Effect of targeted strength, endurance, and coordination exercise on neck and shoulder pain among fighter pilots: a randomized-controlled trial

Abstract

Objectives: To explore in Danish F-16 pilots: (1) the effect on neck and shoulder pain of a 24-week training intervention including targeted training of the deep neck muscles; (2) selected clinical signs and symptoms at baseline; (3) the prevalence and intensity of neck and shoulder pain.

Methods: Fifty-five F-16 pilots were randomized to 24 weeks of 3-times-a-week training (n = 27) using individual training diaries or to a control group (n = 28) that did not receive any treatment. The primary outcome was reduction in neck and shoulder pain over the previous 3 months and previous 7 days, estimated on an 11-point numeric box scale. Analysis of data was by intention-to-treat. Baseline clinical examination included palpation of muscles and joints and a craniocervical flexion test with an activation score of 10 as best and a cumulative performance index of 300 as best.

Results: At baseline, 82% of the participants experienced neck pain within the last year. Tenderness of either the right or the left levator scapulae was significantly indicative of self-reported neck pain within the last 3 months (P = 0.02). In craniocervical flexion test, the mean activation score was 6.7 (6.1 to 7.3) and the mean cumulative performance index was 127.6 (107.0 to 153.0). At follow-up, analyses of covariance revealed a clinically significant decrease from 2.0 to 1.0 in neck pain during the previous 3 months in the training group (P = 0.01) compared with the control group.

Discussion: High prevalences of self-reported neck and shoulder pain and clinical signs and symptoms were found among Gz-exposed F-16 pilots with repeated whiplash-like exposures. Twenty-four weeks of targeted training combining deep neck muscle, strength, and endurance training proved effective in reducing neck pain.