Effects of Local Treatment With and Without Sensorimotor and Balance Exercises in Neck Pain

Effects of Local Neck Treatment With and Without Tailored Sensorimotor Control and Balance Exercises for Individuals With Chronic Neck Pain: Protocol for a Randomized Controlled Trial

The sensorimotor disturbance and postural instability have been demonstrated to be associated with neck pain. Specific therapeutic exercise and manual therapy for the cervical spine are effective interventions for improving dizziness symptoms, neck impairments, functional ability and quality of life. However, the effects of these interventions on the actual impairment of joint position sense and balance remain uncertain. Adaptive changes in the sensorimotor and postural control systems may need to be specifically addressed.

The sensorimotor (joint position sense and oculomotor control) and postural stability (balance) disturbances have been demonstrated to be associated with neck pain. Specific therapeutic exercise directed to neuromuscular impairments and manual therapy for the cervical spine are effective interventions for improving dizziness symptoms, neck impairments, functional ability and quality of life. However, the effects of these interventions on the actual impairment of joint position sense and balance remain uncertain. Adaptive changes in the sensorimotor and postural control systems may need to be specifically addressed. Currently, it is not known whether the clinician has to train every impairment or can choose between sensorimotor training and balance training in the rehabilitation of neck pain. Different training approaches may have specific influences on the different outcomes and their outcomes will be important to inform the optimal and efficient management of persons with chronic neck pain.

Inclusion Criteria:

• insidious neck pain for at least 3 months
• an average neck pain intensity over the past week ≥ 30 mm on a 100 mm visual analog scale (VAS)
• a score of neck pain and disability ≥ 10/ 100 on the Neck Disability Index-Thai version
• an absolute error of cervical joint position error > 4.5°
• an inability to stand in tandem stance with eyes closed for 30 seconds
• cervical segmental joint dysfunction (pain provoked >2/10 with abnormal tissue resistance)

Exclusion Criteria:

• a previous history of neck and head injury or surgery
• known or suspected vestibular pathology
• vertigo or dizziness caused by underlying pathology in the ear, brain, or sensory nerve pathways (e.g. benign paroxysmal positional vertigo and BPPV)
• vascular disorders (e.g. a migraine and hypertension)
• any musculoskeletal or neurological conditions that could affect a balance
• inflammatory joint disease
• systemic conditions
• cognitive impairment
• taking four or more medications
• received physiotherapy treatment for their neck disorder in the past 12 months