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Thursday, November 29, 2007

Losing Inches: Heavy Gear Compressing Veterans' Spinal Disks

While not PTSD-related, quite interesting information on how combat is changing the physical body of troops. From the St. Paul-Minneapolis Pioneer Press:

After 16 months in Iraq, Minnesota National Guard members who came home this summer expected aches and pains. They did not expect to shrink.

Brian Hesse figures he lost an inch or so - a consequence of the heavy body armor and the gear he toted on convoy and security missions. The armor alone weighed more than 30 pounds. And then there was the 4-pound helmet, the 7.5-pound loaded M-4 rifle, the 10 pounds of extra ammunition and other necessities.

"I shrunk," the 25-year-old from Minnetonka said, "and got a bit wider. It's like my body said, 'OK, I need a wider base.' "

It's no myth. Some returnees and their doctors agree they did get shorter - if at least temporarily. The 60 to 90 pounds of gear around their torsos, shoulders and heads likely caused their spinal discs to compress, making the soldiers shorter and causing back pain.

Guard officials expected the 2,600 members of the state's returning 1st Brigade Combat Team to suffer from a host of physical ailments. While less dramatic than gunshot wounds or brain injuries caused by blast exposures, musculoskeletal injuries are easily the most common health problems for Iraq returnees.

"A good chunk of what we're seeing is actually overuse that we would really anticipate would get better in a short period of time," said Dr. Michael Koopmeiners, who directs community clinics for the Minneapolis VA Medical Center.

The key question , now that returnees have been home for three months, is how many are in fact developing chronic problems and how many are getting better.

In educational interest, article(s) quoted from extensively.


About 1,300 Minnesota National Guard members returned home from Iraq and Afghanistan before the return of the 1st Brigade Combat Team. Of those, 716 were referred for health care services after completing their reassessments, according to the Minnesota National Guard. The majority reported "nagging injuries" to their joints and muscles, the Guard reported.

Nationwide, more than 96,000 National Guard members and reservists have completed reassessments since October 2006, and 49 percent reported health problems unrelated to combat wounds, according to the U.S. Defense Department.

Low back problems are most common, Koopmeiners said, followed by neck, shoulder, knee and ankle injuries. The risk appears even greater for the 1st Brigade Combat Team, whose 16-month deployment in Iraq is the longest of any U.S. military unit. Research has shown that deployment length increases injury risk.

"The longer they're deployed," Koopmeiners said, "the more likely that they have injuries, especially to the musculoskeletal system." ...

The high number of returnees with joint and muscle pain poses two questions for military leaders.

First, there's the age-old question of combat load: Body armor and weapons may be getting lighter, but the net weight isn't changing much. Many soldiers are now wearing extra armor plates to protect their sides, throats and groins.

A 2004 study of an Army unit in Afghanistan estimated that riflemen were carrying equipment that equaled 36 percent of their body weight during combat and 55 percent of their body weight during patrols. The recommended load is no more than 30 percent of body weight.

Some soldiers using mortars or heavy weapons carried nearly 100 percent of their body weight at times, the study found.

"Can you imagine walking around carrying yourself, all the time, day in and day out?" asked Charles Dean, a retired Army colonel who led the study. "It would definitely have an impact."

Second, there's the question of lasting injury: Will muscle and joint pains heal with time? Or will they become chronic? Guard officials are hoping the health screenings and reintegration events persuade returnees to confront physical problems before they are aggravated. Even if pain goes away, it could resurface in the future.

"That's one of those things we're going to notice again five or 10 years down the line," said Maj. Gen. Larry Shellito, adjutant general to the Minnesota Guard. "That's why I would like for us to deal with it up front."

Wartime operations put soldiers in awkward positions, said Michelle Peterson, a physical therapist at the Minneapolis VA. Patients include machine-gunners who sat in uncomfortable turrets atop vehicles and infantrymen who pointed their weapons in ready positions for hours.

VA therapists also speculate that Iraq's sandy, loose terrain contributed to back problems because it was poor footing for the weighed-down soldiers.

Peterson has treated many soldiers who ignored their pain and injuries while in Iraq. She understands their thinking - not wanting to be held back from duty while their buddies and units are fighting - but said the choice can have a toll.

"When you're active duty, you might view pain as a weakness," she said. "So you don't admit to having pain, and by doing that, you further injure yourself."

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