BACKGROUND: Musculoskeletal disorders, including back pain, pose a significant challenge to workforce health, particularly in professions characterized by prolonged periods of sedentary activities. This challenge is notably relevant in commercial airline piloting due to unique ergonomic issues. Despite extensive research on back pain in various occupational settings, an understanding of the specific factors contributing to back pain among commercial airline pilots in Saudi Arabia is still lacking. METHODS: This cross-sectional survey aimed to investigate the prevalence of back pain among Saudi Arabian commercial airline pilots. A structured questionnaire, developed through literature review and expert consultation, covered demographic information, occupational details, and back pain history. The survey was administered online to active pilots recruited through the Saudi Airlines Medical Services, with data collection spanning six weeks. RESULTS: Among 310 predominantly male participants (99.0%), a significant prevalence of back pain was identified, with 71.3% reporting lower back pain in the last 12 months. Factors associated with a decreased likelihood of low back pain included comfortable seat conditions (odds ratio [OR]: 0.3
95% confidence interval [CI]: 0.2-0.7), a senior officer position (OR: 0.5, 95% CI: 0.3-0.8), and regular exercise (OR: 0.6, 95% CI: 0.3-1.0). Higher flying hours in the past year were associated with an increased prevalence of back pain (OR: 2.2, 95% CI: 1.2-4.1). The multivariable analysis revealed that a comfortable seat was the single independent factor most significantly associated with back pain (OR: 0.3
95% CI: 0.1-0.7). CONCLUSIONS: This study highlights a notable prevalence of back pain among Saudi Arabian commercial airline pilots, underscoring the need for targeted interventions. The critical role of seat comfort emphasizes the importance of ergonomic considerations. Findings contribute to the global discourse on pilot health, emphasizing the necessity for ongoing evaluation and potential revisions to existing guidelines. CLINICAL TRIAL NUMBER: Not applicable.