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Effects of Cervical Joint Manipulation on Joint Position Sense of Normal Adults

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Abstract

[Purpose] The purpose of this study was to identify the effects of cervical joint manipulation on joint position sense (JPS) of normal adults. [Subjects] Thirty normal adults were divided into a test group of 15 subjects and a control group of 15 subjects. [Methods] The test group was treated with cervical joint manipulation and massage, whereas the control group received only massage. Both groups were evaluated in terms of joint position error (JPE) using a digital dual clinometer before and after the interventions. [Results] The comparision of the pre- and post-test results revealed the test group exhibited statistically significant changes in flexion, extension, left lateral flexion, right lateral flexion, left rotation, and right rotation. On the other hand, the control group showed no statistically significant changes in any of the variables. [Conclusion]Cervical joint manipulation reduced JPE and improved joint position sence. Therefore, we consider its application to the treatment of patients with cervical problems in clinical practice is desirable.
Effects of Cervical Joint Manipulation on Joint
Position Sense of Normal Adults
Wontae GonG, PhD, PT
1)
1)
Department of Physical Therapy, Korea Nazarene University: Wolbong Ro 48, Seobuk-gu,
Cheonan-Si, Chungcheongnam-do 330-718, Republic of Korea. TEL: +82 41-570-4286,
FAX: +82 41-570-7925
Abstract. [Purpose] The purpose of this study was to identify the effects of cervical joint manipulation on joint
position sense (JPS) of normal adults. [Subjects] Thirty normal adults were divided into a test group of 15 subjects
and a control group of 15 subjects. [Methods] The test group was treated with cervical joint manipulation and
massage, whereas the control group received only massage. Both groups were evaluated in terms of joint position
error (JPE) using a digital dual clinometer before and after the interventions. [Results] The comparision of the
pre- and post-test results revealed the test group exhibited statistically signicant changes in exion, extension, left
lateral exion, right lateral exion, left rotation, and right rotation. On the other hand, the control group showed
no statistically signicant changes in any of the variables. [Conclusion]Cervical joint manipulation reduced JPE
and improved joint position sence. Therefore, we consider its application to the treatment of patients with cervical
problems in clinical practice is desirable.
Key words: Cervical joint manipulation, Joint position sense, Joint position error
(This article was submitted Jan. 11, 2013, and was accepted Feb. 8, 2013)
INTRODUCTION
Neck pain is a frequent and disabling complaint in the
general population, and joint position sense (JPS) is an im-
portant function of the human body, recognizing the loca-
tion of joints, and an essential element in the maintenance
of balance or kinesthetic sense
1)
. In a previous study, ex-
ion, extension, left lateral exion (LLF) right lateral ex-
ion (RLF), left rotation (LR), right rotation (RR), and range
of motion (ROM) of female ofce workers with neck pain
were measured. That study reported that their neck mobility
had declined in all directions and that altered muscle re-
cruitment strategies were employed. Moreover, to help the
ofce workers manage their neck pain, exercise programs
including motor re-education were considered necessary
2)
.
Therefore, reduction in cervical ROM may decrease JPS
and alter muscle recruitment strategy. There are various
methods of increasing cervical ROM, but research has dem-
onstrated that spinal manipulative therapy has particularly
benecial effects
3)
. In the literature of JPS-related studies,
one study reported that conventional proprioceptive train-
ing improved JPS
4)
. Another identied relations between
JPS and dizziness. However, most JPS-related studies have
focused on patients with persistent neck pain or whiplash
injuries, and JPS was improved JPS through exercises. The
present study aimed to identify whether an increase in the
ROM of the cervical joint, resulting from manipulation
techniques for joint mobility, improved cervical JPS.
SUBJECTS AND METHODS
The study subjects were 30 students attending N Univer-
sity in Chungcheongnam-do, Korea. The subjects were di-
vided into a test group of 15 subjects (1 male and 14 females)
and a control group of 15 subjects (1 male and 14 females).
The test group was aged 21.9±0.2 years, 163.3±5.8 cm in
height, and 55.2±7.0 kg in weight. The control group was
aged 21.0±0.3, 162.5.9 cm in height, and 53.1±7.5 kg in
weight. The two groups showed no statistically signicant
differences in their general characteristics. Subjects who
had undergone surgery, were undergoing hospital treat-
ment, or had a ruptured cervical disk were excluded from
this study. All the subjects were given an explanation about
the purpose of this study and the entire process of the ex-
periment and submitted their voluntary written consent be-
fore participation.
The test group received cervical joint manipulation and
massage for 25 minutes in a single session. In the cervi-
cal joint manipulation for the rotation correction, the thera-
pist placed his thumb on the posterior articula pilla in the
segment intended for rotation, applied rotational pressure
against the y-axis in the horizontal plane, and then applied
a short and quick thrust at the end range of rotation. For
the correction of lateral exion (LF), the therapist placed
his index nger on the exterior of the segment intended
for correction, generated LF against the z-axis in the coro-
nal plane, and then applied a short and quick thrust at the
end range of LF. To increase the extension ROM, Gong’s
mobilization was used
5)
. The sternocleidomastoid, upper
trapezius, levator scapulae, and posterior cervical muscles
were massaged. After each subject lay supine on a table,
J. Phys. Ther. Sci.
25: 721–723, 2013
E-mail: owntae@hanmail.net
J. Phys. Ther. Sci. Vol. 25, No. 6, 2013722
the therapist sat down at the side of the subject’s head. The
therapist supported the patient’s head with the hand closest
to the patient and placed the other hand below the subject’s
neck and massaged the posterior cervical muscles along the
muscle bers. Thereafter, the therapist turned the subject’s
head in the opposite direction to the intended massaging di-
rection, and then massaged the sternocleidomastoid, upper
trapezius, and levator scapulae muscles
6)
. The control group
received only a single session of massage for 15 minutes.
JPS was evaluated through JPE, with a greater JPE de-
noting a lower JPS. The JPE was measured using a digi-
tal dual clinometer (Dualer IQ, JTECH Medical, U.S.A.).
To measure the JPE, the subjects were shown twice how
to adopt the exact positions of 3exion, 35° extension,
30° LLF, 30° RLF, 45° LR, and 45° RR with passive cervi-
cal movements in a neutral position under the measurer’s
instructions. Afterward, the subjects had to adopt these six
positions using their own active cervical movements with-
out the measurer’s instructions. During the test, the differ-
ence between each positions measured and correct values
was recorded. The joint position was measured three times
before and after the intervention, and the averages were
used for the evaluation.
The experimental results were statistically analyzed us-
ing SPSS 12.0 KO (SPSS, Chicago, IL, U.S.A.). After the
general characteristics of the subjects were determined, the
paired t-test wsa used to compare the changes in the ex-
ion, extension, LLF, RLF, LR, and RR between pre-test and
post-test in each group. The differences between the two
groups were tested using the independent t-test. The statis-
tical signicance level was chosen as α=0.05.
RESULTS
The comparison of the pre- and post-test results of the
test group revealed statistically signicant differences in
exion, extension, LLF, RLF, LR, and RR (p<0.05). On the
other hand, the control group showed no statistical signi-
cant differences in any of the variables (p>0.05) (Table 1).
Based on the results of the independent t-test for the two
groups before and after the test, only the differences be-
tween the pre- and post-test values of LLF and LR were
statistically signicant (p<0.05). All the other variables
showed no statistically signicant differences (p>0.05)
(Table 2).
DISCUSSION
In a similar study related to cervical functions, Jull et
al. reported that cranio-cervical exion training increased
deep cervical exor electromyographic amplitudes and de-
creased sternocleidomastoid and anterior scalene electro-
myographic amplitudes across all stages of cranio-cervical
exion training
7)
. In a study related to JPS, Treleaven et
al. measured JPE in 102 subjects with dizziness and un-
steadiness following whiplash injuries and in 44 normal
adults. They reported that compared to normal adults,
those with dizziness and unsteadiness following whiplash
injuries showed larger declines in JPS. They further noted
that cervical mechanoreceptor dysfunction can give rise
to dizziness in patients with whiplash injuries
8)
. Jull et al.
implemented conventional proprioceptive training and cra-
niocervical exion training for 64 female subjects with a
history of chronic neck pain of either idiopathic (n=39) or
traumatic (n=25) origin over a 6-month period. After the
training, they measured JPE in cervical extension and ro-
tation. They reported that while both groups exhibited de-
clines in JPE, the proprioceptive training group showed a
larger decline. In their study, the degree of JPE decreased
Table 1. Comparison of cervical joint position errors between
pre-test and post-test of each group (unit: degree)
Group Category Pre-test Post-test
Experiment group
Fle* 2.4±1.5 1.2±0.9
Exe* 2.8±1.2 1.2±1.5
LLF* 2.3±1.1 1.0±1.0
RLF* 3.0±1.6 1.2±0.9
LR* 2.7±2.0 1.0±1.0
RR* 2.8±1.6 1.2±1.4
Control group
Fle 2.8±1.5 2.0±1.4
Exe 2.6±1.4 1.8±1.2
LLF 2.4±1.5 2.0±1.4
RLF 2.8±1.3 2.2±1.6
LR 3.0±1.4 2.4±1.4
RR 2.8±1.5 2.0±1.7
* p<0.05, Mean±SD. Fle: exion, Exe: extension, LLF: left lat-
eral exion, RLF: right lateral exion, LR: left rotation, RR:
right rotation
Table 2. Comparison of cervical joint position errors between
the experiment and control groups (unit: degree)
Category
Experiment
group
Control
group
Pre-test
Fle 2.4±1.5 2.8±1.5
Exe 2.8±1.2 2.6±1.4
LLF 2.3±1.1 2.4±1.5
RLF 3.0±1.6 2.8±1.3
LR 2.2.0 3.0±1.4
RR 2.8±1.6 2.8±1.5
Post-test
Fle 1.2±0.9 2.0±1.4
Exe 1.2±1.5 1.8±1.2
LLF* 1.0±1.0 2.0±1.4
RLF 1.2±0.9 2.2±1.6
LR* 1.0±1.0 2.4±1.4
RR 1.2±1.4 2.0±1.7
Difference of pre-test
and post-test
Fle 1.2±1.9 0.8±2.5
Exe 1.6±1.5 0.8±1.6
LLF 1.3±1.1 0.4±2.5
RLF 1.7±1.8 0.6±1.8
LR 1.7±2.3 0.6±1.1
RR 1.6±2.0 0.8±1.5
* p<0.05, Mean±SD
Abbreviations used are the same as those used in Table 1
723
from 4–5° before the intervention to 2–3° after the interven-
tion. In the present study, the degree of JPE declined from
2.5–3.0° before the intervention to 1.01.2° after the inter-
vention
4)
. This difference is likely due to the present study
having only included normal subjects.
In this study, the test group was treated with both cervi-
cal joint manipulation and massage, and displayed larger
declines in JPE than the massage-only control group. Al-
though no previous studies have reported an improvement
in JPS through joint manipulation, mobility in the present
study was likely to have been generated in each segment
through joint mobilization, which, in turn, would have ac-
tivated the proprioceptors in the joint capsules and deep
muscles, eventually leading to improvement in JPS. How-
ever, in the comparison of the two group’s of differences
between the pre- and post-test values of exion, extension,
LLF, RLF, LR, and RR, only LLF and LR exhibited statisti-
cal signicance. This suggests that while increase in cervi-
cal ROM leads to reduced JPE and improved JPS, JPE can
also be reduced and JPS can be improved through massage.
However, the differences between the two treatments were
not statistically signicant. In other words, while a single
session of massage can reduce JPE and improve JPS, the
combined treatment of massage and cervical joint manip-
ulation was much more effective at increasing the ROM.
Therefore, we recommend that when treating patients with
reduced JPS due to decreased ROM, persistent neck pain, or
whiplash injuries, the combined application of cervical joint
manipulation and massage is used.
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... Further evidence for this model comes from studies that have shown proprioceptive improvements occur following spinal adjustments (Haavik and Murphy 2011;Holt et al. 2016a, b;Palmgren et al. 2006Palmgren et al. , 2009. Improved head repositioning accuracy has been demonstrated several times following chiropractic care (Palmgren et al. 2006(Palmgren et al. , 2009Rogers 1997;Gong 2013;García-Pérez-Juana et al. 2018), suggesting that spinal adjustments can improve vertebral column proprioception. ...
... All of the above animal studies suggest that rapid stretch of the deep, small paraspinal muscles, that occurs during an HVLA adjustment, play a major role in the mechanisms of spinal adjustments, by bombarding the CNS with mechanoreceptive and proprioceptive input (Boal and Gillette 2004;Evans 2002;Haavik and Murphy 2012;Haavik 2014;Henderson 2012;Pickar 2002;Pickar and Bolton 2012;Potter et al. 2013;Cao et al. 2013;Pickar and Wheeler 2001;Pickar and Kang 2006;Pickar et al. 2007;Sung et al. 2005;Reed et al. 2013aReed et al. , b, 2014aReed et al. , b, 2017a. This explains why spinal adjustments improve vertebral column proprioception (Palmgren et al. 2006(Palmgren et al. , 2009Rogers 1997;Gong 2013;García-Pérez-Juana et al. 2018). Interestingly, not only do spinal adjustments improve vertebral column proprioception, but studies have shown that spinal adjustments also can improve upper and lower limb proprioception (Haavik and Murphy 2011;Holt et al. 2016a, b). ...
... Because spinal stiffness had little effect on spindle responses during HVLA thrusts that were delivered with longer thrust durations (≥250 milliseconds), it appears that speed of thrust is important to elicit a muscle spindle response and that slower mobilisations are likely to alter CNS function via different mechanoreceptors. (Gong 2013) 'Normal adult human' (n = 30) "In the cervical joint manipulation for the rotation correction, the therapist placed his thumb on the posterior articula pilla in the segment intended for rotation, applied rotational pressure against the y-axis in the horizontal plane, and then applied a short and quick thrust at the end range of rotation. For the correction of lateral flexion (LF), the therapist placed his index finger on the exterior of the segment intended for correction, generated LF against the z-axis in the coronal plane, and then applied a short and quick thrust at the end range of LF. ...
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... 12,31 Thereby, this kind of therapy produces a bombardment to the CNS with sensory input from muscle proprioceptors, normalizing the behavior of central neurons. 12,31 The SM can affect the muscles innervated by the manipulated segment, 16,18,19,34,38 inducing a stimulus over mechanoreceptors, mainly on muscle spindles and GTOs. 1,5,7,12,15,31,34 This may affect the neural output of muscles related to the spinal manipulated segment. ...
... 1,5,7,12,15,31,34 This may affect the neural output of muscles related to the spinal manipulated segment. 6,7,12,15,16,18,38 Thus, assuming that the sacroiliac joint (SIJ) is innervated from L2 to S3, the quadriceps (L2-L4) and the knee joint (L2-S2) share common nerve root levels, it is expected that the afferent information from one of these structures may alter efferent signals to all structures innervated by a similar nerve root level. ...
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... 12,31 Thereby, this kind of therapy produces a bombardment to the CNS with sensory input from muscle proprioceptors, normalizing the behavior of central neurons. 12,31 The SM can affect the muscles innervated by the manipulated segment, 16,18,19,34,38 inducing a stimulus over mechanoreceptors, mainly on muscle spindles and GTOs. 1,5,7,12,15,31,34 This may affect the neural output of muscles related to the spinal manipulated segment. ...
... 1,5,7,12,15,31,34 This may affect the neural output of muscles related to the spinal manipulated segment. 6,7,12,15,16,18,38 Thus, assuming that the sacroiliac joint (SIJ) is innervated from L2 to S3, the quadriceps (L2-L4) and the knee joint (L2-S2) share common nerve root levels, it is expected that the afferent information from one of these structures may alter efferent signals to all structures innervated by a similar nerve root level. ...
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Background: Previous research demonstrated that manipulation of the extremities was associated with changes in multisegmental postural sway as well as improvement in a lower extremity balancing task. We were interested if these effects would extend to an upper extremity task. Our aim in this study was to investigate whether extremity manipulation could influence dual task performance where the explicit suprapostural task was balancing a water filled tube in the frontal plane. Methods: Participants were healthy volunteers (aged 21-32 years). Upper- or lower-extremity manipulations were delivered in a participant and assessor blinded, randomized crossover, clinical trial. Postural (center of pressure) and suprapostural (tube motion) measurements in the frontal plane were made pre-post manipulation under eyes open and eyes closed conditions using a BTrackS™ force plate and a Shimmer inertial measurement unit, respectively. Pathlength, range, root mean square and sample entropy were calculated to describe each signal during the dual task performance. Results: There was no main effect of manipulation or vision for the suprapostural task (tube motion). However, follow-up to interaction effects indicates that roll pathlength, range and root means square of tube motion all decreased (improvement) following lower extremity manipulation with eyes open. Regarding the postural task, there was a main effect of manipulation on mediolateral center of pressure such that pathlength reduced with both upper and lower extremity manipulation with larger decreases in pathlength values following upper extremity manipulation. Conclusion: Our findings show that manipulation of the extremities enhanced stability (e.g. tube stabilization and standing balance) on performance of a dual task. This furthers the argument that site-specific manipulations influence context specific motor behavior/coordination. Trial Registration: Clinicaltrials.gov, NCT03877367, Registered 15 March 2019, https://clinicaltrials.gov/ct2/show/NCT03877367?term=NCT03877367&draw=2&rank=1
... In an early study, Sterling et al. (2001) proposed that the stimulation of articular mechanoreceptors (as well as mechanoreceptors of deep muscles) via passive mobilisation may excite γ-motorneurons, increase muscle spindle sensitivity and result in improved proprioceptive awareness and thus improved muscle control at low loads. Since then, some supporting evidence, that passive mobilisations may benefit joint position sense, has been published (Gong 2013(Gong , 2014K€ ohne et al., 2007). Nonetheless, further research is needed to thoroughly investigate this possible mechanism of action. ...
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... This method has been well established in previous studies. [28][29][30] Notably, joint position sense becomes more inaccurate as the degree of position sense error increases. Subjects stood upright and put their head position in a neutral start position, keeping their eyes closed. ...
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... This warmup progressed from upper body ergometer to ambulation to jogging on an incline. There is precedence for utilizing manual therapy to diminish cervicalgia, dizziness, and cervical proprioception deficits (Bialosky et al. 2009;Bracher et al. 2000;Galm et al. 1998;Gong 2013;Li and Peng 2015;Reid and Rivett 2005). ...
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Purpose: This case report presents evidence-based physical therapy assessments and interventions for a patient with unilateral vestibular hypofunction (UVH). UVH is the result of peripheral vestibular dysfunction in the inner ear. Case description: The patient was a 48-year-old male with symptoms of dizziness, cephalalgia, and cervicalgia. The examination and treatment were focused on impaired cervical proprioception, which is a vital component of balance training in addition to visual, vestibular, and somatosensory re-education for patients with dizziness. Toward the end of the physical therapy episode of care, the patient was medically diagnosed with Chiari malformation, a congenital cerebellar tonsillar herniation. Outcomes: The patient made significant strides on the Dizziness Handicap Inventory, Ten Meter Walk Test, Single Leg Stance, Balance Error Scoring System, Fukuda Stepping Test, Cervical Joint Position Error Sense Test, Convergence Distance, Global Rate of Change, and cervical range of motion assessments. The patient did not demonstrate comparable improvements on the Dynamic Visual Acuity Test. Conclusion: This case report demonstrates a physical therapy program for a patient with peripheral UVH-related symptoms. This approach may also be applicable for patients with the central cause of dizziness such as Chiari malformation. Future directions for research and clinical practice are also suggested in this report.
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Dizziness and/or unsteadiness are common symptoms of chronic whiplash-associated disorders. This study aimed to report the characteristics of these symptoms and determine whether there was any relationship to cervical joint position error. Joint position error, the accuracy to return to the natural head posture following extension and rotation, was measured in 102 subjects with persistent whiplash-associated disorder and 44 control subjects. Whiplash subjects completed a neck pain index and answered questions about the characteristics of dizziness. The results indicated that subjects with whiplash-associated disorders had significantly greater joint position errors than control subjects. Within the whiplash group, those with dizziness had greater joint position errors than those without dizziness following rotation (rotation (R) 4.5 degrees (0.3) vs 2.9 degrees (0.4); rotation (L) 3.9 degrees (0.3) vs 2.8 degrees (0.4) respectively) and a higher neck pain index (55.3% (1.4) vs 43.1% (1.8)). Characteristics of the dizziness were consistent for those reported for a cervical cause but no characteristics could predict the magnitude of joint position error. Cervical mechanoreceptor dysfunction is a likely cause of dizziness in whiplash-associated disorder.
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[Purpose] In this study, the effectiveness of Gong's Mobilization and sustained naturalapophyseal glides (SNAGS) were compared in college students who had problems with cervical posture and range of motion (ROM) in order to examine the effects of Gong's Mobilization on cervical lordosis, forward head posture (FHP), and cervical ROM. [Subjects] Forty college students in their twenties with problems of cervical posture and ROM were divided into a Gong's Mobilization group (n=20) and a SNAGS group (n=20). [Methods] Gong's Mobilization and SNAGS were administered three times a week for four weeks to each respective group and then changes in cervical lordosis, FHP, and cervical ROM were evaluated. [Results] Gong's Mobilization was effective at increasing cervical lordosis, cervical extension ROM (CER), and ranges of flexion and extension motion (RFEM), as well as decreasing FHP. In contrast, SNAGS was effective at increasing CER and decreasing FHP. [Conclusion] Although both Gong's Mobilization and SNAGS affected cervical posture and ROM, Gong's Mobilization was more effective at increasing cervical lordosis, CER, and RFEM.
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The response of paraspinal cutaneous pain tolerance levels to spinal manipulation has not been studied in an experimental model. This paper proposes such a model of pain tolerance measurement and describes the results of a controlled study of 50 assymptomatic subjects. The group receiving a spinal manipulation demonstrated a 140% increase in local cutaneous pain tolerance levels which was statistically significant (p less than 0.05). This is consistent with previous hypotheses regarding the mode of action of manipulation in the relief of spinal pain.
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Cervical joint position error (JPE) has been used as a measure of cervical afferent input to detect disturbances in sensori-motor control as a possible contributor to a neck pain syndrome. This study aimed to investigate the relationship between cervical JPE, balance and eye movement control. It was of particular interest whether assessment of cervical JPE alone was sufficient to signal the presence of disturbances in the two other tests. One hundred subjects with persistent whiplash-associated disorders (WADs) and 40 healthy controls subjects were assessed on measures of cervical JPE, standing balance and the smooth pursuit neck torsion test (SPNT). The results indicated that over all subjects, significant but weak-to-moderate correlations existed between all comfortable stance balance tests and both the SPNT and rotation cervical JPE tests. A weak correlation was found between the SPNT and right rotation cervical JPE. An abnormal rotation cervical JPE score had a high positive prediction value (88%) but low sensitivity (60%) and specificity (54%) to determine abnormality in balance and or SPNT test. The results suggest that in patients with persistent WAD, it is not sufficient to measure JPE alone. All three measures are required to identify disturbances in the postural control system.
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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.
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Cross-sectional study. To explore aspects of cervical musculoskeletal function in female office workers with neck pain. Evidence of physical characteristics that differentiate computer workers with and without neck pain is sparse. Patients with chronic neck pain demonstrate reduced motion and altered patterns of muscle control in the cervical flexor and upper trapezius (UT) muscles during specific tasks. Understanding cervical musculoskeletal function in office workers will better direct intervention and prevention strategies. Measures included neck range of motion; superficial neck flexor muscle activity during a clinical test, the craniocervical flexion test; and a motor task, a unilateral muscle coordination task, to assess the activity of both the anterior and posterior neck muscles. Office workers with and without neck pain were formed into 3 groups based on their scores on the Neck Disability Index. Nonworking women without neck pain formed the control group. Surface electromyographic activity was recorded bilaterally from the sternocleidomastoid, anterior scalene (AS), cervical extensor (CE) and UT muscles. Workers with neck pain had reduced rotation range and increased activity of the superficial cervical flexors during the craniocervical flexion test. During the coordination task, workers with pain demonstrated greater activity in the CE muscles bilaterally. On completion of the task, the UT and dominant CE and AS muscles demonstrated an inability to relax in workers with pain. In general, there was a linear relationship between the workers' self-reported levels of pain and disability and the movement and muscle changes. These results are consistent with those found in other cervical musculoskeletal disorders and may represent an altered muscle recruitment strategy to stabilize the head and neck. An exercise program including motor reeducation may assist in the management of neck pain in office workers.
Basic Clinical Massage Therapy: Intergrating anatomy and treatment
  • J H Clay
  • D M Pounds
Clay JH, Pounds DM: Basic Clinical Massage Therapy: Intergrating anatomy and treatment. Philadelphia: Lippincott Williams & Wilkins press, 2006, pp 92-110.