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Lumbar spine .............................................................................................. III-8-1
Arthritis ....................................................................................................... III-8-2
Extremity deficiencies ..................................................................................... III-8-2
Guidelines for assessment ............................................................................... III-8-3
ICAO Preliminary Unedited Version — November 2009 III-8-1
INTRODUCTION
In the introductory chapters of this manual, the basic principles for the assessment of an applicant’s
medical fitness for aviation duties are outlined.
The general provisions of Annex 1, 6.2.2, state that an applicant shall be required to be free from any
abnormality, disability, etc., “such as would entail a degree of functional incapacity which is likely to
interfere with the safe operation of an aircraft or with the safe performance of duties.”
The minimum levels of fitness to be accepted when assessing the musculoskeletal system of an applicant
are detailed in Annex 1, 6.3.2.23 for Class 1 Medical Assessment (and in the corresponding paragraphs of
Chapter 6 for Class 2 and Class 3 Medical Assessments.)
6.3.2.23 The applicant shall not possess any abnormality of the bones, joints, muscles, tendons or
related structures which is likely to interfere with the safe exercise of the applicant’s licence and
rating privileges.
Note.— Any sequelae after lesions affecting the bones, joints, muscles or tendons, and certain
anatomical defects will normally require functional assessment to determine fitness.
It is, however, understood that a degree of interpretation and assessment must always be exercised at the
discretion of the medical examiner, taking into consideration not only medical but also operational and
environmental factors of relevance for the over-all aeromedical evaluation of an applicant’s fitness.
When assessing the musculoskeletal system, the medical examiner should specifically note the following
points.
BACK PROBLEMS
Back problems are commonly occurring and present a special case. Instability and muscular weakness are
strong indications for shoulder harness support. Any stiffness of hips will also increase back strain with
prolonged sitting and pedal usage. Neck motion and stability must be present.
Cervical spine
A neck motion of 45° will in most cases provide enough lateral vision for flight safety; it is unlikely that a
pilot with less motion ability will move shoulders and torso in flight sufficiently to compensate for lack of
neck motion.
Lumbar spine
Lower back pain is a common complaint among flight crew members. It may be accompanied by pain
radiating to the legs in the distribution of the sciatic nerve. The causes may include:
a) local mechanical defect, e.g. injury (“acute low back”) or structural deficiency (“chronic low
back”), or intervertebral disc abnormality;
b) specific diseases of the vertebrae;
c) physiologic or abnormal function elsewhere in the body.
ICAO Preliminary Unedited Version — November 2009 III-8-2
Of special importance for flight safety is the sudden, and many times unpredictable, occurrence of acute
attacks of pain which may result in serious in-flight incapacitation.
Medical fitness for aviation duties should be based on the degree of functional recovery and risk of
recurrence that might cause sudden incapacity.
The treatment of different types of (low) back pain does not lie within the scope of this manual. A special
problem facing the medical examiner, nevertheless, is how to evaluate the possible adverse effects of any
long-term (analgesic/muscle relaxant) drug treatment, to which reference is also given in Part III, Chapter
13 of this manual.
ARTHRITIS
When assessing the medical fitness of an applicant with a history of arthritis, the medical examiner should
give consideration to:
a) severity of the disease;
b) rate of progression;
c) musculo-skeletal function with special regard to any significant restrictions of motion;
d) any complications that might cause sudden incapacity in flight.
As indicated above, the effects of long-term treatment should also be taken into consideration with regard
to possible interference to flight safety or cause of sudden incapacitation.
EXTREMITY DEFICIENCIES
Any significant sequelae from disease, injury or congenital abnormality of the bones, joints, muscles or
tendons should be assessed with regard to remaining functional capacity necessary for safe performance
of aviation duties, including emergency procedures.
Amputation of any part of an upper limb should be disqualifying for a professional pilot’s licence unless
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Manual of Civil Aviation Medicine 2(10)
