Neck Pain Explained: How Your Body’s Internal GPS May Be the Missing Link
Neck pain is a prevalent issue affecting countless Australians, yet its causes remain largely mysterious. While there are many causes such as trauma, infectious disease, whiplash and cancer, the majority of neck pain has no known cause. 2 This enigmatic nature makes both diagnosis and treatment incredibly challenging.
A recent article published in Pain and Therapy, explores key factors in neck pain and the role of proprioception1. The authors discuss how many studies have been done over the years to explain and identify a connection between structural pathology, e.g. damaged joints, ligaments and connective tissue, and neck pain. Regrettably, they have never succeeded in discovering a physical connection. The authors also discuss recent research which has shed light on a critical factor in neck pain: abnormalities in cervical sensorimotor control that arise from the impairment of cervical proprioception.
The Delicate Proprioceptive System of the Cervical Spine /The Fine-Tuned System That Helps Your Neck Move Safely
Keeping your head straight, your eyes focused, and your body stable is no small task—your body must work hard to make it all happen. To achieve this, you need a strong and well-coordinated neck. The process that manages this complex balancing act in your neck is known as sensorimotor control. This process involves your brain and nervous system continuously processing and integrating information from several sources: your eyes (visual input), your inner ear (which helps with balance, known as vestibular input), and the muscles and joints in your neck (cervical proprioceptive input). All this information is combined to help your body make the right movements with your neck muscles. This ensures that your head stays upright, your balance is maintained, and your neck joints remain stable. In short, cervical sensorimotor control is the system that keeps everything working together smoothly so that you can maintain proper posture and balance without even thinking about it1.
Let’s go a bit deeper:
The cervical spine, or neck, is a complex structure made up of bones, ligaments, muscles, nerves, and other tissues that support the head and connect it to the upper body. It is full of sensory nerves and receptors including muscle spindles or stretch receptors. These receptors provide information about the head’s position relative to the trunk and the alignment of each spinal segment with one another. This signalling process which enables the body to sense its position and movement in space is known as proprioception, and is a crucial function for everyday activities. Your body must seamlessly integrate signals from sensory nerves from each level of your spine, with visual information from the eyes and the inner ear (or vestibular system) to inform the brain of its position. The brain then determines the necessary adjustments and sends signals to the muscles to maintain or adjust the neck’s position for optimal comfort. This harmonious collaboration is known as sensorimotor control1.
The proprioceptive system of the cervical spine is essential for maintaining posture and balance. The proprioceptive system relies on mechanoreceptors, which are specialised sensory receptors found in the skin, muscles, joints, and other tissues. These receptors detect mechanical changes such as pressure, vibration, stretching, and touch. The aforementioned article notes that when this system is impaired, it can lead to disrupted sensorimotor control, contributing to neck pain1.
Mechanisms of Cervical Proprioceptive Impairment / What Disrupts the Neck’s Sense of Position
Cervical proprioceptive impairment can occur through various mechanisms:
1. Experimental Neck Muscle Pain:
It has been reported that patients with nonspecific neck pain have motor control impairments3, and further, that acute neck pain can be triggered by injecting hypertonic saline into the muscles of the upper neck. This causes a disruption in cervical proprioception, leading to changes in muscle function on the side where the injection was given. The experiment highlights how pain can directly impact muscle function by reducing the activation of the muscle that was targeted with the injection. This finding sheds light on the connection between pain and muscle performance, particularly in how pain can interfere with the normal function of neck muscles, proprioception and sensorimotor control.4
2. Chronic Neck Pain: Over time, chronic neck pain causes both structural and functional impairments in cervical muscles, weakening their ability to support and move the neck properly.
3. Degenerative Changes: Overstimulation of mechanoreceptors in degenerative cervical discs and facet joints can flood the body with misleading sensory signals, disrupting the proprioceptive system.
Challenges in Clinical Examinations
Traditional clinical examinations aimed at linking structural pathology with neck pain have often been unsuccessful. This failure has prompted a shift towards developing function-based tests to better assess and manage neck pain.
Sensorimotor Control Tests for Neck Pain / Assessing Movement Control in People with Neck Pain
There are currently at least eight different neck sensorimotor control tests to evaluate patients with chronic neck pain. These tests aim to measure sensorimotor control in the neck and may involve various subsystems, such as the oculomotorand vestibular systems. Among these tests, the most commonly used is the Cervical Joint Position Error (JPE) test. The JPE is a clinical test used to assess the ability of an individual to sense the position of a joint in space. The test usually involves the patient sitting in a neutral position with a headband or a laser pointer attached to their head. A target is placed in front of them, often at eye level. The patient is asked to focus on the target, and their head position is recorded. This position serves as the baseline or reference point. The patient is then instructed to move their head in a specific direction—usually flexion, extension, or rotation—away from the target. After reaching a certain point, they are asked to return their head to the original position without any visual cues1.
The test measures how accurately the patient can return their head to the original position. The difference between the actual and original position is noted, often referred to as the “error” in joint position sense. Recent studies 9 performed the JPE in populations of healthy subjects and compared them to people with chronic neck pain. Interestingly, chronic neck pain sufferers showed significantly larger errors in their ability to position the neck using the JPE in all direction tested. These errors were just as significant no matter how old the subjects were. The authors of the study concluded that cervical joint position sense is impaired in subjects with chronic neck pain.5 Another group performing testing on this also concluded that people with cervical spondylosis have diminished proprioception compared to healthy individuals. Moreover, those with more intense pain generally exhibit greater errors in joint position testing.6
Effective Treatments: Retraining Cervical Proprioception
Current studies 7,8 recommend exercises that focus on different aspects of sensorimotor function, especially retraining aimed at improving proprioception and muscle coordination in the neck. These exercises can help restore balance and control, providing relief for those with neck pain.
Recommendations for Managing Neck Pain
Based on the available evidence, it is recommended that patients with neck pain be assessed and managed for cervical proprioceptive impairment and sensorimotor control disturbances. By focusing on these aspects, healthcare providers can offer more effective treatments, improving the quality of life for those affected by neck pain. Neck pain often leads to increased muscle tension, and if left unaddressed, this tension can worsen over time, causing more pain and problems in the neck. This can lead to poor posture and sensory mismatches. By treating the pain early, you can prevent these issues from escalating, reduce future discomfort, and help restore normal proprioception.
While neck pain remains a complex and challenging issue, advances in understanding cervical proprioception and sensorimotor control offer hope for better diagnosis and treatment. By continuing to explore these areas, we can develop more targeted and effective interventions to alleviate neck pain and enhance overall well-being. It has been suggested 10,11 that chiropractic manipulation and similar therapeutic interventions may provide a highly leveraged and refined proprioceptive stimulation, utilising the body’s inbuilt sensorimotor system to gain the changes in perceived pain, muscle recruitment and coordination.
Further information
If you would like to learn more about neck pain or proprioception or if you would like to make an appointment with one of our chiropractors, please contact us on (07) 5580 5655, or you can book an appointment online.
1. Peng B, Yang L, Li Y, Liu T, Liu Y. Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review. Pain Ther. 2021 Jun;10(1):143-164. doi: 10.1007/s40122-020-00230-z. Epub 2021 Jan 12. PMID: 33464539; PMCID: PMC8119582.
2. Evans G. Identifying and treating the causes of neck pain. Med Clin North Am. 2014;98(3):645–661.
3. Stensdotter AK, Meisingset I, Pedersen MD, Vasseljen O, Stavdahl Ø. Frequency-dependent deficits in head steadiness in patients with nonspecific neck pain. Physiol Rep. 2019;7(5):e14013.
4. Malmström EM, Westergren H, Fransson PA, Karlberg M, Magnusson M. Experimentally induced deep cervical muscle pain distorts head on trunk orientation. Eur J Appl Physiol. 2013;113(10):2487–2499.
5. Alahmari KA, Reddy RS, Silvian P, Ahmad I, Nagaraj V, Mahtab M. Influence of chronic neck pain on cervical joint position error (JPE): Comparison between young and elderly subjects. J Back Musculoskelet Rehabil. 2017 Nov 6;30(6):1265-1271. doi: 10.3233/BMR-169630. PMID: 28800305.
6. Reddy RS, Tedla JS, Dixit S, Abohashrh M. Cervical proprioception and its relationship with neck pain intensity in subjects with cervical spondylosis. BMC Musculoskelet Disord. 2019 Oct 15;20(1):447. doi: 10.1186/s12891-019-2846-z. PMID: 31615495; PMCID: PMC6794723.
7. Revel M, Minguet M, Gregoy P, Vaillant J, Manuel JL. Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Arch Phys Med Rehabil. 1994;75(8):895–899. doi: 10.1016/0003-9993(94)90115-5.
8. 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):404–412. doi: 10.1002/jor.20220.
9. Chen X, Treleaven J. The effect of neck torsion on joint position error in subjects with chronic neck pain. Man Ther. 2013;18(6):562–567. doi: 10.1016/j.math.2013.05.015.
10. Pickar JG. Neurophysiological effects of spinal manipulation. Spine J. 2002 Sep-Oct;2(5):357-71. doi: 10.1016/s1529-9430(02)00400-x. PMID: 14589467.
11. Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study. Clin Neurophysiol. 2007 Feb;118(2):391-402. doi: 10.1016/j.clinph.2006.09.014. Epub 2006 Nov 29. PMID: 17137836.
