Biomedical Human Kine ics, 9, 133–139, 2017
DOI: 10.1515/bhk-2017-0019
O iginal Pape
MRI indings and physical pe o mance as p edic o s o ligh -induced
musculoskele al pain incidence among igh e pilo s
Ha i Rin ala1, Roope So elius2, Pi jo Rin ala3, Heini Huh ala4, Simo Sii onen5, Heikki Ky öläinen1,6
1 Uni e si y o Jy äskylä, Facul y o Spo and Heal h Sciences, Jy äskylä, Finland; 2 Cen e o Mili a y Medicine, Sa akun a
Ai Command Heal h Clinic, Pi kkala, Finland; 3 Cen al Hospi al o Cen al Finland, Depa men o Physical Medicine and
Rehabili a ion, Jy äskylä, Finland; 4 School o Public Heal h, Uni e si y o Tampe e; Resea ch Uni , Tampe e Uni e si y
Hospi al, Tampe e, Finland; 5 De ence S a , Medical B anch, Helsinki, Finland; 6 Na ional De ence Uni e si y, Helsinki,
Finland
Summa y
S udy aim: The aim o his s udy was o e alua e he possible associa ion o p e-ca ee magne ic esonance imaging (MRI) ind-
ings and physical pe o mance le el wi h possible musculoskele al diso de s du ing je ligh aining.
Ma e ial and me hods: The s udy g oup consis ed o 73 igh e pilo s who had unde gone p e-ca ee ce ical and lumba spine
MRI. Physical pe o mance o a subg oup o he pilo s (n = 67) was measu ed ini ially a he same ime and ollowed up o he as
je aining phase ( anging om 3.8 o 7.0 yea s). Musculoskele al pain his o y du ing pilo aining was aken om he medical
cha s. MRI indings and physical pe o mance we e associa ed wi h pe cei ed clinical complain s du ing he ollow-up.
Resul s: 82% o he ce ical and 92% o he lumba spines showed abno mali ies a a leas one disk le el. MRI did no e eal
signi ican ce ical degene a ion. Thi een disk bulges in he lumba spine we e disco e ed, while 5 pilo s had lis hesis and/o
os eophy e o ma ion on he spine (lumba e eb a 4/sac oiliac join le el, L4-SI). 41% o he s udied pilo s su e ed spinal
symp oms du ing he ollow-up, bu only 16% and 17% o he ce ical and lumba MRI indings, espec i ely, we e associa ed
wi h subsequen symp oms. Endu ance and s eng h le els we e no , bu lowe body mo o skills we e, s ongly ( ela i e isk,
RR 0.46) associa ed wi h a dec eased numbe o ligh -induced medical appoin men s in he ea ly ligh ca ee .
Conclusions: Mino MRI indings ha e no p edic able alue in he e y ea ly ligh ca ee . Ne e heless, e sa ile, skills/
powe -o ien ed exe cises be o e he ligh ca ee seem o be occupa ionally bene icial in educing musculoskele al diso de s.
Keywo ds: MRI – Disk degene a ion – Ce ical spine – Lumba spine – Mili a y pilo – Fi ness
In oduc ion
Pilo s o mode n igh e s encoun e high +Gz o ces.
The occupa ional wo k load may exceed he limi s o mus-
cula pe o mance, hus causing musculoskele al pain and/
o disabili y in he daily se ice. Comba lying places high
demands on bo h he pilo s’ spinal s uc u e and physical
pe o mance. P ac ical me hods a emp ing o p edic pos-
sible ligh -induced musculoskele al p oblems la e du ing
he ligh ca ee include spinal column magne ic esonance
imaging (MRI) and speci ic, occupa ionally o ien ed phys-
ical i ness es ing du ing he pilo selec ion p ocess.
Since a numbe o epo s indica e ha Gz exposu e has
caused acu e in- ligh pain [15, 27] and inju ies [16, 21]
as well as p ema u e degene a ion [13, 24], he heal h o
spinal s uc u es should be assessed du ing selec ion o pi-
lo s. The NATO Resea ch and Technology O ganiza ion
has ecommended ha some o m o spinal diagnos ic im-
aging should be included in he e alua ion o ec ui s in
o de o de ec any spinal abno mali ies [8].
Findings wi h imaging echniques a e common among
asymp oma ic young people, bu he e a e con adic o y
epo s among pilo s. Among a selec ed popula ion o 232
No wegian mili a y pilo ec ui s, he spinal adiog aphs
o only 1/3 o hem we e conside ed no mal, while 1/10
o ec ui s we e ejec ed om ligh aining due o a-
diological indings [2]. A Ge man epo co e ing 10 922
asymp oma ic pilo ec ui s s a ed ha no mo e han 3%
o hem we e “no mal”; i.e., hey had no mo phological
changes in spinal X- ays [11]. In a g oup o young inex-
pe ienced Swedish pilo s (a e age age 23 yea s, 220 ligh
Au ho ’s add ess Ha i Rin ala, Uni e si y o Jy äskylä, P.O. Box 35, FI-40041 Uni e si y o Jy äskylä, Finland
[email p o ec ed]
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H. Rin ala e al.
134
hou s), ce ical MRI showed a low equency o occu -
ence o low-g ade degene a i e lesions [23]. A Finnish
s udy showed ha he e we e no signi ican changes in pi-
lo s’ spinal column du ing 13 yea s o ollow-up, bu only
12 pilo s we e ollowed [28].
Magne ic esonance scans a e mo e accu a e han con-
en ional adiog aphs due o hei abili y o demons a e al-
so in e e eb al disk pa hology. O he imaging echniques
such as adiog aphy, myelog aphy and compu ed omog a-
phy (CT) may p o ide complemen a y in o ma ion in se-
lec ed cases [18]. A mild deg ee o degene a i e changes
is pa aphysiological and should be conside ed pa hological
only i abno mali ies de e mine symp oms [10]. The signi i-
cance o adiological indings needs o be u he discussed.
Recen li e a u e has sugges ed ha ne e comp ession is
an impo an inding ha may con ibu e o he p edic ion
o symp oms [9]. An associa ion be ween ecen lowe back
pain and endpla e changes, disk degene a ion, annula ea s
o ace degene a ion was no ound o be a isk ac o in
a h ee-yea ollow-up. In addi ion, only limi ed in o ma ion
o he associa ions be ween occupa ional musculoskele al
diso de s, induced disabili y and physical pe o mance is
a ailable among mili a y pilo s. Howe e , i has been sug-
ges ed ha a high le el o muscula i ness p o ec s agains
disabili y bu no wo k- ela ed diso de s [25].
The e is only limi ed epidemiological e idence o he
associa ions be ween pilo s’ physical pe o mance and
occupa ional musculoskele al diso de s [25]. Long- e m,
comp ehensi e ials and/o ollow-ups on his issue do
no exis in he mode n ae omedical li e a u e, so he e
is an e iden equi emen o his kind o s udy design.
The e o e, he aim o he p esen s udy was o g ade and
examine p e-ca ee MRI indings among pilo candida es
and e alua e hei impo ance in he p edic ion o wo k-
ela ed musculoskele al diso de s du ing subsequen ligh
aining. Simul aneously, he baseline le el in pilo s’ oc-
cupa ional physical pe o mance and i s associa ion wi h
pe cei ed ligh -induced symp oms du ing he ea ly ligh
ca ee we e de e mined.
Ma e ial and me hods
Da a we e ob ained om 73 ou o 88 pilo s who
had unde gone p e-ca ee MRI o he ce ical and
lumba spine. Thei mean age du ing he ligh phase
was 26.9 ± 1.5 yea s, heigh 178 ± 5 cm, body mass
77.0 ± 7.0 kg, and body mass index (BMI) 24.1 ± 1.8 kg
m–2. Thei o al mean accumula ed lying ime was 673
± 228 h and ime in high-Gz capable ai c a (Hawk and
F-18) was 504 ± 120 h. Fi een pilo s we e excluded om
he analysis. Two o hem had ejec ed du ing hei ca ee ,
3 pilo s lacked ce ical o lumba MRI o a comple e
medical his o y, and 10 o hem had been pulled ou o
igh e aining due o a ious easons. The excluded pilo s
did no di e om he s udy sample in hei age o BMI.
Two pilo s, whose igh e pilo aining had been e mi-
na ed due o back p oblems, we e, howe e , included in
he analysis.
A e ospec i e, e idence-based analysis o neck and
back pain his o y du ing ea ly igh e pilo aining was
unde aken using in o ma ion om medical cha s (pilo s’
medical appoin men s o ligh -induced pain) [25]. The
a e age ollow-up ime a e he MRI examina ion was
6.5 yea s ( ange om 3.8 o 7.0 yea s). The MR images
we e analysed by one MRI-expe ienced medical doc o ,
specialized in physical ehabili a ion, in a blinded ashion
independen ly om clinical in o ma ion. The MR exam-
ina ions we e pe o med wi h a 1.0 T de ice (GE Signa
Ho izon, UK), and hey included he T1 and T2 weigh ed
sagi al and axial MRI o he ce ical and lumba spine.
The g ading o indings in he ce ical spine [17] is p e-
sen ed in Table 1, and he g ading o he lumba spine
indings [29] is p esen ed in Table 2. The design o his
s udy was app o ed by he E hical Commi ee o he Cen-
al Finland Heal h Ca e Dis ic (Jy äskylä, Finland) be-
o e da a collec ion.
The MRI indings we e linked wi h clinical complain s
du ing he ollow-up. These complain s we e g aded
om 0 o 2 (0 = no symp oms, 1 = mode a e and empo-
a y symp oms, and 2 = se e e o con inuous diso de s,
e.g. scia ic symp oms, con i med disk bulges wi h clini-
cal symp oms). An expe imen al physical pe o mance
es p o ocol was conduc ed in he pilo selec ion p oc-
ess o assessing he ligh cade s’ “occupa ional speci ic
i ness” cha ac e is ics. All es s we e conduc ed by an
ae ospace physiologis in he Ae omedical Cen e (Hel-
sinki, Finland). Six y-se en pilo s, who al eady had MRI
esul s a ailable wi hin 6 mon hs o he es s, we e ol-
lowed up on a e age o 5.4 yea s ( anging om 3.8 o
7.0 yea s). The d op-ou o six pilo s was due o he lack
o some physical pe o mance es s. The es s consis ed o
Disk nucleus signal P olapse Bone ma ow signal
1 = no signal loss 1 = no p olapse 1 = no in ensi y change
2 = mode a e signal loss 2 = p o usion 2 = in ensi y change
3 = o al loss 3 = p olapse
Table 1. G ading o MRI indings a he ce ical spine le el
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Figh e pilo ’s MRI and physical i ness
135
e alua ion o ae obic powe by indi ec maximal oxygen
up ake wi h a bicycle e gome e (E goline 800, Bi z, Ge -
many) [26], anae obic powe by coun e mo emen jump
on a con ac ma wi h addi ional mo o con ol e alua ion,
isome ic maximal neck and unk o ce measu emen s
[3], and 1 kg medicine ball h ow h ough in a- ed pho o
cells wi h a maximal e o (New es T unk/Neck o ce
and Powe ime , Kempele, Finland) [22]. The medical ap-
poin men s due o he ligh -induced pain we e associa ed
wi h he pilo candida es’ physical pe o mance le el du -
ing he selec ion phase.
The le el o ag eemen (kappa alue) in he adiologi-
cal a ing o e e y MR image was calcula ed by he same
eade (physia is ) in wo sepa a e eadings. The in a-
obse e ag eemen o MRI a ings was 92% (0.58). Bi-
na y logis ic eg ession analysis was used o de e mine he
associa ion o MRI indings wi h he incidence o symp-
oms. The odds a ios (OR) and 95% con idence in e als
a e p esen ed. An e idence-based ligh -induced pain in-
cidence cu e was c ea ed acco ding o he eal medical
appoin men s, and a Poisson uni a ia e eg ession model
was used o p edic (RR, ela i e isk; 95% CI) he ligh -
ela ed pain incidence wi h he le el o physical pe o m-
ance. The signi icance le el was se a p ≤ 0.05 in all s a-
is ical analyses.
Resul s
Eigh y- wo pe cen o he ce ical and 92% o he lum-
ba spines we e obse ed o ha e abno mali ies a a leas
one disk le el. No signi ican ce ical degene a ion was
ound in he p e-ca ee MRIs. All a ed changes in he ce -
ical spine we e indica ed by only mode a e signal loss in
in e e eb al disks, and he e we e no disk p o usions o
bone ma ow signal in ensi y changes. These indings we e
mos common a he ce ical e eb a 5- ho ax e eb a 1
(C5-Th1) le el. Ra ed degene a i e changes in he lumba
spine we e ound as ollows: 41 subjec s had a p o usion
a a leas one disk le el (56% o he subjec s), 2 subjec s
An e io column Pos e io column
1 = no mal 1 = no ace join degene a ion
2 = disk nucleus signal loss 2 = ace join degene a ion wi hou s enosis
3 = p o usion 3 = ace join degene a ion wi h s enosis o spondylolysis
4 = p olapse
5 = degene a i e lis hesis
6 = os eophy es
Table 2. G ading o MRI indings a he lumba spine le el
C1-2 C2-3 C3-4 C4-5 C5-6 C6-7 C7-T1
No changes 99 97 97 88 66 42 40
Signal loss in a disk 1 3 3 12 34 58 60
P olapse 0 0 0 0 0 0 0
Bone ma ow signal in ensi y change 0 0 0 0 0 0 0
L1-2 L2-3 L3-4 L4-5 L5-S1
No changes 100 100 95 51 27
Signal loss in a disk 0 0 5 34 25
P o usion 0 0 0 14 42
P olapse 0 0 0 1 1
Lis hesis 0 0 0 0 4
Os eophy es 0 0 0 0 0
Face degene a ion wi h s enosis* 0 0 0 0 3
Table 3. De ailed ela i e occu ence o MRI changes [%] a each ce ical (C) and lumba (L) spine le el be o e ligh se ice.
The same subjec can be included in mul iple ca ego ies (n = 73)
*The g aded ace degene a ions we e ela ed o subjec s wi h lis hesis, and he igu e o lis hesis includes he subjec s wi h ace degene a ion.
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H. Rin ala e al.
136
had a p olapsed disk (2%), and 3 subjec s had a lis hesis a
he L5-SI-le el (4%).
One hi d o he pilo s had a medical appoin men due
o ligh -induced pain du ing he i s 5.4 yea s om he
beginning o he se ice, bu only 16.5% (OR 3.8, CI95%:
0.8 o 18.7) o he ce ical and 16.4% (OR 2.8, CI95%: 0.7
o 11.0) o he lumba MRI indings we e associa ed wi h
subsequen symp oms (Fig. 1). Highe -deg ee MRI ind-
ings we e associa ed wi h subsequen se e e symp oms
only in 6.8% (OR 1.7, CI95%: 0.4 o 7.1) o he pilo s.
Mos o hem wi h mo e signi ican indings, e.g., a leas
p o usion (g ade 3 o mo e), we e asymp oma ic du ing
he ollow-up (28 ou o 37).
Ou o 2 pilo s who showed se e e o con inuous ce i-
cal symp oms (g ade 2), he i s one had a no mal ce ical
MRI, and he o he one had signal loss in he h ee low-
es ce ical in e e eb al disks. The e we e 8 pilo s wi h
clinical ou comes g aded as 2. Thei lumba MRI indings
included 2 no mal, 1 signal loss, 4 p o usions a a leas
one disk le el, and one lis hesis. No mal MRI was associ-
a ed wi h asymp oma ic ollow-up in 92% o cases in he
ce ical spine and in 60% o cases in he lumba spine.
Fu he mo e, no signi ican associa ion was no ed be ween
p e- ligh ca ee MRI indings and ligh -induced medical
appoin men s in he ea ly ligh syllabus.
Table 4 shows he pilo s’ main cha ac e is ics in physi-
cal pe o mance be o e he ollow-up. In Table 5, he as-
socia ions be ween di e en physical pe o mance es
esul s and he incidence o any ligh -induced medical ap-
poin men a e p esen ed. The pilo s’ luen mo o con ol
in he anae obic jumping es and neck lexion o ces had
he s onges associa ions wi h ligh -induced medical ap-
poin men s and hus in he es ic ion o he occupa ional
ela ed musculoskele al diso de s.
Table 4. Figh e pilo s’ (n = 67) physical pe o mance and
backg ound cha ac e is ics du ing he selec ion phase
Va iable Mean SD
Age, yea s 18 –
BMI 24.1 2.3
Ae obic powe [W/kg] 4.2 0.5
Anae obic powe [W/kg] 24.9 7.2
Neck lexion [N] 221 52
Neck ex ension [N] 294 48
T unk lexion [N] 660 156
T unk ex ension [N] 900 146
Ball h ow ime [ms] 220 15
Table 5. Associa ion ( ela i e isk, RR) be ween he pilo s’
di e en physical pe o mance es esul s and hei medical
appoin men s because o any ligh -induced musculoskele al
diso de du ing he ollow-up (n = 67)
Tes RR p
Ae obic powe 1.0 0.009
Anae obic powe 1.01 0.393
*mo o con ol in jumping 0.46 <0.001
Neck lexion 0.96 <0.001
Neck ex ension 1.02 0.084
T unk lexion 0.99 0.106
T unk ex ension 1.00 0.595
Ball h ow ime 1.00 0.247
Discussion
This s udy lays he basis o a ligh -ca ee long ol-
low-up by de e mining he essen ial in o ma ion o he
wo p ac ical occupa ional a iables o u u e pu poses.
Nei he he MRI indings no he occupa ional spe-
ci ic physical pe o mance indispu ably p edic ed ligh -
induced musculoskele al pain a a s a is ically signi ican
le el du ing he ea ly yea s o he ligh se ice. E en mos
o he pilo s wi h highe -deg ee MRI indings in he lum-
ba spine we e asymp oma ic du ing he ollow-up despi e
ha ing unde aken high-Gz lying. So a in ou s udy, Gz
exposu e seems o ha e no bea ing on musculoskele al
symp oms i espec i e o he occu ence o mo phological
changes in he spinal s uc u e. These esul s a e simila o
Je aine ligh yea s
0 1 2 3 4 5 6 7 8 9 10
Medical appoin men s due he ligh -induced pain [%]
0
10
20
30
40
50
60
70
80
90
100
Fig. 1. Associa ion be ween je aine ligh yea s and
medical appoin men s because o ligh -induced, ligh se ice
dis u bing musculoskele al pain (n = 67)
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Figh e pilo ’s MRI and physical i ness
137
hose o ea lie non-pilo s udies [5, 6, 9, 14] and some ob-
se a ions made among Gz-exposed popula ions [7, 24].
Howe e , no mal ce ical MRI seems less likely o be
subsequen ly associa ed wi h neck pain.
The incidence o ce ical disk degene a ion changes
was highe in his s udy compa ed wi h ea lie simila
s udies, bu he deg ee o degene a i e changes was low-
e [5, 19, 28]. This may be due o he ac ha he sub-
jec s ep esen ed a popula ion selec ed wi h e y special
c i e ia. Mos changes we e loca ed in he lowe ce ical
spine, which is con a y o he s udy o Abdulka im e al.
[1] which sugges ed ha indings in he ce ical spine
a e dis ibu ed e enly a a young age bu end o occu
in he lowe disks wi h inc easing age. I imaging o he
neck and back we e used in selec ion, some challenging
ques ions – such as wha would be conside ed c i ical o
p edic i e indings, and how c i e ia o he ejec ion o
asymp oma ic ec ui s wi h pa hological indings should
be es ablished – would need o be ho oughly discussed.
The lumba spine MRI indings and hei ou comes
we e also well in line wi h ea lie s udies [6, 9]. The le el
o changes seems o be concen a ed in he lowe lumba
spine. The incidence o musculoskele al symp oms ei he
in he ce ical o lumba spine was ob iously sligh ly low-
e han a es epo ed in he li e a u e [12, 15]. The e migh
exis non-disabling symp oms ha do no lead an indi idu-
al o con ac occupa ional heal h ca e se ices in he ea ly
phases o he ligh syllabus. This migh pa ially explain
why he incidence o ligh -induced medical appoin men s
showed a s eeply ascending end in he p esen ollow-up
(Fig. 1). Secondly, his end e lec s quickly cumula ing
physical load in he la e ligh se ice, and hus may lead
o an inc easing amoun o wo k- ela ed, mo e disabling
symp oms.
The ollow-up ime was no long enough in iew o he
cumula i e indi idual G exposu e. This is an in e es ing
phenomenon in ae ospace physiology and su ely needs
mo e esea ch o be de ined and measu ed. Howe e ,
as clinical in o ma ion was based on he pilo s’ medical
eco ds, he e was no ecall bias ha may be a ac o in
any e ospec i e ques ionnai e.
O he occupa ional (non-Gz ela ed) o leisu e ime
physical loadings may also cause musculoskele al symp-
oms and degene a ion. De e minan s o hese ypes o
phenomena a e no adjus able du ing a pilo ’s ca ee , and
hey ha e been epo ed o ha e only a modes in luence on
degene a i e changes [4, 30]. Symp oms o he han ligh -
induced ones also a ec pilo s’ i ness o ly and hei qual-
i y o li e. Al hough he e ec s o physical ac i i y we e no
e alua ed in his s udy, i is sugges ed ha he co ela ion o
physical ac i i y wi h ligh - ela ed musculoskele al diso -
de s should also be examined in u u e s udies.
The young pilo s pe o med qui e well in he physical
pe o mance es s compa ed o he li e a u e [3, 26, 28],
bu he a e age esul s we e only ba ely sa is ac o y com-
pa ed o ypical endu ance o s eng h spo s a hle ic le els
[20]. The physical pe o mance, like he MRI indings, was
mainly no associa ed wi h pe cei ed pain, which e lec s
well he mul i ac o ial na u e o his issue. The absolu e
physical pe o mance, compa ed o a hle es, was poo o
only sa is ac o y in di e en es s [22], bu he pilo s we e
qui e good in e ms o mili a y pe o mance, in gene al.
Jumping skills seemed, howe e , o conside ably educe
he numbe o ligh -induced medical appoin men s. Ob i-
ously, o e all exe cising has c ea ed such a good body bal-
ance, co e muscle s abili y and pos u e ha i has p o en
o be occupa ionally bene icial. High neck lexion and ex-
enso muscles’ s eng h, as a p o ec i e ac o , p obably
ep esen an ideal agonis -an agonis ela ionship; how-
e e , muscula balance was no measu ed in his s udy.
Excellen physical pe o mance will educe he induced
wo k- ela ed disabili y du ing he whole ligh ca ee [25].
Howe e , due o he sho - e m design used in his s udy,
i is so a impossible o conclude whe he he measu ed
physical pe o mance and, especially, i s changes a e as-
socia ed wi h pe cei ed pain in he u u e. The pilo s we e
ob iously young, a he e y beginning o hei ligh ca-
ee , and no ele an con ols exis ed.
A e he e any p edic able issues ha could be ega ded
as wa ning signs o la e spinal p oblems? Mino o e en
mode a e changes may o may no esul in symp oms
du ing he la e phases o a pilo ’s ca ee . S udies among
non-pilo s indica e ha ne e oo con ac s a e he mos
p edic able indings o pain. Howe e , MRI indings a e
no p edic i e o he de elopmen o du a ion o back pain
and ice e sa. Indi iduals su e ing om p olonged back
pain may no ha e he g ea es deg ee o ana omical ab-
no mali y [6]. Longe ollow-up could yield mo e in o -
ma ion abou de eloping degene a i e changes and hei
ela ionships wi h di e en phases o ligh aining (i.e.
di e en G- o ces). I could also be use ul o assess he
su ounding so issues such as muscle and a mass and
i s loca ion, and elas ic s uc u e including connec i e is-
sue ypes, o seek new associa ions be ween wo k- ela ed
symp oms and pe o mance.
Some limi a ions mus be discussed. The ollow-up
ime was no equal o each subjec , which esul ed in de-
ia ion in comple ed aining ( ligh hou s) and Gz expo-
su e. Howe e , he pilo s had comple ed hei minimum
basic and ac ical je aining. Those ones whose ca ee
di e ed om ac i e lying wi h high pe o mance ai c a
o who had been pulled ou om ai comba aining we e
excluded om he ma e ial. Thus, i was conside ed ha
he ollow-up da a we e homogeneous enough o enable
eliable e alua ion o he ou come o he MRI indings and
p edic ion o de eloping symp oms. 1.0 T MRI de ices
a e also al eady subs i u ed by mode n equipmen . Thus,
i migh be possible ha he baseline indings migh ha e
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H. Rin ala e al.
138
been mo e accu a e wi h he newes me hods. Ha ing only
one eade o in e p e images has i s p os and cons. On
one hand, he e is no a ia ion in opinions when a single
eade pe o ms g ading; on he o he hand, he absence o
con ol eade s may esul in unp o en opinions. Hence, i
was conside ed ha he use o jus one eade in his s udy
was a ele an me hod in e ms o occupa ional medicine.
Fi ness es s we e no conduc ed exac ly a he same ime
as MR imaging, bu he p o ocol was a anged du ing he
same p e- ligh phase wi h MRIs in he ligh syllabus, in
he same i ness es labo a o y, and by he same es pe -
sonnel and weekly calib a ed equipmen .
This may be one o he i s s udies whe e mili a y
pilo s’ MRI and physical pe o mance we e e alua ed o-
ge he in de ail wi h la e clinical ou come. As he esul s
o his s udy do no indica e a clea co ela ion wi h he
ce ical o lumba MRI, physical pe o mance and subse-
quen symp oms in he ea ly ligh syllabus, mo e ollow-
up ime o he syllabus is needed, especially up o ac i e
ligh se ice and e i emen yea s. Mino degene a i e
changes do no seem o cause se e e diso de s despi e ex-
posu e o high Gz loadings, which sugges s ha i could
be aluable o emphasize ne e oo con ac s and clea ly
de o med spinal s uc u es in he pilo selec ion p ocess.
Clinical co ela ion is essen ial o de e mine he impo -
ance o abno mali ies on magne ic esonance images,
which should also be used o de e mine he su ounding
issues s a us, i.e. body a and ac i e issue balance and
he ci cum e ence o he ac i e muscula issue, no jus
o make no es on bone s uc u e anomaly. Occupa ional-
o ien ed physical pe o mance and especially i s changes
should be included e en in he basic mili a y i ness es -
ing o ae omedical examina ion p ocedu es o cla i y he
impo ance in he igh e pilo s’ ca ee -long occupa ional
pe o mance.
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Recei ed 27.05.2017
Accep ed 11.09.2017
© Uni e si y o Physical Educa ion, Wa saw, Poland
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