Morbidity burdens attributable to various illnesses and injuries among deployed active and reserve component service members of the U.S. Armed Forces, 2023.

This report updates previous analyses of health care burden distributions among active and reserve component service members of the U.S. Armed Forces in deployed settings. Musculoskeletal disorders in combination with administrative and other health services (ICD-10 "Z" codes) accounted for more than half of all medical encounters in 2023 among service members deployed to the U.S. Central Command (CENTCOM) and Africa Command (AFRICOM). Three common injury conditions occurred among male and female service members deployed to U.S. CENTCOM and U.S. AFRICOM: other back problems, arm and shoulder injuries, and knee injuries.

The Effect of Cautionary Versus Resiliency Spine Education on Maximum Deadlift Performance and Back Beliefs: A Randomized Control Trial.

ABSTRACT: Scott, KM, Kreisel, BR, Florkiewicz, EM, Crowell, MS, Morris, JB, McHenry, PA, and Benedict, TM. The effect of cautionary versus resiliency spine education on maximum deadlift performance and back beliefs: A randomized control trial. J Strength Cond Res 38(7): e341-e348, 2024-The purpose of this study was to determine the effect of cautionary information about the spine vs. a message of spine resiliency on maximum deadlift (MDL) performance and beliefs regarding the vulnerability of the spine. This cluster randomized control trial involved 903 military new cadets (n = 903) during their mandatory fitness test in cadet basic training (mean age 18.3 years, body mass index 23.8 kg·m-2, 22% female). Subjects were cluster randomized to 3 groups. The cautionary group received a message warning them to protect their backs while deadlifting, the resiliency group received a message encouraging confidence while deadlifting, and the control group received the standardized Army deadlift education only. The outcome measures were MDL weight lifted and perceived spine vulnerability. Significance was set at alpha ≤0.05. There were no between-group differences in weight lifted (p=0.40). Most subjects believed that the spine is vulnerable to injury. Three times as many subjects who received the resiliency education improved their beliefs about the vulnerability of their spines compared with those receiving the cautionary education (p<0.001). This study demonstrated the potential for brief resiliency education to positively influence beliefs about spine vulnerability, whereas cautionary education did not impair performance.

Identifying factors associated with physical therapy use versus non-use among injured workers with back pain in Washington State.

BACKGROUND: There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data. METHODS: We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors. RESULTS: Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors. CONCLUSION: We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system.

Traumatic spinal cord injury in South Korea for 13 years (2008-2020).

Traumatic spinal cord injury (TSCI) has significant physical, psychological, and socioeconomic impacts. However, the epidemiological characteristics and treatment patterns of TSCI in South Korea remain unclear. This study aimed to investigate TSCI incidence and treatment behaviors in South Korea from 2008 to 2020. We included data from 30,979 newly diagnosed TSCI patients obtained from the Health Insurance Review and Assessment Service (HIRA). Treatment trends, location of surgery, surgical method, comorbidities, factors affecting hospital stay, and risk factors affecting readmission were analyzed. Patients were divided into the surgery group [n = 7719; (25%)] and the non-surgery group [n = 23,260; (75%)]. Surgical cases involved cervical (64%), thoracic (17%), and lumbar/sacral (19%) lesions. Anterior fusion (38%), posterior fusion (54%), and corpectomy (8%) were the surgical methods. Surgical treatments increased annually. Factors influencing hospital stay included male sex, older age, and higher Charlson comorbidity index (CCI). Female sex and higher CCI scores were associated with readmission. In conclusion, a quarter of all TSCI patients underwent surgery, with an upward trend. Risk factors for longer hospital stays were thoracic spine injury, older age, higher CCI, and male sex. Risk factors for readmission included age range of 40-59 years, lumbar/sacral spine injuries, CCI score of 2, and female sex.

Epidemiology of musculoskeletal injury in professional and amateur golfers: a systematic review and meta-analysis.

OBJECTIVE: To determine the prevalence and incidence of musculoskeletal injury in amateur and professional golfers, and to identify common injury sites and factors associated with increased injury frequency. DESIGN: Systematic epidemiological review and meta-analysis. DATA SOURCES: PubMed (Medline), Embase, the Cochrane Library and SPORTDiscus were searched in September 2023. ELIGIBILITY CRITERIA: Studies published in the English language reporting the incidence or prevalence of musculoskeletal injuries in golfers at all anatomical sites. RESULTS: 20 studies (9221 golfers, 71.9% male, 28.1% female) were included, with mean age 46.8 years. Lifetime injury prevalence was significantly greater in professional golfers (73.5% (95% CI: 47.3% to 93.0%)) than amateur golfers (56.6% (95% CI: 47.4% to 65.5%); relative risk (RR)=1.50, p<0.001). Professional golfers had a significantly greater lifetime prevalence of hand and wrist (RR=3.33, p<0.001) and lower back injury (RR=3.05, p<0.001). Soft tissue injuries were most common, and diagnoses were typically non-specific. Injury frequency was not associated with age or sex. Two studies reported a greater injury risk in amateur golfers playing more than three and four rounds per week. CONCLUSION: Over half of golfers are at risk of sustaining a musculoskeletal injury during their lifetime. Risks and patterns of injury differ between professional and amateur golfers, with professionals significantly more likely to develop lower back, and hand and wrist injuries. A recent international consensus statement on the reporting of injury and illness in golf should aid consistency in future research assessing the epidemiology of specific diagnoses, informing golf injury prevention and management strategies. PROSPERO REGISTRATION NUMBER: CRD42023408738.

The Burden of Back and Neck Strains and Sprains in Professional Baseball Players.

STUDY DESIGN: A retrospective case series study. OBJECTIVE: To analyze the epidemiology of diagnoses of back and neck strains and sprains among Major League (MLB) and Minor League (MiLB) Baseball players. BACKGROUND: Baseball players perform unique sets of repetitive movements that may predispose to neck and back strains and sprains. Data are lacking concerning the epidemiology of these diagnoses in this population. MATERIALS AND METHODS: De-identified data on neck/back strains and sprains were collected from all MLB and MiLB teams from 2011 to 2016 using the MLB-commissioned Health and Injury Tracking System database. Diagnosis rates of conditions related to cervical, thoracic, and lumbar musculature and their impact on days missed due to injury, player participation, and season or career-ending status were assessed. Injury rates were reported as injuries per 1000 athlete exposures (AEs). RESULTS: There were 3447 cases of neck/back strains and sprains in professional baseball players from 2011 to 2016. Seven hundred twenty-one of these occurred in MLB versus 2726 in MiLB. Of injuries 136 were season-ending (26 in MLB, 110 in MiLB); 22 were career-ending (2 in MLB, 20 in MiLB). The total days missed were 39,118 (8838 from MLB and 30,280 from MiLB). Excluding season or career-ending injuries, the mean days missed were 11.8 (12.7 and 11.6 in MLB and MiLB, respectively). The median days missed were 4 (3 and 5 in MLB and MiLB, respectively). Combining MLB and MiLB, the pitcher injury rate was 1.893 per 1000 AEs versus 0.743 per 1000 Aes for other position players ( P < 0.0001). CONCLUSION: There was a high incidence of neck/back strains and sprains in MLB and MiLB players, with nearly 40,000 aggregate days missed in our 6-year study period. The median days missed were lower than the mean days missed, indicating rightward outliers. Pitchers had over double the rates of injuries compared with other position players. LEVEL OF EVIDENCE: Level III.

Save Your Back: Comparison of the Compressive Force on the Lower Back Based on Differences in the Training Techniques.

INTRODUCTION: Musculoskeletal injury prevention for nurses is aimed at removing the need to manually position patients. In the ED, this is not always possible or practical. The purpose of this study is to compare the calculated estimated compressive force on the lumbar spine between recommended lifting techniques and the SHAPE lifting method during the horizontal transfer of a patient. METHODS: Twenty-one student nurses completed the horizontal transfer of a simulated patient while motion was collected using inertial measurement units. Motion data were analyzed to calculate an estimated compressive force on the lumbar spine while completing the movement based on current recommended lifting methods and while using the SHAPE lifting method. RESULTS: A significant reduction in estimated peak and average compressive force at the lumbar spine was found during both the push and the pull portions (P < .001) of the horizontal transfer. DISCUSSION: While the optimal way to limit musculoskeletal injury among nurses is to eliminate the need for manual handling of a patient, this is not always possible in the ED. It is critical that when emergency nurses must reposition a patient, they perform the movement in the most biomechanically sound method while using a friction reduction. These findings, coupled with the previous biomechanical risk factor reduction related to the SHAPE lifting intervention, gives promise to a safer lifting strategy for emergency nurses moving forward.

Injury patterns in Swedish elite female and male ice hockey - A cross-sectional comparison of past-season's injuries.

OBJECTIVES: To describe and compare seasonal prevalence, anatomical location, severity, and onset of injuries between female and male elite ice hockey players. DESIGN: Cross-sectional survey study. SETTING: Elite ice hockey. PARTICIPANTS: Swedish elite ice hockey players (170 females & 190 males). MAIN OUTCOME MEASURES: Past season injuries reported on a modified version of the Oslo Sports Trauma Research Center overuse injury questionnaire. Proportions of players who experienced any and substantial problems, as well as respective injury severity scores were presented and compared between sexes. RESULTS: Highest seasonal prevalence was reported for hip/groin [31.1% (n = 112)], lower back [24.2% (n = 87)], and shoulder injuries [23.6% (n = 85)]. Prevalence of injuries was approximately similar between sexes. Substantial injuries were most prevalent in the hip/groin (13.3% [n = 48]) and knee (18.6% [n = 67]) region. Females reported a higher proportion of substantial hip/groin injuries. Most reported injuries were acute except for hip/groin and lower back injuries (74.4% and 81.8% due to overuse). CONCLUSION: Seasonal prevalence of injuries in elite ice hockey players were comparable between sexes. Acute injuries were most common but hip/groin as well as lower back injuries were predominantly due to overuse. The highest reported prevalence was found for hip and groin-, lower back-, and shoulder injuries.

Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players.

OBJECTIVE: To describe the presentation and management of lumbar bone stress injuries (LBSI), recurrent LBSI, and lumbar nonunited defects in elite Australian male and female cricket players. DESIGN: Retrospective case series. SETTING: Professional domestic and international cricket teams over 13 seasons. PARTICIPANTS: Elite Australian cricket players. INDEPENDENT VARIABLES: Symptomatic LBSI requiring time off cricket and lumbar nonunited defects, both confirmed by imaging. MAIN OUTCOME MEASURES: Incidence, presentation, history, healing, and management. RESULTS: 211 LBSI were identified at an average incidence of 5.4 per 100 players per season. LBSI were most common in male pace bowlers younger than 20 years of age (58.1 per 100 players per season), however, were also observed in older players, females, and non-pace bowlers. Recurrent LBSI accounted for 33% (27%-40%) of all LBSI. Median days to return to match availability was 182 (128-251) days for all LBSI, with a shorter time frame observed for new and less severe injuries, and male spin bowlers. Healing was demonstrated in 87% (81%-91%) of all LBSI cases. 29 nonunited defects were identified and predisposed subsequent pain, LBSI, and spondylolisthesis. CONCLUSIONS: LBSI are experienced by approximately 5.4 in every 100 elite Australian cricket players per season, with a high time cost of approximately 4 to 8 months. Nonunited defects also have a high time cost with associated subsequent lumbar spine issues. The findings of this study reinforce the importance of early detection and conservative management of LBSI, particularly for younger male pace bowlers and players with recurrent LBSI, which may be supported by MRI.

A Novel Passive Back-Support Exoskeleton With a Spring-Cable-Differential for Lifting Assistance.

Lower back injuries are the most common work-related musculoskeletal disorders. As a wearable device, a back-support exoskeleton (BSE) can reduce the risk of lower back injuries and passive BSEs can achieve a low device weight. However, with current passive BSEs, there is a problem that the user must push against the device when lifting the leg to walk, which is perceived as particularly uncomfortable due to the resistance. To solve this problem, we propose a novel passive BSE that can automatically distinguish between lifting and walking. A unique spring-cable-differential acts as a torque generator to drive both hip joints, providing adequate assistive torque during lifting and low resistance during walking. The optimization of parameters can accommodate the asymmetry of human gait. In addition, the assistive torque on both sides of the user is always the same to ensure the balance of forces. By using a cable to transmit the spring force, we placed the torque generator on the person's back to reduce the weight on the legs. To test the effectiveness of the device, we performed a series of simulated lifting tasks and walking trials. When lifting a load of 10 kg in a squatting and stooping position, the device was able to reduce the activation of the erector spinae muscles by up to 41%. No significant change in the activation of the leg and back muscles was detected during walking.

Occupational Injuries and Illnesses among Paramedicine Clinicians: Analyses of US Department of Labor Data (2010 - 2020).

OBJECTIVE: Paramedicine clinicians (PCs) in the United States (US) respond to 40 million calls for assistance every year. Their fatality rates are high and their rates of nonfatal injuries are higher than other emergency services personnel, and much higher than the average rate for all US workers. The objectives of this paper are to: describe current occupational injuries among PCs; determine changes in risks over time; and calculate differences in risks compared to other occupational groups. METHODS: This retrospective open cohort study of nonfatal injuries among PCs used 2010 through 2020 data from the US Department of Labor (DOL), Bureau of Labor Statistics; some data were unavailable for some years. The rates and relative risks (RRs) of injuries were calculated and compared against those of registered nurses (RNs), fire fighters (FFs), and all US workers. RESULTS: The annual average number of injuries was: 4,234 over-exertion and bodily reaction (eg, motion-related injuries); 3,935 sprains, strains, and tears; 2,000 back injuries; 580 transportation-related injuries; and over 400 violence-related injuries. In this cohort, women had an injury rate that was 50% higher than for men. In 2020, the overall rate of injuries among PCs was more than four-times higher, and the rate of back injuries more than seven-times higher than the national average for all US workers. The rate of violence-related injury was approximately six-times higher for PCs compared to all US workers, seven-times higher than the rate for FFs, and 60% higher than for RNs. The clinicians had a rate of transportation injuries that was 3.6-times higher than the national average for all workers and 2.3-times higher than for FFs. Their overall rate of cases varied between 290 per 10,000 workers in 2018 and 546 per 10,000 workers in 2022. CONCLUSIONS: Paramedicine clinicians are a critical component of the health, disaster, emergency services, and public health infrastructures, but they have risks that are different than other professionals.This analysis provides greater insight into the injuries and risks for these clinicians. The findings reveal the critical need for support for Emergency Medical Services (EMS)-specific research to develop evidence-based risk-reduction interventions. These risk-reduction efforts will require an enhanced data system that accurately and reliably tracks and identifies injuries and illnesses among PCs.

Is MRI screening for bone marrow oedema useful in predicting lumbar bone stress injuries in adult male professional cricketers? A New Zealand pilot study.

OBJECTIVES: The aims were to (1) prospectively observe the incidence of bone marrow oedema in asymptomatic adult male domestic professional cricketers during a season and evaluate its relationship to the development of lumbar bone stress injury and (2) further understand the practicalities of implementing a Magnetic Resonance Imaging-based screening program to prevent lumbar bone stress injury in New Zealand cricket. DESIGN: Prospective observational cohort. METHODS: Adult male pace bowlers received 6-weekly pre-planned Magnetic Resonance Imaging scans over a single season to determine the presence and intensity of bone marrow oedema in the posterior vertebral arches of the lumbar spine. The participants bowling volume and back pain levels were monitored prospectively. RESULTS: 22 participants (mean age 25.3 years (range 20-32 years)) completed all 4 scans. Ten participants had a prior history of lumbar bone stress injury. Ten participants (45 %, 95 % confidence interval 24-68 %) had bone marrow oedema evident on at least one scan, with 9 (41 %) participants recording a bone marrow oedema intensity ≥ 2 and 5 (23 %) participants demonstrated an intensity ≥ 3. During the study one participant was diagnosed with a lumbar bone stress reaction. No participants developed a lumbar bone stress fracture. CONCLUSIONS: Due to the lower incidence of lumbar bone stress injuries in adult bowlers coupled with uncertainty over appropriate threshold values for bone marrow oedema intensity, implementation of a resource intense screening program aimed at identifying adult domestic cricketers at risk of developing a lumbar bone stress injury is not currently supported.

Injuries in Ballroom DanceSport: A Retrospective Study on Prevalence and Relation With Demographic Data.

BACKGROUND: DanceSport is a variant of Ballroom dancing, a style that is performed as a couple dancing together. Although there are many participants worldwide, the amount of research on injuries done in this style of dancing is limited. OBJECTIVE: The aim of this study was obtaining information about the DanceSport Athletes in the Netherlands including anthropometrics, level, frequency and duration of dance training per week. Our second objective was to investigate injury prevalence and type of injuries. STUDY DESIGN: Retrospective questionnaire study. METHODS: All 816 registered active dancers within the Dutch DanceSport Association received an online questionnaire with questions on anthropometrics, level of dancing, frequency and duration of dance training, and questions on injuries. The Chi-Square test was used to calculate differences between categorical variables. RESULTS: A total of 218 dancers (33.7%) completed the questionnaire, 107 males (49.1%), and 111 females (50.9%). The mean age for men was 42 ± 15.9 and 36 ± 15.1 for women. 176 dancers (80.7%) reported 1 or more injuries. Foot, ankle, and lower leg injuries were reported most frequently, 49 males (45.8%), and 60 females (54.1%). No significant difference was found in the total number of injuries for the variables sex (P = .761) and discipline (P = .225). Significantly more head and neck injuries were identified in female Standard dancers (P < .001) compared to male dancers. Also, Standard dancers have more back injuries compared to dancers in both disciplines (P < .009). CONCLUSION: With the described anthropometrics and an 80% lifetime prevalence of injuries, this group can be compared to other dance forms. Significant differences in injuries of the head and neck for female Standard dancers compared to male dancers and significantly more back injuries in Standard dancers compared to dancers in both disciplines were found. Future studies need to translate and validate existing questionnaires in Dutch for use in this population.

Staff Low Back Injury Risk During Assisted Falls Virtual Reality Simulations.

BACKGROUND: Assisted falls occur when staff try to minimize the impact of falls by slowing a patient's descent. Assisting a patient fall may decrease patient injury risk, but biomechanical risk of injury to staff has not been evaluated. Assisted falls virtual reality (VR) simulations were conducted to examine staff low back injury risk during common assisted falls scenarios. METHODS: VR simulations of a toilet to wheelchair transfer were developed with a male patient avatar for three assisted falls scenarios: standing up from toilet, sitting down on wheelchair, and ambulation. Patient avatar weight was modified to reflect normal, underweight, and overweight adult patients. The average spinal compression force at L5/S1 was calculated for each participant with five trials per three scenarios while utilizing physical ergonomic techniques and compared to the safe spinal compression limit of 3,400 Newtons (N). FINDINGS: Six staff participants completed 90 VR simulations in total. The average calculated spinal compression force ranged from 7,132 N to 27,901 N. All participant trials exceeded the safe spinal compression limit of 3,400 N for every assisted falls scenario and avatar weight despite application of ergonomic techniques including wide stance, knees bent, and backs straight. CONCLUSIONS/APPLICATION TO PRACTICE: Staff are at risk for low back injury if they assist falls regardless of the adult patient weight and application of ergonomic techniques. Safer alternatives like the implementation of mobility screening tools and safe patient handling and mobility technology are needed to help prevent assisted falls to decrease injury risk to both patients and staff.

Incidence and risk factors of lumbar plexus injury in patients undergoing oblique lumbar interbody fusion surgery.

PURPOSE: To investigate the incidence and risk factors of lumbar plexus injury (LPI) after oblique lumbar interbody fusion (OLIF) surgery. METHODS: A total of 110 patients who underwent OLIF surgery between January 2017 and January 2021 were retrospectively reviewed. Patients were divided into two groups: the group with LPI (LPI group) and the group without LPI (non-LPI group). The baseline demographic data, surgical variables and radiographic parameters were compared and analyzed between these two groups. RESULTS: Among all participants, 13 (8.5%) had LPI-related symptoms postoperatively (short-term), and 6 (5.5%) did not fully recover after one year (long-term). Statistically, there were no significant differences in the baseline demographic data, surgery duration, intraoperative blood loss, preoperative diagnosis, surgical procedures used and incision length. Compared with the non-LPI group, patients in the LPI group had a narrower OLIF channel space. In LPI group, the anterior edge of left psoas major muscle overpasses the anterior edge of surgical intervertebral disk (IVD) on axial MRI. Logistic regression analysis revealed that narrow OLIF channel space and the anterior edge of left psoas major muscle overpassing the anterior edge of surgical IVD on axial MRI were independently associated with both short-term and long-term LPI. CONCLUSION: Narrow OLIF channel space and the anterior edge of left psoas major muscle overpassing the anterior edge of surgical IVD are significant risk factors of OLIF surgery-related LPI. Surgeons should use preoperative imaging to adequately assess these risk factors to reduce the occurrence of LPI.

Biomechanical evaluation of Back injuries during typical snowboarding backward falls.

To prevent spinal and back injuries in snowboarding, back protector devices (BPDs) have been increasingly used. The biomechanical knowledge for the BPD design and evaluation remains to be explored in snowboarding accident conditions. This study aims to evaluate back-to-snow impact conditions and the associated back injury mechanisms in typical snowboarding backward falls. A previously validated snowboarder multi-body model was first used to evaluate the impact zones on the back and the corresponding impact velocities in a total of 324 snowboarding backward falls. The biomechanical responses during back-to-snow impacts were then evaluated by applying the back-to-snow impact velocity to a full human body finite element model to fall on the snow ground of three levels of stiffness (soft, hard, and icy snow). The mean values of back-to-snow normal and tangential impact velocities were 2.4 m/s and 7.3 m/s with maximum values up to 4.8 m/s and 18.5 m/s. The lower spine had the highest normal impact velocity during snowboarding backward falls. The thoracic spine was found more likely to exceed the limits of flexion-extension range of motions than the lumbar spine during back-to-snow impacts, indicating a higher injury risk. On the hard and icy snow, rib cage and vertebral fractures were predicted at the costal cartilage and the posterior elements of the vertebrae. Despite the possible back injuries, the back-to-snow impact force was always lower than the force thresholds of the current BPD testing standard. The current work provides additional biomechanical knowledge for the future design of back protections for snowboarders.

A Longitudinal Study of Prevalence Ratios for Musculoskeletal Back Injury Among U.S. Navy and Marine Corps Personnel, 2009-2015.

INTRODUCTION: Medical readiness to deploy is an increasingly important issue within the military. Musculoskeletal back pain is one of the most common medical problems that affects service members. This study demonstrates the associations between risk factors and the prevalence of musculoskeletal back pain among active duty sailors and Marines within the Department of the Navy (DoN). MATERIALS AND METHODS: Utilizing the Military Health System Data Repository, we conducted a retrospective cross-sectional review of administrative healthcare claim data for all active duty DoN personnel with at least one medical encounter during fiscal years 2009-2015. For each fiscal year, we identified all claims with an ICD-9 code for back pain and calculated prevalence. We compared those with and without back pain across all variables (age, gender, rank, race, body mass index, tobacco use, occupation, and branch of service) using chi-square analysis. Unadjusted and adjusted log-binomial regressions were used to calculate prevalence ratios and examine associated risk factors for back pain. RESULTS: The number of active duty subjects per fiscal year ranged from 424,460 to 437,053. The prevalence of back pain showed an upward trend, ranging from 9.99% in 2009 to 12.09% in 2015. Personnel aged 35 years and older had the strongest adjusted prevalence ration (APR) for back pain (APR 2.59; 95% CI, 2.53-2.66). There were also strong associations with obese body mass index (APR 1.76; 95% CI, 1.66-1.86), overweight body mass index (APR 1.29; 95% CI, 1.27-1.32), and tobacco use (APR 1.39; 95% CI, 1.36-1.42). Females were more likely to have back pain than males (APR 1.43; 95% CI, 1.40-1.47) and Marines more likely than sailors (APR 1.39; 95% CI, 1.36-1.42). The occupation with the highest prevalence ratio was healthcare (APR 1.34; 95% CI, 1.29-1.40) when compared to the reference group of combat specialists. CONCLUSIONS: There was an increasing prevalence of back pain across the DoN from 2009 to 2015. Different occupational categories demonstrate different prevalence of back pain. Surprisingly, combat occupations and aviators were among the groups with the lowest prevalence. Lifestyle factors such as excess body weight and use of tobacco products are clearly associated with increased prevalence. These results could inform military leaders with regard to setting policies that could increase medical readiness.

Agricultural Injuries: Risk Factors and Severity by Affected Body Part among US (Midwest) Farmers.

OBJECTIVES: Statistics from the United States Bureau of Labor Statistics indicate that agriculture consistently ranks as the most hazardous industry in the US. To identify specific targets for prevention, we investigated injury risk factor profiles separately for each injured body site. We also characterized the severity of agricultural injuries by injured body site using the type of medical care and lost work time due to injury. METHODS: We used the Central States Center for Agricultural Safety and Health (CS-CASH) surveillance data for 2018 to perform descriptive statistics and regression modeling. RESULTS: We found that 12% (513/4351) of the participants experienced one or more injuries in the previous 12 months. Compared to female operators, male operators had 3.53 (95% CI: 1.17-10.68) times higher odds of back injury. Operators in livestock production had 2.77 times (95% CI:1.12-6.82), 2.28 times (95% CI:1.25-4.14), and 1.69 times (95% CI:1.10-2.59) higher odds of injury to the chest/trunk, finger, and leg/knee/hip, respectively, compared to operators in crop or mixed production. After adjusting for age and gender, operators who worked full time (vs. part-time) on the farm/ranch had 2.11 times (95% CI:1.03-4.34) higher odds of back injury. Arm/shoulder and leg/knee/hip injuries were more frequent in older age groups. CONCLUSIONS: Prevention measures should be tailored considering specifically livestock producers with emphasis on trainings on proper livestock handling, such as being gentle, establishing routine, keeping distance, and avoiding sudden and loud noise when handling animals. Applying these techniques avoid startling the animals and reduce the risk of injuries.

Feature Identification Framework for Back Injury Risk in Repetitive Work With Application in Sheep Shearing.

BACKGROUND: Lower back injuries are a serious global problem. Most of these injuries occur over time with repeated sub-acute stresses. Neuromuscular control dysfunction could predict injury, however injuries are almost never observed alongside this data. No labels are available to identify important features that may be predictive of injury. While there are many individual differences in injury development, the population trend is that each individual's injury tolerance decreases over time with exposure, indicating a monotonic process. METHODS: This paper proposes a framework for identifying key features of injury using an unsupervised technique that exploits knowledge of injury aetiology by analysing which features contribute to the popular trend using weak monotonicity from data segmented by task repetitions. The feature selection also evaluates feature redundancy. The efficacy of the framework is demonstrated through data from on-site sheep shearers over one day using 17 wearable inertial measurement units and 16 surface electromyography (sEMG) sensors. RESULTS: Consistent with literature, the results demonstrate sEMG features derived from the erector spinae and multifidus muscles are the most important indicators for lower back injury. To evaluate the performance of the proposed population-trend based unsupervised feature selection technique, the self-reported fatigue information is treated as some 'ground truth' information so that this proposed technique can compare with 5 existing unsupervised feature selection techniques. CONCLUSION: The proposed technique is shown to be the most consistent with the self-reported fatigue information, demonstrating the effectiveness of the proposed method.

Bloqueo ecoguiado bajo el músculo multífido para el dolor postoperatorio tras cirugía de columna lumbar: serie prospectiva de casos / Ultrasound-guided sub-multifidus block for postoperative pain after lumbar spine surgery — a prospective case series

Describimos esta serie de 15casos programados para descompresión de columna lumbar a un único nivel con instrumental, en la que practicamos bloqueo ecoguiado bajo el músculo multífido (SMFB). Se inyectó el anestésico local en profundidad hacia el músculo multífido logrando el bloqueo seguro de las ramas dorsales de los nervios espinales a múltiples niveles en esta serie. Con ultrasonidos (US) puede identificarse el músculo multífido en los planos axial y parasagital. La punta de la aguja se visualiza fácilmente bajo el músculo multífido y en posición medial hacia el proceso transverso. Se documentó la buena calidad de la analgesia utilizando las puntuaciones para el dolor. No se produjeron episodios adversos. Este bloqueo debe compararse con la analgesia multimodal rutinaria o el bloqueo en el plano interfascial del músculo toracolumbar recientemente descrito, en términos de seguridad y eficacia analgésica.(AU)

We describe a series of 15 patients scheduled for single level lumbar spine decompression with instrumentation receiving ultrasound (US) guided submultifidus block (SMFB). In this series, injections of local anesthetic deep to the multifidus muscle provided reliable block of dorsal rami of spinal nerves at multiple levels. With US, the multifidus muscle can be identified both in axial and parasagittal planes. Needle tip is easily visualized beneath the multifidus and medial to the transverse process. Good quality analgesia was documented by pain scores. There were no adverse events. Further studies are needed to compare this nerve block with routine multimodal analgesia or with the recently described thoracolumbar interfascial plane block to compare safety and analgesic efficacy.(AU)