Massage in the Military
By Michael Devitt
Massage in the Military
By Michael Devitt
Wars have been fought since time immemorial. From simple sticks and rocks to guided missiles and uranium-tipped artillery shells, the methods civilized nations have used to annihilate one another have changed dramatically over the centuries. Despite the advances in modern warfare, the types and degrees of injury suffered in combat have remained frighteningly constant. Surprisingly, research suggests a major cause of attrition (a reduction in number or strength) among military personnel in recent wars has resulted not from injuries incurred on the battlefield, but, rather to more typical conditions such as accidents and musculoskeletal complaints.
To determine what types of painful conditions affect soldiers during wartime, researchers in the United States and Germany examined 162 soldiers engaged in Operation Iraqi Freedom who were evacuated to pain treatment centers outside the theater of combat. Results of the study, published in the journal of Anesthesia & Analgesia, show that many of the injuries suffered by military personnel during conflict are indeed similar to those sustained by people in the civilian sector. Even more important, the use of alternative therapies in the treatment of pain among injured soldiers appears to be growing, with massage the most common alternative therapy used for pain relief.
All of the soldiers included in the study had been injured during OIF between March 2003 and June 2004, and were medically evacuated to one of two treatment facilities: Walter Reed Army Medical Center in Bethesda, Md., and Landstuhl Regional Army Medical Center in Landstuhl, Germany. Most of the injured personnel received "consultations for treatment recommendations to be implemented at military treatment facilities located at the patient's home duty station."
Analysis of the complaints showed most soldiers suffered injuries comparable to those that would have been sustained by similarly aged civilians. Not surprisingly, more than half of the pain complaints reported by the soldiers (53 percent) involved the low back. The second most common complaint was "nonradicular extremety pain," which accounted for 23 percent of the presenting complaints.
The most common diagnosis of injury was lumbar herniated disk which, according to the researchers," accounted for almost one-quarter of all pain disorders." Postsurgical pain was the second most common diagnosis, and was experienced by 14 percent of all patients.
More than three dozen treatment modalities were utilized for pain relief; on average, each soldier was treated with 3.5 different therapies. Not surprisingly, drugs were the most popular form of pain relief, beginning with nonsteroidal anti-inflammatory drugs (NSAIDs), which were given to 91 service members. Seventy-nine patients received opiods; 66 patients received some kind of neuropathic pain medication.
Drugs and surgical procedures weren't the only treatment options available, however. According to the study authors, 28 soldiers (17 percent of the study population) were treated with "some type of alternative therapy." The most common alternative therapy offered was therapeutic massage, which was performed on 13 soldiers, and administered more frequently than chiropractic manipulation, acupuncture and glucosamine/chondroitin supplements combined. More than half of these patients treated with alternative therapies (15) were diagnosed with postsurgical pain or lumbar herniated disk before receiving care. In fact, more than one-third of all military personnel diagnosed with postsurgical pain were treated with massage.
The study pointed out the number of injuries suffered during combat was significantly less than the number of non-combat injuries; in fact, only 17 percent of the patients stated they were injured during battle.
Such nonbattle-related injuries, or NBIs, can take a serious toll on overall troop strength in modern warfare. According to the authors, "Among the 21,655 soldiers admitted to army hospitals in Southwest Asia during the Persian Gulf War, acute NBI comprised 25 percent of all hospitalizations, with musculoskeletal conditions ranking second at 13 percent."
|Presenting Pain Complaints in Soldiers Injured in Operation Iraqi Freedom*|
|Pain Presentation (n=162)||Frequency||Percentage|
|Lumbar radicular pain||49||30.2%|
|Axial low back pain||37||22.8%|
|Nonradicular leg pain||24||14.8%|
|Nonradicular arm pain||16||9.9%|
|Cervical radicular pain||6||3.7%|
|Thoracic radicular pain||2||1.2%|
|* The percentage of pain complaints is based on the number of patients (162), not the number of presenting symptoms (185).|
Taking these numbers into account, this would mean that more than 2,800 soldiers were hospitalized due to musculoskeletal complaints during the Gulf War. Given the increasing number of low back and other musculoskeletal injuries that seem to be the norm in modern warfare, and given that these conditions often are seen by massage therapists in the civilian sector, it would appear that massage therapists are just as qualified as other health care providers in helping to ease the pain and suffering of injured military personnel.
- Cohen SP, Griffith S, Larkin TM, Villena F, Larkin R. Presentation, diagnoses, mechanisms of injury, and treatment of soldiers injured in Operation Iraqi Freedom: An epidemiological study conducted at two military pain management centers. Anesth Analg 2005;101:1098-1103.
- Hoeffler DF, Melton LJ. Changes in the distribution of Navy and Marine Corps casualties from World War I through the Vietnam conflict. Mil Med 1981;146:776-9.
- Writer JV, DeFraites RF, Keep LW. Non-battle injury casualties during the Persian Gulf War and other deployments. Am J Prev Med 2000;18:64-70.