Lower Back Pain & Neck Pain: A Curse for helicopter and fighter pilots

1. Lower Back Pain & Neck Pain: A Curse for
helicopter and fighter pilots
Lt Col Dr. Nururnnabi – Ibn – Hossain
Flight Surgeon & Aviation Med Spl
Kuwait Armed Force
Subhan Cantt
Kuwait

2. INTRODUCTION
Most occupations come with their own
occupational health issues. Voice strain for the teachers
and public speakers, carpal tunnel syndrome (CTS)
(pain and numbness in the fingers) for the IT programmers,
deafness for factory workers, just to name a few.
Neck pain & back pain in military pilots, particularly
helicopter and fighter jet pilots, is a major concern. Pilots
sometimes forgot medical treatment for fear of being
grounded or losing their flight status.
It commonly occurs due to poor posture & Air craft
vibration ( spl helicopter).

3. Causes of neck and back pain ( PILOT )
Pain in back and neck, usually associated with muscle
stiffness and soreness, can be a result of several factors,
although the impact of each depends on the type of pilot
(helicopter versus fighter).
Conditions inherent in flying helicopters and jets put
these pilots (and crew) at a greater risk for developing
Neck and Back pain due to :-
► Misaligned postures,

4. Misaligned
postures

5. Most current helicopter cockpits were designed to reduce
injuries from the hard landings and vertical crashes that
were common during the Vietnam War.
This design forces helicopter pilots to assume a unique
position, often referred to as “helo-hunch,” a misaligned
posture in which a pilot’s trunk is curved forward and
slightly rotated.

6. Helmet-mounted
equipment like
NVG/NVE
Helmet
The use of additional equipment like helmets

7. ► Long hours in the cockpit –
► Exposure to high G – forces.
Ergonomic concerns for fighter pilots are more related to
G-forces and neck movements associated with various
maneuvers like “Checking six,” or turning to look towards
the tail of the aircraft, requires extreme neck rotation that
uses relatively weak muscles in the neck.

8. ► Ineffective lumbar support and seat padding,
► The whole - body vibrations during the flight,
► Poor seat posture

9. ► High-risk head movements

10. ► Stretching the body to reach the controls and
switches.
► Forces exerted on the back during take-offs
and landings as the plane is at an angle
Other risk factors (without flying):
Long time Table work / Desk work/ Computer work
Long drive
Mobile/Internet browsing
Long time TV/ movie watch
Sleeping in abnormal posture
Sports/Gym (accident)
Occupational Specific

11. Posture
Posture is the way you hold your body while standing,
sitting, or performing tasks like lifting, bending, pulling,
or reaching. In good posture the bones of the spine — the
vertebrae — are correctly aligned.

12. How poor posture provokes back pain
You may not feel any ill-effects after sitting with poor
posture for a few hours, but over time the stress that
poor posture places on your spine can lead to
anatomical changes in your spine. This in turn can
provoke back pain through the constriction of your
blood vessels and nerves. In addition, the stress from
poor posture can lead to back pain by causing problems
with your muscles, discs, and joints.

13. Common posture mistakes
Slouching in a chair
Sticking your bottom out

14. Standing with a flat back
Leaning on one leg

15. Hunched back and 'text neck'
Poking your chin

16. Rounded shoulders
Cradling your phone

17. Vibration & Spine Injury
Vibration can cause short-term or long-term effects
due to the biomechanical properties of the body.
The effects are of two types:
Frequency dependent: Responses attributable
directly to the differential movement or
deformation of the organs or tissues of the body -
Body resonance.
Intensity dependent: Effects related more to the
intensity of vibration and the cumulative duration
of exposure.

18. Degenerative changes in the cervical spine were
significantly more prevalent in the helicopter pilots.
Helicopter (Rotary Wing) pilots are exposed to higher WBV
levels which induced physiological effects, including
musculoskeletal disorders.

19. Helicopter vibrations can seriously
damage the discs in a pilot's back
which is generally caused by poor
posture during flight.
It occurs when the spine is bent
forward and is a contributing factor
in the back pain diagnosis of a pilot.
By sitting with the body hunched
forward, pilots are able to bring their
arms closer to the dashboard to
maneuver the controls more
efficiently.

20. Unfortunately, this slouch position is further exacerbated
as pilots use their right thigh as an armrest to support and
stabilize the forearm. Since the elbow rest position is three
to five inches above the thigh, pilots must lean forward
and slightly to the right, to make contact.

21. At the same time, they need to tilt their torso to the left to
be able to look out the side window. This asymmetric
hunching has resulted in a “hunched-back” curvature (ie.
flattening of the lower back, increased mid-back curvature,
and straightening of neck) which further increases the
loading of the mid-back because of the forward
displacement of the upper torso and head.

22. These repetitive vibratory insults to the spinal column
specifically to the center of gravity at the lumbosacral
region.
This leads to spasm of the paraspinous muscles which then
eventually gets fatigued and a resultant straightening of the
normal body lordotic (curved) postion.
These actions flatten and stretch the posterior longitudinal
ligament which is very pain sensitive, thereby manifesting
the LBP in rotary wing pilots.

26. How to maintain good posture
Walk tall
While walking, it's important to look straight ahead of you
and to keep your head balanced straight above your spine.
Lift carefully
To help you avoid back pain, here are three simple rules
for lifting both light and heavy objects:
Keep your chest forward
To ensure you keep your back straight while lifting, bend
your hips—not your lower back—and keep your chest
out.

27. Lead with your hips
When changing directions while lifting, lead with
your hips to avoid placing additional strain on your
back.
Keep weight close to your body
Keep the object you are lifting as close to your
body as possible.
Sit with support
One common posture mistake many people make is the
"office chair hunch," where a person sits at the front of
their chair and hunches forward to reach their computer
screen.

28. Improving your posture for lower back pain

33. PROTECTIVE MEASURES(Vibration)
At the source
Reduction of vibration emitting from aircraft by better
design/ maintenance.
Appropriate routing of aircraft to avoid turbulent air
In the transmission path
Dynamic vibration absorbers
Vibration isolation of aircrew seat

34. At the receiver
By alteration of the dynamic property of the
body:Tensing of the muscles or by using harness
Using air mattress or hanging stretcher for cas-evac
Reducing the duration of exposure

35. PREVENTION
Military pilots suffering chronic back and neck problems
have been covertly seeking treatment at civilian medical
facilities rather than use their health insurance at a military
medical facility, fearing that their injuries could jeopardize
to avoid being grounded or losing their flight status.
Military researchers are looking at improving and updating
the ergonomics of aircraft seats and cockpits, as well as
helmet fit.

36. PREVENTION
Exercise programs specifically like Yoga, Pilates and
Aerobic exercises for strengthening the neck area can be
helpful in preventing pain.
Focus on the flexibility exercises, these will not only
stretch and relax the hardened muscles, they will
strengthen the muscles to prevent LBP. Be cautious when
lifting heavy objects which include your flight bags,
Always try to keep the spine in a vertical position and use
the power of the legs rather than the back. This helps to
prevent back injuries.

37. PREVENTION
Check if you require supplementary seat cushion for the
flight to give your back enough support and try to keep the
back straight when sitting down
Use a firm mattress at home. This helps to give support to
the back while at sleep
“G-warm up” maneuvers can also be beneficial to prepare
a fighter pilot for high G-forces..

38. Conditioning exercises for the neck

39. Conditioning exercises for the neck.

40. Conditioning exercises for the neck.

41. CONCLUSION
Pilot health is of paramount importance to the safe
operation of all flights. Prolonged, unsupported sitting will
lead to reduced flexibility in the lower back and hip joints.
Effectiveness and readiness are compromised if a pilot
can’t fly because of pain. A pilot experiencing a painful
distraction while controlling an aircraft could compromise
flight safety.
Practice good flight posture, exercise proper flying
techniques and drink two liters of water daily.

42. Have a Safe Flying