News | July 10, 2024

Making Injury Prevention a HABIT

By Anne Owens

Pilots are routinely exposed to physical stressors and demands when flying throughout the course of their careers. These demands can result in an elevated chance to develop physiological issues including neck and back pain, or more serious injuries years later. In an effort to reduce and mitigate these issues at the outset of each pilot’s career, CNATRA partnered with some of the Navy’s top aeromedical safety officers (AMSO) to implement a virtual injury prevention program that is the first of its kind in Naval Aviation. 

The Head and Back Injury Training (HABIT) program seeks to increase mission performance by providing flight instructors and Student Naval Aviators (SNA) with the resources and training necessary to reduce the chance of injury by adequately preparing their bodies for cockpit environment. This includes a collection of stretches, exercises and workouts specifically developed to enhance mobility and address the stressors frequently experienced by pilots and aircrew. The HABIT program is governed by CNATRA Instruction 6200, which requires these procedures be included as part of the pilots’ briefing. By developing a virtual exercise program within the Navy App Locker to supplement this program, HABIT workouts can be incorporated into pre- and post-flight briefs with the goal of injury prevention and long-term health support for Naval Aviators. 

Lt. Cmdr. Taylor Burton, CNATRA aeromedical safety officer and deputy surgeon, saw many neck and back injuries during his time in the EA-18G Growler community. These aircraft, along with the F/A-18, utilize an Improved Joint Helmet-Mounted Cuing System (IJHMCS) helmet that weighs 22 pounds. This weight, in addition to G-force, creates a strain for neck muscles during high performance maneuvers. Over time, the exposure to repeated neck strain can result in a higher likelihood of chronic neck and back pain. Burton expanded his research to the strike fighter wing community and found similar issues.

“Aircrew didn’t want to stop flying, so they would often ignore physical symptoms and not seek help,” Burton said. “There wasn’t a mechanism in place in Naval Aviation to prevent these symptoms from developing. While physical therapy was an option, the information wasn’t adequately distributed so enough pilots would seek help through physical therapists.”


Using volunteers as a study group, and utilizing the knowledge of Navy physiologists, an effort known as “prehabilitation” emerged to strengthen, stretch and improve physiology before and after flights with the goal to ultimately reduce the development of neck and back pain or injuries.

“With prehabilitation, we will use the Navy App Locker to ensure every Navy pilot has access to CNATRA HABIT,” Burton said. “We all have mirror motor neurons, which are specialized nerve cells that enable someone to mimic a movement with 85 percent accuracy. If our pilots have access to a catalog of tested and approved exercises and movements that can help them reduce the chance of injury, we have that 85 percent chance that they will get the movements right and it improves with practice.”

The HABIT program is divided into two options: the “High G Series,” completed in 12 minutes, and the “Relative Flight Series,” completed in eight minutes. Each set of stretches and movements can be incorporated into specific Naval Air Training and Operating Procedures Standardization (NATOPS) checklists. Instructors and students can perform these exercises whenever access to a tablet allows. Most stretches are simple movements performed while seated in a chair or in a space large enough to fit a yoga mat.

Lt. Tyler Grubic, an aerospace/operational physiologist with Marine Aircraft Group (MAG) 13, lent his extensive research and perspective with strength and conditioning in order to develop the exercises within the HABIT app.  

“My background allowed me to treat athletes and learn how to make them bigger, faster and stronger,” Grubic said. “When I started training professional athletes at the Olympic level, it was a matter of keeping them injury-free and healthy. With prehabilitation, we make sure injuries don’t happen by warming up the body and strengthening smaller muscles around the big movers. Something I noticed from the beginning in aerospace physiology is that aircrew and pilots all deal with the prevalence of neck and back pain.”

Grubic collaborated with other physical therapists and naval physiologists to review all published literature and research on neck and back pain associated with Naval Aviation. With those findings, they developed a succinct 10-minute routine.

“Pilots are sent into very dynamic flights under high G-force, or long flights where pilots sit with poor posture in a way that their vest or helmet is weighing them down,” Grubic said. “We worked with the test pilot community in numerous aircraft to help pilots stationed there improve their health and get back into the cockpit. During my time at MAG-13, I have worked with F-35 pilots who have a large helmet, about 5 pounds, also flying dynamic flights anywhere up to 7 to 7.5 Gs. That is a lot of force on the body even without added weight of the helmet.”

Several pilots who endured back and neck pain reduced their flying hours due to those stressors. As Grubic began to train them, strengthening the spine and overall body, they built their base strength, corrected posture and increased durability of the body, especially around the spine.

“We have already seen a big turnaround and success with those pilots who build their bodies up and incorporate these exercises into their flight plan,” Grubic said. “AMSO’s have vastly different backgrounds, some are biochemists, some are researchers, and a lot are athletic trainers. That diverse background lets us assist pilots as well. As a physiologist, we frequently fly with the aircrew. We have a unique opportunity to hear their concerns, build trust with them and then encourage them to begin strength training, taking care of their bodies. When we share their successes with other pilots and aircrew, they will want to participate as well.”
Initial testing of the HABIT app by pilots, physiologists and physical therapists makes the HABIT app as user-friendly as possible. Allowing for personalization, HABIT app users can measure their pre- and post-workout pain scales, and track their strength as it improves. Depending on what physical stressor a pilot experiences, they can select, from the app, the type of pain or location on the body and be shown a series of movements to alleviate that pain. Exercises are designed for all, but can be scaled for different ability levels by utilizing resistance tools and techniques to strengthen problematic muscle groups gradually without causing soreness. This creates a personalized strength-training program with supporting data for pilots and aircrew to share with their medical caregivers. Additionally, the app will be able to track use, provide analytics, and collect feedback to continually improve service and support.

“In the long term, we are hoping that our seasoned pilots and aircrew who have experience with neck and back pain will utilize HABIT and upon seeing improvement, be able to attest to its effectiveness,” Burton said. “We hope to meet in the middle with those who have existing pain and hard-to-reverse pain from injuries and new pilots who look to their mentors for guidance and example. We would like to see a culture change towards shifting tolerance for pain levels, utilizing the Navy PTs [physical therapists] early to address back and neck issues rather than waiting until the end of your career and filing a claim with the VA to try to reverse years of damage.”

“I just want to see people get better,” Grubic said. “Giving people the tools in their own hands so they can put in the work, strengthen themselves to be resistant to these injuries, this will be an invaluable resource. It’s amazing that CNATRA is taking this research under their wing to give pilots an avenue to take care of themselves.”

CNATRA’s mission is to train, mentor and deliver the highest quality Naval Aviators who prevail in competition, crisis and conflict. Headquartered at NAS Corpus Christi, CNATRA comprises five training air wings in Florida, Mississippi and Texas, which are home to 17 training squadrons. In addition, CNATRA oversees the Navy Flight Demonstration Squadron the Blue Angels and the training curriculum for all fleet replacement squadrons. 

Anne Owens is the Chief of Naval Training deputy public affairs officer.