Proprioceptive Training Improves Postural Stability and Reduces Pain in Cervicogenic Headache Patients: A Randomized Clinical Trial.

Abstract

Background: Headache is one of the leading causes of disability in the world. Neck proprioception, pain, and postural control are interconnected in both healthy individuals and those with chronic neck pain. This study examines the effects of proprioceptive training using a gaze direction recognition task on postural stability and pain in cervicogenic headache patients. Methods: Patients with cervicogenic headache (n = 34, age: 35-49 y) were randomized into a control group (CON), receiving only selected physical therapy rehabilitation or to an experimental group (EXP), performing proprioceptive training using a gaze direction recognition task plus selected physical therapy rehabilitation. Both programs consisted of 24, 60 min long sessions over 8 weeks. Postural stability was assessed by the modified clinical test of sensory integration of balance (mCTSIB) and a center of pressure test (COP) using the HUMAC balance system. Neck pain was assessed by a visual analog scale. Results: In all six tests, there was a time main effect (p < 0.001). In three of the six tests, there were group by time interactions so that EXP vs. CON improved more in postural stability measured while standing on foam with eyes closed normalized to population norms, COP velocity, and headache (all p ≤ 0.006). There was an association between the percent changes in standing on foam with eyes closed normalized to population norms and percent changes in COP velocity (r = 0.48, p = 0.004, n = 34) and between percent changes in COP velocity and percent changes in headache (r = 0.44, p = 0.008, n = 34). Conclusions: While we did not examine the underlying mechanisms, proprioceptive training in the form of a gaze direction recognition task can improve selected measures of postural stability, standing balance, and pain in cervicogenic headache patients.