Conservative Management of Uncomplicated Mechanical Neck Pain in a Military Aviator
Written by Editor   
Friday, December 16, 2016 12:00 AM

News Bite: Fighter jet military personnel frequently suffer mechanical neck pain.  Military guidelines call for manipulative therapy, but published studies describing manipulative therapy for fighter jet aviators are scarce.  This report discusses the treatment and resolution of the mechanical neck pain of an F/A 18 instructor pilot.


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. Fighter jet aviators are exposed to large tensile, axial compression, and shear forces when flying, especially during aerial combat maneuvers (ACM). Non-radicular neck pain arising from mechanical structures in the neck (somatic pain) is a common outcome of exposure to high gravitational (G) forces. 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. Spinal disorders can result in disability and conditions that may disqualify pilots from flight duties.

In addition to non-steroidal anti-inflammatory medications, the US Navy Aeromedical Reference and Waiver Guide and the US Air Force 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.