In 2008, a groundbreaking study conducted by Christoffer Brushøj and colleagues, the effectiveness of an exercise program in preventing overuse injuries among army recruits facing heightened physical activity levels was rigorously examined. The trial, a randomized controlled trial with a robust Level 1 evidence, enrolled 1020 soldiers undergoing three months of basic military training between December 2004 and December 2005.

The study aimed to address a critical gap in knowledge: whether a tailored exercise regimen could mitigate the risk of lower extremity overuse injuries, particularly in the context of abrupt increases in activity levels—a common challenge encountered in military training.

Hypothesized on the basis of an extensive literature review of intrinsic risk factors, the preventive training program was designed to run concurrently with the increased physical activity. The regimen, consisting of 15-minute sessions thrice weekly, comprised five exercises targeting strength, flexibility, and coordination. In contrast, the placebo group underwent a program focusing solely on upper body exercises.

Throughout the observation period, 223 subjects experienced injuries, with 50 and 48 of these meeting the study criteria for overuse knee injuries and medial tibial stress syndrome, respectively. Surprisingly, the study did not find significant differences in injury incidence between the prevention group and the placebo group (incidence, 0.22 vs 0.19; P = .162; relative risk = 1.05 [range, 0.98-1.11]).

However, intriguingly, soldiers in the prevention group demonstrated greater improvement in running distance during 12-minute run tests compared to their counterparts in the placebo group (82 vs 43 m; P = .037).

In conclusion, despite the exercise program’s emphasis on muscular strengthening, coordination, and flexibility, based on intrinsic risk factors identified through comprehensive literature review, it did not appear to influence the risk of developing overuse knee injuries or medial tibial stress syndrome in subjects undergoing an increase in physical activity. Nonetheless, the program did yield a notable enhancement in maximal running distance, as evidenced by the 12-minute test results.

This seminal trial sheds important light on preventive measures for overuse injuries in physically demanding settings such as military training, underscoring the complexity of injury prevention strategies and the need for further research in this crucial domain.

Reference: Brushøj, C., Larsen, K., Albrecht-Beste, E., Nielsen, M. B., Løye, F., & Hölmich, P. (2008). Prevention of overuse injuries by a concurrent exercise program in subjects exposed to an increase in training load: a randomized controlled trial of 1020 army recruits. The American journal of sports medicine, 36(4), 663-670.