title: High-risk head and neck movements at high G and interventions to reduce associated neck injury.
abstract: BACKGROUND
  Neck injuries are a significant concern for aviators of high performance aircraft. A recent comprehensive technical report on cervical spinal injury associated with exposure to sustained acceleration, from NATO's Research and Technology Organization, recommended delineating the neck muscles used by aviators in this flying environment and developing improved neck muscle strengthening programs in an attempt to reduce such injuries.
  
  
  METHODS
  A review of current literature was conducted in the fields of biomechanics, ergonomics, orthopedics, neurology, neurosurgery, rehabilitative medicine, and aerospace medicine. An objective description is provided of the muscles involved in specific head and neck movements, and those movements that are associated with a greater risk of injury during high-G sorties. The intensity and duration of force exposures common to high performance aircraft sorties, the effects of seat-back angle on these exposures, and the types and mechanisms of neck injury reported in this environment are also described.
  
  
  RESULTS
  Primary, secondary, and tertiary preventive interventions are introduced with the goal of providing unit-level flight surgeons an approach to reducing neck injury and promoting prompt, safe return to flying of aviators with identified neck injury. A central component of these interventions is a "specific" and "intensive" neck muscle training regimen, as described in the medical literature.
  
  
  CONCLUSIONS
  Increased axial compressive force and unique biomechanics combine to make neck injury likely in high performance aviators. The application of some proposed intervention strategies may reduce the occurrence of these injuries.
authors.affiliation: US Air Force School of Aerospace Medicine, Brooks AFB, TX, USA. mark.coakwell@misawa.af.mil
authors.forename: Mark R
authors.initials: MR
authors.lastname: Coakwell
authors.forename: Donald S
authors.initials: DS
authors.lastname: Bloswick
authors.forename: Royce
authors.initials: R
authors.lastname: Moser
mesh_terms: D000054:Acceleration; D000062:Accidents, Occupational / Q000517:prevention & control*; D000337:Aerospace Medicine / Q000379:methods*; D001359:Aviation; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000502:physiology; D005081:Exercise Therapy; D006801:Humans; D018471:Hypergravity / Q000009:adverse effects*; D008889:Military Personnel; D018482:Muscle, Skeletal / Q000293:injuries / Q000502:physiology; D009333:Neck / Q000502:physiology; D019838:Neck Injuries / Q000209:etiology / Q000517:prevention & control*; D000078329:Workforce