Self-administered physical exercise training as treatment of neck and shoulder pain among military helicopter pilots and crew: a randomized controlled trial.
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SUBMITTER: Murray M
PROVIDER: S-EPMC5383986 | biostudies-literature | 2017 Apr
REPOSITORIES: biostudies-literature
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Self-administered physical exercise training as treatment of neck and shoulder pain among military helicopter pilots and crew: a randomized controlled trial.
Murray Mike M Lange Britt B Nørnberg Bo Riebeling BR Søgaard Karen K Sjøgaard Gisela G
BMC musculoskeletal disorders 20170407 1
<h4>Background</h4>Neck pain is frequent among military helicopter pilots and crew-members, and pain may influence individual health and work performance. The aim of this study was to examine if an exercise intervention could reduce neck pain among helicopter pilots and crew-members.<h4>Methods</h4>Thirty-one pilots and thirty-eight crew-members were randomized to either an exercise-training-group (n = 35) or a reference-group (n = 34). The exercise-training-group received 20-weeks of specific n ...[more]
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Project description:BackgroundFlight-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 would reduce the prevalence and incidence rate of neck/shoulder pain among helicopter pilots and crew members.MethodThis study used a prospective, parallel group, single blinded, randomized controlled design. Participants were military helicopter pilots and crew members recruited from the Royal Danish Air Force. Inclusion criteria were: 1) employed within the Royal Danish Air Force as a helicopter pilot or onboard crew member (technician, systems-operator, tactical helicopter observer and/or navigator), 2) maintaining operational flight status at enrollment, and 3) operational flying within the previous 6 months. Primary outcome was change in neck and shoulder pain assessed by 1) a modified version of the "Standardized Nordic questionnaire for the analysis of musculoskeletal symptoms" and by 2) pressure pain threshold measurements. Secondary outcomes included: postural balance, strength, stability, and rate of force development for neck and shoulder muscles. Measurements at baseline and follow-up were conducted at four air force bases in Denmark. Sixty-nine participants were individually randomized to either a training group (TG) or a reference group (RG). Participants in the TG performed 20-weeks of physical exercise training divided into sessions of 3 × 20 min per week. Training was completed within working hours and consisted of specific exercise training for the neck and shoulder muscles based on the principles of "Intelligent Physical Exercise Training". The RG received no training.DiscussionIn spite of the high prevalence of flight related neck/shoulder pain among military helicopter pilots and crew members there are currently no evidence based guidelines for the prevention or clinical handling of neck pain among these occupational groups. Results from this study may therefore be beneficial for future establishment of such guidelines.Trial registrationEthical committee of Southern Denmark (S-20120121) 29 August, 2012. Clinical Trail Registration (NCT01926262) 16 August, 2013.
| S-EPMC4544796 | biostudies-literature
Project description:Purpose: To evaluate the effects of physical exercise on neck and shoulder muscle strength and pain in military pilots. Method: Embase, PubMed, and Cochrane Library databases were searched studies published up to April 1, 2022. Studies that met the screening criteria were included in the final meta-analysis. We calculated neck and shoulder maximal voluntary isometric contractions (MVICs), prevalence of pain, and pain intensity. Heterogeneity was explored by subgroup and sensitivity analyses. Result: A total of 15 studies with 907 participants were included. In the exercise group, muscle strength was significantly increased in four directions of neck motion: flexion (standardized mean difference (SMD) = 0.45; 95% CI, 0.08-0.82), extension (SMD = 0.63; 95% CI, 0.27-1.00), right lateral flexion (Rtflx) (SMD = 0.53; 95% CI, 0.12-0.94), and left lateral flexion (Ltflx) (SMD = 0.50; 95% CI, 0.09-0.91). Subgroup analysis showed that fighter pilots, strength plus endurance training, and a follow-up period <20 weeks exhibited more significant muscle strength improvements than helicopter pilots, simple strength training, and a follow-up period ≥20 weeks. Overall, the pooled odds ratio (OR) for the effect of physical exercise on the prevalence of neck pain was not statistically significant (I2 = 60%). Sensitivity analysis revealed that the heterogeneity was restored after removing each of two studies (I2 = 47%), and the pooled OR was statistically significant (OR = 0.46; 95% CI, 0.23 to 0.94, or OR = 0.47; 95% CI, 0.24-0.91). Furthermore, compared with observational studies (OS), the reduction in the prevalence of neck pain was more significant in randomized controlled trials (RCTs) (OR = 0.37; 95% CI, 0.18-0.78). No significant differences in the effects of exercise on shoulder muscle strength and neck and shoulder pain intensity were observed. Conclusion: Physical exercise can improve neck muscle strength in military pilots. After removing studies that may be the source of heterogeneity, exercise showed a protective effect on neck pain, especially in RCTs. The conclusion that exercise had no effects on shoulder muscle strength and pain intensity should be taken with caution.
| S-EPMC9479108 | biostudies-literature
Project description:BACKGROUND:Flight related low back pain (LBP) among helicopter pilots is frequent and may influence flight performance. Prolonged confined sitting during flights seems to weaken lumbar trunk (LT) muscles with associated secondary transient pain. Aim of the study was to investigate if structured training could improve muscular function and thus improve LBP related to flying. METHODS:39 helicopter pilots (35 men and 4 women), who reported flying related LBP on at least 1 of 3 missions last month, were allocated to two training programs over a 3-month period. Program A consisted of 10 exercises recommended for general LBP. Program B consisted of 4 exercises designed specifically to improve LT muscular endurance. The pilots were examined before and after the training using questionnaires for pain, function, quality of health and tests of LT muscular endurance as well as ultrasound measurements of the contractility of the lumbar multifidus muscle (LMM). RESULTS:Approximately half of the participants performed the training per-protocol. Participants in this subset group had comparable baseline characteristics as the total study sample. Pre and post analysis of all pilots included, showed participants had marked improvement in endurance and contractility of the LMM following training. Similarly, participants had improvement in function and quality of health. Participants in program B had significant improvement in pain, function and quality of health. CONCLUSIONS:This study indicates that participants who performed a three months exercise program had improved muscle endurance at the end of the program. The helicopter pilots also experienced improved function and quality of health. TRIAL REGISTRATION:Identifier: NCT01788111 Registration date; February 5th, 2013, verified April 2016.
| S-EPMC5477756 | biostudies-literature
Project description:BackgroundFlying related transient Low Back Pain (LBP) among helicopter pilots is considered an occupational distress.ObjectiveTo examine if exercise programs can alleviate transient LBP.MethodsSixty-five helicopter pilots (92% males), all reporting flying related LBP, responded to an epidemiological survey and a long-term follow-up, 44.8 months later, comprising questions regarding transient LBP and number of sick leaves. Data from 37 pilots participating in two exercise programs, A; general for LBP, B; focused for lumbar trunk (LT), included information from clinical examinations and muscular endurance tests of the LT before and after intervention. Twenty-eight pilots did not participate in any intervention.ResultsAt long-term follow-up 42% of the pilots still reported flying related transient LBP. Among participants in program B 26% had persistent pain, 70% in program A and 46% among pilots without intervention. Sick-leave reduction was only observed among participants in program B (30% to 4%). Upon re-occurrence of LBP symptoms, half of the pilots in program B again performed exercises to improve their pain.ConclusionThis study indicates that exercise programs focused towards lumbar trunk muscular endurance reduces flying related transient LBP and sick-leave among helicopter pilots. These findings may have implications for the pilots' working conditions.
| S-EPMC5859454 | biostudies-literature
Project description:Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists. The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments. Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach.A randomized controlled trial of 10 weeks duration is currently being conducted. Employed office workers with severe neck-shoulder pain are randomized to 3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active. Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius.An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work. The first 100 positive replies entered the study. Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0-9 scale. Exclusion criteria were cardiovascular disease, trauma, hypertension, or serious chronic disease. Before and after the intervention period the participants replied to a questionnaire about musculoskeletal disorders and work disability, and underwent a standardized clinical examination of the neck and shoulder girdle. Further, on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week.The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results from the clinical examination. Secondary outcomes are strength and work disability.ClinicalTrials (NCT): NCT01205542.
| S-EPMC3033867 | biostudies-literature
Project description:Background:Shoulder pain affects up to 67% of the population at some point in their lifetime with subacromial pain syndrome (SAPS) representing a common etiology. Despite a plethora of studies there remains conflicting evidence for appropriate management of SAPS. Purpose:To compare outcomes, for individuals diagnosed with SAPS, performing a 6-week protocol of eccentric training of the shoulder external rotators (ETER) compared to a general exercise (GE) protocol. Study Design:Randomized controlled trial. Methods:Forty-eight individuals (mean age 46.8 years?+?/-17.29) with chronic shoulder pain, and a clinical diagnosis of SAPS were randomized into either an experimental group performing ETER or a control group performing a GE program. The intervention lasted for six weeks, and outcomes were measured after three weeks, six weeks, and again at six months post intervention. Results:The primary outcome of function, measured by the Western Ontario Rotator Cuff Index, demonstrated a significant interaction effect derived from a multilevel hierarchical model accounting for repeated measures favoring the experimental group at week 3: 14.65 (p=.003), Week 6: 17.04 (p<.001) and six months: 15.12 (p=.007). After six months, secondary outcome measures were improved for Numeric Pain Rating Scale levels representing pain at worst (p=.006) and pain on average (p=0.02), external rotator (p<.001), internal rotator (p=0.02), and abductor strength (p<.001). There were no statistically significant differences in secondary outcome measures of Global Rating of Change, Active Range of Motion, the Upper Quarter Y Balance Test and strength ratios after six months. Conclusion:An eccentric program targeting the external rotators was superior to a general exercise program for strength, pain, and function after six months. The findings suggest eccentric training may be efficacious to improve self-report function and strength for those with SAPS. Level of Evidence:2b.
| S-EPMC5717488 | biostudies-literature
Project description:Emotion regulation (ER) is a strong predictor of different aspects of mental health and wellbeing. However, only recently has ER been examined in relation to physical activity and its effects on fitness. In the present study, 26 elite helicopter pilots, serving in the Spanish Air Force, were physically trained for 6 months, and their level of fitness (maximum oxygen consumption and time to exhaustion in a treadmill-running test) was assessed before and after that period. Additionally, two indices of emotion regulation (general adaptiveness of ER strategies, as measured by the Emotion Regulation Questionnaire (ERQ), and negative urgency, as measured by the UPPS-P questionnaire) measured at baseline were used as prospective predictors of fitness improvement. After controlling for individual features, baseline fitness, and type of training, better emotion regulation strategies (more cognitive reappraisal plus less expressive suppression) predicted larger fitness gains (p = 0.028). Incidental emotion regulation, as measured by the negative urgency index, failed to predict pre-post-fitness changes (p = 0.734). These results suggest that fostering emotion regulation skills may improve the effectiveness of fitness training programs.
| S-EPMC7312943 | biostudies-literature
Project description:Background:Musculoskeletal disorders are highly prevalent among office workers, with strong evidence suggesting that workplace-based resistance training programs can prevent several upper extremity musculoskeletal disorders. The aim of the present study was to examine the dose-response relationship between resistance training frequency and pain relief among office workers with neck- and shoulder pain. Methods:Thirty participants with mild to moderate neck- and shoulder pain attended a 16-week intervention starting with an eight-week control period followed by an eight-week training period. After the control period, the participants were randomized into either a 10?min (TG10) or 2?×?10?min (TG2) workplace-based, high-intensity neck- and shoulder specific resistance training program that was executed 5 days per week and consisting of four exercises. The participants were tested pre and post each period for mean and worst pain using the 0-100?mm visual analog scale (VAS), 0-100?mm health-related quality of life and isometric strength of the neck-and shoulder region. The analysis of variance (ANOVA) and Friedman with Bonferroni post hoc corrections were used to assess differences in between and within groups for the three testing times pre, mid and post intervention. Results:No differences were observed between the groups in any of the variables in the control period (p?=?0.27-0.97) or training period (p?=?0.37-0.68). When merging the two groups, the mean and worst pain was reduced by 25 and 43% (p?=?0.05 and?<?0.01, ES?=?0.41 and 0.55) in the training period in addition to 10.6% increase in health-related quality of life (p?=?0.01, ES?=?0.52). No difference in strength was observed (p?=?0.29-0.85). Conclusion:Daily bouts of specific high-intensity resistance training of the shoulder and neck region at the workplace reduced neck- and shoulder pain and improved quality of life of office workers. However, 10?min bouts were equally effective as 2?×?10?min bouts per day. The authors recommend office workers to perform daily neck- and shoulder resistance training to possibly prevent and/or decrease pain in the neck- and shoulder area. Trial registration:ISRCTN69968888, retrospectively registered (24/09/2019).
| S-EPMC7110779 | biostudies-literature
Project description:BackgroundShoulder complaints are common and the recommended first-line treatment is exercise therapy. However, it remains unknown if increased shoulder pain after an exercise session is a barrier for subsequent exercise dose, particularly in people with high fear-avoidance beliefs. Such knowledge could indicate ways to optimise shoulder rehabilitation. The aim was to examine whether increased shoulder pain across an exercise session was associated with a lower subsequent exercise dose, and if high fear-avoidance beliefs exaggerated this association.MethodsWe conducted a prospective cohort study using data from a randomised controlled trial in Central Denmark Region 2017-2019. Participants were employees (n = 79) with shoulder complaints and high occupational shoulder exposures. The intervention was a home-based or partly supervised exercise programme lasting 2-3 months. Linear mixed models were used to examine the associations between change in shoulder pain and exercise dose (number of repetitions, progression level (1-3), resistance level (1-3), and time until next exercise session [days]).ResultsAt baseline, the participants had a median pain intensity at rest of 2 on a numerical rating scale (0-10). For a 1-cm increase in pain on a visual analogue scale (0-10 cm) during an exercise session, the subsequent number of repetitions, progression level and resistance level were - 1.3 (95% confidence interval [CI] - 3.4 to 0.9), 0.0 (95% CI - 0.1 to 0.0) and - 0.0 (95% CI - 0.1 to 0.0), respectively. Likewise, the time until next exercise session was - 0.6 (95% CI - 2.4 to 1.3) days for a 1-cm increase. There were no interactions with fear-avoidance beliefs.ConclusionIncreased pain across an exercise session was not associated with subsequent exercise dose, regardless of fear-avoidance beliefs, among employees with shoulder complaints and high occupational shoulder exposures.Trial registrationThe trial was registered at Clinicaltrials.gov 19/05/2017 (ID: NCT03159910).
| S-EPMC9336042 | biostudies-literature
Project description:PurposeNeck and shoulder complaints are common among employees in occupations characterized by intensive computer use. Treatment has varied from passive rest to active treatments and active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach. The purpose of this study was in a randomised controlled trial to investigate if intensive scapular function training (SFT)-in terms of training of the lower trapezius and the serratus anterior muscle while minimizing direct training of the upper trapezius-is effective in reducing pain in adults with chronic non-specific pain in the neck/shoulder region.Methods47 office workers with chronic non-specific pain in the neck/shoulder region were randomized to 10 weeks 3 × 20 min SFT with training supervision or to a control group. At baseline and at follow-up the participants were tested for maximum isometric shoulder strength by a blinded tester. Further, once a week participants reported pain intensity of the neck/shoulder during the previous week.ResultsIn intention-to-treat analysis neck- and shoulder pain decreased 2.0 (95 % CI 0.35; 3.64) in SFT compared with control group (p < 0.05). Pressure Pain Threshold (PPT) increased 129 kPa in the lower trapezius in SFT compared with the control group (p < 0.01). Shoulder elevation strength increased 7.7 kg in SFT compared with the control group (p < 0.01) with no change in shoulder protraction strength.ConclusionsSFT reduces pain intensity and increases shoulder elevation strength in adults with chronic non-specific pain in the neck/shoulder region. The magnitude of improvement in pain intensity was clinically relevant.
| S-EPMC4000422 | biostudies-literature