Joint Position Error Test Research Articles

Unveiling the Therapeutic Impact of Virtual Reality Game-Based Exercises on Cervicocephalic Kinesthetic Sensibility in Individuals Battling Cervical Vertigo

This study was aimed to investigate the therapeutic impact of Virtual Reality game-based exercises with Epley maneuver on cervicocephalic kinesthetic sensibility in individuals experiencing cervical vertigo. 8 subjects were selected by simple random sampling method included clinically diagnosed male and female cervical vertigo patients between 40-55 years of age, who had recurring symptom of dizziness over three months, episodic dizziness lasting minutes to hours .Written consent was taken and a detailed outcome assessment was done.Intervention includes Virtual Reality abyss sharks & sea worlds for a duration of 10 minutes with a five-minute rest period and Virtual Reality thrills, for a duration of 10 minutes with a five-minute rest period along with epley maneuver 10 minutes targeting cervicocephalic kinesthetic sensibility.Total duration of the intervention includes 40min/day for 6 days for 12 weeks. Pre test included Cervical Joint Position Error Test for cervicocephalic kinesthetic sensibility and Videonystagmography measures nystagmus, rapid eye movements with a slow and fast phase, to provide objective information about vertigo. Post test done on 6th and 12th week of intervention with the same measures. On comparing pre- and post-intervention outcomes shows higher mean value (P≤0.001).In conclusion the findings of this study had the potential to contribute valuable insights into the therapeutic utility of Virtual Reality game-based exercises in managing cervical vertigo, offering a novel and engaging approach to rehabilitation. Virtual Reality-based interventions is found effective treatment for individuals battling cervicocephalic kinesthetic sensibility among patients with cervical vertigo.

Effects of Cervical Mobilization on Balance and Proprioception in Patients With Nonspecific Neck Pain

ObjectiveThis study investigates the effect of cervical mobilization on balance and cervical proprioception in patients with nonspecific neck pain. MethodsA prospective, double-blind, randomized clinical trial was conducted involving a 3-week treatment protocol for which 66 patients were randomly assigned to 2 groups. Both groups underwent conventional physiotherapy (hot pack and transcutaneous electrical nerve stimulation) twice a week for 3 weeks along with additional cervical mobilization in the mobilization group, and sham mobilization in the sham control group. Static and dynamic balance, cervical proprioception, cervical mobility, and pain intensity were evaluated using a Kinesthetic Skill Training System 3000 device, the “Joint Position Error Test,” Cervical Range-of-Motion Instrument, and the visual analog scale, respectively. ResultsAfter treatment, significant improvements were noted in dynamic balance, mobility, pain intensity (P < .001, P < .001, P < .001, respectively), and proprioception in the left direction of rotation in the mobilization group (P = .003) that were significantly greater than those observed in the sham mobilization group (P < .001, P < .001, P < .001, P = .003, respectively). Although a significant decrease was observed in the deficits of static balance (P = .044) and proprioception in the right direction of rotation (P = .011) after mobilization, the changes were similar in both the mobilization and sham mobilization groups (P = .192, P = .154, respectively). ConclusionCervical mobilization led to significant improvements in dynamic balance, pain intensity, mobility, and partial improvements to proprioception in a comparison with a sham mobilization group, while the effect on static balance was not significant.

The Correlation Between Cervical Proprioception and Scapular Dyskinesis in Patients With Neck Pain: A Case-Control Study.

Introduction Neck pain is common among office workers, and the assessment of cervical proprioception and scapular dyskinesis is key in the management of patients with neck pain. While some studies have shown the relevance of both factors in neck pain patients, the correlation between the two parameters has not yet been investigated. Hence, this study aimed to determine the correlation between cervical proprioception and scapular dyskinesis in workplacecomputer userswithout neck pain (control group) versus those with neck pain (case group). Methodology A case-control, correlational study was performed within office settings; based on the selection criteria, 88 participants were included and categorized into two groups consisting of 44 workplacecomputer users without neck pain in the control group (Group A) and 44 workplacecomputer users with neck pain in the case group (Group B). Cervical proprioception was evaluated by using the joint position error (JPE) test and scapular dyskinesis was assessed using the modified lateral scapular slide test (MLSST). Results There was a statistically significant difference in cervical proprioception and scapular dyskinesis between the case and control groups (p<0.001). Workplacecomputer users with neck pain showed greater JPEcompared to those without neck pain, and scapular dyskinesis was observed in the case group. Moreover, Spearman's correlation coefficient showed a significant correlation between cervical proprioception and scapular dyskinesis in workplacecomputer users with neck pain. Conclusions The present study provides guidance on the assessment as well as management of JPE with different positions of scapular dyskinesia. The evaluation of scapular dyskinesis is frequent clinically; given its positive correlation, managing JPE in neck pain patients is feasible.

Normative Scores and Test-Retest Reliability of Neck Strength, Endurance, and Proprioception Tests in Children and Adolescents

OBJECTIVE: To determine normative scores, test-retest reliability, and minimal detectable change for the neck flexor endurance test (NFET), craniocervical flexion test (CCFT), and joint position error test (JPET) in children. DESIGN: Cross-sectional. METHODS: Two hundred typically developing children (10-15 years) were recruited. Participants were screened for cervical spine instability using the alar and transverse ligament tests prior to administering the NFET, CCFT, and JPET. Testing was performed twice on the same day, 6 hours apart. RESULTS: For the younger age group, average NFET scores were as follows: females = 9.1 seconds, males = 10.1 seconds. Mean CCFT scores decreased with an increase in pressure (22 millimeters of mercury [mmHg]: females = 6.1 seconds [1], males = 6.8 seconds [1]; 30 mmHg: females = 4.07 seconds [1.1], males = 4.1 seconds [0.9]). For the CCFT, reliability reduced as pressure increased. The JPET had moderate reliability (ICC2, k = 0.4-0.63) with the highest error in right rotation (females = 14.1 cm [5], males = 13.4 cm [4.7]). The NFET had excellent reliability (ICC2, k = 0.96 [0.94-0.97], P&lt;.001). CONCLUSION: The normative scores presented serve as a reference standard for future studies and for systematic screening and head and neck injury prevention. JOSPT Open 2024;2(4):348-353. Epub 20 May 2024. doi:10.2519/josptopen.2024.1135

Efficacy of scapulothoracic exercises on proprioception and postural stability in cranio-cervico-mandibular malalignment: A randomized, double-blind, controlled trial.

Cranio-cervico-mandibular (CCM) malalignment is associated with forward head posture (FHP) and temporomandibular joint (TMJ) disorders and affects masticatory muscles. This randomized, double-blind controlled trial aimed to compare the efficacy of scapula-thoracic (ST) exercises on temporomandibular and cervical joint position sense and postural stability in individuals with CCM malalignment. Fourty-nine participants with CCM malalignment were randomly assigned to the ST exercise group (STEG, n= 24) or the control group (CG, n= 25). STEG included progressive strengthening, proprioceptive, and stabilization exercises. All participants were assessed before treatment, at the end of the 8th week treatment period and at the 12th week post-treatment follow-up. Cranio-vertebral angle measurement, Fonseca's Questionnaire, Helkimo Clinical Dysfunction Index, TMJ position test, cervical joint position error test and postural stability assessment were used. The TMJ and cervical joint position sense, total sway degree, area gap percentage, sway velocity and antero-posterior body sway results showed significant improvement in the STEG compared to the CG (p< 0.05), however medio-lateral body sway did not differ between groups (p> 0.05). Postural stability, TMJ and cervical joint position sense appear to be affected in individuals with CCM malalignment. Our results showed that an exercise program including ST stabilization, proprioception and strengthening of the scapular muscles may be effective in the management of CCM malalignment and will allow clinicians to plan holistic treatment.

Sensorimotor tests in patients with neck pain and its associated disorders: a systematic review and meta-analysis

This systematic review aimed to synthesize the current evidence regarding neck sensorimotor testing in individuals with neck pain, assess the differences between neck pain groups and healthy controls, and recognize factors that might affect test results. We performed the data search using PubMed, Embase, PsycINFO, CINAHL, and Scopus databases. We used a two-step screening process to identify studies. Furthermore, we screened the reference lists for additional studies. Hedges g was used to present the difference between neck pain groups and asymptomatic individuals. We assessed the quality of the studies using the QUADAS tool. The final review included 34 studies, of which 25 were related to the joint position error test, four to the smooth pursuit neck torsion test and six to the balance test. Our meta-analysis showed poorer joint-position sense, oculomotor function, and wider postural sway in individuals with neck pain than healthy controls. The size of the difference between the groups seemed to be influenced by the intensity of the pain and the presence of dizziness. Therefore, it might be helpful in future studies to differentiate patients with neck pain into subgroups based on their symptom and demographic profiles to assess other factors that significantly affect cervical sensorimotor control.

Investigation of The Correlation Between Pain, Proprioception and Range of Motion in Patients With Temporomandibular Joint Dysfunction

Purpose: The aim of study was to investigate the relationship between pain, proprioception and range of motion in patients with temporomandibular joint dysfunction (TMD). Material and Methods: The study was completed with 45 participants diagnosed with TMD and 45 healthy controls. Visual analog scale and graded chronic pain scale were used to assess pain intensity, dolorimeter was used for pain pressure threshold (PPT) assessment. Evaluation of cervical proprioception by cervical joint position error test (JPET), cervical joint range of motion assessment by digital goniometer, mouth opening measurements were made with a ruler. Results: In the study, pain intensity was high and PPT was low in the TMD group. In the JPET, the right-left rotation and left lateral flexion values in the TMD group had higher mean values than the control group (p=0.028, p=0.003, p=0.004, respectively). There was a significant difference between the groups in digital goniometer measurement in right-left rotation, right-left lateral flexion movements(p=0.008, p=0.001, p=0.041, p=0.005, respectively). The TMD group had a lower mean than the control group in painless, maximum assisted and unassisted mouth opening measurements(p=0.001, p=0.001, p=0.001, respectively). Conclusion: TMD patients presented a lower PPT, less accurate head repositioning, and some impairment in cervical range of motion.

Responsiveness of the cervical joint position error test to detect changes in neck proprioception following four weeks of home-based proprioceptive training.

People with chronic neck pain (CNP) commonly exhibit a range of physical impairments including cervical proprioceptive deficits. Assessing proprioception using a head mounted laser to assess joint position error (JPE) is a reliable and valid measure. However, the responsiveness of this measure has not been assessed. To assess the responsiveness of the measure of cervical JPE after a 4-week home-based neck proprioceptive training intervention in people with CNP. An observational study to assess the responsiveness of the measure of cervical JPE. The JPE test was assessed in people with CNP before and after 4 weeks of neck proprioception training. JPE was assessed as participants performed neck joint position sense tests for flexion, extension, right rotation, and left rotation in sitting and standing which were performed in a random order. Both the absolute and constant JPE were assessed. The intervention consisted of neck repositioning exercises as well as movement sense exercises. Cohen's d effect size was used to assess the internal responsiveness of the JPE test. The Pearson's correlation was used to assess the change of scores of the laser pointer and measures from inertial measurement units (IMUs) (external responsiveness). After 4 weeks of proprioception training, JPE assessed in sitting reduced from 2.69◦-3.57◦ to 1.88◦-1.98◦ for flexion, extension, and right rotation with large effect sizes (Cohen's d range: 1.25-2.00). For left rotation, JPE reduced from 3.23◦ to 1.9◦, and the effect size was close to being large (Cohen's d: 0.79). When assessed in standing, JPE reduced from 3.49◦-4.52◦ to 1.5◦-2.33◦ with large effect sizes (Cohen's d range: 0.89-1.25) for flexion, extension, right rotation, and left rotation. Large effect sizes were not observed for the constant JPE when assessed in either sitting or standing. The assessment of the external responsiveness revealed weak correlations between the change of scores obtained from the laser pointer and the IMUs for all movements, apart from the constant JPE in sitting for left rotation, which showed a strong correlation (r = 0.7). The results of this study showed that the measure of the JPE has sufficient internal responsiveness, however, the external responsiveness was inadequate. Further research is advised.

Effect of pain on cranio-cervico-mandibular function and postural stability in people with temporomandibular joint disorders.

Neck and jaw pain is common and is associated with jaw functional limitations, postural stability, muscular endurance, and proprioception. This study aimed to investigate the effect of jaw and neck pain on craniocervico- mandibular functions and postural stability in patients with temporomandibular joint disorders (TMJDs). Fifty-two patients with TMJDs were included and assessed using Fonseca's Questionnaire and the Helkimo Clinical Dysfunction Index. An isometric strength test was performed for the TMJ depressor and cervical muscles. The TMJ position sense (TMJPS) test and cervical joint position error test (CJPET) were employed for proprioception. Total sway degree was obtained for the assessment of postural stability. Deep neck flexor endurance (DNFE) was assessed using the craniocervical flexion test. The mandibular function impairment questionnaire (MFIQ) was employed to assess mandibular function, and the craniovertebral angle (CVA) was measured for forward head posture. Jaw and neck pain negatively affected CVA (R2 = 0.130), TMJPS (R2 = 0.286), DNFE (R2 = 0.355), TMJ depressor (R2 = 0.145), cervical flexor (R2 = 0.144), and extensor (R2 = 0.148) muscle strength. Jaw and neck pain also positively affected CJPET for flexion (R2 = 0.116) and extension (R2 = 0.146), as well as total sway degree (R2 = 0.128) and MFIQ (R2 = 0.230). Patients with painful TMJDs, could have impaired muscle strength and proprioception of the TMJ and cervical region. The jaw and neck pain could also affect postural stability, and the endurance of deep neck flexors as well as mandibular functions in TMJDs.

Decoding the impact of driving postures: Comparing neck pain, mobility, proprioception in car and bike drivers with and without Forward Head Posture

ObjectivesThe study sought to examine the effects of Forward Head Posture (FHP) on neck pain, cervical mobility, and proprioception in drivers. Additionally, it aimed to ascertain if the influence of FHP varied between car and bike drivers. MethodsEmploying a comparative cross-sectional approach, 100 drivers (50 car drivers and 50 bike users) aged 18–65, each reporting a minimum of 10 h of driving weekly, were studied. Participants were categorized based on the presence or absence of FHP. Assessment tools encompassed Surgimap for FHP detection, the Visual Analogue Scale (VAS) for pain intensity, the Cervical Range of Motion (CROM) for mobility, and the Joint Position Error Test (JPET) for proprioception. Results60% of participants manifested FHP. At 70%, car drivers had a notably higher prevalence of FHP than bike drivers at 50%. Marked cervical mobility and proprioception differences were observed between drivers with and without FHP. Car drivers with FHP recorded an average pain score of 6.8 ± 1.2 on the VAS, significantly higher than the 3.1 ± 0.8 reported by those without FHP. Bike drivers with FHP reported elevated pain scores (5.9 ± 1.1) compared to those without FHP (3.4 ± 0.7). ConclusionThe findings underscore the significant repercussions of FHP on neck pain intensity, cervical mobility, and proprioception in drivers. Notably, vehicle type emerges as a critical factor, with car drivers displaying a heightened vulnerability compared to bike riders. This research emphasizes the importance of tailored interventions, informed driver education, and vehicle-specific ergonomic modifications to foster better postural health among drivers.

Correlation between cervical proprioception with the neck length and neck pain in patients of cervical spondylosis

Background: Cervical proprioception has been a major source of attention among the population of cervical spondylosis as it is associated with neck pain, whereas it can lead to alteration in physiological manifestations which enhance neck pain as a consequence of disturbed proprioception. Objective: To determine the correlation between cervical proprioception with neck length and neck pain in patients with cervical spondylosis. Methodology: It is a cross-sectional correlational study conducted at Innovative Health Concepts (IHC) and Pakistan Society for Rehabilitation for Differently-abled Lahore, in the duration of six months from November 2021 to March 2022. The sample size of n=130 participants was recruited and data was collected through non-probability purposive sampling. Patients diagnosed with cervical spondylosis aged 25 to 50 years with neck pain, decreased neck range of motion, and osteophytes formation were included. Whereas, vestibule basilar artery insufficiency or any systemic illness was excluded. Joint Position Error Test (JPET) for cervical proprioception assessment, Numeric Pain Rating Scale (NPRS) was used for neck pain, and lateral view X-rays were taken for neck length measurement. Data was analyzed using Statistical Package for Social Sciences (IBM-SPSS) version 22. Results: There was no significant association between proprioception except for left rotation (r=0.21, p=0.016) which showed a weak positive correlation. On the other hand, neck pain showed a significant strong positive correlation with flexion (r=0.88, p=0.002), moderate with extension (r=0.39, p=0.004), strong with right rotation (r=0.81, p=0.001) and left rotation (r=0.61,p=0.001) respectively. Conclusion: It was concluded that the population of cervical spondylosis has no correlation between cervical proprioception and cervical length. Whereas, a positive strong correlation was found between cervical proprioception and neck pain. Keywords: Joint position error test, Neck pain, Proprioception.

Muscle strength, balance and upper extremity function are not predictors of cervical proprioception in healthy young subjects

Purpose/Aim: The aim of this study is to examine the relationship between cervical proprioception sense and balance, hand grip strength, cervical region muscle strength and upper extremity functionality in healthy young subjects. Methods: A total of 200 people with a mean age of 20.8 ± 1.8 participated in the study. Cervical proprioception sense of the participants was evaluated with Cervical Joint Position Error Test (CJPET), balance with Biodex Stability System, hand grip strength with hand dynamometer, and upper extremity functionality with Perdue Pegboard test. The relationship of variables with cervical proprioception was evaluated with Pearson Correlation analysis. Results: According to this study results, there was no significant relationship between CJPET (extension, left rotation, right rotation) and sub-parameters of dynamic balance (anteroposterior, mediolateral, overall), cervical muscle strength and hand grip strength (p > 0.05). There was a significant correlation between CJPET flexion and static balance variables (p < 0.05). Conclusion: According to this study, there is no relationship between cervical proprioception and balance, hand grip muscle strength, cervical region muscle strength and upper extremity functionality in healthy young subjects.

Conventional Cervical Exercises Compared with a Mixed-Reality-Based Game in Asymptomatic Subjects: An Exploratory Crossover Pilot Study

Mixed reality presents itself as a potential technological tool for the management of people with musculoskeletal disorders, without having as many adverse side effects as immersive virtual reality. The objective of this study was to explore the possibilities of a mixed-reality game, performing task-oriented cervical exercises compared to conventional therapeutic exercises in sensorimotor outcome measures in asymptomatic subjects. A randomized crossover pilot study was performed with two intervention groups: a mixed-reality group (MRG) and a conventional exercise group (CEG). The cervical joint position error test (CJPET) and deep cervical flexor endurance test (DCFET) were measured as sensorimotor outcomes. Statistically significant differences were found in the pre–post comparison in the DCFET for both groups (MRG: t = −3.87, p &lt; 0.01; CEG: t = −4.01, p &lt; 0.01) and in the extension of the CJPET for the MRG (t = 3.50, p &lt; 0.01). The rest of the measurements showed no significant differences comparing both groups pre- and postintervention (p &gt; 0.05). Mixed reality has apparently the same positive effects as conventional exercises in sensorimotor outcomes in asymptomatic subjects. These results could help in future studies with mixed virtual reality in the management of people with musculoskeletal disorders.

Poor cervical proprioception as a risk factor for concussion in professional male rugby union players

BackgroundConcussion is one of the most common injuries in male professional Rugby Union (‘rugby’) and accounts for significant time loss from training and competition. Despite the most recent Concussion in Sport Group consensus statement recommending a focus on the identification of modifiable risk factors, limited evidence for their existence is available. ObjectiveTo investigate the association between cervical proprioception and concussion incidence in a group of professional male rugby players over the course of a full season. Methods165 players were assessed at pre-, mid- and end of season time points using the Cervical Joint Position Error Test (CJPET). Associations with diagnosed concussion injuries are presented as incidence rate ratios with 95% confidence intervals. We present the Incidence Rate Ratios (IRR) for a 10% increase in each variable and compared results against concussion using match minutes to account for risk exposure. ResultsDuring the study period, 45 concussions were incurred by 44 players [or 19.7 concussions per 1000 player-match hours]. There was a significant association between right rotation repositioning error and concussion, with a 5% increase in concussion rate for each 10% increase in gross right rotation error (P = 0.021). ConclusionPoor gross right rotation repositioning error is a modifiable intrinsic risk factor for concussion in professional male rugby players. Interventions to improve proprioceptive function may act as an effective method for reducing concussion incidence in this population.

Contribution of Cervical Proprioception, Vision, and Vestibular Feedback on Reducing Dynamic Head-Trunk Orientation Error in the Yaw Direction.

The contribution of cervical proprioception, vision, and vestibular feedback to the dynamic head–trunk orientation error in the yaw direction was investigated to further the understanding over the mechanism of coordination among different sensory modalities for dynamic head–trunk orientation. To test the contribution of each sensory modality, individually and together, to dynamic head–trunk orientation, 10 healthy human subjects participated in the extended cervical joint position error test, measuring the ability of repositioning the head back to the reference orientation after 45° yaw rotation of head or trunk. The error between initial and returned angles was measured. The test was repeated under eight different conditions of sensory feedback, with or without each of three sensory modalities. Each subject completed 64 trials (8 per condition) in a random order for fair comparison. No change was found in bias when one of the three modalities was missing, while variance was largest at the lack of dynamic cervical proprioception. When two of the three modalities were missing (i.e., one of the three modalities was present), both bias and variance were minimum at the presence of cervical proprioception. Additionally, both visual and vestibular feedback was redundant (i.e., no further improvement in both bias and variance), if the other one (visual or vestibular feedback) was present with dynamic cervical proprioception. In sum, the experimental results suggest that dynamic cervical proprioception is the most significant sensory modality for reducing the dynamic head–trunk orientation error in the yaw direction.

The relationship between cervical proprioception and balance in patients with fibromyalgia syndrome.

Proprioceptive abnormalities, balance, and postural disorders have been previously reported in fibromyalgia syndrome (FMS). Unlike previous research, the aim of this study was to compare the proprioception of the cervical region of patients with FMS with a healthy control group. The relationship between cervical proprioception impairment and loss of balance was also examined. A total of 96 female FMS patients and 96 female healthy control subjects were enrolled in this case-control study. The cervical joint position error test (CJPET) was administered to the patient and control groups for cervical proprioception evaluation. FMS patients were assessed with a visual analogue scale (VAS), fibromyalgia impact questionnaire (FIQ), and fatigue severity scale (FSS). Balance tests were applied to both groups. FMS patients had significantly impaired CJPET results in all directions (p < 0.001). There were significant positive correlations between FIQ scores and CJPET results (r = 0.542 and p < 0.001 for right rotation; r = 0.604 and p < 0.001 for left rotation; r = 0.550 and p < 0.001 for flexion; r = 0.612 and p < 0.001 for extension). Significant correlations were found between CJPET measurements and balance tests (for sit-to-stand test; r = 0.510 and p < 0.001 for right rotation; r = 0.431 and p < 0.001 for left rotation; r = 0.490 and p < 0.001 for flexion; r = 0.545 and p < 0.001 for extension), (for timed up and go test; r = 0.469 and p < 0.001 for right rotation; r = 0.378 and p < 0.001 for left rotation; r = 0.410 and p < 0.001 for flexion; r = 0.496 and p < 0.001 for extension) and (for one-legged balance test; r = -0.479 and p < 0.001 for right rotation; r = -0.365 and p < 0.001 for left rotation; r = -0.392 and p < 0.001 for flexion; r = -0.469 and p < 0.001 for extension). Cervical proprioception and balance were impaired in FMS patients. As the disease activity and fatigue level increased, so the deterioration in cervical proprioception became more evident. There were correlations that demonstrated an association between impaired cervical proprioception and poor balance tests. Therefore, proprioception and balance assessments should be integrated into the physical examination processes of FMS patients.

ANALYSIS OF THE EFFECT OF THE DIFFERENCE BETWEEN STANDING AND SITTING POSTURES ON NECK PROPRIOCEPTION USING JOINT POSITION ERROR TEST

The proprioceptive sense is a very important function for the body, and joint position error test (JPET) is commonly used to measure it. This study was to analyze the difference of proprioception in standing and sitting postures through the JPET. A total of 60 students (M/F, 12/48) in D University in Gyeongsangbuk-do, South Korea participated in this study. A JPET was performed with the subject’s eyes closed to assess the neck proprioception. The movement of the neck was measured in flexion, extension, and lateral flexion, and separately measured when sitting and standing. The difference in repositioning errors between sitting and standing postures was analyzed using paired [Formula: see text]-test. There was a significant difference in repositioning errors between sitting and standing posture in neck extension. There was no significant difference in repositioning errors between sitting and standing posture in neck flexion and lateral flexion. In conclusion, in a sitting posture, posterior neck muscles are used more than in the standing posture, which may negatively affect the proprioceptive accuracy of the neck and may also increase the neck repositioning errors.

Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review.

Neck pain is very common, but most of the causes are unknown, making diagnosis and treatment extremely challenging. Current studies have found that one of the main problems in patients with neck pain is the impairment of cervical proprioception, which subsequently leads to cervical sensorimotor control disturbances. Cervical spine has a very delicate proprioceptive system that plays a crucial role in controlling posture and balance. Cervical proprioceptive impairment in neck pain occurs through a variety of mechanisms. Experimental neck muscle pain induced by injection of hypertonic saline results in inhibition of the activation of painful muscle; chronic neck pain causes structural and functional impairment of cervical muscles; excessive activation of mechanoreceptors in degenerative cervical discs and facet joints produces a large number of erroneous sensory signals. Clinical examinations to assess the link between structural pathology and neck pain have been unsuccessful, opening the way for the development of function-based tests. To date, eight neck sensorimotor control tests have been reported to evaluate patients with chronic neck pain. Although some tests may involve different subsystems (such as oculomotor system and vestibular system), all tests measure sensorimotor control in the neck, and the most commonly used is cervical joint position error (JPE) test. Current studies support the effectiveness of exercises targeting different aspects of sensorimotor function, in particular retraining aimed at improving cervical proprioception and muscle coordination. Based on the available evidence, it is recommended that patients with neck pain should be assessed and managed for cervical proprioceptive impairment and sensorimotor control disturbances.

Evaluation attempt of own body sensing amongst persons with and without scoliosis.

Adolescent idiopathic scoliosis (AIS) is a common structural spine deformity affecting 2%-4% of adolescents. Due to the unknown cause of idiopathic scoliosis, its therapy is a long-term and often unsatisfactory process. In the literature, it is often suggested that problems related to the feeling of one's own body are caused by AIS. The aim of this study was to assess the feeling of one's own body among children with and without scoliosis on the example of feeling the head position, pelvis shape and balance. The research included 62 children: 30 with scoliosis and 25 without diagnosed scoliosis with an age range between 11 to 19 years. The minimum scoliosis value was 7∘ and the maximum was 53∘. The average value was 25∘. During the study, three functional tests were used: Cervical Joint Position Error Test (CJPET), Clinical Test of Sensory Integration on Balance (CTSIB) and Body proportion demonstration test (BPDT). The results of the tests showed statistically significant differences (CJPET p= 3.54*10-14, CTSIB p= 0.0376, BPDT p= 0.0127). However, none of the studies showed a correlation between the results of people with scoliosis and the value of their Cobb angles.

Clinical Changes in Cervical Neuromuscular Control Following Subconcussive Impacts.

Increased injury rates following concussive injury have been attributed to decreased neuromuscular coordination frequently documented following a concussion. However, altered integration between the vestibular system and oculomotor pathways following impacts at subconcussive thresholds implicate all sports-related impacts not just those at a concussive threshold in future musculoskeletal injury. While, several studies have explored the utility of vestibular and oculomotor clinical testing to detect altered neuromuscular control and then correlated those alterations to future injury risk, no research has explored the use of cervical clinical tests in the same capacity. Cervical joint position error test, Neck Disability Index and head acceleration. Soccer headers, fatigue protocol, soccer headers + fatigue. To explore the clinical utility of a novel clinical approach to measuring changes in cervical neuromuscular control following subconcussive impacts in a controlled lab environment. 40 current female colligate club soccer athletes were recruited. Inclusion criteria included between the age of 18 and 25 and a minimum of 4-year soccer heading experience. Laboratory. Design: A repeated-measures design with 4 groups was utilized to test the hypothesis. A 65%, 54%, and 49% increased error was observed following the soccer heading, fatigue only, and soccer heading + fatigue interventions, respectively. Meanwhile, the controls saw a 6% decrease in neck position error. Concussion: While, cervical joint position error testing was sensitive to decreased neuromuscular coordination following soccer heading, it was not specific enough to rule out an exercise effect in the absence of subconcussive impacts. Further research is warranted to explore the clinical utility and specificity of cervical joint position error testing to measured alterations in supraspinal processing following subconcussive impacts, and how these alterations may lead to decreased coordination and movement of the body during sports-related task.