Correlation Between Cervical Deep Flexors Endurance and Proprioception Function in Cervical Radiculopathy

Correlation Between Endurance and Proprioception Function in Cervical Radiculopathy

In cervical radiculopathy, reduced endurance of the deep cervical flexor muscles is associated with impaired cervical proprioception. This relationship reflects altered sensorimotor control due to muscle dysfunction and neural compromise, emphasizing the need for deep flexor endurance training in rehabilitation.

Study Overview

• Status: Not yet recruiting
• Conditions: Cervical Radiculopathy
• Intervention / Treatment: Device: cevical range of motion device

Detailed Description

In patients with cervical radiculopathy, endurance of the deep cervical flexor muscles (longus capitis and longus colli) plays a crucial role in maintaining cervical segmental stability and accurate sensorimotor control. These muscles are rich in muscle spindles and provide continuous afferent input necessary for cervical proprioception, including joint position sense and movement accuracy. When deep cervical flexor endurance is reduced, there is increased reliance on superficial neck muscles, leading to altered motor patterns and diminished quality of proprioceptive feedback.

Cervical radiculopathy further disrupts proprioceptive function through nerve root compression, inflammation, and impaired neural conduction, which affect both sensory input and motor output. This neuromuscular dysfunction results in increased joint position errors, delayed muscle activation, and poor postural control. Consequently, a significant correlation is observed between decreased deep cervical flexor endurance and impaired cervical proprioception, suggesting that deficits in muscle endurance contribute directly to sensorimotor dysfunction. These findings support rehabilitation approaches that emphasize endurance training of the deep cervical flexors to restore proprioceptive accuracy and cervical motor control in patients with cervical radiculopathy.

• Study Type: Observational
• Enrollment (Estimated): 80

Contacts and Locations

• Study Contact: Name: ibrahim A abu ella, Phd; Phone Number: +201008442281; Email: ibrahimneuron@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

The study population consisted of 80 patients with cervical radiculopathy recruited from outpatient physical therapy clinics. Participants were adults of both sexes, aged between 20 and 60 years, presenting with neck pain associated with unilateral or bilateral upper limb radicular symptoms, including pain, numbness, or weakness. Cervical radiculopathy was diagnosed based on clinical examination findings such as dermatomal pain distribution, positive cervical compression tests, and neurological deficits, with imaging confirmation when available.

All participants were in the subacute to chronic stage of the condition and were able to sit independently and follow verbal instructions during assessment. Patients with a history of cervical spine surgery, recent trauma, vestibular disorders, or other neurological or systemic conditions affecting cervical proprioception were excluded. This population was selected to investigate the relationship between cervical deep flexor endurance and cerv

Description

Inclusion Criteria:

• Adults diagnosed with cervical radiculopathy based on clinical examination (± imaging confirmation).

Presence of neck pain with radiating symptoms to the upper limb for at least 4 weeks.

Age range 20-60 years.

Ability to understand instructions and participate in cervical endurance and proprioception assessments.

Exclusion Criteria:

• History of cervical spine surgery or acute cervical trauma.

Presence of neurological disorders other than cervical radiculopathy (e.g., stroke, multiple sclerosis).

Vestibular disorders or conditions affecting balance and head position sense.

Inflammatory, rheumatologic, or severe musculoskeletal conditions involving the cervical spine.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cervical proprioception errors by using joint position sense via CROM device	Cervical proprioception was assessed using the CROM device by measuring joint position sense error. Participants were seated upright with the trunk stabilized and the CROM mounted on the head; visual input was eliminated by closing the eyes. From a neutral head position, participants actively moved the head to a predetermined target angle (approximately 50-60% of available cervical range of motion) in flexion, extension, or rotation, held the position briefly, returned to neutral, and then attempted to reproduce the target position. The absolute difference between the target and reproduced angles, recorded in degrees by the CROM, represented the joint position error, and the mean of three trials for each movement direction was used for analy	baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Deep flexor cervical muscle endurance using biofeedback device	Deep cervical flexor muscle endurance was assessed using a pressure biofeedback unit. Participants were positioned in crook-lying with the pressure cuff placed suboccipitally and inflated to a baseline pressure of 20 mmHg. After instruction and practice of the craniocervical flexion action, participants were asked to incrementally increase and maintain pressure (22-30 mmHg) by performing a gentle nodding movement without activation of superficial neck muscles. Endurance was recorded as the maximum pressure level that could be held steadily for 10 seconds with correct technique, and the total performance score was determined based on the highest successfully maintained pressure level.	baseline

Collaborators and Investigators

• Sponsor: Delta University for Science and Technology

Publications and helpful links

General Publications

• Rafiq S, Zafar H, Gillani SA, Waqas MS, Liaqat S, Zia A, Rafiq Y. Effects of Neurodynamic Mobilization on Health-Related Quality of Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized Trial. Biomed Res Int. 2022 Oct 5;2022:9385459. doi: 10.1155/2022/9385459. eCollection 2022.

Study record dates

Study Major Dates

• Study Start (Estimated): January 1, 2026
• Primary Completion (Estimated): February 1, 2026
• Study Completion (Estimated): March 1, 2026

Study Registration Dates

• First Submitted: December 13, 2025
• First Submitted That Met QC Criteria: December 26, 2025
• First Posted (Actual): January 6, 2026

Study Record Updates

• Last Update Posted (Actual): January 6, 2026
• Last Update Submitted That Met QC Criteria: December 26, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases; Radiculopathy
• Other Study ID Numbers: trial registry 3

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No