Cervical Spine Range of Motion Assessment in Aviators with Neck Pain – a Novel Approach using Virtual Reality System

Introduction:
Neck pain in aviators is a common problem. Examination of neck ROM in aviators has been executed with inaccurate tools or observation, but the introduction of new technologies such as the Virtual Reality (VR) system can increase the sensitivity of ROM measurements that the pilots undergo annually. Our goal was to evaluate the changes in cervical spine ROM among aviators and identify the possible association between those changes and increased risk for neck pain.

Materials:
In this retrospective study, we included 626 active Israeli Air Force aviators - 302 Jet aircraft pilots, 148 Helicopter pilots, 130 Transport aircrew members and 46 Flight academy instructors. All aviators were evaluated by using the VR system in order to assesses the CROM. Age and Gender, usage of Head Up Display or Night Vision system, the role in the aircraft (Navigator or pilot), aircraft type, and reported back pain or neck pain were correlated with the CROM measurements.

Results:
A significant decrease in CROM was demonstrated in subjects with Neck Pain in the axis of Flexion (P value < 0.001), Right Side Flexion (P value = 0.025) and Left Side Flexion (P value = 0.011). There was no significant association between decreased CROM and the use of HUD or NVG. CROM decreased significantly above age 50 in contrast to the all the other age groups, but in the Left Rotation and both side flexions, a significant decrease occurred earlier - between ages 30 to 40. Fighter pilots were found to suffer less from back pain as compared to navigators.

Conclusions:
CROM assessment in aviators by using the VR device can predict distinct motions that are associated with increased risk for neck pain. Further research is needed in order to analyze the alteration in CROM with respect to different risk factors.