A Question

Which is worse for your neck and lower back, sitting in front of a screen for several hours answering e-mail or sitting in front the Heads-Up-Display of a fighter jet, being whipped left and right by G-forces while your life is on the line?

Some Data

The Research Approach

It turns out there is actually a fair amount of research available to answer this question. A systematic review and meta-analysis on the prevalence of neck and back pain as well as signs of spinal degeneration on x-ray in fighter pilots was published in the British Medical Journal in September 2014. The Finish research team lead by Rahman Shiri reviewed 27 articles on the topic and conducted a meta-analysis on the results of 20 of these studies [1]. Most of the studies reviewed in the paper were case-control studies. Because this research design is observational and retrospective it cannot definitively determine causation. Future higher quality research is needed.

Pilots vs Other Military Personnel

Shiri et. al  found that that both neck and back pain as well as radiographic signs of degeneration were no more common in fighter pilots than other military personnel. More hours of flight time was not associated with more pain or degeneration when age was accounted for. But according to a review by Yang et. al published in February of 2015, military personnel have the highest prevalence of neck pain of any occupational group [2]. So the answer to the title question is: Yes fighter pilots have more pain than the general population but not more than other military personnel.

Neck pain in pilots

The review by Shiri et. al did come up with a few characteristics that were associated with neck pain in their pilots. First, those who reported neck pain were three times more likely to have been flying agile fighter jets and thus exposed to the highest g-forces (Odds ratio 3.12).  Second, among those pilots who did have neck pain, four studies found that looking back over their shoulder was the most common painful posture. Third, one study in the review found that neck pain was more common in a training environment than an operational one.  Fourth, one study in the review found that neck pain was more severe in the person in the rear seat of a double seat plane.

F-16 Pilot looking over his shoulder to “check his 6 o’clock”- the posture most reported as painful by pilots.

What about other occupations?

The review by Yang et al, found that 13.3% of the general population reported having neck pain in the last three months. The following list shows prevalence and odds ratios (OR) of neck pain in different occupations.

• Military personnel 19.5% (OR 2.5)
• Arts,design,entertainment,sports,media 16.2% (OR 1.7)
• Scientists 11.8% (OR 1.67)
• Health care support 17.3% (OR 1.55)
• Installation,maintenance, and repair  13.3% (OR 1.54)
• Architects and engineers had the lowest prevalence of neck pain at 11% (OR 1) and was used as the baseline group for calculation of the odds ratios.

Your neck is probably better off in front of a draft table than in a dogfight.

Long hours and neck pain

Yang et. al also found a linear relationship between working more than 40 hours per week and prevalence of neck pain. Neck pain was 1.2x more common among those who worked 46-59 hours and 1.35x more common among those who worked 60 hours or more per week.

Frank Lloyd Wright, Architect, Drafting the Marin County Civic Center, 1958 or 1959

My Application

The primary finding of Shiri et al is that flying planes failed to be associated with more spinal pain and degeneration than just being in the military. The lack of association between the biomechanical forces placed on the body and the presence of pain and degeneration defies common sense but is nonetheless a common finding. I believe that these  biomechanical forces on the body do matter (and more for some people than others) but are not a consistently important enough part of the equation to show up as an independent risk factor.

It seems that sitting in front of a computer all day is not as bad for your neck as being in the military. In general people with more physical jobs have more neck pain than those with sedentary jobs and the military has historically been classified as a physical job (although this is probably less true now than it used to be).

I am not sure what to make of the finding that engineers have the lowest prevalence of neck pain.

We don’t know how much of the difference in pain reports between populations is the result of the physical demands of the job and how much is the result of the psychological demands. A finding from Yang et. al which the authors made little mention of (because this was a review focused on comparing occupations) was that the prevalence of neck pain among people in serious psychological distress was a whopping 33.9% (OR3.28).

It seems that stress in your life is a much bigger risk factor for neck pain than the postures or movements of your job.

While some occupations are less likely to cause spinal pain than others, a good 35-58% of neck pain and 52-68% of low back pain have been attributed to heredity including both the “genetic determinants of spinal disc degeneration as well as one’s genetic tendency towards psychological distress.”

References

1. 2014 Shiri- Cervical and lumbar pain and radiological degeneration among fighter pilots_ A systematic review and meta-analysis
2. 2015 Yang-Work-Related Risk Factors for Neck Pain in the US Working Population
3. 2004 MacGregor- Structural, Psychological and Genetic Influences on Low Back Pain and Neck Pain: A Study of Adult Female Twins
4. Photo: Expert Infantry- Best of the U.S. Air Force – Department of Defense Image Collection – September 1998. Flickr Creative Commons Attribution License 2.0
5. Photo -110418-F-HA566-162- US Deparment of Defence Current Photos Photo Stream.  Flickr Creative Commons  Attribution License 2.0
6. Photo- Frank Lloyd Wright, Architect, Drafting the Marin County Civic Center, 1958 or 1959- sswj. Flickr Creative Commons Attribution License 2.0