>162</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">162</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cowan, DN</author><author>Bedno, SA</author><author>Urban, N</author><author>Yi, B</author><author>Niebuhr, DW</author></authors></contributors><titles><title>Musculoskeletal injuries among overweight army trainees: incidence and health care utilization</title><secondary-title>Occupational Medicine</secondary-title></titles><periodical><full-title>Occupational Medicine</full-title></periodical><pages>247-252</pages><volume>61</volume><number>4</number><dates><year>2011</year></dates><publisher>Soc Occupational Med</publisher><isbn>0962-7480</isbn><urls></urls></record></Cite></EndNote>[16]. Bullock et al. (2010) have introduced a strategic plan to prevent physical training�related injuries, the most important of which are : educating and informing soldiers about the risks and the necessity of having physical preparedness, avoiding tough and dangerous exercises, doing practices reinforcing agility, using protective tools for susceptible parts such as ankle brace, wearing special shoes and socks preventing blisters, eating food compensating the lost energy for one hour after sever activities  ADDIN EN.CITE <EndNote><Cite><Author>Bullock</Author><Year>2010</Year><RecNum>99</RecNum><record><rec-number>99</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">99</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bullock, Steven H</author><author>Jones, Bruce H</author><author>Gilchrist, Julie</author><author>Marshall, Stephen W</author></authors></contributors><titles><title>Prevention of physical training�related injuries: recommendations for the military and other active populations based on expedited systematic reviews</title><secondary-title>American journal of preventive medicine</secondary-title></titles><periodical><full-title>American journal of preventive medicine</full-title></periodical><pages>S156-S181</pages><volume>38</volume><number>1</number><dates><year>2010</year></dates><publisher>Elsevier</publisher><isbn>0749-3797</isbn><urls></urls></record></Cite></EndNote>[17]. Similarly, educating soldiers about physical fitness, correct principles of  exercising and nutrition, avoidance of smoking and proper stress management are among necessary educational requirements for military recruits in preventing injuries  ADDIN EN.CITE <EndNote><Cite><Author>Mitchell</Author><Year>2012</Year><RecNum>175</RecNum><record><rec-number>175</rec-number><foreign-keys><key app="EN" db-id="ve9z0w9fq59aaleavpcvpvapt25swrpe0rx2">175</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Mitchell, Tarah D</author></authors></contributors><titles><title>A Women-Only Comparison of the US Air Force Fitness Test and the Marine Combat Fitness Test</title></titles><dates><year>2012</year></dates><publisher>DTIC Document</publisher><urls></urls></record></Cite></EndNote>[18].
Thus recognizing susceptible individuals at the beginning of the training course in terms of primary risk factors in soldiers such as overweight and obesity, anomalies in the lower parts, smoking experience, weakness and lack of proper physical preparedness to endure exercises is recommended. To prevent injuries, the following are recommended: creating required fitness and physical preparedness before entering into practical and field stage in military training and practices, learning and observing the principles of safety / hygiene and self-aid on the part of soldiers, observing safety principles and avoiding tough and sometimes unneccsary practiceson the part of trainers and commanders as well as providing more security equipments and facilities for the soldiers, carrying out military training courses in local garrisons for native soldiers for more climate adaptability and finally revising and formulating educational programmes of training garrisons with scientific and principled approach and homogenizing these programmes in all garrisons to reduce these injuries.
Acknowledgement
The present article has been derived from the university student thesis. In closing, I would like to express my gratitude to all respected professors, executives, and soldiers of the garrisons under study as well as Sport Physiology Research Center of Baqiyatallah University of Medical Sciences support us to accomplish this research.


 ADDIN EN.REFLIST 1.	Najafi Mehri, S., et al., Epidemiology of physical injuries resulted from military training course. MilMed Journal, 2010. 12(2): p. 89-92.
2.	Pandolf, K.B., et al., United States Army Research Institute of Environmental Medicine: Warfighter research focusing on the past 25 years. Advances in Physiology Education, 2011. 35(4): p. 353-360.
3.	Rosendal, L., et al., Incidence of injury and physical performance adaptations during military training. Clinical Journal of Sport Medicine, 2003. 13(3): p. 157-163.
4.	Billings, C.E., Epidemiology of Injuries and Illnesses during the United States Air Force Academy 2002 Basic Cadet Training Program-Documenting the Need for Prevention. Military medicine, 2004. 169(8): p. 664-670.
5.	Linda, D., M. Kathleen, and E. Mary, Critical Care Nursing. Vol. 38. 2010: mosby elsevier.
6.	Nikravanmofrad, M., Management of trauma victims. 1385, Tehran: Nour e Danesh.
7.	Larsson, H., M. Tegern, and K. Harms-Ringdahl, Influence of the implementation of a comprehensive intervention programme on premature discharge outcomes from military training. Work: A Journal of Prevention, Assessment and Rehabilitation, 2012. 42(2): p. 241-251.
8.	Parkkari, J., et al., Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study. BMC medicine, 2011. 9(1): p. 35.
9.	Zambraski, E.J. and K.E. Yancosek, Prevention and rehabilitation of musculoskeletal injuries during military operations and training. The Journal of Strength & Conditioning Research, 2012. 26: p. S101-S106.
10.	Kaufman, K.R., S. Brodine, and R. Shaffer, Military training-related injuries: surveillance, research, and prevention. American journal of preventive medicine, 2000. 18(3 Suppl): p. 54.
11.	Taanila, H.P., et al., Predictors of low back pain in physically active conscripts with special emphasis on muscular fitness. The Spine Journal, 2012. 12(9): p. 737-748.
12.	Epstein, Y., A. Druyan, and Y. Heled, Heat injury prevention�a military perspective. The Journal of Strength & Conditioning Research, 2012. 26: p. S82-S86.
13.	Knapik, J.J., et al., A prospective investigation of injury incidence and injury risk factors among Army recruits in military police training. BMC Musculoskel Disord, 2013. 14(1): p. 32.
14.	Qu, X., Effects of cognitive and physical loads on local dynamic stability during gait. Applied ergonomics, 2012.
15.	Jannesari, M., S. Asari, and M. Sadeghi, Cause of recourse in to clinic during military traning. Military Medicine, 1384. 7(3): p. 187.
16.	Cowan, D., et al., Musculoskeletal injuries among overweight army trainees: incidence and health care utilization. Occupational Medicine, 2011. 61(4): p. 247-252.
17.	Bullock, S.H., et al., Prevention of physical training�related injuries: recommendations for the military and other active populations based on expedited systematic reviews. American journal of preventive medicine, 2010. 38(1): p. S156-S181.
18.	Mitchell, T.D., A Women-Only Comparison of the US Air Force Fitness Test and the Marine Combat Fitness Test. 2012, DTIC Document.















Table 1: Frequency distribution of subjects in terms of Body Mass Index (BMI)

Distribution IndexAbsolute FrequencyRelative FrequencyFrequency
BMI
Mean (SD) = 23.26 � 4.1
Min. = 13.24
Max. = 13.5513919.7%Less than 18.535149.8%18.5-24.918125.7%25-29.9344.8%More Than 29.9705100%Total  (No.)






Table 2: Absolute and relative frequency of where the trauma was occurred.
Absolute frequencyRelative frequencyFrequency

Where the  trauma was occurred405.7%Shooting range12217.3%Resting place15021.3%Classroom26137%Morning practices and training 
field of the garrison11516.3%Out of Garrison172.4%While off705100%Total  (No.)

Table 3: Absolute and relative frequency distribution of injuries in terms of anatomic condition.
Absolute frequencyRelative frequencyFrequency

Injuries location233.3%Head and neck203%Chest203%Stomach284%Pelvic bone8712%Upper body46265.5%Lower body20.2%Spine162%Kidneys and urinary tract477%Skin705100%TotalDiagram 1: The main complaint which were  the reasons of soldiers going to the physicians.
 EMBED MSGraph.Chart.8 \s 



Diagram 2:  Relative frequency of trauma in terms of mechanism.
 EMBED MSGraph.Chart.8 \s 



Diagram 3: Relative frequency distribution of injuries in terms of trauma type.
 EMBED MSGraph.Chart.8 \s 













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Youez - 2016 - github.com/yon3zu
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