title: Neck/shoulder exercise for neck pain in air force helicopter pilots: a randomized controlled trial.
abstract: METHODS
  The study was a randomized, controlled trial with blinded outcome assessment. A 6-week intervention was followed up directly afterwards and after 12 months.
  
  
  OBJECTIVE
  The purpose was to evaluate the preventive efficacy of a neck/shoulder exercise regimen for neck pain in air force helicopter pilots.
  
  
  BACKGROUND
  Neck pain is a significant medical problem in modern military aviation. Research shows neck-muscle dysfunction in subjects with various neck disorders. So far, evidence for neck exercise as prevention or early intervention is sparse, and few trials use randomized controlled design.
  
  
  METHODS
  Sixty-eight helicopter pilots on active flying duty with or without neck pain were randomly assigned to a supervised neck/shoulder exercise regimen or a control group receiving no such regimen. The key outcome was change in the prevalence of neck pain cases at the 12-month follow-up, rated for the previous week and the previous 3 months. Secondary outcomes included neck-flexor surface electromyographic activity during active craniocervical flexion and pain-related fear regarding physical activity. In addition, a secondary regression analysis included preintervention predictors that may be associated with change in prevalence of neck-pain cases at the 12-month follow-up.
  
  
  RESULTS
  Eighty-two percent (56/68) of the participants assigned at random completed the intervention and provided data at month 12. Regression analysis showed a reduction in the prevalence of neck pain cases in the exercise group, which was significant for pain ratings during the previous week, OR = 3.2 (95% CI = 1.3-7.8), and previous 3 months, OR = 1.9 (95% CI = 1.2-3.2). Electromyographic activity at the highest contraction level was significantly reduced in the exercise group, P < 0.05, whereas no between-groups effect emerged for pain-related fear. Results from the secondary analysis showed that general strength training for more than 1 hour per week before the intervention predicted reduction in prevalence of pain at follow-up.
  
  
  CONCLUSIONS
  A supervised neck/shoulder exercise regimen was effective in reducing neck pain cases in air force helicopter pilots. This was supported by improvement in neck-flexor function postintervention in regimen members. However, no effect emerged for pain-related fear. General strength training before the intervention predicted reduction in prevalence of pain at follow-up.
authors.affiliation: Department of Orthopedic Surgery, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden. Bjorn.Ang@ki.se
authors.forename: Björn O
authors.initials: BO
authors.lastname: Ang
authors.forename: Andreas
authors.initials: A
authors.lastname: Monnier
authors.forename: Karin
authors.initials: K
authors.lastname: Harms-Ringdahl
mesh_terms: D000328:Adult; D000337:Aerospace Medicine / Q000379:methods; D004311:Double-Blind Method; D004576:Electromyography; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D019547:Neck Pain / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D009784:Occupational Diseases / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D010865:Pilot Projects; D015995:Prevalence; D012044:Regression Analysis; D020069:Shoulder Pain / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome