Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Health Sciences


Rehabilitation Sciences

First Advisor

Dr. Johanna M. Hoch

Second Advisor

Dr. Timothy L. Uhl


Career firefighters must perform physically and psychologically challenging duties in unpredictable and dangerous conditions. Previous investigations have found that firefighters suffer nearly 4 times the recorded musculoskeletal disorders (MSD) and workplace injuries compared to private and public sector workers, and take approximately 1.5 days longer to return to normal work. Thus, the burden of firefighter MSD experiences has been a growing area of exploration. The few investigations that have concurrently examined physical and psychosocial consequences experienced by firefighters have found a positive relationship between increased occupational stress reports and MSD experiences. However, these investigations, as well as those that individually examined physical and psychosocial factors related to firefighter MSDs, have primarily been cross-sectional in nature. Further, the incidence of these conditions has minimally been explored, with previous studies primarily relying on formal reports of MSDs. Reliance on data sourced from mechanisms such as worker’s compensation claims neglects the cultural and structural barriers identified which may deter firefighters from reporting MSDs. Utilization of methods not sensitive to the population may obstruct the understanding of the true burden that MSDs pose to firefighters and their municipalities. Without a thorough understanding of these aspects of firefighter MSD occurrences, the development of prevention and treatment efforts is restricted.

The purpose of this dissertation was to determine self-reported MSD symptoms among firefighters, and identify related physical and psychosocial factors. A series of cross-sectional and longitudinal studies were conducted to identify a foundation for future MSD prevention efforts, and to shape relevant policies surrounding firefighter health and safety. The results of this dissertation first suggest that resilience among firefighters is greater than among civilians, and that grit and compassion satisfaction may influence firefighter resilience. Further, we identified that firefighters report a high incidence rate of recorded MSDs and MSD symptoms, similar to other tactical populations. Those firefighters who were assigned to a rescue apparatus reported roughly twice the incidence rate of MSD symptoms compared to standard members, and those assigned to an ambulance. We additionally found that both physical and psychosocial factors differed between those who did and did not report MSD symptoms over 6 months of observation. These results support the use of a biopsychosocial approach to investigating firefighter MSDs, as well as in the development of prevention and treatment strategies.

Digital Object Identifier (DOI)

Funding Information

Chapter 3 was fully funded by Doctoral Grant #2021DGP03 from the National Athletic Trainer’s Association Research and Education Foundation. These funds were awarded to Jennifer Tinsley Kubala as the primary investigator, with Dr. Johanna M. Hoch serving as her faculty supervisor. Funds were awarded in 2021.

Chapters 4 and 5 were partially funded by the Endowed University Professor of Health Sciences pilot grant, which was awarded to Jennifer Tinsley Kubala. Funds were awarded in 2023.

Chapters 4 and 5 were partially funded by the Central Appalachian Regional Education and Research Centers pilot funds. These funds were awarded indirectly to Jennifer Tinsley Kubala, with Dr. Johanna M. Hoch serving as her faculty supervisor. Funds were awarded in 2023.

Available for download on Sunday, May 11, 2025