Foot Drill and Stress Fracture

Historically armies practised drill to prepare soldiers for battle. Drill enabled commanders to quickly move their forces from one point to another, mass their forces into a battle formation that afforded concentration of both human effort and firepower and maneuver the forces as the situation developed – akin to our school morning assembly.

The first lesson of Drill or Foot Drill for most of us was the school morning assembly.  We trooped into the Assembly Hall/ Ground, wearing our school uniform, from our classrooms in single file, mostly led by our class teacher.  The files then assembled, aligning in a straight line from the front and to our sides.  We stood at ‘Attention’ for the prayer and the national anthem and for the rest of the assembly was in ‘Stand at Ease’ position.

The drill was employed to train soldiers over and over until a task became second nature and everyone knew how the whole formation moved at any given time. It was in fact Drilled into every soldier that they reacted to commands than thought. The Greeks and Romans had the phalanx involving the soldiers standing side by side in ranks. Just before contact with the enemy, the soldiers moved in very close together so that each man’s shield helped to protect the man on his left. In the beginning, drill gave the soldiers the ability to lock their shields together and form a moving wall of swords and spears. Today, this drill is employed by police across the globe for riot control by locking their shields.

Mahabharata describes Chakravyuh (nodal point defence), Kamalvyuh (lotus array formation), Ardh-Chandravyuh (half-moon array formation) and Shakaatvyuh (T shape formation with a Chakra on it.)  Vyuh is a geometrical shape formed for battle with battle drills by maneuvering foot-soldiers, horses, chariots, and elephants. To beat any formation, it was by Makarvyuh (assaulting human waves) which the Indian Army employed during Kargil War.  The origin of chess is attributed to these arrays so that the new maneuvers and formations could be war-gamed to surround the enemies.

The hallmarks of military drill are efficiency, precision, and dignity. These qualities are developed through self-discipline and practice. They lead to unit pride and cohesion.  Military troops which display constant competence in drill are considered highly trained, well-disciplined, and professional. Drill develops individual pride, mental alertness, precision, and esprit-de-corps which will assist the soldiers to always carry out orders instinctively.  Good drill, well-rehearsed, closely supervised, and precise, is an exercise in obedience and alertness. It builds a sense of confidence between commanders and subordinates that is essential to high morale.

The personal qualities developed on the parade ground must be maintained in all aspects of military life. Commanders must insist on the same high standards both on and off parade, to instill these qualities strongly enough to endure the strain of military duty in peace or war. The systematic correction of minor errors strengthens these characteristics and improves both individual and unit standards.

Goose Stepping, throwing their legs as high as they could while marching was a form of extreme marching held by German, Prussian, and Russian militaries to be an ultimate display of the unbreakable will and discipline of its soldiers.  While marching, they do not dig their heels hard. Most modern armies have done away with this ‘fascist’ approach to marching as being too extreme.  Only a few countries use it as a powerful display of military discipline. 

Today, foot drill is a fundamental activity of the military and is practised regularly during initial military training.  Foot drill involves marching with an exaggerated heel strike, and regimented manoeuvres performed while marching and standing characterised by an exaggerated stamping of one foot into the ground.

High levels of bone strain caused by such exaggerated drills results in stress fracture.  It may also cause micro-damage to bones.  Digging down of heels, especially with the foot raised over the head may cause severe strain to the neck and spine and brain damage.  These soldiers may also end up with joint pains, migraines, and headaches.

A recent post on the social media that the large number of stress fracture of the hips among Lady Cadets in OTA was attributed was the difference in bone structure of women and the fact that the female hips are not meant to take the same stress as males because they have widened pelvis to enable childbearing.  This made me research into the subject of stress fracture during military training.

Stress fractures represent one of the most common and potentially serious overuse injuries, especially among recruits and Officer Cadets the world over.  Repetitive weight-bearing activities such as running and marching are the most frequently reported causes of stress fracture.  Stress fractures have been reported in most bones of the limbs, as well as the ribs and the spine, but the most common location is the lower limb.

Military foot drill generates higher forces, loading rates and accelerations on the human body and especially the lower limbs compared to running and load carriage.  This large biomechanical loading of foot drill may contribute to the high rate of stress fracture during initial military training.  Lower limb injury rates, in particular stress fractures, are reportedly higher for running in women compared with men. [i]

A US Army study found that 14% of women suffered stress fractures[ii] compared to 2.3% of men. Women have an anatomical disadvantage that increase their risk of developing stress fractures. Women have wider pelvic breadths, which negatively alter loading strains. A wider pelvis alters the angular tilt on the hips and knees, increasing the stress on these bones and on those of the lower leg and foot. This anatomical difference may explain the greater distribution of stress fractures in the pelvis and hip observed in female recruits.[iii]

In female Army cadets, women who had fewer than 10 menstrual cycles in the year preceding training had significantly lower spine and hip Bone Mineral Density (BMD) than women with at least 10 cycles.  In studies of elite Australian female athletes, those who suffered from stress fractures had significantly fewer menstrual cycles/year. Thus, female bones may be more sensitive to severe energy deficiencies that cause depressed estrogen levels and altered bone remodeling.[iv]

3,025 US Marine recruits were studied for 12 weeks of training at Parris Island, South Carolina. Polymer and standard mesh insoles were systematically distributed in boots that were issued to members of odd and even numbered platoons. The most important finding was that an elastic polymer insole with good shock absorbency properties did not prevent stress reactions of bone during a 12-week period of vigorous physical training.[v]

Another study that examined 1,299,332 US Soldiers found that female soldiers had a 3.6-fold higher incidence of stress fracture than male soldiers.  They examined age, sex, Body Mass Index (BMI,) and race-origin of stress fracture cases. In both sexes, non-Hispanic white men and women had the highest risk of stress fracture, with a 59% and 92% higher risk respectively, than non-Hispanic blacks. The second highest risk group was Hispanics, with Hispanic men and women having a 19% and 65% greater risk respectively, than non-Hispanic black men and women.  Among Native Americans /Native Alaskans and Asians, only women showed increased stress fracture risk compared with their non-Hispanic black counterparts. Asian women had 32%, higher risk of stress fracture than non-Hispanic black women.[vi]

Notwithstanding women joining the Indian Army, it is time to revisit the training norms – both for drill and Physical Training (PT.)

That brings me to the Gun Drill of the Regiment of Artillery where the detachments are trained to bring the gun into/ out of action and engagement of targets, as if in a war situation.  Here too, over a period, exaggerated movements did creep in, causing skeletal damage to soldiers.


[i] Force and acceleration characteristics  of military foot drill: implications  for injury risk in recruits : Patrick P J Carden, Rachel M Izard, Julie P Greeves, Jason P Lake, Stephen D Myers

[ii] The impact of lifestyle factors  on stress-fractures in female Army recruits: Lappe JM , Stegman MR , Recker RR :.

[iii] Females Have a Greater Incidence of Stress Fractures Than Males in Both Military and Athletic Populations: A Systemic Review Laurel Wentz , MS, RD ; Pei-Yang Liu , PhD, RD ; Emily Haymes , PhD ; Jasminka Z. Ilich , PhD, RD

[iv] Bone density of elite female  athletes with stress-fractures : Carbon R , Sambrook PN , Deakin V , et al :. Med J Aust 1990..

[v] Prevention of lower extremity stress fractures: a controlled trial of a shock absorbent insole. L I Gardner, Jr, J E Dziados, B H Jones, J F Brundage, J M Harris, R Sullivan, and P Gill

[vi] Risk of Stress Fracture Varies by Race/Ethnic Origin in a Cohort Study of 1.3 Million US Army Soldiers.  Lakmini Bulathsinhala, Julie M Hughes, Craig J McKinnon, Joseph R Kardouni, Katelyn I Guerriere, Kristin L Popp, Ronald W Matheny Jr, Mary L Bouxsein

2 thoughts on “Foot Drill and Stress Fracture

  1. Reji, very well written. The effort put in by you in research is clearly visible.

    Having been part of the system from childhood, i find it difficult to accept that we need to change our drills so well ingrained that present drills are bedrock of military and is identified with Military and regal bearing.

    However, the facts mentioned merit consideration and review of drills may be most appropriate.

    Once again thanks for a very informative and actionable info.

    Like

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