Medical Support of the Tactical Athlete
Brian L. Springer
Douglas M. Kleiner
John M. Wightman
OBJECTIVES
After reading this section, the reader will be able to:
State the roles of the tactical medical provider (TMP) in advising operational commanders on team fitness and nutrition for peak performance.
Outline basic principles of physical training and be able to provide an exercise prescription for basic aerobic and strength maintenance for a tactical operator.
List the two basic types of fitness tests and identify components from each test that is useful assessing the tactical operator’s physical readiness.
Identify common acute and overuse injuries seen in tactical operations and describe management in the field as well as appropriate follow-up and referral.
INTRODUCTION
The performance of tactical operations places tremendous physical demands on the human body. Medical personnel must themselves be in the best physical condition possible. They must also be prepared to support the health and fitness of team members during all phases of preparation for, execution of, and recovery from tactical missions. The dangers inherent in these operations demand no less than peak mental and physical performance at all times. Failure to do so will, at best, complicate mission completion and, at worst, may jeopardize the safety of team members and civilians.
Tactical operators and their supporting tactical medical providers (TMPs) may be required to run, walk, or crawl long distances; avoid or scale multiple obstacles; climb stairwells or steep surfaces; or breach heavy barricades. In most cases, these tasks will be performed while wearing a heavy duty load, which may include a helmet, body armor, communications and weapon systems, ammunition, task-specific equipment, and medical supplies. Despite these necessary encumbrances, operators may—at a moment’s notice—be required to deliver precise aimed fire, engage in hand-to-hand physical confrontation with an adversary, or move a hostage or bystander who cannot do so under their own power. In the event that an officer is incapacitated, a teammate may be required to drag or carry him or her—complete with their duty load—to safety.
Sports medicine is a very generic term. There are several disciplines within sports medicine, such as athletic training, exercise physiology, strength and conditioning, exercise science, biomechanics, kinesiology, sports nutrition, injury rehabilitation, physiological effects of human performance, motor learning, motor control, fitness, and wellness.
The term tactical athlete has been described in several sports medicine publications. It originated as a spin-off of the athletic trainers’ campaign to include nontraditional occupations within their scope of practice by calling them “athletes” (e.g., the “industrial athlete”). Special weapons and tactics (SWAT) operators are often the most physically fit and the most physically active officers of the law enforcement agency; therefore, they are considered the “athletes” of the agency. Thus, these individuals are likely to sustain the same types of injuries as traditional athletes. The definition of an athlete is a person who is trained or skilled in exercises, sports, or games requiring physical strength, agility, or stamina. The tactical operator is unquestionably an athlete who requires these attributes for the successful completion of duties. To ensure mission safety and success, the TMP requires the knowledge and skills needed to maintain health and peak performance among team members and the ability to rapidly diagnose and treat athletic injury. These enable the TMP to advise the tactical commander on the fitness of human resources for the assigned duties and tasks expected of them.
PHYSICAL PERFORMANCE
Fitness
Regular exercise not only benefits the team member during the performance of duties, but provides for a healthier lifestyle. By promoting physical activity among all personnel, the TMP promotes wellness within the team, which leads to better performance of many tasks. There is also strong evidence that participation in regular exercise prevents work absenteeism through reduction of musculoskeletal complaints and sick days requested (1,2).
Some advantages of regular exercise are listed in Box 6.1 (3). A myriad of information on exercise benefits is available through the National Institutes of Health (www.nlm.nih.gov/medlineplus/exerciseandphysicalfitness.html). Another useful resource for the TMP is the Gatorade Sport Science Institute Web site (www.gssiweb.com), which is an excellent source of information on training, nutrition, and hydration. The American College of Sports Medicine (ACSM) Web site (www.acsm.org) contains links to consensus statements on the medical care of athletes.
BOX 6.1. Advantages of Regular Exercise.
Strengthening the cardiovascular and respiratory systems:
Regular exercise improves lipid profile, decreases the risk of coronary artery disease and hypertension, and enhances lung capacity.
Strengthening muscle and bone:
Weight-bearing exercise maintains muscle strength and bone density, which may prevent osteoporosis and falls associated with aging.
Weight management:
Exercise burns off excess calories, which would otherwise be deposited as fat and potentially lead to the development of obesity.
Prevention of diabetes:
By burning off blood glucose and helping maintain a proper weight, regular exercise can prevent the development of type-2 diabetes mellitus, which is linked to a myriad of health problems including heart and kidney diseases.
Stress management:
Regular exercise activates serotonin and norepinephrine in the brain helping to relieve stress and stave off depression. Endorphin release during exercise also helps alleviate mental stress.
Reduced cancer risk:
Regular exercise has been linked to reduced rates of prostate, breast, and colon cancers.
Improved sleep:
Regular exercise ensures proper sleep hygiene essential for maximal mental focus while on duty.
Exercise is defined as an activity by activated muscles that generate force. This includes all physical activities in tactical operations (e.g., running, crawling, climbing, pulling, physical manipulation of a weapon). Any exercise can be quantified by the physical characteristics of muscular action (4):
▪ Force: the product of an object’s mass and the acceleration imparted to it
▪ Work: the product of force exerted on an object and the distance it moves (no time limit)
▪ Power: the amount of displacement (work) over time
▪ Torque: the degree to which force rotates an object around a fulcrum
▪ Strength: the maximal force that a muscle can generate at a specified velocity
General Strength and Endurance Training
The tactical officer may require any given combination of strength and endurance over a highly variable period of time. Exercise training as preparation for operations must encompass the development of muscular strength as well as cardiorespiratory endurance. The ultimate goal is the development and maintenance of a high degree of physical fitness. The ACSM’s position stand, The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults, gives a detailed overview of the primary components of physical fitness (5).
▪ Cardiorespiratory fitness: the ability of the cardiovascular and respiratory systems to perform at aerobic (i.e., oxygen-consuming) capacity
▪ Body composition: the relative amounts of muscle, bone, and fat in the body, which is affected by the balance between cardiorespiratory and strength training
▪ Muscular strength: a muscle’s ability to generate maximal force
▪ Muscular endurance: a muscle’s ability to generate repetitive force
▪ Flexibility: the ability to move a joint or joints through a full range of motion
To carry out his or her role as a health advisor to the team, the TMP should have a fundamental understanding of how the human body performs during a physical challenge. The motor unit is the simplest functional component of muscle activity, consisting of the activating nerve—or motor neuron of the peripheral nervous system—and all of the muscle fibers that neuron innervates. Electrochemical impulses are transmitted from the central nervous system through the motor neuron to cause an all-or-nothing excitation at the motor endplate with contraction of those fibers.
Muscle fiber types can grossly be divided into type-1 (slow-twitch) fibers and type-2 (fast-twitch) fibers. Type-1
fibers rely predominantly on aerobic metabolism, which makes them resistant to fatigue, but they have a limited capability to produce high forces rapidly. Type-2 fibers rely primarily on anaerobic metabolism. They can generate high forces rapidly, but fatigue quickly. The type and intensity of activity determines the preferential recruitment of fibers (6). The degree of muscle force is dependent on the frequency of activation of the motor unit and the number of individual motor units that are recruited. Contraction of the fibers generates force that may be used to develop movement or resist movement against an external source (7).
fibers rely predominantly on aerobic metabolism, which makes them resistant to fatigue, but they have a limited capability to produce high forces rapidly. Type-2 fibers rely primarily on anaerobic metabolism. They can generate high forces rapidly, but fatigue quickly. The type and intensity of activity determines the preferential recruitment of fibers (6). The degree of muscle force is dependent on the frequency of activation of the motor unit and the number of individual motor units that are recruited. Contraction of the fibers generates force that may be used to develop movement or resist movement against an external source (7).
Muscles involved in physical activity are arranged through a complex system of levers, wherein the various joints act as a fulcrum. Muscles are grouped into combinations of agonists and antagonists, with primary movement initiated by contraction of the agonist, and joint stabilization and braking of the limb controlled by contraction of the antagonist. Agonist/antagonist muscles will switch roles depending on the specific motion of the joint. Muscles are connected to bone either through direct attachment of muscle fibers or through fibrous connective tissue known as tendon. Ligaments are fibrous tissues that attach bone to bone and provide stability at the joint. Through highly coordinated contraction and relaxation of specific muscles and muscle groups, the human body is able to generate a variety of coordinated movement.
▪ Concentric muscle action: occurs when motor unit activation generates sufficient force to overcome resistive force resulting in muscle shortening where the opposite ends of the muscle are drawn toward one another
▪ Eccentric muscle action: occurs when resistive force exceeds the tension generated in the motor unit resulting in muscle lengthening
▪ Isometric muscle action: occurs when muscle force equals resistive force and there is no net change in muscle length
TABLE 6.1. FITT Recommendations for Exercise Prescription (29). | |||||||||||||||
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Strength is most often developed through resistance training, generating force against resistance provided by free weights, machines, or one’s own body weight. This results in muscle hypertrophy (i.e., enlargement in muscle fiber mass, but not number). This occurs disproportionately among type-2 fibers. Aerobic conditioning is attained through endurance exercises such as running, biking, or swimming. Aerobic conditioning results in increased maximal oxygen uptake in the trained musculature, which allows the athlete to perform at a given intensity with greater ease. Additionally, both resistance and endurance training result in neural, endocrine, and vascular changes that facilitate performance of exercise.
The exercise prescription is a means of developing a basic exercise regimen aimed at achieving and maintaining an adequate level of general fitness. Exercise prescription is not designed to directly affect the ability to perform operational tasks, but rather serves as an indirect means to develop the physical abilities to enable the performance of tactical operations. The FITT mnemonic may be used for exercise prescription: frequency, intensity, type, and time. Recommendations for the performance of cardiorespiratory and strength training may be found in Table 6.1. These recommendations are tailored toward the concerns and needs of the tactical athlete.
Stretching and maintenance of flexibility are poorly understood regarding their contribution to the prevention of injury. Certainly, recent evidence has shown that acute stretching prior to exercise can actually reduce performance (8). Controlled stretching of trained muscles should be accomplished several times weekly to ensure adequate muscular control through a useful range of motion. Extreme flexibility, although an aesthetic necessity in certain sports, is not a required attribute for the tactical athlete.
Task-Specific Training
Sports conditioning can be thought of as a pyramid. At the base is general athletic fitness, which makes up the bulk of training. Above this lies sport-specific athletic fitness, such as the ability to jump, sprint, and pull up one’s body weight. At the peak are task-specific skills. In the case of tactical operations, these might include sprinting in full gear, handling a ram, or running a mile in full gear then being able to take an aimed shot (9).
Optimal general training for the tactical officer would be a combination of strength and endurance training, especially given that an operator may have to serve multiple roles in a given operation. An example would be comparing a breacher to a defensive lineman in football. Both perform tasks that are comparatively static, but require strength and proper leverage. A professional football team will usually have the option of specialty training a select group of individuals to fill the lineman role. A law enforcement SWAT team or infantry fire team may or may not have adequate personnel to do the same, and the hazards of the tactical environment may create a situation where a different, less specifically trained individual must fill that breacher role. Therefore, all team personnel must meet minimum strength and endurance requirements to provide depth as well as breadth to the group’s ability to accomplish tasks necessary for mission accomplishment.
Training should concentrate on tasks the team members will perform. Specificity holds that training is most effective when exercises are similar to the activity in which improvement is sought. Although general fitness training should consist of whole-body exercise routines, supplementary exercises similar to the activity should be implemented to provide a training advantage (7). Some controversy remains, however, as to the use of weighted objects when performing tasks. Performing movements against resistance is useful for building strength, but will not necessarily improve performance of that specific movement when unburdened.
The most effective means to design a SWAT-specific or similar program is to individualize training regimens to the most common functions of the team. Reviewing previous missions can provide a valuable resource for training plans. For example, a team covering a relatively rural jurisdiction may find that missions require members to traverse long stretches of unimproved land. This may be done at a run, a controlled pace consistent with a patrol, or at a crawl when maximum concealment is required. Urban teams may find that they are more frequently climbing through windows, up stairs, and onto rooftops. These maneuvers should be practiced frequently while in full duty load.
Fitness Testing Standards
Some controversy exists as to ideal testing standards for tactical officers. However, many agree that operational fitness standards must meet several criteria to be considered reflective of job-related tasks. The content of the test must reproduce critical fitness-related functions of the specific job, be able to predict who can and cannot perform those functions, be based on scientific validity as evidenced by standards of care put forth by ACSM, and be nondiscriminatory with respect to age, sex, race, or physical handicap (10, 11 and 12).
The two basic schools of thought revolve around the fitness test battery, as represented by the Cooper Institute for Aerobic Research’s (CIAR) Law Enforcement Physical Fitness Test and job-task simulation, as represented by Operational Tactics’ (OpTac) Operational Fitness Requirements for SWAT officers. The CIAR test examines the physical fitness components that are underlying factors for performance of specific tasks, whereas the OpTac examination has the officers perform the actual tasks most likely to occur during operations. Both tests (Tables 6.2 and 6.3) are designed to be administered in a specific order, and all team members are expected to pass all aspects of testing, regardless of age, sex, height, or weight.
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