Retraining cervical joint position sense: The effect of two exercise regimes

Abstract

This study compared the effects of conventional proprioceptive training and craniocervical flexion (C-CF) training on cervical joint position error (JPE) in people with persistent neck pain. The aim was to evaluate whether proprioceptive training was superior in improving proprioceptive acuity compared to another form of exercise, which has been shown to be effective in reducing neck pain. This may help to differentiate the mechanisms of effect of such interventions. Sixty-four female subjects with persistent neck pain and deficits in JPE were randomized into two exercise groups: proprioceptive training or C-CF training. Exercise regimes were conducted over a 6-week period, and all patients received personal instruction by an experienced physiotherapist once per week. A significant pre-to postintervention decrease in JPE, neck pain intensity, and perceived disability was identified for both the proprioceptive training group ( p < 0.001) and the C-CF training group ( p < 0.05). Patients who participated in the proprioceptive training demonstrated a greater reduction in JPE from right rotation compared to the C-CF training group ( p < 0.05). No other significant differences were observed between the two groups. The results demonstrated that both proprioceptive training and C-CF training have a demonstrable benefit on impaired cervical JPE in people with neck pain, with marginally more benefit gained from proprioceptive training. The results suggest that improved proprioceptive acuity following intervention with either exercise protocol may occur through an improved quality of cervical afferent input or by addressing input through direct training of relocation sense. ß

Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: A prospective randomized study comparing three exercise programs

“…The advantages to the groups who performed the specific neck exercises and especially those that included a behavioural approach is likely due to the intervention addressing some of the possible causes of altered cervical afferent input, such as neck pain, muscle fatigue, altered neuromotor control and improvement of psychological distress and kinesiophobia that may have led to the symptom of dizziness and changes in sensorimotor control. Previous research has suggested that improving neck muscle endurance improves postural stability in those with WAD (Stapley et al , 2006) and that exercises to address neuromotor control of the deep neck flexor (DNF) musculature improves HRA and/or dizziness in those with neck pain (Jull et al , 2007) ( Thoomes-de Graaf and Schmitt, 2012). Similarly reduction in pain can influence balance measures (Dehner et al, 2008).…”

“…There is some evidence that programs that emphasize gaze stability, eye head co-ordination and cervical position sense and balance tasks without local cervical spine treatment have resulted in either decreased medication intake, improved neck pain and disability, HRA and or balance in those with neck pain (Revel et al , 1994, Fitz-Ritson, 1995, Humphreys and Irgens, 2002, Jull et al, 2007, Treleaven, 2010. Improvements in balance and symptoms of dizziness have also been observed following a vestibular or oculomotor rehabilitation program or tailored sensorimotor program in patients with persistent WAD (Hansson et al , 2006, Storaci et al , 2006, Treleaven, 2010.…”

Neck muscle vibration can improve sensorimotor function in patients with neck pain

“…However, our findings reveal for the first time a positive effect of neck muscle vibration on impaired joint position sense acuity in patients with neck pain. For patients, different long-term treatments have previously been shown to improve repositioning accuracy: conscious head relocation tasks [26], chiropractic care [27], and balance training [28]. All these interventions took place over a period of several weeks.…”

Immediate Effect of Neck Stabilization Exercise on Neck Repositioning Accuracy in Chronic Neck Pain Patients

“…As the body's center for controlling balance is located within the inner ear, neck position sense is vital in the control and maintenance of balance [23].…”