What is the term military neck?

Military Neck: Definition and Clinical Significance

Military neck refers to a straightening or loss of the normal cervical lordosis (natural forward curve) in the neck, resulting in a straight alignment of the cervical spine when viewed on lateral radiographs.

Anatomical Considerations

The cervical spine normally has a gentle lordotic curve (concave posteriorly) that serves several important biomechanical functions:

• Acts as a shock absorber for the head and brain
• Distributes forces evenly across vertebral structures
• Maintains proper alignment of the head over the shoulders
• Facilitates normal range of motion

In military neck:

• The normal lordotic curve is reduced or completely straightened
• The cervical spine appears as a straight line on lateral X-rays
• This alters the normal biomechanics of the neck

Clinical Significance

Symptoms

Military neck may be associated with:

• Neck pain and stiffness
• Reduced range of motion
• Headaches
• Radiating pain to shoulders or upper extremities
• Premature degenerative changes in the cervical spine

Prevalence in Military Personnel

Military personnel have a particularly high prevalence of neck pain and associated conditions:

• 1-year prevalence of neck pain as high as 83% in military personnel 1
• Lifetime prevalence as high as 78% 1
• Only 14% of service members with neck pain severe enough to require medical evacuation return to their units 2

Risk Factors

Several factors contribute to the development of military neck, particularly in military populations:

1. Occupational factors:

   • Prolonged wear of heavy helmets and night vision systems (OR = 1.9) 1
   • High-G flight exposure in pilots (OR = 1.6) 1
   • Longer flight time (OR = 2.53) 1
   • Type of aircraft flown (OR = 3.93) 1

2. Individual factors:

   • Poor neck mobility (OR = 3.61) 1
   • Older age (OR = 5.0) 1
   • Presence of shoulder pain (OR = 4.9) or low back pain (OR = 2.3) 1

3. Training factors:

   • Frequency of exercise (number of training sessions per week) is positively related to injury risk 3
   • Total amount of training is an important determinant of injury risk 3

Evaluation

When evaluating military neck, imaging is essential for diagnosis:

• Radiography (X-ray) of cervical spine: First-line imaging to assess alignment and identify straightening of the normal lordotic curve 3

• MRI of cervical spine: Recommended for suspected spinal injury or when neurological symptoms are present 4

• CT of cervical spine: May be useful when bony abnormalities are suspected 3

Management Considerations

Management should focus on:

1. Pain management:

   • Non-steroidal anti-inflammatory medications
   • Physical therapy focused on postural correction
   • Muscle strengthening and flexibility exercises

2. Ergonomic modifications:

   • Adjustment of equipment (especially for military pilots)
   • Proper positioning during operational activities
   • Regular breaks from static postures

3. Prevention strategies:

   • Neck-specific conditioning exercises
   • Proper posture education
   • Balanced training regimens

Military-Specific Considerations

Military personnel face unique challenges that may contribute to or exacerbate military neck:

• Combat-related neck injuries have significant impact on military readiness 5
• Military helicopter pilots report a one-year prevalence of neck pain at 43%, with 20% reporting regular or continuous neck pain 6
• Neck injuries in military settings often require specialized interventions, with 12% of neck-injured personnel requiring advanced airway interventions compared to 3% of non-neck injured personnel 5

Conclusion

Military neck represents a significant occupational health concern, particularly in military populations where equipment, training, and operational demands place additional stress on the cervical spine. Early identification and appropriate management are essential to prevent progression to chronic pain and disability.