Equal opportunities, equal risks? Overuse injuries in female military recruits

Background The rate of female personnel medically discharged from service in the British Army has been rising steadily since 1992 from around 3 per 1000 per year to over 35 per 1000 in 1996, although there has been only a minor increase in medical discharges for males over the same period. This paper examines the increasing rate of medical discharge in young female members of the British Army from an aetiological perspective and reviews the literature to identify risk facto rs that may be relevant. Methods Data from published military medical statistical reports were reviewed and the clinical records of a 10 per cent sample of females medically discharged for relevant conditions were examined. Results The majority of the excess medical discharges had occurred in females under the age of 22 and were due to musculoskeletal disorders and injuries caused by military training. Data from the clinical records showed that 75.5 per cent (37/49) of those medically discharged for these conditions were recruits. Stress fractures and other overuse syndromes accounted for 70.2 per cent of medical discharges among the recruits in the sample. Conclusion Females undertaking strenuous exercise alongside males are at increased risk of injury. Risk factors include smoking, short stature, restricted dietary intake and menstrual disturbance. Equal opportunities legislation has been interpreted to require identical training for males and females, but some segregation of training may be acceptable provided the outcome of training is no less favourable to either gender, and this may reduce the excess risk of injury to females.