Ask the Flight Surgeon / By MAJ Erik S. Johnson, DO: Q: I experience a lot of back pain and I am worried I might have a bulging disc. I am concerned that I may need surgery and won’t be able to fly again. What should I do?
FS: Back pain, in one form or another, is one of the most common reasons people seek medical attention, and aircrew members are no exception. There are a myriad of potential causes, including occupational overuse, compression injuries, poor lifting techniques, poor posture, and excessive body weight. In the aviation environment there are a few unique considerations. The aircrew members sit for an extended period of time, which places the back’s natural support mechanisms at a mechanical disadvantage and is compounded by extra gear such as flight vest, body armor, and ballistic plates. Rotating helicopter blades and aircraft engines also create a significant amount of vibration, which can result in the earlier fatigue of the postural musculature of the back and core.
Despite technological advances in blade design and improvements in cabin and cockpit ergonomics, which have reduced the severity of some of these factors, back pain and injury continue to be some of the more frequent reasons that aircrew seek medical attention. These visits can range broadly from mild soreness, to moderate to severe spasms that put a pilot down for a day or two, to some requiring career-altering back surgeries. Finding a clear, single cause for the back pain is uncommon. In my experience it is best explained by the complex interplay between postural habits, occupational stressors on the back, and physical fitness (including both body weight and exercise habits). In some cases simple lifestyle changes and the loss of a few excess pounds have been successful at eliminating back pain. Other times, more intensive therapy or more invasive procedures may be necessary.
If you have persistent back pain, I strongly recommend you make an appointment to see your medical provider soon. Bulging discs, which are very common even among those without back pain, can cause significant pain, particularly when they compress nerves. In the event of compressed nerves, a patient may note intermittent shooting pains and potentially periods of numbness, tingling, or weakness. However, most back pain is likely unrelated to bulging discs and imaging, such as an MRI, is usually not necessary. Your medical team will determine if imaging, and what type, is warranted.
Things to Consider
Some important things to consider even before you see your provider are the following: work on your posture, improve your flexibility, maintain a strong core, exercise smart, and manage your weight. Using approved over-the-counter pain medicines, such as acetaminophen or anti-inflammatories might be helpful in the short term. A physical therapist and/or a chiropractor can assist you to re-train your spinal musculature, which is a critical aspect of reducing postural and occupational-related pain in the long term. You should not ignore the pain, especially if it is recurrent or has been persistent. You should work with your aeromedical provider to determine whether or not it is medically advisable to continue flight duties while being evaluated and treated for your back pain. While each case is different, return to flight duties after evaluation and treatment for back pain is common.
To summarize, back problems can range significantly in severity and stem from a number of individual factors or a combination of them. Most aircrew with back pain do not require invasive treatment and usually will not require significant time on a down-slip. Maintaining good back health through flexibility, strengthening, watching one’s weight, and establishing good postural habits (both seated and standing) can reduce the likelihood you will need medical attention for your back. Recurrent or severe problems should prompt early visits to your healthcare provider so that measures to prevent worsening can be put in place as soon as possible.
Be safe, stay healthy, and keep flying.
Question for the Flight Surgeon?
The views and opinions offered are those of the author and researchers and should not be construed as an official Department of the Army position unless otherwise stated
MAJ (Dr.) Erik S. Johnson is a flight surgeon at the U.S. Army School of Aviation Medicine, Fort Rucker, AL.