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Backbone of Readiness

The vital role of spinal health for military personnel

Military medical services face the complex task of supporting operational and training activities that often take place in 'extreme' environments and expose personnel to intense physical and mental stress. Service members are driven to endure pain, fatigue, extreme temperatures, fear, sleep deprivation, emotional strain and a lack of physical comfort. They may also have to manage a range of biomechanical overload risk factors, including prolonged poor posture, the weight of their personal equipment, handling heavy loads, exposure to prolonged vibration, impact injuries from contact with the ground and operations conducted in low-light conditions or on rugged terrain. Other risk factors include advancing age, being overweight weight, poor physical condition, excessive joint and muscle stiffness, systemic diseases, chronic osteoarticular conditions, significant postural abnormalities, disabilities and the after-effects of trauma or injuries that have not fully healed or been properly rehabilitated. 

Military personnel, due to a mindset favouring physical and psychological endurance, often report to medical staff with multiple concurrent musculoskeletal conditions or at a more advanced stage of injury than when symptoms first presented. This creates a risk that treatment and rehabilitation might take longer. Having one or more soldiers with such conditions can compromise a unit’s combat readiness and place an additional burden on the public healthcare system. Musculoskeletal disorders affect the limbs or the spine and can lead to pain in soft tissue (muscles, tendons, blood vessels), joints, bones and peripheral nerves. These conditions may arise suddenly and go away quite quickly – such as fractures, sprain or strains – or evolve into chronic, degenerative disorders that cause long-term pain and disability. 

Posture and the spine

Spinal health is closely linked to posture. Indeed, it is one of the most influential factors in the onset and progression of musculoskeletal disorders.  

Posture does not simply mean the body’s position in space, but rather the complex interaction between an individual and the surrounding environment.  A person's posture is the result of multiple variables, including genetics, lifestyle, emotional state, physical activity, job, previous physical or psychological trauma and cultural background. 

There is no universally 'perfect' posture. Instead, the totality of a person's motor experiences shape an automatic postural pattern that can be functional or dysfunctional. The latter arises when biomechanical overload occurs, leading to stress and degeneration of joints, soft tissues, the nervous and cardiovascular systems and, potentially, psychological distress. 

The spine, the body’s primary structural support for posture, is made up of 33 or 34 vertebrae, divided into five regions: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 4 or 5 coccygeal vertebrae. Its main functions are to protect the spinal cord running through the vertebral canal, support the body and enable movement of the trunk and head. Viewed from the front, the spine appears vertically straight; from the side, however, it features four natural curves that help absorb axial loads: two inward (lordotic) curves in the cervical and lumbar regions, and two outward (kyphotic) curves in the thoracic and sacral regions.

Between each pair of vertebral bodies lies an intervertebral disc, consisting of a fibrous outer ring that encases a soft, gelatinous nucleus composed of approximately 88% water. Its primary function is to absorb shock between vertebrae, acting like a soft sphere compressed between two surfaces.

Disc pathologies 

Disc pathologies are among the most common conditions affecting the spine. Over time, intervertebral discs naturally lose water content and undergo degenerative changes due to ageing. In themselves, such changes are not pathological and do not cause pain. However, if the fibrous ring of the disc is damaged, material from the nucleus pulposus can begin to push outward and press against the spinal nerve. This process may start as a disc bulge and develop into a full herniation, potentially causing lower back pain and sciatica. Over time, it can also contribute to increased wear on the joints of the spine — a condition known as spinal osteoarthritis. 

Disc herniations occur most frequently in individuals between the ages of 30 and 50, with the L4–L5 and L5–S1 discs being the most commonly affected. The principal contributing factors are biomechanical overload, obesity and a sedentary lifestyle. 

Depending on the severity and the specific nerve root involved, symptoms may include altered sensitivity to heat, touch or pain; reduced muscle strength; and diminished deep tendon reflexes.

Prevention programme

Prevention, treatment and rehabilitation are the three key pillars for effectively addressing musculoskeletal disorders. 

Prevention is based on analysing the risks and hazards/dangers but cannot be entrusted solely to the organisational structure. Indeed, workers themselves must play an active role in the process through appropriate information, education and training. Such aspects also foster greater awareness of basic workplace safety rules, postural hygiene and ergonomics, and promote healthy lifestyle habits and greater awareness of physical and mental wellbeing. 

Primary prevention is meant to reduce risk factors through targeted actions such as: promoting a healthy lifestyle (e.g. reducing alcohol intake, quitting smoking, maintaining a balanced diet, engaging in regular physical activity, sleeping at least seven hours a night and looking after one's wellbeing); encouraging the use of personal protective equipment; and automating the handling of heavy loads and so on. Secondary prevention focuses on medical surveillance of workers, including fitness-for-duty examinations, routine occupational health assessments, screening initiatives, and postural and biomechanical evaluations. These measures enable early diagnosis, timely treatment and identification of the need for rehabilitation for any unresolved musculoskeletal issues. Tertiary prevention focuses on managing established conditions, aiming to prevent complications, improve quality of life and reduce levels of disability.  Examples of intervention at this stage include rehabilitative care and psychological support.

Rehabilitation medicine plays a vital role in the management of musculoskeletal disorders, as it brings together clinical assessment, the prevention of musculoskeletal injuries and relapses, genuine therapeutic treatment of the issue and support for returning to both work and sport. A crucial factor is interdisciplinary teamwork, involving a range of complementary healthcare professionals – including the director of military medical services, general practitioner, occupational health physician, orthopaedic surgeon, physiatrist, physiotherapist and other clinical specialists — followed by athletic coaches who assist with the return to sport. This coordinated, multidisciplinary approach ensures more effective patient management, helping to reduce sick leave, foster faster recovery and reduce the risk of relapse or progression to chronic conditions. Finally, patients must be particularly cautious not to rely on internet ‘gurus,’ unqualified healers or other individuals promoting alternative treatments that lack a scientific basis. 

Training

Training regularly is one of the most effective ways to reduce the risk of occupational musculoskeletal disorders and workplace injuries. Physical activity plays a vital role in preventing and managing a range of musculoskeletal conditions – including back pain – by improving muscle strength, joint load capacity, mobility, coordination and posture. It also helps reduce physical and mental stress by triggering the release of endorphins, with positive effects on perceived pain, quality of life, concentration and work performance.

Exercise helps prevent neurodegenerative diseases, supports healthy weight management, reduces the risk of cardiovascular disease, diabetes and certain types of cancer, and improves or maintains bone density, thus reducing the risk of osteoporosis. 

The most recent World Health Organization guidelines recommend: 

• 150–300 minutes of moderate-intensity aerobic activity per week, or 75–150 minutes of vigorous-intensity aerobic activity (or a combination of both); 
• Muscle-strengthening activities on at least two days per week; 
• Reducing sedentary behaviour. 

To achieve lasting results, it is essential to manage the intensity, frequency, duration, progression and type of training stimuli effectively. Only through a balanced approach can a sustainable model of wellbeing be achieved. This means it is essential to rely on qualified military physical education instructors to tailor training programmes to each service member’s physical and mental profile  (factoring in age, sex, medical history, physical condition, mental state, occupational aptitude, problem-solving ability and teamwork skills) as well as the specific requirements of their role and operational environment. 

A practical example of a training session designed to improve military performance, to be repeated three times a week, includes: 

• Warm-up: light running and joint mobility exercises (15 minutes)
• Functional circuit training, for example: 10 pull-ups, 10 push-ups, 10 squats, 10 deadlifts, 10 shoulder presses, 20 crunches — repeated 5 times. 
• Cool-down and stretching (15 minutes)

Conclusions

Spinal health is essential to ensuring the readiness and operational effectiveness of military personnel. Investing in the prevention, treatment and rehabilitation of musculoskeletal disorders not only enhances individual performance, but also strengthens the military’s ability to meet future challenges, maximising the potential of the entire force.

Story by Warrant Officer ITA Army Fausto MAZZONE (NRDC-ITA)