MRI findings and physical performance as predictors of flight-induced musculoskeletal pain incidence among fighter pilots

Abstract

SummaryStudy aim: The aim of this study was to evaluate the possible association of pre-career magnetic resonance imaging (MRI) findings and physical performance level with possible musculoskeletal disorders during jet flight training. Material and methods:The study group consisted of 73 fighter pilots who had undergone pre-career cervical and lumbar spine MRI. Physical performance of a subgroup of the pilots (n = 67) was measured initially at the same time and followed up to the fast jet training phase (ranging from 3.8 to 7.0 years). Musculoskeletal pain history during pilot training was taken from the medical charts. MRI findings and physical performance were associated with perceived clinical complaints during the follow-up. Results: 82% of the cervical and 92% of the lumbar spines showed abnormalities at at least one disk level. MRI did not reveal significant cervical degeneration. Thirteen disk bulges in the lumbar spine were discovered, while 5 pilots had listhesis and/or osteophyte formation on the spine (lumbar vertebra 4/sacroiliac joint level, L4-SI). 41% of the studied pilots suffered spinal symptoms during the follow-up, but only 16% and 17% of the cervical and lumbar MRI findings, respectively, were associated with subsequent symptoms. Endurance and strength levels were not, but lower body motor skills were, strongly (relative risk, RR 0.46) associated with a decreased number of flight-induced medical appointments in the early flight career. Conclusions: Minor MRI findings have no predictable value in the very early flight career. Nevertheless, versatile, skills/ power-oriented exercises before the flight career seem to be occupationally beneficial in reducing musculoskeletal disorders.

Paraspinal muscle hypotrophy and chronic discogenic low back pain

“…This condition may be a result of pain limiting patients' physical activity, but so far it has not been explained whether changes in the structure of muscles are the cause of disc disease or its result [16]. Some reports have shown a small or non-significant relationship between muscle strength, endurance, MRI changes and low back pain [20], while others have proved that the trunk muscles in patients with back pain were significantly weaker than in healthy subjects [14], and unilateral lumbar multifidus hypotrophy was often associated with back pain [6]. Structural changes within the multifidus and the erector spinae have also been reported in patients undergoing surgery due to sciatica [12].…”