Introduction:​ Neck pain is a common complaint among fighter pilots. With implementation of the joint helmet mounted cuing system (JHMCS), the strain on the pilot’s neck has increased.

Methods:​ We surveyed 58 F-16 pilots from the Royal Danish Air Force by anonymous questionnaires. More than half of these pilots used JHMCS regularly.

Results:​ The response rate was 100%. Of the pilots, 97% experienced neck pain in flight or shortly after flying, 83% within the last year. Right side neck pain was signifi cantly more frequent than left side, odds ratio 3.25. There was a strong tendency toward predominant right-sided shoulder pain. The pilots reported that combined rotation and extension movements were especially hazardous. Only 1 in 10 pilots moved his head independent of G-load. Neck pain influenced operational flying, especially the ability to perform a “check six ”movement sufficiently, and affected flying with high G loads as occurs in basic fighter maneuvers and air combat maneuvering.

Discussion:​ To avoid neck problems the majority of pilots aim to avoid certain head movements and to fix their neck before exposing themselves to high 1G z loads. With the implementation of JHMCS, two conflicting goals are evident and working at cross-purposes. A pilot’s head should remain stationary while exposed to high 1G z loads. However, maximizing the advantages of JHMCS encourages the pilot to move his head sharply while exposed to high 1G z loads. Training programs to help the pilots cope with these challenges are warranted