title: Effect of targeted strength, endurance, and coordination exercise on neck and shoulder pain among fighter pilots: a randomized-controlled trial.
abstract: OBJECTIVE
  To explore in Danish F-16 pilots: (1) the effect on neck and shoulder pain of a 24-week training intervention including targeted training of the deep neck muscles; (2) selected clinical signs and symptoms at baseline; (3) the prevalence and intensity of neck and shoulder pain.
  
  
  METHODS
  Fifty-five F-16 pilots were randomized to 24 weeks of 3-times-a-week training (n = 27) using individual training diaries or to a control group (n = 28) that did not receive any treatment. The primary outcome was reduction in neck and shoulder pain over the previous 3 months and previous 7 days, estimated on an 11-point numeric box scale. Analysis of data was by intention-to-treat. Baseline clinical examination included palpation of muscles and joints and a craniocervical flexion test with an activation score of 10 as best and a cumulative performance index of 300 as best.
  
  
  RESULTS
  At baseline, 82% of the participants experienced neck pain within the last year. Tenderness of either the right or the left levator scapulae was significantly indicative of self-reported neck pain within the last 3 months (P = 0.02). In craniocervical flexion test, the mean activation score was 6.7 (6.1 to 7.3) and the mean cumulative performance index was 127.6 (107.0 to 153.0). At follow-up, analyses of covariance revealed a clinically significant decrease from 2.0 to 1.0 in neck pain during the previous 3 months in the training group (P = 0.01) compared with the control group.
  
  
  CONCLUSIONS
  High prevalences of self-reported neck and shoulder pain and clinical signs and symptoms were found among Gz-exposed F-16 pilots with repeated whiplash-like exposures. Twenty-four weeks of targeted training combining deep neck muscle, strength, and endurance training proved effective in reducing neck pain.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Odense University Hospital, Odense, Denmark. Britt.Lange@ouh.regionsyddanmark.dk
authors.forename: Britt
authors.initials: B
authors.lastname: Lange
authors.forename: Palle
authors.initials: P
authors.lastname: Toft
authors.forename: Corrie
authors.initials: C
authors.lastname: Myburgh
authors.forename: Gisela
authors.initials: G
authors.lastname: Sjøgaard
mesh_terms: D000328:Adult; D001359:Aviation; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D008889:Military Personnel; D019547:Neck Pain / Q000175:diagnosis* / Q000534:rehabilitation*; D010147:Pain Measurement; D010807:Physical Endurance; D020069:Shoulder Pain / Q000175:diagnosis* / Q000534:rehabilitation*; D016896:Treatment Outcome