The investigation reported here identified common injury diagnoses, activities associated with injury, comparisons of injury incidence rates in men and women, and the associations between fitness and injuries in FBI new agent training. Thirty-seven percent of men and 44% of women experienced one or more injuries in training. Defensive tactics and physical fitness training were associated with 74% of all injuries. A 6-year examination of temporal trends in physical fitness showed little change in push-up, sit-up, or 300-meter sprint performances, but the average 1.5-mile run performance did improve. Lower levels of physical fitness were associated with higher injury risk.
Besides musculoskeletal pain, the largest numbers of injuries were from strains, sprains, contusions, and abrasions/lacerations. These are common injuries in physically active groups of individuals who are involved in running, sports, recreational activities, and military training [4–14]. Only a few cases of more serious traumatic injuries such as bone fractures, dislocations, and subluxations occurred; these totaled less than 2% of all injuries. In runners and collegiate athletes, fractures, subluxations, dislocations have accounted for 3% to 13% of all injuries [4, 6, 7, 9–12]. Less serious injuries like abrasions/lacerations and contusions each accounted for about 9% of new agent injuries, which is comparable to that reported in the literature: 8% to 11% for abrasions/lacerations [7, 10, 12] and 6% to 24% for contusions [6, 9, 11, 12]. This suggests that compared to other groups of active individuals, new agent training has a lower proportion of more serious injuries. However, it is possible that had the musculoskeletal pain (not otherwise specified) cases been diagnosed at higher levels of medical care, these may have been added to other diagnostic categories.
Among new agent trainees only 15% of injuries were classified as overuse with 70% classified as traumatic. With regard to specific injuries, tendonitis accounted for less than 2% of FBI new agent injuries, but in runners, college athletes, and military trainees this injury accounts for 5% to 12% of all injuries [4–6, 8, 10, 13]. In military basic combat training (BCT) overuse-type injuries account for about 75% of all injuries . Contrasting the activity patterns in military training with that of FBI new agent training might assist in accounting for some of these differences. In BCT, recruits perform virtually all physical training as a group, regardless of fitness level. During running activities individuals of similar fitness run together  but with this single exception: all other physical and operational training is conducted together, regardless of fitness level. The basic rationale is to keep the recruits together to build fitness and operational competence while at the same time developing morale (esprit de corps) and teamwork, all under the guidance of a knowledgeable leader, the drill sergeant. In contrast, most FBI new agent trainees performed physical fitness training on their own. A proportion of new agents who failed the first PFT were required to attend a group physical training program three times per week. It is likely that the individualized physical training performed by most FBI new agent resulted in fewer overuse injuries since the intensity, frequency, and duration was determined by the individual. In contrast to physical fitness training, defensive tactics instruction was conducted in a group, with all new agents training together. Defensive tactics involved boxing, self-defense techniques, and subduing suspects (wrestling, grappling, handcuffing). The violent nature of these activities likely led to a higher incidence of traumatic injuries. Another consideration with regard to distinguishing between overuse and traumatic injuries might be workman's compensation that all FBI new agents are eligible for. There is some incentive to link specific injuries to specific causes (rather than note that the injury had occurred gradually over time) because workman's compensation forms require a "cause" of injury. Thus, it may be difficult to truly separate overuse and traumatic injuries in this population.
In the present investigation, 37% of cases involved the lower body and 52% involved the upper body. In sports and recreational activities, the lower body is the site of over 50% and up to 84% of all injuries [7, 11, 17, 18]. In military basic training, 77% to 88% of injuries are to the lower body [13, 15], and in military infantry operational training about 50% to 60% of injuries involve the lower body [19, 20]. Much of military training involves the lower body in activities like running for physical training and patrols on foot while carrying equipment (road marching), walks to training area, drill and ceremony, and the like. In contrast, many injuries in FBI new agent training are associated with defensive tactics which involved largely the upper body.
From an injury-prevention standpoint, the most important information in the medical records is how the injury occurred (i.e., activity or cause). Since almost 50% of injuries were associated with defensive tactics, this is the obvious focus for injury prevention efforts. Given the emphasis in the curriculum and the physical involvement, it is reasonable that most of the injuries would occur in defensive tactics and physical training. We observed that many safety features were in place at the FBI academy during defensive tactics training. Examples are in boxing, the use of boxing gloves, headgear, and mouthguards. During other defensive tactics training, agents practiced on cushioned mats, which offered some protection during falls and takedowns. Nonetheless, additional efforts to reduce injuries in defensive tactics should be explored.
Over the 6-year period from FY 2004 to FY 2009 there was virtually no change in the performance of push-ups, sit-ups, or the 300-meter sprint, but performance on the 1.5-mile run did improve. This is in contrast to studies of US Army Basic Combat Training and international data on youth that show declines in running performance [21–23]. Since 2005, statistical reviews of physical fitness testing have been provided periodically to FBI field offices . These reviews noted the number and percent of new agent trainees who have failed the initial PFT and compares failures among field offices. Field offices are charged with assuring that new agent trainees sent to the FBI Academy are physically prepared, including prepared to pass the PFT. It is possible that these reports have called more attention to fitness issues at these field offices, helping maintain pre-academy push-up, sit-up and 300-meter sprint performance and improving 1.5-mile run times.
Associations between Fitness and Injuries
Because of the limitations in defining and separating overuse and traumatic injuries mentioned above, the any injury variable was used to examine the association between fitness and injuries. The data generally showed that higher levels of physical fitness were associated with lower levels of injury. This agrees well with investigations in military basic training [13, 15, 25–29] and studies of infantry soldiers [19, 20, 30]. However, the FBI new agent data do not agree with most studies of free living individuals [17, 31–36], which generally find that individuals with higher fitness levels have higher injury incidence.
One of the common characteristics of military basic training and FBI new agent training is that individuals perform many physical activities with their fellow trainees. In the present investigation, about 50% of all activities were associated with defensive tactics which all new agent trainees perform together and thus are all exposed to similar risks. About 25% of injuries were associated with new agent physical training. New agent trainees who fail the initial PFT are required to attend supervised physical training three times per week and these new agent trainees would be performing very similar training. New agent trainees who pass the initial PFT are allowed to perform physical training on their own. Nonetheless, the types of physical training performed by these new agent trainees was likely similar to that of other new agent trainees and this training likely involved both strength and aerobic training and focused on passing the PFT in Week 7. It is possible that the relationship between low fitness and higher injury risk can be demonstrated in military basic training and in new agent training (but not in civilian groups) because in basic training and new agent training, the level and type of physical training are similar among participants.
Law enforcement agencies in the United States and abroad can benefit from the results of this study by emphasizing physical fitness in the training of new officers. This study and previous ones [13, 15, 25–27, 29] have shown that individuals who arrive for training at a higher level of physical fitness are less likely to be injured. Thus, individuals should be strongly encouraged to attain a high level of fitness prior to entry into law enforcement training. Consideration should also be given to developing pre-law enforcement training physical training programs, especially for individuals who display low initial levels of physical fitness. Previous military studies have shown that such structured fitness-orientated programs result in lower injury rates once individuals begin boarder military training [37, 38].
Injury diagnoses were limited to descriptions in the medical records. Many of these did not involve diagnostic tests which would have provided more definitive diagnoses. The largest category of injury was traumatic musculoskeletal pain, which was not more specifically defined. This category involved encounters where an individual reported pain in a specific musculoskeletal location but no more specific diagnosis was found in the medical record. Thus, the actual incidence of specific diagnoses was very likely underestimated. Nonetheless, the data provides a comprehensive look at the available medical visits and shows a high incidence of strains, sprains, contusions and lacerations which are common injuries in physically active populations [4–14].
Injury risk was probably slightly underestimated. The analysis assumes that all agents completed the 17-week training course, but some new agent trainees did not for various reasons. Agents who dropped out of training had less time at risk (i.e., less time exposed to the hazards of training). To obtain an idea of the size of this error, we obtained group data (individual data were not available) on the number of new agent trainees who did not complete the course in FY 2005 through FY 2007. There was only a 2.9% to 3.8% drop out rate. The effect of drop outs on the data is likely small.