Objectives To explore gender differences in the cause of low back pain in a population of military personnel who are expected to undertake high levels of sport, exercise and physical military training.

Methods A prospective study of trained British soldiers, with symptomatic low back pain, referred to the Colchester Garrison Sports Injury and Rehabilitation Centre over a four year period.

Results The study demonstrates that 928 (17.8%) of the 5214 referrals were for new cases of low back pain. The incidence of low back pain in female soldiers is higher than their male counterparts with an odds ratio of 3.17 (95% CI 2.31 – 4.35). There was a highly significant cross gender difference in low back pain caused by activities in the following categories: military physical training (OR 2.65, 95% CI 1.70 – 4.02), work or occupation (OR 2.49, 95% CI 1.56 – 3.87) and off-duty pursuits (OR 2.91, 95% CI 1.72 – 4.72). There was no cross gender difference in low back pain caused by sport, road traffic accidents or activities pre-dating military service.

Conclusions Female soldiers are significantly more likely to suffer low back pain as a result of physical military training, their occupation, or off-duty activities. Sporting activities do not cause low back pain in women to a greater extent than men. By demonstrating the scale of the problem and by determining of the cause of injury, it should now be possible to propose methods of effective intervention to reduce injury, implement those interventions and audit effectiveness.