Self-Kinematic Training for Flight-Associated Neck Pain: A Randomized Controlled Trial

Background: Flight-associated neck pain (FANP) is a serious problem in fighter pilots. Despite the high impact of FANP there is little evidence for effective management. However, self-kinematic training showed a positive effect in the general population.

Aim: The purpose of this study was to investigate the effectiveness of a self-kinematic training program using virtual reality in improving neck pain in fighter pilots.

Methods: There were 45 pilots with FANP who were randomized to a control group (N=23) or a training group (N=22). Training participants were instructed to exercise by a personalized self-training program, for 20 min/wk, for 4 weeks. Primary outcome measures were neck disability (NDI%) and mean velocity (° · s 2 1), and secondary were pain, health status, accuracy, and isometric strength. Assessments were conducted by a blinded assessor and intention-to-treat analysis by a blinded statistician.

Results: There were 40 pilots who completed the post-intervention assessments, and 35 completed the 6-month follow-up. Baseline measurements showed mild pain and disability (mean VAS 5 43 6 22.73, NDI 5 17.76 6 9.59%) and high kinematic performance. Compliance with self-training was poor. No differences were observed in self-reported measures and strength. Exercise duration was correlated with NDI% improvement.

Discussion: This self-kinematic training promoted kinematic performance, but was ineffective in engaging the pilots to exercise, and consequently did not improve pain and disability. Poor compliance was previously reported in self-training for FANP, suggesting further studies should prioritize supervised training. Considering the high baseline kinematic performance, kinematics does not seem to be a key factor in FANP, and future exercise research should aim for intense strengthening to increase endurance to the high Gz pilots’ experience.