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The aims of the study were to compare the prevalence of soldiers with musculoskeletal symptoms between soldiers that participated in a prevention program (INT) and a control group (CONT); and, to assess whether ‘high risk’ for a symptom  indicator  [participants with patellar tendon (PT) echo-type III+IV &gt;10%  or  Achilles tendon (AT) echo-type III &gt;8.5%] applies when a prevention intervention is used. Soldiers from two consecutive infantry commanders courses (year 1-CONT, n = 165; year 2-INT, n = 196) were examined pre-course for AT and PT structure using ultrasound tissue characterization (UTC), and their musculoskeletal overuse symptoms were assessed and recorded by military physicians throughout the course. A prevention program was provided to the INT group (year 2) during the 14-week course. No significant differences were found in the prevalence of soldiers with symptoms between the two groups [INT: 39 (19.9%), CONT: 40 (24.2%); p = .32]. Using the  indicator  at baseline, 20 soldiers (10.2%) were suggested to be at ‘high risk.’ Of those 20 soldiers, 17 actually had symptoms during the course (positive predictive value-85%). The prevalence of soldiers with a suggested ‘high risk’ according to our  indicator  who had no symptoms during the course was low (3/20, 15%). Twenty-two soldiers who had symptoms during the course had not been suggested to be at ‘high risk’ by our  indicator . Our intervention did not reduce the prevalence of soldiers with symptoms. Our ‘high risk’ pre-course, AT and PT structure  indicator  is valid and can be used as a screening tool to reduce the prevalence of symptoms in combat soldiers; with the caution that soldiers that were not identified by the  indicator , might also have symptoms along the course.

Achilles and patellar tendon structure following a prevention program in male combat soldiers