Assessment of Neuromuscular and Psychological Function in People with Recurrent Neck Pain during a Period of Remission: Cross-Sectional and Longitudinal Analyses

Sensorimotor tests in patients with neck pain and its associated disorders: a systematic review and meta-analysis

This systematic review aimed to synthesize the current evidence regarding neck sensorimotor testing in individuals with neck pain, assess the differences between neck pain groups and healthy controls, and recognize factors that might affect test results. We performed the data search using PubMed, Embase, PsycINFO, CINAHL, and Scopus databases. We used a two-step screening process to identify studies. Furthermore, we screened the reference lists for additional studies. Hedges g was used to present the difference between neck pain groups and asymptomatic individuals. We assessed the quality of the studies using the QUADAS tool. The final review included 34 studies, of which 25 were related to the joint position error test, four to the smooth pursuit neck torsion test and six to the balance test. Our meta-analysis showed poorer joint-position sense, oculomotor function, and wider postural sway in individuals with neck pain than healthy controls. The size of the difference between the groups seemed to be influenced by the intensity of the pain and the presence of dizziness. Therefore, it might be helpful in future studies to differentiate patients with neck pain into subgroups based on their symptom and demographic profiles to assess other factors that significantly affect cervical sensorimotor control.

Responsiveness of the cervical joint position error test to detect changes in neck proprioception following four weeks of home-based proprioceptive training

INTRODUCTION

People with chronic neck pain (CNP) commonly exhibit a range of physical impairments including cervical proprioceptive deficits. Assessing proprioception using a head mounted laser to assess joint position error (JPE) is a reliable and valid measure. However, the responsiveness of this measure has not been assessed.

OBJECTIVE

To assess the responsiveness of the measure of cervical JPE after a 4-week home-based neck proprioceptive training intervention in people with CNP.

DESIGN

An observational study to assess the responsiveness of the measure of cervical JPE.

METHODS

The JPE test was assessed in people with CNP before and after 4 weeks of neck proprioception training. JPE was assessed as participants performed neck joint position sense tests for flexion, extension, right rotation, and left rotation in sitting and standing which were performed in a random order. Both the absolute and constant JPE were assessed. The intervention consisted of neck repositioning exercises as well as movement sense exercises. Cohen's d effect size was used to assess the internal responsiveness of the JPE test. The Pearson's correlation was used to assess the change of scores of the laser pointer and measures from inertial measurement units (IMUs) (external responsiveness).

RESULTS

After 4 weeks of proprioception training, JPE assessed in sitting reduced from 2.69◦-3.57◦ to 1.88◦-1.98◦ for flexion, extension, and right rotation with large effect sizes (Cohen's d range: 1.25-2.00). For left rotation, JPE reduced from 3.23◦ to 1.9◦, and the effect size was close to being large (Cohen's d: 0.79). When assessed in standing, JPE reduced from 3.49◦-4.52◦ to 1.5◦-2.33◦ with large effect sizes (Cohen's d range: 0.89-1.25) for flexion, extension, right rotation, and left rotation. Large effect sizes were not observed for the constant JPE when assessed in either sitting or standing. The assessment of the external responsiveness revealed weak correlations between the change of scores obtained from the laser pointer and the IMUs for all movements, apart from the constant JPE in sitting for left rotation, which showed a strong correlation (r = 0.7).

CONCLUSION

The results of this study showed that the measure of the JPE has sufficient internal responsiveness, however, the external responsiveness was inadequate. Further research is advised.

Greater muscle volume and muscle fat infiltrate in the deep cervical spine extensor muscles (multifidus with semispinalis cervicis) in individuals with chronic idiopathic neck pain compared to age and sex-matched asymptomatic controls: a cross-sectional study

Muscle size and composition (muscle volume and muscle fat infiltrate [MFI]) may provide insight into possible mechanisms underpinning chronic idiopathic neck pain, a common condition with no definitive underlying pathology. In individuals with chronic idiopathic neck pain > 3 months and age- and sex-matched asymptomatic controls, muscle volumes of levator scapulae, multifidus including semispinalis cervicis (MFSS), semispinalis capitis, splenius capitis including splenius cervicis (SCSC), sternocleidomastoid and longus colli from C3 through T1 were quantified from magnetic resonance imaging. Between-group differences were determined using linear mixed models, accounting for side (left or right), muscle, spinal level, sex, age, and body mass index (BMI). Individuals with pain had greater muscle volume (mean difference 76.8mm³; 95% CI 26.6-127.0; p = .003) and MFI (2.3%; 0.2-4.5; p = .034) of the MFSS compared to matched controls with no differences in relative volume, accounting for factors associated with the outcomes: muscle, spinal level, side (left had smaller volume, relative volume and MFI than right), sex (females had less volume and relative volume than males), age (older age associated with less relative volume and greater MFI), and BMI (higher BMI associated with greater muscle volume and MFI). Greater MFI in individuals with chronic idiopathic neck pain suggests a possible underlying mechanism contributing to neck pain. Perspective: These findings suggest MFI in the MFSS may be radiologic sign, potentially identifying patients with a less favourable prognosis. Future studies are needed to confirm this finding and determine if MFI is a contributor to the development or persistence of neck pain, or consequence of neck pain.