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Though Thoracic Outlet Syndrome (TOS) with vascular findings can be more easily resolved by disappearance of pulse, neurogenic TOS remains more controversial. The unique structure of the vertebral column serves to protect the spinal cord, accompanying vessels, and viscera, and to allow controlled movement of the back, neck and head.
The vertebrae from C3 to L5 have a common pattern of an anterior vertebral body and a posterior neural arch (175-177).
Cervical vertebrae have foramina in the transverse processes for vertebral arteries, and superolateral ridges (uncal processes) for the joints of Luschka (these increase lateral stability while facilitating free motion between vertebrae).
Thoracic vertebrae have long transverse processes directed posteriorly; articular facets for ribs occur on their tips and on the posterior corners of the bodies.
The atlas (Cl) and the axis (C2) are unique (178, 179), the axis having the odontoid peg, and the atlas being a ring that receives the odontoid peg anteriorly, held in place by the transverse ligament. Intervertebral discs (IVDs) are complex symphyses comprising about 25% of the total height of the spine. The outermost fibrocartilaginous annulus fibrosus, with concentrically arranged fibres (kept under tension by the nucleus), firm attachment to the vertebral bodies, and innervation to its outer layer. The central mucoid nucleus pulposus, containing a high proportion of water, permitting shape (but not volume) change in response to compressive force. IVD height (and movement between vertebrae) is greatest in the cervical and lumbar regions, and their anteroposterior asymmetry largely determines the normal spinal curves. The large superficial muscles of the back (trapezius, latissimus dorsi) largely cover the deeper lavers of intrinsic muscles within the lumbodorsal fascia. Movement of occipital condyles on the atlas produces discrete nodding (about 30% and the atlanto-axial joint permits discrete rotation (about 30°) of the head. The variable sacroiliac joints (SIJs) lie between the wedge-shaped sacrum and the medial aspect of each ilium (183, 184). Innervation of apophyseal joints, outer annulus, longitudinal and short ligaments, and spinal dura is ultimately shared by the same spinal nerve, with considerable overlap between segments. Axial or unilateral proximal girdle pain from unilateral compression and tension of the dura mater. Root pain along part or all of the dermatome (variable between individuals) from pressure on dural sheath. Although symptoms worsen on activity, they may be absent or improve when the lumbar spine flexes forward, increasing the diameter of the canal (walking up steep inclines is better than down, cycling may cause no problems). Neurological signs (decreased sensation, reflexes) may be present, though these may occur only after exercise. This is characterised by diffuse axial pain and stiffness, worsened by rest, but improved by continuing exercise (initial movement may worsen it). Characterised by diffuse, ill-defined pain in the ipsilateral buttock, radiating down the back of the leg (190), sacroiliac pain is worsened by stressing the joint, e.g. Neck or back pain that is constant, severe, progressive, and present at night is very suggestive of malignancy or infection. This may be from proximal locomotor structures (especially glenohumeral, hip joints), the major viscera, retroperitoneal structures, the urogenital system, or aorta.
Upper cervical and lumbar spinous processes normally lie deep within the spinal muscles:spinous processes of C7 ('vertebra prominens') and T1 (even more prominent) are most readily identified (191), and the thoracic spines are usually well seen, particularly on bending forward. Forward or lateral angulation of the head is common, resulting from diminished lower cervical lordosis and compensatory extension at the craniocervical junction: this may cause prominence of posterior muscles and horizontal skin folds below the occiput. Its site is represented by the apex of the curve (thoracic, thoracolumbar, or lumbar), its laterality by the side of the convexity (192). Usually resulting from intrathoracic disease, reduced chest movement may also occur with arthropathy. Moles, vascular malformations, and hairy tufts may indicate the site of underlying congenital abnormalities of vertebral bodies. With low-back problems the pelvis may not rotate fully with the advancing leg, remaining mainly aligned with the thorax. With the patient still standing, the examiner places the fingers of one hand over consecutive lumbar spinous processes and asks the patient to bend forward to touch the toes (this also involves hip flexion). For these, fix the shoulder girdles to the trunk by getting the patient to clasp their arms across their chest, and fix the pelvis by firmly holding each iliac crest (with the patient's feet apart) or, preferably, by seating the patient astride a chair. Numerous named tests exist, all using manoeuvres to distract roots or increase intrathecal pressure and thus reproduce the patient's symptoms. The principal abnormalities of sensation, power, and reflexes accompanying individual root lesions are summarised in Tables 9 and 10.
A spastic gait, lower limb ataxia, increased reflexes, and extensor plantar responses (i.e.
Assessment of power, plantar responses, and sensation may be difficult in patients with polyarthritis and joint deformity, muscle wasting, and entrapment or peripheral neuropathy. Pain in the spine may be referred, and a thorough assessment of other systems (particularly the lower bowel and genital tract) may be required in individual cases. In addition to simply assessing distraction of fingers placed on spinous processes, thoracolumbar flexion can be estimated by the modified Schober test (216).
Other measurements employed include the finger-to-floor distance when the standing patient attempts to touch the floor with legs straight; and the occiput-to-wall distance, measured with the patient standing upright, heels back against a wall, eyes level. These drills dynamically prepare the body for more vigorous running activities and develop motor efficiency. The 300-yard Shuttle Run develops the ability to repeatedly sprint after changing direction. Hill repeats are an effective means of developing explosive leg strength, anaerobic power, and speed. Ability group runs train Soldiers in groups of near-equal ability to sustain running for improvement in aerobic endurance.
Unit formation runs are based on a time and distance that can be achieved with unit integrity and a display of unit cohesion. Release runs combine the benefits of formation running and individual performance at higher training intensities.
Foot marching as a movement component of maneuver, is a critical Soldier physical requirement. Running the conditioning obstacle course for time challenges Soldiers’ strength, endurance, and mobility, improving individual movement techniques. Use of endurance training equipment may be based on environmental constraints, safety for Soldiers on physical profile, and isolation of specific muscle groups to be trained during rehabilitation and reconditioning.
Movement: Bring the hips quickly to 90-degrees of bend without raising the knees above waist level. Arm swing is strong and smooth with the forward arm at 90-degrees and the rearward arm relatively straight. Arm swing is from front to rear, not side to side, with the upper part of the forward arm reaching parallel to the ground as it swings to the front.
Starting Position: Straddle stance, slightly crouched, with the back straight, arms at the side with elbows bent at 90-degrees and palms facing forward. Movement: Step out with the lead leg and then bring the trail leg up and toward the lead leg.
Movement: Run quickly to the 25-yard mark (as arrow 1 in the following exercise illustration shows). Soldiers should squat while bending the trunk when reaching to touch the ground as they change direction. Soldiers touch the ground with their left hand on the first turn, then with their right hand on the second turn. Purpose: This exercise develops leg power, coordination, and jumping ability from a single leg. Movement: Step with the left foot, then hop and land on the left leg followed by the same action with the opposite leg.
Start slowly and progress the speed and height of the skip throughout each 25-yard interval.
Soldiers should gradually incorporate larger arm swings as they jump to get higher elevation. Purpose: This exercise improves leg coordination and trains Soldiers to move laterally (Figure 10-8). Starting Position: Straddle stance, slightly crouched, with the back straight, arms at the side with elbows bent at 90-degrees, and palms facing forward or holding weapon. Movement: Cross the trail leg first to the front of the lead leg and step in the direction of travel to return to the starting position. Maintain the trunk perpendicular to the direction of travel while allowing the hips to move naturally. Purpose: This exercise develops the ability to run quickly in a crouched position (Figure 10-9). Movement: Power out of the starting position, performing one repetition of mountain climber, then upon finishing count 4, run forward in the crouch position to the 25-yard mark. Move from the crouch run starting position by executing one repletion of mountain climber and firing out of count four with the right leg and swinging the left arm forward to the crouch run.
Neither the United States Army nor any other component of the Department of Defense has approved, endorsed, or authorized this website. The normal balanced spinal curves (cervical and lumbar lordosis, thoracic and sacral kyphosis; 174) help maintain an upright posture with minimal muscular effort and, together with the resilience of the intervertebral discs, facilitate impact loading through the spine.
The arch comprises three processes, two lateral (transverse) and one posterior (spinous), that are primarily adapted for muscle attachment, and a synovial facet or apophyseal joints above and below, for articulation with adjacent arches. No disc exists between the atlas and the axis (or occiput and atlas), the axis articulating with the atlas through midline and paired lateral synovial joints. The interwoven concentric fibre arrangement affords great tensile strength while facilitating torsional movements. Loss of spinal height with age largely results from decrease in water content of the nucleus (from about 90% in youth to 65% in old age: associated decrease in turgor slackens tension in the annulus, predisposing to tears). Posture has a profound effect on intra-disc pressure, particularly at the lumbosacral junction where forward flexion associates with the highest increase. The posterior and anterior longitudinal ligaments run the length of the spine attaching to discs (particularly the posterior ligament) and vertebral bodies (especially the stronger anterior ligament): they act to restrict flexion and extension and protect the discs. Below the craniocervical junction, movement involves distortion of IVDs and sliding movements of the facet joints. The narrow, rigid confines of the spinal canal and emerging foramina may cause problems relating to root or, less commonly, cord compression. As a result of high mechanical stresses through the spine (amplified by poor posture and muscle tone, and obesity), sprain injuries of ligaments, entheses, and muscles are particularly common. Pain from spinal locomotor structures is thus poorly defined, with radiation over a wide area (which includes, potentially, the head, thorax, abdomen, and the upper or lower limb). The pain is predominantly axial (unilateral, bilateral, or central) but may radiate into proximal or even distal limbs in an ill-defined, non-dermatomal pattern.
It is characteristically sharp and shooting, and made worse by movement and increased intrathecal pressure (coughing, sneezing, straining at stool).
The patient may adopt a 'simian' posture for this reason (hips, knees, lumbar spine slightly flexed).
Lateral angulation with rotation may accompany sternomastoid contracture, and several congenital abnormalities result in a short neck.
Scoliosis may be compensated (T1 centred over sacrum) or uncompensated (a perpendicular from T1 lying outside the sacrum). If expansion appears reduced, measure from full expiration to full inspiration at the nipple line, with the patient's arms on or behind their head (normally 4 cm or more in the adult male).
Spasm may be unilateral or bilateral, and may associate with spasm of ipsilateral buttock muscles (especially with sciatic pain due to disc prolapse). This gives a shortened step, jerkiness of movement, and considerable caution and awkwardness when turning.
The lumbar lordosis should be replaced by a smooth curve, the degree of movement indicated by separation of the examiner's fingers (193). Ask the patient to turn round as far as possible to each side (rotation - mainly thoracic, 196). For palpation of the neck, place a pillow under the upper chest; for the thoracic and lumbar spine, move the pillow under the abdomen - this helps to relax the muscles, supports the spine in flexion, and aids separation of the spinous processes (201, 202). Applying firm, jarring pressure with each thumb just lateral to the spinous process (206) may cause pain relating to local facet joint, disc, or ligament lesions. This is a common site of tenderness, with reproduction of the patient's pain ('iliolumbar' or 'iliac crest syndrome').
Only florid inflammation or damage to the fibrous portion is likely to result in local tenderness posteriorly (most such tenderness is probably ligamentous). Firm downward pressure over both sides of the pelvis with the patient lying supine (207), or over the pelvis with the patient lying on one side (208). With the patient lying flat, flex and adduct one hip and push the flexed knee towards the opposite shoulder, stressing the ipsilateral SIJ. With the patient lying flat on the back and completely relaxed, slowly raise the straightened leg on the affected side by 70°, maintaining full extension at the knee, until the patient complains of pain or tightness down the leg (210-212).


Lay the patient on the unaffected side with the affected hip and knee slightly flexed, the back straight and the head flexed. Get the patient as flexed as possible (standing or sitting) and, starting from an upper sacral spinous prominence, mark out three 10cm segments up the spine. In Milgram's test the supine patient performs active bilateral SLR to a height of 6 inches. Running short distances at high speed is essential to moving under direct and indirect fire (Figure 10-1).
The purpose of running is to improve the overall conditioning of the Soldier by developing endurance.
As a result of their increased anaerobic and aerobic endurance, Soldiers will be able to sustain performance of physically demanding tasks at a higher intensity for a longer duration. Soldiers will run in formation to a specified time (no more than 15 minutes), then are released to run as fast as they can back to the starting point. Running through local training areas, over hills, and around obstacles improves mobility, endurance, and the ability to stop, start, and change direction.
The commander will specify the appropriate uniform based on the type of running activity to be performed. The PRT leader and AIs must be able to demonstrate and lead all types of running activities. In the sustaining phase, Soldiers continue to perform the speed and sustained running activities from the toughening phase.
Calling of cadence and commands is the responsibility of the PRT leader or ability group leader. The shoulders should assume a neutral posture, neither rounded forward nor forcefully arched backward. The purpose of MMD1 in the toughening phase (Figure 10-3) is to enhance running form, dynamically prepare the body for more vigorous running activities, and develop motor efficiency. The Soldier always faces the same direction so that for the first 25-yards he is moving to the left and for the second 25-yards he is moving to the right. Turn clockwise while planting the left foot and bending and squatting to touch the ground with the left hand. The purpose of MMD2 in the sustaining phase is to enhance running form, dynamically prepare the body for more vigorous running activities, and develop motor efficiency. When the right leg is forward, the left arm swings forward and the right arm is to the rear. Then cross the trail leg to the rear of the lead leg and step in the direction of travel to return to the starting position. Turn clockwise while planting the left foot and bending and squatting to touch the ground with the left hand, as in performing the shuttle sprint in MMD1. Speed running is based on the training principle that a greater amount of intense work can be performed if the work is interspersed with periods of recovery. The PRT leader positions himself to supervise the conduct of speed running and uses a stopwatch and a whistle for signaling the ?Start? and ?Stop? of each work and rest interval.
Hill repeats are an effective means of developing explosive leg strength, speed and anaerobic endurance.
A short, steep hill is ideal for explosive uphill efforts of 15-20 seconds sprinting up 40-60 yards and 60-90 seconds walking back down for 6 to 10 repetitions. Some Soldiers may make the cut off times to qualify for an ability group but are unable to maintain the prescribed running pace listed in the PRT schedule. Refer to Table 10-2 for endurance and mobility activities, prescriptions of intensity, duration, and volume within the toughening and sustaining phases. The UFR elicits intangible rewards gained from running with a group, such as esprit de corps, team building, and discipline. The RR combines the benefits of formation running and individual performance at higher training intensities. Foot marching as a movement component of maneuver is a critical Soldier physical requirement.
Obstacle course running develops physical capacities, fundamental skills, and abilities that are important to Soldiers in combat operations. When using ETM there are four primary variables to consider: exercise mode, training frequency, exercise duration, and training intensity. Exercise mode refers to the specific activity performed by the Soldier: running, cycling, swimming, and the use of a variety of endurance training equipment.
Training frequency refers to the number of training sessions conducted per day or per week. Exercise duration is 20 minutes or longer and varies from machine to machine, depending on the intensity of the exercise routine being performed (hill profile, speed, degree of incline, resistance).
The bodies and their separating discs are the main weight-bearing portions, body size increasing from C2 to the first sacral segment, then decreasing down to the coccyx as body weight transmits to the pelvis.
The lumbosacral junction is the point of transition between movable and immovable parts of the spine: the spine can act as a lever on the pelvis at this point (this, together with the marked angulation between L4, L5, and S1, makes it a common site for spondylolisthesis).
There are also ligaments between adjacent vertebral arches (ligamenta flava), transverse processes (intertransverse ligaments) and spinous processes (interspinous and supraspinous ligaments). The longest and strongest extensors are the erector spinae (sacrospinalis), which run either side of the spinous processes, from the sacrum to the skull; they are most developed in the lumbar region. Flexion and extension is mainly at the low cervical and low lumbar spine, lateral flexion is greatest in the neck, and rotation greatest in the lower thoracic spine. The lower portion of each SIJ is aligned in an anteroposterior plane, but the upper portion is oblique, with the ilia extending beyond the lateral aspect of the sacrurn posteriorly. The cervical cord is widest and most susceptible to compression; it is also vulnerable to damage by atlanto-axial subluxation.
Apophyseal joint osteoarthritis and degenerative disc disease are also common, especially at the mobile, stressed lower cervical and lower lumbar regions: root syndromes, caused by pressure from extruded disc material or bony encroachment (particularly apophyseal joint osteophyte) also predominate here. The differential diagnosis of spinal syndromes may therefore be wide and embrace other systems.
It may be made worse by movement (usually in one plane) or prolonged standing or lifting, and is usually relieved by rest. Examination may reveal neurological signs (altered sensation, reduced power, reduced reflex) consistent with single root involvement. Examination shows diffuse, symmetrical tenderness and muscle spasm, and restriction of movement in several or all directions.
The 'dimples of Venus' overlie the posterior iliac spines: a line between them overlies the S2 spinous process. Postural scoliosis (no intrinsic bony abnormality in spine or ribs) resolves as the patient flexes forwards; by contrast, structural scoliosis persists or is accentuated by flexion. SIJ pain may be worsened by weight bearing and is particularly provoked by standing on one (the ipsilateral) leg.
Then, holding the patient's 'fixed' shoulders, ask the patient to put their chin on their chest (flexion, 197), look up in the air (extension, 198), look round to each side (rotation, 199), and then put each ear over onto the shoulder (lateral flexion, 200).
Tenderness with reproduction of the patient's pain suggests local ligamentous or disc disease. Reproduction of pain in the affected side by elevation of the opposite leg (cross-over sign' or 'well leg raise test) indicates thecal compression by an often large lesion medial to the nerve root (disc or tumour). Gently extend the hip and increase knee flexion; pain down the anterior thigh indicates a positive test (214). Then remeasure the distances between the marks with the patient erect: the lowest segment should shorten by at least 50%, the middle by 40%, the upper by 30% (shortening is greater in tall subjects). Conversely, upward traction on the neck, by lifting with one hand under the chin and the other under the occiput, may relieve pain due to root compression (distraction test; 218). This greatly increases thecal pressure and ability to hold this position for any time excludes significant thecal pathology.
The PRT leader and AI must monitor run time and pace during the conduct of running activities. Other types of running such as terrain running or speed running will be conducted in one or more columns as determined by the training area and installation safety standing operating procedures. They must also be familiar with formations, commands, cadence, and placement of Soldiers into ability groups for sustained and speed running. When conducting collective training, running is optimized when Soldiers are grouped by near-equal ability. The 300-yard SR, in both the toughening and sustaining phases, and sustaining phase terrain running are also integrated to develop Soldier skills. Rounding the shoulders forward is the most common fault in everyday posture while walking and running. A common problem with fatigue is allowing the trunk to lean forward of the legs and pelvis.
Energy is wasted as the knees come higher and the large muscles of the hips and thighs are engaged. Military movement drill 1 is conducted following preparation and the HSD prior to running activities during the PRT session.
When the left leg is forward, the right arm swings forward and the left arm swings to the rear.
Run quickly back to the starting line (arrow 2) and plant the right foot, then turn counterclockwise and touch the ground with the right hand. Military movement drill 2 is conducted following preparation and the HSD prior to running activities during the PRT session. When the left leg is forward, the right arm swings forward and the left arm is to the rear.
Crouch run quickly back to the starting line and plant the right foot, turn counter-clockwise and touch the ground with the right hand. Improvements in physical fitness are affected to a greater extent by the intensity of training than by the frequency or duration of the training. Refer to Table 10-2 for endurance and mobility activities, prescriptions of intensity, and duration and volume within the toughening and sustaining phases. Downhill repeats are performed at a high intensity of 15-20 seconds of downhill sprinting (near maximal effort) with rest intervals consisting of walking back up the hill for 60-90 seconds for 6 to 10 repetitions. Each ability group runs at a prescribed pace intense enough to produce a training effect for that group and each Soldier in it. If this occurs, they may drop down to the slower group and progress later to the faster running group. In addition, Chapter 5, Planning Considerations, provides the template for commanders and PRT leaders to implement endurance and mobility activities into their PRT programs. Soldiers will run in formation for a specified time (no more than 15 minutes), then released to run as fast as they can back to the starting point. Regular foot marching helps to avoid the cumulative effects of lower injury trauma and prepares Soldiers to successfully move under load.
Exercise prescription specifies training frequency, exercise duration, and training intensity.
There are advantages to using endurance training equipment (environmental constraints, safety for Soldiers on physical profile, and isolation of specific muscle groups to be trained during rehabilitation and reconditioning). The sliding apophyseal joints help stabilise the vertebrae, particularly limiting anterior displacement: varying alignment of their articular surfaces largely determines the extent and type of movement at different regions.
Particularly vulnerable to mechanical stress, the lumbosacral region is also a common site for congenital anomalies of the vertebrae and abnormalities of the IVDs. Viewed from in front, the upper one-third (superior, posterior) is a fibrous joint (syndesmosis), while the lower two-thirds (anterior, inferior) is synovial. Less commonly, spinal joints and entheses are target sites for inflammatory disease (especially, seronegative spondyloarthropathy), and bone involvement by malignancy or sepsis may also occur.
With thoracic scoliosis, rotation of vertebrae may produce a hump or 'gibbus' of the ribs on the convex side. During lateral flexion, pain felt on the side to which the head moves suggests facet joint disease, whereas pain on the opposite side is more likely muscle spasm. This is a useful but poor localising sign suggesting possible pathology in the nearby region of the spine (analogous to generalised abdominal tenderness with appendicitis). Now ask the patient to flex the neck by putting the chin on the chest, or passively dorsiflex the raised foot.
An alternative is to measure the C7-T12 and T12-S1 distances erect and then during maximal flexion; the thoracic measurement should increase 2-3cm, the lumbar distance 7-8 cm. In Hoover's test the patient performs unilateral SLR with the examiner's hand under the other heel; absence of downward heel pressure indicates that the patient is not really trying (219).
Aerobic endurance is developed by performing low to moderate intensity activities for a long duration. The best way to assign Soldiers to ability groups is by their most recent 1-mile run time assessment.
Soldiers should strive to demonstrate and maintain proper running form during all running activities. The intensity for speed running during the 30-and 60-second work intervals is 75 to 85 percent maximal effort.


Hill repeats start with 6 repetitions and add no more than 1 repetition every 2 weeks, not to exceed 10 repetitions. The command ?Quick Time, MARCH? terminates formation running (see FM 3-21.5, Drill and Ceremonies). The arm swing should be free of tension, but do not allow the hands to cross the midline of the body. This forces the lower back muscles to expend too much energy resisting further trunk lean to the front. When the right leg is forward, the left arm swings forward and the right arm swings to the rear.
Military movement 2 contains three dynamic, plyometric exercises that are conducted in the same manner as MMD1. Always face the same direction so that movement of the first 25-yards is to the left and movement of the second 25-yards is to the right. Accelerate out of the crouch run to an upright position and sprint back to the 25-yard mark gradually accelerating to near maximum speed. During speed running, Soldiers perform a work interval in a specified time for a specific number of repetitions. From there, the Soldiers can easily hear his whistled commands to start and stop walking and running intervals.
The 300-yard SR is conducted from the extended rectangular formation (covered) as shown in Figure 10-3.
Uphill repeats build leg strength, power, and anaerobic endurance, while downhill repeats improve speed though rapid leg turn-over and releasing neural inhibitions.
Ability group runs must be conducted for the duration and intensity specified in the training schedules in Chapter 5, Planning Considerations.
Unit formation runs are organized by squad, platoon, company, or battalion; not by ability. Upon completion of the release run, additional PRT activities may be conducted or recovery performed. See FM 21-18, Foot Marching, for specific instructions and guidance for the conduct of foot marches. Furthermore, with individual body armor and fighting load, they must be able to perform all these tasks for long periods of time without exhaustion or injury, even after fatigue has set in. Consideration for use of specific types of equipment may be based on the Soldier’s ability to participate in weight-bearing or non-weight-bearing activities.
Training sessions that involve high intensity or longer duration may necessitate less frequent training to allow for adequate recovery. Endurance exercise sessions that address additional caloric expenditure for body fat reduction should be of low intensity and may last up to 60 minutes. The bones are bound by ventral and dorsal interosseous, sacrotuberous, sacrospinous and iliolumbar ligaments and, except in pregnancy (and childhood), there is no movement.
Nerve roots are most vulnerable as they emerge from their dural sheaths, just after leaving the exit foramina: they lie in the immediate path of a prolapsing lateral disc. In many cases, anatomical localisation is difficult and no specific title can be given; in some cases, however, localised tenderness may permit labelling in anatomical terms (189). Pelvic tilt (iliac crests at different heights ± asymmetry of gluteal folds) may accompany scoliosis or relate to leg shortening, or to hip or other lower limb arthropathy. Reproduction of pain by either action indicates stretching of the dura (a central prolapse often causing back > leg pain, a lateral prolapse the reverse); SLR pain not reproduced by these actions suggests hamstring pain (mainly posterior thigh) or lumbar or sacroiliac pain (felt more in the back than the leg). Anaerobic endurance is developed by performing high-intensity activities for a short duration, resting, and then repeating the sequence. During the 60-and 120-second recovery intervals, all Soldiers walk until the next work interval begins.
The PRT leader designates the number of repetitions and signals the start of each group or individual. Attempts to force Soldiers to conform to one standard may do more harm than good; however, there are some basic guidelines that may improve running efficiency without overhauling the natural stride. On the command, ?Ready,? one Soldier in each column will move behind the starting line and assume the ready position (staggered stance). The intensity and duration of the repetitions will depend on the characteristics of the hill. This training method provides a challenge for each ability group while controlling injuries.
Keeping a large unit in step, with proper distance intervals and correct running form, offers intangible benefits that commander’s desire. Each ETM contains specific instructions for proper use and adjustments for the Soldier to obtain optimal posture during endurance exercise (seat height on cycle ergometers or seat distance on rowing machines). The neck has a complex system of musculature that enables fine movements to be accurately controlled. Aerobic training alone does not fully prepare Soldiers for the functional endurance and strength requirements of WTBDs. When performing formation sustained running, the PRT leader should be on the left side of the formation and toward the rear to have a full view of all Soldiers and maintain control.
Multiple work intervals cause the onset of fatigue many times during a single training session.
Speed running will cause Soldiers to spread out over the course of the running track during the work interval.
Speed running causes Soldiers to spread out over the course of the running track during the work interval. In addition, Chapter 5, provides the template for commanders and PRT leaders to implement endurance and mobility activities into their PRT programs.
Ability group runs, speed running, and foot marching (greater than 5 km) should not be conducted on the same or consecutive days.
Distances should generally be 1 mile for densely wooded areas and up to 2 miles on tank trails and open fields. If the ETM has no visible list of operating instructions, ask the PRT leader or AI for assistance (Figure 10-12). Cervical roots Cl-C7 emerge over the top of their respective vertebra, but the C8 root emerges below C7 and above T1 (giving eight cervical roots but only seven vertebrae). The analysis of the physical demands needed to successfully accomplish WTBDs demonstrates a more significant requirement for anaerobic endurance.
Speed running may be conducted individually or collectively by ability group, on a track or designated running area. The SR is performed only one time when performed as an activity during a PRT session, in conjunction with 60:120s. All running courses should be marked at ?-mile intervals so PRT leaders can monitor split times to ensure the maintenance of the appropriate running pace. The following information addresses optimal running form for the major body segments (Figure 10-2).
This drill is conducted using the extended rectangular formation (covered) and performed by rank.
Speed running improves the resistance to fatigue of the active muscles by repeatedly exposing them to high intensity effort.
If required, the PRT Leader will have Soldiers regroup before the start of the next work interval. If required, the PRT leader has Soldiers regroup before the start of the next work interval. Based on each Soldier’s 1-mile run assessment time, the PRT leader assigns the Soldier to one of the groups shown in Table 10-3. They should be performed no more than once per quarter due to the limited training effect offered for the entire unit.
Use of limited or non-weight-bearing endurance training equipment is desirable for obtaining higher caloric expenditure through additional training sessions by overweight Soldiers trying to reduce body fat. In order to train the complete spectrum of endurance, speed running, sustained running, and foot movement under load must be performed.
When conducting speed running, the PRT leader will control running and recovery times from the center of the track or running area using a whistle and stopwatch. Sustained running progression is accomplished by moving the Soldier from a lower ability group to the next higher ability group.
Military movement drill 1 consists of exercises performed at 25-yard intervals: verticals, laterals, and the shuttle sprint. As a result of their increased anaerobic and aerobic endurance, Soldiers are able to sustain performance of physically demanding tasks at a higher intensity for a longer duration.
Soldiers should move to faster groups when they are ready because they progress at different rates. The UFR begins with a gradual increase in intensity for the first three minutes or ? mile, then continues at a prescribed target pace for a specified time, and concludes with a gradual decrease in intensity for the last three minutes or ? mile.
Physical readiness training leaders will form the unit and maintain an interval suitable for the terrain and environmental conditions.
Movements and their root supplies are shown in 185 and 186; dermatomes are shown in 187 and 188.
The running activities described in this chapter may be performed individually or collectively. Assistant instructors may run with the Soldiers to provide positive motivation and running form corrections.
At the conclusion of the recovery (walk) interval (60 or 120 seconds), the PRT leader will again signal with one short whistle blast. The training stimulus associated with speed running occurs from the combination of work and recovery. Those who have difficulty maintaining the specified pace within an ability group should be placed in a slower ability group. The gradual increase and gradual decrease quarter miles will be conducted at a pace two minutes slower than the target pace. All running courses should be marked at ?mile intervals so PRT leaders can monitor split times to ensure the maintenance of the appropriate running pace. A very short recovery period may not allow the body to recover sufficiently to perform the next work interval at the desired intensity.
Soldiers should walk at least 3 minutes before performing additional activities or recovery.
Supervision will prevent a constant shifting of Soldiers between groups due to lack of individual effort. The unit commander is responsible for establishing a pace achievable by all Soldiers in the unit. Soldiers may progress to performing terrain running with IBA, ACH, individual weapon, and under fighting load.
Table 10-2 describes endurance and mobility activities and the prescription of intensity, duration, and volume within the toughening and sustaining phases. Sustained running progression is built into the PRT training schedules through the employment of release runs and by moving Soldiers from lower ability groups to higher ability groups.
During the sustaining phase, the 300-yard SR may be performed in ACUs and boots, progressing to individual body armor (IOTV) without plates, then with plates, then with fighting load. Soldiers of varied abilities run for different numbers of repetitions during the toughening phase. A very long recovery period may allow the body to recover too much and some of the training effect would be lost. The PRT leader and AIs ensure that Soldiers sprint in their own lanes and run with their heads up to watch for other Soldiers who may be moving in the opposite direction. Soldiers who finish early will continue to walk until all Soldiers have completed the activity. Generally, duration of the recovery period depends on the intensity and duration of the work interval. Routes used for sustained running in ability groups should be well lighted, free from hazards and traffic, and marked at ?-mile intervals. At the end of the activity, the entire group will walk for 2 to 3 minutes before performing any subsequent activities or recovery. Ability group leaders will ensure running is at the proper pace prescribed for their group by checking their split times at each ?-mile marker along the route.
Repetitions, pace, load, uniform, and total exercise time must be adjusted when exercising at high altitudes and in hot, humid environments.
Speed running has three variables: work duration, recovery duration, and the number of repetitions. Refer to Table 10-2 for appropriate speed running prescriptions for the toughening and sustaining phases.



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