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Volume 17, Issue 3 (2025)
Iran J War Public Health 2025, 17(3): 293-298 |
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Ethics code: IR.SBMU.TEB.POLICE.REC.1404.006
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Received: 2025/06/26 | Accepted: 2025/07/29 | Published: 2025/08/11
Received: 2025/06/26 | Accepted: 2025/07/29 | Published: 2025/08/11
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Nezhad Mohammadi M, Taheri H, Niazipour A. Prevalence of Postural Abnormalities in Iranian Military Managers at the Command of Law Enforcement. Iran J War Public Health 2025; 17 (3) :293-298
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1- Department of Sports Rehabilitation and Health, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
2- Department of Physical Education, Faculty of Physical Education, Amin University of Law Enforcement Sciences, Tehran, Iran
3- Department of Physical Education, Central Tehran Camus (CT.C.), Islamic Azad University, Tehran, Iran
2- Department of Physical Education, Faculty of Physical Education, Amin University of Law Enforcement Sciences, Tehran, Iran
3- Department of Physical Education, Central Tehran Camus (CT.C.), Islamic Azad University, Tehran, Iran
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Introduction
The human body is a complex system of interacting elements, in which dysfunction in one organ or system can lead to dysfunction in other parts [1]. This coherence is crucial when considering posture, which is defined as the natural, non-forced, and habitual position of the body in space [2, 3]. The development and deterioration of posture are individual processes that are strongly influenced by the structural and functional integrity of skeletal and muscular components [4]. Many factors, including genetic, environmental, and lifestyle factors, influence human body posture [5].
Studies have shown that poor posture poses health risks, including reduced cardiovascular capacity, decreased respiratory capacity, bone loss, and back pain [5]. Good posture, according to the Posture Committee of the Academy of Orthopaedic Surgeons, is the relative alignment of the various parts of the body [6]. Postural abnormalities are common among different age groups. Studies have reported the prevalence of forward head posture (85%), lumbar lordosis (80%), and dorsal kyphosis (35%) among college students [7]. Similar findings have been observed in children and adolescents, with a prevalence of forward head posture (53%), elevated shoulders (74%), and winged shoulders (66%) reported [8]. Additionally, among the commanders of a military facility, flexed knee complication (50%), lumbar lordosis (50%), forward head posture (44%), dorsal kyphosis (42%), elevated shoulders (42%), and knee varus (5%) were reported [9]. The results of another study on nurses in a military hospital showed a positive correlation between work experience and forward head posture and hyperkyphosis [10]. Postural disorders are common among senior police officers. One study with a 12-month follow-up reported a prevalence of 72% [11]. These disorders are said to significantly affect work quality [12]. Studies have reported a significant correlation between back problems and reduced job performance among office workers, with musculoskeletal disorders causing more than 10 days of absence from work [13].
On the other hand, the direct effects of musculoskeletal disorders on work productivity have been confirmed in 170 employees [14]. Similar studies have reported a high prevalence of work-related postural disorders in 309 physiotherapists [15]. The work-limiting complications of musculoskeletal disorders significantly affect senior employees and increase the risk of losing their jobs before retirement age [16]. Postural abnormalities are highly disabling and are often associated with back pain and poor quality of life [17]. Therefore, it is expected that appropriate interventions to prevent and improve these abnormalities will be considered among individuals who consistently repeat or maintain incorrect movement or posture patterns. Studies have shown that counseling and awareness education (verbal or written), aimed at improving individuals’ understanding of their musculoskeletal condition, exercise therapy, manipulation and massage techniques, physiotherapy, and drug treatments are effective interventions in this field [18]. Additionally, modifiable risk factors include BMI, physical activity level, lifestyle habits, and occupational demands [19].
Another study evaluating musculoskeletal disorders in Nedja submarine personnel showed that there is a significant relationship between years of service and kyphosis and forward head posture. Therefore, it is recommended to provide corrective interventions and exercises for senior personnel [20]. Another epidemiological study involving 420 people aged 15 to 60 years stated that there were significant differences in age-related postural disorders [21]. Although various studies have examined the prevalence of musculoskeletal disorders in different populations, a distinction must be made between musculoskeletal disorders and postural disorders. In particular, the incidence of musculoskeletal disorders has been examined in various studies using self-report questionnaires, while postural disorders are assessed visually. Musculoskeletal disorders can have painful symptoms, but postural disorders are generally less painful; when they are painful, the pain can be very severe, which delays the treatment process.
Studies have shown that musculoskeletal disorders are the result of postural abnormalities [22], and these disorders have been identified as the main causes of pain, disability, absenteeism, reduced productivity, and significant financial costs for employees [18]. However, no study has been conducted to examine the physical condition of managers in their third decade of service at the Command of Law Enforcement of the Islamic Republic of Iran. Thus, the main aim of the present study was to investigate the prevalence of postural abnormalities in military managers in their third decade of service at the Command of Law Enforcement of the Islamic Republic of Iran.
Instruments and Methods
The present single-group cross-sectional descriptive study was conducted on military managers in their third decade of service at the Command of Law Enforcement of the Islamic Republic of Iran in Tehran during the summer of 2025.
The sample size was determined to be 215 based on the standard formula, with a confidence level of 95%, Z=1.96, p=0.28, and permissible absolute precision (e)=0.06 [23, 24]. Ultimately, the information from 210 individuals was used for statistical analysis.
First, the study objectives were explained to the participants, and they were assured that their information would remain confidential. It was also clarified that participation in the study would be voluntary, and the individuals signed a consent form to participate. The research participants were in their third decade of service.
The inclusion criteria for this study included being male, being in the third decade of service, and having no orthopedic pain or injury. The exclusion criteria included failure to participate in the pre-test or post-test, absence from three or more training sessions, occurrence of any orthopedic injury, and unwillingness to continue in the study.
The New York Posture Test, which was developed by the New York State Department of Education, was used. This test has shown moderate to good reliability and validity [25]. It assesses 13 different body positions, 11 of which are related to the spine. During the test, the subject stands behind a checkerboard, and the examiner records his or her observations on a score sheet. For each position, three scores are recorded on the score sheet, with the left image representing a normal position and a score of 5, the middle image representing mild deformity with a score of 3, and the right image representing severe deformity with a score of 1.
Additionally, since the New York Posture Test cannot examine the knee joint, this joint was evaluated visually while in a standing position, which was conventionally scored as follows: For knee flexion position: 1) knee flexed, 2) normal knee, 3) knee hyperextension; and for knee deviation position: 1) cross knee (Genu Valgum), 2) normal knee, 3) varus knee (Genu Varum).
All statistical analyses were performed using SPSS 26 software. The significance level was set at 95%, with an alpha smaller than or equal to 0.05.
Findings
The sample included 210 managers in their third decade of service at the Command of Law Enforcement of the Islamic Republic of Iran. The most common abnormality in lower body in terms of severity was flexed knee complication (44%), while the most common abnormality in terms of severity in the upper body was forward shoulders (43%; Figure 1).
Figure 1. Prevalence of postural abnormalities based on severity
Discussion
This study was conducted to investigate the prevalence of postural abnormalities in managers in their third decade of service in FARAJA. These abnormalities were prevalent among managers in their third decade of service at the Command of Law Enforcement of the Islamic Republic of Iran. The most common abnormality in the lower body was flexed knee complication (44%), and the most common abnormality in the upper body was forward shoulders (43%).
Recent studies have investigated the prevalence of musculoskeletal disorders in military personnel [26]. These studies have demonstrated, using questionnaires, that back problems, knee pain, and neck pain are common among military personnel [26, 27]. Pav et al. also investigated the prevalence of spinal cord injuries in military personnel, finding them to be common among these individuals [27]. Studies have reported a prevalence of neck pain in military communities of over 70%, particularly after the end of service. Tang cite advanced age, poor joint mobility, long flight time, work environment, use of helmets, and night vision devices as risk factors for the high prevalence of musculoskeletal disorders [28].
Visual assessment of the prevalence of musculoskeletal disorders has received less attention in current society. However, recent studies have found that military paratroopers had a 21.8% incidence of lateral curvature of the spine and a 10.7% incidence of scoliosis [29]. Another study examined flatfoot deformity in military personnel, reporting it to be common among them [2]. Piri et al. studied ship personnel, declaring that postural abnormalities and musculoskeletal disorders are common, with lumbar hyperlordosis and lumbar disorders being the most prevalent [22]. Therefore, our results are consistent with those of Muhammad Khan et al. [2], Montagnon et al. [29], Tang [28], Raei et al. [26], Pav et al. [27], and Piri et al. [22]. No inconsistent studies were found in this regard.
Senior military personnel are exposed to various stresses while performing diverse missions. The inability to participate in regular exercise and physical activity due to busy work schedules, long working hours, insufficient time for rest, participation in numerous meetings, maintenance of fixed postures for extended periods, and the use of non-standard desk and chair systems have led to the development of postural abnormalities in these individuals. The most common postural abnormality in the upper body was forward shoulder posture, while flexed knee complication was the most common abnormality in the lower body. Considering the long hours of sitting and maintaining an incorrect posture (shoulder protraction) over time, the weight of the hands against the force of gravity causes fatigue in the muscles supporting the shoulder and rotator cuff [30]. This tensile force leads to tension in the muscle fibers and results in water leaking out of them, leading to a state of creep [31, 32]. On the other hand, inactivity and lack of stretching exercises or massages contribute to a cycle of chronic pain and inflammation [33]. Maintaining this state for an extended period disrupts the relationship between muscle length and tension, resulting in abnormalities in these individuals [30]. Additionally, sitting in a chair during numerous meetings or in the workplace leads to prolonged knee flexion in these individuals. Maintaining this position for a long time can cause the shortening of muscles, such as the hamstring through muscle length regulation mechanisms, leading to knee flexion deformity [34]. Inactivity and lack of stretching exercises and massages in these individuals exacerbate the condition [33]. The hamstring muscle is one of the key muscles involved in walking and performing daily activities [35].
Due to its nature, which consists of three muscles and affects both the hip joint, the pelvis, and the knee joint, it can cause problems for the individual [36]. Additionally, this muscle connects the upper body muscle subsystems on opposite sides with the lower limb through the sacrotuberous ligament [36]. The bent knee deformity and the forward shoulder deformity may potentially affect each other.
On the other hand, the identified pattern can be directly related to the nature of desk activities (long-term sitting at a desk). Prolonged sitting without adequate breaks leads to the shortening and tightness of the hip flexor muscles and the weakening of the hip extensor muscles. This muscle imbalance manifests itself in the form of a bent knee deformity [37]. This position not only negatively affects the alignment of the pelvis and lumbar spine but can also lead to increased pressure on the patellofemoral joint and chronic knee pain in the long term. The high prevalence of forward shoulder deformity can also be attributed to ergonomic factors in the workplace. Frequent and prolonged activities involving computers, mobile phones, and reading documents, often accompanied by a forward head position and internal rotation of the shoulders, cause the shortening of the pectoralis and upper trapezius muscles, as well as weakness in the mid-back muscles and external rotators of the shoulder [38]. A study by Meng et al. on office workers similarly reports a direct and significant association between desk hours and the severity of forward shoulder deformity [39].
These findings are consistent with several studies in similar populations; Jafari-Nodoushan et al. demonstrate that forward shoulder deformity and forward head deformity are the most common postural disorders among on office workers, further highlighting the role of a sedentary work style [40]. However, the high percentage of flexed knee complication in our study (44%) is striking compared to some studies on more general populations. This difference may be attributed to the older age of the sample (third decade of service) and the cumulative effects of years of sedentary staff activity. The identification of this specific pattern of abnormalities is of clinical and organizational importance. These abnormalities are often precursors to musculoskeletal disorders, such as shoulder impingement syndrome, mechanical low back pain, and patellofemoral pain syndrome. Reduced efficiency and increased absenteeism are possible consequences of these problems. Therefore, the results highlight the need to pay serious attention to the categories of “musculoskeletal health” and “workplace ergonomics”, even at the management and staff levels of the police force.
Conclusion
Postural abnormalities are common in the workplace of military managers in their third decade of service for various reasons.
Acknowledgements: The authors would like to express their gratitude to all those who participated in this study and facilitated its implementation process. This article is taken from the research project on exemption from military service (National Elite Foundation) by Mr. Mohammad Javad Nejad Mohammadi.
Ethical Permissions: The code of ethics for this study was reviewed and approved by the Ethics Committee for Biomedical Research of the FARAJ Deputy of Health, Relief, and Treatment before the study was conducted (IR.SBMU.TEB.POLICE.REC.1404.006).
Conflicts of Interests: The authors declared no conflicts of interests.
Authors' Contribution: Nezhad Mohammadi MJ (First Author), Introduction Writer/Methodologist/Main Researcher/Discussion Writer/Statistical Analyst (40%); Taheri H (Second Author), Introduction Writer/Methodologist/Assistant Researcher/Discussion Writer/Statistical Analyst (35%); Niazipour A (Third Author), Assistant Researcher/Statistical Analyst (25%)
Funding/Support: The financial resources for this study were provided by the authors and from personal sources.
The human body is a complex system of interacting elements, in which dysfunction in one organ or system can lead to dysfunction in other parts [1]. This coherence is crucial when considering posture, which is defined as the natural, non-forced, and habitual position of the body in space [2, 3]. The development and deterioration of posture are individual processes that are strongly influenced by the structural and functional integrity of skeletal and muscular components [4]. Many factors, including genetic, environmental, and lifestyle factors, influence human body posture [5].
Studies have shown that poor posture poses health risks, including reduced cardiovascular capacity, decreased respiratory capacity, bone loss, and back pain [5]. Good posture, according to the Posture Committee of the Academy of Orthopaedic Surgeons, is the relative alignment of the various parts of the body [6]. Postural abnormalities are common among different age groups. Studies have reported the prevalence of forward head posture (85%), lumbar lordosis (80%), and dorsal kyphosis (35%) among college students [7]. Similar findings have been observed in children and adolescents, with a prevalence of forward head posture (53%), elevated shoulders (74%), and winged shoulders (66%) reported [8]. Additionally, among the commanders of a military facility, flexed knee complication (50%), lumbar lordosis (50%), forward head posture (44%), dorsal kyphosis (42%), elevated shoulders (42%), and knee varus (5%) were reported [9]. The results of another study on nurses in a military hospital showed a positive correlation between work experience and forward head posture and hyperkyphosis [10]. Postural disorders are common among senior police officers. One study with a 12-month follow-up reported a prevalence of 72% [11]. These disorders are said to significantly affect work quality [12]. Studies have reported a significant correlation between back problems and reduced job performance among office workers, with musculoskeletal disorders causing more than 10 days of absence from work [13].
On the other hand, the direct effects of musculoskeletal disorders on work productivity have been confirmed in 170 employees [14]. Similar studies have reported a high prevalence of work-related postural disorders in 309 physiotherapists [15]. The work-limiting complications of musculoskeletal disorders significantly affect senior employees and increase the risk of losing their jobs before retirement age [16]. Postural abnormalities are highly disabling and are often associated with back pain and poor quality of life [17]. Therefore, it is expected that appropriate interventions to prevent and improve these abnormalities will be considered among individuals who consistently repeat or maintain incorrect movement or posture patterns. Studies have shown that counseling and awareness education (verbal or written), aimed at improving individuals’ understanding of their musculoskeletal condition, exercise therapy, manipulation and massage techniques, physiotherapy, and drug treatments are effective interventions in this field [18]. Additionally, modifiable risk factors include BMI, physical activity level, lifestyle habits, and occupational demands [19].
Another study evaluating musculoskeletal disorders in Nedja submarine personnel showed that there is a significant relationship between years of service and kyphosis and forward head posture. Therefore, it is recommended to provide corrective interventions and exercises for senior personnel [20]. Another epidemiological study involving 420 people aged 15 to 60 years stated that there were significant differences in age-related postural disorders [21]. Although various studies have examined the prevalence of musculoskeletal disorders in different populations, a distinction must be made between musculoskeletal disorders and postural disorders. In particular, the incidence of musculoskeletal disorders has been examined in various studies using self-report questionnaires, while postural disorders are assessed visually. Musculoskeletal disorders can have painful symptoms, but postural disorders are generally less painful; when they are painful, the pain can be very severe, which delays the treatment process.
Studies have shown that musculoskeletal disorders are the result of postural abnormalities [22], and these disorders have been identified as the main causes of pain, disability, absenteeism, reduced productivity, and significant financial costs for employees [18]. However, no study has been conducted to examine the physical condition of managers in their third decade of service at the Command of Law Enforcement of the Islamic Republic of Iran. Thus, the main aim of the present study was to investigate the prevalence of postural abnormalities in military managers in their third decade of service at the Command of Law Enforcement of the Islamic Republic of Iran.
Instruments and Methods
The present single-group cross-sectional descriptive study was conducted on military managers in their third decade of service at the Command of Law Enforcement of the Islamic Republic of Iran in Tehran during the summer of 2025.
The sample size was determined to be 215 based on the standard formula, with a confidence level of 95%, Z=1.96, p=0.28, and permissible absolute precision (e)=0.06 [23, 24]. Ultimately, the information from 210 individuals was used for statistical analysis.
First, the study objectives were explained to the participants, and they were assured that their information would remain confidential. It was also clarified that participation in the study would be voluntary, and the individuals signed a consent form to participate. The research participants were in their third decade of service.
The inclusion criteria for this study included being male, being in the third decade of service, and having no orthopedic pain or injury. The exclusion criteria included failure to participate in the pre-test or post-test, absence from three or more training sessions, occurrence of any orthopedic injury, and unwillingness to continue in the study.
The New York Posture Test, which was developed by the New York State Department of Education, was used. This test has shown moderate to good reliability and validity [25]. It assesses 13 different body positions, 11 of which are related to the spine. During the test, the subject stands behind a checkerboard, and the examiner records his or her observations on a score sheet. For each position, three scores are recorded on the score sheet, with the left image representing a normal position and a score of 5, the middle image representing mild deformity with a score of 3, and the right image representing severe deformity with a score of 1.
Additionally, since the New York Posture Test cannot examine the knee joint, this joint was evaluated visually while in a standing position, which was conventionally scored as follows: For knee flexion position: 1) knee flexed, 2) normal knee, 3) knee hyperextension; and for knee deviation position: 1) cross knee (Genu Valgum), 2) normal knee, 3) varus knee (Genu Varum).
All statistical analyses were performed using SPSS 26 software. The significance level was set at 95%, with an alpha smaller than or equal to 0.05.
Findings
The sample included 210 managers in their third decade of service at the Command of Law Enforcement of the Islamic Republic of Iran. The most common abnormality in lower body in terms of severity was flexed knee complication (44%), while the most common abnormality in terms of severity in the upper body was forward shoulders (43%; Figure 1).
Figure 1. Prevalence of postural abnormalities based on severity
Discussion
This study was conducted to investigate the prevalence of postural abnormalities in managers in their third decade of service in FARAJA. These abnormalities were prevalent among managers in their third decade of service at the Command of Law Enforcement of the Islamic Republic of Iran. The most common abnormality in the lower body was flexed knee complication (44%), and the most common abnormality in the upper body was forward shoulders (43%).
Recent studies have investigated the prevalence of musculoskeletal disorders in military personnel [26]. These studies have demonstrated, using questionnaires, that back problems, knee pain, and neck pain are common among military personnel [26, 27]. Pav et al. also investigated the prevalence of spinal cord injuries in military personnel, finding them to be common among these individuals [27]. Studies have reported a prevalence of neck pain in military communities of over 70%, particularly after the end of service. Tang cite advanced age, poor joint mobility, long flight time, work environment, use of helmets, and night vision devices as risk factors for the high prevalence of musculoskeletal disorders [28].
Visual assessment of the prevalence of musculoskeletal disorders has received less attention in current society. However, recent studies have found that military paratroopers had a 21.8% incidence of lateral curvature of the spine and a 10.7% incidence of scoliosis [29]. Another study examined flatfoot deformity in military personnel, reporting it to be common among them [2]. Piri et al. studied ship personnel, declaring that postural abnormalities and musculoskeletal disorders are common, with lumbar hyperlordosis and lumbar disorders being the most prevalent [22]. Therefore, our results are consistent with those of Muhammad Khan et al. [2], Montagnon et al. [29], Tang [28], Raei et al. [26], Pav et al. [27], and Piri et al. [22]. No inconsistent studies were found in this regard.
Senior military personnel are exposed to various stresses while performing diverse missions. The inability to participate in regular exercise and physical activity due to busy work schedules, long working hours, insufficient time for rest, participation in numerous meetings, maintenance of fixed postures for extended periods, and the use of non-standard desk and chair systems have led to the development of postural abnormalities in these individuals. The most common postural abnormality in the upper body was forward shoulder posture, while flexed knee complication was the most common abnormality in the lower body. Considering the long hours of sitting and maintaining an incorrect posture (shoulder protraction) over time, the weight of the hands against the force of gravity causes fatigue in the muscles supporting the shoulder and rotator cuff [30]. This tensile force leads to tension in the muscle fibers and results in water leaking out of them, leading to a state of creep [31, 32]. On the other hand, inactivity and lack of stretching exercises or massages contribute to a cycle of chronic pain and inflammation [33]. Maintaining this state for an extended period disrupts the relationship between muscle length and tension, resulting in abnormalities in these individuals [30]. Additionally, sitting in a chair during numerous meetings or in the workplace leads to prolonged knee flexion in these individuals. Maintaining this position for a long time can cause the shortening of muscles, such as the hamstring through muscle length regulation mechanisms, leading to knee flexion deformity [34]. Inactivity and lack of stretching exercises and massages in these individuals exacerbate the condition [33]. The hamstring muscle is one of the key muscles involved in walking and performing daily activities [35].
Due to its nature, which consists of three muscles and affects both the hip joint, the pelvis, and the knee joint, it can cause problems for the individual [36]. Additionally, this muscle connects the upper body muscle subsystems on opposite sides with the lower limb through the sacrotuberous ligament [36]. The bent knee deformity and the forward shoulder deformity may potentially affect each other.
On the other hand, the identified pattern can be directly related to the nature of desk activities (long-term sitting at a desk). Prolonged sitting without adequate breaks leads to the shortening and tightness of the hip flexor muscles and the weakening of the hip extensor muscles. This muscle imbalance manifests itself in the form of a bent knee deformity [37]. This position not only negatively affects the alignment of the pelvis and lumbar spine but can also lead to increased pressure on the patellofemoral joint and chronic knee pain in the long term. The high prevalence of forward shoulder deformity can also be attributed to ergonomic factors in the workplace. Frequent and prolonged activities involving computers, mobile phones, and reading documents, often accompanied by a forward head position and internal rotation of the shoulders, cause the shortening of the pectoralis and upper trapezius muscles, as well as weakness in the mid-back muscles and external rotators of the shoulder [38]. A study by Meng et al. on office workers similarly reports a direct and significant association between desk hours and the severity of forward shoulder deformity [39].
These findings are consistent with several studies in similar populations; Jafari-Nodoushan et al. demonstrate that forward shoulder deformity and forward head deformity are the most common postural disorders among on office workers, further highlighting the role of a sedentary work style [40]. However, the high percentage of flexed knee complication in our study (44%) is striking compared to some studies on more general populations. This difference may be attributed to the older age of the sample (third decade of service) and the cumulative effects of years of sedentary staff activity. The identification of this specific pattern of abnormalities is of clinical and organizational importance. These abnormalities are often precursors to musculoskeletal disorders, such as shoulder impingement syndrome, mechanical low back pain, and patellofemoral pain syndrome. Reduced efficiency and increased absenteeism are possible consequences of these problems. Therefore, the results highlight the need to pay serious attention to the categories of “musculoskeletal health” and “workplace ergonomics”, even at the management and staff levels of the police force.
Conclusion
Postural abnormalities are common in the workplace of military managers in their third decade of service for various reasons.
Acknowledgements: The authors would like to express their gratitude to all those who participated in this study and facilitated its implementation process. This article is taken from the research project on exemption from military service (National Elite Foundation) by Mr. Mohammad Javad Nejad Mohammadi.
Ethical Permissions: The code of ethics for this study was reviewed and approved by the Ethics Committee for Biomedical Research of the FARAJ Deputy of Health, Relief, and Treatment before the study was conducted (IR.SBMU.TEB.POLICE.REC.1404.006).
Conflicts of Interests: The authors declared no conflicts of interests.
Authors' Contribution: Nezhad Mohammadi MJ (First Author), Introduction Writer/Methodologist/Main Researcher/Discussion Writer/Statistical Analyst (40%); Taheri H (Second Author), Introduction Writer/Methodologist/Assistant Researcher/Discussion Writer/Statistical Analyst (35%); Niazipour A (Third Author), Assistant Researcher/Statistical Analyst (25%)
Funding/Support: The financial resources for this study were provided by the authors and from personal sources.
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