Pilot Back Pain- Flynn Heanna-3

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1 Back Pain in Pilots Heanna F. Flynn Embry-Riddle Aeronautical University September 10, 2023

2 Abstract Back pain in pilots is a well-known problem amongst aviators worldwide. Due to longer flying hours (with an average of 75), combined with the pilot shortage does not help. With reports of 42% experiencing back pain in a report by Posch et al., (2019), and numerous studies conducted on the ergonomics of current pilot seats, aviation safety is being put more at risk every day. The vague and small limitation for pilots to roam the cock-pit during flight increases this problem on a physiological level, and pilots need to be made more aware of proper preventative/proactive exercises to be conducted pre and post-flight. As a result, improved seat developments and proper exercise should be the first steps towards an improvement. Keywords : back pain, pilots, safety, ergonomics, pilot seats, exercise

3 Back Pain in Pilots Whenever an extended amount of time is spent in any position that seems uncomfortable to an individual, it will not take long before one starts to feel the effects. Back pain has been a commonly known complaint of pilots for many years now with no immediate action taken on how to reduce it. With pilot comfort directly impacting aviation safety, this is not something that should be overlooked. Problem Statement Aviation safety is the most crucial aspect when it comes to the success of a flight. This is even more relevant to the individuals in control of the aircraft. The issue at hand is that the number of pilots complaining about back pain is not decreasing. This problem can be caused by numerous factors including inadequate seating and “roam time” in the cockpit during flight. This study will focus on the current seating practices conducted during flight, along with average flying times among all pilots, to include fixed-wing and rotorcraft. Seat development, along with pre, mid, and post-flight exercises and precautions will be amongst the recommended solutions. Background Title 14 CFR 121.543 states when a flight crewmember may leave the assigned duty station, to which one says, “ If the crewmember's absence is in connection with physiological needs; or If the crewmember is taking a rest period, and relief is provided—. " Commercial airline pilots spend, on average, 75 hours per month flying. There can also be an addition 150 hours of work spent on pre-flight operations such as preparing flight plans and checking weather conditions ( Airline and Commercial Pilot: Occupational Outlook Handbook: U.S. Bureau of Labor Statistics , 2023). With the Occupational Safety and Health Act of 1970, Congress created the

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4 Occupational Safety and Health Administration (OSHA) to ensure safe and healthful working conditions for workers by setting and enforcing standards and by providing training, outreach, education, and assistance. However, this does not seem to be as deeply implemented with pilots due to interpretation. With any pilot, their main role consists of being in a cockpit. So, ensuring comfortable work conditions during flight, and assistance after, should be no exception given their performance is directly related to flight safety. Literature Review The Nordic Musculoskeletal Questionnaire This questionnaire was published in 1987 by a Council of Ministers to be used as a standard questionnaire when comparing low back, neck, shoulder, and general complaints (Kuorinka et al., 1987). It has also become the most used questionnaire for the study of all musculoskeletal disorders, but primarily focuses on low back pain. This questionnaire tends to record higher levels of occurrences when being administered as a focused study, rather than a general health questionnaire. The term musculoskeletal (2023) is relating to the muscles and skeleton and including bones, joints, tendons, and muscles. The common use of this questionnaire through numerous studies shows that any research done will be based upon the same foundation and thus be interpreted the same way. This creates an “even playing field” in terms of having this questionnaire act as the control in the studies and observations. Studies Posch et al. (2019) conducted a study focused on neck pain in helicopter pilots and aircrew, however since the Nordic Musculoskeletal Questionnaire was used, they collected data for the other body areas as well. In doing so they found that the 12-month prevalence of low

5 back pain was 42%, and closer to 20% for upper back pain. They also made note that the previous year that the study was conducted, 4.1% of helicopter pilots, and 36. % of crew members, self-reported flight related lower back pain. This study provided results that pilots and aircrew with low back pain have a 2.3-fold higher risk to suffer from flight-related neck pain (Posch et al., 2019). This shows the relevance that lower back pain can have on the health of the rest of the body as well. Another study was conducted on Prevalence and Potential Risk Factors for Occupational Low Back Pain Among Male Military Pilots. This was a questionnaire and physical function assessment conducted by Yang, et al., (2022). It was specifically aimed to prove that lower back pain has a negative impact on military combat effectiveness. In this study there were 217 [male] pilots assessed, with a result of 37.8% prevalence amongst fighter (36.0), helicopter (45.8), and transport pilots (35.4). Seat Ergonomics Seat ergonomics have been studied even outside of aviation. Extended periods of sitting by pilots can lead to numerous problems such as back pain, tingling, discomfort in the buttocks, legs, and feet due to surface pressure created between the seat and upper legs (Gupta et al., 2018). Floyd and Roberts (1958) conducted a study on the anatomical and physiological principles in char and table design. While their primary focus was dimensions and shapes for chairs for office and general domestic use, the ergonomics and science behind the design are also relative to pilot chairs. One of the things that was mentioned is that “the weight of the trunk should be borne mainly by the ischial tuberosities.” In doing so, this can maximize comfort, since in typical chair and seat designs, weight is being supported by the thighs which is unsuitable.

6 While their [Floyd and Roberts] research and suggestions prove promising and detailed, the struggle with pilot seats is that “one size must fit all” which is not anatomically possible due to the range of pilot height, weight, and build. Not only this, Lulić et al. (2004) mentions that there are several guidelines and recommendations that aircraft designers must follow to ensure functionality in the cockpit. The cockpit and other mechanical systems are designed based on [assumed] pilot posture and capabilities. This shows that aircraft that have already been manufactured cannot simply take out a seat and replace it with a new one, without running the risk of non-compatibility between the new seat design and current cockpit configuration/design. Salem, et al., (2022) Conducted a study on 417 EgyptAir pilots through a questionnaire survey and the results showed that pilot seat design affects positively aviation safety and its three dimensions. Lifestyle Just like any other job, a pilot’s lifestyle outside of the cockpit can also have an impact on how affected they are by their career. According to the study done by Yang, et al. (2022) not only are high volume flight hours a contributing factor, but this combined with weak core muscles have an even more significant negative effect on a pilots back health. The Aircraft Owners and Pilots Association (AOPA) has flyers on Basic Exercises for Pilots . It is not uncommon that, due to the financial and time-consuming commitment it takes to become a pilot of any degree, individuals seek this out to be a career of some form or fashion. With this, naturally comes aging. The exercise pamphlet states that “muscle mass decreases at a rate of 3 percent to 5 percent per decade after age 40, and the decline increases to 1 percent to 2 percent per year after age 50.” With such a good portion of a pilot’s workload consisting of sitting down, pilots must be aware

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7 of ways that can stay proactive against any form of musculoskeletal issues. Squats, bicep curls, push-ups, and plans, are all good examples of general exercises to help one stay healthy, The Mayo Clinic has an article online stating that the following exercises and stretches are effective for back pain: knee-to-chest stretch, lower back rotational stretch, lower back flexibility exercise, bridges, cat stretch, seated lower back rotational stretch, and shoulder blade squeeze ( Back Exercises in 15 Minutes a Day , 2023). Results The results of this case study show that there is an ongoing problem with back pain in pilots throughout the world. This is shown through studies in the United States, and other countries as well such as Egypt and other middle eastern countries as well. The problem with pilot seat ergonomics and anatomical compatibility for people has also been an ongoing issue for decades. Studies for a better designed pilot seat seems to have not been as deeply researched or pursued. We can also see that even given this information, taking the proper proactive measures such as exercise and stretching for the benefit of the lower back can help to increase the body’s resistance to experiencing it. The direct study of pilot lower back pain seems to have only recently been studied in the 21 st century. There was difficulty finding any type of case work done prior to the 2000’s. However, the study of chair ergonomics ranges back even to the 1950’s. Conclusions Based on the given data and studies, it is apparent to see that there is a direct correlation between pilot careers and lower back pain. The poor design of pilot seats in the cockpit is another contributing factor to this outcome. With the pilot shortage also impacting the industry,

8 that puts more strain on the pilots currently employed. More studies need to be done regarding the design of cockpit seating. Recommendation My recommendations moving forward are as follows: To begin, due to the aviation industry already in development for larger aircraft and seeking to leave a smaller carbon footprint, I believe that more evidence should be collected to innovate more ergonomically sound pilot seats in the cockpit. Agencies and companies that oversee hiring pilots should include exercise or physical therapy incentives to help pilots be proactive in the avoidance of back pain, rather than reacting later when their health and discomfort start to impact their ability to perform. When it comes to in-flight, I believe that, depending on the amount of time in-flight, pilots should be required to take a standing or stretching break for at least 5 minutes. This will also be dependent on the co-pilots’ capabilities to fly the aircraft in accordance with 14 CFR 121.543. In connection with this, the Occupational Safety and Health Administration should dive deeper into the impact of back pain and pilot discomfort on aircraft performance.

9 References 14 CFR 121.543 -- Flight crewmembers at controls. (n.d.). National Arcives. https://www.ecfr.gov/current/title-14/chapter-I/subchapter-G/part-121/subpart-T/section- 121.543 Airline and Commercial Pilots : Occupational Outlook Handbook: : U.S. Bureau of Labor Statistics . (2023, September 6). https://www.bls.gov/ooh/transportation-and-material- moving/airline-and-commercial-pilots.htm#tab-3 Andrade, Yolanda Nicole, "An Ergonomic Evaluation of Aircraft Pilot Seats" (2013). Dissertations and Theses. 14. https://commons.erau.edu/edt/14 Back exercises in 15 minutes a day . (2023, August 15). Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/back-pain/art- 20546859 Floyd, W. F., & Roberts, D. F. (1958). ANATOMICAL AND PHYSIOLOGICAL PRINCIPLES IN CHAIR AND TABLE DESIGN. Ergonomics , 2 (1), 1–16. https://doi.org/10.1080/00140135808930397 Gupta, I., Kalra, P., Chawla, P., & Singh, J. (2018). Evaluation of Pilot’s Seat Design of Civil Aircraft for Indian Anthropometric Data by using Delmia Human Software. Procedia Manufacturing , 26 , 70–75. https://doi.org/10.1016/j.promfg.2018.07.009 Kuorinka, I., Jonsson, B., Kilbom, Å., Vinterberg, H., Biering-Sørensen, F., Andersson, G., & Jørgensen, K. M. (1987). Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Applied Ergonomics , 18 (3), 233–237. https://doi.org/10.1016/0003-6870(87)90010-x

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10 Lulić, J., Muftić, O., and Sušić, A. (2004). Ergonomical analysis of pilot seat KM-1. Proceedings of 2nd International Ergonomics Conference, Croatia. Posch, M., Schranz, A., Lener, M., Senn, W., Äng, B. O., Burtscher, M., & Ruedl, G. (2019). Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study. BMC Musculoskeletal Disorders , 20 (1). https://doi.org/10.1186/s12891-019-2421-7 Salem, Eman & Mahrous, Toka & Al-Romeedy, Bassam. (2022). The Impact of Pilot Seat Design on Aviation Safety . https://www.researchgate.net/publication/364757369_The_Impact_of_Pilot_Seat_Design _on_Aviation_Safety Yang, Y., Liu, S., Ling, M., & Ye, C. (2022). Prevalence and potential risk factors for occupational low back pain among male military pilots: a study based on questionnaire and physical function assessment. Frontiers in Public Health , 9 . https://doi.org/10.3389/fpubh.2021.744601

11 Figures title: Category 1 Category 2 Category 3 Category 4 0 1 2 3 4 5 6 Series 1 Series 2 Series 3 Figure 1 . [Include all figures in their own section, following references (and footnotes and tables, if applicable). Include a numbered caption for each figure. Use the Table/Figure style for easy spacing between figure and caption.] For more information about all elements of APA formatting, please consult the APA Style Manual, 6th Edition .