Evaluation of Low Back Pain and 

Duty Equipment Wear 

Configurations in Police Officers

HHE Report No. 2017-0049-3367

January 2020
Authors: Jessica G. Ramsey, MS, CPE

Judith Eisenberg, MD, MS

Desktop Publisher: Jennifer Tyrawski

Editor: Cheryl Hamilton

Logistics: Donnie Booher, Kevin Moore

Medical Field Assistance: Marita Asmat

Keywords: North American Industry Classification System (NAICS) 922120 (Police Protection), 

Colorado, Low Back Pain, Police, External Vests, Duty Belts, Ergonomics 

Disclaimer

The Health Hazard Evaluation Program investigates possible health hazards in the workplace under

the authority of the Occupational Safety and Health Act of 1970 [29 USC 669a(6)]. The Health

Hazard Evaluation Program also provides, upon request, technical assistance to federal, state, and

local agencies to investigate occupational health hazards and to prevent occupational disease or

injury. Regulations guiding the Program can be found in Title 42, Code of Federal Regulations,

Part 85; Requests for Health Hazard Evaluations [42 CFR Part 85]. 

Availability of Report

Copies of this report have been sent to the employer and employees, at the department. The state

and local health departments and the Occupational Safety and Health Administration Regional

Office have also received a copy. This report is not copyrighted and may be freely reproduced.

Recommended Citation 

NIOSH [2020]. Evaluation of low back pain and duty equipment wear configurations in police 

officers. By Ramsey JG, Eisenberg J. Cincinnati, OH: U.S. Department of Health and Human 

Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety 

and Health, Health Hazard Evaluation Report 2017-0049-3367, 

https://www.cdc.gov/niosh/hhe/reports/pdfs/2017-0049-3367.pdf. 
Table of Contents

Main Report

Introduction....................................................................................................................................................... 1

Our Approach ................................................................................................................................................... 1

Our Key Findings.............................................................................................................................................. 2

Our Recommendations .................................................................................................................................... 3

Supporting Technical Information 

Section A: Workplace Information............................................................................................................ A-1

History of Issue at Workplace................................................................................................................ A-1

Workplace.................................................................................................................................................. A-1

Section B: Methods, Results, and Discussion .......................................................................................... B-1

Methods: Policy Review and Observations.......................................................................................... B-1

Results: Policy Review and Observations............................................................................................. B-1

Methods: Confidential Medical Interviews........................................................................................... B-2

Results: Confidential Medical Interviews.............................................................................................. B-3

Methods: Injury Record Review............................................................................................................. B-4

Results: Injury Record Review ............................................................................................................... B-4

Methods: Survey of Trial Group............................................................................................................ B-4

Results: Survey of the Trial Group ........................................................................................................ B-4

Discussion ................................................................................................................................................. B-5

Conclusions............................................................................................................................................... B-8

Section C: Tables.......................................................................................................................................... C-1

Section D: References.................................................................................................................................. D-1
This page left intentionally blank
1

Introduction

Request

Management representatives at a police department requested a health hazard evaluation concerning

low back pain and back injuries among police officers. The management asked us to evaluate if the 

pain and injuries could be related to officers wearing their duty equipment around their waist on 

leather belts. 

Workplace

At the time of our evaluation, the department consisted of 77 sworn officers (which includes patrol 

officers) and 7 unsworn community service officers. 

All patrol officers and community service officers were required to wear a full uniform while on duty. 

The department’s uniform standards required patrol officers to wear duty equipment that included a 

firearm, two additional ammunition clips for the firearm, a pair of handcuffs, flashlight, and radio. 

This equipment was usually worn on a leather duty belt. Patrol officers worked 10-hour shifts and

community service officers worked 12-hour shifts, both working 4 consecutive days on and then having 

3 consecutive days off. 

Typical body armor for patrol and community service officers was an internal ballistic vest. This 

garment was worn under their uniform shirt and consisted of body armor panels in the front and back. 

Alternatively, officers could wear an external vest, which contained the same body armor panels as the 

internal vest but was worn over the uniform shirt. Patrol officers wearing the external vest were still 

required to carry their holstered firearm on the duty belt. Initially, the external vest was only available to 

officers participating in the department’s trial program. After the initial external vest trial program 

ended, officers were required to obtain a medical necessity note for the department to purchase this 

item for them. Medical necessity waivers were already required for officers to be allowed to wear 

external suspenders to hold up the leather belt.

After 4 years on the patrol team, officers could apply for a transfer to another team; uniform and 

equipment requirements for officers on other teams varied. 

To learn more about the workplace, go to Section A in the Supporting Technical Information

Our Approach

We visited the police department on April 18–20, 2017. During the visit, we conducted these activities: 

• Observed work processes, practices, and workplace conditions. 

• Held confidential medical interviews with 52 of 54 officers assigned to work during our visit. 

• Documented different belt and vest options used by officers. 
2

• Reviewed uniform, equipment, and weapons policies. 

• Observed the annual physical ability testing. 

To learn more about our methods, go to Section B in the Supporting Technical Information

Our Key Findings

Many officers reported having low back pain 

• Nearly half (48%) of the 52 interviewed officers reported having low back pain in the preceding 

3 months, but few were evaluated by a healthcare provider to determine if their symptoms were 

work-related.

• When asked to describe the severity of pain the last time they had low back pain, 60% reported 

a little, 8% reported a lot, and 32% reported between a little and a lot of low back pain. 

• None of the interviewed officers had missed work or required a change in duty because of low

back pain. 

• Of the 21 officers who participated in the department’s external vest trial program, only 5 were 

still wearing the trial vest during our site visit. Of these five, two specifically cited decreased low 

back pain as the reason for continued use of their external vest. 

Communication gaps existed between officers and management in several aspects 

of department operations including uniform policies 

• No department policy document existed that specified what equipment was required versus

what was optional for wear by officers on each team (i.e., patrol, investigations, etc.). As a result,

some officers carried the weight of additional equipment they thought was required but was not.

• New officers did not receive any formal guidance on how they could wear or configure the 

required duty equipment.

• Officers were unaware they could suggest external duty vests or alternate clothing items to 

management.

• Officers were unclear on when management required a medical necessity waiver from their 

healthcare provider to be eligible for obtaining carriage assist devices like suspenders, nylon 

belts, and external duty vests.

Back injury prevention training may need to be modified and periodically reinforced 

• Low back injury prevention training was provided by the Colorado Intergovernmental Risk 

Sharing Agency (CIRSA), which provides workers’ compensation coverage for Colorado State 

employees. The course provided general back injury prevention guidelines, such as office
3

workstation setup and lifting recommendations, but none specific to law enforcement duties or 

use of duty belts.

• Many officers could not recall if they had taken the CIRSA back injury prevention course, 

stating that because they are required to take so many online training courses in different 

subjects, they could not keep track of them all. 

To learn more about our results, go to Section B in the Supporting Technical Information

Our Recommendations

The Occupational Safety and Health Act requires employers to provide a safe workplace.

Benefits of Improving Workplace Health and Safety:

 Improved employee health and well-being  Enhanced image and reputation 

 Better workplace morale  Superior products, processes, and services

 Easier employee recruiting and retention  May increase overall cost savings

The recommendations below are based on the findings of our evaluation. For each recommendation, 

we list a series of actions you can take to address the issue at your workplace. 

We encourage the company to use a health and safety committee to discuss our 

recommendations and develop an action plan. Both employee representatives and 

management representatives should be included on the committee. Helpful guidance can be 

found in “Recommended Practices for Safety and Health Programs” at

https://www.osha.gov/shpguidelines/index.html. 

Recommendation 1: Improve communication between officers and management 

regarding equipment and health and safety concerns

Why? Because of the lack of clear departmental policy on required and (approved) optional 

equipment, many officers may be carrying unnecessary weight. New officers received verbal guidance 

in lieu of a written policy. Many officers were uncertain about the need for a medical necessity waiver, 

configuration options, and how to join future external vest trials. 

How? At your workplace, we recommend these specific actions:

Implement a joint officer/management health and safety committee. 

• Include new officers as well as those with seniority and those in management positions.

• Discuss uniform and duty requirements, options, and changes. 
4

• Conduct regular meetings to develop a more open and streamlined dialogue between 

officers at all levels. 

Create clear departmental uniform wear policies and procedures. 

• Make a uniform wear policy that includes a list of required and optional equipment for 

each team. 

• Create a resource document for new officers regarding duty equipment wear 

configurations based on input from current officers. This may also include a list of assist 

devices, such as suspenders or vests, which other officers have used and found helpful.

• Issue a policy that states when a medical necessity waiver is required to obtain devices, 

such as suspenders, to help redistribute duty belt weight. 

• Initiate a formal process where officers can request the department include new 

equipment carriage devices in future equipment trials. 

Recommendation 2: Restructure training and offer periodic training on back injury 

prevention strategies

Why? Although nearly half of interviewed officers reported low back pain in the preceding 3 months, 

44% (23 of 52) could not recall if they had taken the required CIRSA back injury prevention training 

modules.

How? At your workplace, we recommend these specific actions:

Complete job safety analyses for the department. 

• Can be another role for the officer/management health and safety committee noted 

above. 

• Identify specific ergonomic hazards associated with the job type and potential 

recommended actions to prevent back injuries. 

Use short in-service or preshift messages to serve as periodic refresher 

trainings based on the CIRSA low back injury prevention training module 

and job safety analyses. 

• Highlight information during preshift meetings that may be specific to officers, such as 

the best way to position monitors while working in vehicles and also at their desk.

• Include this training information in new officer information packets.
5

Develop a system to allow officers to see needed training as well as 

completed trainings. 

• Consider computer-based or online systems. 

• Allow access to completed training for officers to review content.

Recommendation 3: Improve health and safety reporting and response processes

Why? Employees’ health can be affected by a perceived lack of response to health and safety 

concerns. 

How? At your workplace, we recommend these specific actions:

Ensure that a formal procedure is in place for reports and responses. 

• Encourage officers to report low back pain and obtain a prompt medical evaluation so 

that the cause may be identified, corrective action implemented, and a treatment plan 

initiated to address reported low back pain.

• Ensure that a process is available to officers for submitting a confidential report on 

safety and health concerns. 

• Inform officers of the steps taken to assess problems, including what is known and what 

remains to be determined. A combination of written reports and face-to-face meetings 

are effective for communicating to officers. 
Supporting Technical Information

Evaluation of Low Back Pain and Duty Equipment 

Wear Configurations in Police Officers

HHE Report No. 2017-0049-3367

January 2020
A-1

Section A: Workplace Information

History of Issue at Workplace

Prior to 2015, an agent for the department’s loss and workers’ compensation insurer, CIRSA, obtained 

anecdotal reports about officers experiencing low back pain while wearing duty belts. The agent 

informed us that, during mandatory on-site audit interviews, officers reported experiencing low back 

pain that they associated with daily wear of heavy duty belts. CIRSA also provided the department with

low back pain prevention training modules and other safety training that officers were required to 

complete. 

Because of the concerns with duty belts, in 2015, the police department started an external duty vest 

trial program, issuing 21 patrol officers vests on which some of their duty equipment could be worn. An 

officer could select equipment he or she wanted to carry on the vest and where those items were placed 

on the vest. The external vest manufacturer provided vest cutouts that officers customized with 

notations to indicate where they wanted extra loops and pockets. The department sent the cutout with 

the notations to the manufacturer, and each vest was custom made. Selection of officers for this trial 

was determined based on seniority. The department ordered external vests from three different 

manufacturers that were selected on the basis of research conducted by an officer workgroup that was 

set up solely to investigate external vest options. The 21 officers were randomly assigned a vest from 

one of the three manufacturers. The external vest trial program was suspended in November 2016 

because of vest fit, wear, and maintenance issues. Some participants of the trial program who preferred 

wearing their duty equipment on their external vest continued wearing it. 

Workplace

At the time of our evaluation, the department consisted of 77 sworn officers and 7 unsworn community 

service officers. Sworn officers were those who attended a law enforcement academy and had the 

authority to carry a badge and firearm, as well as perform arrests. All sworn officers in this department 

started out as patrol officers. This department had the following teams of sworn officers: patrol, SWAT 

(Special Weapons and Tactics), crash and traffic, crime prevention, investigations (drug task force and 

auto theft task force), school resource (based in schools), and management. Unsworn community 

service officers were involved in animal control, park patrol, and nuisance code enforcement.

After 4 years on the patrol team, officers could apply for a transfer to another team, such as 

investigations. Officers working in investigations wore business casual clothes and were only required to 

wear their firearm and badge. These nonpatrol officers usually opted to wear their badge on a lighter 

weight civilian belt and used an underarm holster or a leg holster for their firearm. Investigations 

officers wore ballistic vests during special assignments or tasks. These officers were only required to 

wear their full uniform with the standard patrol equipment for specific official events. Investigation 

officers typically worked 9-hour shifts, Monday through Friday.
B-1

Section B: Methods, Results, and Discussion

Our primary objectives were as follows: 

• Review department policies. 

• Observe work practices and procedures that may cause low back pain. 

• Determine the prevalence of low back pain among officers and whether the pain could be 

associated with any particular duty equipment configuration. 

Methods: Policy Review and Observations 

We observed the departments’ annual physical ability testing and spoke to officers informally about 

items on their duty belts. We also reviewed policy documents on uniform equipment and personal 

appearance, weapons and ammunition, restraining devices, use of force, and the CIRSA back injury 

prevention program. 

Results: Policy Review and Observations 

Policy Reviews

We reviewed policies to identify locations where duty belt item requirements or uniform requirements 

might be listed. We did not find one standard equipment list but found equipment recommendations or 

requirements included in several documents. The Uniform Equipment and Personal Appearance policy listed

specifics for uniformity and standards of appearance. The document stated that officers could request, 

through the chain of command, new or alternative uniform items. Additionally, the policy stated that 

body armor would be replaced at 5-year intervals unless vests failed inspection of wear, cleanliness, and 

fit. This was in line with the manufacturers’ specifications.

We also reviewed the Uniform Specification policy. This policy specified that an authorized firearm and 

dark-colored flashlight had to be worn on the duty belt. The Uniform Specification policy document 

included optional items that uniformed personnel might attach to or wear on their duty belts: black 

leather gloves, black leather surgical glove pouch, expandable baton, key holder, and other equipment as 

authorized by the Chief of Police. 

The Weapons and Ammunition policy required that “uniformed personnel, while on-duty, shall carry their 

primary weapon fully loaded and with enough ammunition to fully reload the firearm two additional 

times.” Therefore, officers were required to carry two additional ammunition clips for their primary 

firearm on their duty belt. The policy also stated that “Undercover personnel and plainclothes personnel 

are encouraged to carry sufficient ammunition to reload their firearm if needed.” Officers could also 

wear a secondary weapon, but those weapons were required to be concealed from view while on duty. 

Electronic control weapons (ECW) were also approved as optional equipment. The policy stated that 

“The ECW will be carried in an approved holster on the side of the body opposite the service 

handgun.” The policy also stated that batons could be carried but should be kept in a “readily available” 

location in the patrol vehicle or on the duty belt in a baton ring. 
B-2

The Use of Restraining Devices policy stated that the police department would issue officers one set of 

standard handcuffs, and the officer could purchase additional sets. We did not note a requirement for 

the number of handcuffs to be worn on the duty belt.

The Use of Force policy outlined when certain types of force were acceptable to use, which included other 

potential optional equipment items for wear. Pepper gas was listed as a force option; however, there 

was no required location listed where this should be stored.

The CIRSA back injury prevention program included general awareness items such as physical 

exposures (repetitive work, awkward postures, and overexertion), individual risk factors (obesity, age, 

and gender), office workstation evaluations, basic lifting techniques, and stretching. The program also 

included a guideline form for completing a job safety analysis that included specific job steps, potential 

hazards, and recommended actions. The program did not include specific items relating to officers, duty 

belts, or their hazards.

Duty Belt Items

We spoke with patrol officers about their duty equipment. Most officers either retained the same 

equipment that was required during training or modified which equipment they carried based on

conversations with senior officers. The duty belts were 2.25-inch wide leather belts. We noted standard 

items included gun with holster, two extra clips of ammunition, radio, handcuffs (usually two pairs), 

flashlight, baton, pepper spray, and gloves. The total weight of these items was approximately 

20 pounds. Patrol officers also wore internal ballistic vests under their uniform shirt, but over a plain 

white t-shirt. Through our informal conversations, we learned that patrol officers were unaware that 

they could suggest or request changes to clothing items to management per the Uniform Equipment and 

Personal Appearance policy.

Physical Ability Examination

Officers were required to complete an annual physical ability test. The test was performed on 

department property and monitored by fellow officers. Officers started by leaving the duty vehicle then 

proceeded through various stations, including running, going up and down stairs, scaling mock fences, 

negotiating through cones and under poles, and finally dragging a human mannequin over a designated 

distance. Officers were timed and were required to meet a standard time. The examination was noted in 

the Uniform Equipment and Personal Appearance policy. This annual test was meant to inform officers of 

their general physical condition. The test was not meant to identify employees with disabilities who 

were otherwise able to perform their assigned duties, with or without reasonable accommodations.

Methods: Confidential Medical Interviews

All officers assigned to work during our visit, including patrol, community service, and investigations 

officers, were invited to participate in confidential medical interviews. The interviews included questions 

on work history (current and former teams), current method of carrying duty equipment, occurrence of 

low back pain in the previous 3 months, and any other health concerns they believed were work-related. 
B-3

Results: Confidential Medical Interviews

Of the 54 officers assigned to work during our site visit, 52 (96%) participated in the confidential 

interviews. The two officers who were unable to participate were working an active case and on

mandatory field training. Of the 52 interviewed officers, 40 (77%) were male, with a median age of 

46 years (range: 25–64 years).

Work History

At the time of our site visit, the median duration of employment at this department was 12 years 

(range: 3–37 years). The median weekly work hours were 45 (range: 40–60 hours). Of the 

52 interviewed officers, 25 (48%) were currently assigned to the patrol team, 16 (31%) were on the 

investigations team, 5 (10%) were on the management team, 2 (4%) were crime prevention officers, 

2 (4%) were school resource officers, and 2 (4%) were community service officers. 

All interviewed officers were asked if they had completed the CIRSA back injury prevention training in 

the past year: 9 (17%) responded no, 20 (38%) responded yes, and 23 (44%) were uncertain if they had 

or not. Several officers reported that it was difficult for them to keep track of what courses they had 

and had not completed because they took so many required training courses.

Current Method of Carrying Duty Equipment

When asked what they were currently using to carry their duty equipment, 32 (62%) reporting using a 

leather duty belt, 13 (25%) reported using a “civilian belt” or “lightweight belt,” 2 (4%) reported using 

an external vest, and 4 (8%) reported “other.” The other responses included one of each of these: 

Safariland® drop holster, concealed gun holster, external suspenders, and none. One officer did not 

report using any equipment because they were on light duty and not required to wear it. 

All interviewed officers reported that they had ever worn body armor. Patrol officers, crime prevention 

officers, community service officers, and school resource officers reported wearing body armor during 

the entire shift of each shift worked. Officers on investigations and management teams reported

wearing body armor on the rare occasions when they were required to be in full uniform for official 

functions. 

Occurrence of Low Back Pain in the Previous 3 Months

Of the 52 interviewed officers, 25 (48%) reported having low back pain in the previous 3 months. Most 

of those who reported low back pain in the previous 3 months were patrol officers (n = 13, 52%), 

followed by investigations officers (n = 9, 36%). Any officer who reported having low back pain in the 

previous 3 months was asked a series of follow-up questions to better understand their symptoms. 

These characteristics are reported in Table C1. Some officers were seen by a healthcare provider. At 

least 32% of those reporting back pain during the interview stated that their healthcare provider felt 

their back pain was work-related; however, the number of officers with work-related pain could be 

higher.

Six (11%) participants reported ever filing a workers’ compensation claim for the low back pain. No 

participant reported missing any work because of the low back pain or having to change jobs or work 

duties as a result of the low back pain. Three officers also reported waist, hip, and/or upper leg pain 

where duty equipment put pressure or rubbed against those areas. 
B-4

Any Other Work-related Health Concerns

Interviewed officers were asked if they had any other concerns regarding how their work may be 

affecting their health. Of the 52 interviewed officers, 10 officers (19%) reported work-related stress 

with 4 officers reporting insomnia as a result. Officers reported having other support systems, such as 

family, friends, recreational activities, hobbies, and other coworkers, to help them handle their stress. 

Methods: Injury Record Review

We also reviewed CIRSA records of all police department workers’ compensation claims related to back 

injuries in the state of Colorado between 2012–2016 and all reported back injuries to police in 2016. 

This department uses CIRSA injury reports in place of the Occupational Safety and Health 

Administration’s (OSHA) Form 300 Log of Work-Related Injuries and Illnesses to record officer 

injuries. 

Results: Injury Record Review 

Between 2012–2016, CIRSA received 77 workers’ compensation claims from police departments 

throughout Colorado related to back pain. Four of the 77 came from officers working in the police 

department we evaluated. Only one of these claims mentioned use of the duty belt in association with 

low back pain. The other claims involved low back pain that started when practicing ground control 

maneuvers used in subject apprehension, removing lug nuts when changing a flat tire on the patrol car, 

and bending down to push paper down into a shredding bin.

In 2016 alone, nine reports of back injuries were reported by officers affiliated with Colorado police 

departments. These records did not include information on officers’ department affiliation. Of these 

nine reports, one report was from back pain caused by the weight of wearing the duty belt. The 

remaining cases involved injuries from various activities including motor vehicle accidents, training 

events, subject apprehension, dog attack, and entrance into a patrol car. 

Methods: Survey of Trial Group 

A few weeks after the site visit, we emailed a survey to all 21 officers who were issued an external vest 

during the department’s trial program. The emailed survey included two questions: (1) did the officer

currently wear duty equipment using the external vest issued by the department, and (2) if they did not 

wear duty equipment using the external vest, please explain why.

Results: Survey of the Trial Group 

Of the 21 officers who were emailed the survey, we received responses from 12 officers, including two 

who were not listed in department records as taking part in the trial program. Five officers who 

responded to the survey had been previously interviewed during the site visit, but only one was still 

wearing the vest. 

Of the 12 responding officers, 5 (42%) reported currently wearing the vest. Out of these five, two

officers mentioned that the use of the vest reduced back pain, and one officer mentioned improved 

comfort with the vest. 
B-5

Figure B1. Intact side Velcro closure on external vest (left). Unsecured side of external 

vest due to worn Velcro pads (right). Photo by NIOSH. 

Some of the reasons the seven responding officers gave for 

discontinuing external vest use were (1) uncomfortable fit

once personalized and (2) highly specialized care 

instructions, making it difficult to keep clean without 

damaging the vest. Additionally, participants reported that

the Velcro on the vests wore out, making the vests 

unwearable (Figure B1), and this worn out Velcro allowed 

pocket contents to easily fall out. Some of the vest pockets 

were reportedly not made deep or wide enough for a 

standard officer notebook (Figure B2). Officers also 

reported difficulty with external vest upkeep and cleaning.

One participant in the trial program reported waiting

approximately 10 weeks to get their vest back from the 

manufacturer when it was sent back to them for cleaning as 

per the care instructions. This officer had to return to 

wearing items on the duty belt in the interim.

Two female officer trial program participants also 

commented that they felt that the vests were helpful 

alternatives for reasons other than low back pain relief. They 

stated they did not have the same waist circumference as their male counterparts, which made it difficult 

to fit all their equipment on the belt. The external vest provided them with additional space on which to 

place their duty equipment.

Discussion 

Low back pain in police officers has been previously described in literature going back at least 20 years. 

The lifetime prevalence rate of low back pain in Canadian police officers was reported to be 33%–75% 

[Brown et al. 1998]. An evaluation of low back pain in U.S. police officers in one county found that 

Figure B2. External vest pocket 

containing standard patrol notebook 

showing pocket top unable to reach 

Velcro pads to secure pocket 

contents. 
B-6

60% of officers reported low back pain [Arts 2006]. Data collected in the 2009–2010 National Health 

and Nutrition Examination Survey revealed a 13% prevalence of low back pain in adults aged 

20–69 years in the general U.S. population [Shmagel et al. 2016]. 

Low back pain in police officers may be due to many factors including total weight of duty equipment 

worn, manner in which equipment weight is distributed on the officer, and strenuous job components 

such as subject foot pursuit and apprehension. The duration of time spent sitting in patrol vehicles was 

also considered a separate risk factor for low back pain [Filtness et al. 2014; Gruevski et al. 2013; Gyi 

and Porter 1998; Holmes et al. 2013]. Officers who carry duty equipment primarily on their belts often 

must contort their body at odd angles in order to clear the steering wheel and seat belt mechanisms to 

enter/exit vehicle. Additionally, officers may be required to twist in the patrol vehicle seat to operate a 

computer located in the center console of the vehicle. 

Body armor can be quite heavy, weighing up to 18.8 pounds (8.5 kg) [Burton et al. 1996]. Duty 

equipment worn on top of this armor may add another 20 pounds for officers in this department. 

This weight covering the torso decreases mobility and can interfere with balance recovery, resulting in 

an increased risk for low back strain due to rapid, twisting motions to correct balance [Dempsey et al. 

2013]. A study found nearly double the annual incidence of low back pain in officers in Northern

Ireland who wore body armor weighing 18.7 pounds compared with British officers who did not wear 

body armor (8.2% versus 4.3%). This study noted these findings were comparable with low back pain 

assessments of other occupations in which heavy equipment is required for daily wear [Burton et al. 

1996]. A previous U.S. study showed that, among police officers reporting low back pain, 54% 

attributed it to wearing their duty belt, and 55% attributed it to excessive time spent sitting in their 

patrol vehicle [Arts 2006]. These studies identified important risk factors for low back pain in police 

officers, including the total weight carried (i.e., body armor, other duty equipment), forced poor posture 

while sitting, awkward postures when entering/exiting a vehicle, and finally, duration of time spent 

seated in a patrol vehicle. However, these studies also highlighted the difficulty in determining the 

degree of contribution that these risk factors have on causing low back pain in police officers. 

Our evaluation showed that 48% of officers in this department reported low back pain in the previous 

3 months. This is lower than a previous research study examining low back pain in police officers in 

Michigan, which found that 60% reported low back pain “at some point in their lives.” Reports of low 

back pain from those officers increased with increasing years of work as a police officer [Arts 2006]. 

Although none of the interviewed officers required transfers or missed work because of back pain, it 

may impact overall quality of life and career longevity [Douma et al. 2017]. All but three of the patrol 

officers we interviewed reported using the duty belt alone to wear their equipment. Of the three

remaining patrol officers, two reported using an external vest, and one wore internal suspenders in 

addition to the duty belt. These three officers reported that wearing their duty equipment with the vest 

or internal suspenders reduced low back pain. This is comparable to a Canadian study on the use of 

duty belt suspenders that found a noticeable reduction in reported discomfort or pain while wearing the 

suspenders [Arnold 2000].

We did not find many formal studies to date that have compared external vest equipment 

configurations with duty belt equipment configurations, with respect to the occurrence of low back pain 
B-7

in police officers. A recent study assessing low back pain in vehicle-based patrol officers found that 

those officers wearing a load-bearing vest instead of a duty belt to carry most of their duty equipment 

had less low back discomfort but higher upper back discomfort [Larsen et al. 2019]. Some external vest 

manufacturers claim increased overall officer comfort as a benefit to use of their product but decreased 

low back pain is not specifically mentioned [Blauer 2013]. This area could clearly benefit from additional 

research. In the meantime, external vest manufacturers need to address the fit, maintenance, and wear 

issues that resulted in some trial program participants discarding the vest.

We found one article that provided limited recommendations for the type of duty belt and location of 

items on the belt [Espinoza 2010]. Narrow nylon belts with plastic buckles were recommended over 

traditional leather belts with metal buckles. Smaller belts conform better to the body, and plastic buckles 

are easier to adjust and customize to the officers’ size. Additionally, this article recommended officers 

avoid placing hard items, such as handcuffs, on the back of the duty belt to reduce pain, pressure, and 

discomfort on the back when seated in the patrol vehicle. Instead, the back of the belt should be 

reserved for soft items such as a glove pouch [Espinoza 2010]. The author also recommended 

suspenders and vests as alternatives to the traditional duty belt. Vests were recommended because they 

could reduce reaching for equipment located toward the back by providing equipment storage space on 

the chest and abdominal areas. Storing duty equipment along the back area of the duty belt requires 

officers to twist their upper bodies to reach those items and also contributes to discomfort while in the 

patrol vehicle because the equipment forces the officer into an abnormal seated posture. Another 

benefit of the vest was reported by officers with small waist circumferences in that the vest provided 

more equipment storage area than they had using the duty belt alone. Suspenders were recommended 

because they can distribute weight over the shoulders and chest. 

We found some indications that departmental policy documentation regarding uniform components 

could be improved. Specifically, there was no single policy document that listed what equipment was 

mandatory versus what was optional for officers on different teams to carry. If total weight carried by 

officers is a risk factor for developing low back pain, then there may be cases of officers carrying 

unneeded equipment because of the lack of clear guidance. Officers acquired information on possible 

uniform wear options by word-of-mouth from other officers rather than from a formalized 

departmental resource material. This was especially true with new officers joining the department 

immediately after graduation from the police academy. Having current officers contribute suggestions 

to a document illustrating possible duty equipment wear configurations may be especially helpful to 

newer officers. 

If an external vest is still permitted for use, then the conditions of obtaining that vest outside of the 

discontinued trial program should be addressed. Additionally, the department’s uniform policy 

document should clearly outline permitted assist devices to distribute the belt weight, such as internal 

suspenders, and how officers can obtain them. For example, we noted confusion between officers on

when a medical necessity waiver was required to be permitted to wear the item or have the department 

purchase the item. 

We found that many interviewed officers could not recall if they had completed the required low back 

pain prevention training module. If officers could not recall completing the training, then it is possible, 
B-8

even if they had completed it, that they may not be able to recall enough of the material to implement 

the low back pain prevention strategies covered in that module. The department may want to assess 

their overall training structure to improve officer retention of module material and implement a better 

tracking system for completion of training. One option may be to implement a dashboard listing of all 

required modules showing the officer’s completion status and date. Refresher training on more 

frequently encountered issues and their prevention strategies, such as low back pain, may be indicated.

Conclusions

We found that nearly half of all officers in this department reported low back pain in the previous 

3 months. Department policy should clearly state what equipment is required versus what is optional. 

Although data are insufficient about using external vests versus standard leather utility belts to reduce 

low back pain, the department should provide officers with examples of different wear configurations, 

including options for internal suspenders and external vests, and clarify when medical necessity waivers 

are required to obtain all equipment. 
C-1

Section C: Tables

Table C1. Characteristics of low back pain reported in the last 3 months by interviewed officers

Characteristic No. (%) officers who reported low back pain 

(n = 25)

Frequency 

Every day 4 (16%)

Most days 7 (28%)

Some days 14 (56%)

Severity 

A lot 2 (8%)

Between a lot and a little 8 (32%)

A little 15 (60%)

Work-related determination by healthcare professional 

Yes 8 (32%)

No 14 (56%)

Don’t know 3 (12%)

 
D-1

Section D: References 

Discussion

Arnold J [2000]. “Millennium backsaver” duty belt suspender. Technical Memorandum. Canadian 

Police Research Centre, TM-01-2000, http://publications.gc.ca/collections/collection_2007/pssp/PS63-1-2000-1E.pdf. 

Arts GA [2006]. Low back pain in police officers. Master’s thesis. Allendale, MI: Grand Valley State 

University. 

Blauer [2013]. Advantages of a police outer vest carrier. October 8,

https://www.blauer.com/dispatch/advantages-of-a-police-outer-vest-carrier/. 

Brown JJ, Wells GA, Trottier AJ, Bonneau J, Ferris B [1998]. Back pain in a large Canadian police force. 

Spine 23(7):821–827, https://doi.org/10.1097/00007632-199804010-00017. 

Burton KA, Tillotson KM, Symonds TL, Burke C, Mathewson T [1996]. Occupational risk factors for 

the first onset and subsequent course of low back trouble: a study of serving police officers. Spine 

21(22):2612–2620, 

https://journals.lww.com/spinejournal/Fulltext/1996/11150/Occupational_Risk_Factors_for_the_Fir

st_Onset_and.11.aspx. 

Dempsey PC, Handcock PJ, Rehrer NJ [2013]. Impact of police body armour and equipment on 

mobility. Appl Ergon 44(6):957–961, https://doi.org/10.1016/j.apergo.2013.02.011. 

Douma NB, Cote C, Lacasse A [2017]. Quebec serve and protect low back pain study: a web-based 

cross-sectional investigation of prevalence and functional impact among police officers. Spine 

42(19):1485–1493, https://doi.org/10.1097/BRS.0000000000002136. 

Espinoza [2010]. Ergonomics and police duty belts: easing their load. American City and County. 

February 2010, https://www.americancityandcounty.com/2010/02/05/ergonomics-and-police-dutybelts-easing-their-load/. 

Filtness AJ, Mitsopoulos-Rubens E, Rudin-Brown CM [2014]. Police officer in-vehicle discomfort: 

appointments carriage method and vehicle seat features. Appl Ergon 45(4):1247–1256, 

https://doi.org/10.1016/j.apergo.2014.03.002. 

Gruevski KM, McKinnon CD, Dickerson CR, Callaghan JP [2013]. The impact of mobile data terminal 

use on posture and low-back discomfort when combined with simulated prolonged driving in police 

cruisers. Int J Occup Saf Ergon 19(3):415–422, https://doi.org/10.1080/10803548.2013.11076998. 

Gyi DE, Porter JM [1998]. Musculoskeletal problems and driving in police officers. Occup Med 

48(3):153–160, https://doi.org/10.1093/occmed/48.3.153. 

Holmes MWR, McKinnon CD, Dickerson CR, Callaghan JP [2013]. The effects of police duty belt and 

seat design changes on lumbar spine posture, driver contact pressure and discomfort. Ergonomics 

56(1):126–136, https://doi.org/10.1080/00140139.2012.739206. 
D-2

Larsen LB, Ramstrand N, Tranberg R [2019]. Duty belt or load-bearing vest? Discomfort and pressure 

distribution for police driving standard fleet vehicles. Appl Ergon 80:146–151, 

https://doi.org/10.1016/j.apergo.2019.05.017. 

Shmagel A, Foley R, Ibrahim H [2016]. Epidemiology of chronic low back pain in US adults: data from 

the 2009–2010 National Health and Nutrition Examination Survey. Arthritis Care Res 68(11):1688–

1694, https://doi.org/10.1002/acr.22890.
Delivering on the Nation’s promise:

Promoting productive workplaces through safety 

and health research

Get More Information

Find NIOSH products and get answers to workplace safety 

and health questions: 

1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348

CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh

Monthly NIOSH eNews: cdc.gov/niosh/eNews