Firefighters’ Perceived Causes of Musculoskeletal Injuries: Identifying Modifiable Targets for Prevention

Musculoskeletal injuries are a major occupational health concern in the fire service and can affect firefighter health, operational readiness, staffing, and injury-related costs. Although prior research has described the epidemiology of firefighter injuries, less is known about how firefighters perceive the causes of musculoskeletal injuries. This study examined perceived contributors to musculoskeletal injury among 113 career firefighters from two Mid-Atlantic fire departments. Firefighters completed an open-ended survey question asking them to identify the top three reasons firefighters are injured on the job. Responses were analyzed using inductive qualitative content analysis, and theme frequencies were summarized overall and compared across department, sex, age group, and years of service. Nine themes were identified. Insufficient physical fitness was the most frequently reported perceived contributor (75.2% of participants), followed by complacency or protocol non-compliance, fatigue and impaired sleep, improper movement technique, and limited mobility or flexibility. Perceived contributors were generally consistent across demographic and occupational subgroups. These findings suggest that firefighters perceive musculoskeletal injuries as largely related to modifiable individual and behavioral factors. Identifying firefighter-perceived causes of injury may help inform worksite prevention efforts, including fitness development, fatigue mitigation, movement education, mobility training, and reinforcement of safe work practices.