Annual Physical Therapy-Led Musculoskeletal Screening As a Medpros Requirement

Closing a Combat Power Preservation Gap for Multidomain Operations

By CPT Thomas Petersen

June 23, 2026 | Pulse of Army Medicine, 2026 E-Edition

Read Time: < 8 mins

The Army screens eight health areas every year. That list covers vision, hearing, dental, and immunizations. It also covers cardiovascular health, cancer risk, behavioral health, and substance use. Musculoskeletal injury (MSKI) causes more Soldier non-deployability than any other body system, yet the musculoskeletal (MSK) system is not included in the annual screens. Multidomain operations require preservation of combat power, which means leaving out the system that causes the most medical non-deployability creates a preventable issue for readiness. Physical therapists leading a yearly MSKI screen via the Medical Protection System (MEDPROS) would close this gap, resulting in a potential return of 390,000 profile days a year and more than 2,250 Soldiers off permanent profile.

A near-peer fight requires as many trained Soldiers as possible. FM 3-0 states the need for commanders to “preserve combat power to defeat threats.” Near-peer threats are willing to accept higher casualty numbers than the United States. The Army cannot afford preventable combat power loss during multidomain operations. MSKI bleeds the Army’s combat power more than any other medical condition. Forty-two percent of all Army outpatient visits are injuries. MSK overuse caused 69 percent of those. MSKI alone caused 59 percent of limited-duty days in the first half of 2019. Noncombat MSKIs cause over 80 percent of Soldier injuries and 65 percent of medical non-deployability. Read that again. A single body system causes over half of medical non-deployability. Shaffer and Moore attribute 87 percent of all nonbattle injuries to the MSK system. Army doctrine further states that MSKI makes up “the majority of deployment-limiting conditions.” Something needs to change. Otherwise, multidomain operations will start with Soldiers out of the fight due to preventable MSKI.

MSK screens combined with physical therapy (PT) can keep more Soldiers in the fight. Teyhen and her colleagues tracked 211 Army Rangers for a year. The screen they used identified Soldiers at risk of injury before injuries occurred. A 2022 study ran direct access PT for 3,653 patients. Injuries involved the knee, ankle, lumbar spine, shoulder, hip, or leg. Soldiers that saw a PT first spent fewer days on profile. They had lower disability scores and medical costs. Other researchers reviewed Operation Iraqi Freedom and Operation Enduring Freedom PT data. Of 71,310 evaluations, 97 percent of Soldiers returned to duty. Without PT, 18 percent of combat support hospital patients would have left the theater. Over 85 percent of MSKI-evacuated Soldiers never returned to the theater. The data is available, and the gap is obvious; it is what is missing in the annual screen.

The Army already screens almost all of the systems important for readiness. Soldiers complete the Periodic Health Assessment (PHA), dental, immunizations, vision, hearing, and medical equipment readiness. The Army even added a Cardiovascular Screening Program (CVSP) to the list. However, MSK screening is still missing from the list. “Musculoskeletal” appears once in AR 40-502 and twice in DA Pam 40-502. Two of the mentions talk about athletic trainer profile templates, not a screening program. The third mention recommends that a clinician review MSKI trend data. Every other system has a program; the MSK system has only mentions.

The Medical Readiness Assessment Tool (MRAT) does not screen Soldiers using a movement assessment, and the Army does not require an annual MRAT for every Soldier. Although Holistic Health and Fitness (H2F) physical therapists (PTs) may conduct unit-level screens, Army doctrine does not require an annual MSK screen or specify a standardized tool. Additionally, H2F data does not go into MEDPROS, and H2F screens do not cover the entire Army. As a result, the Army conducts yearly screens for almost all other readiness elements while omitting the system responsible for 80 percent of injuries and 65 percent of non-deployability. This represents a significant doctrinal gap.

Army physical therapists are able to run the program. AR 40-68 charges PTs with ensuring the operational readiness of the force and grants them authority to perform MSK injury screening, order imaging, prescribe medications, refer to specialty care, and issue duty profiles. DA Pam 40-502 also describes their authority to write profiles. Therefore, the limitation is not provider capability or authority.

A validated screening tool already exists. Roach and her colleagues built a 16-item self-report MSK screen. It uses a traffic light system, identifying “red” Soldiers at highest risk for injury. The tool was validated using a QR code for completion in under 30 minutes for groups of 150 and a full sample size of 2,520 Soldiers. Soldiers classified as “red” were 2.7 to 5.8 times more likely to get injured, and approximately half of the “red” Soldiers reported an MSKI within 48 to 106 days when they subsequently showed up at their local military treatment facility (MTF) for care. These are Soldiers that end up at the MTF anyway; screening identifies them earlier. Roach already validated the screen in a military population. What is missing is a requirement to conduct this screening annually and record it in MEDPROS.

It is hard to argue against numbers, and the numbers support adding both a screen and early PT. Szymanek and her colleagues showed early PT reduced days on profile by 47 per Soldier. Permanent profile rates dropped from 36 to 9 percent, which equates to a 27-percentage-point reduction. Roach’s traffic light system presented 1.83 percent of Soldiers as red. The Army’s active component has 454,784 Soldiers, which is 8,300 red Soldiers each year. The 47-day reduction per Soldier equals about 390,000 fewer profile days. Therefore, applying the 27-percentage-point reduction of permanent profiles to the 8,300 red Soldiers prevents about 2,250 permanent profiles annually, which means more Soldiers in the fight.

The Army can, and should, add the Roach traffic light to the yearly PHA. This already occurs for cardiovascular health through MEDPROS. Additionally, the PHA screens every Soldier annually, and Soldiers answer most of the 16 questions in the PHA. The addition of the traffic light to the PHA would allow the Roach score to post to MEDPROS. Soldiers that screen “red” would be flagged in the Commander’s Portal, replacing self-reporting with an objective risk score. It would then route the “red” Soldiers to PT. This does not require a new portal or new survey. It does not require more staff or a new database. The Army simply needs to add one more body system to its existing screens.

A near-peer threat accepts higher casualty numbers than the United States. The Army needs to preserve as much combat power as possible. It screens Soldiers’ major body systems each year. However, it skips the body system causing the most non-deployability. The Army can close this gap with an annual MEDPROS requirement, and the annual PHA can provide the screen. Physical therapists can then run the follow-up. This new process could return 390,000 profile days every year. It could also reduce yearly permanent profiles by 27 percentage points, allowing the Army to keep Soldiers in the fight.

Statement on the Use of Generative AI

The author used a large language model, to assist writing this article throughout the drafting and iterative revision process. All actions taken by the AI were under the author’s direct guidance and editorial control. The final text, including all arguments, structural decisions, and conclusions, represents the author’s own work and intellectual property. The AI served as a tool to accelerate research, test arguments, and enhance the clarity and depth of the author’s original ideas.

References