Chronic Musculoskeletal Pain and the Military

Excessive exercise can lead to chronic pain in the musculoskeletal system.

The military is known for its intense training and requirement of top physical condition. However, training and conditioning can come at a physical cost to a military service member’s body. Excessive exercise can lead to chronic pain in the musculoskeletal system.

Recommended course: Pain Management: Evidence-Based Interventions and Best Practices

Accurate identification and rehabilitation of pain will increase functional performance in military service members and decrease the psychosocial effects of chronic pain such as anxiety and depression. A work readiness assessment can keep a service member physically and mentally healthy during their military career.

Prevalence and causes of musculoskeletal disorders

According to a study protocol published in BMC Musculoskeletal Disorders, musculoskeletal disorders are a leading cause of morbidity and the most prevalent source of disability for military personnel. Non-combat musculoskeletal injuries (MSKIs) account for more than 80% of soldiers' injuries, as well as 65% of medically nondeployable active-duty soldiers’ injuries.

Based on information from the Army Injury Fact Sheet fact sheets, lower limb injuries are the most common injury. Running long distances with heavy loads is stated as a probable cause of lower limb injuries. Marching with loads and lifting heavy objects on the job were identified as contributing causes to lower limb injuries and pain in the lower back.

Identifying musculoskeletal disorders

A systematic literature review of two decades of qualitative data showed multiple modifiable MSKI risks. The literature includes studies from US military services and military in other countries. Twenty-one risk factors had moderate or strong evidence for increased risk of MSKI in military personnel. The risk factors were separated into two categories: modifiable and non-modifiable risk.

Modifiable risks

The review revealed strong evidence that these modifiable risks can increase individual risk of MSKI. Modifiable risks can be altered by the client and include:

• Higher body fat percentage
• Low physical fitness level
• Low or no participation in sports before military service
• Smoking
• High amount of unit training
• Overweight, underweight, obese

Some of the modifiable risk factors are interrelated. A service member with an MSKI may experience an increase in their body mass index (BMI) and weight gain that puts them in the overweight category. They may lose physical fitness, making them susceptible to future injuries. This study found that active-duty soldiers who adhered to a standardized exercise program had reduced injury risk.

There was moderate evidence strength that low levels of Vitamin D and lower muscle strength can increase MSKI risk.

Non-modifiable risks

There were multiple non-modifiable risks identified that ranged from low to strong evidence. The client does not have control over non-modifiable risks such as:

• A medical history that includes previous MSKIs was categorized as a non-modifiable risk with strong evidence.
• Being female was also characterized as a non-modifiable risk with strong evidence.

Recommended course: Pain Assessment and Management: The Role of Occupational Therapy, 3rd Edition

Prevention and interventions for musculoskeletal treatments

Military OneSource makes these suggestions for overuse injury prevention:

• Increase calf muscle strength with toe raises.
• Engage in high-impact exercises, like running, on soft or even surfaces
• Maintain a healthy diet
• Decrease weight
• Avoiding exercises requiring an extended bent knee position.

Although military service requires high levels of physical fitness, it can also require long periods of daily sitting at a desk. As with any desk job, service members are at risk of the same desk-related MSKIs as civilians. These injuries include carpal tunnel syndrome, low back pain, and shoulder/neck pain. An ergonomic assessment of the work environment can yield recommendations for modifications that support body structures while seated and during physical movement.

The protocol for a randomized controlled trial (RCT) was published in April 2022, detailing a study to establish the effectiveness of group-based supervised training programs as compared to individual physiotherapy care.

Currently, no standardized protocols for treating military injuries consider the physical demands of the service member’s job assignment. In the interim, a graded return to functional tasks should be used to return injured soldiers to full functional status. An individualized rehabilitation program that supports functional, multiplane physical movements improves muscle balance, decreasing the risk of overuse injury when engaged in repetitive activities such as running.

Functional capacity evaluations

Functional Capacity Evaluations (FCE) can provide valuable information for deciding if a client is ready to return to work. The Functional Capacity Evaluation-Military (FCE-M) was created to fill the need for an FCE that targets the demands of military employment. During a study to assess the FCE-M’s usage, three military service members completed all categories of the FCE-M with the results as follows:

• Two service members reached a work-level classification of Heavy-Very Heavy
• One service member achieved a classification of Medium-Heavy

The study concluded that the FCE-M provides a systematic assessment of the performance of highly specified military tasks and may provide value in assessing readiness for returning to duty.

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This article was written by Tasha Holmes, MOT, OTR/L, BCP