Helping soldiers stay healthy.

Published in the Auburn University Graduate School Magazine, as Jessica Nelson 

Not everyone gets gassed on the job. Even fewer do it by choice. But the group of 10 kinesiology graduate assistants who make their way to Fort Benning in Columbus, Ga.,  in the pre-dawn hours each morning are not interested in  the usual graduate school experience.

Auburn University has an agreement with the U.S. Army called the Warrior Athletic Training (WAT) Program that funds 10 graduate assistants who rise at 3 a.m. each day to work with soldiers at Fort Benning during basic training. Their mission involves injury prevention and treatment for soldiers in the 192nd infantry brigade. What they do there is much more complex.

The program began when the Army came to Dr. Joellen Sefton in Auburn University’s Department of Kinesiology for help. They sought a better way to prevent and treat musculoskeletal injuries that occur in basic training. Sefton designed a program using certified athletic trainers to prevent and treat soldier injuries and was awarded a one-year contract with a five-year renewal option, which the army exercised in September. Her graduate assistants are all certified athletic trainers, who are typically found working with sports teams. The athletic training profession has been growing and evolving to include occupational athletes, clinics, wellness centers, and now, the military.

Though athletic trainers, or ATCs as the Army calls them, are used by some branches of the military, this partnership is unique. With this arrangement, graduate assistants get their education paid for, and the Army gets highly competent medical personnel who work closely with Soldiers, Drill Sergeants, and base medical personnel to prevent and more efficiently treat injuries that occur during basic training.

The WAT program ATCs work in pairs and are each stationed with a Battalion in the 192nd Brigade. They work with Soldiers from the minute they enter as fresh recruits by doing an assessment and injury brief for each new Soldier. They brief Soldiers on how to tell the difference between a “good hurt” and “bad hurt,” and tell them what to do if they suspect an injury. Another program Sefton and her colleagues from the Department of Kinesiology developed is called the Gait Instruction Mentoring Program (GIMP), and focuses on correcting Soldiers’ running gait for injury prevention. In some cases, Sefton says, they have to actually teach them how to run. “Some of these guys have never really run before,” she says.

She and her GAs face a lot of challenges, including the Soldiers themselves. Young people are often out of shape and unused to physical activity, and the Army seems to be seeing an unwarranted number of overuse injuries and stress fractures. One of her long-term goals is to try to improve effectiveness and reduce injuries of morning PT, or physical training. “The Army needs ways to train [the Soldiers] without breaking them,” she says. “We are currently involved in assisting them in this process.”

But the challenges now are nothing to what they faced coming in. Laura, a GA in her second year who was with the program from its inception, says they got a lot of cold shoulders from Drill Sergeants and officers who were wary of change. Now, though, she says, “we’ve proved ourselves, we’ve gained their respect and their trust.” Though they don’t mistake the fact that they are not Army, the graduate students all seem to feel that they have earned a place at Fort Benning.

Several of the ATCs are women, and they initially faced an extra challenge. The all-male environment caused some initial skepticism from Cadre, or the ranking officers. However, everyone learned quickly enough that the athletic trainers weren’t there to give anyone an easy time. They expect the proper level of respect from the Soldiers, and they get it, while making sure that everyone continues training to the limit of their ability.

The day begins at 0530 Eastern time (Auburn is on Central time) for Soldiers and GAs. In the cool morning, the flag is raised beside the training field, and hundreds of soldiers stand at attention as Reveille is piped through a tinny PA system.

Two graduate students are assigned to each of the five Battalions that WAT serves. Stasia Burroughs and Daniel Spengler work with the 2-47 Battalion, commonly known as the Panthers. Each morning when they arrive, they go over paperwork and evaluations from the previous day, and then one of them heads outside. The outside person will stop by sick call, where any soldier who feels sick or injured enough to miss PT that day will be waiting. The GA screens for injuries under their jurisdiction – the musculoskeletal ones – and sends those inside. Then he or she goes to the training field for the Battalion. A single Battalion contains five to six Companies of 220 men each. Each company trains separately, but usually three or four companies are at the field in the morning. The purpose there is to watch the Soldiers closely to check for unreported injuries, or injuries that happen on the field. She will also occasionally pull a Soldier out of formation to correct his form while exercising – the prevention part of the job.

The ATCs have also worked to train Drill Sergeants on what to look for. They teach them how to spot injuries early as well as how to correct the Soldiers’ form during exercises to prevent injury.

Meanwhile, back at the sports medicine room, Soldiers sign in and returning patients get to work on previously assigned rehabilitation exercises. As new patients are evaluated, they are assigned a workout/rehabilitation regimen. Sefton and all the GAs are adamant that no one gets off easy. “We don’t want anyone thinking this is a soft place to land,” she says. All of her ATCs echo this statement in some way, but it is most colorfully put by Lt. Col. Brewster, commander of the 2-47 Battalion. He fondly refers to the Auburn group as “ Sefton and her posse of pain people.” Brewster is brimming with enthusiasm and is clearly one of the WAT program’s biggest supporters.

The number one goal is to keep the men training, he says. That is what makes this program so valuable to the people who are involved with it at Fort Benning. Before it began, any injured Soldier would report to sick call, then make the hike up to the Troop Medical Center, an on-base clinic that serves all of Sand Hill (two Brigades, or several thousand soldiers). At the TMC, they might wait all day to see a medical professional, who would then assign treatment. TMC is undermanned, and while they do the best they can, WAT can help the Soldiers get faster care for certain injuries right in their Battalion. This is a huge morale boost for Soldiers and an important way to minimize their down time. WAT works closely with Ft. Benning medical personnel, especially the physical therapists, and say that they feel that the program has integrated well with the existing medical structure on base. Each Soldier that is assessed and treated by the ATCs saves the Army the $250 it costs for them for the initial visit to the medical center – not to mention the costs of hours of missed training time.

Lt. Col. Brewster stresses, “You find people don’t want to stop, to fall behind. They don’t want to miss training, so they’ll run until they get hurt.” He hopes that what the ATCs are doing is changing the culture of Army basic training, and therefore changing not just the way they deal with injuries, but the number of serious injuries they have to deal with.

The graduate students’ morning is wrapped up with paperwork. One of the keys to making the program work is the way they keep everyone informed. They send hand-written notes to Drill Sergeants about new patients or progress reports and daily reports to the Company detailing who they saw, what progress is made, and when that Soldier will be back to duty.

Four of the 5 Battalions covered under the agreement – the 2-47, 3-47, 2-54, and 1-378 – are all training Battalions and operate basically the same way. However, two students work with a smaller group – the 30th AG Rehabilitation  Company. This Company is comprised of seriously injured Soldiers who need more intensive rehabilitation and longer convalescence, which comes with its own challenges.

Mike Hickey and Eileen Strube both work with the company known variously as PTRP, FTU, or simply “Delta Company.” This is unofficially called the rehab Company, as the men in the 30th AG are all returning to Fort Benning after 30 days convalescent leave. This usually means stress fractures or other serious overuse injuries that prevent the men from training.

Part of the challenge is that 30-day leave, which usually means that the injured Soldier is at home, doing no training and receiving no treatment. By the time the Soldiers return to the 30th AG, morale is often a serious problem. As a result, their days are a little different.

They get started around 6 a.m. Their Soldiers have likely been standing in formation, which alone is a challenge for some, Hickey says. Then the group splits up and those who are cleared to walk will go to a half-mile track and begin a walk-to-run progression intended to ease them back into PT training. The GA on duty will walk with them, demonstrating simple exercises as they walk. Hickey says that getting them moving again and feeling part of a team is a key aim. The others, not cleared for walking, will go to the gym. Either way, he insists, they leave sweating.

However, Strube and Hickey agree that the differences with the 30th AG don’t end there. They see the men for a lot longer as they complete more slow-paced recovery and rehab. They often end up listening to personal stories or just doing more encouraging. Hickey says that often guys will come in enthusiastic about getting back to training, but will lose confidence as their recovery takes longer than they hoped.

“For some of these guys,” Strube says, “this is their shot. If they mess it up, they don’t really have anything waiting for them outside.” And it can be bad luck – a mishandled mat on the training field – more than anything that lands them there. But the rewards are there when they see Soldiers graduate that they’ve helped return to duty. They often come back and say, “thank you.” This is a repeated story from all the GAs, and it is clearly a part of the job they treasure.

Although all of the students are officially done for the day around 9 a.m., this doesn’t always mean they go home. Every GA in the program has participated in training activities with their Soldiers, which they say went a long way toward building a rapport with both the Soldiers and the Drill Sergeants and other Cadre. They go on ruck marches (a long walk with a heavy backpack), they rappel down Eagle Tower, and a lucky few have gone through the gas chamber.

“When we showed up the first day, we didn’t know anything,” Stasia said as an explanation for their extra hours. “To better understand everything, we started staying late to see what they’re doing every day, running around in the woods with guns or whatever they’re doing. That helped us understand more about what they’re doing and what it takes to do it.” This is how Auburn graduate students ended up getting gassed on the job.

Lexi Douglas, a second-year GA assigned to the 3-47 battalion says, “The biggest thing we did toward cementing ourselves there was that we went through the CS gas chamber. And that was awful. It’s like breathing aluminum foil.” They all believe though that not only did these things build goodwill from Soldiers who saw them willing to do what they do each day, but they also help them treat the injuries better by understanding what is required of them. They all have volunteered many extra hours at Fort Benning just getting to know their Soldiers and what they go through.

With few exceptions, the graduate students say that the novelty of the program was what first attracted their attention. “At this point in time,” Douglas says, “I don’t think there’s anything like it.” Masa Mizutani was also interested in doing something new. “Our year was the first year,” he says, “so I thought it’s going to be very interesting.”

Amanda Pizzi is the exception. She actually was attracted to the GA position at Auburn precisely because she had always wanted to work with the military. She came from a military family, and she says that she’s heard lots of stories about injuries that don’t receive proper treatment. So when she saw the Auburn position, her mind was pretty much made up.

In addition to their work at Fort Benning in the mornings, the GAs, especially second-year students, are preparing a final research project for completion of their degrees. Many are focusing on projects inspired by their work with basic training Soldiers.

Several students are focusing on research that hopes to address a serious problem at Fort Benning that is actually rare in most other contexts – femoral neck stress fractures. These are stress fractures that occur in the main leg bone just below the pelvis, and if this injury develops into a fracture, it can be a career-ending injury, Sefton says. The thing is that no one is really sure why this rare injury is so common at Fort Benning. Strube, Masa, and Marie Lackamp are all studying the way soldiers carry loads (like on ruck marches) and how these loads affect posture and balance, and whether these have any bearing on the hip stress fractures that they are seeing.

Strube, who works in the rehab company, is passionate about the subject. She says soldiers of different ages and body types are seeing this injury, and their recovery rates differ widely. “Why is this happening?” she exclaims. “Why do I have 15 Soldiers looking like this when I shouldn’t have any?” This group of students will actually be working with Auburn ROTC students, since access to Fort Benning Soldiers would be difficult for this kind of study.

They will have the ROTC students, who are experienced carrying the kind of loads that soldiers carry, stand in different positions, wearing different amounts of weight, and will measure the changes that take place in their body. They will use motioncapture cameras and an instrument called the balance master to get precise data about balance and posture changes under loads. Hopefully, this will lay the groundwork for other studies that will go further into the question of the hip stress fractures.

Hickey hopes to build on their work and develop a screening program to help prevent these stress fractures in Soldiers who may be at higher risk for developing them. He said that though he is still in his first year and won’t be working with the trio studying posture, this was an obvious subject for him. “The first week I got here, all I heard was everybody talking about these femoral neck stress fractures,” he says.

Douglas is also looking at stress fractures and overuse injuries. They are approaching it from the angle of the Soldiers’ boots, which have no cushioning whatsoever, but are worn all day. Just because they aren’t doing their morning runs for PT doesn’t mean they aren’t running and potentially getting injured. She is looking at providing shock attenuation with shock-absorbing insoles. They will be testing two different kinds to find out if they see any reduction in the number or severity of injuries in their Battalion with the use of the insoles in the combat boots.

Meanwhile, Laura Waples will be studying the effects of cryotherapy, or icing. Specifically, she will test proprioception – how well an athlete or other patient can sense the position of her body after icing. Ice slows down nerve activity, and she wonders just how long the body needs to get back up to speed, so to speak. Waples thinks this will have relevance for athletes especially. For example, could an athlete ice in the first half of a game and safely return to the game later? Michael Methvin is looking at running shoes and how the gait and heel strike change during barefoot running.

As they move forward, all of the graduate assistants are simply grateful for the experience in ways that go beyond an education. Lackamp points out that in the Fort Benning setting, they have more autonomy and get more experience than they would ever get in an athletic setting. “On my first day,” she says, “I was thrown right into an evaluation.” Mizutani and Pizzi agree. “If you work with a football team,” Pizzi says, “you work with maybe 150 guys. We have 1,000 to 2,000 Soldiers. You see a larger volume of injuries.” More than that, Mizutani says, the diversity of age and background of the Soldiers means more diverse kinds of injuries. This program, they think, allows them to just learn more than a traditional athletics GA position.

They get most earnest though when they talk about what this experience means to them outside of the academic realm. “It really hits you hard when you’re thinking about these Soldiers who you’re helping just advance to get to go and fight for us,” Waples says. Strube agrees immediately, “It’s nice to know that you’re serving those that serve our country.” Hickey, at a different time, unconsciously echoes them when he says, “Regardless of what happens with a guy, at least he signed up to serve the country. At least I can give back to him what he was trying to give to us.”

These are the things, Strube says, that get them up at 3 a.m. every day.

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