Joint Position Error Testing and Treatment in the Cervical Spine
Does It Work?
Joint Position Error Testing
Conclusion
- Joint position sense/error (JPS or JPE) is often used to evaluate proprioceptive ability
- Involves assessing an individual’s ability to relocate to neutral head/neck posturing (or to a target position) after active or passive neck movement
- Cervical proprioception is the sense of position of the head or neck in space, describing the complex interaction between afferent and efferent receptors to monitor the position and movement
- Evidence from randomised controlled trials suggests that proprioceptive-targeted treatment improves JPS at the neck and also results in pain reduction.
- The alleviation of pain afforded by both exercise regimes may also contribute to the effect by lessening any interference with transmission of afferent input in the dorsal horn or at cortical and subcortical levels.
- It remains unknown what proprioceptive tests may best reflect clinically relevant dysfunction. Further, it is unclear if performance on certain proprioceptive tests is predictive of clinical outcome.
- Lack of high-quality studies evaluating proprioceptive training interventions in neck or back pain
- Cervical JPE can be found in pts with WAD and idiopathic chronic neck pain
- Based on altered proprioception inputs to brain
- JPE can be useful in pain reduction and training cervical proprioception
De vries J, Ischebeck BK, Voogt LP, et al. Joint position sense error in people with neck pain: A systematic review. Man Ther. 2015.
Jull G, Falla D, Treleaven J, Hodges P, Vicenzino B. Retraining cervical joint position sense: the effect of two exercise regimes. J Orthop Res. 2007;25(3):404-12.
Stanton TR, Leake HB, Chalmers KJ, Moseley GL. Evidence of Impaired Proprioception in Chronic, Idiopathic Neck Pain: Systematic Review and Meta-Analysis. Phys Ther. 2015.
Available at: http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1156. Accessed November 18, 2015.
Proposed Physiological Mechanisms
How Do We Train It?
- Attributed to altered input from cervical afferents.
- Abundance of receptors in the cervical muscles
- Multiple cervical central and reflex connections to the vestibular, visual, and postural control systems.
- Deep portions of the suboccipital muscles have the highest cervical receptor density
- Receptors are known to have a specific role in these reflex and central connections.
- Joint position sense has its neurological basis in muscle spindles, Golgi tendon organs, cutaneous receptors, and joint receptors
Why Do We Care?
- Abnormal joint position error (JPE) has been detected in patients with neck pain
- Mainly used in patients with WAD
- Those with chronic, idiopathic neck pain demonstrate impaired neck proprioception
- No inciting trauma or injury in this condition, so it would seem less likely that peripheral mechanoreceptors would be affected
- Relationship between muscle spindle function and position sense is complex in painful conditions.
- Proprioceptive dysfunction in idiopathic neck pain may stem from spinal or supraspinal causes.