Movement Clearing Screens for Military Service Member Musculoskeletal Injury Risk Identification

Context: Pain during movement screens is a risk factor for musculoskeletal injury (MSKI). Movement screens often require specialized or clinical expertise and large amounts of time to administer. Objective: Evaluate if self-reported pain (1) with movement clearing screens is a risk factor for any MSKI, (2) with movement clearing screens is a risk factor for body region-specific MSKIs, and (3) with a greater number of movement clearing screens progressively increases MSKI risk. Design: Retrospective cohort study. Setting: Field-based. Patients or Other Participants: Military service members (n = 4222). Main Outcome Measure(s): Active-duty service members self-reported pain during movement clearing screens (Shoulder Clearing, Spinal Extension, Squat-Jump-Land). Musculoskeletal injury data were abstracted up to 180 days post-screening. A traffic light model grouped service members if they selfreported pain during 0 (Green), 1 (Amber), 2 (Red), or 3 (Black) movement clearing screens. Cox proportional hazards models adjusted for age, gender, body mass index, and prior MSKI determined the relationships between pain during movement clearing screens with any and body region-specific MSKIs. Results: Service members self-reporting pain during the Shoulder Clearing (adjusted hazard ratio and 95% confidence interval [HR_adj (95% CI)] = 1.58 [1.37, 1.82]), Spinal Extension (HR_adj = 1.48 [1.28, 1.87]), or Squat-Jump-Land (HR_adj = 2.04 [1.79, 2.32]) tests were more likely to experience any MSKI than service members reporting no pain. Service members with pain during the Shoulder Clearing (HR_adj = 3.28 [2.57, 4.19]), Spinal Extension (HR_adj = 2.80 [2.26, 3.49]), or SquatJump-Land (HR_adj = 2.07 [1.76, 2.43]) tests were more likely to experience an upper extremity, spine, back, and torso, or lower extremity MSKI, respectively, than service members reporting no pain. The Amber (HR_adj = 1.69 [1.48, 1.93]), Red (HR_adj = 2.07 [1.73, 2.48]), and Black (HR_adj = 2.31 [1.81, 2.95]) cohorts were more likely to experience an MSKI than the Green cohort. Conclusions: Self-report movement clearing screens in combination with a traffic light model provide clinician- and nonclinician-friendly expedient means to identify service members at MSKI risk.