Research on cervical spine function, core stability and strength of fighter pilots_West China Medical Journal

Authors：

 YE Chaoqun ¹ , YANG Yizhuo ¹ , LI Li ² , LIU Shuai ¹ , ZHANG Dantao ³ , LING Mengyu ¹ , LIU Shuping ²

1. Rehabilitation Medicine Department, Airforce Medical Center, Beijing 100142, P. R. China;
2. Ultrasound Department, Airforce Medical Center, Beijing 100142, P. R. China;
3. Unit 95806, People’s Liberation Army of China, Beijing 100076, P. R. China;

Corresponding author：

YE Chaoqun, Email: yechaoqun@sina.com

Keywords：

Pilot; Non-specific neck pain; Cervical spine function; Core stability; Core strength

DOI：

10.7507/1002-0179.202103216

Video：

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Objective To understand the cervical spine function, core stability and strength of fighter pilots, and to explore the difference of that between fighter pilots with and without neck pain.Methods From October to December 2020, a double-blind design was used to test the cervical spine function, core stability and strength of fighter pilots of a certain part of the Air Force. At the same time, the area of deep cervical flexor and the thickness of transverse abdominis and multifidus muscles were measured. According to the presence or absence of neck pain in the last 3 months, they were divided into neck pain group and non-neck pain group. The cervical spine function, core stability and core strength, deep cervical flexor and transversus abdominis endurance of the two groups were compared and analyzed.Results A total of 38 pilots were included. There was no significant difference in age, body mass index, service life, flight time, total flight time and weekly flight time between the neck pain group and the non-neck pain group (P>0.05). There was no significant difference in cervical spine mobility between the two groups of pilots (P>0.05). The cervical flexor muscle strength [(15.5±4.9) vs. (12.1±3.0) N] and the ratio of cervical flexion/neck extension (0.6±0.1 vs. 0.5±0.1) in the non-neck pain group were higher than in the neck pain group (P<0.05). There was no significant difference in the muscle strength of other superficial cervical muscles between the two groups (P>0.05). The average value of deep neck flexor endurance in the neck pain group [25.36 mm Hg(1 mm Hg=0.133 kPa)] better than the non-neck pain group group (17.11 mm Hg) (P=0.026). There was no significant difference in test values of transverse abdominis endurance between the two groups (P>0.05). The left hip internal rotator strength [(11.9±2.6) vs. (10.0±2.1) N] and the left hip external rotator strength [(13.7±2.2) vs. (11.9±2.0) N] in the non-neck pain group were higher than in the neck pain group (P<0.05). There was no significant difference in the muscle strength of the other hip joint muscles between the two groups (P>0.05). The thickness of the right transversus abdominis in the neck pain group [(1.1±0.3) vs. (0.8±0.3) cm] was higher than that in the non-neck pain group (P<0.05). There was no significant difference in the thickness of the left transversus abdominis, the cross-sectional area of deep cervical flexor muscle and the thickness of lumbar multifidus muscle between the two groups (P>0.05).Conclusions Fighter pilots with neck pain have superficial cervical flexor muscle strength and decreased left hip internal and external rotation muscle strength, and the superficial cervical flexor and extensor muscle strength is unbalanced. Strengthening the superficial cervical flexor muscle strength, improving the balance between the superficial cervical flexor and extensor muscles, and enhancing the hip internal and external rotator muscle strength may help prevent neck pain.

Citation： YE Chaoqun, YANG Yizhuo, LI Li, LIU Shuai, ZHANG Dantao, LING Mengyu, LIU Shuping. Research on cervical spine function, core stability and strength of fighter pilots. West China Medical Journal, 2021, 36(5): 606-612. doi: 10.7507/1002-0179.202103216 Copy

1.	Lawson BK, Scott O, Egbulefu FJ, et al. Demographic and occupational predictors of neck pain in pilots: analysis and multinational comparison. Aviat Space Environ Med, 2014, 85(12): 1185-1189.
2.	Posch M, Schranz A, Lener M, et al. Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study. BMC Musculoskelet Disord, 2019, 20(1): 44.
3.	Riches A, Spratford W, Witchalls J, et al. A systematic review and meta-analysis about the prevalence of neck pain in fast jet pilots. Aerosp Med Hum Perform, 2019, 90(10): 882-890.
4.	Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ, 2017, 358: j3221.
5.	Katz J, Melzack R. Measurement of pain. Surg Clin North Am, 1999, 79(2): 231-252.
6.	Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther, 1991, 14(7): 409-415.
7.	Farooq MN, Mohseni Bandpei MA, Ali M, et al. Reliability of the universal goniometer for assessing active cervical range of motion in asymptomatic healthy persons. Pak J Med Sci, 2016, 32(2): 457-461.
8.	Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. 3rd ed. Philadelphia: F.A. Davis Company, 2004: 312-328.
9.	Goodarzi F, Rahnama L, Karimi N, et al. The effects of forward head posture on neck extensor muscle thickness: an ultrasonographic study. J Manipulative Physiol Ther, 2018, 41(1): 34-41.
10.	Versteegh T, Beaudet D, Greenbaum M, et al. Evaluating the reliability of a novel neck-strength assessment protocol for healthy adults using self-generated resistance with a hand-held dynamometer. Physiother Can, 2015, 67(1): 58-64.
11.	Craig L. 脊柱康复医学—高级理论与临床实践. 洪毅, 海涌, 李建军, 译. 2版. 北京: 人民军医出版社, 2012: 180-181.
12.	Thorborg K, Petersen J, Magnusson SP, et al. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports, 2010, 20(3): 493-501.
13.	Jeong BL, Ha SM, Jeon IC, et al. Reliability of ultrasonography measurement for the longus colli according to inward probe pressure. J Phys Ther Sci, 2015, 27(11): 3579-3581.
14.	Wilson A, Hides JA, Blizzard L, et al. Measuring ultrasound images of abdominal and lumbar multifidus muscles in older adults: a reliability study. Man Ther, 2016, 23: 114-119.
15.	郑耀超, 林彩娜, 柯松坚, 等. 多裂肌核心稳定性训练: 超声联合表面肌电监测与无监测的比较. 中国组织工程研究, 2018, 22(36): 5785-5790.
16.	Moon BJ, Choi KH, Yun C, et al. Cross-sectional study of neck pain and cervical sagittal alignment in air force pilots. Aerosp Med Hum Perform, 2015, 86(5): 445-451.
17.	Grossman A, Nakdimon I, Chapnik L, et al. Back symptoms in aviators flying different aircraft. Aviat Space Environ Med, 2012, 83(7): 702-705.
18.	Ang BO. Impaired neck motor function and pronounced pain-related fear in helicopter pilots with neck pain - a clinical approach. J Electromyogr Kinesiol, 2008, 18(4): 538-549.
19.	Murray M, Lange B, Chreiteh SS, et al. Neck and shoulder muscle activity and posture among helicopter pilots and crew-members during military helicopter flight. J Electromyogr Kinesiol, 2016, 27: 10-17.
20.	Nagai T, Abt JP, Sell TC, et al. Neck proprioception, strength, flexibility, and posture in pilots with and without neck pain history. Aviat Space Environ Med, 2014, 85(5): 529-535.
21.	Shiri R, Frilander H, Sainio M, et al. Cervical and lumbar pain and radiological degeneration among fighter pilots: a systematic review and meta-analysis. Occup Environ Med, 2015, 72(2): 145-150.
22.	Chumbley EM, Stolfi A, McEachen JC. Risk factors for cervical pain in F-15C pilots. Aerosp Med Hum Perform, 2017, 88(11): 1000-1007.
23.	Wagstaff AS, Jahr KI, Rodskier S. +G_z-induced spinal symptoms in fighter pilots: operational and individual associated factors. Aviat Space Environ Med, 2012, 83(11): 1092-1096.
24.	Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine (Phila Pa 1976), 2004, 29(13): 1436-1440.
25.	Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and relaxation times in normal subjects and subjects with unilateral neck pain and headache. Arch Phys Med Rehabil, 1996, 77(7): 680-687.
26.	Jordan A, Mehlsen J, Ostergaard K. A comparison of physical characteristics between patients seeking treatment for neck pain and age-matched healthy people. J Manipulative Physiol Ther, 1997, 20(7): 468-475.
27.	Chiu TT, Lam TH, Hedley AJ. Maximal isometric muscle strength of the cervical spine in healthy volunteers. Clin Rehabil, 2002, 16(7): 772-779.
28.	Lange B, Toft P, Myburgh C, et al. Effect of targeted strength, endurance, and coordination exercise on neck and shoulder pain among fighter pilots: a randomized-controlled trial. Clin J Pain, 2013, 29(1): 50-59.
29.	Falla D, Jull G, Hodges PW. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Exp Brain Res, 2004, 157(1): 43-48.
30.	Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine (Phila Pa 1976), 2004, 29(19): 2108-2114.
31.	Johnston V, Jull G, Darnell R, et al. Alterations in cervical muscle activity in functional and stressful tasks in female office workers with neck pain. Eur J Appl Physiol, 2008, 103(3): 253-264.
32.	Lindstrøm R, Schomacher J, Farina D, et al. Association between neck muscle coactivation, pain, and strength in women with neck pain. Man Ther, 2011, 16(1): 80-86.
33.	Schomacher J, Farina D, Lindstroem R, et al. Chronic trauma-induced neck pain impairs the neural control of the deep semispinalis cervicis muscle. Clin Neurophysiol, 2012, 123(7): 1403-1408.
34.	Cagnie B, Dolphens M, Peeters I, et al. Use of muscle functional magnetic resonance imaging to compare cervical flexor activity between patients with whiplash-associated disorders and people who are healthy. Phys Ther, 2010, 90(8): 1157-1164.
35.	Jull G, Falla D. Does increased superficial neck flexor activity in the craniocervical flexion test reflect reduced deep flexor activity in people with neck pain?. Man Ther, 2016, 25: 43-47.

1. Lawson BK, Scott O, Egbulefu FJ, et al. Demographic and occupational predictors of neck pain in pilots: analysis and multinational comparison. Aviat Space Environ Med, 2014, 85(12): 1185-1189.
2. Posch M, Schranz A, Lener M, et al. Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study. BMC Musculoskelet Disord, 2019, 20(1): 44.
3. Riches A, Spratford W, Witchalls J, et al. A systematic review and meta-analysis about the prevalence of neck pain in fast jet pilots. Aerosp Med Hum Perform, 2019, 90(10): 882-890.
4. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ, 2017, 358: j3221.
5. Katz J, Melzack R. Measurement of pain. Surg Clin North Am, 1999, 79(2): 231-252.
6. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther, 1991, 14(7): 409-415.
7. Farooq MN, Mohseni Bandpei MA, Ali M, et al. Reliability of the universal goniometer for assessing active cervical range of motion in asymptomatic healthy persons. Pak J Med Sci, 2016, 32(2): 457-461.
8. Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. 3rd ed. Philadelphia: F.A. Davis Company, 2004: 312-328.
9. Goodarzi F, Rahnama L, Karimi N, et al. The effects of forward head posture on neck extensor muscle thickness: an ultrasonographic study. J Manipulative Physiol Ther, 2018, 41(1): 34-41.
10. Versteegh T, Beaudet D, Greenbaum M, et al. Evaluating the reliability of a novel neck-strength assessment protocol for healthy adults using self-generated resistance with a hand-held dynamometer. Physiother Can, 2015, 67(1): 58-64.
11. Craig L. 脊柱康复医学—高级理论与临床实践. 洪毅, 海涌, 李建军, 译. 2版. 北京: 人民军医出版社, 2012: 180-181.
12. Thorborg K, Petersen J, Magnusson SP, et al. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports, 2010, 20(3): 493-501.
13. Jeong BL, Ha SM, Jeon IC, et al. Reliability of ultrasonography measurement for the longus colli according to inward probe pressure. J Phys Ther Sci, 2015, 27(11): 3579-3581.
14. Wilson A, Hides JA, Blizzard L, et al. Measuring ultrasound images of abdominal and lumbar multifidus muscles in older adults: a reliability study. Man Ther, 2016, 23: 114-119.
15. 郑耀超, 林彩娜, 柯松坚, 等. 多裂肌核心稳定性训练: 超声联合表面肌电监测与无监测的比较. 中国组织工程研究, 2018, 22(36): 5785-5790.
16. Moon BJ, Choi KH, Yun C, et al. Cross-sectional study of neck pain and cervical sagittal alignment in air force pilots. Aerosp Med Hum Perform, 2015, 86(5): 445-451.
17. Grossman A, Nakdimon I, Chapnik L, et al. Back symptoms in aviators flying different aircraft. Aviat Space Environ Med, 2012, 83(7): 702-705.
18. Ang BO. Impaired neck motor function and pronounced pain-related fear in helicopter pilots with neck pain - a clinical approach. J Electromyogr Kinesiol, 2008, 18(4): 538-549.
19. Murray M, Lange B, Chreiteh SS, et al. Neck and shoulder muscle activity and posture among helicopter pilots and crew-members during military helicopter flight. J Electromyogr Kinesiol, 2016, 27: 10-17.
20. Nagai T, Abt JP, Sell TC, et al. Neck proprioception, strength, flexibility, and posture in pilots with and without neck pain history. Aviat Space Environ Med, 2014, 85(5): 529-535.
21. Shiri R, Frilander H, Sainio M, et al. Cervical and lumbar pain and radiological degeneration among fighter pilots: a systematic review and meta-analysis. Occup Environ Med, 2015, 72(2): 145-150.
22. Chumbley EM, Stolfi A, McEachen JC. Risk factors for cervical pain in F-15C pilots. Aerosp Med Hum Perform, 2017, 88(11): 1000-1007.
23. Wagstaff AS, Jahr KI, Rodskier S. +G_z-induced spinal symptoms in fighter pilots: operational and individual associated factors. Aviat Space Environ Med, 2012, 83(11): 1092-1096.
24. Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine (Phila Pa 1976), 2004, 29(13): 1436-1440.
25. Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and relaxation times in normal subjects and subjects with unilateral neck pain and headache. Arch Phys Med Rehabil, 1996, 77(7): 680-687.
26. Jordan A, Mehlsen J, Ostergaard K. A comparison of physical characteristics between patients seeking treatment for neck pain and age-matched healthy people. J Manipulative Physiol Ther, 1997, 20(7): 468-475.
27. Chiu TT, Lam TH, Hedley AJ. Maximal isometric muscle strength of the cervical spine in healthy volunteers. Clin Rehabil, 2002, 16(7): 772-779.
28. Lange B, Toft P, Myburgh C, et al. Effect of targeted strength, endurance, and coordination exercise on neck and shoulder pain among fighter pilots: a randomized-controlled trial. Clin J Pain, 2013, 29(1): 50-59.
29. Falla D, Jull G, Hodges PW. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Exp Brain Res, 2004, 157(1): 43-48.
30. Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine (Phila Pa 1976), 2004, 29(19): 2108-2114.
31. Johnston V, Jull G, Darnell R, et al. Alterations in cervical muscle activity in functional and stressful tasks in female office workers with neck pain. Eur J Appl Physiol, 2008, 103(3): 253-264.
32. Lindstrøm R, Schomacher J, Farina D, et al. Association between neck muscle coactivation, pain, and strength in women with neck pain. Man Ther, 2011, 16(1): 80-86.
33. Schomacher J, Farina D, Lindstroem R, et al. Chronic trauma-induced neck pain impairs the neural control of the deep semispinalis cervicis muscle. Clin Neurophysiol, 2012, 123(7): 1403-1408.
34. Cagnie B, Dolphens M, Peeters I, et al. Use of muscle functional magnetic resonance imaging to compare cervical flexor activity between patients with whiplash-associated disorders and people who are healthy. Phys Ther, 2010, 90(8): 1157-1164.
35. Jull G, Falla D. Does increased superficial neck flexor activity in the craniocervical flexion test reflect reduced deep flexor activity in people with neck pain?. Man Ther, 2016, 25: 43-47.

West China Medical Journal

Research on cervical spine function, core stability and strength of fighter pilots

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