Abstract
BackgroundMusculoskeletal disorders (MSDs) are the main reason for morbidity during military training. MSDs commonly result in functional impairment leading to premature discharge from military service and disabilities requiring long-term rehabilitation. The purpose of the study was to examine associations between various risk factors and MSDs with special attention to the physical fitness of the conscripts.MethodsTwo successive cohorts of 18 to 28-year-old male conscripts (N = 944, median age 19) were followed for six months. MSDs, including overuse and acute injuries, treated at the garrison clinic were identified and analysed. Associations between MSDs and risk factors were examined by multivariate Cox's proportional hazard models.ResultsDuring the six-month follow-up of two successive cohorts there were 1629 MSDs and 2879 health clinic visits due to MSDs in 944 persons. The event-based incidence rate for MSD was 10.5 (95% confidence interval (CI): 10.0-11.1) per 1000 person-days. Most MSDs were in the lower extremities (65%) followed by the back (18%). The strongest baseline factors associated with MSDs were poor result in the combined outcome of a 12-minute running test and back lift test (hazard ratio (HR) 2.9; 95% CI: 1.9-4.6), high waist circumference (HR 1.7; 95% CI: 1.3-2.2), high body mass index (HR 1.8; 95% CI: 1.3-2.4), poor result in a 12-minute running test (HR 1.6; 95% CI: 1.2-2.2), earlier musculoskeletal symptoms (HR 1.7; 95% CI: 1.3-2.1) and poor school success (educational level and grades combined; HR 2.0; 95% CI: 1.3-3.0). In addition, risk factors of long-term MSDs (≥10 service days lost due to one or several MSDs) were analysed: poor result in a 12-minute running test, earlier musculoskeletal symptoms, high waist circumference, high body mass index, not belonging to a sports club and poor result in the combined outcome of the 12-minute running test and standing long jump test were strongly associated with long-term MSDs.ConclusionsThe majority of the observed risk factors are modifiable and favourable for future interventions. An appropriate intervention based on the present study would improve both aerobic and muscular fitness prior to conscript training. Attention to appropriate waist circumference and body mass index would strengthen the intervention. Effective results from well-planned randomised controlled studies are needed before initiating large-scale prevention programmes in a military environment.
Highlights
Musculoskeletal disorders (MSDs) are the main reason for morbidity during military training
The findings of the present study provide a reliable insight into the intrinsic risk factors for MSDs
This study showed that a low cardiorespiratory fitness level expressed by poor results in a 12-minute running test at entry into the military service is strongly associated with MSD in a dose-response manner
Summary
Musculoskeletal disorders (MSDs) are the main reason for morbidity during military training. Previous epidemiological studies report that several risk factors are associated with injuries during military training. These include, amongst others: female gender [6,7,8,9], Caucasian race [10,11,12], biomechanical factors such as foot structure and flexibility [1,7,11], previous history of injury, high running mileage, high amount of weekly exercise [3,4,13,14,15,16,17], tobacco use [7,11,18,19] and low levels of physical fitness and activity [3,7,10,14,20,21,22,23,24]. Despite the large number of injuries, there is a lack of epidemiological data concerning the causes and risk factors for musculoskeletal injuries or disorders during conscription military service [9]. The number of conscripts, their quality and motivation, as well as practices and training schedules differ substantially in the professional army
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