Impact of exercise programs among helicopter pilots with transient LBP

Abstract

BackgroundFlight related low back pain (LBP) among helicopter pilots is frequent and may influence flight performance. Prolonged confined sitting during flights seems to weaken lumbar trunk (LT) muscles with associated secondary transient pain. Aim of the study was to investigate if structured training could improve muscular function and thus improve LBP related to flying.Methods39 helicopter pilots (35 men and 4 women), who reported flying related LBP on at least 1 of 3 missions last month, were allocated to two training programs over a 3-month period. Program A consisted of 10 exercises recommended for general LBP. Program B consisted of 4 exercises designed specifically to improve LT muscular endurance. The pilots were examined before and after the training using questionnaires for pain, function, quality of health and tests of LT muscular endurance as well as ultrasound measurements of the contractility of the lumbar multifidus muscle (LMM).ResultsApproximately half of the participants performed the training per-protocol. Participants in this subset group had comparable baseline characteristics as the total study sample. Pre and post analysis of all pilots included, showed participants had marked improvement in endurance and contractility of the LMM following training. Similarly, participants had improvement in function and quality of health. Participants in program B had significant improvement in pain, function and quality of health.ConclusionsThis study indicates that participants who performed a three months exercise program had improved muscle endurance at the end of the program. The helicopter pilots also experienced improved function and quality of health.Trial registrationIdentifier: NCT01788111 Registration date; February 5th, 2013, verified April 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1631-0) contains supplementary material, which is available to authorized users.

Low Back Pain Prevalence in Brazilian Helicopter Pilots

“…When considering the pilots as a single group as Brazilian HP, the prevalences of spinal pain (54.8%), low back pain (44.6%), pain during or immediately after flights with less than two hours (36.5%), recurrent (85%), and chronic pain (15%) found in this investigation are similar to the findings in the literature [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The LBP prevalence of 44.6% is similar to the 48.1% found by Posh, et al [15].…”

“…More than 98% of pilots that has experienced low back pain have associated it with the flight corroborating previous studies [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. For the 108 pilots with pain only 2 indicated that the back pain was not related to the flight.…”

“…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.…”

Long-term effects of exercise programs among helicopter pilots with flying related LBP

“…Based on data showing that transient LBP is provoked by awkward sitting and followed by decreased lumbar trunk muscular function, it has been postulated that training of these muscles could reduce the pain [ 6 , 7 ]. In a short-term study, we showed that exercise programs could improve pain, function and quality of health and this was related to a marked improvement of muscular endurance of the lumbar trunk [ 12 ]. In the present study, we have examined the persistence of flying related LBP at mean 26.6 months after intervention.…”