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. 2010 Jun;54(2):92-9.

Conservative management of uncomplicated mechanical neck pain in a military aviator

Bart N Green  1 , Andrew S Dunn, Solomon M Pearce, Claire D Johnson
Affiliations

Conservative management of uncomplicated mechanical neck pain in a military aviator

Bart N Green et al. J Can Chiropr Assoc. 2010 Jun.

Abstract
in English, French

Non-radicular neck pain arising from local musculoskeletal structures, known as mechanical neck pain or somatic dysfunction, is highly prevalent in the fighter jet aviator population. The management of this problem includes both therapeutic and aeromedical decisions. In addition to non-steroidal anti-inflammatory medications, waiver guides recommend therapeutic exercise and manipulative therapy as treatments for somatic spine pain in aviators, and such treatments are employed in many military locations. However, there are currently no published studies that describe the use of manipulative therapy for fighter jet aviators. We report the case of an F/A-18 instructor pilot who experienced long-term relief of uncomplicated mechanical neck pain following interdisciplinary management that included manipulation and a home exercise program. Diagnostic considerations, conservative treatment options, and aeromedical concerns are discussed.

Douleur au cou non radiculaire découlant des structures musculosquelettiques locales, connue sous le nom de douleur mécanique au cou ou trouble somatique, très prévalente auprès des pilotes d’avion de combat à réaction. La gestion de ce problème inclut des décisions à la fois d’ordre thérapeutique et aeromédicale. En plus de médicaments anti-inflammatoires non stéroïdiens, les guides de dérogation recommandent de l’exercice thérapeutique et de la thérapie manuelle comme traitement pour la douleur somatique de la colonne vertébrale chez les pilotes. Ces traitements sont employés dans de nombreuses installations militaires. Toutefois, il n’existe à présent aucune étude publiée qui décrit l’usage de la thérapie manuelle chez les pilotes d’avion de combat à réaction. Nous rapportons le cas d’un pilote instructeur de F/A-18 qui a éprouvé un soulagement à long terme d’une douleur mécanique au cou non complexe à la suite d’une gestion interdisciplinaire qui incluait la thérapie manuelle et un programme d’exercices à domicile. Les considérations diagnostiques, les options de traitement conservatrices et les soucis au plan aéromédical font l’objet d’une discussion.

Keywords: aviation; exercise therapy; manipulation; manual therapy; neck pain; spinal.

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Figures

Figure 1
Figure 1
Standing isometric neck exercises. The patient stands upright, slightly contracts his abdominal muscles for stability, and pushes his forehead against a ball that is held against a wall (isometric neck flexor contraction) for at least 10 seconds. The patient is then instructed to position his body 45 degrees to the ball and repeat the isometric procedure, thereby exercising the neck with combined muscle groups. Isometric exercises are prescribed for each successive 45 degree radius for a total of 8 positions and the patient is asked to perform 2 repetitions of each position and 2 sets of these exercises daily.
Figure 2
Figure 2
Standing isotonic scapular stabilization exercises. The patient stands upright and slightly contracts the abdominal and interscapular muscles for stability. An elastic therapy band is used to create resistance and the patient simulates the movement associated with shooting an arrow from a bow. These exercises employ 2-second concentric muscle contractions from the starting point to the point of tension, a 5-second isometric hold at the point of maximum tension, and a 5-second eccentric contractions back to the starting point. These can be performed with the leading arm parallel to the floor and also angled 45 degrees toward the ceiling and toward the floor. Ten repetitions of each exercise vector were prescribed.
Figure 3
Figure 3
Red flags for neck pain, which suggest more ominous underlying pathology than uncomplicated mechanical neck pain and may require further evaluation (adapted from reference 18).
See this image and copyright information in PMC

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