MRI findings and physical performance as predictors of flight-induced musculoskeletal pain incidence among fighter pilots

Study aim: The aim of this study was to evaluate the possible association of pre-career magnetic resonance imaging (MRI) find­ings and physical performance level with possible musculoskeletal disorders during jet flight training. Material and methods: The study group consisted of 73 fighter pilots who had undergone pre-career cervical and lumbar spine MRI. Physical performance of a subgroup of the pilots (n = 67) was measured initially at the same time and followed up to the fast jet training phase (ranging from 3.8 to 7.0 years). Musculoskeletal pain history during pilot training was taken from the medical charts. MRI findings and physical performance were associated with perceived clinical complaints during the follow-up. Results: 82% of the cervical and 92% of the lumbar spines showed abnormalities at at least one disk level. MRI did not reveal significant cervical degeneration. Thirteen disk bulges in the lumbar spine were discovered, while 5 pilots had listhesis and/or osteophyte formation on the spine (lumbar vertebra 4/sacroiliac joint level, L4-SI). 41% of the studied pilots suffered spinal symptoms during the follow-up, but only 16% and 17% of the cervical and lumbar MRI findings, respectively, were associated with subsequent symptoms. Endurance and strength levels were not, but lower body motor skills were, strongly (relative risk, RR 0.46) associated with a decreased number of flight-induced medical appointments in the early flight career. Conclusions: Minor MRI findings have no predictable value in the very early flight career. Nevertheless, versatile, skills/power-oriented exercises before the flight career seem to be occupationally beneficial in reducing musculoskeletal disorders.