title: Self-administered physical exercise training as treatment of neck and shoulder pain among military helicopter pilots and crew: a randomized controlled trial.
abstract: Neck pain is frequent among military helicopter pilots and crew-members, and pain may influence individual health and work performance. The aim of this study was to examine if an exercise intervention could reduce neck pain among helicopter pilots and crew-members.
  
  
  
  Thirty-one pilots and thirty-eight crew-members were randomized to either an exercise-training-group (n = 35) or a reference-group (n = 34). The exercise-training-group received 20-weeks of specific neck/shoulder training. The reference-group received no training.
  
  
  
  Intensity of neck pain previous 3-months (scale 0-10).
  
  
  
  additional neck/shoulder pain intensity variables and pressure-pain-threshold in the trapezius muscle (TRA) and upper-neck-extensor muscles (UNE). Regular training adherence was defined as ≥1 training session a week. Statistical analyses performed were intention-to-treat and per-protocol. Students t-test was performed (p < 0.05).
  
  
  
  Intensity of neck pain previous 3-months at baseline was: 2.2 ± 1.8 and previous 7-days: 1.0 ± 1.5, and pressure-pain-threshold in TRA and UNE (right/left) was in kPa: 424 ± 187 / 434 ± 188 and 345 ± 157 / 371 ± 170 in the exercise-training-group, and 416 ± 177 / 405 ± 163 and 334 ± 147 / 335 ± 163 in the reference-group, with no differences between groups. Intention-to-treat-analysis revealed no significant between-group-differences in neck pain intensity and pressure-pain-threshold. Between-group-differences, including participants who trained regularly (n = 10) were also non-significant. Within-group-changes were significant among participants with regular training adherence in the exercise-training-group regarding intensity of neck pain previous 3-months (from 2.2 ± 0.6 to 1.3 ± 1.3, p = 0.019). Likewise, within the whole exercise-training-group, neck pain previous 7-days decreased (from 1.0 ± 1.4 to 0.6 ± 1.1, p = 0.024). Additional within-group-changes regarding pressure-pain-threshold in kPa were for the reference-group a reduction in TRA and UNE (right/left) to: 342 ± 143 / 332 ± 154 and 295 ± 116 / 292 ± 121 implying increased pain sensitivity, while for the exercise-training-group only a reduction in left TRA was seen: 311 ± 113.
  
  
  
  The exercise intervention did not reduce neck pain among helicopter pilots and crew-members as no significant between-group-differences were found. However, some trends were demonstrated as some neck pain intensity and sensitivity improved more within the exercise-training-group but not within the reference-group. The lack of effect may be due to low adherence since only ~ 1/3 of subjects in the exercise-training-group engaged in regular training which may be due to the self-administration of the training.
  
  
  
  Ethical committee of Southern Denmark (S-20120121) 29 August, 2012. Clinical Trail Registration ( NCT01926262 ) 16 August, 2013.
authors.affiliation: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. mike_ster@hotmail.com.
authors.forename: Mike
authors.initials: M
authors.lastname: Murray
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Britt
authors.initials: B
authors.lastname: Lange
authors.affiliation: Royal Danish Air Force, Air Force Staff, Defence Command Denmark, Karup, Denmark.
authors.forename: Bo Riebeling
authors.initials: BR
authors.lastname: Nørnberg
authors.affiliation: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: Karen
authors.initials: K
authors.lastname: Søgaard
authors.affiliation: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: Gisela
authors.identifier: 0000-0002-2961-7800
authors.initials: G
authors.lastname: Sjøgaard
mesh_terms: D000328:Adult; D003718:Denmark / Q000453:epidemiology; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D019547:Neck Pain / Q000453:epidemiology / Q000628:therapy*; D010349:Patient Compliance; D000070356:Pilots / Q000706:statistics & numerical data*; D015995:Prevalence; D012648:Self Care; D020069:Shoulder Pain / Q000453:epidemiology / Q000628:therapy*
keywords: Clinical trial; Crew-member; Exercise; Intervention; Musculoskeletal disorders; Neck; Pain; Pilot; Pressure-pain-threshold