By Tyler Inman
Preventable musculoskeletal (MSK) injuries plague Army readiness.
Among Active Duty Soldiers, MSK injuries result in over 10 million limited duty days each year and account for over 70% of medically non-deployable Soldiers. Described by health experts as the single biggest health problem in the U.S. Military, almost 50% of service members experience one or more injuries each year, resulting in over 2 million medical encounters, and requiring 90-120 days of lost duty for each injury. Most of these injuries are a result of overuse strains, sprains, and stress fractures to the lower leg and foot; more than half are exercise or sports-related. Of note, available statistics and literature identify running as one of the major causes of MSK injuries. Recruitment, societal, and cultural issues aside, most health experts and senior Army leaders agree a “balanced fitness program” is a critical component of the prescription required to diminish preventable MSK injuries and increase Army readiness. What does a “balanced fitness program” look like? Who will develop, implement, and supervise these efforts? What Army doctrine should we look towards to further understand how to optimize fitness while simultaneously reducing risk of injury?
Current Army doctrine does not sufficiently address these issues. It is incumbent upon platoon-level leaders to plan, prepare, and execute physical readiness training that logically and systematically generates the type of comprehensive physical readiness capable of reducing preventable MSK injuries. To achieve this end state, leaders must understand the fundamental principles offered in “A Leader’s Guide to Training for the ACFT;” more importantly, leaders must empower subordinates to develop and implement training strategies that look vastly different than the physical training that produced success on the APFT. What follows is a practical, evidence-based template intended for use by junior Army leaders to develop physical readiness training strategies representative of the “balanced fitness program” the Army needs.
The ACFT is not an impediment to action; the ACFT is the impetus for action.
The Army Combat Fitness Test (ACFT) presents some challenges; it also presents a great deal of opportunity. As we learn to train for a new fitness test, we must fine-tune our understanding of fitness in the context of performance. Overall fitness can be divided into two categories: physical fitness and motor fitness. Measurable qualities of the human body’s physical processes, or physiology, are the components of physical fitness: muscular strength and endurance; aerobic and anaerobic endurance. Elements of motor fitness like power, speed, agility, coordination, balance, and reaction time, are often overlooked by traditional training programs, but no less vital to performance. The type of overall fitness that will make Soldiers more resistant to injury can only be obtained when we combine efforts to improve physical fitness with deliberate efforts to improve motor fitness.
Precision – the best place to start.
Evidence suggests that precise movement patterns are fundamental to overall fitness by way of reducing injury risk and increasing basic function.[1] Precise movement, developed by “grooving appropriate and perfect motion and movement patterns,” should be the foundation of a well-designed training program.[2] The ability to move precisely (and pain free) through each of the movement patterns demanded by our “sport” also contributes to improved performance in both categories of overall fitness. There are six fundamental athletic movement patterns Soldiers must groove appropriately to reduce injury risk and improve performance.
The Precise Pattern Six
There are six fundamental movement patterns for which Soldiers must build progressive competence: hinge, squat, push, pull, lunge, and rotate.[3] For optimal performance and injury prevention, Soldiers must learn to execute each of these patterns with an appropriate range of motion, a high degree of stability, and precise alignment of the body’s joints for best use of the body’s levers. Figures 1 describes each of the fundamental movement patterns.
Figure 1: The six fundamental movement patterns.
Preventing the most likely of scenarios.
Somewhere, right now, on an installation near you, a Soldier is executing a squat, deadlift, or power clean with a load that is too heavy and with poor form. One of his or her teammates is not only watching but encouraging them to keep pushing forward. Over time, repetitive execution with poor mechanics will result in an injury (not unlike the previously mentioned MSK injuries caused by chronically poor running mechanics). We should applaud our Soldiers for identifying the need to train for muscular strength, but we also have a responsibility to ensure Soldiers have the appropriate motor fitness foundations before we load a potentially compromised system. Here’s how:
Conduct a PMCS: Precise Movement Competency Screening
Movement competency, or the “cognitive awareness and technical quality of an individual’s movement strategies,” influences muscle activation; joint loading; and ultimately injury risk, strength, and power expression.[1] Using the Precise Pattern Six as a guide, Soldiers at the platoon level and below should conduct a screening for movement competency before initiating a training program that progressively loads variations of the six key patterns. Figure 2 is a practitioner’s guide to determining whether a Soldier is ready to advance to more dynamic or intense training techniques.
Figure 2: Precise Movement Competency Screening (PMCS).
The PMCS is intended for use at the squad level as both a preventive tool (as the acronym alludes) and a gateway to more advanced training techniques. Based on a Soldier’s competency in a given movement, he or she may need to spend more time grooving appropriate and perfect movement patterns before adding a load or increasing intensity. This is a qualitative assessment; leaders must conduct some self-study or depend on a teammate with a strong athletic background, to provide corrective feedback with the potential to improve a Soldier’s movement. In some cases, a simple cue like “retract your shoulders and maintain a flat back” may be enough to correct a Soldier’s movement during a PMCS. When a Soldier demonstrates the ability to execute a given movement well, they may progress to loaded movements in accordance with the unit’s training plan.
Remember: a high-quality unit training plan accounts for varying degrees of movement competency and overall fitness by “individualizing” the selected exercises; this means that each prescribed exercise can be scaled to the appropriate level of difficulty for both the weakest and strongest performer in the squad.
As the intensity of the training program increases, Soldiers must continue to demonstrate competency through each of the Precise Pattern Six movements. As with the unloaded PMCS, simple cues may be enough to correct a Soldier’s form; video feedback can also be a powerful tool.[1] When cues are no longer effective, or when the intensity of an exercise overcomes the Soldier’s ability to maintain precision, he or she must make the wise choice to reduce the intensity until precision is restored. This may require identifying the limiting factor in the kinematic chain. For example, a common error in the squat movement is failing to maintain the entire foot in contact with the ground — usually observed as “coming up on the toes.” A simple cueing strategy is to remind the performer to “keep the weight in the heels.” If a Soldier is unable to achieve this standard, it may indicate a lack of mobility in the ankles or hips, or a lack of stability in the foot or trunk. In this case, the Soldier may need to use a more comprehensive strategy to develop a precise squat pattern. This might include: assisted squats to groove the appropriate motion pattern; exercises to increase hip and/or ankle mobility; and exercises for increasing trunk strength and stability.
“We need to treat our Soldiers like elite athletes.”
Many have heard this mantra before, but most don’t know where to begin. A common misconception about “training like an elite athlete” is that cutting-edge techniques and dynamic, high intensity programs rule the day. Often, elite performers focus on precise execution of the fundamentals above all else. Understanding, teaching, and enforcing fundamentals (for movement, for nutrition, for recovery) is exactly how we start treating our Soldiers like elite athletes. In the physical domain, paramount to performance and injury prevention, precise execution of fundamental movement patterns is where it all begins.
Where do we go from here? Progression
Precise execution of fundamental movement patterns (hinge, squat, push, pull, lunge, rotate) is vital to increased performance and injury prevention. As Soldiers increase overall fitness by grooving perfect motor patterns, leaders should progress the training through the following stages:
Groove. Stabilize. Increase. Build. Develop.[2]
- Groove: appropriate and perfect motion and motor patterns.
- Stabilize: build whole-body and joint stability (mobility at some joints and stability though the lumbar and trunk).
- Increase: endurance.
- Build: strength.
- Develop: speed, power, and agility.
A low to moderate degree of loading may be appropriate to assist Soldiers in building competency in the Precise Pattern Six. Steps 1 and 2, groove and stabilize, have a complementary relationship because an inability to achieve precision in the fundamental movements may result from a lack of mobility or stability. If this is the case, the Soldier must take deliberate action to improve mobility and/or stability in the appropriate joints and regions of the body.
Potential Scenario: A new Soldier arrives to the unit and their squad leader conducts a PMCS during their in-processing. The Soldier demonstrates a moderate degree of competency in the squat and progresses to a goblet squat with a moderate load. During the execution of the loaded squat, the Soldier demonstrates an inability to maintain proper posture of the torso and the Soldier’s heels rise from the ground before the Soldier reaches an appropriate squat depth. The most appropriate course of action is to remove or reduce the load until the Soldier can perform the exercise with precision. While the Soldier works on grooving the appropriate pattern with a reduced load, the squad leader should prescribe some concurrent training aimed at improving both trunk stability and hip and ankle mobility.
The list below represents “a way” to progress through each of the Precise Pattern Six movements as Soldiers develop competency in each pattern. Videos for many of these exercises are available here.
Progression of the Precise Pattern 6
Hinge
- PVC pipe deadlift and good morning
- Bilateral hip thrust, single leg hip thrust
- Bilateral kettlebell (KB) deadlift, bilateral KB romanian deadlift (RDL)
- KB Swing
- Hex-bar deadlift, unilateral KB/dumbbell (DB) deadlifts
- Loaded good morning, unilateral and single leg RDLs
- Progression through loaded barbell deadlift and RDL
Squat
- Band or strap assisted squat
- Air squat
- Goblet squat
- Squat with PVC pipe overhead
- Barbell front squat, DB front squat
- Unilateral DB or KB front squat
- Back squat
- Pistol squat
- Loaded overhead squat
Push
- DB overhead press
- BB overhead press
- Push press
- Hand-release push-up (HRPU), t-push-up
- Ring push-up, dip
- Bench press
- Plyo push up
- Slide board push up
Pull
- DB row, ring row
- Bent over row
- Straight-arm pull
- Pull-up
- Ring pull up
Lunge
- Forward lunge
- Backward lunge
- Walking lunge
- Side lunge (cossack squat)
- Each w/ load (front, back, overhead, unilateral)
- Step up/down
- With load
- Jumping lunge, w/ switch
Rotate
- Unloaded – lunge with twist, deep lunge with twist
- Resist rotation with the two-point hold
- Lunge position – resist rotation with band resistance
- Dynamic – rotation with med ball throw – 4-way plyo circuit
- Side-shuffle, turn and run
- Backwards run and turn
Check back tomorrow for part 2!
CPT Tyler Inman is an Army Infantry officer and current instructor in the West Point Department of Physical Education. He has a Masters in Kinesiology and is a Certified Strength and Conditioning Specialist (CSCS) and Tactical Strength and Conditioning Facilitator (TSAC-F) through the NSCA. He’s passionate about physical readiness training, leader development, and getting better everyday. His website, Training For 600, is dedicated to providing Army leaders with actionable tools, techniques, and strategies for improving performance. You can connect with Tyler on Facebook: @TF600acft, Twitter: @TrainingFor600
[1]Nowels, Russell G., and Jennifer K. Hewit. “Improved Learning in Physical Education through Immediate Video Feedback.” Strategies31, no. 6 (2018): 5-9.
[2]McGill, Stuart. “Core training: Evidence translating to better performance and injury prevention.” Strength & Conditioning Journal32, no. 3 (2010): 33-46.
[1]Ibid; Hewett, Timothy E., Joseph S. Torg, and Barry P. Boden. “Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: lateral trunk and knee abduction motion are combined components of the injury mechanism.” British journal of sports medicine43, no. 6 (2009): 417-422; Myer, Gregory D., Kevin R. Ford, and Timothy E. Hewett. “Rationale and clinical techniques for anterior cruciate ligament injury prevention among female athletes.” Journal of athletic training39, no. 4 (2004): 352.
[1]O’connor, Francis G., Patricia A. Deuster, Jennifer Davis, Chris G. Pappas, and Joseph J. Knapik. “Functional movement screening: predicting injuries in officer candidates.” Medicine and science in sports and exercise43, no. 12 (2011): 2224-2230; Lisman, Peter, Francis G. O’connor, Patricia A. Deuster, and Joseph J. Knapik. “Functional movement screen and aerobic fitness predict injuries in military training.” Medicine & Science in Sports & Exercise45, no. 4 (2013): 636-643.
[2]McGill, Stuart. “Core training: Evidence translating to better performance and injury prevention.” Strength & Conditioning Journal32, no. 3 (2010): 33-46.
[3]Kritz, Matthew, John Cronin, and Patria Hume. “The bodyweight squat: A movement screen for the squat pattern.” Strength & Conditioning Journal31, no. 1 (2009): 76-85; Kritz, Matthew, John Cronin, and Patria Hume. “Using the body weight forward lunge to screen an athlete’s lunge pattern.” Strength & Conditioning Journal31, no. 6 (2009): 15-24; Kritz, Matthew, John Cronin, and Patria Hume. “Screening the upper-body push and pull patterns using body weight exercises.” Strength & Conditioning Journal32, no. 3 (2010): 72-82.
