Physical Therapist Geneva Foundation, US Air Force Academy Monument, Colorado
Abstract Text:
Background: Concussions occur during military training. Concussions can interfere significantly with a trainee’s ability to participate in training activities. Different than a musculoskeletal injury, a brain injury limits return to not only physical training but also academic training. The rigorous schedule of military training (long days of physical activity and academics, noise, stress, lack of sleep) makes the return to training during concussion recovery challenging. Commanders, medical staff and cadre would benefit from understanding the range of concussion recovery timeframes during military training to assist with expectation management and/or retraining decisions.
Methods: A retrospective review of concussion cases recorded at the United States Air Force Academy (USAFA) cadet concussion clinic during the five and a half weeks of Basic Cadet Training (BCT), from 2014-2022. All cadets were managed by the cadet concussion clinic, monitored by medical personnel every 1-3 days, utilizing the USAFA concussion protocol. The academic and physical return to training was overseen and progressed by trained cadre as allowed per the medical providers instructions. Days to symptom free and days until full return to duty were recorded.
Results: 10,522 trainees (approximately 1,169 per year) participated in training. 347 trainees (3.3% of trainees) suffered 354 concussions during the nine years of observation. 44 concussions were removed from recovery analysis because: 31 (8.8%) left USAFA before complete recovery, 7 (2.0%) sustained a second injury while recovering from first injury, 5 (1.4%) were considered outliers with 90–270-day recoveries, and 1 (0.3%) is missing data. Of the 310 (87.5%) that recover within 90 days: 50% perform partial training by day 6 and full training by day 12, and 90% perform partial training by day 17 and full training by day 30.
Discussion: The incidence of concussion is 1 in 30 during USAFA basic cadet training. Most concussions sustained during USAFA basic cadet training will recover and allow partial training within a few days and full return to training in 3-4 weeks. Approximately 1 in 11 (8.8%) of the concussed trainees did not continue training and left USAFA before complete recovery (representing 1 in 345 trainees); of this group, over half had additional reasons beyond a concussion diagnosis for training withdrawal. While medical providers dictate allowed levels of participation during recovery, commanders make the decision to pass or fail a trainee based upon numerous factors including training participation, candidate potential, and recovery potential. This data can perhaps assist in making those decisions. While this training may be like other officer basic training venues in some regards, it should be noted that all military training is not homogenous in duration, intensity or activity, and caution should be used when considering this data in respect to other military training environments.
Conclusion: One in 30 trainees experienced concussion during USAFA basic cadet training. 50% return to partial training within the first week after injury and 75% are performing full training within 3 weeks. Around 1 in 11 cadets withdrew from training before full concussion recovery. Predicting outcomes for an individual case of concussion is difficult, and the USAFA experience may not be generalizable to all military training; however, commanders, medical staff and patients alike may benefit from understanding general trends of recovery timeframes after a military training concussion.
Keywords: military training, incidence, USAFA, return to duty, concussion
