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The rate of amputee soldiers returning to active duty is at an all-time high. In the 1980s only about 2.3% of amputees returned to duty; the rate among Iraq/Afghanistan veterans is 16.5%. A lot of factors have contributed to this increase, but the most influential is unquestionably the advancement in technology. We now have centralized centers for amputee care that provide state-of-the-art custom rehabilitation, the most up-to-date prosthetic devices, and peer therapy. These centers enable wounded active duty members to rehabilitate together—interaction that is crucial for recovery. Rehabilitation is now specifically tailored to meet each Warfighter’s needs, and is geared towards the goals he or she has set for the future.
In order to return to active duty, a wounded warrior needs to obtain a final disposition of “fit for duty” from the Physical Evaluation Board (PEB). To do this, he or she must demonstrate a level of function with a prosthesis that exceeds basic movement skills, such as engaging in a high-impact activity typical for an active adult or athlete - i.e., box jumps or sprints. Despite the vast advances in prostheses, rehabilitation therapists mention that it’s the warrior’s drive and motivation that returns him or her to work.
Yoga’s popularity is growing in the United States, but many Americans are still not familiar with the details of this ancient practice. Yoga roots are holistic in nature—body and mind are of equal importance, and the asanas, or poses, which define yoga for many of us, are only one aspect of practice. Together with meditation and breath control, yoga promotes strength, flexibility, and awareness of body and mind. Yoga can help achieve wellness through meditation, deep relaxation, stretching, and breathing. Several organizations are now beginning to provide yoga classes tailored to veterans and active-duty service members who suffer from combat stress. VA facilities, Warrior Transition Units, and civilian studios are using it to complement traditional treatment of patients with post-traumatic stress disorder and traumatic brain injury.
Individuals who struggle with PTSD describe it as a feeling of disconnectedness from themselves and others. Yoga, which means “bringing together parts as a whole,” helps people feel connected again. One traditional type of yoga that has been shown to decrease anxiety in the military population is sensory-enhanced hatha yoga, which involves breathing, meditation, and certain poses. A specific benefit reported by participants in sensory-enhanced yoga was a decrease in insomnia. Combat-stressed adults also experienced reduced hyperarousal symptoms such as anxiety, depression, and rage. Integrative Restoration (iRest) is a yoga-based meditative practice that teaches a person to focus on breathing when a negative memory arises. Soldiers and marines have expressed satisfaction in these breathing techniques because of the method’s simplicity and ease. It allows a person to regain control over his/her thoughts whenever symptoms of PTSD present themselves. A study found that iRest decreases rage, anxiety, and emotional reactivity all of which encourage negative thoughts and memories. Those practicing iRest also reported increased feelings of relaxation, peace, self-awareness, and self-efficacy. Walter Reed Army Medical Center (WRAMC) was one of the first military facilities to research the outcomes of yoga for veterans and active-duty warriors suffering from PTSD. WRAMC immediately added iRest to its weekly treatment programs for soldiers suffering from PTSD and TBI after observing its effects: increased calm and peaceful feelings, less severe reactions to situations, and increased outlook on life.
There are many more yoga practices than the ones mentioned here, and each yoga method is different, so you can find the right one for you!
Although there are individual differences in sleep needs, most people need seven to eight hours of sleep at night to function optimally, and anyone who sleeps only four to five hours each night will experience some loss of performance. Sleep loss hinders your ability to accurately interpret the emotions of others and identify what they’re feeling. Specifically, sleep loss impacts your ability to interpret the emotions anger and happiness expressed in the faces of others, making it difficult to interact effectively and communicate clearly with the people around you, reducing one’s ability to maintain good relationships.
It’s been commonly thought that exercise can ward off the effects of sleep loss, but it turns out that exercise only mitigates sleepiness and fatigue for an hour and doesn’t seem to have any effect on boosting performance throughout the day. Although regular exercise—both strength training and high-intensity endurance—does help you sleep better, it can’t replace lack of sleep—only actual sleep will do that. The loss of sleep affects physical performance primarily by reducing your motivation to exercise—so, when thinking about your workout plan for the week, include a plan to get enough sleep.
For information on how to improve the quality and length of your sleep, check out HPRC’s Mind Tactics Sleep Optimization section. For information on how sleep loss impacts other areas of fitness, check out the HPRC’s Total Force Fitness article The impact of sleep loss on total fitness, and for information on physical fitness check out HPRC’s Physical Fitness domain.
Preparation for the PFT/PRT takes time and discipline. Training for the test should not be something you start the week prior, and the habits you begin leading up to the test should be ones you continue after the test. Weekend warriors and procrastinators are at greater risk for injury, and it’s likely that performance will be less than optimal when it comes time for PFT/PRT. If you’re just getting back into shape, be sure to do it gradually. Once you’ve resumed a regular exercise routine you may notice aches and pains associated with getting back in shape. Listen to your body. Be vigilant for symptoms of overuse injuries and knee pain, which are common athletic injuries. It’s important to address these issues early to minimize any damage and get you back in action as soon as possible. Maintaining your exercise routine after the PFT/PRT and challenging yourself along the way will keep you in soldier-athlete shape year round, and prevent deconditioning. Check back to past articles on cardiovascular, muscular and mobility fitness for guidelines and tips.
It’s always a good idea to replace old sunscreen, but next summer you’ll have even more reason to do so. Sunscreen companies have until December 2012 to revise their labels to abide by FDA’s new guidelines. The new labels will prevent manufacturers from false advertising with respect to the level of protection they provide. Sunscreens also will have to go through FDA’s testing to determine their effectiveness.
The new guidelines are summarized below:
Broad-spectrum designation: Sunscreens will have to pass FDA’s broad-spectrum test to be labeled as such. This confirms the sunscreen protects against both ultraviolet A and B rays, both of which contribute to skin cancer and early skin aging.
Use claim: Only broad-spectrum sunscreens with an SPF of 15 or higher can claim to reduce skin cancer risk and early skin aging if used as directed. Sunscreens with SPFs between 2 and 14 can claim only to help prevent sunburn.
Waterproof, sweatproof, and sunblock claims: Sunscreens will no longer be able to claim they are waterproof, sweat-proof, or “sunblock,” since those claims over-exaggerate their effectiveness. No sunscreen is waterproof or sweat-proof without the proper reapplication. Also, sunscreens do not “block” the sun; they reduce the penetration of the ultraviolet rays.
Water-resistance claims: Any sunscreen with a “water-resistant” label must indicate whether it is effective for 40 or 80 minutes while swimming or sweating.
Drug facts: All sunscreens must include standard drug-facts information on the label.
Dealing with the stress of deployment and re-adjusting to home life post-deployment can be tough. It’s important to focus on managing your stress, finding ways to cope, and building your resilience. According to Real Warriors, you can get “behaviorally fit” by managing stress and reaching out to others. Among several tips offered is how to deal with problems as they come—head on. Don’t avoid discussing tough issues or finding ways to deal with them. For problems that seem too big, try breaking them down into smaller, manageable steps. For issues that you still find yourself struggling with even after breaking them down, the best bet is to get help from a professional, friend, or supportive family member.
Your body is a segmented, or jointed, system designed for potentially powerful and efficient movement. Coordinated and efficient movements require a give and take between mobility and stability of the involved joints, as well as the surrounding muscles, tendons, and ligaments. These components, together with muscular fitness, are necessary to achieve functional movement, which is integral in performance and sport related skills.
According to the American Council on Exercise (ACE), joint mobility—also known as range of motion (ROM)—is the degree to which a joint is able to move before it is restricted by surrounding ligaments, muscles, and tendons. Joint stability is the ability to control or restrict joint movement through the coupled actions of surrounding tissues. Preventing injuries requires, among other things, both mobility and stability of your musculoskeletal system. Deficiencies in one or the other, due to improper or imbalanced training, may lead to injuries during movement patterns, such as walking, running, and repetitive lifting.
One example of an elite training program is the Army Ranger RAW functional fitness program. It is unique in that it focuses on whole-body mobility and stability. Exercises are typically performed using your own body weight against fixed surfaces (i.e. the floor or wall), instead of using free weights or machine weights.
For joint stability and balance, the National Academy of Sports Medicine (NASM) recommends performing one to three sets of 12-20 repetitions at a slow, controlled pace. According to American College of Sports Medicine (ACSM), there is not enough research to make definitive recommendations on the frequency and duration for this type of training. However some research has shown improvements using training frequencies of 2-3 days per week, with sessions lasting ≥20-30 minutes, for a total of ≥60 minutes per week.
The amount of joint mobility is partially determined by the flexibility of the surrounding muscles, tendons, and ligaments. For example, decreased shoulder flexibility might impact your ability to complete a full pushup. Refer to these FITT guidelines for flexibility training.
Frequency: According to ACSM, short-term improvements in flexibility may be seen after each bout of stretching. More long-term changes, however, are seen after three to four weeks of regular stretching. Flexibility exercises should be performed at least two to three days per week, but daily exercise will improve range of motion.
Intensity: ACSM also recommends that flexibility exercises should involve major muscle groups (neck shoulders, upper and lower body), stretching to the point of slight discomfort within the range of motion, but no further. You should feel slight tension in the muscle, but it should not be painful.
Type: There are several different types of stretches:
• Static stretching slowly elongates a muscle by holding the position for a period of time.
• Dynamic stretching is usually sport specific. It requires a joint to be stretched through its full range of motion, to lengthen and increase the muscles temperature.
• Ballistic stretching is a type of dynamic stretch where the muscle is forcefully elongated through a bouncing motion. There’s no evidence that ballistic stretching results in injury, but there is still question and ongoing research as to whether this technique affects muscular performance.
• Proprioceptive Neuromuscular Facilitation or PNF stretching may produce greater gains in ROM, however, it may be less practical since an experienced partner is needed to perform this type of exercise.
Time: Your stretching routine should take about ten minutes or so to complete. Static stretches should be held for 15-20 seconds, while PNF stretches should involve a six-second contraction followed by a 10- to 30-second assisted stretch.
Use caution when working on mobility and stability exercises. Done properly, these exercises should not cause pain in the joint or muscle. Never push through your threshold, have patience, and treat your joints with care.
One thing all Warfighters need—and often don’t get enough of—is sleep. This essential restorative affects, and is affected by, virtually every aspect of total fitness. HPRC has already taken a look at the basics of sleep in “How Much Sleep Does a Warfighter Need?” Now we take a look at how it relates to mind tactics, stress management, relationships, exercise, nutrition, dietary supplements, and environment in a new review: “The impact of sleep on total fitness.” Insufficient sleep will make it difficult to concentrate, make decisions, solve problems, and cope with stress. It affects your relationships with others as well as your physical endurance. Exercise, nutrition, and environment—especially time zone changes—affect how well you sleep. Some dietary supplements may enable you to function with little sleep for a while, but in the long run they can’t substitute for a regular night’s sleep. Sleep significantly impacts ALL areas of Total Fitness and can greatly enhance or undermine your ability to be fit and resilient.
It’s no news that stress can take a toll on your life and can affect your relationships—which may already be under a strain from repeated deployments and combat exposure. But unmanaged stress doesn’t affect only you; it can create a ripple effect in families, which is why learning to effectively manage stress is so important. Deep breathing, mindfulness, meditation, guided imagery, and body scanning are just a few strategies that can help you relax, manage your stress, and help you live your life better—and everyone in the family can learn and benefit from them.
For more tips on how to manage stress, check out HPRC’s Stress Control section.