Joint Position Error: Talk About a Pain in the Neck…Literally

Nearly two thirds of the population will experience neck pain at some point in their life, and for some of those people, the symptoms will become chronic (in fact, Côté et al.  found the prevalence of persistent neck pain to be over 30%). One impairment from this ongoing neck pain that at times is overlooked involves proprioception, also known as joint positioning sense (where is my head in space). A recent systematic review and meta-anyalysis by Stanton et al.. looked at the current evidence regarding proprioceptive dysfunctions in people with chronic neck pain, and the following conclusion was made:

  • Individuals with chronic neck pain performed significantly worse in head-to-neutral repositioning tests (the subject’s head was passively brought into various positions, and a measure was taken between the initial neutral position and the final neutral position after the completion of the movement)

So why do we care? Nearly 80% of your cervical stabilization comes through the surrounding musculature, and previous studies have shown impairments in deep neck flexor muscle activation in individuals with neck pain. What does this mean? People who have persistent neck pain are unable to engage the important stabilizing muscles which helps keep their head on their shoulders. Basically your head is a 12 pound bowling ball stacked on top of a bunch of building blocks, so having a wobbly head would be expected if you are having trouble activating the necessary muscle groups.

So what do we do about it? Along with incorporating deep neck flexor exercises into your treatment plan, you may want to look into adding proprioceptive training for the cervical spine as well. But how do we know if we should be implementing these types of exercises? One objective test, the cervical joint position error test, will allow for you to establish baseline figures for your patient’s performance, and be able to track progress throughout therapy (check out this link for more information about how to conduct this test: Cervical Joint Position Error Test). While you can simply tape a laser pointer to the brim of a baseball hat to conduct the test/incorporate exercises, you can also look into purchasing a laser headlamp like the following: SenMoCOR Laser Headlamp.

Finally, why is it important to add this type of training? A 2007 study by Jull et al. examined the effects of proprioceptive training and craniocervical flexion training on cervical joint position error (JPE) in people with persistent neck pain. While both groups showed improvements in JPE, the proprioceptive group showed more significant changes. Why not add another tool to your toolbox to get your patients better? So next time a patient walks into your clinic with neck pain, take a look at their cervical proprioception, and hopefully their rehab won’t be a pain in your neck.