A Narrative Review: Risk Factors of Low Back Pain in Military Personnel/Recruits

Abstract

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 – 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 – 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 – 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 – 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.

Job requirements and physical demands (JRPD) questionnaire: cross-cultural adaptation and psychometric evaluation in Iranian Army personnel with chronic low back pain

“…CLBP is a multifactorial disorder, and previous studies have confirmed the roles of individual factors, health behaviors, work organization, psychosocial, and biomechanical (occupational) risk factors in the back pain onset and its exacerbation [4,5,10]. Overall, the LBP-related risk factors in Army personnel are categorized as individual, psychosocial, and occupational risk factors [3]. Despite the critical role of the individual and psychosocial factors in developing LBP, Army personnel are at high risk of developing LBP due to job demands [3].…”

“…Low back pain (LBP) is the most common disorder among Army personnel, defined as pain localized below the costal margin and above the inferior gluteal folds, with or without leg pain [1][2][3]. LBP impacts troop readiness and leads to ambulatory care, work duty limitation, lost days, and disability in the Armed forces [4][5][6][7].…”

“…Overall, the LBP-related risk factors in Army personnel are categorized as individual, psychosocial, and occupational risk factors [3]. Despite the critical role of the individual and psychosocial factors in developing LBP, Army personnel are at high risk of developing LBP due to job demands [3]. Army occupations involve heavy physical activities, causing a higher-than-average chance of disability [3,11].…”

“…Despite the critical role of the individual and psychosocial factors in developing LBP, Army personnel are at high risk of developing LBP due to job demands [3]. Army occupations involve heavy physical activities, causing a higher-than-average chance of disability [3,11]. Army-related activities, such as repetitive heavy lifting, frequent twisting/bending, forceful pushing and pulling, and awkward body postures are associated with the CLBP [5,7,11,12].…”

Prevalence and factors associated with low back pain among Malaysian army personnel stationed in Klang Valley

“…Army personnel have a high risk of developing LBP due to the demands of the job. The findings of narrative review by Waqqash et al [20] revealed that army personnel have high occupational physical exposure as their job scope requires usage of heavy body armour for a prolonged duration, heavy carrying and lifting, standing and marching for a long duration, and undergoing rigorous physical and combat training. According to Roy et al [16], the relative risk rates for LBP identified among army personnel are: (1) wearing a load more than 10% BW (RR = 2.00, 1.31-4.57), (2) wearing an average load for more than 1 hour (RR = 2.44, 1.30-4.57), (3) load worn more than 15% BW (RR = 5.83, 1.51-22.50), (4) wearing a backpack (RR = 1.82, 1.23-2.80), (5) wearing body armour >1 hour (RR = 1.62, 1.002-2.62), (6) Lifting objects weighing above 22.68 kg (RR = 1.96, 1.08-3.57), (7) Lifting objects one to two times (RR = 1.73, 1.002-2.97), and (8) carrying objects more than 7.62 m (RR = 2.01, 1.19-3.42).…”