The prevalence of Low Back Pain in commercial long haul pilots.

[tomfaulkner]

Dear All,

My name is Thomas Faulkner; I am currently carrying out a research project as part of my Masters Degree in Chiropractic.

As im sure of many of you know, back pain in general has been identified as one of the most costly disorders among the world wide population. Within the aviation industry there has been a particularly high incidence noted for many years now. However very little research as been conducted into its cause, prevention and management.

The purpose of my research is to find the prevalence pilots out there with low back pain and find out what the possible causes might be as well as looking at improvement strategies for the industry.
I am currently in talks with BALPA and hope to present the research to them on its completion.

If you are a medium/long haul pilot please follow the link below and take part in my survey, even if you have never experience low back pain. The survey should take no longer than 5 minutes.

https://www.surveymonkey.com/s/PrevalenceOfLBPinLongHaulPilots

Thank you very much for your time!

Thomas Faulkner

[cavortingcheetah]

By addressing your request to medium and long haul pilots aren't you rather missing the targeted majority group sufferers of back problems in pilots? Aircraft cockpit seats have been pretty comfortable places on which to sit since the British stopped making commercial airliners of any note. They're usually padded out with sheepskin and many pilots take their own whoopee cushions on board with them in order to make the long hours really quite comfortable. These guys do nothing much except plonk themselves down, summon the cabin attendant to bring them breakfast and, in the case of the 747 and larger Airbus machines, go back for some full length L 1.2.3 etc Lordosis straightening sleep from time to time when soft life fatigue sets in. The guys that do the damage to themselves are the short haul pilots who, instead of sitting in one place hour after hour, actually have to work with their bodies as well as with their brains for their bankroll. These are the chaps who are for ever getting in and out of their seats, sector after sector, twisting their bodies around central binnacles and performing dwarfistic contortions with overhead pressurization and hydraulic panels. If you search for statistics and take the elder pilot group into consideration then you should perhaps also look at those who started their flight lives in such European machines as F27s, HS748s, J31s, or BAC 111s. These are the cockpits that might more likely have been responsible for sowing the seeds of long term pilots' back problems. It only seems to take one wrong kink to open up that Pandora's box of pain and all of those small aircraft cockpits with limited seat manouevre provided plenty of opportunity for the start of a long and painful association with the lower lumber region.

[tomfaulkner]

Really interesting points you've made there, so thanks for your reply.

However my reasons for not choosing short haul pilots were:

1) A high percentage of long haul pilots have either previously flown short haul, rotary wing, fast jet in some stage in their career.

2) The majority of research into occupational low back pain (LBP) seems to conclude that their is a strong relationship between LBP and; exposure duration of sitting, whole body vibration, awkward postures and twisting movements. Of these factors, exposure to long durations of sitting has the strongest association with LBP especially when combined with the other variables.
The reason for this is thought to be that a) when you are seated for a long period of time, the increased loading upon the intervertebral disc causes dehydration and a lack of nutrition within the disc therefore increasing it's susceptibility to herniation and injury, especially upon twisting movements. b) if the time seated is spent in an awkward or incorrect posture over activation of certain muscles leads to hypertonicity, pain and functional deformation. c) each of the multiple joints of every spinal vertebra under these pressures become stiff, fixated and very painful due to their high nociceptive capacity.

3) When carrying out research, especially an undergrad project the more specific you can make the project the more clinically and statistically significant it can be. In this case although both are pilots, like you clearly stated their job roles are very different, therefore so to are there potential causative or aggravation factors or back pain. Increasing the number of variables like this would not only lead to a large and long project which i cannot fit in in the time we are allocated, but would also decrease its specificity.

So i don't think that i am missing the target group no, instead just separating them between the two, as i'm sure both have a high prevalence yet as the research into this area is so limited (only 1 paper regarding back pain to commercial pilots in comparison to other aviators) and old (the stated paper is 26 years old). I felt it would be appropriate to be specific and highlight the differences between the 2 commercial roles, as they cannot be classed as having identical causative factors.

Given the opportunity post-graduation i would love to follow this up looking into the prevalence of LBP in Short haul pilots if this isn't done by then. As the causative factors which you rightly stated are numerous, prominent and interesting. I feel there is in general a lack of preventative, managerial and treatment options incorporated within the industry for the benefit of their pilots and an increase in research in this area may highlight and help the addressing of this.

[cavortingcheetah]

Completely understand the points and had, totally stupidly, not thought of the first. But where did it all start, this lower back pain, that's the long and the short of it.

[Loose rivets]

Once there is the slightest uncomfortable feeling deep in the lower back, all the small movements of the day are probably 'nibbling' into damaged discs and surrounding nerve structures - the smooth movements of the facet joints now degraded and jerky.

The Swedish/Scandinavian? studies showed years ago that the highest core pressures were when sitting. Huge increases. Continuous small movements during these high pressure periods can scarcely be tolerated by a young inter-vertebral disc, let alone on oldie with a core having the substance of crab meat.

Just what causes 'Spurs' to grow, and do their blade-like ends cut into muscle fibers more when sitting?

[tomfaulkner]

Apologies for the late reply!

Bone spurs can occur due to a number of reasons, the process of growth is a result of the body promoting new bone cell production at a site of damage, degeneration or stress. This can be due to muscle, ligaments or tendons rubbing on it, degeneration, or just continued stress i.e. being in a seated posture for long periods of time accumulatively. Joints are commonly affected, especially in the spine as there are so many under such constant stress. They are very common and are classed as one of the factors of DJD (degenerative joint disease).

The spurs are usually very small and smooth bone growths and can live quite happily without causing any symptoms. However if the spur starts to impinge ever so slightly on a muscle, or especially a spinal nerve, it can cause great pain and discomfort. If it presses on the nerve too much, it can actually cause cell death and thus great loss of neurological conduction. This is when you may have heard people complain of muscle weakness, numbness, burning, tingling, pain and atrophy in the lower back or legs at the same time or after having back troubles. It can even present symptomatic in the legs without causing back pain.

[pulse1]

I get the impression from this bulletin board that many airline pilots drive considerable distances to work and, from personal experience of the driving rather than the flying, I think that this is just as likely to cause LBP. You will need to take this into consideration in your project.

[tomfaulkner]

Thank you for your input, yes unfortunately it is an uncontrollable, external contributing factor. However it has been taken into account and will be explained within the literature.

[gingernut]

Hi Tom, it sounds a realy interesting project, it'll be interesting to see the results.

Couple of comments-can't help noticing you're using the terms "prevalence" and "incidence," from experience, take care when performing your write up. It sounds like you're focussing on robust outcome measures, rather than unreliable proxy outcome measures- I should imagine there are many in the field of back pain.

Also, out of interest, what is your research question?

[tomfaulkner]

Thank you for your response and encouragement!
The proposed title is : 'The prevalence of low back pain in commercial long haul pilots' and there were 10 research questions for the outcome of the survey, as follows;

1. What is the point, period, lifetime prevalence of low back pain in long haul pilots?
2. What is the point, period, lifetime prevalence of work related low back pain in long haul pilots?
3. What type of work related low back pain do long haul pilots suffer from?
4. What factors do pilots believe may lead to low back pain?
5. What in-flight aggravating/relieving factors of low back pain do the pilots suffer from.
6. What treatments do the pilots suffer for their low back pain?
7. How beneficial do pilots think treatment for their low back pain would be?
8. How important do the pilots think musculoskeletal conditioning are with respect to preventation of low back pain?
9. How important do the pilots think musculoskeletal checkup's are with respect to preventation of low back pain related working ability?
10. Is there a relationship between work related low back pain and flying conditions ?

I hope this helps? Please let me know if there is anything else you would like to know!

[Emoclew]

Just some thoughts which might be relevant:
Paper filled cockpits; ie regular twisting >90degrees downwards, to pickup heavy Jeppie chart folders, Tech Logs etc while having to remain strapped into a fixed seat.
I know of one airline where pilots were warned to be aware of this after several back problems.
Will problems decrease with EFB's/iPads, where relevant documents are forward of the seatback line ??
I reckon this is not a factor from office staff with free, movable, swivel seats.

Aircraft specific vibrations; I am not a medic but what is the long term effect of vertical, high amplitude vibrations on the spinal discs?? (not to mention the odd "cruncher").

[cavortingcheetah]

The prevalence of lower back pain in long haul pilots would be much obviated if a protocol were established whereby a lower lumbar MRI were conducted every five years or so. The cost in the UK for such a procedure is in the region of £600. A base line would thus be established at an arguably reasonable cost which would allow early determination of the likelihood of herniated disc, tumours or spinal abnormality.

[teresa green]

For many Australian pilots it just seemed to go with the job. Having flown both long haul and short haul for just on forty nine years, it was a common complaint from day one. As it takes us basically a long time to go anywhere sitting for long hours, most have devised some sort of exercise for relief, just bending over and staying that position for a short while often brings relief. Other than that I have seen some amazing cushions and devices that their owners swear by. Backache was right up there with the other usual conversations on the flight deck, salary, super, management and sex!:{

[Soab]

I understand the airline can choose the seats when ordering, or at least upgrade to better seats.
Certainly wasnt with my airlines, however I was told this by pilots who had worked for such an airline that ordered better seats.

I believe my lower back pain first started when lifting and twisting my suitcase onto the security scanner conveyor. (That was the first time I experienced backpain) This also sets me off occasionally, or lifting things elsewhere now, but I believe the damage was done at work. Every flight requires our suitcase to be scanned.

Luckily I dont get it that often.

I need a smaller suitcase, but when your away for some time you need to take a bit with you.

[homonculus]

I would be happy to discuss this with you

Any study needs to know the objective pathology - simply using pain in the back is of little value

You also need to know the aircraft type - the Concorde fleet had a big issue so this will skew your results

Cavorting cheetah - great idea but it won't work. Over 40 you will see degenerative pathology in most MRIs but the symptamotology in relation to the scan is important. The scan in isolation may stop companies hiring but won't help pilots.

[gingernut]

The prevalence of lower back pain in long haul pilots would be much obviated if a protocol were established whereby a lower lumbar MRI were conducted every five years or so.It's a great idea, but I'd agree with Homonculus, what you're talking about here is a screening process. I'm wondering if you're thinking more like an engineer than a pilot ! (Hope that's not to patronising:))

When I'm trying to look at pathways for care and all that (how we spend taxpayers money and the such like), then this is a good starting point....

The Wilson criteria for screening emphasise the important features of any screening program, as follows:


the condition should be an important health problem
the natural history of the condition should be understood
there should be a recognisable latent or early symptomatic stage
there should be a test that is easy to perform and interpret, acceptable, accurate, reliable, sensitive and specific
there should be an accepted treatment recognised for the disease
treatment should be more effective if started early
there should be a policy on who should be treated
diagnosis and treatment should be cost-effective
case-finding should be a continuous process

It's quite old fashioned, (the WHO have some updated stuff) - but, without fulfilling these (or most of them) then we're probably on a road to nothing:)

[berno stander]

Hi tom faulkner,
I just finished reading your research topic.

I am really interrested in the research you are currently doing. To avoid posting too many threads would you be able to contact me on [email protected].

thank you kindly
berno stander

[Zoyberg]

Agree with the poster who emphasised the problem of twisting and lifting. Tech logs and plate manuals are not that heavy but pulling out an dlifting up at the same time as twisting is as bad a movement as you can get. Also many pilots have huge flight bags and don't use their wheel/handle arrangement...sounds stupid but was the cause of several weeks off for me.

[Loose rivets]

Hi Tom. Are you still reading in on this thread?