NPR News Investigations
8:03 am
Fri August 24, 2012

Before Reaching War Zones, Troops Risk Concussions

Originally published on Fri August 24, 2012 5:47 pm

A new military study suggests that some soldiers suffer mild traumatic brain injuries even before they go to war. These concussions, as they're also called, can come from taking "combatives" classes that teach hand-to-hand fighting during the soldiers' training.

The study looks, in part, at soldiers at sprawling Fort Hood, Texas, one of the Army's major bases. The preliminary findings, which NPR and ProPublica have obtained, suggest that a soldier got a concussion in those classes every other day, on average, over nine months.

The researchers say they need more evidence before they know how big the problem is throughout the Army. But the early findings raise questions about whether combatives training harms some troops more than it helps them.

Researchers stress that their study is relatively small, examining subjects from classes at Fort Hood with just under 2,000 soldiers. And they haven't finished the study yet.

But here's why the findings already raise red flags: The researchers found that almost 6 percent of the soldiers in those classes reported that they had just been struck in the head and were suffering the constellation of symptoms that the Defense Department says signal mild traumatic brain injuries.

They include "altered mental status," such as confusion and disorientation, plus a combination of other symptoms such as headaches, nausea and balance problems.

Potentially Large Numbers

To put that 6 percent figure in perspective: Army spokesmen say more than 100,000 soldiers took hand-to-hand combat last year, at bases across the country, and hundreds of thousands have taken combatives over the past decade.

If the findings at Fort Hood reflect what's happening at other bases, it could mean that thousands of soldiers went to fight in Iraq and Afghanistan after suffering concussions in training.

Brain specialists say those soldiers run a greater risk of suffering long-term cognitive damage if their heads are injured again in battle. The nation's leaders have called concussions from explosions the "signature" injury of the wars in Iraq and Afghanistan.

"The more hits your brain takes, the less likely it will be that you will have a full recovery," said Dr. Alex Dromerick, director of neuroscience research at the National Rehabilitation Hospital in Washington, D.C. Dromerick, who has studied brain injuries with the military, didn't work on this new study on concussions. But he says that based on our description of the findings, they raise a troubling scenario.

Say a soldier gets a mild traumatic brain injury in combatives class, during training. Then he or she goes to Iraq and Afghanistan and suffers another concussion, in an explosion.

"Just like those football quarterbacks seem to get more and more vulnerable as they get more and more concussions," Dromerick says, "the same thing can happen in the military situation, where a person's response times are slowed, their reasoning might not be as good, so they are just more vulnerable to add-on injuries."

Dromerick stresses that more than 1 million civilians in the U.S. get concussions every year from activities like riding bicycles and playing soccer, according to federal statistics, and most of them appear to recover.

Risk Of Permanent Damage

But he cautions that some don't recover. Some studies suggest that 5 to 15 percent of people with mild traumatic brain injuries suffer long-term or permanent symptoms. So if soldiers go to war after they've suffered concussions in training, and they don't realize they have cognitive damage, they could put their whole unit at risk.

"If there's a soldier, a war fighter, on the battlefield, members of their unit need to be able to count on them," Dromerick says.

The Army has been teaching different versions of hand-to-hand combat off and on since World War I. It designed the modern course about 10 years ago — a hybrid of boxing and kickboxing, Brazilian jujitsu, and other martial arts.

We wanted to observe the combatives courses at Fort Hood, since that's where researchers working on the concussion study did most of their work. Spokesmen at Fort Hood didn't respond to our numerous phone calls.

But commanders at Fort Benning in Georgia allowed us to watch two days of classes that train advanced students to become combatives instructors. When we arrived, 10 pairs of soldiers spread out on blue and green mats. They wore black shorts and khaki T-shirts, plus boxing gloves and padded helmets — and shin guards, for some drills.

As trainers shouted orders and coaching tips, the soldiers in each pair took turns, with one soldier punching and kicking, the other trying to block. In some drills, they sparred. "Follow that jab up with a cross," one trainer barked. "Take the face, take the face," he shouted, as he saw one student get an opening to punch his opponent in the head.

Most of the student instructors in this class have fought in Iraq or Afghanistan, or both. They say they never saw or heard about battles where soldiers actually fought hand-to-hand.

Putting Training To Use

Instead, they used combatives training to control unruly crowds or detainees. For instance, Sgt. Nkosi Campbell told us, he was leading a unit one day in Iraq when they detained a couple of men along the highway who they suspected were planting bombs. Suddenly, the detainees rushed a soldier and tried to escape.

But Campbell says his soldiers quickly regained control, using combatives techniques. "Took the guy down," Campbell said, with a broad smile. He said to see his soldiers "use something [they learned] in training in real life, I was impressed."

Military researchers say they've always known that soldiers occasionally get hurt during combatives classes. But until recently, a lot of military officials didn't take concussions seriously. Then came the wars in Iraq and Afghanistan.

Investigations by NPR and ProPublica, and others, suggested that thousands of soldiers who suffered concussions from explosions have trouble thinking, remembering and using judgment. Congress ordered the military to screen soldiers with computer tests that can quickly diagnose these injuries, and Army researchers wanted to find the best one.

They went to Fort Hood to find soldiers who had concussions so they could compare a variety of diagnostic computer programs. The researchers also visited three other bases, and they were struck by how fast they found concussion victims in combatives classes, especially at Fort Hood.

Tough Drills

Retired Col. Harvey Watson, a psychologist who is working on the study, says when he watched soldiers practicing the "punch and clinch drill," he could see why some soldiers get concussions.

"The punch and clinch drill is one of the basic training sessions," Watson said. As soldiers pair off and begin the exercise, one soldier wearing boxing gloves starts trying to punch the opponent.

Meanwhile, the opponent tries to pin the boxer's arms, or "clinch" them, before the attacker can hurt him. In fact, Watson said, some defenders get pummeled — especially small, inexperienced soldiers.

"Imagine this guy, 6-2 or 6-3, who weighs 210 pounds, who's given the word to punch," Watson said. Meanwhile, the clincher may be a woman who is "5-3 or 5-4, 110 or 130 pounds, [and ] he's smacking her pretty good. In the head."

Watson said he kept thinking of his eldest daughter, who served in the Army, as he watched the punch and clinch drills unfold. "And I just sat there wondering what this would've been like for her, as tough as she is. That concerned me," he says.

Watson says they're still collecting and analyzing the evidence, but "it appears as if women in those kinds of drills become concussed, percentagewise, more often than men."

The researcher who is leading the Army study, Michael Russell, said he won't comment on it until it's finished.

Developing Brains

John Corrigan, a brain injury researcher at Ohio State University who has consulted with the military, says most soldiers in combatives classes are "kids" in the age range he worries about.

"You may think I'm referring to children, and I am," Corrigan says. "I consider an 18-, 19-, 20-, 21-, 22-year-old brain to still be developing. So we would want to still be concerned about concussions for them. But anywhere that you have regularly occurring concussions, it would really make sense to look at, 'How can I reduce or eliminate that?' "

The Army officer who is funding the study on concussions agrees and says that the final results of the study might prod Army commanders to revamp combatives training.

"Even 1 percent of soldiers [getting concussions] would concern me," says Col. Carl Castro, director of the Military Operational Medicine Research Program. "I'd say we need to do something. We don't want soldiers getting injured while training, if we can prevent it."

Officers at Fort Benning say they've already changed the way they teach combatives, partly to minimize concussions. For instance, Staff Sgt. James Hanson, the master trainer, said they stopped holding weekly boxing matches last year, and they let soldiers rest more often between drills.

Hanson said they have also mixed in more punches and kicks to the body — which aren't exactly harmless but reduce the risk of concussions.

"When I say, 'Hey, now we can kick anywhere on the body,' " Hanson said, "instead of a minute and a half of just swinging at your head, it's a minute and a half of, 'Hey, I can kick at your legs and throw some punches at your body.' And it's no longer, 'Hey, I'm just going to punch you in the head.' "

This story was reported by Daniel Zwerdling of NPR and Joaquin Sapien of ProPublica. More stories about brain injuries can be found at our Brain Wars special report. And at ProPublica.org.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

AUDIE CORNISH, HOST:

And I'm Audie Cornish. Military researchers say a new study suggests a surprising number of soldiers suffer concussions not only on the battlefield, but during training here in the U.S. These mild traumatic brain injuries come from taking classes in hand-to-hand combat. The study looks, in part, at soldiers at Fort Hood in Texas, one of the Army's main bases. [POST-BROADCAST CORRECTION: Though Fort Hood is one of the Army's major bases, it is not one of the main centers for basic training.]

NPR and ProPublica have obtained the preliminary findings. And they suggest that on average, during the nine-month study, one soldier got a concussion in those classes every other day. The researchers say they need more evidence to know just how big the problem is; but these early findings raise questions about whether this training hurts some troops more than it helps them. NPR's Daniel Zwerdling has our story.

DANIEL ZWERDLING, BYLINE: This is a relatively small study. Researchers say they looked at classes in hand-to-hand combat at Fort Hood, with roughly 2,000 soldiers; and they haven't finished the study yet. But here's why the findings already raise red flags. The researchers found that almost 6 percent of the soldiers in those classes reported they had been struck in the head. And they were suffering symptoms that the Pentagon says signal mild traumatic brain injuries. The soldiers were confused, disoriented; and they were nauseous. They had headaches and balance problems.

And now, put that 6 percent in perspective. Army spokesmen say that more than 100,000 soldiers took hand-to-hand combat last year, at bases across the country. The classes are called combatives. Many hundreds of thousands have taken combatives over the past decade. The researchers don't know if other bases have the same problem. But if Fort Hood is typical, it could mean that thousands of soldiers who went to war, had recently suffered concussions from their training.

Does this suggest that some soldiers went to war, actually already impaired by the concussions they got during the combatives course?

DR. ALEX DROMERICK: Yeah, it does.

ZWERDLING: That's the director of neuroscience research at the National Rehabilitation Hospital in Washington, D.C. Alex Dromerick has done studies on brain injuries with the military. He didn't work on this new study on concussions, but we told him the findings. And Dromerick says they raise a troubling scenario. Say, a soldier gets a mild traumatic brain injury in combatives class here in the United States Then he or she goes to Iraq or Afghanistan, and they get another concussion in an explosion.

DROMERICK: Just like those football quarterbacks seem to get more and more vulnerable, as they get more and more concussions - they get slower, they're more likely to get tackled - the same thing can happen in the military situation; where a person's response times are slowed, their reasoning may not be as good. So they are just more vulnerable to add on injuries.

ZWERDLING: Dromerick says remember, more than a million civilians in the U.S. get concussions every year, doing things like riding bicycles or playing soccer. And most of them appear to recover. He says on the other hand, some don't recover. So if soldiers go to war after they've suffered concussions in training, and they don't realize they have cognitive damage, they could put their whole unit at risk.

DROMERICK: If there's a soldier - a war fighter - on the battlefield, members of their unit need to be able to count on them accomplishing the role that they have in that particular unit. If they can't count on this - that person, then the safety of everybody else involved is affected.

(SOUNDBITE OF COMBATIVES INSTRUCTOR TRAINING)

UNIDENTIFIED SOLDIER #1: Combo two, get ready!

(RESPONSE)

UNIDENTIFIED SOLDIER #2: Get ready!

(RESPONSE)

UNIDENTIFIED SOLDIER #1: Begin!

(HAND-TO-HAND COMBAT NOISES)

ZWERDLING: We wanted to see combatives classes at Fort Hood. That's where the researchers collected a lot of their evidence. And we called more than a dozen times, to ask for permission. The spokesman at the base didn't return our calls. But commanders at another base said, come on down. So we went to Fort Benning, in Georgia. That's where they train instructors who teach combatives.

UNIDENTIFIED SOLDIER #3: There you go, feel him out. Use that jab! Use that jab!

ZWERDLING: They hold the classes in an old gym. Thick blue and green mats cover the floor. At the moment, 10 pairs of soldiers are sparring. They're wearing black shorts, khaki T-shirts, boxing gloves and helmets.

UNIDENTIFIED SOLDIER #3: Follow your jab up with a cross. Follow your jab up with a cross.

ZWERDLING: Trainers keep circling the fighters, coaching.

UNIDENTIFIED SOLDIER #4: Don't lead with your head. Lead your head again, we're going to have problems.

ZWERDLING: The Army's been teaching different versions of hand-to-hand combat off and on, since World War I. They designed the modern course about 10 years ago. It's a hybrid of boxing and kick-boxing, and various martial arts. In one exercise, half the soldiers work on twisting their hips just right, so they can kick.

UNIDENTIFIED SOLDIER #5: I've seen you turn that hip in there, when you throw that - throw that (unintelligible).

ZWERDLING: The other soldiers work on blocking them.

UNIDENTIFIED SOLDIER #6: So when he fires his kick, my check comes in. And I plant my foot back down so I can come with that power cross afterwards. All right, anybody have any questions? All right, go do it.

ZWERDLING: Most of the student instructors in this class have fought in Iraq or Afghanistan - or both - and they say they never saw any battles where soldiers actually fought hand-to-hand. Instead, they use this training kind of like a policeman would. For instance, Nkosi Campbell was leading a unit one day in Iraq. He says they detained a couple men along the highway; they suspected they were planting bombs. And suddenly, the detainees rushed a soldier, and tried to escape.

SGT. NKOSI CAMPBELL: And as soon as they rushed him - I mean, immediately - they did the little seatbelt - modified seatbelt. It's kind of where the guy rushed him, and he pushes his arm up and over. It's kind of hard to explain - I could show you. But it's really nice. Took the guy down. I mean, for a sergeant first class to sit back and see his Joes utilize something in training, in real life? I was impressed.

ZWERDLING: Military researchers say they've always known that soldiers who go through combatives training, occasionally get hurt. But until recently, a lot of military officials didn't take concussions seriously. Then came Iraq and Afghanistan. Press reports, and studies, suggested the thousands of soldiers who suffered concussions had trouble thinking and using judgment and remembering. And Army researchers wanted to develop a reliable test that can diagnose these injuries.

So last summer, they went to Fort Hood and a few other bases, to try to find soldiers who had concussions so they could try out different tests. And the researchers were struck how fast they found test subjects - in combatives class. Harvey Watson says, just watch soldiers doing the punch and clench drill, and you'll see why some soldiers get concussions.

HARVEY WATSON: The punch and clench drill is one of the basic training sessions, if you will, in early combatives training.

ZWERDLING: Watson is a psychologist and a retired colonel. He's doing field research for this Army study. He says when you start the punch and clench drill, two soldiers face each other on a mat.

WATSON: One wears a pair of boxing gloves. And the other has no gloves, but has to defend him or herself against the person that punches.

ZWERDLING: The defender is supposed to learn how to pin the attacker's arms - or clench them - before the attacker can hurt him. But Watson says when the trainer shouts, "Begin!" some students get pummeled.

WATSON: You know, image - this guy 6-2 or 6-3, who weighs 210 pounds - who's given the word to punch the clencher, who's a woman of 5-3 or 5-4; 120, 130 pounds. You know, he's smacking her pretty good - in the head. I was kind of surprised because I have - my oldest daughter, who's now 39 years old, spent five years in the Army. And I just sat there, wondering what this would have been like for her, as tough as she is. Anyway, that concerned me.

ZWERDLING: Watson says they're still analyzing the evidence.

WATSON: I can tell you that it appears as if women in those kinds of drills become concussed - percentage-wise - more often than men.

ZWERDLING: The researcher who's leading the study, Michael Russell, wouldn't give us an interview. He said he wants to wait until it's finished. Brain specialists - like John Corrigan - say that most soldiers in combatives classes are right in the age range he worries about because kids are especially vulnerable to concussions.

JOHN CORRIGAN: And you may think I'm referring to children - and I am - but, you know, many of our service members are young people with still-developing brains.

ZWERDLING: Corrigan hasn't worked on the combatives study, but he's consulted to the military on other brain injury projects. He's a researcher at Ohio State University. Corrigan says evidence suggests that once you suffer one concussion, you're more prone to get injured by another.

CORRIGAN: You know, I consider an 18-, 19-, 20-, 21-, 22-year-old brain to still be developing. So we would want to be concerned about concussions for them. But anywhere that you have regularly occurring concussions, it would really make sense to look at, how can I reduce or eliminate that?

ZWERDLING: The Army officer who's funding the study on concussions, agrees. Col. Carl Castro.

COL. CARL CASTRO: People originally thought that you could harden someone by, you know, sort of toughing them up. But in point of fact, what it does - if anything - it primes them. It makes them more susceptible to follow-on concussions.

ZWERDLING: Castro runs the Military Operational Medicine Research Program that's based at Fort Detrick, Maryland. Castro says he can't say yet whether the Army should revamp the combatives courses. He wants to see the final study.

CASTRO: And then make recommendations based on scientific findings. If you have a concussion, that's going to degrade your performance, and degrade your readiness. And we're very concerned about both of those things.

ZWERDLING: Back at Fort Benning, officers say they've already changed the way they train, partly to minimize concussions.

(SOUNDBITE OF COMBATIVES INSTRUCTOR TRAINING)

STAFF SGT. JAMES HANSON: This is their actual bouts now, to where they can implement all the techniques they've learned.

ZWERDLING: James Hanson is the master trainer at Fort Benning. He teaches the student instructors. Hanson says they used to have boxing matches here every Friday. But they halted them for safety sake, just last year. He says now, they let the soldiers rest more between fighting drills. They mix in more wrestling and kicking - which aren't exactly harmless, but Hanson says it reduces the number of concussions.

HANSON: If I tell you, hey, we're only going to punch each other in the head, then we're only going to punch each other in the head. But when I say hey, now we can kick anywhere on the body, instead of a minute and a half of just swinging at your head, it's a minute and a half of hey, I can kick at your legs and throw some punches at your body. And it's no longer hey, I'm just going to punch you in the head.

ZWERDLING: And the commanders say they keep warning the students: Look out for traumatic brain injuries.

HANSON: Come back in, so you guys can get your head-injury brief.

ZWERDLING: The soldiers are about to break for the day but first, they sprawl on the mats.

HANSON: All right.

ZWERDLING: Hanson stands before them, and he runs down a checklist that says one of the warning signs is a simple headache.

HANSON: Make sure your spouses, significant others or your buddies see this, also. All right? It's not like trying to be tough and "I got a headache, I'm going to fight through it." If you have any type of headache or anything like that, let somebody know.

ZWERDLING: Researchers on the concussion study say so far, their observations suggest that these combatives classes at Fort Benning are safer than the ones at a base like Fort Hood - although they need more evidence to confirm that. Hanson's still going down the checklist.

HANSON: Immediately seek an - attention of a combatives instructor, or a physician, if you have any of these symptoms: you're - nausea or vomiting, unusual drowsiness, confusion and inability to concentrate, blurred vision or double vision...

ZWERDLING: Researchers say the challenge preventing brain injuries is, every base is different. Every combatives course is taught by different instructors. And researchers say everybody has not gotten the message. Even the course at Fort Benning isn't totally safe. Late in the afternoon, two soldiers were sparring - and one got kicked in the head. He froze. He looked dazed. He dropped to his knees, on the mat. The medic rushed over and shined a light in his eyes, and asked him to track his finger. After a couple of minutes, the soldier said, "I'm fine." But they told him to go to the clinic, for an evaluation.

Daniel Zwerdling, NPR News.

CORNISH: Our story was co-reported by Joaquin Sapien, of ProPublica. Transcript provided by NPR, Copyright NPR.

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