Nagai T, Abt JP, Sell TC, Clark NC, Smalley BW, Wirt MD, Lephart SM. Neck proprioception, strength, flexibility, and posture in pilots with and without neck pain history. Aviat Space Environ Med 2014; 85:529–35. Introduction: Neck pain (NP) is common among military helicopter pilots. Older age and more flight-hours have been associated with pilots with a history of NP. However, modifiable neuromuscular and musculoskeletal characteristics such as neck proprioception, strength, flexibility, and posture have rarely been investigated in military helicopter pilots with a history of NP. The purpose of the study was to compare demographics, flight characteristics, physical fitness information, neck proprioception, strength, flexibility, and posture between helicopter pilots with and without a history of NP. Methods: A total of 27 Army helicopter pilots with NP in the past 12 mo (pain group) were matched based on age with pilots without a history of NP (nonpain group). All pilots had flown at least 100 h in the past 12 mo and were cleared for flight and physical training. All pilots completed a battery of laboratory testing: neck proprioception, neck and scapular muscular strength, neck active range-of-motion (ROM), forward head and shoulder posture, and pectoralis minor length. Paired t-tests or Wilcoxon tests were used to compare differences between groups. Results: The pain group had significantly less cervical extension (63.7 ± 8.5°) and rotation ROM (R rotation: 67.7 ± 8.8°; L rotation: 67.4 ± 9.0°) when compared to the nonpain group (extension: 68.3 ± 7.4°; R rotation: 73.4 ± 7.4°; L rotation: 72.9 ± 6.8°). No significant differences were found for other variables. Conclusion: The results demonstrate less neck active ROM in pilots with a history of NP. Operating a helicopter with limited neck ROM or NP may negatively impact flight safety and force readiness. Continued research is warranted.