Increase in Neck and Back Pain in Fighter Pilots After the Introduction of the F-35 Platform

Fighter pilots face unique occupational challenges, including exposure to high G-forces in suboptimal seating postures and wearing heavy equipment around neck and head. These factors contribute to a high prevalence of neck and back complaints, which can impair flight performance and prevent deployment of pilots. A cross-sectional survey was performed on the self-reported prevalence of neck and back pain among F-16 and F-35 pilots in the Royal Netherlands Air Force. Of the 121 pilots who were invited to participate, 50% (N = 61) were included. The questionnaire was based on prior research and adapted for military pilots. Differences between F-16 and F-35 pilots were analyzed. The subjects were 36 yr (IQR 30.0-46.0) of age and had 1900 flight hours (IQR 1000-2800). We observed a statistically significant higher prevalence of back pain among F-35 pilots compared to F-16 pilots (46% vs. 8%), whereas neck pain was higher but not statistically significant among F-35 pilots (51% vs. 38%). Contributing factors included seat angle, heavy (helmet-mounted) equipment, and specific flight maneuvers. A majority (83%) reported a negative impact on flight performance, with 38% stating it affected flight safety. Suggested preventive strategies include a multidisciplinary approach as well as adjustments of equipment. This study represents the first investigation into neck and back pain among F-35 pilots and shows a higher rate of both back and neck pain compared to F-16 pilots. Equipment and seat angle appear to be the main contributing factors. Targeted interventions are needed to prevent structural injuries, improve performance, and increase deployability. den Bult-van Wieren GB, van Rijswijk A, Kuypers MI, Steinman Y, Wingelaar TT, Nelissen RGHH. Increase in neck and back pain in fighter pilots after the introduction of the F-35 platform. Aerosp Med Hum Perform. 2025; 96(5):431-435.