Abstract: BACKGROUND: Military personnel are twice as likely as civilians to experience chronic musculoskeletal pain. Identifying prognostic factors for poor recovery from musculoskeletal disorders may support the development of tailored care pathways to improve outcomes. OBJECTIVES: Identify prognostic factors for poor recovery in active military personnel with musculoskeletal disorders. DESIGN: Systematic review of prognostic studies including prospective, retrospective, and secondary analyses of randomised controlled trials. METHODS: MEDLINE, EMBASE, AMED, PsychInfo, Cinahl, Scopus, and SPORTDiscus databases were searched from inception to March 2025. Studies were included if they evaluated prognostic factors for association with recovery outcomes (pain, disability, work status, or perceived recovery) in active military personnel with any musculoskeletal disorder. Two reviewers independently screened eligible studies and assessed methodological quality using the Quality in Prognostic Studies (QUIPS) tool. Descriptive analysis of multivariate data was undertaken with meta-analyses performed where possible. RESULTS: Twenty-eight studies were included in this review. The factor most strongly associated with poor short-term outcome (disability) was initial pain severity [OR 3.88 (95 %CI 1.50-10.07)] followed by male sex (outcome restricted duty) [OR 2.63 (95 %CI 1.57-4.40)]. The factor most strongly associated with poor long-term outcome (restricted duty) was the presence of comorbid psychiatric diagnosis [RR 6.02 (95 % 4.25-8.51)]. CONCLUSIONS: Assessing initial pain severity and psychological stressors may help clinicians identify military personnel with musculoskeletal disorders at risk of poor outcome. Understanding the interaction between occupational psychological stressors and pain symptoms may identify modifiable factors that can be targeted to improve recovery.