High-stakes performance: Mastering physio management of tactical personnel

Physios play a crucial role in optimising the performance and overall well-being of individuals. We are used to doing this in the context of the weekend warrior, or even the higher level athlete – but how many of us know what to consider when managing tactical personnel such as military or police forces? In these situations, the stakes are high and tactical personnel face unique challenges both in terms of physical and psychological demands. In his Masterclass, Professor Robb Orr explains the nuances of treating tactical personnel – this blog will outline just a few considerations to get you started.

If you’d like to learn more about physio management of tactical personnel from expert physio Rob Orr, watch his full Masterclass HERE.

1- Understanding the tactical environment

While we may be tempted to compare management of tactical personnel to athletes, there are many differences which make rehab for tactical personnel particularly complex. First of all, their ‘game days’ are unpredictable, meaning they can be required to perform time and time again, with little recovery time; this can not only contribute to the risk of overuse injury, but also fatigue related-injury, resulting in more complicated rehab and return-to-service planning. Secondly, the high-stakes nature of the environment needs to be taken into consideration. If you send a football player back out onto the field at sub-100% the worst that can happen (aside from the risk of re-injury) is that the team loses. However, if you send personnel back into a tactical, high-stakes environment at sub-100%, this carries a risk of morbidity or even mortality for not only that person, but their tactical team, and potentially the community. On the same token, we want to get tactical personnel back out into the field as quickly as possible – as Rob Orr points out in his Masterclass, sidelined tactical personnel can have a detrimental effect on their work-mates in the form of increased working hours and workload to compensate for their injured personnel, thereby increasing overuse and fatigue-related injury risk for the rest of the team. Additionally, uniform can be another key factor to consider – while performance is the priority for sportspeople when selecting uniforms, the priority for tactical personnel is safety which can contribute to injury (e.g. heavy boots contributing to foot injury, heavy loads contributing to back injury).

2- Under-reporting of injuries

For tactical personnel, sometimes pushing through injury is essential – they don’t get to call injury time-outs when they’re on the job. There seems to be a culture of under-reporting of injuries in tactical forces, which means if you’re seeing overuse injuries as a clinician, then it’s likely these have been around for a while, gradually getting worse and becoming more chronic. In his Masterclass, Rob highlights the importance of getting a clear history of injury from tactical personnel, with an emphasis of gaining an understanding of other injuries for which they may not have sought treatment in the past.

3- Load carriage

This is a huge component of the daily lives of tactical personnel, and can be a big factor in the development of injury. General duties police carry approximately 10kgs of load (1), firefighters carry approximately 20kgs (2), and military personnel can carry over 45kgs (3). Additionally, females tend to carry a higher overall percentage of their body weight than men. This has strong implications for rehab – not only do tactical personnel need to have the strength to carry this load, they need to have the muscular endurance to carry it around all day, as well as the cardiovascular capacity to run, sprint and jump with this load on their person. Importantly, a recent systematic review found that occupational performance seems to be optimised with programs including a combination of strength (combo of lower and upper extremity), aerobic endurance training and specific load carriage training (4).

4- Impact of deficits

In the sporting environment, deficits in strength and cardiovascular fitness can reduce performance and potentially result in injury and team losses, but in the tactical setting, deficits can have a more significant impact. In his Masterclass, Rob outlines that studies reporting fixed-distance, timed run events suggest that poor metabolic fitness carries an increased risk of injury during initial tactical training (5). Additionally, studies by Rob and his team have found that people in the police force with a grip strength of more than 24 kilograms on each hand were able to reduce their injury risk, and those with less grip strength than 24 kilograms were more likely to fail their defensive tactics course and marksmanship (6). A reduction in performance for tactical personnel as a result of strength/endurance/cardiovascular deficits could lead to the inability to successfully complete their job, therefore risking themselves, their team and potentially the community. Therefore, when rehabilitating tactical personnel we must ensure we cover all bases.

Wrapping up

There are multiple considerations we need to take into account when treating tactical personnel, there are many factors unique to their circumstances which may mean we need to alter how we would approach their management plan as compared to the elite athlete or weekend warrior, and this blog hasn’t even touched on the myriad of psychological factors which may impact injury and rehabilitation in this population. As always, it’s most important to learn about each person’s circumstances to inform an individualised and relevant management plan for them.

If you’d like to know more about the physio management of tactical personnel, watch expert physio Professor Robb Orr’s full Masterclass HERE.