“Are we building our soldiers up or are we just breaking them down?” asked Eric Robitaille, one of the opening keynote speakers for 2024’s Canadian Institute for Military and Veteran Health Research (CIMVHR) conference in Winnipeg.

A Defence Department physio-therapist who also serves as an assistant professor at the University of Toronto, his question was evidently rhetorical. Nevertheless, in revealing data about damage to the bones, joints and muscles of military personnel caused by sudden or repetitive stresses—known as musculoskeletal injuries or MSKI—it soon became clear that his words were chosen as a call to action. 

“Soldiers are largely trained to go, even when their bodies suggest they should stop,” continued Robitaille, joined on stage by fellow researcher Hans Christian Tingelstad for CIMVHR’s 14th annual event held Oct. 20-23, 2024.

Soldiers are largely trained to go, even when their bodies suggest they should stop.

Together, they produced startling evidence suggesting that MSKI comprised 45 per cent of urgent care medical appointments for in-garrison personnel and up to 43 per cent of the same appointments for those deployed. MSKI were also reported to be the leading cause of medical releases at some 53 per cent.

Acknowledging the impact of training for such incidents, combined with factors like overall physical capacity and health history, the physiotherapists proposed that a modified exercise program called “generating resilience to injuries through training,” or GRIT for short, could make a marked difference. Among its recommendations, explained Robitaille, was “individually, externally loaded strength training sessions, limited distance running and less frequent load marches that progressed gradually in load or distance.” Equally, the duo advocated for ability groups whereby personnel could advance through aspects of training in an individualized manner while limiting their risks of such injuries.

The results? Over a four-year period (2019-2023), participants reported “65 per cent fewer overuse MSKI, 611 fewer limited duty days, and 22 fewer attritions” using GRIT compared to the usual—and typically non-standardized—military routine.

“Integrated MSKI prevention strategies not only minimized MSKI risk and their burdens,” concluded Robitaille, “but holistically contributed to each soldier’s health, offering them a clear path to meeting their mandate and the [force’s] operational readiness.”

Exploring the merits of GRIT was just the start of a far larger exchange of ideas at the RBC Convention Centre, a short walk from Memorial Boulevard where the Winnipeg Cenotaph stands near the Manitoba Legislative Building. In a city brimming with rich military heritage, the assembled scientists, academic researchers, entrepreneurs, military personnel—former and serving—and others understood that their very presence, not to mention their networking efforts and presentations, could lead to better health and well-being for veterans.

More than 500 delegates from around the world were in attendance, though speakers and guests from the intelligence-sharing countries known as the Five Eyes—Canada, Australia, New Zealand, the U.K. and the U.S.—were especially well represented, a sizable proportion of whom provided insights considered internationally transferable.

Day 2’s keynote address was but one example. U.S. Department of Defense Senior Research Scientist Jaques Reifman presented his examination of artificial intelligence (AI) applications for enhancing military medical readiness.

“Obviously, if we can make predictions, we can then perhaps prevent injuries and illnesses,” said Reifman. He noted that goal is now achievable as he detailed the evolution of AI in military medicine and how his team’s AI-enabled software—the only program cleared by the U.S. Food and Drug Administration for triage of trauma casualties at hemorrhage risk—works.

“Approximately 90 per cent of our service members who die on the battlefield, die of uncontrolled bleeding before ever reaching a medical treatment facility,” said Reifman. The AI analytical tool can assess vital signs to predict hemorrhage probability, affording combat medics the chance to “optimize care” for high-risk cases and thus “save lives.”

The third and final plenary on Oct. 23, meanwhile, seemed like a fitting end to the event.

“Invisible,” noted Veterans Affairs Canada’s Chief Medical Officer Dr. Cyd Courchesne. “This is the word that we’ve heard most often from women veterans since Veterans Affairs held its first women veterans’ forum in 2019.”

In introducing day 3’s keynote speaker, Courchesne went further to recognize a fundamental paucity of health research focused on female military personnel, including in Canada. “Despite some recent progress,” she continued, “[these] veterans largely feel that Veterans Affairs Canada programs have not taken sufficient account of their particular needs and concerns.”

That wasn’t lost on presenter Dawne Vogt of the U.S. National Center for PTSD. Having conducted extensive research on women’s health needs and concerns, her presentation highlighted the unique challenges confronting female veterans, the importance of contextualizing issues and how to ensure that adequate support is available.    

“Part of our goal here was to really provide a framework that would help us understand factors that are of greater relevance for minoritized populations, and particularly women veterans,” said Vogt in explaining her “generalizable” findings from the U.S. “So, for example, paying attention to something like sexual harassment, which we know women are more likely to experience than men.”

However, the scope of her research went beyond that to also examine harassment of a non-sexual nature “directed at [female personnel] because of their identity as women.” Family stress during deployment and mental health following the military-to-civilian transition were among other key issues that disproportionally impacted female veterans, said Vogt, who, in recommending tailored solutions, said peer support “holds a lot of promise.”

So, too, did the forum overall. From discourse surrounding equity-deserving groups to proposals for allowing veterans to age in place, the conference was a pledge best encapsulated by its own motto: “Serving those who serve us.”

RCL veteran health scholarships

This year’s CIMVHR conference marked the first awarding of the Doctoral Scholarship in Military and Veteran Health Research by The Royal Canadian Legion. On the forum’s second day, Dominion President Berkley Lawrence presented a $50,000 grant to Raphaëlle Merlo of Quebec City’s Université Laval, whose PhD research project includes evaluating the effects of self-treatment on PTSD symptoms. Merlo told Legion Magazine she was very happy to receive the funding, adding that it felt “encouraging to have other people interested in what I’m interested in.”

Meanwhile, the year’s $30,000 Masters Scholarship in Veterans Health Research, first established by the RCL and now administered by the Legion National Foundation (LNF), was presented on day 3 of the conference to retired
captain SueEllen MacGowan.

“Her research has the potential to improve our understanding
of brain regions implicated in post-traumatic stress disorder,” said RCL Grand President and LNF board member Larry Murray, “and specifically to determine the effectiveness of neurofeedback training and treatment—particularly for those suffering from PTSD who are resistant to pharmaceutical and other trauma treatments.”