Neck Pain in Military Pilots and in Civilians – Is It Different?

Background: Neck pain (NP) is prevalent in the general population and more so in fighter aircrews, whose fitness-to-flight may be compromised. Yet, a comparison reveals gaps of knowledge regarding flight-associated NP (FANP) characteristics.

Aims: To explore subjective and physical measures of NP and their inter-relations, within and between groups.

We expected pilots` Neck Disability Index (NDI) and Tampa scale of kinesiophobia (TSK) levels to be lower, and their physical performance to be higher compared to civilians.

Methods: Forty-five pilots and 40 civilians with NP participated in this cross-section study. Pain descriptive, NDI, TSK, and health-status were collected. Kinematics (velocity, accuracy, range) of cervical motion were measured using the Neck Virtual-Reality System, and isometric strength through dynamometry.

Results: Compared to civilians, pilots reported fewer headaches and arm pain, tracked moving targets more accurately, and their response-times were shorter. The logistic-regression model demonstrated that larger rotational accuracy errors (Odds-Ratio=0.91), headaches (OR=0.23), and forearm pain (OR=0.13), differentiated civilians from pilots with 43% accuracy. Of the weak inter-relations between subjective and physical measures, the strongest indicated that pilots’ perception of health-status improved with shorter response time, and their disability level, with larger rotation motion (r=0.42, p0.01). Civilians’ disability improved with larger acceleration-to-deceleration ratio (r=-0.41, p0.01) and with higher mean velocities (r=-0.36, p0.05).

Conclusion: Pilots’ kinematic performance was partially better, and they reported less severe symptoms – which may reflect under-reporting due to fear of temporary medical disqualification. However, the subjective measures, neck muscles` isometric strength, and the little amount of physical activity reported, were similar between groups. To improve prevention and treatment, further research of FANP characteristics is needed, specifically of cervical kinematics amongst pilots with and without NP.