Most Effective Treatments for Lower Extremity Bones Stress Injuries in Military Recruits: A Scoping Review

Publication Date

Spring 2026

Document Type

Capstone Project

Degree Name

Doctor of Physical Therapy

Department

Physical Therapy

First Advisor

Amy Bala

Second Advisor

Valerie Coolman

Third Advisor

Christopher McElroy

Abstract

Bone stress injuries (BSIs) are common in military training populations and can affect performance, training completion timelines, and return to duty. Physical therapists (PTs) and other clinicians working with military recruits need a clear understanding of the evidence on risk factors, prevention strategies, and management approaches. This scoping review aimed to explore the current evidence on BSIs in military recruit populations and summarize study characteristics, interventions, and clinical relevance to physical therapy practice. Key themes across the literature were that BSI risk is influenced by multiple risk factors, gradual activity modification and load management are key to prevention, and that nutritional supplementation may help reduce injury risk. Follow PRISMA-ScR guidelines, nine sources met inclusion criteria from electronic database searches and gray literature. The evidence included six primary studies; two were prospective cohorts, one quasi-experimental cohort, one retrospective cohort, one prospective intervention, and one randomized double-blind placebo-controlled trial. Three Level V narrative literature reviews were also included. Studies were published between 2011 and 2024 and focused on military populations such as U.S. Army, British Army, and Reserve Officers' Training Corps (ROTC) settings. Across the included studies, BSIs were associated with training load, low physical fitness, female sex, nutritional factors, and other training-related variables. Interventions included calcium and vitamin D supplementation, structured training programs, and injury-prevention strategies. Not all studies evaluated PT interventions; many emphasized prevention, screening, and risk factors. The literature suggests that BSIs in military recruit populations are influenced by multiple modifiable and nonmodifiable risk factors, but explicit evidence for PT specific interventions remains limited. Future research should examine rehabilitation interventions and functional mobility outcomes within military recruit populations.

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