Updated: Oct 14, 2019
An Argument for Precision - Part 1
Preventable musculoskeletal (MSK) injuries plague Army readiness.
Among Active Duty Soldiers, MSK injuries result in over 10 million limited duty days each year and account for over 70% of medically non-deployable Soldiers. Described by health experts as the single biggest health problem in the U.S. Military, almost 50% of service members experience one or more injuries each year, resulting in over 2 million medical encounters, and requiring 90-120 days of lost duty for each injury. Most of these injuries are a result of overuse strains, sprains, and stress fractures to the lower leg and foot; more than half are exercise or sports-related. Of note, available statistics and literature identify running as one of the major causes of MSK injuries. Recruitment, societal, and cultural issues aside, most health experts and senior Army leaders agree a “balanced fitness program” is a critical component of the prescription required to diminish preventable MSK injuries and increase Army readiness. What does a “balanced fitness program” look like? Who will develop, implement, and supervise these efforts? What Army doctrine should we look towards to further understand how to optimize fitness while simultaneously reducing risk of injury?
Current Army doctrine does not sufficiently address these issues. It is incumbent upon platoon-level leaders to plan, prepare, and execute physical readiness training that logically and systematically generates the type of comprehensive physical readiness capable of reducing preventable MSK injuries. To achieve this end state, leaders must understand the fundamental principles offered in “A Leader’s Guide to Training for the ACFT;” more importantly, leaders must empower subordinates to develop and implement training strategies that look vastly different than the physical training that produced success on the APFT. What follows is a practical, evidence-based template intended for use by junior Army leaders to develop physical readiness training strategies representative of the “balanced fitness program” the Army needs.
The ACFT is not an impediment to action; the ACFT is the impetus for action.
The Army Combat Fitness Test (ACFT) presents some challenges; it also presents a great deal of opportunity. As we learn to train for a new fitness test, we must fine-tune our understanding of fitness in the context of performance. Overall fitness can be divided in two categories: physical fitness and motor fitness. Measurable qualities of the human body’s physical processes, or physiology, are the components of physical fitness: muscular strength and endurance; aerobic and anaerobic endurance. Elements of motor fitness like power, speed, agility, coordination, balance, and reaction time, are often overlooked by traditional training programs, but no less vital to performance. The type of overall fitness that will make Soldiers more resistant to injury can only be obtained when we combine efforts to improve physical fitness with deliberate efforts to improve motor fitness.
Precision - the best place to start.
Evidence suggests that precise movement patterns are fundamental to overall fitness by way of reducing injury risk and increasing basic function. Precise movement, developed by “grooving appropriate and perfect motion and movement patterns,” should be the foundation of a well-designed training program. The ability to move precisely (and pain free) through each of the movement patterns demanded by our “sport” also contributes to improved performance in both categories of overall fitness. There are six fundamental athletic movement patterns Soldiers must groove appropriately to reduce injury risk and improve performance.
The Precise Pattern Six
There are six fundamental movement patterns for which Soldiers must build progressive competence: hinge, squat, push, pull, lunge, and rotate. For optimal performance and injury prevention, Soldiers must learn to execute each of these patterns with an appropriate range of motion, a high degree of stability, and precise alignment of the body’s joints for best use of the body’s levers. Figures 1-6 describe each of the fundamental movement patterns.
Preventing the most likely of scenarios.
Somewhere, right now, on an installation near you, a Soldier is executing a squat, deadlift, or power clean with a load that is too heavy and with poor form. One of his or her teammates is not only watching but encouraging them to keep pushing forward. Over time, repetitive execution with poor mechanics will result in an injury (not unlike the previously mentioned MSK injuries caused by chronically poor running mechanics). We should applaud our Soldiers for identifying the need to train for muscular strength, but we also have a responsibility to ensure Soldiers have the appropriate motor fitness foundations before we load a potentially compromised system. Here’s how:
Conduct a PMCS: Precise Movement Competency Screening
Movement competency, or the “cognitive awareness and technical quality of an individual’s movement strategies,” influences muscle activation; joint loading; and ultimately injury risk, strength, and power expression. Using the Precise Pattern Six as a guide, Soldiers at the platoon level and below should conduct a screening for movement competency before initiating a training program that progressively loads variations of the six key patterns. Figure 7 is a practitioner’s guide to determining whether a Soldier is ready to advance to more dynamic or intense training techniques.
The PMCS is intended for use at the squad level as both a preventive tool (as the acronym alludes) and a gateway to more advanced training techniques. Based on a Soldier’s competency in a given movement, he or she may need to spend more time grooving appropriate and perfect movement patterns before adding a load or increasing intensity. This is a qualitative assessment; leaders must conduct some self-study or depend on a teammate with a strong athletic background, to provide corrective feedback with the potential to improve a Soldier’s movement. In some cases, a simple cue like “retract your shoulders and maintain a flat back” may be enough to correct a Soldier’s movement during a PMCS. When a Soldier demonstrates the ability to execute a given movement well, they may progress to loaded movements in accordance with the unit’s training plan.
Remember: a high-quality unit training plan accounts for varying degrees of movement competency and overall fitness by “individualizing” the selected exercises; this means that each prescribed exercise can be scaled to the appropriate level of difficulty for both the weakest and strongest performer in the squad.
As the intensity of the training program increases, Soldiers must continue to demonstrate competency through each of the Precise Pattern Six movements. As with the unloaded PMCS, simple cues may be enough to correct a Soldier’s form; video feedback can also be a powerful tool. When cues are no longer effective, or when the intensity of an exercise overcomes the Soldier’s ability to maintain precision, he or she must make the wise choice to reduce the intensity until precision is restored. This may require identifying the limiting factor in the kinematic chain. For example, a common error in the squat movement is failing to maintain the entire foot in contact with the ground -- usually observed as “coming up on the toes.” A simple cueing strategy is to remind the performer to “keep the weight in the heels.” If a Soldier is unable to achieve this standard, it may indicate a lack of mobility in the ankles or hips, or a lack of stability in the foot or trunk. In this case, the Soldier may need to use a more comprehensive strategy to develop a precise squat pattern. This might include: assisted squats to groove the appropriate motion pattern; exercises to increase hip and/or ankle mobility; and exercises for increasing trunk strength and stability.
“We need to treat our Soldiers like elite athletes.”
Many have heard this mantra before, but most don’t know where to begin. A common misconception about “training like an elite athlete” is that cutting-edge techniques and dynamic, high intensity programs rule the day. Often, elite performers focus on precise execution of the fundamentals above all else. Understanding, teaching, and enforcing fundamentals (for movement, for nutrition, for recovery) is exactly how we start treating our Soldiers like elite athletes. In the physical domain, paramount to performance and injury prevention, precise execution of fundamental movement patterns is where it all begins.
Where do we go from here? Progression
Precise execution of fundamental movement patterns (hinge, squat, push, pull, lunge, rotate) is vital to increased performance and injury prevention. As Soldiers increase overall fitness by grooving perfect motor patterns, leaders should progress the training through the following stages:
Groove. Stabilize. Increase. Build. Develop.
Groove: appropriate and perfect motion and motor patterns.
Stabilize: build whole-body and joint stability (mobility at some joints and stability though the lumbar and trunk).
Develop: speed, power, and agility.
A low to moderate degree of loading may be appropriate to assist Soldiers in building competency in the Precise Pattern Six. Steps 1 and 2, groove and stabilize, have a complementary relationship because an inability to achieve precision in the fundamental movements may result from a lack of mobility or stability. If this is the case, the Soldier must take deliberate action to improve mobility and/or stability in the appropriate joints and regions of the body.
Potential Scenario: A new Soldier arrives to the unit and their squad leader conducts a PMCS during their in-processing. The Soldier demonstrates a moderate degree of competency in the squat and progresses to a goblet squat with a moderate load. During the execution of the loaded squat, the Soldier demonstrates an inability to maintain proper posture of the torso and the Soldier’s heels rise from the ground before the Soldier reaches an appropriate squat depth. The most appropriate course of action is to remove or reduce the load until the Soldier can perform the exercise with precision. While the Soldier works on grooving the appropriate pattern with a reduced load, the squad leader should prescribe some concurrent training aimed at improving both trunk stability and hip and ankle mobility.
The list below represents “a way” to progress through each of the Precise Pattern Six movements as Soldiers develop competency in each pattern. Videos for many of these exercises are available here.
Progression of the Precise Pattern 6
PVC Pipe deadlift and good morning
Bilateral hip thrust, single leg hip thrust
Bilateral kettlebell (KB) deadlift, bilateral KB romanian deadlift (RDL)
Hex-Bar Deadlift, unilateral KB/dumbbell (DB) deadlifts
Loaded good morning, unilateral and single leg RDLs
Progression through loaded barbell deadlift and RDL
Band or strap assisted squat
Squat with PVC pipe overhead
Barbell front squat, DB front squat
Unilateral DB or KB front squat
Loaded overhead Squat
DB overhead press
BB overhead press
Hand-release push-up (HRPU), t-push-up
Ring push-up, dip
Plyo push up
Slide board push up
DB row, ring row
Bent over row
Ring pull up
Side lunge (cossack squat)
Each w/ load (front, back, overhead, unilateral)
Jumping lunge, w/ switch
Unloaded - lunge with twist, deep lunge with twist
Resist rotation with the two-point hold
Lunge position - resist rotation with band resistance
Dynamic - rotation with med ball throw - 4-way plyo circuit
Side-shuffle, turn and run
Backwards run and turn
Understanding Integration - Part 2
Any attempt to develop a comprehensive physical training strategy must begin with a basic understanding of the scientific underpinnings offered in “A Leader’s guide to Training for the ACFT.” With those foundations in mind, the next step is to conduct a “mission-focused needs analysis” and assess how well the unit can meet those demands. If the physical demands of the mission are well-defined and prove vastly different than the physical demands of the ACFT, it may be appropriate to develop additional assessments of physical and motor fitness. If the physical demands of the mission are broad or unknown, the Army has already conducted a scientifically-based needs analysis and the ACFT is an appropriate fitness assessment.
Figure 1 is a graphic depiction of ACFT results that could represent an individual performance or unit averages. Visualizing the results in this manner may assist in determining the focus of a comprehensive training program. In this example, performance in the leg tuck event indicates that trunk strength and/or stability is significantly lacking. This weakness in the kinetic chain not only impacted leg tuck performance, but poor trunk stability likely contributed to weak deadlift and power throw performances as well. When compared to 2 mile run performance, sprint-drag-carry scores indicate a less-developed anaerobic energy system. Given this insight, this Soldier or unit should focus on stabilizing the trunk and increasing anaerobic endurance.
A comprehensive program should:
Consider the “groove, stabilize, increase, build, and develop” model as training progresses through each of the fundamental movement patterns.
Appropriately load each pattern according to an individual’s readiness as determined by an iterative PMCS process.
Develop the components of fitness (aerobic and anaerobic endurance; muscular strength and endurance) according to the specific needs of the Soldier via stressing the appropriate energy systems and physiological mechanisms frequently enough to elicit an adaptation.
Generally, progress from prescriptions of high volumes and low intensities to prescriptions of low volumes and high intensities.
Intelligently sequence activities for a single training day. Elements of motor fitness are generally practiced first; precision should be maintained throughout.
Warm-up: general to specific; less to more dynamic
Agility, coordination, balance
Energy system development: Anaerobic and Aerobic endurance
The Army’s Holistic Health and Fitness (H2F) vision includes important initiatives like integrating physical therapists, strength and conditioning coaches, and nutritionists at the battalion level. While these additions appear imminent for some units, it may be several years before the Army implements a broader solution. In either case, unit fitness will remain the primary responsibility of the small-unit leader. Leaders should consider the new requirements of the ACFT a call to action and approach this event like any other well-planned training: assess, plan, prepare, execute, and repeat. The models offered in this article are not a comprehensive solution, but they may serve as a guide as junior leaders develop their own innovative techniques to train Soldiers like warrior-athletes.
Sample Week of Training. Focus: Trunk Stability and Anaerobic Endurance
* This is not an introductory week of physical training and not intended for beginners. Instead, it is intended to demonstrate how training should be sequenced within a single day, and how the various components of fitness can be addressed during a single week.
Monday - Hinge & Horizontal Pull
Warmup. 3 rounds of: banded RDL (10 reps); knee-hug lunge-twist (10m); static inch worm (5 reps)
Develop. 3 sets of: hip extension (15 reps) + ring row (10-12 reps)
Run Specific Warmup. 10m A-march, 10m hi-knees, 10m A-skip, 1x400m run @ 50%, 1x400m run @ 75%
Anaerobic Interval Training. 6x400m repeats @ 90% of max effort (1:4 work to rest ratio)
Cool-down. 5-10 minute jog or bike
Tuesday - Squat & Vertical Push
Warmup. 3 rounds of: spiderman crawl w/ elbow drop (10m); shoulder pass thrus w/ PVC pipe (10 reps); scap depressions (10 reps); then: 3 rounds of Cindy (5 pull-ups, 10 push-ups, 15 squats).
Power. 5 x single broad jumps; 3 x 15-20lb reverse medicine ball toss
3 x double broad jump (w/ pause); 3 x 15-20lb reverse medicine ball toss
5 x triple broad jump (no pause); 3 x 15-20lb reverse medicine ball toss
Groove. 3 sets of: 15 goblet squats + 15 standing DB/KB shoulder press
Stabilize & Increase. 6 rounds for time:
Single arm farmer’s carry 20m right arm
Single arm farmer’s carry 20m left arm
80m shuttle sprint (sprint 40m to start line and 40m back to KB/DB)
Wednesday - Lunge & Vertical Pull
Warmup. 3 rounds of: 30 sec deadbug hold, 30 sec contralateral deadbug; cossack squats (5RT/5LT); glute bridge (10 reps w/3 sec hold at top of each rep).
Groove. 3 sets of: plate overhead walking lunge (20m)
Then, accumulate 25 pull-ups (as few sets as possible; if you can do this in 2 sets or less, accumulate 40 pull-ups)
Increase. Aerobic endurance training - 20 minute bike, run, row, versa-climber or stairs @ 60-65% max heart rate (talk-test)
Thursday - Move Under Load
Warmup. 3 rounds of: knee-hug lunge-twist (10m); static inch worm (5 reps); pillar hold w/ hand reach (5RT/5LT).
Stabilize & Increase. Ruck 4 miles (15 min/mile).
Friday - Hinge & Horizontal Push
Warmup. 3 rounds of: air squat (15 reps); lunge w/ jump switch (5RT/5LT); captain morgans (5RT/5LT)
Groove & Increase. As many repetitions as possible in 7 sets of:
KB Swing - 15 seconds
Rest - 15 seconds
HRPU - 15 seconds
Rest 15 seconds
Run Specific Warmup. 10m A-March, 10m hi-knees, 10m A-skip, 1x400m run @ 50%, 1x400m run @ 75%
Anaerobic Interval Training. 8 Sets of: 30:60s (30 second run + 60 second walk)
Cool-down. 5-10 minute jog or bike