Conservative Management of Uncomplicated Mechanical Neck Pain in a Military Aviator
SOURCE: J Can Chiropr Assoc. 2010 (Jun); 54 (2): 92–99
Bart N. Green, DC, MSEd, Andrew S. Dunn, DC, MEd, MS,
LCDR Solomon M. Pearce, DO, and
Claire D. Johnson, DC, MSEd
Chiropractic Division,
Department of Physical and Occupational Therapy,
Naval Medical Center, San Diego,
Marine Corps Air Station Miramar,
Branch Medical Clinic,
San Diego, CA 92145-2002
Non-radicular neck pain arising from local musculoskeletal structures, known as mechanical neck pain or somatic dysfunction, is highly prevalent in the fighter jet aviator population. The management of this problem includes both therapeutic and aeromedical decisions. In addition to non-steroidal anti-inflammatory medications, waiver guides recommend therapeutic exercise and manipulative therapy as treatments for somatic spine pain in aviators, and such treatments are employed in many military locations. However, there are currently no published studies that describe the use of manipulative therapy for fighter jet aviators. We report the case of an F/A-18 instructor pilot who experienced long-term relief of uncomplicated mechanical neck pain following interdisciplinary management that included manipulation and a home exercise program. Diagnostic considerations, conservative treatment options, and aeromedical concerns are discussed.
KEYWORDS: aviation; exercise therapy; manipulation; manual therapy; neck pain; spinal
The Full-Text Article:
Introduction
Fighter jet aviators are exposed to large tensile, axial compression, and shear forces when flying, especially during aerial combat maneuvers (ACM). [1] Non-radicular neck pain arising from mechanical structures in the neck (somatic pain) is a common outcome of exposure to high gravitational (G) forces. [2] The weight of the helmet and oxygen mask and the various non-neutral head postures assumed when observing for enemy aircraft contribute to this problem. [1] Spinal disorders can result in disability [3] and conditions that may disqualify pilots from flight duties. [4] Thus, neck pain in the fighter jet aviator population has a negative impact on work performance, productivity, and is a threat to combat readiness. [5]
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In addition to non-steroidal anti-inflammatory drugs (NSAIDs) and short courses of analgesics, the US Navy Aeromedical Reference and Waiver Guide and the US Air Force Waiver Guide recommend mobilization exercises and manipulative therapy in the management of mechanical non-radicular spine pain. [6, 7] Despite recommendations by these guides and the high prevalence of neck pain, [8] we could find no published studies that describe the use of manual therapy, spinal manipulation, or spinal mobilization and therapeutic exercise for managing mechanical neck pain in aviators. In this article we present the case of a jet fighter aviator with uncomplicated mechanical neck pain who had a favorable response to conservative interdisciplinary management using manual therapy and therapeutic exercise.
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