Left of Bang: USU's ARMORR Pushes Warfighter Care Ahead of Injury

USU's new ARMORR embeds human performance teams in operational units to optimize warfighter readiness before injuries occur.

ARMORR builds on the idea of the "warrior athlete," treating strength and conditioning as daily readiness work rather than something to repair after an injury. (U.S. Army photo by Spc. Alexander Johnson)

July 9, 2026 by Hadiyah Brendel

Musculoskeletal injuries and burnout are among the leading reasons service members lose training time and duty days. For decades, military medicine has focused much of its care on treating these injuries after they occur, often in garrison clinics and military treatment facilities (MTFs) far from where the damage begins. The Uniformed Services University of the Health Sciences (USU) is helping extend that care further upstream, before injuries occur and closer to where operational readiness begins. Its new center — Advanced Research in Military Optimization, Readiness, and Rehabilitation (ARMORR) — embeds health and performance teams inside operational units to keep warfighters ready “left of bang,” a military phrase for getting ahead of a health problem rather than reacting after it forces a clinic visit.

USU launched ARMORR in May 2026 by consolidating three existing efforts: the Center for Rehabilitation Sciences Research, the Consortium for Health and Military Performance, and the Musculoskeletal Injury Rehabilitation Research for Operational Readiness program. The merger pushed researchers to look earlier in the readiness timeline, toward what happens before a service member is hurt. 

USU researchers and joint medical leaders made the case for this approach at the 2026 annual meeting of AMSUS, the Society of Federal Health Professionals, during a breakout session titled “Holistic Health and Performance for Musculoskeletal Care of the Warrior Athlete: Lessons from the Field.” Co-leading the session were Dr. Xiaoning (Jenny) Yuan, vice chair for research in USU’s Department of Physical Medicine and Rehabilitation, and Dr. Gabriel Paoletti, director of human performance optimization integration and HPRC in support of ARMORR.

The session grew out of a musculoskeletal injury thought leadership forum that USU co-sponsored with AMSUS in February 2025. That first meeting looked at how to rehabilitate personnel inside MTFs; the ARMORR merger pushed the conversation upstream, to prevention.

Yuan, who organized the session, says the goal was to look further ahead than rehabilitation. “We wanted to take a more proactive approach regarding what happens before the injury,” she says. “The panel came together as a true multi-service team effort, bringing opinions from the Army, Navy, Air Force, and Marine Corps that meshed around common threads of prevention.”

The panel also featured medical and operational leaders from across the services: Army Brig. Gen. Deydre Teyhen of the Defense Health Agency, Navy Cmdr. Kevin Bernstein, Air Force Maj. Jennifer Cadwell of the Air Force Operational Support Team, and Nicholas Gounaris of the Marine Corps Warrior Athlete Readiness and Resilience Program.

Paoletti noted that delivering raw medical metrics to units rarely sparks lifestyle changes. Instead, training frameworks need to connect health practices directly to a service member's personal values, operational experiences, and career longevity. (U.S. Army photo by Spc. Zachary Potter)

Positioning Health Assets in Garrison and Down Range

For Yuan, the change starts with proximity. The idea is to keep health expertise close enough that service members use it as part of daily life. “Proactive care means having assets embedded or immediately accessible to the service member in garrison,” Yuan says, rather than siloing them to hospitals or MTFs.

That closeness lets service members build healthy practices into their routines before their bodies start to break down: performance nutrition, hydration, sleep management, and functional movement. 

Paoletti compares it to training for an endurance race. “You don’t train for a marathon after or during the marathon,” Paoletti says. “You build those habits beforehand.”

That preparation matters most in today’s distributed operations, where small units may deploy far from established medical support. Building habits early, panelists said, lets service members carry that readiness into any environment. “The future of down range is constantly evolving, so distributing this knowledge, training, and support across all the services ensures the force is protected when they reach an austere environment,” Paoletti says.

Historical casualty data and current unit metrics support the approach. Bernstein pointed to past conflicts showing that positioning medical assets closer to forward Role 2 facilities, the small surgical and resuscitation teams nearest the fight, reduced medical evacuations and sped return-to-duty timelines. Cadwell and Gounaris shared program data showing that embedding health structures inside unit commands cut attrition during demanding training pipelines, such as at the Marine Corps School of Infantry East.

Interconnected Pillars of Readiness

The panel stressed that the domains of health overlap, in line with a recent memorandum from the Secretary of the Army on Warfighter Performance Optimization that updates the principles of Total Force Fitness.

Paoletti said his own career taught him that lesson. He had spent years coaching mental skills while running on too little sleep and poor nutrition, until a joint assignment showed him how tightly the pieces connect. “For years, I was doing mental fitness training, while surviving on four to six hours of sleep and poor nutrition,” Paoletti says. “Coming to this joint environment made me realize you can train all the mental skills in the world, but if someone isn’t sleeping or eating right, they are only going to get so far.”

Turning clinical advice into daily habits takes more than handing units their health metrics, Paoletti said. ARMORR uses evidence-based behavioral methods built around what he calls “meaning-making,” connecting health practices to a service member’s personal values, operational experiences, and career longevity.

That shift works, the speakers said, when embedded performance teams first build real trust with the people they serve. When service members trust the team, they are more likely to seek out health support on their own.

That trust feeds what Paoletti calls the “Tail Light Effect.” Leaders and teammates often notice early signs of burnout or stress in one another before the person notices it themselves, and that shared awareness closes the gap between knowing what resources exist and using them in daily choices.

Tracking Efficacy and Broadening Education

A main goal for ARMORR is to measure whether these preventive approaches actually hold up in the field. Tracking the health of units that move across changing training environments calls for systematic study through implementation science, the research discipline that tests how well programs work in real-world settings.

Yuan is candid that prevention does not make injuries disappear. “The expectation isn’t that a warrior athlete won’t get injured. In many environments, injuries are an inevitable reality,” Yuan says. The goal, she says, is to change how that recovery unfolds: whether proactive education builds resiliency, supports rehabilitation, and preserves a service member’s ability to stay in the fight.

ARMORR’s peer-reviewed findings feed into digital toolkits on platforms like HPRC-Online.org, and USU faculty are folding the same principles into the medical curriculum. By teaching human performance early, the university aims to send new medical officers to their first assignments already thinking about prevention, so that a young provider at a remote training site can spot the strain on a service member and step in before it becomes an injury.