Importance of strength training to prevent secondary lower limb musculoskeletal injury in military personnel

Considerable operational and financial costs are associated with musculoskeletal injury (MSKI) across military organisations. Following an MSKI, reaching 'medically fully deployable' status is often contingent on meeting physical employment standards. Strength training has a critical role to play in military physical preparation, injury mitigation and guiding rehabilitation practice. Low levels of muscle strength are associated with increased MSKI risk, and previous MSKI is a leading risk factor for re-injury. When an MSKI does occur, it is essential that all attempts to mitigate the risk of secondary MSKI are met. Maximal force (muscle strength) and rapid force (rate of force development and reactive strength) production have been identified as important strength characteristics requiring targeted training interventions and assessment prior to returning to operational roles. This review investigates the importance of strength training and its assessment during late-stage rehabilitation to inform return-to-duty exit criteria, meet physical employment standards and mitigate secondary MSKI.