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Conditioning exercises for the neck. Conditioning exercises for the deep cervical flexors (Exercise 1 a + b) and co-contraction between cervical flexor and extensor muscles of the neck (Exercise 2 a + b)
Source publication
Flight-related neck/shoulder pain is frequent among military helicopter pilots and crew members. With a lifetime prevalence of 81 % for pilots and 84 % for crew members, the prevalence of neck pain is considered high compared to the general population. The aim of this study was to investigate whether a specifically tailored exercise intervention wo...
Context in source publication
Context 1
... position with eyes looking straight forward. During the movement, shoulders were elevated as high as possible toward the ears and lowered again [26] ( both arms pointing towards the floor. Elbows were kept in a static and slightly flexed position (~5°). During the exercise both arms were raised toward a horizontal level and lowered again [26] (Fig. 4, Exercise 10). The two ex- ercises were previously found to increase strength/en- durance and reduce neck/shoulder pain among office workers [27,28]. The training intervention was based on the principles of Intelligent Physical Exercise Training (IPET). In doing so, the intervention was designed according to: 1) the physiological ...
Citations
... 13 In response to the high burden of MSK-I, 1 2 16 MSK-I mitigation and prevention programmes (MSK-IMPP) have been developed and studied across different global militaries and within different military arms and branches. [17][18][19][20] MSK-IMPPs have focused on various strategies to mitigate injury risk, including embedding medical assets, 21 modifying physical training programming (eg, decreasing running mileage), 22 neuromuscular warm-ups, 23 bracing and equipment, 24 nutritional interventions and dietary supplementation. 25 26 Although several MSK-IMPPs have demonstrated success at reducing injuries, 21 27 28 a recent systematic review revealed that some programmes increased injury rates compared with control groups. ...
... Barnes et al 2015 26 Berg Rice et al 2002 50 Brushøj et al 2008 23 Hartig and Henderson 1999 27 Knapik et al 2004 95 Lappe et al 2008 25 Murray et al 2015 19 Rudzki, 1997 3 Rudzki, 1999 122 Strong stakeholder engagement (n=22) ...
Introduction
Musculoskeletal injury (MSK-I) mitigation and prevention programmes (MSK-IMPPs) have been developed and implemented across militaries worldwide. Although programme efficacy is often reported, development and implementation details are often overlooked, limiting their scalability, sustainability and effectiveness. This scoping review aimed to identify the following in military populations: (1) barriers and facilitators to implementing and scaling MSK-IMPPs; (2) gaps in MSK-IMPP research and (3) future research priorities.
Methods
A scoping review assessed literature from inception to April 2022 that included studies on MSK-IMPP implementation and/or effectiveness in military populations. Barriers and facilitators to implementing these programmes were identified.
Results
From 132 articles, most were primary research studies (90; 68.2%); the remainder were review papers (42; 31.8%). Among primary studies, 3 (3.3%) investigated only women, 62 (69%) only men and 25 (27.8%) both. Barriers included limited resources, lack of stakeholder engagement, competing military priorities and equipment-related factors. Facilitators included strong stakeholder engagement, targeted programme design, involvement/proximity of MSK-I experts, providing MSK-I mitigation education, low burden on resources and emphasising end-user acceptability. Research gaps included variability in reported MSK-I outcomes and no consensus on relevant surveillance metrics and definitions.
Conclusion
Despite a robust body of literature, there is a dearth of information about programme implementation; specifically, barriers or facilitators to success. Additionally, variability in outcomes and lack of consensus on MSK-I definitions may affect the development, implementation evaluation and comparison of MSK-IMPPs. There is a need for international consensus on definitions and optimal data reporting elements when conducting injury risk mitigation research in the military.
... 13 Despite this evidence regarding the functional adaptations of individuals with chronic neck pain, those studies are based on the general population, which makes it difficult to extrapolate these results to military pilots. Several studies have shown the effectiveness of neck strengthening for the treatment of chronic pain in military pilots, [14][15][16] but conflicting results are showing whether military pilots with chronic neck pain have less neck strength than military pilots without chronic neck pain. 17,18 A study of French military pilots showed that those with neck pain have less neck strength than those without such pain, 17 yet another study, of American military pilots, did not show these results. ...
Objective
This systematic review aimed to assess whether there is a difference in neck strength between military pilots and aircrew with and without chronic neck pain.
Methods
The PubMed, Embase, and Scopus databases were searched. Two independent reviewers selected relevant full articles comparing neck strength between military pilots and aircrew with and without chronic neck pain. Two independent reviewers extracted the data from the full articles selected. A meta-analysis was used to assess standardized mean differences in neck strength based on a random-effects model.
Results
The search returned 3554 results; 5 articles were included in the study. Military pilots and aircrew with chronic neck pain showed no difference in neck strength from military pilots and aircrew without chronic neck pain for flexion and extension, but did show a neck strength reduction for right and left lateral flexion -0.29 (95% confidence interval, -0.52 to -0.06; I² = 3%) and -0.23 (95% confidence interval, -0.45 to 0.00; I² = 0%), respectively.
Conclusion
Based on this meta-analysis with a 3a level of evidence, military pilots and aircrew with chronic neck pain have reduced neck strength for coronal head movement, but not sagittal movement compared with military pilots and aircrew without chronic neck pain.
... LBP poses a serious threat to helicopter pilots because it can impair the operational capabilities closely related to flight safety, such as attention, motion control and postural stability (Harrison et al., 2009;Gaydos, 2012). To prevent LBP and alleviate its adverse effects, a comprehensive set of solutions, including flight-specific exercises, the use of lumbar support as well ergonomic cockpit and seat, have been applied for helicopter pilots (Gaydos, 2012;Murray et al., 2015;Andersen et al., 2017). Unfortunately, the incidence of LBP among helicopter pilots has remained high as a result of inevitable vibration and poor sitting posture. ...
Low back pain (LBP) is known to pose a serious threat to helicopter pilots. This study aimed to explore the potential of electrical bio-impedance (EBI) technique with the advantages of no radiation, non-invasiveness and low cost, which is intended to be used as a daily detection tool to assess LBP in primary aviation medical units. The LBP scales (severity) in 72 helicopter pilots were assessed using a pain questionnaire, while the bilateral impedance measurements of the lumbar muscle were carried out with a high precision EBI measurement system. Results showed that the modulus of lumbar muscle impedance increased with LBP scale whereas the phase angle decreased. For different LBP scales, significant differences were found in the modulus of lumbar muscle impedance sum on both sides (Zsum), as well as in the modulus and phase angle of lumbar muscle impedance difference between both sides (Zdiff and ϕdiff), respectively (P < 0.05). Moreover, Spearman’s correlation analysis manifested a strong correlation between Zsum and LBP scale (R = 0.692, P < 0.01), an excellent correlation between Zdiff and LBP scale (R = 0.86, P < 0.01), and a desirable correlation between ϕdiff and LBP scale (R = −0.858, P < 0.01). In addition, receiver operator characteristic analysis showed that for LBP prediction, the area under receiver operator characteristic curve of Zsum, Zdiff, and ϕdiff were 0.931, 0.992, and 0.965, respectively. These findings demonstrated that EBI could sensitively and accurately detect the state of lumbar muscle associated with LBP, which might be the potential tool for daily detection of LBP in primary aviation medical units.
... In contrast, some studies have followed a global exercise approach targeting all neck extensor muscles (i.e., deep and superficial neck muscles). These studies reported positive effects on pain and disability, neuromuscular function Murray et al., 2015;O'leary et al., 2015), and structural muscular changes (O'leary et al., 2015). To date the efficacy of exercises specifically targeting the deep neck extensors has neither been tested nor compared to global exercises for the neck extensors. ...
... Global exercises for the neck extensors have shown significant reductions in pain and disability, improved functional outcomes (i.e., neuromuscular coordination) O'Leary et al., 2012;Murray et al., 2015), and changes in structural muscle parameters (i.e., fatty infiltration) (O'leary et al., 2015). Recent studies have shown reduced activation of the deep neck extensors (i.e. ...
Background
Structural and functional impairments of the cervical extensor muscles have been demonstrated in people with neck pain. A global exercise approach targeting all neck extensor muscles has shown positive effects in this population. However, to date, the efficacy of exercises specifically targeting the deep neck extensors has neither been tested nor compared to global exercises for the neck extensors.
Objectives
To compare the effects on pain and disability of a specific lower deep neck extensors (SLDNE) versus a general neck extensor (GNE) exercise program in women with chronic idiopathic neck pain.
Methods
Fourty-three women with chronic idiopathic neck pain were randomly allocated to either a six-week SLDNE or a GNE exercise program. As primary outcome, neck disability was measured with the Neck Disability Index (NDI). Secondarily, pain intensity (VAS), cervical ROM, pressure pain thresholds (PPTs), cervical and thoracic posture and self-perceived benefit of treatment (GROC) were also measured. Every outcome was measured at baseline and immediately after treatment, except NDI, which was also measured at 6-months follow-up. The GROC was only assessed post-intervention.
Results
Both exercise programs lead to reduced neck disability immediately post-intervention (within-group mean difference [MD] = −6.09; 95% Confidence Interval [CI]: 7.75, −4.42 and −4.73; 95%CI: 6.57, −2.91 respectively) and at the 6-months follow-up (−4.47; 95%CI: 6.41, −2.53 and −4.74; 95%CI: 6.50, −2.97), but with no between group differences. Similar results were found for pain intensity post-intervention, with no between group interaction (within-group MD = −20.87 mm; 95% CI: 28.55, −13.19 and −18.00 mm; 95%CI: (−26.24, −9.76) for SLDNE and GNE groups, respectively). GROC improved after both interventions without any between-group difference.
Conclusions
A six-week exercise program specifically targeting the lower deep neck extensors lead to comparable outcomes as a general neck extensor exercise program in women with chronic idiopathic neck pain.
... This results in a total of 318 different programs for one-hour training sessions to be offered to the working population but may of course be increased manifold if further individualized. A number of strength training programs were developed Johnston et al., 2014;Lange et al., 2013;Murray et al., 2015;Ying et al., 2020;Zebis et al., 2011)\ while other interventions programs also included aerobic and functional training Blangsted et al., 2008;Burich et al., 2015;Christensen et al., 2016;Gram et al., 2012;Holtermann et al., 2010;Jay et al., 2014;Sjøgaard et al., 2014). Strength training was in most studies designed to counteract neck/shoulder pain related to low-level static contraction performed during monotonous repetitive work or to train muscle strength due to low force capacity or for improving capacity to meet challenging high-performance job tasks. ...
Physical activity is known to benefit health while muscle activation and movements performed during occupational work in contrast may result in work-related musculoskeletal disorders. Therefore, we posed the research question: which mode of muscle activation may result in a reversal of work-related disorders? To address this, we performed electromyographic (EMG) and kinematic assessments of workers with diverse exposure categories: sedentary monotonous work, prolonged walking/standing, and physically heavy work. The various job-specific exposure variables could be categorized in terms of duration, intensity, repetition, static component, peak force etc. that were subsequently identified as risk factors. Based on sports science principles we developed tailored exercise programs to counteract job exposure. EMG activity during exercise training was monitored to identify principal differences between exercise training and job patterns. Evidence from more than 20 RCT studies including >4000 workers showed positive effects such as decreased muscle pain and increased workability. Finally, we identified plausible underlying mechanisms in muscle tissue - human and animal - that confirmed metabolic, morphological, and hormonal changes with e.g. repetitive work that were reversal to adaptations reported with exercise training. Progress has been made in developing intelligent physical exercise training, IPET, as the best complementary activity to job exposure and includes muscle activations and movements that limit work-related inactivity atrophy as well as overload injury.
... With a lifetime prevalence of 81% for pilots and 84% for helicopter crew members, the prevalence of neck pain was considered high in this occupational group compared to the general population. 2 Neck pain can be assessed using a variety of different standard results, and the NOOS (Neck Outcome Score) is a widely used, researched and validated instrument for assessing disability in patients with neck pain causing neck functional impairment. 3,4 Studies on cervical disorders show that weakness of the deep cervical flexor muscles (longus capitis, superior longus colli, and anterior rectus capitis) is the cause or plays a role in the pathogenesis of mechanical neck pain. ...
... Overloading of the cervical muscles may be potential to cause changes in neuromuscular function and subsequently cause neck pain. 2 DCF exercises are exercise to strengthen the DCF muscles. DCF exercises can directly activate the DCF muscular system, which has a relatively high muscle coil density. ...
Background: Mechanical neck pain is defined as neck pain due to biomechanical dysfunction in the neck or upper back. Exercise can reduce muscle tension and strengthen deep cervical flexor (DCF) muscles by helping to relieve pain. The prevalence of neck pain is considered high in helicopter crews compared to the general population. Aim: To investigate the effectiveness of DCF exercise on neck functional scores (study of helicopter crews with mechanical neck pain).Material and Methods: Experimental one pre and post-test group design. The samples were 14 squadron-31/serbu helicopter crew performing conventional DCF muscle exercise 12 times for 4 weeks with a frequency of 3 times each week. Neck function was assessed using the Neck Outcome Score (NOOS) which consists of domains of mobility, stiffness, symptoms, sleep disturbances, everyday activity and pain, participating in everyday life, and quality of life.Results: This study showed that the mean NOOS score before intervention was 30.64 (SD: 9.44) and the mean NOOS score after intervention was 8.57 (SD: 5.33). There was a significant difference in the NOOS score before and after deep cervical flexor exercise (p = 0.001).Conclusion: DCF exercises are effective for improving neck functionality in helicopter crew with mechanical neck pain.
... For instance, such evidence is needed in order to establish specific guidelines on physical exercise training for the prevention or rehabilitation of flight related neck pain within the helicopter community. This paper presents secondary outcome analyses, in terms of muscle strength, from a randomized controlled trial introducing a physical exercise training intervention aiming to reduce and prevent neck pain among military helicopter pilots and crew-members (30). At baseline the 12-month prevalence of neck pain was 82 and 90% for crew and pilots, respectively, and around 1/3 had experienced pain 8-30 days. ...
... The randomization procedure was performed after baseline assessments. A detailed description can be found elsewhere (30). ...
... Sessions ranged between 2 and 4 sets and training intensity ranged between 12 and 20 repetitions over the 20 weeks of training. This has previously for each of the 20 weeks of training been described in details in the protocol for the study (30). ...
Introduction: This study presents secondary outcome analyses, in terms of muscle function [i.e., maximal voluntary contraction (MVC) and rate of torque development (RTD)] from a parallel group, single blinded, randomized controlled trial introducing a physical exercise training intervention aiming to reduce neck pain among military helicopter pilots and crew-members.
Methods: Participants (50 pilots, 58 crew-members) were recruited from the Royal Danish Air Force and randomized to either an exercise-training-group (ETG; n = 35) or a reference-group (REF; n = 34). Participants in ETG received 20 weeks of self-administered exercise training specifically tailored to target the neck and shoulder muscles. REF received no training. Outcome: (1) MVC was measured for cervical extension and flexion as well as shoulder elevation and abduction, (2) RTD was measured for cervical extension and flexion. Adherence to training was self-reported and categorized as regular if performed at least once a week.
Results: MVC for cervical extension was significantly increased at follow-up in ETG (37.5 ± 11.2 Nm at baseline, change: 2.1 ± 8.3 Nm) compared to REF (38.1 ± 10.7 Nm at baseline, change: −2.4 ± 6.8 Nm) according to intension-to-treat analysis (p = 0.018). Likewise, RTD was significantly increased in ETG for cervical extension (149.6 ± 63.3 Nm/s at baseline, change: 14.7 ± 49.0 Nm/s) compared to REF (165.4 ± 84.7 Nm/s at baseline, change: −16.9±70.9 Nm/s) (p = 0.034). The cervical extension/flexion MVC-ratio was significantly different at follow-up (p = 0.039) between ETG (1.5 ± 0.5 at baseline, change: −0.0 ± 0.3) compared to REF (1.5 ± 0.5 at baseline, change: −0.2 ± 0.4). Per-protocol analysis of MVC, including only participants in ETG with regular training adherence (n = 10), showed a significant increase for cervical extension (33.2 ± 7.3 Nm at baseline, change: 6.0 ± 5.4 Nm) and shoulder elevation right side (143.0 ± 25.8 Nm at baseline, change: 15.8 ± 18.1 Nm).
Conclusion: Physical exercise training significantly improved MVC and RTD in the upper neck extensors. Only approximately 1/3 of participants in ETG adhered to training regularly, which likely attenuated the effectiveness of the training intervention on neck and shoulder muscle function. Future studies should focus on the practical implementation of self-administered exercise training to improve adherence.
... These complex exercises have been applied in training interventions of helicopter pilots [8]. However, the attendance rate was low, which was possibly due to the more complex head band exercises; and, in that study, it was not investigated whether the more complex exercises actually resulted in a higher activation for the specific muscles when compared to the more simple neck exercises, like shrugs and reverse flyes [8,14]. The aim of the present study was to assess whether simple exercises as compared to the more complex exercises may suffice for sufficient activation of the neck and shoulder muscles. ...
... The exercises were performed with a head harness (Neck Flex ® , Leesburg, VA, USA) while using different color-coded elastic resistance bands (Thera-Band ® , The Hygenic Corporation, Akron, OH, USA). The individual exercises are briefly presented below, as a detailed description can be found in an earlier publication [14] and video material is available online: Neck exercises. ...
Background: Specific strength training at a high intensity is effective in reducing work related neck/shoulder pain. However, it remains to be documented as to which exercises most specifically target neck and shoulder muscles at high activation level while using simple equipment as e.g., elastic bands. We hypothezised that selected exercises would specifically target the respective muscles, as follows: (1) shrugs and reverse flyes: the upper trapezius muscle, (2) cervical extension and lateral flexion: the upper neck extensor muscle, and (3) cervical flexion and rotation: the sternocleidomastoideus muscle. Methods: Eleven healthy males (25.9 ± 1.4 years, BMI 24.3 ± 1.4) with no neck/shoulder pain (VAS = 0) performed the six exercises with elastic bands at 12RM (repetition maximum) and 20RM in a randomized order. Electromyography was bilaterally recorded from the three muscles and it was normalized to maximal voluntary activation (%MVE). Exercises that evoke more than 60%MVE were considered as high intensity activation. Results: High muscle activation level was attained during 12RM in the upper trapezius muscle during shrugs (100.3 ± 29.8%MVE) and reverse flyes (91.6 ± 32.8%MVE) and in the upper neck extensor muscle during cervical extension (67.6 ± 29.8%MVE) and shrugs (61.9 ± 16.8%MVE). In the sternocleidomastoideus muscle, the highest activity was recorded during cervical flexion (51.7 ± 16.4%MVE) but it did not exceed 60%MVE. The overall activity was ~10% higher during 12RM when compared to 20RM. Conclusion: The simple exercises shrugs and reverse flyes resulted in high intensity activation of both the upper trapezius and neck extensors, while no exercises activated sternocleidomastoideus at high intensity.
... M. Smulders, et al. Applied Ergonomics 79 (2019) 25-37 conducted a maximal voluntary contraction (MVC) of the neck muscles at the end of the study, by flexing the head against a load created by a TheraBand™ Red (medium strength) or Green (heavy strength, for some physically stronger subjects), and extending the head against the headrest (exercise inspired by Murray et al. (2015)). ...
The purpose of this study is to research if a headrest benefits the comfort of the passenger and lowers muscle activity in the neck when sitting in a reclined (slouched) posture while watching in flight entertainment (IFE) in an aircraft business class seat. No significant differences in muscle activity in the musculus sternocleidomastoid and musculus trapezius pars descendant were found between the conditions with headrest and without headrest. A significant difference in expected comfort rating was found. Subjects indicated they expect to experience more comfort with a headrest when watching IFE for a duration of two movies during a long-haul flight. This study also found a significant difference in posture. In the condition without headrest the head was more upright compared to the condition with headrest. The lack of significant difference in muscle activity and the significant difference in posture may indicate that humans tend to look for a head position that is neutral, in the sense of minimal muscle effort. This study shows that the use of a headrest may benefit the comfort experience of the passenger during flight. However, further research is necessary on the design of the headrest and the long-term effects of head support on comfort, discomfort, muscle activity and fatigue for watching IFE in a slouched posture.
... In this line, previous researches highlighted the necessity of full body training on pilots involving muscle strength and endurance to prevent pilots from suffering neck, shoulder or back pain injuries [16,17]. Moreover, fighter pilots experience different manoeuvres such as attack and defence, which could elicit a different psychophysiological response on them since the manoeuvres and mechanical load, supported in each one is different. ...
Extreme limits of the human body could be reached in air combat. We analysed 29 fighter pilots before and after offensive and defensive manoeuvres on heart rate (HR), heart rate variability, leg and hand strength, spirometry, temperature, blood oxygen saturation (BOS), lactate, hydration (USG), cortical activation, memory and psychological variables. The defensive manoeuvre produced a significative decrease in forced vital capacity from spirometry and USG post flight, a moderate effect in the decrease in cognitive anxiety and an increase in leg strength. A significant increase in mean HR and an increase with a large effect size was reported for Stress Subjective Perception and Rating of Perceived Exertion in both manoeuvres. With this data we can conclude that high level of physical fitness and specific training programs should be applied to fighter pilots.
