Neck Pain & Joint Position Error Test
Short Version:
Neck pain sucks. When our body’s self-awareness is decreased either by injury, fatigue or chronic pain, our neck pain is likely to get worse due to feedback errors within the systems controlling movement of the head and neck. The Joint Position Error Test allows us to see how well the neck’s “self-awareness” system is working or not and allows us to be more specific when creating a plan of action to help correct the issue at hand.
When it comes to helping patients find a resolution for their neck pain or dysfunction the details matter. This is one of the countless reasons why we collect a lot of data(details) about how well a patient’s body is working and coordinating information, more on that later.
A few of the test/measurements we collect are:
Range of Motion- how well an area of the body is able to go through it’s normal motion.
MCTSIB- This test evaluates sensory contributions to postural control. Four trials are performed on different surfaces with eyes opened or closed to give an indication of how proprioception, vision and vestibular information are respectively used for balance.
Limits of Stability- This test measures the functional base of support of an individual. A decreased Limits of Stability score is often times seen in individuals with lower back pain and in individuals that are at a greater risk of falling.
Cervical Challenge Test- The Cervical Challenge is an evaluation of changes in postural sway that occur when the head is placed into different anatomical positions. There are ten different positions tested, which are compared to a reference condition where the person stands with the head neutral. This test allows us to see which position negatively affects balance and if there is possible vestibular dysfunction.
And…
The Joint Position Error Test (JPE). This test looks at the ability to relocate the head and neck to the same position after rotating the head and neck to one side or the other (neck reposition sense).
“When it comes to helping patients find a resolution for their neck pain or dysfunction the details matter. ”
The JPE test is performed by having the patient seated 90cm away from the target seen on the right. Then with a laser mounted on their head they are instructed to look over their left shoulder and then bring back their head and neck back to the original position. This is repeated 6 times, marking where the patient is able to bring the laser back to on the target each time.
Now you might be wondering, “Why does it matter if I look over my shoulder and then bring my head back to a neutral position and it isn’t exactly in the right spot?”
It matters because when we aren’t able to bring our head back to a neutral position or find the previous position we were in it tells us that the self-awareness system (proprioception and sensorimotor control) of the head and neck isn’t working properly.
Before we go further lets talk a little more about the self-awareness system.
First of all that’s not the proper medical term but proprioception and sensorimotor control don’t do a very good job of explaining what the system does, so when these two systems are working together I like to call it the self-awareness system, because that is essentially what proprioception and sensorimotor control entail.
Proprioception involves conscious and unconscious awareness of the position of a joint (joint position sense), movement (kinesthesia), and force, heaviness, and effort (force sense).
Sensorimotor control is the ability of the central nervous system to control movement, balance, posture and joint stability.
The combination of the proprioception and sensorimotor control allows our body to know the how, when, where, what and why of the movements of our ligaments, muscles and tendons and then allow for conscious or unconscious reaction to allow us to maintain our balance, movement, etc. When our proprioception or sensorimotor control is negatively affected it can increase our risk for injury.
Neck pain, trauma to the head or neck, swelling of a joint, and fatigue of a muscle will all negatively affect proprioception and therefore negatively affect the function of our neck and lead to increased pain and dysfunction.
Why?
In order for pain free movement (proper sensorimotor control) to occur the body has to have the proper information about everything that is going to be involved in the movement. As we went over previously this is: joint position sense (conscious or unconscious awareness of a joint), kinesthesia (movement), and force, heaviness, effort (force sense).
What does improper information look like?
Have you ever gone to pick up an item and it was a lot lighter or heavier than you thought?
I have and here’s how it went. My mom is an art teacher and a large portion of my childhood was spent carrying art supplies from our car into the art room. One of these times my mom had filled a bucket with river rocks and my job was to carry it to the car. At the old age of about 8 my plan was to straddle the bucket, lift it up, then waddle to the car. I stepped up to the bucket grabbed onto the handle, lifted with all my might, and ended up flying backwards onto my back covered in river rocks and a bucket laying between my legs filled with bubble wrap that had previously had a small layer of river rocks covering this light weight material. Now this isn’t an exact example of proprioception gone awry, but kind of.
You see as I stepped up to the bucket, that I thought was loaded with river rocks, my body was subconsciously calculating how much force would be required to lift the “heavy” bucket, (force sense). However, because I thought the bucket was filled with rocks I put too much force into lifting the bucket and landed flat on my back.
Now I want you to imagine you’ve woken up with a stiff neck. You get into your car, proceed to look over your shoulder as you back your car out of the drive but as soon as you turn your neck you feel your muscles tighten up, a sharp “grabbing” tight pain. The rest of the day your neck feels tight but you slowly move your neck around all day and by the end of the day you feel like you are able to turn your neck normally with little to no pain. So what caused this pain? At the end of the day we don’t really know, but here’s what researchers think might be happening.
Pain = Less accurate proprioception. That means if you have pain in an area it isn’t able to coordinate and move itself as fluidly or as normally since its ability to sense force, heaviness, movement isn’t as accurate. During the process of turning your head certain muscles are contracting and shortening (concentric contraction) and other muscles are contracting while lengthening (eccentric contraction). In order for the body to know how, when and at what force to contract the body relies on accurate proprioception, when the proprioception is inaccurate the body doesn’t have the right information to make decisions off of and it can result in abnormal firing of muscles leading to the feeling of tightness, ratchety movement and pain. Is the inaccurate proprioception persist than it can eventually lead to abnormal movement patterns and chronic pain.
So how do we correct this issue? First we use the joint position error test to find out if there is abnormal ability for the neck to reposition itself. We then use a multitude of other test to see how much in the body the abnormal proprioception is affecting.
Is it affecting balance? Is it affecting range of motion? Etc.
We then if necessary apply a structural corrective adjustment to the neck releasing tightness, allowing normal motion to return, stimulating a plethora of different receptors passively and bringing the head and neck back to a muscularly symmetric state (as measured by Kinetisense). After the correction we then put the patient through different guided neck movements where the proprioceptors are essentially “retrained/re-educated” to move without pain, the muscles are retrained to start working together again resulting in stabilization of the musculature, less pain, better movement, and an overall improvement in our ability to move.
If you or someone you know has neck pain and is looking to finally correct the issue feel free to forward this blog post to them or click below to schedule your complimentary consultation.