Musculoskeletal disorders and their associations with health- and work-related factors: a cross-sectional comparison between Swedish air force personnel and army soldiers

Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021

BACKGROUND

Active duty service members (ADSMs) of the U.S. Armed Forces are uniquely at risk for musculoskeletal injuries (MSKIs) of the Head/Neck region, including the eye and face, from training with head gear, donning Kevlar, operating aircraft, and maintaining sitting or standing postures for prolonged durations. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Head/Neck MSKIs across the Services from fiscal years (FYs) 2016 to 2021.

METHODS

This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities, private sector care (PC) claims, and theater medical data from October 1, 2015 to September 30, 2021 (FYs 16-21), using the Military Health System Data Repository. Utilization associated with Head/Neck MSKIs in both the direct care and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to Head/Neck MSKIs were captured for each year.

RESULTS

In FY21, 109,683 ADSMs sought care for Head/Neck MSKIs, representing 7.3% of the U.S. Armed Forces. The prevalence of Head/Neck MSKIs ranged from 6.9 to 7.8% during FY16-21, with the highest annual prevalence among the Air Force (8.0-9.4%) and Army (7.9-8.8%). Within direct care across the services, Soldiers presented for the highest proportion (45.9-47.9%) of outpatient encounters for Head/Neck MSKI annually. The Air Force relied most heavily on PC for outpatient Head/Neck MSKI care, which accounted for $9,134,741 in PC costs and comprised 37.2% of all PC encounters in FY21.

CONCLUSIONS

This retrospective, descriptive study established prevalence/incidence, health care utilization, and PC costs for Head/Neck MSKIs across the services from FY16-21, emphasizing the burden of Head/Neck MSKIs among the U.S. Armed Forces, with PC costs amounting to $42,912,940 in FY21 alone.

High Physical Exposure During Female Recruits' Basic Military Training in Sweden-A Descriptive Study

INTRODUCTION

There is a knowledge gap concerning the occurrence of physical complaints/injuries, i.e., musculoskeletal disorders (MSD), among Swedish women who undergo basic military training (BMT). The aims were to describe prevalence and factors related to MSD and explore physical exposure and performance in Swedish female recruits during BMT.

MATERIALS AND METHODS

A total of 144 females (mean age 22 years) who underwent BMT in 2016 participated in this cross-sectional study. Data regarding self-reported MSD, physical performance, physical activity and exercise, motivation and mental and physical preparation, and physical exposure during BMT and perceived health were collected at the end of BMT through the Musculoskeletal Screening Protocol questionnaire. Additional data on muscle strength were retrieved from IsoKai isokinetic lift tests. Descriptive and analytic (paired samples t-test and logistic binary regression) statistics were used.

RESULTS

The prevalence of MSD was high, with 33% (n = 48) reporting MSD before BMT, 78% (n = 113) during, and 50% (n = 72) at the end of BMT. Knee and upper back were the most frequently reported MSD locations. Forty-four (30%) participants felt insufficiently physically prepared for BMT. The physical exposure was high with loaded marches/runs and carrying heavy loads as the most demanding tasks. The longest walking distance was reportedly 55 km, and the reported maximum load was 50 kg. Forty-five participants (31%) had carried a load representing over 50% of their body weight. Most participants reported good to excellent health at the end of BMT. There was a small (8 N) but significant (P = 0.045) increase in mean force over time. Two variables, MSD before BMT (odds ratio 2.24, P = 0.03) and being physically unprepared (odds ratio 3.03, P < 0.01), were associated with MSD at the end of BMT.

CONCLUSION

This study showed that the prevalence of MSD in Swedish female recruits was high before, during, and at the end of BMT, with knee and upper back as the most frequent locations. Although the physical exposure during BMT was occasionally high, self-rated health was mainly perceived as good to excellent at the end of BMT. Previous MSD and being physically unprepared were related to MSD at the end of BMT. These important and relevant findings indicate the necessity for implementing interventions to increase physical fitness and treat MSD at the beginning of BMT.

Associations Between Rank, Sex, and Parity With Musculoskeletal Injuries Sustained During Annual Military Physical Fitness Test

ABSTRACT

Edwards, CM, da Silva, DF, Puranda, JL, Souza, SCS, Semeniuk, K, and Adamo, KB. Associations between rank, sex, and parity with musculoskeletal injuries sustained during annual military physical fitness test. J Strength Cond Res 38(2): 367-373, 2024-Musculoskeletal injuries pose a significant threat to the well-being of military personnel. Attempts to use physical employment standard test results as predictors of injury are underway, but little is known about injuries sustained during the tests. This study sought to identify body regions most likely to be reported as injured during the annual Canadian Armed Forces (CAF) physical fitness evaluation. In addition, sex, rank, and parity status are explored as possible associated factors for injury. A total of 1,796 actively serving CAF members were categorized by sex (1,030 male participants; 766 female participants), rank (1,142 Non-Commissioned Members [NCM]; 638 Officers), and parity (314 parous female participants; 435 nulliparous female participants). Sex, rank, and parity were associated with body regions reportedly injured during an annual CAF fitness assessment (significance p ≤ 0.05). When compared with male participants, female participants were more likely to be injured {aOR: 1.797 (95% [confidence interval] CI: 1.45-2.23)} and more prone to injury of the wrist (adjusted odds ratio [aOR]: 1.933 [95% CI: 1.20-3.12]), hip (aOR: 3.445 [95% CI: 2.07-5.728]), or lower back (aOR: 1.55 [95% CI: 1.18-2.04]). Non-Commissioned Members were more likely to injure the neck (aOR: 2.14 [95% CI: 1.18-3.88]) or shoulder (aOR: 2.03 [95% CI: 1.31-3.15]), when compared with Officers. Parous female participants reported pelvis/abdomen injury at a higher rate than the nulliparous group (5 vs. 1.7%, p = 0.019). Injuries sustained during an annual CAF fitness assessment differ based on sex, rank, and parity. Canadian Armed Forces female participants, NCM, and parous female participants may require specific physical fitness support in preparation for the annual physical fitness test.

Prevalence and risk factors of occupational neck pain in Chinese male fighter pilots: a cross-sectional study based on questionnaire and cervical sagittal alignment

Background

Neck pain (NP) is a common musculoskeletal disorder among fighter pilots and has become a rising concern due to its detrimental impact on military combat effectiveness. The occurrence of NP is influenced by a variety of factors, but less attention has been paid to the association of NP with demographic, occupational, and cervical sagittal characteristics in this group. This study aimed to investigate the prevalence and risk factors of NP in Chinese male fighter pilots using a questionnaire and cervical sagittal measurements.

Methods

Demographic and flight-related data, as well as musculoskeletal pain information, were gathered from Chinese male fighter pilots via a self-report questionnaire. Cervical sagittal parameters were measured and subtypes were classified using standardized lateral cervical radiographs. Differences in various factors between the case and control groups were analyzed using t-tests or chi-square tests. Binary logistic regressions were conducted to explore potential risk factors contributing to NP. Predictors were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs), along with their respective 95% confidence intervals (CIs).

Results

A total of 185 male fighter pilots were included in this cross-sectional study. Among them, 96 (51.9%) reported experiencing NP within the previous 12 months. The multivariate regression analysis revealed that continuous flight training (AOR: 4.695, 95% CI: 2.226-9.901, p < 0.001), shoulder pain (AOR: 11.891, 95% CI: 4.671-30.268, p < 0.001), and low back pain (AOR: 3.452, 95% CI: 1.600-7.446, p = 0.002) were significantly associated with NP.

Conclusion

The high 12-month prevalence of NP among Chinese male fighter pilots confirms the existence of this growing problem. Continuous flight training, shoulder pain, and low back pain have significant negative effects on pilots' neck health. Effective strategies are necessary to establish appropriate training schedules to reduce NP, and a more holistic perspective on musculoskeletal protection is needed. Given that spinal integrated balance and compensatory mechanisms may maintain individuals in a subclinical state, predicting the incidence of NP in fighter pilots based solely on sagittal characteristics in the cervical region may be inadequate.

Pilots After Shoulder Surgery and Rehabilitation in a Dedicated Musculoskeletal Rehabilitation Unit of a Major Airline Returned to Work Earlier When Compared to Standard Rehabilitation by External Providers

Purpose

The purpose of this study was to compare the time to return to work (RTW) for pilots who underwent shoulder surgery and underwent rehabilitation within a dedicated musculoskeletal rehabilitation (MSK) unit of a major airline to a group of pilots who had standard rehabilitation and to calculate cost savings.

Methods

The database of Emirates Airline was searched for all ICD-10 codes relating to shoulder pathology. Pilots who had shoulder surgery between January 2017 and June 2021 were included. Pilots who had previous shoulder surgery, underwent fracture surgery, joint replacement, revision surgery, or conservative treatment were excluded. The time between suspension and reinstatement of their license was defined as RTW. Cost savings were calculated on the basis of the median salary and rosterable fraction of a commercial airline pilot. RTW compared between a group undergoing rehabilitation in the MSK unit and a group receiving standard rehabilitation by external providers. Group allocation for either attending MSK unit or standard rehabilitation occurred randomly and according to the individual pilots preferences.

Results

The MSK unit treated 36 pilots (36 males/0 females, mean age 45.4 ± 9.4), and 18 pilots (17 males/1 female, mean age 50.3 ± 7.3) were treated by external physical therapist providers. Patients treated by the MSK unit returned to work at a mean of 85.3 ± 32.8 days, and patients treated by external providers returned to work at a mean of 117.9 ± 42.5days (P = .02). The cost savings for pilots treated by the MSK unit were calculated to be $27,948 USD per patient.

Conclusions

The results of this study showed that pilots’ after shoulder surgery RTW times range between 85 to 118 days. Rehabilitation in a dedicated MSK unit reduced the return to flying duties by 39%. Pilots treated by the MSK unit returned to work by a mean of 33 days earlier with cost savings of $27,948 USD per pilot.

Musculoskeletal disorders and the physical activity of territorial army soldiers during the COVID-19 pandemic

BACKGROUND

The aim of this study was to assess the occurrence of self-reported musculoskeletal disorders (MSD) among Polish territorial army soldiers during the COVID-19 pandemic and to investigate whether there was a relationship between occupational physical activity (OPA), leisure time physical activity (LTPA), and MSD.

METHODS

The study used a cross-sectional design with a sample of 373 territorial army soldiers ages 18-55 who had not previously suffered from COVID-19 and were not convalescents. The symptoms prevalence data was collected using the standardized Nordic Musculoskeletal Questionnaire. OPA and LTPA data was collected using the Seven-Day Physical Activity Recall (SDPAR).

RESULTS

The OPA, LTPA, and total physical activity (PA) among the studied soldiers was very diverse and the mean level of PA was relatively high. A total of 56 and 40% of territorial army soldiers had experienced pain or other discomfort in one or more of nine body regions during the past 12 months and during the past 7 days, respectively. The most common MSD among Polish territorial army soldiers were low back pain, followed by pain in the neck and knees.

CONCLUSIONS

The study revealed that the OPA of the studied soldiers, especially vigorous-intensity and high vigorous-intensity OPA, was associated with a higher prevalence of MSD in several regions of the body, i.e. the lower back, elbows, wrists or hands, hips or thighs, and ankles or feet. Along with the increase in energy expenditure on total PA, a greater percentage of respondents experienced low back pain. Vigorous and high vigorous-intensity PA may contribute to the occurrence of MSD.

Cervico-thoracic pain and associated impairments in air force personnel: a cross-sectional study

BACKGROUND

Pain and impaired function in the cervical region are common in Air Force personnel (AFP), but evidence is limited regarding the thoracic region. This cross-sectional cohort study examined associations between cervico-thoracic pain and physical performance among Swedish AFP and explored possible differences and similarities in test performance between fighter pilots (FP), helicopter pilots (HP) and rear crew (RC).

METHODS

AFP (n = 73) from one airbase performed eight tests of movement control of the spine, active cervical range of motion (ROM) in all six directions and isometric strength and endurance of the cervical flexors and extensors. The association between test performance and cervico-thoracic pain (based on the 'Musculoskeletal screening protocol' questionnaire) were analysed in a multiple binary logistic regression model.

RESULTS

For AFP with cervico-thoracic pain (30%), movement control was impaired in the 'neck flexion test' (OR [95%CI] =3.61 [1.06-12.34]) and the 'forward lean test' (OR [95%CI] =3.43[1.04-11.37]), together with reduced flexion ROM (OR [95%CI] =0.93 [0.87-0.99]). Test performance was in general similar between the three groups, but FP and HP could control the 'forward lean test' to a significantly higher degree than RC (p = 0.000). Further, FP showed significantly greater ROM in lateral flexion to the right compared to HP and RC (mean: 40.3°, 36.2° and 33.4°, respectively, p = 0.000), and they showed higher, although not significant, flexor strength than RC (p = 0.026).

CONCLUSIONS

The impaired function associated with cervico-thoracic pain highlights the need for a deeper understanding of such relationships when designing tools to systematically optimize the physical performance and prevent pain among AFP. Studies with a longitudinal design are warranted to examine any causative associations between pain and impairments.