Effectiveness of adding rehabilitation of cervical related sensorimotor control to manual therapy and exercise for neck pain: A randomized controlled trial

Background: Local neck treatments and sensorimotor training can improve cervical proprioception and balance, but it remains unclear what treatments and treatment combination achieve the best outcomes.Objectives: To investigate the most effective interventions to improve disturbances in joint position sense (JPS) and balance and their effects on neck pain, dizziness and related features in the short- and long-terms.Design: 2x2 factorial, randomized controlled trial. Methods: Participants with neck pain (n = 152) were randomly allocated to one of four intervention groups: i) local neck treatment (NT), ii) NT + JPS/oculomotor exercises (JPS/OC), iii) NT + balance exercises, and iv) all treatments.Participants received 12 treatments over 6 weeks. Primary outcomes were postural sway and joint position error. Secondary outcomes included gait speed, dizziness, pain intensity and disability, cervical range of motion, functional ability, and quality of life. Outcome measures were taken at baseline, posttreatment and 3-, 6and 12-month follow-ups.Results: All four interventions resulted in short- and long-term improvements in primary and secondary outcomes with medium to large effect sizes, but JPS and balance in neck torsion improved most with the addition of a combined program of JPS/OC + balance exercises to NT while balance in neck neutral improved most with the addition of balance exercises. Adding sensorimotor training was also more effective in maintaining levels of improvement in neck pain and disability at 6- and 12-months. Effect sizes of additional treatment benefits were medium to large.Conclusions: Adding specific training of JPS/OC and balance to NT best addresses deficits in cervical proprioception and balance. Clinical trial registration number: xxxxx.