Cervical Sensorimotor Control Tests in Neck Pain & Asymptomatic Subjects
- Dr. Shawn Thistle
Cervical sensorimotor control generally refers to the control and accuracy of head movements, which has been suggested to be important for the assessment of individuals with neck pain. Sensorimotor control is defined as all afferent and efferent information streams contributing to joint stability, consisting of multiple systems including proprioception and kinesthesis, the vestibular system, and the visuomotor system. The proprioception and kinesthetic systems are responsible for the sensation of head orientation, the vestibular system is responsible for postural balance and spatial orientation and the visuomotor system processes visual information used for all head and neck movements. It is hypothesized that if sensorimotor impairments differ between those with neck pain compared to healthy individuals, treatment interventions can be tailored to the neck pain patients.
Past research has suggested that cervical sensorimotor control differs between neck pain individuals compared to asymptomatic individuals. However, several of these studies have significant flaws such as small sample sizes, large number of statistical tests and a lack of blinding which may lead to significant differences based on chance alone. In addition, there is little consistency between the study findings as some report differences and others report no differences. Furthermore, studies that have included larger samples have an issue of heterogeneity among participants. This is a problem, as pain mechanisms and vestibular function differ between neck pain conditions.
Idiopathic neck pain is defined as neck pain without a clear reason for its onset, which generally develops gradually over time. It has been suggested that idiopathic neck pain individuals may present with a sensorimotor control deficit. A recent meta-analysis identified the Joint Position Error (JPE) test as having the most support in the literature with small and statistically significant differences between participant groups, but the clinical relevance is questionable.
Currently, cervical sensorimotor control tests are being used clinically but the evidence regarding their applicability to idiopathic neck pain patients is lacking. This study aimed to report outcomes on 7 cervical sensorimotor control tests and investigate whether there are differences in these outcomes in individuals with chronic idiopathic neck pain compared to asymptomatic individuals. The 7 cervical sensorimotor tests that were used were: joint position error, postural balance, subjective visual vertical, head-tilt response, “the Fly” test, head steadiness, and smooth pursuit neck torsion.…enjoy!
THIS WEEK'S RESEARCH REVIEW: “Cervical Sensorimotor Control Tests in Neck Pain & Asymptomatic Subjects”
This paper was published in JOSPT (2020) and this Review is posted in Recent Reviews, Neck Pain, Clinical Testing & Procedures and the 2021 Archive.
IMAGE: Joint Position Error (JPE) testing with a head-mounted laser