Frequency of musculoskeletal symptoms among police officers: systematic review

Eduardo Frio Marins Luana Siqueira Andrade Marcio Botelho Peixoto Marcelo Cozzensa da Silva About the authors

ABSTRACT

BACKGROUND AND OBJECTIVES:

Musculoskeletal symptoms are considered one of the major health problems among police officers. However, no study has synthesized the frequency of these disorders in different parts of the body in this population. The study aimed to describe the frequency of musculoskeletal symptoms in different body regions of the police officers.

CONTENTS:

A search was conducted in the electronic databases Pubmed/Medline, Web of Science, LILACS, and Scielo, as well as a manual search in the references of the articles. Ten of the 4025 possible studies found were included, which reported different types of musculoskeletal symptoms frequency in different body regions and periods. The frequency of musculoskeletal symptoms within 12 months ranged from 42-52% for the lower back, 34-43% for the knees, 7-32% for the shoulders, 7-27% for the wrists/hands/fingers, 29-42% for the neck, 18-28% for ankle/foot, 8-10% for elbow, 22-45% for upper back and 12-18% for hip/thigh.

CONCLUSION:

The frequency of musculoskeletal symptoms in police officers was high, especially in the lumbar, dorsal, knee, neck, and shoulder regions. Preventive measures such as physical activity and ergonomic adaptations to reduce these symptoms in this population are necessary.

Keywords:
Epidemiology; Pain; Police; Prevalence

RESUMO

JUSTIFICATIVA E OBJETIVOS:

Os sintomas musculoesqueléticos são considerados um dos maiores problemas de saúde entre policiais, porém nenhum estudo sintetizou a frequência desses distúrbios em diferentes partes do corpo nessa população. O objetivo deste estudo foi descrever a frequência dos sintomas musculoesqueléticos nas diferentes regiões do corpo de policiais.

CONTEÚDO:

Foi conduzida uma busca nas bases eletrônicas Pubmed/Medline, Web of Science, LILACS e Scielo, bem como busca manual nas referências dos artigos. Foram incluídos 10 dos 4.025 possíveis estudos encontrados, os quais reportaram diversos tipos de frequência de sintomas musculoesqueléticos em diferentes regiões do corpo e períodos. A frequência de sintomas musculoesqueléticos no período de 12 meses variou entre 42-52% para região lombar, 34-43% para joelhos, 7-32% para ombros, 7-27% para punhos/mãos/dedos, 29-42% para pescoço, 18-28% para tornozelo/pé, 8-10% para cotovelo, 22-45% para parte superior das costas e 12-18% para quadril/coxa.

CONCLUSÃO:

A frequência de sintomas musculoesqueléticos em policiais foi alta, principalmente nas regiões lombares, dorsais, joelhos, pescoço e ombros. Devem ser realizadas medidas preventivas, tais como atividades físicas e adaptações ergonômicas, visando a redução desses sintomas nessa população.

Descritores:
Dor; Epidemiologia; Polícia; Prevalência

INTRODUCTION

Musculoskeletal diseases are one of the major health problems related to work in different professions11 Umer W, Antwi-Afari MF, Li H, Szeto GPY, Wong AYL. The prevalence of musculoskeletal symptoms in the construction industry: a systematic review and meta-analysis. Int Arch Occup Environ Health. 2018;91(2):125-44.,22 ZakerJafari HR, YektaKooshali MH. Work-related musculoskeletal disorders in Iranian dentists: a systematic review and meta-analysis. Saf Health Work. 2018;9(1):1-9., among which, the police activity stands out due to their physically demanding character33 Larsen LB, Andersson EE, Tranberg R, Ramstrand N. Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting. Int Arch Occup Environ Health. 2018;91(4):425-33.,44 Marins E, Crespo P, Rombaldi A, Del Vecchio F. Occupational physical fitness tests for police officers - a narrative review. TSAC Rep. 2018;50:26-34.. The activities commonly performed by most police officers require that they remain in uncomfortable static or repetitive positions, such as sitting in police vehicles33 Larsen LB, Andersson EE, Tranberg R, Ramstrand N. Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting. Int Arch Occup Environ Health. 2018;91(4):425-33.,55 Larsen LB, Ramstrand N, Tranberg R. Duty belt or load-bearing vest? Discomfort and pressure distribution for police driving standard fleet vehicles. Appl Ergon. 2019;80:146-51., as well as using personal protective equipment such as duty belts, weapons and ballistic vest which generates high physical overload55 Larsen LB, Ramstrand N, Tranberg R. Duty belt or load-bearing vest? Discomfort and pressure distribution for police driving standard fleet vehicles. Appl Ergon. 2019;80:146-51.,66 Marins EF, Cabistany L, Farias C, Dawes J, Del Vecchio FB. Effects of personal protective equipment on metabolism and performance during an occupational physical ability test for Federal Highway Police Officers. J Strength Cond Res. 2018;1. [Epub ahead of print]. that could put them at risk of developing musculoskeletal symptoms (MSS)33 Larsen LB, Andersson EE, Tranberg R, Ramstrand N. Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting. Int Arch Occup Environ Health. 2018;91(4):425-33.,77 Benyamina Douma N, Côté C, Lacasse A. Occupational and ergonomic factors associated with low back pain among car-patrol police officers: findings from the Quebec Serve and protect low back pain study. Clin J Pain. 2018;34(10):960-6.,88 Gyi DE, Porter JM. Musculoskeletal problems and driving in police officers. Occup Med. 1998;48(3):153-60., with higher prevalence in the lower back33 Larsen LB, Andersson EE, Tranberg R, Ramstrand N. Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting. Int Arch Occup Environ Health. 2018;91(4):425-33.,99 Marins EF, Del Vecchio F. Programa Patrulha da Saúde: indicadores de saúde em policiais rodoviários federais. Sci Médica. 2017;27(2):25855..

The high prevalence of MSS related to the police work can lead to absenteeism, decrease in productivity, overburdening other police officers, decreasing the population’s security, and increasing costs for the treatment and rehabilitation of police officers on leave of absence1010 Douma NB, Cote C, Lacasse A. Quebec Serve and Protect Low Back Pain Study a web-based cross-sectional investigation of prevalence and functional impact among police officers. Spine. 2017;42(19):1485-93.. Approximately 18.5% of sick pay and disability retirement reported in Brazil in 2014 were caused by musculoskeletal diseases, which significantly impacted the country’s socioeconomic profile, with spending reaching 534.5 million reais1111 Anuário Estatístico da Previdência Social. 26ª ed. Vol. 24. Brasilia: Secretaria da Previdência; 2017. 1-980 p.. In addition, studies with Brazilian police officers have reported a prevalence of low back pain around 41.5-51.5%99 Marins EF, Del Vecchio F. Programa Patrulha da Saúde: indicadores de saúde em policiais rodoviários federais. Sci Médica. 2017;27(2):25855.,1212 Trindade APNT, Oliveira LCN, Santos BMO, Oliveira FB, Quemelo PRV. Symptoms of musculoskeletal disorders among police officers. Arq Ciênc Saúde. 2015;22(2):42-5..

Although some studies have reported the prevalence rates of MSS among police from different countries, there is no review study systematizing such findings. The results of this review will help authorities linked to public health and security to understand the problem, with the allocation of necessary resources for the prevention and rehabilitation practices of police officers with MSS. This study aimed to summarize the frequency of MSS among police officers.

CONTENTS

The review and writing process for this article was carried out following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyzes (PRISMA)1313 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg. 2010;8(5):336-41..

The articles were searched in Pubmed/Medline, Web of Science, LILACS, and Scielo databases. The definition of the keywords was based on the Medical Subject Headings (MeSH) system, covering the following specific terms referring to the frequency of symptoms or musculoskeletal disorders in the different body regions of the police officers: “prevalence”, “incidence”, “musculoskeletal”, “disorder”, “symptom”, “disease”, “discomfort”, “complaint”, “trauma disorder”, “musculoskeletal injury”, “police”, “law enforcement”. The logical operators AND/OR were used with no additional filters.

Inclusion and exclusion criteria

The inclusion criteria were studies in Portuguese, English, and Spanish, with a randomized, quasi-experimental, cross-sectional, or case-control design that reported the prevalence of MSS in police populations. The exclusion criteria are described in table 1.

Table 1
Exclusion criteria of the studies

The search process for the articles ended in November 2018. After the selection in the databases, articles in duplicate were excluded. All articles were input in a library of a specific software to store bibliographic references (Zotero(®), Center for History and New Media at George Mason University, USA).

For the final selection of articles, three more steps were followed. In the first moment, the titles of the articles were read with the exclusion of those that did not meet the established criteria. In the second stage, the abstracts of the articles were read, and those that met the inclusion criteria were selected, and those that did not have sufficient information to make a decision on inclusion or exclusion. Finally, in the third stage, the selected articles were analyzed in full, remaining only those that met the inclusion criteria. At this stage, the references of the eligible articles were also analyzed in an attempt to find new references for the review, which might not have been found during the process. All stages were conducted independently by two reviewers, in order to avoid any bias in the selection of the manuscripts. At each stage, the reviewers compared the articles, and when faced with a divergence, they read again for the final decision. If the divergence remained, a third evaluator was consulted.

Data on authorship, year of publication, study design, sample description, sample size, measurement instrument, as well as the main prevalence results of any MSS were extracted.

Selection of the studies

The searches in the databases identified 4023 possible studies related to the investigated topic, and 502 were excluded because they were duplicated. After reading the titles and abstracts, 3490 articles were excluded because they did not meet the previously defined criteria. Thirty-one articles remained for the reading of the full text. After analyzing the articles in full, seven studies were excluded because they had no relation with the analyzed topic, 13 because they did not present frequency values, one for evaluating a non-police population, and yet, it was not possible to access two studies. Finally, two studies were identified through searches in the references, totaling ten studies included in this review (Figure 1).

Figure 1
Flowchart of the procedures to select the studies included in this systematic review

Characteristics of the studies

Five studies were conducted in Brazil, three in Canada, one in Sweden and one in the United Kingdom. Eight studies had a sample equal to or greater than 100 individuals, and seven evaluated people of both genders. Seven studies were conducted after the year 2000, six as of 2015. All were characterized as observational studies based on a cross-sectional design. Pain assessment was performed using questionnaires, being the Nordic Musculoskeletal Questionnaire (NMQ)1414 Pinheiro FA, Tróccoli BT, Carvalho CV. Validity on the Nordic Musculoskeletal Questionnaire as morbidity measurement tool. Rev Saude Publica. 2002;36(3):307-12., the most used.

The ten studies that analyzed the frequency of MSS in police officers had different characteristics concerning the body regions, the moments, and periods investigated. Three presented the prevalence of symptoms in the last seven days and/or 12 months in the low back; knees; dorsal region; shoulders; wrists, hands and fingers; neck; ankles and feet; hips and thighs; elbows; forearms. One study showed the frequency of chronic musculoskeletal pain in the last three months in four regions of the body: upper back or neck; lower back; shoulders or arms; hips, legs, knees or feet. Two studies showed the frequency of pain, specifically in the back region. One study showed the frequency of low back pain before and after a work shift. One study showed the frequency of MSS reported or treated in the last year by the civil and military police. Table 2 shows the characteristics of the studies included in the review, describing the place where they were conducted, the characterization of the sample, the data collection instruments, and the main findings.

Table 2
Characteristics and results of the studies included in the review

The analysis of the MSS frequency in different anatomical regions in the last seven days and/or 12 months showed that the most affected areas by discomfort are the lumbar region, dorsal region, neck and knees99 Marins EF, Del Vecchio F. Programa Patrulha da Saúde: indicadores de saúde em policiais rodoviários federais. Sci Médica. 2017;27(2):25855.,1212 Trindade APNT, Oliveira LCN, Santos BMO, Oliveira FB, Quemelo PRV. Symptoms of musculoskeletal disorders among police officers. Arq Ciênc Saúde. 2015;22(2):42-5.,1818 Braga KK, Trombini-Souza F, Skrapec MV, Queiroz DB, Sotero AM, Silva TF. Pain and musculoskeletal discomfort in military police officers of the Ostensive Motorcycle Patrol Group. BrJP. 2018;1(1):29-32.. In the seven-day period, the frequency of discomfort varied between 25.2-26.8% in the lumbar region, 14.9-19.5% in the knees, 12.2-16.4% in the dorsal region, 14.5 -17.1% on the shoulders, 9.5-17.1% on wrists, hands and fingers, 12.2-14.5% on the neck, 4.9-13% on ankles and feet, 7.3- 9.9% on hips and thighs, 9-5.3% on the elbows and 4.9-5.0% on the forearms99 Marins EF, Del Vecchio F. Programa Patrulha da Saúde: indicadores de saúde em policiais rodoviários federais. Sci Médica. 2017;27(2):25855.,1212 Trindade APNT, Oliveira LCN, Santos BMO, Oliveira FB, Quemelo PRV. Symptoms of musculoskeletal disorders among police officers. Arq Ciênc Saúde. 2015;22(2):42-5.. In the 12-month period, the frequency varied between 41.5-51.5% in the lumbar region, 34.4-43% in the knees, 22-45% in the dorsal region, 29-41.5% in the neck, 7-32.4% on the shoulders, 18-28.2% on ankles and feet, 7-26.8% on wrists, hands and fingers, 12.2-18.3% on hips and thighs, 7.3-11.5% forearms and 8-9.8% in the elbows99 Marins EF, Del Vecchio F. Programa Patrulha da Saúde: indicadores de saúde em policiais rodoviários federais. Sci Médica. 2017;27(2):25855.,1212 Trindade APNT, Oliveira LCN, Santos BMO, Oliveira FB, Quemelo PRV. Symptoms of musculoskeletal disorders among police officers. Arq Ciênc Saúde. 2015;22(2):42-5.,1818 Braga KK, Trombini-Souza F, Skrapec MV, Queiroz DB, Sotero AM, Silva TF. Pain and musculoskeletal discomfort in military police officers of the Ostensive Motorcycle Patrol Group. BrJP. 2018;1(1):29-32.. Investigating the anatomical regions and the different periods, a study33 Larsen LB, Andersson EE, Tranberg R, Ramstrand N. Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting. Int Arch Occup Environ Health. 2018;91(4):425-33. observed frequency values of discomfort in the last three months of 43.2% in the lower back, 38.0% in the hips, legs, knees or feet, 33.7% in the upper back or neck and 25.5% in the shoulders or arms.

Regarding specifically to back pain, another study1010 Douma NB, Cote C, Lacasse A. Quebec Serve and Protect Low Back Pain Study a web-based cross-sectional investigation of prevalence and functional impact among police officers. Spine. 2017;42(19):1485-93. found that 91.5% of the sample had back pain at some time in their life, 67.7% in the last 12 months, and 28.7% had chronic low back pain. Another survey with Canadian police officers1616 Brown JJ, Wells GA, Trottier AJ, Bonneau J, Ferris B. Back pain in a large Canadian police force. Spine. 1998;23(7):821-7. found a frequency of 54.9% of chronic low back pain. Another study reported that 33% of police officers reported problems with back pain1515 Finkelstein MM. Back pain and parenthood. Occup Environ Med. 1995;52(1):51-3..

Study1919 Cardoso ES, Fernandes SGG, Corrêa LCAC, Dantas GAF, Câmara SMA. Low back pain and disability in military police: an epidemiological study. Fisioter Mov. 2018;31:e003101-e003101. identified low back pain frequency values of 58.8% before a work shift and 89.7% after a work shift. Another study1717 Minayo MCS, Assis SG, Oliveira RVC. Impacto das atividades profissionais na saúde física e mental dos policiais civis e militares do Rio de Janeiro (RJ, Brasil). Ciênc Saúde Coletiva. 2011;16(4):2199-209. investigating the frequency of MSS in civil and military police officers in the last year showed symptoms related to pain in the neck, back and spine (civil officers = 42%; military officers = 38.8%), torsion or joint dislocation (civil officers) = 18.3%; military officers = 23.8%) and other muscle or tendon problems (civil officers = 17.0%; military officers = 18.5%). A study88 Gyi DE, Porter JM. Musculoskeletal problems and driving in police officers. Occup Med. 1998;48(3):153-60. comparing different occupations observed a frequency of low back problems for more than eight days in the last 12 months in 29% of traffic cops and 15% in general services officers.

This is the first systematic review that synthesized the results of studies that investigated the frequency of MSS in police officers. Although it is an occupation in all parts of the world, with a significant number of workers, few specific studies on their musculoskeletal health have been found in the literature, despite police officers being constantly exposed to numerous risk factors for the development of work-related musculoskeletal disorders1818 Braga KK, Trombini-Souza F, Skrapec MV, Queiroz DB, Sotero AM, Silva TF. Pain and musculoskeletal discomfort in military police officers of the Ostensive Motorcycle Patrol Group. BrJP. 2018;1(1):29-32., as demonstrated by the study1010 Douma NB, Cote C, Lacasse A. Quebec Serve and Protect Low Back Pain Study a web-based cross-sectional investigation of prevalence and functional impact among police officers. Spine. 2017;42(19):1485-93. in which the presence of chronic low back pain was related to working time.

Eight of the ten studies that comprised the review were conducted in the American continent, five in Brazil. The organization of the police work and the dynamics of violence are factors that not only compromise the country’s economy but also affect the health of citizens, placing the police officer at the center of a combination of forces, demanding constant combat, which is also fought with the precariousness of their work that can endanger their physical and mental health2020 Silva MB, Vieira SB. O processo de trabalho do militar estadual e a saúde mental. Saúde Soc. 2008;17(4):161-70.. Perhaps, due to the importance of the work of these professionals in a country where violence has been increasing, associated with the reduction in headcount in the field, the number of researches about these professionals has shown to be higher in Brazil.

The cross-sectional design was used in all investigative studies of the review. The speed and low cost presented by the cross-sectional design when compared to other epidemiological designs were important factors for its choice. However, an important limitation, which is the possibility of reverse causality, must be remembered. In the specific case of this study, such bias does not affect its results since the investigation focused exclusively on the location and frequency of pain in each anatomical site.

All studies were conducted using questionnaires, used in populational surveys, due to their practicality, lower financial cost, and collection time. However, the reliability of the questionnaire depends on the probability of being in accordance with the gold standard, accuracy.

The NMQ was the most used to collect the site and frequency of MMS among police officers, which facilitates the comparison, even if the versions used are those validated for the countries in which they were applied. This questionnaire is validated in different languages and with different populations. It is used worldwide to evaluate musculoskeletal symptoms, as well as in combination with an ergonomic approach in different occupational groups2121 De Barros ENC, Alexandre NMC. Cross-cultural adaptation of the Nordic musculoskeletal questionnaire. Int Nurs Rev. 2003;50(2):101-8.. One study described that the use of the instrument could be recommended due to its practicality and speed of completion, particularly in epidemiological studies, in which the feasibility of applying it in large samples is often the criterion for choosing the method to be used1414 Pinheiro FA, Tróccoli BT, Carvalho CV. Validity on the Nordic Musculoskeletal Questionnaire as morbidity measurement tool. Rev Saude Publica. 2002;36(3):307-12..

Although 10 articles were included, the heterogeneity of the periods analyzed and the difference in the definitions of the cases prevented the inclusion of a frequency meta-analysis. Collectively analyzing the findings of the selected studies, it was observed that police officers suffer from MSS predominantly in the lumbar, knees, and dorsal regions33 Larsen LB, Andersson EE, Tranberg R, Ramstrand N. Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting. Int Arch Occup Environ Health. 2018;91(4):425-33.,99 Marins EF, Del Vecchio F. Programa Patrulha da Saúde: indicadores de saúde em policiais rodoviários federais. Sci Médica. 2017;27(2):25855.,1010 Douma NB, Cote C, Lacasse A. Quebec Serve and Protect Low Back Pain Study a web-based cross-sectional investigation of prevalence and functional impact among police officers. Spine. 2017;42(19):1485-93.,1212 Trindade APNT, Oliveira LCN, Santos BMO, Oliveira FB, Quemelo PRV. Symptoms of musculoskeletal disorders among police officers. Arq Ciênc Saúde. 2015;22(2):42-5.,1515 Finkelstein MM. Back pain and parenthood. Occup Environ Med. 1995;52(1):51-3.,1717 Minayo MCS, Assis SG, Oliveira RVC. Impacto das atividades profissionais na saúde física e mental dos policiais civis e militares do Rio de Janeiro (RJ, Brasil). Ciênc Saúde Coletiva. 2011;16(4):2199-209.

18 Braga KK, Trombini-Souza F, Skrapec MV, Queiroz DB, Sotero AM, Silva TF. Pain and musculoskeletal discomfort in military police officers of the Ostensive Motorcycle Patrol Group. BrJP. 2018;1(1):29-32.
-1919 Cardoso ES, Fernandes SGG, Corrêa LCAC, Dantas GAF, Câmara SMA. Low back pain and disability in military police: an epidemiological study. Fisioter Mov. 2018;31:e003101-e003101.. Besides, according to studies that investigated the prevalence of MSS in several anatomical regions, it is noteworthy that the neck and shoulders are also among the main sites with symptoms of discomfort mentioned by the police officers33 Larsen LB, Andersson EE, Tranberg R, Ramstrand N. Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting. Int Arch Occup Environ Health. 2018;91(4):425-33.,99 Marins EF, Del Vecchio F. Programa Patrulha da Saúde: indicadores de saúde em policiais rodoviários federais. Sci Médica. 2017;27(2):25855.,1212 Trindade APNT, Oliveira LCN, Santos BMO, Oliveira FB, Quemelo PRV. Symptoms of musculoskeletal disorders among police officers. Arq Ciênc Saúde. 2015;22(2):42-5.,1818 Braga KK, Trombini-Souza F, Skrapec MV, Queiroz DB, Sotero AM, Silva TF. Pain and musculoskeletal discomfort in military police officers of the Ostensive Motorcycle Patrol Group. BrJP. 2018;1(1):29-32..

The high frequency of discomfort symptoms in the lower back, dorsal, knees, neck, and shoulder regions may be associated with several factors related to the police officers’ duties. For instance, the overload due to the inherent activities of the profession that require extreme physical demand during some working periods, such as running, jumping, fighting to handcuff someone who resists the arrest44 Marins E, Crespo P, Rombaldi A, Del Vecchio F. Occupational physical fitness tests for police officers - a narrative review. TSAC Rep. 2018;50:26-34.. Additionally, it is important to mention the overload of the personal protective equipment used by these officers, such as, for example, ballistic vest, lethal and non-lethal weapons, which add a physical overload of approximately 10kg66 Marins EF, Cabistany L, Farias C, Dawes J, Del Vecchio FB. Effects of personal protective equipment on metabolism and performance during an occupational physical ability test for Federal Highway Police Officers. J Strength Cond Res. 2018;1. [Epub ahead of print].,2222 Lewinski WJ, Dysterheft JL, Dicks ND, Pettitt RW. The influence of officer equipment and protection on short sprinting performance. Appl Ergon. 2015;47:65-71.. Also, inadequate postures during several working hours in the sitting position, for those officers in administrative functions or driving cars or motorcycles88 Gyi DE, Porter JM. Musculoskeletal problems and driving in police officers. Occup Med. 1998;48(3):153-60..

It is important to note that musculoskeletal disorders can evolve to even more severe problems, such as absenteeism, and, thus, influence the work activity and job performance, as well as negatively impact the economic and social aspects2323 Taanila H, Suni J, Pihlajamäki H, Mattila VM, Ohrankämmen O, Vuorinen P, et al. Musculoskeletal disorders in physically active conscripts: a one-year follow-up study in the Finnish Defence Forces. BMC Musculoskelet Disord. 2009;10(1):89.. The prevalence of leave of absence due to musculoskeletal disorders was 35.3% for police officers in administrative functions and 23.5% in operational functions1212 Trindade APNT, Oliveira LCN, Santos BMO, Oliveira FB, Quemelo PRV. Symptoms of musculoskeletal disorders among police officers. Arq Ciênc Saúde. 2015;22(2):42-5.. A study showed that the federal highway patrol officers reported absenteeism in the last year due to MSS in the knee and lumbar regions, respectively, in the order of 22 and 14.6%99 Marins EF, Del Vecchio F. Programa Patrulha da Saúde: indicadores de saúde em policiais rodoviários federais. Sci Médica. 2017;27(2):25855..

In order to avoid absenteeism, studies have investigated the effect of physical exercise programs in the prevention or treatment of MSS in the public security professionals2424 Brandt Y, Currier L, Plante TW, Schubert Kabban CM, Tvaryanas AP. A randomized controlled trial of core strengthening exercises in helicopter crewmembers with low back pain. Aerosp Med Hum Perform. 2015;86(10):889-94.,2525 Mayer JM, Quillen WS, Verna JL, Chen R, Lunseth P, Dagenais S. Impact of a supervised worksite exercise program on back and core muscular endurance in firefighters. Am J Health Promot. 2015;29(3):165-72.. Thus, a study2424 Brandt Y, Currier L, Plante TW, Schubert Kabban CM, Tvaryanas AP. A randomized controlled trial of core strengthening exercises in helicopter crewmembers with low back pain. Aerosp Med Hum Perform. 2015;86(10):889-94. that conducted a randomized controlled clinical trial with the helicopter pilots of the US Air Force, in which the intervention group had a 12-week muscle strengthening training of the central body, showed a reduction in the symptoms of low back pain and disability at the end of the study period. Another study2525 Mayer JM, Quillen WS, Verna JL, Chen R, Lunseth P, Dagenais S. Impact of a supervised worksite exercise program on back and core muscular endurance in firefighters. Am J Health Promot. 2015;29(3):165-72. concluded that a supervised exercise program in the workplace was safe and effective in improving the muscle endurance of the lower back and the core in firefighters, helping to prevent future pain in the lower back. Therefore, police institutions should consider investing in physical exercise programs to prevent leave of absence due to these disorders.

Despite the methodological care observed in carrying out the present study, some limitations must be described. First, by presenting police populations from different countries, as well as police institutions and, therefore, work tasks with different characteristics such as police officers in the administrative sector and motorcyclists, and by the definitions of MSS cases, the frequencies found must be analyzed with caution. Also, because most studies adopted self-reported reports of pain and its frequency, and without validated medical tests, the frequency may have been underestimated due to memory bias, especially those related to longer periods.

CONCLUSION

The studies analyzed showed that the most affected areas by symptoms of musculoskeletal discomfort among police officers are the lumbar, dorsal, knee, and neck regions. There is a need for further studies evaluating the risk factors associated with MSS related to the police work, as well as controlled clinical trials with physical exercise programs to reduce the functional disability and intensity of the most prevalent MSS in this population.

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    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg. 2010;8(5):336-41.
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    Pinheiro FA, Tróccoli BT, Carvalho CV. Validity on the Nordic Musculoskeletal Questionnaire as morbidity measurement tool. Rev Saude Publica. 2002;36(3):307-12.
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Publication Dates

  • Publication in this collection
    08 June 2020
  • Date of issue
    Jan-Mar 2020

History

  • Received
    21 Oct 2019
  • Accepted
    14 Mar 2020
Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
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