EFFECTS OF A PILATES-BASED EXERCISE PROGRAM ON LOW BACK PAIN IN BRAZILIAN AIR FORCE HELICOPTER PILOTS.
military; rehabilitation; exercise; physical therapy; muscle fatigue; Electromyography
Introduction: Helicopter pilots often experience chronic low back pain and muscle performance alterations due to exposure to the vibration produced by the aircraft, as well as the asymmetric posture adopted during flight. Supervised physiotherapeutic exercise is considered one of the most effective treatment options for improving disability associated with nonspecific chronic low back pain. However, few studies have used the Pilates Method as a training program in this population. Objectives: Study I = To analyze the effects of a Pilates-based exercise program on low back pain among helicopter instructors of the Brazilian Air Force at Natal Air Base.
Study II: To observe electromyographic behavior related to fatigue among trained and untrained helicopter pilot instructors before and after flight. Methods: Study I: This is a single-blinded randomized controlled trial. Fifteen helicopter pilots of the Brazilian Air Force were assessed for pain intensity (Numerical Pain Rating Scale - NPRS), disability associated with low back pain, and spinal muscle endurance in three positions: trunk extension (Ito test) and right and left side bridge. Individuals were randomly allocated to the regular exercise group (REG, n = 7), instructed to maintain their normal exercise routine, or to the Pilates group (PG, n = 8), which followed a Pilates-based exercise program twice a week for 12 weeks. Reassessments occurred after 6 and 12 weeks. Assessments and reassessments were conducted by a blinded researcher. Data analysis was performed using SPSS 20.0 software, with a significance level of 5%.
Study II: This is a cross-sectional analytical observational study conducted with 14 Brazilian Air Force helicopter pilot instructors. The fatigue resistance of the multifidus muscles was observed bilaterally in trained and untrained pilots. Evaluation was performed before and immediately after the flight, using the median frequency recorded during the Ito test. Results: Study I: The PG showed a significant reduction in low back pain after 12 weeks of training (mean difference of 3.5 points on the NPRS, p = 0.015), compared to the REG (p < 0.0001). We also observed an increase in trunk extensor endurance (p = 0.002) and right (p = 0.001) and left (p = 0.001) lateral muscle endurance in the PG compared to the REG. However, disability scores did not change between the groups.
Study II: Significant differences were observed for the variable median frequency (Fmed) between trained and untrained groups before the flight. After the flight, this condition varied between the groups. In the analysis of the percentage drop in median frequency during fatigue induction, no significant difference was observed between the groups at any of the evaluated times. Conclusions: Study I: Pain intensity was significantly reduced, while spinal muscle endurance increased in the PG compared to the REG after the intervention. Thus, Pilates-based exercises should be included in physical conditioning programs for helicopter pilots.
Study II = Trained individuals exhibited a higher median frequency in the multifidus muscles than untrained individuals, as revealed by electromyography, in the pre-flight condition and showed less variation in this variable after the flight. However, no difference was observed in the percentage drop of this variable during fatigue induction when the groups were compared.