Relationship Between Neck Flexor Endurance and Flight-Related Neck Pain in Typhoon Pilots

Flight-related neck pain (FRNP) is common among fast-jet pilots. The neck flexor endurance test (NFET) provides a reliable measure of isometric neck flexor muscles endurance. This study aimed to establish NFET performance values for Royal Air Force Typhoon pilots and explore the relationship between endurance and FRNP.

There were 81 Royal Air Force pilots who completed an FRNP survey and undertook the NFET. The associations between NFET and FRNP over the last 3 and 12 mo were assessed with Pearson's correlation. One-way analysis of variance with Bonferroni correction was used for categorical variables.

FRNP prevalence was 86% in the last 12 mo and 61% in the last 3 mo. NFET performance did not show statistically significant correlations with FRNP; however, pilots with the highest neck flexor endurance (>150.7 s) were 24% less likely to report FRNP than those with the lowest performance (<83.2 s). Pilots with the highest NFET scores self-reported increased levels of neck strength, stability, and endurance exercises weekly or more frequently. Greater cumulative Typhoon hours were associated with reduced FRNP during flight. Pilots wearing the Mk10 helmet were more likely to experience FRNP after flight. Repetitive high +Gz (>+6) maneuvers wearing a helmet-mounted symbology system were an attributable cause of FRNP both during and after flight for all.

Despite high NFET performance, FRNP remained high in this cohort. Higher neck flexor endurance was linked to reduced likelihood and frequency of FRNP. More objective measurement of flight-related loading and fatigue could help refine injury-prevention and performance-enhancement strategies. Magill J, Kelly A, McRobert C, Slungaard E. Relationship between neck flexor endurance and flight-related neck pain in typhoon pilots. Aerosp Med Hum Perform. 2026; 97(7):478-487.