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Reconditioning in Army PRT 2024

RECONDITIONING

Injuries, illnesses, and other medical setbacks pose challenges to the military’s readiness. It’s crucial for leaders to understand and manage injury risks while conducting rigorous training. 

  • By strictly adhering to the principles of PRT, leaders can minimize these risks. For those affected by injuries or illnesses, well-structured reconditioning programs are essential to reintegrate them into regular PRT.
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INJURIES EXPLAINED

  • Definition: Injuries refer to any harm sustained by the body due to various forms of energy exposure or lack of essential elements.

Focus on Musculoskeletal Conditions: 

These injuries are most impacted by proper PRT practices.

  • Account for over half of all disabilities in the Army.
  • Result in compensations of approximately $125 million annually.
  • Knee and back injuries are notably prevalent.
  • Injuries from training and sports significantly affect military readiness.

Note: According to the DoD Injury Surveillance and Prevention Work Group, injuries are the most significant medical barrier to military readiness, causing massive annual costs.

PREVENTION

The reconditioning program aims to uphold the DoD Injury Work Group’s recommendation by improving soldiers’ fitness during recovery, ultimately decreasing injury rates.

The Army Physical Readiness Training System’s Objectives:

  1. Performance Enhancement: Improving the soldier’s physical capabilities.
  2. Injury Control: Minimizing injury risks.

While these goals may seem contradictory, proper PRT execution ensures both objectives are achieved. The DoD Injury Work Group’s recommendations include:

  1. Launch programs to boost fitness and reduce training injury rates.
  2. Focus additional preventive measures on knee and back injuries.
  3. Prioritize the prevention of training and sports injuries.
Figure 6-1. Army Physical Readiness Training System.
Figure 6-1. Army Physical Readiness Training System.

The Army PRT System’s primary aim is to facilitate the recovery of Soldiers from injuries, illnesses, or other medical conditions. 

  • This system intends for recovering Soldiers to re-enter the unit’s PRT in equal or superior physical condition to what they had before the incident. 
  • Given the inevitable occurrence of injuries despite all preventive measures, it’s crucial to have a strategy to bridge the gap between injury and physical readiness – this is where reconditioning comes in.

Key Quotation:

“Injuries are not random events; they are the predictable result of a complex set of risk factors, many of which can and should be controlled.” – MG Patrick Scully, Deputy Surgeon General, U.S. Army (1998-2002)

COMMANDER’S ROLE IN INJURY CONTROL

  • Ensuring Proper Execution: The accuracy of all PRT activities is vital for injury control. Commanders should allocate sufficient time for trained PRT leaders and AIs to teach and ensure proper PRT execution.
  • Setting and Maintaining Standards: Transitions between training phases rely on maintaining standards. For instance, to avoid back injuries, there should be a focus on posture during all drills.
  • Balancing Running Volume with Intensity: Research indicates that less sustained running reduces injury rates, provided the quality remains high.
  • Avoiding Training Conflicts: PRT leaders should be vigilant about conflicts between PRT and unit training schedules, considering the physical demands and ensuring adequate recovery time.

EXECUTING UNIT RECONDITIONING PROGRAMS

  • Purpose: The reconditioning program aims to help Soldiers regain physical readiness safely after injuries, illnesses, or other medical conditions.
  • Profiles: These are official documents that describe limitations to physical activities due to medical reasons. DA Form 3349 is preferred over DD Form 689 because it provides a detailed account of the Soldier’s injury and possible activities during recovery.

Who Should be Enrolled in Reconditioning:

  • Soldiers with temporary medical profiles.
  • Soldiers in the recovery phase post a temporary profile.
  • Soldiers with permanent profiles detailing specific limitations and unique fitness needs.

Reconditioning in Army Training: Levels I & II and the Toughening Phase

  • Reconditioning in the Army is crucial to ensure Soldiers recover efficiently from injuries and can return to active duty in optimal physical condition.
  •  The Army uses a two-level system to guide Soldiers through this process.

Level I Reconditioning:

  • Description: Level I is gym-based and is designed to cater to Soldiers on medical profile. It aims to maximize the recovery potential while safeguarding the injured part.
  • Entry Criteria: Soldiers are permitted to begin Level I activities upon clearance for limited activity from their healthcare provider.
  • Activities: Level I focuses on using strength training machines (STMs) and endurance training machines (ETMs).

Level II Reconditioning:

Entry Criteria: Soldiers must meet the requirements illustrated in Figure 6-2 to begin Level II. This includes:

  • Performing 5 partial squats without pain in 5 seconds.
  • Doing 10 standard push-ups.
  • Completing 10 standard sit-ups.
  • Hanging from a pull-up bar for 15 seconds.
  • Walking unassisted for 30 minutes with a normal gait without pain.
Partial Squats Without Pain5 Repetitions in 5 Seconds
Push-Ups10 Repetitions to Standard
Sit-Ups10 Repetitions to Standard
Hang From Pull-Up Bar15 Seconds
Walk30 Minutes Unassisted, at Normal Gait without Pain
  • Activities: On entering Level II, Soldiers start to engage in the PRT program, albeit potentially in a modified form. Both the preparation and recovery stages are the same as regular unit PRT.

Exit Criteria: 

Before Soldiers can leave Level II and rejoin unit PRT, they must fulfill the requirements in Figure 6-3, such as:

  • Executing 5 repetitions of the preparation to standard.
  • Performing 1 repetition of the Military Movement Drill 1 to standard.
  • Achieving 5 repetitions of Conditioning Drill 1 and Climbing Drill 1 to standard.
  • Running continuously for 30 minutes at the unit’s slowest AGR pace.
  • Holding each stretch for 20 seconds during recovery to standard.
Preparation5 Repetitions to Standard
Military Movement Drill 11 Repetition to Standard
Conditioning Drill 15 Repetitions to Standard
Climbing Drill 15 Repetitions to Standard
Continuous Running30 Minutes at Slowest AGR Pace in Unit
RecoveryHold Each Stretch for 20 Seconds To Standard

TOUGHENING PHASE RECONDITIONING

  • Context: Rehabilitation and reconditioning during Initial Military Training (IMT) take place at all Army Training Centers within the Physical Training and Rehabilitation Program (PTRP).
  • Purpose: PTRP offers physical rehabilitation and conditioning for Soldiers who sustain injuries during Basic Combat Training (BCT) or One-Station Unit Training (OSUT).
  • Implementation: Typically, a physical therapist is in charge of these programmes, which operate under the training command. 
  • Outcome: Soldiers remain in PTRP until they’re fit enough to return to their previous phase of BCT/OSUT or restart at day one of IMT. Minor injuries that don’t severely affect training might not necessitate PTRP.

SUSTAINING PHASE RECONDITIONING

  • Reconditioning during the sustaining phase caters to AIT (Advanced Individual Training) and operational units. 
  • It is vital for maintaining the overall health, morale, and readiness of the force, especially when injuries or medical conditions have been encountered.

Infrastructure and Oversight:

  • Battalion Consolidation: Grouping reconditioning programs at the battalion level reduces administrative and logistical pressures.
  • Medical Oversight: The brigade surgeon should oversee the reconditioning program, with battalion medical officers acting as the bridge between the brigade surgeon and the reconditioning program leaders (RPLs).
  • Physical Therapists: The first military treatment facility in the area with rehabilitation services could provide physical therapists and assistants to supervise the Level I gym-based reconditioning program.

Reconditioning Program Leadership:

  • Medical Platoon’s Role: Typically, the medical platoon leader acts as the RPL, with the medical platoon sergeant being the assistant RPL (ARPL).
  • Alternate Leaders: If the above arrangement isn’t feasible, RPL and ARPL should be individuals familiar with the Army’s PRT program, understand profiling regulations, can adapt activities for profiled Soldiers, and can liaise efficiently with medical personnel.
  • Company NCOs: Each battalion company should assign an NCO to support the RPL daily. These NCOs should fit the criteria laid out for the ARPL.
  • Training: NCOs must undergo training sessions quarterly, led by the physical therapist or the therapy assistant, to ensure that they observe optimal safety practices.

Facilities and Equipment:

  • Location: Ideally, reconditioning takes place at brigade or installation fitness facilities.
  • Equipment: Due to many Soldiers having lower extremity injuries, a variety of ETMs are required. These include cycle ergometers, steppers, elliptical machines, rowing machines, and treadmills. Among these, cycle ergometers offer the most support.
  • Pool Activities: These can eliminate weight-bearing stress. Activities like swimming laps, aqua-jogging, and aquatic exercises are beneficial. Soldiers recovering from surgeries or with open wounds must get a physician’s clearance before entering pools.
  • Planning: Ensure all participants remain active during group sessions. Introduce occasional pool trips for variety and cross-training.
  • Availability: Units relying on shared facilities should make sure that space and equipment are available during reconditioning sessions. It might necessitate policies to reserve these facilities for reconditioning exclusively.
  • Scheduling: To ensure undisturbed access to gym spaces and equipment, reconditioning might need to be scheduled outside standard PRT times.

COMMAND RESPONSIBILITIES IN THE RECONDITIONING PROGRAM

  • The reconditioning program is pivotal for battalion commanders and command sergeant majors. Its success hinges on the value assigned to it, from the top leadership down to the company commanders. 
  • The end goal is to ensure soldiers regain their pre-injury fitness levels and reintegrate seamlessly into their units.

Key Responsibilities:

Command Leaders:

  • Battalion Commander and Command Sergeant: Oversee the program. Their dedication determines the program’s success.
  • Company Commanders and First Sergeants: Must provide ample NCO support and ensure the program’s objectives are met.

Medical Oversight:

  • Brigade Surgeon & Battalion Medical Officers: Ensure consistent monitoring and evaluation of the program.
  • Installation Medical Consultant: Ideally someone with a rehabilitation background, they advocate for RPLs, provide training to RPLs, ARPLs, and NCOs, and bridge any communication gaps.
Figure 6-4. Rehabilitation and reconditioning responsibilities

Training Responsibilities:

  • Trainers: They should have an in-depth knowledge of the reconditioning program, akin to RPLs. Their additional expertise in exercise science makes physical therapists or therapy assistants ideal for this role.
  • Training Content:
    • STM & ETM Orientation:
      • Familiarity with equipment, including purpose, technique, and safety.
      • Etiquette, including observing rules, returning equipment, and maintaining cleanliness.
    • Reconditioning Session Orientation:
      • Preparation: Ensuring the body is adequately warmed up.
      • Activity: Focus on neural adaptation, improving strength, endurance, and mobility.
      • Recovery: Assure a safe return to pre-exercise conditions.

Reconditioning Objectives:

  • Level I (Gym-Based):
    • Prevent any form of de-conditioning.
    • Adhere to any profile limitations.
    • Regain functional strength, endurance, and mobility.
    • Avoid any new injuries or re-aggravating existing ones.
    • Smooth transition to level II reconditioning.
  • Level II:
    • Return to the soldier’s pre-injury fitness level.
    • Again, no new injuries or aggravations.
    • Seamlessly reintegrate into unit PRT.

PROFILES AND RECOVERY PERIODS

  1. Physical Profile: Soldiers under the reconditioning program will be given a physical profile or be within an authorized recovery period from a temporary profile.
  2. Permanent Medical Profile: At the commander’s discretion, soldiers with permanent profiles might be directed towards the reconditioning program or allowed to continue with unit PRT.
  3. Convalescence Leave: Soldiers on this leave might be exempt from the reconditioning program, based on the profiling medical officer’s decision.
  4. Profile Duration: A temporary profile cannot exceed 12 months. If the profile extends, actions to address the issue or forward the case to a military medical review board are necessary.
  5. Post-Profile Recovery: Soldiers get double the time of the temporary profile, with a maximum of 90 days, to train for the APFT. However, they’re not mandated to take the APFT post-recovery unless it coincides with the semi-annual test.
  6. Transition to PRT: Post-profile expiration, soldiers remain in the reconditioning program until they meet criteria to join unit PRT. The RPL oversees the transition based on medical advice.

Exercise Progression:

  1. Goal: A well-structured reconditioning program aims to help injured soldiers attain a “return-to-duty” fitness level.
  2. Pitfalls: Progression that is too fast can lead to aggravated injuries. On the other hand, too slow progression can result in overall deconditioning.
  3. Recommendations:
    • Strict Adherence: Follow the limitations as mentioned in the DD Form 689 or DA Form 3349.
    • Communication: If a soldier shows faster improvement than the profile suggests, connect with the profile writer for clarity.
    • Understanding Limitations: Ensure a clear understanding of the soldier’s capabilities and restrictions. Clarify with the profile writer if needed.
    • Log Keeping: Maintain a record of the workouts of every individual expected to undergo more than two weeks of gym reconditioning.

Conclusion: The reconditioning program plays a crucial role in a soldier’s healing and recovery process. Ensuring effective communication, meticulous documentation, and a structured progression approach ensures that soldiers can reintegrate into their units without setbacks. The priority remains the soldier’s health, and decisions should always be taken with this in mind.

George N.
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