Active-duty United States service members require medical treatment for injuries almost 5 million times each year, according to the Department of Defense (DoD). Military personnel face unique challenges and must withstand occupational loads under difficult conditions that put them at significant risk for injury. Some of these injuries can even occur from the much-needed equipment that keeps them safe.

Special Forces combat soldiers often carry equipment on their heads that collectively weigh between six to seven pounds – this includes their helmet, communication gear, night vision goggles and various other safety devices and attachments. Carrying this amount of weight can result in cervical spine injuries during parachute operations and ground-based activities that involve landing, jumping and sharp decelerations.

During parachute operations, individuals free-fall from a plane with their head-heavy gear and other equipment then experience a forceful deceleration when their parachute opens which is followed by a landing. Both of these instances can cause a harsh strain on the neck and spine. These injuries can result in significant pain, time lost or restricted duties, medical visits and even surgery. In some cases, these injuries also result in frequent headaches, difficulty with concentration and disturbed sleeping.

Timothy Sell, PhD, PT, professor of orthopaedic surgery and director of the Atrium Health Musculoskeletal Institute’s Performance Center, is working to better understand these injuries and provide recommendations on injury prevention through physical interventions and equipment modifications through a three-year, $4.5 million grant from the DoD. Sell is the primary investigator of this study.

Timothy Sell, PhD

"Our overall objective is to reduce the risk of cervical spine injuries in this particular group. Special Forces combat soldiers can suffer cervical spine injuries due to wearing this heavy equipment during high acceleration events such as parachute opening shock. This can result in neck pain and cervical spine degeneration. Our goal is to determine effective injury prevention strategies will reduce the stress and strain on cervical spine through physical interventions and possible equipment modifications."

- Timothy Sell, PhD, PT, professor of orthopaedic surgery and primary investigator

This research is a continuation of ongoing studies with a unit of Special Forces combat soldiers who are at risk for cervical spine injuries and neck pain due to their exposure to head-supported mass (protective helmet, night vision goggles and communication gear). Research and enrollment will be expanded to collect data on more combat soldiers and follow-up with individuals already enrolled in the current study. Sell will continue to collaborate with Cameron Bass, PhD, professor of biomedical engineering at Wayne State University and Jason Luck, PhD, assistant research professor of biomedical engineering at Duke University, on progressing this initiative.

A man standing behind a medical gurney.

This research team will work with Special Forces combat soliders stationed at Fort Liberty (formerly Fort Bragg) in Fayetteville, North Carolina and civilians in the Charlotte area as part of a control group. For the active military members, Sell and his team will travel to the base every two weeks to conduct strength and range of motion testing of military participants. While on base they will also collect injury data on study participants’ cervical spine injuries including injuries that have been suffered since initial baseline testing. This follow-up testing will also include musculoskeletal imaging to examine the effects of service time on potential degenerative changes of the cervical spine. The team will also examine different military tasks in-the-field to determine potential mechanisms of cervical spine injury.

“We aren’t making recommendations to the DoD on protective equipment or what to wear; our role is to report the effects of current equipment and potential configurations of head-worn equipment and how to wear to best reduce injury,” Sell said. “Can we change where the weight is located to reduce stress and strain on the cervical spine? This is the type answer we’re looking for. Ultimately, we’re aiming to gain insights on how to prevent these injuries while also doing some modeling to provide recommendations on how they might be able to reconfigure the head supporting mass.”

While this study directly relates to military personnel, it can also be applied to civilian public service professionals, including fire departments, state, county and city police departments and federal agencies, who all face similar issues with head-supported mass and tactical equipment. The conclusions and tools developed through Sell’s research can be utilized by all personnel who are required to wear head-supported equipment in the performance of their duties.