Evaluating the Impact of a Spine Training Program on Air Force Student Fighter Pilots

A 2022 survey conducted by Headquarters Air Combat Command Aircrew Performance Branch found that 98% of fighter aircrew reported flight-related neck pain during their career. Despite the high prevalence of neck pain and growing operational demands, there remains no consensus regarding best practices for mitigating aircrew pain and injury. Although most pilot training locations have established aircrew performance teams, only select locations have mandated training hours to support injury mitigation training. Eglin Air Force Base (EAFB) F-35A student pilots (SPs) engage in a mandatory 8-week standardized spine training program (STP). In contrast, the F-15E Flying Course at Seymour Johnson Air Force Base (SJAFB) does not have syllabus hours to support the STP, resulting in the capability to utilize this site as a comparison group for this analysis. The primary objective of this study was to determine if completion of the STP led to significant differences in the Cervical Endurance Hold (CEH). We hypothesized that SPs would exhibit significant training adaptations only if they had dedicated training hours that could support the completion of the STP.

SPs from EAFB who were actively enrolled in the F-35A Flying Course from 2022 to 2024 participated in an 8-week STP. The CEH test was administered before the start of the Flying Course (pre-flying training), after the 8-week STP intervention (post-8 week), after the air-to-air phase of training (post air-to-air), and after the completion of the Flying Course (post-flying training). SPs from SJAFB who were actively enrolled in the F-15E Flying Course from 2022 to 2024 did not participate in the standardized STP. The CEH test was administered before the Flying Course (pre-flying training) and following the completion of the Flying Course (post-flying training). JMP 16.0 (SAS Institute Inc., Cary, NC, United States) was used to retrospectively analyze the data from this study.

There was a significant effect from the STP between the intervention (EAFB) and comparison (SJAFB) groups (F(1,81.28) = 7.456; P = .008). Additionally, the STP had a significantly positive effect on CEH time, following the initial 8-week intervention (pre-training = 96.28s ± (37.95s), 8-week = 132.81 seconds ± (30.96s) P < .001), which was maintained throughout the duration of the Flying Course (pre-training = 96.28s ± (37.95s), post-training = 117.34s ± (29.73s) P = .013).

The study results show a significant improvement in CEH outcomes after the 8-week STP intervention, which was not seen at the comparison site. Notably, the benefits of the STP at the intervention site were sustained even after the Flying Course was completed, indicating that the program may have a sustained protective effect. Future analysis of flight profiles between locations that implement the STP and those that do not should be conducted. This comparison could help determine whether the STP is contributing to a reduction in duty limitations. Furthermore, if a relationship exists, these findings may provide valuable insights for experts seeking the most effective spine training methods to mitigate pain, injury, and attrition in fighter aircrew.