Aetiology and risk factors of musculoskeletal disorders in physically active conscripts: a follow-up study in the Finnish Defence Forces

<p>Abstract</p> <p>Background</p> <p>Musculoskeletal 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.</p> <p>Methods</p> <p>Two successive cohorts of 18 to 28-year-old male conscripts (<it>N </it>= 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.</p> <p>Results</p> <p>During 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.</p> <p>Conclusions</p> <p>The 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.</p

Allometric scaling of strength measurements to body size

For comparative purposes, normalisation of strength measures to body size using allometric scaling is recommended. A wide range of scaling exponents have been suggested, typically utilising body mass, although a comprehensive evaluation of different body size variables has not been documented. Differences between force (F) and torque (T) measurements of strength, and the velocity of measurement might also explain some of the variability in the scaling exponents proposed. Knee extensor strength of 86 young men was assessed with measurement of torque at four velocities (0-4.19 rad s(-1)) and force measured isometrically. Body size variables included body mass, height and fat-free mass. Scaling exponents for torque were consistently higher than for force, but the velocity of torque measurement had no influence. As the confounding effects of fat mass were restricted, scaling exponents and the strength of the power-function relationships progressively increased. Fat-free mass determined a surprisingly high proportion of the variance in measured strength (F, 31%; T, 52-58%). Absolute force and torque measurements, and even torque normalised for body mass, were significantly influenced by height, although strength measures normalised to fat-free mass were not. To normalise strength measurements to body mass, for relatively homogenous lean populations (body fat 20%) lower body mass exponents appear more suitable (F, 0.45; T, 0.68). Nevertheless, fat-free mass is the recommended index for scaling strength to body size, and higher exponents (F, 0.76; T, 1.12) are advocated in this case