VIPER Clinic program aims to reduce AF physical training injuries Published Feb. 2, 2016 By Staff Sgt. Chelsea Browning 59th Medical Wing JOINT BASE SAN ANTONIO-LACKLAND, Texas -- Musculoskeletal injuries in basic military training cost the Air Force about $35 million annually. A new 59th Medical Wing initiative aims to reduce these costs by preventing injuries before they occur. Managed by the 559th Medical Group, the initiative embeds certified athletic trainers into Air Force BMT and technical school physical training programs at Joint Base San Antonio-Lackland. "Our goal is to have every graduate be healthier. We want to teach them a better running form and better running techniques, skills that will benefit them for their entire career," said Capt. (Dr.) Nathaniel Nye, a primary care sports medicine physician with the 59th MDW's Versatile Injury Prevention and Embedded Reconditioning (VIPER) Clinic. "Even a 10 percent reduction in injuries - a savings of about $3.5 million - would be a significant success," Nye said. The VIPER Clinic teamed up with the 37th Training Wing to test the effectiveness of embedding certified athletic trainers into military training and potentially reshape how care is provided to injured trainees. The 37th TRW is the largest training wing in the Air Force, overseeing 80,000 students annually. The concept of embedding athletic trainers into the training program originated with college and professional sports, Nye explained. "In sports, athletic trainers keep athletes in the game. Professional athletes are expected to perform at a high level. Trainers prevent injuries and, when injuries do occur, rehabilitate (the athletes) and get them back into the game as soon as possible," he said. The VIPER Clinic began implementing that same concept in December, with a focus on embedding experts in musculoskeletal care. The trainers observe the trainees throughout training, monitoring and correcting their marching and running form, Nye said. "By having athletic trainers who understand the mission and who have built rapport with the trainees, high-risk trainees can be identified and injuries treated early," he said. A team of doctors including Nye, worked with the University of the Incarnate Word in San Antonio, to secure a $980,000 congressional research grant that embeds athletic trainers into BMT for 30 months. In BMT, the 323rd Training Squadron is testing the initiative with two embedded trainers. "An effort like this requires a lot of dedication from a whole team of people, and this certainly wouldn't be possible without the work of Capt. Bryant Webber, who led the grant writing process and oversees the research aspects. Many others make critical contributions as well," Nye said. The VIPER team will collect data and compare it to squadrons without embedded athletic trainers. Once the team provides the proof-of-concept in one squadron at BMT, athletic trainers can be added to other squadrons. In addition to the BMT research grant, the VIPER team has embedded four athletic trainers into the 342nd and 343rd Training Squadrons. The squadrons train security forces and battlefield Airmen; including pararescue, combat control, special operations weather, and tactical air control party specialties. Students there undergo a rigorous training program. From grueling swim training to long runs and ruck marches, their physical limitations are constantly tested, said Stephanie Lamb, an athletic trainer embedded with the special operations technical training students at the 342nd TRS. "This population is very active. We want to prevent injuries by catching bad mechanics early, such as poor running or rucking form, to avoid lost training time and ensure on-time graduations," Lamb said. The trainees also benefit from having embedded trainers who have a good working relationship with the medical staff. "It helps keep trainees on track with their recovery," Lamb said. "We constantly communicate with the VIPER staff physician and the 59th MDW about the patients' progress. That close relationship ensures we're providing the best care to our patients." If successful, the impact of the initiative may extend beyond the training environment. "(Our) long-term goal is to have a healthier Air Force," Nye said.