Neck pain in military pilots, particularly helicopter and fighter jet pilots, is a major concern. Conditions inherent in flying helicopters and jets put these pilots (and crew) at a greater risk for developing neck pain due to misaligned postures, the use of additional equipment on their helmets, and exposure to high G-forces. Effectiveness and readiness are compromised if a pilot can’t fly because of pain. Pilots sometimes forego medical treatment for fear of being grounded or losing their flight status and, as a result, pain is left untreated.

Exercise programs specifically for strengthening the neck area can be helpful in preventing pain. “G-warmup” maneuvers can also be beneficial to prepare a fighter pilot for high G-forces. Military researchers are looking at improving and updating the ergonomics of aircraft seats and cockpits, as well as helmet fit. In the meantime, see your doctor if your neck pain doesn’t improve with rest and basic at-home treatments. 

Both international and American studies have found that a significant and increasing number of helicopter and fighter pilots suffer from neck (and other) pain as a result of their occupation. Many pilots seek out civilian rather than military medical treatment to avoid being grounded or losing their flight status. Others self-medicate with high doses of over-the-counter remedies such as ibuprofen, which can cause other health problems when taken long term.

Neck pain, usually associated with muscle stiffness and soreness, can be a result of several factors, although the impact of each depends on the type of pilot (helicopter versus fighter). However, seat postures, G-forces, high-risk head movements, whole-body vibration, and helmet-mounted equipment and fit play major roles in the development of pilot and aircrew neck pain. Other risk factors include age, flight hours, duration of flights, decreased muscle strength, and the onset rate of G-forces.

Key Points

• An increasing number of helicopter and fast-jet military pilots are reporting neck, back, and leg pain related to their flight experience.
• Chronic neck pain can be related to helmet fit, use of night vision goggles (NVG), seat posture, vibrations, flight duration, frequency of exposure, and physical conditioning.
• Pilots and aircrew frequently do not seek medical attention for chronic or acute neck pain for fear of losing flight status or being grounded.
• Measures to prevent neck pain in pilots include changes in the ergonomics of aircraft cockpits and helmets, as well as the implementation of pre- and post-flight exercise programs for the neck and upper body.

What We Know

Three major factors contribute to neck pain among military pilots: posture (ergonomics), helmets, and vibration. Most current helicopter cockpits were designed to reduce injuries from the hard landings and vertical crashes that were common during the Vietnam War. This design forces helicopter pilots to assume a unique position, often referred to as “helo-hunch,” a misaligned posture in which a pilot’s trunk is curved forward and slightly rotated. Ergonomic concerns for fighter pilots are more related to G-forces and neck movements associated with various maneuvers. “Checking six,” or turning to look towards the tail of the aircraft, requires extreme neck rotation that uses relatively weak muscles in the neck. Chronic exposure to such postures puts pilots at greater risk for neck pain.

The way a helmet fits, in addition to the equipment added to it—night vision goggles (NVG) and other helmet-mounted displays (HMDs)—can contribute to neck pain. The equipment mounted on a helmet changes its weight distribution on the head and neck in a way that can impede vision and cause irritation that forces the pilot to use more awkward neck positions.

Whole-body vibration, especially in helicopters, transmits mechanical vibration from the aircraft throughout the bodies of its occupants, but primarily to the pilot. The amount of whole-body vibration (WBV) a pilot experiences, combined with other factors such as posture and helmet fit, further increases the risk for neck pain or worsens existing pain.

Concerns

Pilots are not the only military personnel at risk for neck pain. Those who are confined to small spaces, with poor seating posture, and/or are exposed to WBV (e.g., tanks and high-speed marine craft) for a long period of time may also experience symptoms.

It is important to recognize symptoms of potentially serious neck pain and seek medical advice early on. Avoid self-medicating with high doses of over-the-counter drugs such as ibuprofen, which can lead to other health problems if taken for a long time. Only medical treatment can address whether the pain is easily treatable or a symptom of a more serious chronic condition.

Debrief

Several studies strongly recommend the use of “G-warm up” and neck stretching techniques prior to flying. Other research suggests that neck stabilization and strengthening exercise routines may also improve neck pain and range of motion (ROM). While these techniques have not proven to be effective for all pilots, some individuals have had success with personalized neck strengthening and training regimens.

Researchers also have recommended equipment-related solutions that are undergoing military scrutiny and development, such as the redesign of cockpits and pilot seating, inner lining of helmets, and seat pads to reduce transmission of mechanical vibration to aircraft occupants.