A Narrative Review: Risk Factors of Low Back Pain in Military Personnel/Recruits
Keywords:Risk factor, low back pain, lumbar pain, military personnel.
Military personnel are one of the occupations at high risk of developing low back pain (LBP) due to its job demands. Low back pain (LBP) is a major cause of morbidity and lost from work among military personnel. This narrative review was conducted to determine the risk factors of LBP in military personnel/recruits. Searches focusing on causal comparative and epidemiology studies using OVIDMedline, CINAHL, SPORTDiscus, PubMed, and Scopus databases from year January 1950 to April 2018. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was used to select and synthesis of studies. The strongest personal risk factors identified were history of LBP (OR = 8.91, CI = 1.71 -46.5), female gender (OR: 6.59, CI 1.79 â€“ 24.24), aerobic exercise involvement (OR = 4.39, CI 1.53- 12.57) and older age (OR 4.16). The strongest occupational risk factors identified were prolonged hours of flight per day (OR=11.3, CI 5.2 -24.8), driving in forward bending posture (OR = 3.63, CI 1.06 â€“ 12.42), branch of services (Army; OR 2.74, CI 2.60-2.89 & Air Force; 1.98, CI 1.84 -2.14), Night training (OR = 1.8-2.0, CI 1.1 â€“ 3.1) and whole-body vibration exposure (OR 1.94, CI 1.02 -3.69). The strongest psychosocial risk factors identified were worries (OR = 5.47, CI 1.70- 17.62), no support from others (OR = 4.0, CI 1.31 -12.34) high work stress (OR = 3.47, CI 1.31 â€“ 12.34), depression (OR = 1.75, CI 1.08 -2.83), and psychological stress (OR 1.71). This review summarizes the personal, occupational and psychosocial risk factors associated with LBP among military personnel/ recruits. LBP risk factors differs based on the military branch of services and job scope. Primary LBP risk factor for Air Force pilots, helicopter pilots and military vehicle drivers LBP is sitting ergonomics. Primary LBP risk factor for army (i.e. combat infantry) identified are occupational physical exposure (military training, heavy lifting and carrying, patrol durations.) Further studies are required to verify if there is any interaction between personal, occupational, and psychosocial LBP risk factor categories among military personnel/recruits.
 Shams Vahdati, S., et al., Evaluation of Prevalence of Low Back Pain Among Residents of Tabriz University of Medical Sciences in Relation with Their Position in Work. Turkish Journal of Emergency Medicine, 2014. 14(3): p. 125-129.
 Govindu, N.K. and K. Babski-Reeves, Effects of personal, psychosocial and occupational factors on low back pain severity in workers. International Journal of Industrial Ergonomics, 2014. 44(2): p. 335-341.
 Mendelek, F., et al., On the quantitative relationships between individual/occupational risk factors and low back pain prevalence using nonparametric approaches. Joint Bone Spine, 2011. 78(6): p. 619-624.
 Gubata, M.E., et al., Risk factors for back-related disability in the US army and marine corps. Spine, 2014. 39(9): p. 745-753.
 Cohen, S.P., et al., Spine-area pain in military personnel: a review of epidemiology, etiology, diagnosis, and treatment. The Spine Journal: Official Journal Of The North American Spine Society, 2012. 12(9): p. 833-842.
 Mattila, V.M., et al., Incidence and trends of low back pain hospitalisation during military service - An analysis of 387,070 Finnish young males. BMC Musculoskeletal Disorders, 2009. 10.
 Nissen, L.R., et al., Deployment-related risk factors of low back pain: a study among danish soldiers deployed to Iraq. Military Medicine, 2014. 179(4): p. 451-458.
 Monnier, A., et al., Musculoskeletal pain and limitations in work ability in Swedish marines: A cross-sectional survey of prevalence and associated factors. BMJ Open, 2015. 5(10).
 Knox, J., et al., The incidence of low back pain in active duty United States military service members. Spine (03622436), 2011. 36(18): p. 1492-1500.
 Gao, Y., et al., Adaptation of muscles of the lumbar spine to sudden imbalance in patients with lower back pain caused by military training. The Journal Of Spinal Cord Medicine, 2014. 37(6): p. 774-781.
 Seay, J.F., et al., A history of low back pain affects pelvis and trunk mechanics during a sustained lift/lower task. Ergonomics, 2013. 56(6): p. 944-953.
 Monnier, A., et al., Risk factors for back pain in marines; a prospective cohort study. BMC Musculoskeletal Disorders, 2016. 17: p. 319-319.
 Bar-Dayan, Y., et al., Back disorders among Israeli youth: A prevalence study in young military recruits. Spine Journal, 2012. 12(9): p. 749-755.
 Bongers, P.M., et al., Back pain and exposure to whole body vibration in helicopter pilots. Ergonomics, 1990. 33(8): p. 1007-1026.
 Ernat, J., et al., Incidence and risk factors for acute low back pain in active duty infantry. Military Medicine, 2012. 177(11): p. 1348-1351.
 Feuerstein, M., et al., Working with low back pain: workplace and individual psychosocial determinants of limited duty and lost time. American Journal Of Industrial Medicine, 2001. 40(6): p. 627-638.
 Feuerstein, M., et al., How do job stress and ergonomic factors impact clinic visits in acute low back pain? A prospective study. Journal of Occupational and Environmental Medicine, 2006. 48(6): p. 607-614.
 George, S.Z., et al., Predictors of occurrence and severity of first time low back pain episodes: findings from a military inception cohort. Plos One, 2012. 7(2): p. e30597-e30597.
 Taanila, H.P., et al., Predictors of low back pain in physically active conscripts with special emphasis on muscular fitness. The Spine Journal: Official Journal Of The North American Spine Society, 2012. 12(9): p. 737-748.
 HÃ¤mÃ¤lÃ¤inen, O., Thoracolumbar pain among fighter pilots. Military Medicine, 1999. 164(8): p. 595-596.
 Hansen, O.B. and A.S. Wagstaff, Low back pain in Norwegian helicopter aircrew. Aviation, Space, And Environmental Medicine, 2001. 72(3): p. 161-164.
 Hermes, E.D.A., T.S. Webb, and T.S. Wells, Aircraft type and other risk factors for spinal disorders: Data from 19,673 military cockpit aircrew. Aviation Space and Environmental Medicine, 2010. 81(9): p. 850-856.
 Honkanen, T., et al., Functional test measures as risk indicators for low back pain among fixed-wing military pilots. J R Army Med Corps, 2017. 163(1): p. 31-34.
 Hou, Z.-h., et al., Prevalence of low back pain among soldiers at an army base. Chinese Medical Journal, 2013. 126(4): p. 679-682.
 Knox, J.B., J.R. Orchowski, and B. Owens, Racial differences in the incidence of acute low back pain in United States military service members. Spine (03622436), 2012. 37(19): p. 1688-1692.
 Knox, J.B., et al., Occupational driving as a risk factor for low back pain in active-duty military service members. The Spine Journal: Official Journal Of The North American Spine Society, 2014. 14(4): p. 592-597.
 Seay, J.F., et al., Lower Extremity Injury Increases Risk of First-time Low Back Pain in the U.S. Army. Medicine And Science In Sports And Exercise, 2017.
 Kang, S.H., et al., Military rank and the symptoms of lumbar disc herniation in young Korean soldiers. World Neurosurgery, 2014. 82(1-2): p. e9-e14.
 Kardouni, J.R., T.L. Shing, and D.I. Rhon, Risk Factors for Low Back Pain and Spine Surgery: A Retrospective Cohort Study in Soldiers. American Journal Of Preventive Medicine, 2016. 51(5): p. e129-e138.
 Mu, J., et al., Analysis of association between IL-1, CASP-9, and GDF5 variants and low-back pain in Chinese male soldiers: Clinical article. Journal of Neurosurgery: Spine, 2013. 19(2): p. 243-247.
 Nelson, D.A., N. Menzel, and P. Horoho, Prior depression and incident back pain among military registered nurses: A retrospective cohort study. International Journal of Nursing Studies, 2017. 74: p. 149-154.
 O'Connor, F.G. and S.S. Marlowe, Low back pain in military basic trainees. A pilot study. Spine, 1993. 18(10): p. 1351-1354.
 33. Orsello, C.A., A.S. Phillips, and G.M. Rice, Height and in-flight low back pain association among military helicopter pilots. Aviation Space and Environmental Medicine, 2013. 84(1): p. 32-37.
 Roy, T.C. and H.P. Lopez, A comparison of deployed occupational tasks performed by different types of military battalions and resulting low back pain. Military Medicine, 2013. 178(8): p. e937-e943.
 Roy, T.C., H.P. Lopez, and S.R. Piva, Loads worn by soldiers predict episodes of low back pain during deployment to afghanistan. Spine (03622436), 2013. 38(15): p. 1310-1317.
 Rozali, A., et al., Low back pain and association with whole body vibration among military armoured vehicle drivers in Malaysia. Med J Malaysia, 2009. 64(3): p. 197-204.
 Secer, M., et al., Nonspecific low back pain in a group of young adult men. Turkish Neurosurgery, 2011. 21(2): p. 135-139.
 Tvaryanas, A.P., et al., Statins and Musculoskeletal Conditions in U.S. Air Force Active Duty Service Members. Military Medicine, 2017. 182(9): p. e1938-e1945.
 Mattila, V.M., et al., Low back pain and its risk indicators: a survey of 7,040 Finnish male conscripts. European Spine Journal: Official Publication Of The European Spine Society, The European Spinal Deformity Society, And The European Section Of The Cervical Spine Research Society, 2008. 17(1): p. 64-69.
 Taanila, H., et al., Aetiology and risk factors of musculoskeletal disorders in physically active conscripts: a follow-up study in the Finnish Defence Forces. BMC Musculoskeletal Disorders, 2010. 11: p. 146-146.
 Bar-Dayan, Y., et al., Degenerative disease in lumbar spine of military parachuting instructors. Journal Of The Royal Army Medical Corps, 2003. 149(4): p. 260-264.
 Roy, T.C., et al., Heavy Loads and Lifting are Risk Factors for Musculoskeletal Injuries in Deployed Female Soldiers. Military Medicine, 2016. 181(11): p. e1476-e1483.
 Schoenfeld, A.J., et al., Incidence and risk factors for lumbar degenerative disc disease in the United States Military 1999-2008. Military Medicine, 2011. 176(11): p. 1320-1324.
 Knapik, J., et al., Physical fitness, age, and injury incidence in infantry soldiers. Journal of Occupational Medicine, 1993. 35(6): p. 598-603.
 Games, K.E., et al., Prolonged restricted sitting effects in UH-60 helicopters. Aerospace Medicine and Human Performance, 2015. 86(1): p. 34-40.
 Grossman, A., et al., Back symptoms in aviators flying different aircraft. Aviation, Space, And Environmental Medicine, 2012. 83(7): p. 702-705.