Low back pain: considerations for rotary-wing aircrew

Low back pain remains a significant issue among helicopter aircrew. There is a considerable body of scientific literature devoted to the problem, including epidemiologic and experimental studies addressing prevalence, characteristics, primary etiology, and contributing factors. It is endemic and multinational, with a prevalence ranging from 50-92%. Archetypal pain begins with flight or within hours of flight, is mostly targeted in the low back/lumbar region and/or buttocks, is transient, and is commonly described as dull and achy. A minority develop chronic, persistent pain that is variously described with dissimilar characteristics. The pernicious effects of back pain or discomfort while piloting may affect flight performance and safety, including reduced operational effectiveness and lost duty time, occupational attrition, curtailed or cancelled missions, compromised emergency egress, and performance deficits during critical phases of flight. The majority of etiologic studies have focused on the pathophysical posture adopted by pilots for aircraft control and exposure to whole body vibration. With more evidence for the former, it remains likely that both, as well as other factors, may have a contributory and perhaps integrative or concerted role. Corrective and mitigation strategies have addressed lumbar support, seat and cockpit ergonomic redesign, and improved aircrew health. Flight surgeons should be familiar with this prevalent issue and future research must address longitudinal cohort studies with clear definitions, relevant and valid exposure data, dose-response detail, and control for contributing factors and confounders.