Neuromuscular Research Laboratory University of Pittsburgh Exposure-Related Differences on Neck and Trunk Musculoskeletal Characteristics in US Army Helicopter Pilots Nagai T*, Abt JP*, Sell TC*, Lovalekar M*, Smalley BW † , Wirt MD ‡ , Lephart SM** Warrior Human Performance Research Center, Neuromuscular Research Laboratory, University of Pittsburgh, Pittsburgh, PA* US Army School of Aviation Medicine, Fort Rucker, AL † US Army Institute of Surgical Research, Fort Sam Houston, TX ‡ College of Health Sciences, University of Kentucky, Lexington, KY**
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Exposure-Related Differences on Neck and Trunk Musculoskeletal Characteristics in US ... · 2016. 9. 21. · Neuromuscular Research Laboratory University of Pittsburgh Exposure-Related
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Neuromuscular Research Laboratory University of Pittsburgh
Exposure-Related Differences on Neck and Trunk Musculoskeletal Characteristics in
Warrior Human Performance Research Center, Neuromuscular Research Laboratory, University of Pittsburgh, Pittsburgh, PA*
US Army School of Aviation Medicine, Fort Rucker, AL† US Army Institute of Surgical Research, Fort Sam Houston, TX‡
College of Health Sciences, University of Kentucky, Lexington, KY**
Neuromuscular Research Laboratory University of Pittsburgh
Disclosure Information 86th Annual Scientific Meeting
Takashi Nagai
Funding: the U.S. Army Medical Research and Materiel Command: W81XWH-11-2-0097. Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the U.S. Army
I have no financial relationships to disclose I will not discuss off-label use and/or investigational use in my
presentation
Neuromuscular Research Laboratory University of Pittsburgh
Introduction: High Prevalence of Neck Pain and Low Back Pain in US Army Helicopter Pilots
1yr self-reported NP/LPB among the US Army Helicopter Pilots
Potential for Interventions / Modifications – STOP THE BLEEDING!!!
Neuromuscular Research Laboratory University of Pittsburgh
Investigating the Musculoskeletal, Proprioception, and Posture Characteristics
Pilots with NP History • The NP pain group had significant
reductions in cervical extension and rotation range-of-motion (ROM)
• No differences in neck strength, upper quadrant posture, and neck proprioception
Nagai 2014
Neuromuscular Research Laboratory University of Pittsburgh
Investigating the Musculoskeletal, Proprioception, and Posture Characteristics
Pilots with NP History • The NP pain group had significant
reductions in cervical extension and rotation range-of-motion (ROM)
• No differences in neck strength, upper quadrant posture, and neck proprioception
Nagai 2014
Pilots with LBP History • The LBP group had significantly lower
trunk extension strength and trunk extension/flexion strength ratio
• The LBP group had less lumbar spine lateral flexion ROM and greater ROM asymmetry on lumbar spine lateral flexion and rotation
Nagai 2015
Neuromuscular Research Laboratory University of Pittsburgh
Non-Specific Neck Pain /
Low Back Pain
Total Flight / NVG Hours
Fatigue/Altered Proprioception
Altered Neuromotor
Control
Problem Statement • Few studies have evaluated
the musculoskeletal characteristics and compared them among groups of pilots with different flight-hours
Neuromuscular Research Laboratory University of Pittsburgh
Purpose Statement
• The purpose of the study was to examine and compare the neck/trunk strength, ROM, and posture among pilots with different total flight-hours
Neuromuscular Research Laboratory University of Pittsburgh
Clinical/Tactical Significance
• It is clinically significant to understand general patterns of the decrement of musculoskeletal characteristics so that clinicians and pilots can be aware of potential changes and participate intervention programs to reverse the trend
• Maintaining adequate strength, flexibility, and posture is essential to protect the spine so that a prevalence of NP/LBP or early progression of OA will be mitigated
• Experienced pilots play essential role in critical missions – their musculoskeletal characteristics can directly influence flight performance and readiness
Neuromuscular Research Laboratory University of Pittsburgh
Methods Subjects
• Helicopter pilots from the 101st Combat Aviation Brigade were recruited
• 115 male pilots participated in laboratory testing
• They were divided into 5 groups based on their total flight-hours 1. 0-999: n = 61 2. 1000-1999: n = 22 3. 2000-2999: n = 17 4. 3000-3999: n = 8 5. 4000+: n = 7
Laboratory Testing One-time visit (~2hr testing) • Neck strength (normalized to body weight) • Trunk strength (normalized to body weight) • Neck active range-of-motion • Lumbar spine range-of-motion • Hip rotation range-of-motion • Forward head posture • Forward shoulder posture • Pectoralis minor tightness
Statistical Analyses • Normality tests • One way ANOVA or Kruskal-Wallis • Post-hoc analyses for each group comparisons
Neuromuscular Research Laboratory University of Pittsburgh
Results: Demographics / APFT 0-999 1000-1999 2000-2999 3000-3999 4000+ p
• Strengthening focusing neck/back extensors and lateral flexors
• Proper posture and stretching pec minor muscle
• Flexibility/ROM have downward trends throughout their career while strength may vary
Neuromuscular Research Laboratory University of Pittsburgh
Immediate Cares and Prehab
Anti-WBV / NVG Countermeasures
No Fatigue / No Pain / Good
Proprioception
Build the Body: Smart and
Specific
STOP THE BLEEDING!!!
SOF Truth: “Humans are more important than hardware”
Neuromuscular Research Laboratory University of Pittsburgh
Take Home Messages
1. Suboptimal musculoskeletal characteristics exhibited by the experienced pilots resemble those exhibited by the pilots with a history of NP/LBP
2. It is clinically important for pilots to focus on pre-flight warm-up and post-flight cool-down (stretching)
3. Scientifically designed and validated programs do work in our previous study (101st Div – ETAP), and similar programs should be implemented to reduce the NP/LBP burden among helicopter pilots
Neuromuscular Research Laboratory University of Pittsburgh