Human and Behavioral Factors Contributing to Spine-Based Neurological Cockpit Injuries in Pilots of High-Performance Aircraft: Recommendations for Management and Prevention

Abstract

In high-performance aircraft, the need for total environmental awareness coupled with high-g loading (often with abrupt onset) creates a predilection for cervical spine injury while the pilot is performing routine movements within the cockpit. In this study, the prevalence and severity of cervical spine injury are assessed via a modified cross-sectional survey of pilots of multiple aircraft types (T-38 and F-14, F-16, and F/A-18 fighters). Ninety-five surveys were administered, with 58 full responses. Fifty percent of all pilots reported in-flight or immediate post-flight spine-based pain, and 90% of fighter pilots reported at least one event, most commonly (> 90%) occurring during high-g (> 5 g) turns of the aircraft with the head deviated from the anatomical neutral position. Pre-flight stretching was not associated with a statistically significant reduction in neck pain episodes in this evaluation, whereas a regular weight training program in the F/A-18 group approached a significant reduction (mean = 2.492; p < 0.064). Different cockpit ergonomics may vary the predisposition to cervical injury from airframe to airframe. Several strategies for prevention are possible from both an aircraft design and a preventive medicine standpoint. Countermeasure strategies against spine injury in pilots of high-performance aircraft require additional research, so that future aircraft will not be limited by the human in control.

Neck Pain Among Fighter Pilots After the Introduction of the JHMCS Helmet and NVG in Their Environment

“…We found two other prevalence studies including F-16 pilots: a study from 1988 found 58% of 200 F-16 pilots had experienced acute neck injury during the preceding 3 mo, with 13% of the injuries described as ' major ' with distal upper extremity symptoms ( 12 ), and a study from 2000 found 23 of 24 F-16 pilots had in-fl ight or postfl ight neck pain, the pain having a trend of being of longer duration and with right side lateralization when compared to pilots of the F-18, which has center stick control ( 6 ). Most injuries were described as muscle strain and stiffness and facet joint syndromes, but more serious injuries such as disc protrusions and bulges ( 4,10,11 ) and ligament injury and fractures ( 1,11 ) are described in the literature, as well as degeneration following long-term exposure to high 1 G z forces ( 5 ).…”

“…Studies have drawn attention to the problem that pilots, in general, are reluctant to voluntarily provide accurate personal, medical-type information or complete detailed questionnaires ( 6 ). In this study, we endeavored to overcome this problem by tracking the completion of the questionnaires, well aware that this might be regarded as a kind of pressure and could result in perfunctory responses on some surveys.…”

Disc herniations in astronauts: What causes them, and what does it tell us about herniation on earth?

“…Performing high-G manoeuvres [41], pilot ejection [42], and helicopter vibration [43] present risk factors for injury to the neck. Potentially, the resulting high-compressive forces on the spine could result in end plate fractures, then leading to adjacent IVD degeneration [44].…”

Functional Assessment of the Cervical Spine in F-16 Pilots With and Without Neck Pain

“…Newman concluded that prefl ight stretching might not be protective in terms of G-induced neck injury ( 25 ). In the survey of Jones et al, prefl ight stretching did not appear to prevent fl ight-related pain; however, a more defi ned prefl ight stretching routine was recommended as a part of a potentially effective prevention strategy ( 20 ). One survey of 268 pilots showed that prefl ight range-of-motion stretching had a benefi cial effect ( 1 ).…”