Injuries Associated With Mandated Wear of Body Armor in Iraq

Protective ballistic body armor (BA) may be needed during certain threat postures while deployed. This requirement often adds between 35 and 45lbs of extra weight carried by the service member (SM) for multiple hours during the day. The physical toll of that extra weight and the effect it may have on deployed medical resources has not been clearly characterized in the literature. We sought to evaluate the association of a protective BA wear requirement with musculoskeletal (MSK) complaints and to better characterize how these effects are manifested within the deployed military health care system.

All encounters at a Role III Field Hospital were evaluated and queried for MSK injury. Data collected included the SM type, age, gender, MSK anatomy of concern, type of evaluating provider, disposition, and medications rendered. Injuries and outcomes were then compared between two groups; SMs who were seen for MSK complaints while BA was required (October 2023 to March 2024) and those during a period when BA was not required (No-BA = October 2022 to March 2023).

A total of 2,805 encounters were evaluated. Non-SM visits were excluded (455) leaving 2,350 left for evaluation. In all, 969 (41.2%) were identified as encounters for MSK injury. No-BA had significantly fewer visits of MSK injury at 429 (38%) compared to the BA group at 540 (44%, P = .001). Active duty (AD) and National Guard (NG) SMs made up a larger portion of MSK visits in the BA group at 54% and 41%, respectively, compared to 35% Reserve (AR) and 36% NG in the No-BA group (P < .001). Service member were 12 times more likely to require a physical therapy treatment in the BA group (60%) vs. the No-BA (5%, P < .001). Prescriptions of non-steroidal anti-inflammatory medication were more common in the BA group at 11% of all visits compared to 4% in the No-BA group (P < .001). This was also true for muscle relaxers at 1% vs. 3% (P = .008). Shoulder and back injuries represented the largest proportion of MSK areas of concern at 22% and 24%, respectively, with only neck injuries being higher in the BA group at 8.5% vs. 5% (P = .03).

Required wear of BA was associated with an increase in MSK visits across all types of US SMs. Shoulder and back injuries were the most common with a significant increase in visits to physical therapy in the BA group. Anti-inflammatory and muscle-relaxing medications were prescribed more frequently in the BA group. A dedicated prospective study would help better elucidate the causality of these associations. Risk-benefit analysis of threat posture, with the knowledge of these health care associations, deserves serious consideration.