The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Investigating the Effect of Addition of Cervical Proprioceptive Training to Conventional Physiotherapy on Visual, Vestibular and Proprioceptive Dependency of Postural Control in Patients with Chronic Non-Specific Neck Pain: A Randomized Controlled Clinical Trial

Document Type : RESEARCH PAPER

Authors
Leila Goudarzi 1
Hamed Ghomashchi 2
Mohsen Vahedi 3
Amir Hossein Kahlaee 4
1 1 Clinical Research Development Center of Rofeideh Rehabilitation Hospital, Tehran, Iran 2 Physiotherapy Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2 KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, , Toronto, Canada
3 Department of Biostatistics and Epidemiology, Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
4 Physiotherapy Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
10.22038/abjs.2023.74763.3462
Abstract
Objectives: While cervical proprioception deficit has been suggested as a contributing factor to clinical 
consequences of chronic non-specific neck pain (CNSNP), the effect of addressing such impairments 
on postural control strategies has remained unexplored. The aim of this study was to compare the 
response of the postural control system to alteration of sensory afferents in CNSNP with asymptomatic 
individuals. Furthermore, we examined whether proprioceptive training would yield superior outcomes 
to routine physiotherapy for improvement of postural control, pain and disabi lity.
Methods: Center of pressure (CoP) variables of sixty CNSNP patients equally distributed in any of the 
proprioception-specific or conventional physiotherapy groups and 30 asymptomatic participants were evaluated 
under four standing conditions:1) normal, 2) foam, 3) cervical extension/eyes open and 4) cervical extension/eyes 
closed standing.
Results: CoP anteroposterior range and anteroposterior and mediolateral velocity in patients were significantly 
higher than the control group under condition 2 (P<0.05). Patients also demonstrated lower anteroposterior lyapunov 
exponent under conditions 2 and 4 (P<0.05). Both interventions significantly decreased anteroposterior range and 
anteroposterior velocity(P<0.05). Anteroposterior lyapunov exponent also increased under condition 2 (P<0.05).. 
After the interventions, CoP anteroposterior range and anteroposterior velocity were significantly lower in the 
proprioceptive exercise group than the conventional physiotherapy group (P<0.05). Anteroposterior lyapunov 
exponent was also significantly higher in the proprioceptive exercise group (P<0.05).This while there was no 
significant difference between these patients and control group participants in any of the CoP variables after 
intervention.
Conclusion: Our results rejected the hypothesis that impaired neck proprioception in the presence of CNSNP is 
compensated by overweighting other sources of sensory afferent information. The findings also revealed that while 
proprioceptive exercises successfully returned postural strategies of CNSNP patients to those in asymptomatic 
participants, they do not add to clinical recovery of these patients.
 Level of evidence: I
Keywords
Chronic neck pain
Postural control
Proprioceptive training
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 1
January 2024
Pages 36-50

  • Receive Date 05 September 2023
  • Revise Date 12 November 2023
  • Accept Date 30 October 2023