Cervico-thoracic pain and associated impairments in air force personnel: a cross-sectional cohort study

Background: Pain and impaired function in the cervical region is common in Air Force personnel (AFP), but evidence is limited regarding the thoracic region. This cross-sectional cohort study examined associations between cervico-thoracic pain and physical performance among Swedish AFP and explored possible differences and similarities in test performance between fighter pilots (FP), helicopter pilots (HP) and rear crew (RC). Methods: AFP (n=73) from one airbase performed eight tests of movement control of the spine, active cervical range of motion (ROM) in all six directions and isometric strength and endurance of the cervical flexors and extensors. The association between test performance and cervico-thoracic pain (based on the ´Musculoskeletal screening protocol´ questionnaire) were analysed in a multiple binary logistic regression model. Results: For AFP with cervico-thoracic pain (30%), movement control was impaired in neck flexion (OR=3.61) and forward lean (OR=3.43) tests, together with reduced flexion ROM (OR=0.93). Test performance was in general similar between the three groups, but FP and HP could control the forward lean test to a higher degree than RC (p=0.000), FP were more flexible in lateral flexion to the right compared to HP and RC (p=0.000) and they showed higher flexor strength than RC (p=0.015). Conclusions: The impaired function associated with cervico-thoracic pain highlights the need for a deeper understanding of such relationships when designing tools to systematically optimize the physical performance and prevent pain among AFP. Studies with a longitudinal design are warranted to examine any causative associations between pain and impairments.