Identifying contributory risk factors for neck pain in fast jet aircrew: a prospective cohort study

Fast jet aircrew (FJA - aka fighter pilots, fighter aircrew) commonly suffer musculoskeletal complaints, particularly of the neck, which degrades operational capability and workforce health. Establishing injury aetiology is a prerequisite for developing effective preventative interventions. Our objective was to examine the aetiology of neck-related musculoskeletal complaint episodes (NRMCEs) among FJA across a range measures including physical capacity, psycho-social recovery-stress states, workload measures, and strength and conditioning (S&C) participation.

279 Royal Australian Air Force (RAAF) FJA were followed over four 5-month reporting periods. Forty-four baseline measures and 26 weekly measures were analysed for their effect on weekly risk of NRMCEs. Mixed-effects logistic regression was used, potential confounders were adjusted for, and non-linear relationships were examined.

320 new NRMCEs were included with mean weekly prevalence of 4.1% (SD 2.3) and mean 5-month reporting period prevalence of 22.4% (range 15.3-28.5%). Previous neck pain, higher worry scores, larger acute flying workloads, more weekly flights, and larger acute and chronic S&C workloads, were factors identified to increase weekly risk of NRMCE. Significant non-linear effects were identified for chronic flying workloads, acute and chronic sleep quality scores, and absolute isometric strength of neck rotation and trunk flexion. Demographics, flying history, anthropometry measures, neck and trunk range of motion, and S&C participation, however, did not affect weekly risk of new NRMCE.

These findings provide crucial support for the design of targeted prevention programs for FJA, ensuring they are both effective and efficient, which will in turn optimise operational capability.