Rehabilitative Interventions for Flight-Related Musculoskeletal Injuries in the Neck, Shoulder, and Back among...

Military pilots and aircrew frequently experience musculoskeletal injuries (MSKIs), particularly in the neck, shoulder, and back, because of the physical and environmental demands of flight. The prevalence of these injuries varies depending on the type of aircraft operated. Such injuries can significantly impact operational readiness and flight capabilities, especially in deployed settings where access to therapy may be limited. Interventions to prevent or mitigate MSKIs are critical to keeping pilots and aircrew flight ready. Non-pharmacological therapies provide accessible, autonomous care, and promote recovery and a more rapid return to duty, especially in remote settings. This review will evaluate the effectiveness of non-pharmacological interventions versus control/usual care therapy in improving strength and pain among military pilots/aircrew with MSKIs in the neck, shoulder and back.

We searched English publications in Ovid MEDLINE ALL, Embase, CENTRAL, Scopus, ClinicalTrials.gov, National Technical Reports Library, CINAHL Complete, and Google Scholar from their inception to June 2024. Two evaluators independently conducted title and abstract screening and reviewed eligible studies. Full-text articles were screened against eligibility criteria by 2 independent reviewers, with any lack of reviewer consensus being resolved by a third reviewer. The systematic review identified 22 reports from 20 studies of military pilots and/or aircrew, including 14 randomized controlled trials (RCT), 5 non-randomized trials, and 3 observational studies, all of which were included in the analyses. A meta-analysis was performed to address the level of improvement in strength and pain with the indicated treatments. Data were converted to standard mean differences (SMD) between treatment and control groups. A 3-level mixed effects model was used for the meta-analysis.

While 126 reports were considered for full-text review, 22 met the eligibility criteria and were included in the systematic review. The analyses demonstrated modest improvements in strength and pain with rehabilitative therapies directed to neck, shoulder or back as compared to control/usual care.

Rehabilitative therapies potentially provided by embedded healthcare teams show promise in improving physical strength, reducing pain, and addressing the high prevalence of MSKI among military pilots and aircrew. However, further research is needed to refine intervention strategies, evaluate the long-term impact of embedded teams, and enhance recovery, resilience, and physical health outcomes tailored to their demanding operational needs.