High +Gz Flight Reduces Cervical 3D Kinematics and Increases Neck Pain in Fighter Pilots

INTRODUCTION: Military jet pilots are exposed to extreme +Gz, imposing strain on the cervical musculoskeletal system. Neck pain prevalence is well documented, but the acute effects of real flight on cervical muscles and kinematics remain unclear. This study assessed acute effects in Eurofighter pilots vs. non-pilot controls. It was hypothesized that acute high +Gz exposure during a real flight affects cervical 3D kinematics, muscle mechanical properties, and pilot-reported pain scores compared to a nonexposed control group and effects of acute high +Gz exposure persist 24 h postflight, resulting in altered cervical 3D kinematics, modified muscle mechanical properties, and increased subjective pain compared to the nonexposed control group. METHODS: A controlled, longitudinal study compared 20 Eurofighter pilots with 20 matched controls. Cervical 3D kinematics, subjective neck pain, and cervical muscle stiffness were assessed preflight, immediately postflight, and 24 h postflight. Pilots executed high +Gz maneuvers during real flight following a scripted mission. Primary outcomes were group-by-time differences. Statistics included repeated-measures of variance. RESULTS: In pilots, cervical extension range of motion decreased postflight from 56.4 ± 6.5° to 52.4 ± 7.8°, and at 24 h to 53.3 ± 6.4°. Subjective neck pain increased postflight and persisted at 24 h [pain 0.0-10.0; medians from 0.0 (0.0)-2.1 (3.0), then 1.8 (2.9)]. Right trapezius muscle stiffness decreased postflight (241.0 ± 20.3-227.8 ± 20.7 N · m-1) and after 24 h at 234.1 ± 20.1 N · m-1. DISCUSSION: High +Gz exposure and extreme head postures reduce range of motion and increase neck pain in fighter pilots. The stiffness decrease suggests a muscular mechanical overload. Findings support the need for targeted neck conditioning and real-time monitoring to mitigate injury risk to sustain operational readiness. Lingscheid R, Nuesse R, Rein R, Goell F, Albracht K, Braunstein B. High +Gz flight reduces cervical 3D kinematics and increases neck pain in fighter pilots. Aerosp Med Hum Perform. 2026; 97(3):151-159.