Use of Neck Physical Training in Military Aircrew to Treat or Prevent Flight-associated Neck Pain: A Review of the Literature

Objective: To review the literature evaluating physical training exercises to treat or prevent flight-associated neck pain in military aircrew.

Methods: PubMed and Google Scholar were searched using the search terms “neck pain” OR “back pain” OR “spine pain” AND “pilot” OR “aviator” OR “aircrew” from initial indexing years to November 30, 2014. References of each article were scoured for additional papers not obtained in the search. All study designs were included. Exclusion criteria were: not aviation-related, not about exercises to treat or prevent flight-associated neck pain, not in English, and not published in peer-reviewed sources.

Results: Of 375 citations initially found, 12 papers met inclusion criteria, including 3 randomized controlled trials, 2 non-controlled trials, 1 cohort, 1 case-control, 2 cross-sectional surveys, 1 two-group lab experiment, 1 narrative overview, and 1 case report. The reports were not homogenous, precluding the pooling of data. Neck pain was identified as a public health problem in this population. Fighter jet pilots were studied most frequently (9 studies), followed by helicopter pilots (3 studies), and helicopter cabin crew (reported in 1 of the helicopter pilot papers). Isotonic strength training of the neck was associated with a decreased prevalence of neck pain, although neck muscle endurance and movement coordination were beneficial in some studies. Preflight warm ups and stretching were also studied.

Conclusion: The use of exercises to prevent or treat neck pain in military aircrew is a nascent area of investigation. Early evidence points toward the use of flexibility, strength, endurance, and movement coordination training.