Helicopter Pilots and Low Back Pain: How to Manage the Risk Factors?

Abstract

A high prevalence of LBP in helicopter pilots has been reported by several epidemiological surveys since the early 1960's. As pointed out by several authors the most important etiologic factor of LBP in helicopter pilots is the asymmetrical posture adopt during flight. The aim of the study is understand the pathomechanical model of the low back pain (LBP) that affects helicopter pilots in order to propose a risk management addressed to reduce this issue. A comprehensive literature review was performed to identify evidences about low back pain in helicopter pilots, risk factors related and some interventions/risk management adopted. In addition, a self-reported questionnaire was applied for LBP prevalence and pain characterization. Results showed asymmetrical in-flight posture; cockpit design/geometry; seat design; WBV; static posture; prolonged sitting; and flight duration as mainly risk factors and a higher prevalence of LBP among helicopter pilots as well as a significant influence of flight activity on pain features when compared to office workers. In order to solve the problem it will be necessary to provide a comprehensive solution composed by three different and complementary steps: a specific exercise program (as an immediate solution), the use of lumbar support (as a short term solution), and a proposal for redesign cockpit and seat (as a long term solution).

Low Back Pain Prevalence in Brazilian Helicopter Pilots

“…Studies have suggested a higher prevalence of low back pain in helicopter pilots (HP) when compared to the general population in which the prevalence of spinal pain (SP) in HP ranges from 21 to 95% and the prevalence of low back pain in helicopter pilots during the flight varies from 40 to 100%. This rises a flag to flight safety, since the pain can deconcentrate the pilot, putting human lives in danger and even causing an accident [6][7][8][9][10][11][12][13][14][15][16][17].…”

“…One of the most cited primary factor that predisposes helicopter pilots to LBP is the awkward posture adopted by them during the flight [6,10,13,[17][18][19]. To keep the aircraft under control, depending on the layout of the control commands, they should to adopt a posture that is bent forward, with a slight lateral inclination and trunk rotation to the left.…”

“…To keep the aircraft under control, depending on the layout of the control commands, they should to adopt a posture that is bent forward, with a slight lateral inclination and trunk rotation to the left. This awkward, prolonged, and static position requires a high effort from the paravertebral musculature [7][8][9][10][20][21][22][23] Along with the described poor posture, the whole body vibration (WBV) which helicopter pilots are submitted during flight has been considered one of the most important causes for the LBP onset. Byeon et al 2013 study indicates that WBV, along with other factors like accumulated flight hours, age and longtime flights, is related to degenerative changes of the lumbar spine in helicopter pilots [21,22].…”

“…The main features of the low back pain in HP can be summarized as follows: it is non-irradiating and temporary pain (lasts only a few hours) that manifests itself in a diffuse manner in the lower back region accompanied by a feeling of tiredness that normally appears during or immediately after the flight and that only it manifests after some time from the beginning of air activity, which characterizes it as recurrent/transient pain [6,10,13,[18][19][20]. The time of onset of transient pain depends on the pilot, the helicopter, the type of mission and the total hours flown since complaints of transient pain start to be reported by the HP between 300 and 1500 flight hours, that is, in pilots with a certain experience.…”

“…Low back pain in helicopter pilots can be caused either by factors existing in the cabin's internal environment, or by factors arising from the behavior and lifestyle of this population. In a review on this subject, several researchers [6][7][8][9][10][11][12][13][14][15][16][17] have pointed out the following causes as being the main causes: the posture adopted by the pilot in the seated position during the flight, ergonomic issues in the cockpit; the vibration transmitted by the seat, the weak back muscles, sedentary life style and other individual characteristics. Da Silva [10] in his analysis found the following etiological factors asymmetrical in-flight posture; cockpit design/ geometry; seat design; WBV; static posture; prolonged sitting; and flight duration as mainly risk factors.…”