Proprioception interventions to improve cervical position sense in cervical pathology

Background: Non-specific cervical pain is a common pathology and is difficult to treat. Various types of treatment interventions have been used individually or in combination. Proprioception training has been suggested as an aspect of intervention for cervical pathology but no systematic review has been conducted to evaluate the effectiveness of cervical proprioception retraining on reposition sense. Methods: A systematic review of the literature was performed to evaluate the effectiveness of proprioception interventions to improve cervical position sense (PS) in patients with pathology. A modified American Academy of Cerebral Palsy and Developmental Medicine method was used to systematically grade the level of evidence. In addition, a meta-analysis was performed on the intervention effects on PS or pain. Findings: PS was measured in 11 studies; seven used a laser pointer while four used motion detection instrumentation. Various treatment interventions, including deep cervical flexor activation, eye-head neck coordination exercises, mobilisation, manipulation and a multi-behavioural exercise approach were used individually or in combination to affect proprioception. Pain was measured in six studies using various outcome measures. The meta-analyses showed high heterogeneity of results in favour of treatment interventions for flexion/extension and for right/left rotation to improve PS as well as for pain reduction for the pain outcome measures. Conclusions: All the treatment interventions activated proprioceptors through muscle activation and joint or skin sensory receptors. The use of eye-head-neck coordination exercises produced moderate and large treatment effects for improving PS. This type of exercise links the sensory/motor (proprioception) systems of the neck with the oculomotor and vestibular systems to improve PS. Pain was also reduced (moderate effect size) with the use of these techniques. Clinicians targeting improvements in cervical PS may use this evidence, but further research is needed.