Active duty service members' experiences navigating musculoskeletal health throughout their military careers: a qualitative interview study

Introduction Musculoskeletal injury (MSK-I) and pain (MSK-P) pose a substantial burden to Active Duty Service Members (ADSM) and are a leading cause of medical encounters and lost duty days. Evidence indicates that barriers exist to musculoskeletal (MSK) health care-seeking, which can result in exacerbation of MSK conditions (e.g., MSK-I, MSK-P), chronic pain, and greater healthcare costs. The objective of this qualitative study was to interview ADSM about their experiences navigating MSK health during their military careers to inform the development of tools and resources that better equip ADSM and military medical providers to prevent and manage MSK conditions. Methods Semi-structured individual interviews were conducted with male and female ADSM ( n = 60). Interviews assessed ADSMs' experiences with MSK-I/P during military service, the use of military resources to maintain MSK health, and barriers and facilitators to seeking care for MSK-I/P. Interviews lasted 20–60 min, were conducted in-person or over video conference, and were audio recorded and transcribed. Transcript data were analyzed using applied thematic analysis (ATA). Results Participants included male ( n = 31) and female ( n = 29) ADSM (age=38 ± 10 years, 16 ± 9 years of service) representing all military branches except for the Space Force. The ATA resulted in seven themes: military impact, care-seeking, Military Health System (MHS), prevention and optimization, leadership, mental health, and gender. Discussion ADSM revealed that while the military culture promotes physical fitness, it also encourages a “push through pain” mentality, leading to delayed care due to fears of career repercussions or being seen as weak or a burden to one's unit. Additionally, ADSM pointed to certain challenges within the MHS, including long wait times, inconsistent access to specialized care, and a perception that some providers dismiss ADSM pain. Results revealed additional areas of investigation and intervention, such as a bidirectional link between MSK-P and mental health, and identified gender-specific challenges, such as a lack of resources for women's health issues like postpartum MSK conditions. Overall, the findings identified opportunities for systemic and cultural changes to destigmatize MSK issues, prioritize prevention and proactive care-seeking, and improve healthcare access for MSK conditions during military service.