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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Neck Pain | Research article

Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study

Authors: Markus Posch, Alois Schranz, Manfred Lener, Werner Senn, Björn O. Äng, Martin Burtscher, Gerhard Ruedl

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

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Abstract

Background

Flight-related neck, shoulder and low back pain are the most common musculoskeletal disorders among helicopter pilots and their crewmembers, thus becoming a growing concern. Information on the combined prevalence of these types of pain and related risks are scarce. The aim of this study was therefore to estimate pain prevalence and to evaluate potential risk factors for neck pain among helicopter pilots and crewmembers within the armed forces, the airborne police and airborne rescue organizations in Austria.

Methods

Among a cohort of 104 helicopter pilots and 117 crewmembers (69.8% compliance), demographics, flying experience, use of Night Vision Goggles (NVG), helicopter type flown, prevalence and intensity of musculoskeletal symptoms (pain was defined as any reported pain experience, ache or discomfort) were collected by an online-based questionnaire.

Results

For helicopter pilots the 12-month prevalence of neck pain was 67.3%, followed by low back (48.1%) and shoulder pain (43.3%). Among crewmembers, the 12-month pain prevalence were 45.3, 36.8 and 30.8% among the neck, lower back and shoulder, respectively. During this period, 41.8% of these helicopter pilots had experienced 8–30 pain days in the areas of neck (45.7%), shoulder (37.8%) and lower back (42.0%) whereas 47.8% of crewmembers self-reported 1–7 days of neck (54.7%), low back (44.2%) and shoulder (44.4%) pain in the previous year. The 3-month prevalence of neck pain was 64.4% followed by low back (42.3%) and shoulder pain (38.5%) for helicopter pilots. Among crewmembers, 41.9% suffered from neck, 29.9% from low back and 29.1% from shoulder pain the previous 3 months. Multivariate regression analysis revealed NVG use (OR 1.9, 95% CI, 1.06–3.50, p = 0.032), shoulder pain (OR 4.9, 95% CI, 2.48–9.55, p < 0.001) and low back pain (OR 2.3, 95% CI, 1.21–4.31, p = 0.011) to be significantly associated with neck pain.

Conclusions

The 12- and 3-month prevalence of neck, shoulder and low back is considerably high among both, helicopter pilots and crewmembers confirming the existence of this growing concern. The use of NVG devices, shoulder and low back pain in the previous 12 months represent independent risk factors for neck pain. These findings highlight the need for longitudinal studies.
Literature
1.
Lischke V, Byhahn C, Westphal K, Kessler P. Mountaineering accidents in the European Alps: have the numbers increased in recent years? Wilderness Environ Med. 2001;12(2):74–80.CrossRef
2.
Mair P, Frimmel C, Vergeiner G, Hohlrieder M, Moroder L, Hoesel P, Voelckel W. Emergency medical helicopter operations for avalanche accidents. Resuscitation. 2013;84(4):492–5.CrossRef
3.
Burtscher M, Pachinger O, Schocke MF, Ulmer H. Risk factor profile for sudden cardiac death during mountain hiking. Int J Sports Med. 2007;28(7):621–4.CrossRef
4.
Burtscher M, Pochia A. The risk of cardiovascular events during leisure time activities at altitude. Prog Cardiovasc Dis. 2010;52(6):507–11.CrossRef
5.
Harrison MF, Coffey B, Albert WJ, Fischer SL. Night vision goggle-induced neck pain in military helicopter aircrew: a literature review. Aerosp Med Hum Perform. 2015;86(1):46–54.PubMed
6.
Thomae MK, Porteous JE, Brock JR, Allen GD, Heller RF. Back pain in Australian military helicopter pilots: a preliminary study. Aviat Space Environ Med. 1998;69(5):468–73.PubMed
7.
Bridger RS, Groom MR, Jones H, Pethybridge RJ, Pullinger N. Task and postural factors are related to back pain in helicopter pilots. Aviat Space Environ Med. 2002;73(8):805–11.PubMed
8.
Lis AM, Black KM, Korn H, Nordin M. Association between sitting and occupational LBP. Eur Spine J. 2007;16(2):283–98.CrossRef
9.
Pokorski T. Analysis of flight gear for female pilots. In: Naval Aeromedical Research Laboratory Pensacola. 1994.
10.
Newman DG. Gz-induced neck injuries in Royal Australian air Force fighter pilots. Aviat Space Environ Med. 1997;68(6):520–4.PubMed
11.
Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15(6):834–48.CrossRef
12.
Van den Oord MH, Sluiter JK, Frings-Dresen MH. Differences in physical workload between military helicopter pilots and cabin crew. Int Arch Occup Environ Health. 2014;87(4):381–6.PubMed
13.
Äng B, Harms-Ringdahl K. Neck pain and related disability in helicopter pilots: a survey of prevalence and risk factors. Aviat Space Environ Med. 2006;77(7):713–9.PubMed
14.
Wickes S, Scott J, Greeves J. Epidemiology of flight-related neck pain in Royal air Force (RAF) aircrew. Aviat Space Environ Med. 2005;76:298.
15.
Walters PL, Cox JM, Clayborne K, Hathaway AJ. Prevalence of neck and back pain amongst aircrew at extremes of anthropometric measurements. In: Defense technical information center. Alexandria: USAARL reports no. 2012–12; 2012.
16.
Adam J. Results of NVG-induced neck strain questionnaire study in CH-146 griffon aircrew. In: Defence R&D Canada. Toronto: DRDC Toronto technical report no; 2004. p. 2004–153.
17.
Chafe GS, Farrell PS. Royal Canadian air Force CH-146 griffon aircrew 2014 spinal musculoskeletal trouble survey. In: Defence R&D Canada. Toronto: DRDC Toronto scientific report no. 179; 2016.
18.
Butler BP, Alem NM. Long-duration exposure criteria for head-supported mass. In: Defense technical information center. Alexandria: USAARL report no; 1997. p. 97–34.
19.
Brozoski FT, Mobasher AA, McEntire BJ, Alem NM. Mass and location criteria of head-supported devices using articulated total body simulations. In: NATO RTO meeting proceedings. San Diego: Current Aeromedical Issues in Rotary Wing Operations. p. 1998.
20.
Harrison MF, Neary JP, Albert WJ, Veillette DW, McKenzie NP, Croll JC. Physiological effects of night vision goggle counterweights on neck musculature of military helicopter pilots. Mil Med. 2007;172(8):864–70.CrossRef
21.
Knight JF, Baber C. Neck muscle activity and perceived pain and discomfort due to variations of head load and posture. Aviat Space Environ Med. 2004;75(2):123–31.PubMed
22.
Thuresson M, Äng B, Linder J, Harms-Ringdahl K. Mechanical load and EMG activity in the neck induced by different head-worn equipment and neck postures. Int J Ind Ergon. 2005;35(1):13–8.CrossRef
23.
Pousette MW, Lo Martire R, Linder J, Kristoffersson M, Äng B. Neck muscle strain in air force pilots wearing night vision goggles. Aerosp Med Hum Perform. 2016;87(11):928–32.CrossRef
24.
Van den Oord MH, Frings-Dresen MHW, Sluiter JK. Optimal helmet use and adjustments with respect to neck load: the experience in military helicopter aircrew. Int J Ind Ergon. 2012;42(1):73–9.CrossRef
25.
Äng B. Impaired neck motor function and pronounced pain-related fear in helicopter pilots with neck pain-a clinical approach. J Electromyogr Kinesiol. 2008;18(4):538–49.CrossRef
26.
Sjolander P, Michaelson P, Jaric S, Djupsjöbacka M. Sensorimotor disturbances in chronic neck pain-range of motion, peak velocity, smoothness of movement, and repositioning acuity. Man Ther. 2008;13(2):122–31.CrossRef
27.
Bahat HS, Weiss PL, Laufer Y. The effect of neck pain on cervical kinematics, as assessed in a virtual environment. Arch Phys Med Rehabil. 2010;91(12):1884–90.CrossRef
28.
Jorgensen MB, Skotte JH, Holtermann A, Sjogaard G, Petersen NC, Soogard K. Neck pain and postural balance among workers with high postural demands-a cross-sectional study. BMC Musculoskelet Disord. 2011;12(1):176.CrossRef
29.
Hämäläinen O, Vanharanta H. Effect of +Gz forces and head movements on cervical erector spinae muscle strain. Aviat Space Environ Med. 1992;63(8):709–16.PubMed
30.
Hämäläinen O. Flight helmet weight, +Gz forces, and neck muscle strain. Aviat Space Environ Med. 1993;64(1):55–7.PubMed
31.
Hämäläinen O, Vanharanta H, Bloigu R. +Gz-related neck pain: a follow-up study. Aviat Space Environ Med. 1994;65(1):16–8.PubMed
32.
Murray M, Lange B, Nornberg BR, Sogaard K, Sjogaard G. Self-administered physical exercise training as treatment of neck and shoulder pain among military helicopter pilots and crew: a randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):147.CrossRef
33.
Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, Jorgensen K. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233–7.CrossRef
34.
Harms-Ringdahl K, Carlsson AM, Ekholm J, Raustorp A, Svensson T, Toresson HG. Pain assessment with different intensity scales in response to loading of joint structures. Pain. 1986;27(3):401–11.CrossRef
35.
Polit DF, Beck CT, Owen SV. Is the CVI an acceptable Indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459–67.CrossRef
36.
Beckstead JW. Content validity is naught. Int J Nurs Stud. 2009;46(9):1274–83.CrossRef
37.
Davis LL. Instrument review: getting the most from a panel of experts. Appl Nurs Res. 1992;5(4):194–7.CrossRef
38.
Van den Oord MH, De Loose V, Meeuwsen T, Sluiter JK, Frings-Dresen MHW. Neck pain in military helicopter pilots: prevalence and associated factors. Mil Med. 2010;175(1):55–60.CrossRef
39.
Sovelius R, Oksa J, Rintala H, Huhtala H, Siitonen S. Neck muscle strain when wearing helmet and NVG during acceleration on a trampoline. Aviat Space Environ Med. 2008;79(2):112–6.CrossRef
40.
Aherne BB, Zhang C, Chen WS, Newman DG. Pilot decision making in weather-related night fatal helicopter emergency medical service accidents. Aerosp Med Hum Perform. 2018;89(9):830–6.CrossRef
41.
Makela M, Heliovaara M, Sievers K, Impivaara O, Knekt P, Aromaa A. Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol. 1991;134(11):1356–7.CrossRef
42.
Selig HF, Hüpfl M, Trimmel H, Voelckel WG, Nagele P. Pediatric trauma in the Austrian Alps: the epidemiology of sport-related injuries in helicopter emergency medical service. High Altitude Medicine Biol. 2012;13(2):112–7.CrossRef
43.
Faulhaber M, Pocecco E, Niedermeier M, Ruedl G, Walter D, Sterr R, Ebner H, Schobersberger W, Burtscher M. Fall-related accidents among hikers in the Austrian Alps: a 9-year retrospective study. BMJ Open Sport Exerc Med. 2017;3(1):e000304.CrossRef
44.
Salmon DM, Harrison MF, Neary JP. Neck pain in military helicopter aircrew and the role of exercise therapy. Aviat Space Environ Med. 2011;82(10):978–87.CrossRef
45.
Ylinen J. Physical exercises and functional rehabilitation for the management of chronic neck pain. Eura Medicophys. 2007;43(1):119–32.PubMed
46.
Andersen LL, Andersen CH, Zebis MK, Nielsen PK, Sogaard K, Sjogaard G. Effect of physical training on function of chronically painful muscles: a randomized controlled trial. J Appl Physiol. 2008;105(6):1796–801.CrossRef
47.
Zebis MK, Andersen LL, Pedersen MT, Mortensen P, Andersen CH, Pedersen MM, Boysen M, Roesller KK, Hannerz H, Mortensen OS, Sjogaard G. Implementation of neck/shoulder exercises for pain relief among industrial workers: a randomized controlled trial. BMC Musculoskelet Disord. 2011;12(1):205.CrossRef
48.
Äng B, Monnier A, Harms-Ringdahl K. Neck/shoulder exercise for neck pain in air force helicopter pilots: a randomized controlled trial. Spine. 2009;34(16):544–51.CrossRef
49.
Salmon DM, Harrison MF, Sharpe D, Candow D, Albert WJ, Neary JP. Exercise therapy for improved neck muscle function in helicopter aircrew. Aviat Space Environ Med. 2013;84(10):1046–54.CrossRef
50.
Sjøgaard G, Justesen JB, Murray M, Dalager T, Sogaard K. A conceptual model for worksite intelligent physical exercise training-IPET-intervention for decreasing life style health risk indicators among employees: a randomized controlled trial. BMC Public Health. 2014;14(1):652.CrossRef
51.
Sovelius R, Oksa J, Rintala H, Huhtala H, Ylinen J, Siitonen S. Trampoline exercise vs. strength training to reduce neck strain in fighter pilots. Aviat Space Environ Med. 2006;77(1):20–5.PubMed
Metadata
Title
Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study
Authors
Markus Posch
Alois Schranz
Manfred Lener
Werner Senn
Björn O. Äng
Martin Burtscher
Gerhard Ruedl
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2421-7

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