Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review

Baogan Peng, Liang Yang, Yongchao Li, Tanghua Liu, Yanqing Liu, Baogan Peng, Liang Yang, Yongchao Li, Tanghua Liu, Yanqing Liu

Abstract

Neck pain is very common, but most of the causes are unknown, making diagnosis and treatment extremely challenging. Current studies have found that one of the main problems in patients with neck pain is the impairment of cervical proprioception, which subsequently leads to cervical sensorimotor control disturbances. Cervical spine has a very delicate proprioceptive system that plays a crucial role in controlling posture and balance. Cervical proprioceptive impairment in neck pain occurs through a variety of mechanisms. Experimental neck muscle pain induced by injection of hypertonic saline results in inhibition of the activation of painful muscle; chronic neck pain causes structural and functional impairment of cervical muscles; excessive activation of mechanoreceptors in degenerative cervical discs and facet joints produces a large number of erroneous sensory signals. Clinical examinations to assess the link between structural pathology and neck pain have been unsuccessful, opening the way for the development of function-based tests. To date, eight neck sensorimotor control tests have been reported to evaluate patients with chronic neck pain. Although some tests may involve different subsystems (such as oculomotor system and vestibular system), all tests measure sensorimotor control in the neck, and the most commonly used is cervical joint position error (JPE) test. Current studies support the effectiveness of exercises targeting different aspects of sensorimotor function, in particular retraining aimed at improving cervical proprioception and muscle coordination. Based on the available evidence, it is recommended that patients with neck pain should be assessed and managed for cervical proprioceptive impairment and sensorimotor control disturbances.

Keywords: Cervical joint position error; Cervical proprioception; Cervical proprioceptor; Cervical sensorimotor control; Neck pain; Pathophysiology; Rehabilitation.

Figures

Fig. 1
Fig. 1
Schematic diagram of cervical sensorimotor control
Fig. 2
Fig. 2
Cervical joint position error (JPE) test using a laser pointer. The patient is sitting 90 cm from the wall, and the starting point (center of target or reference point) of the laser projection is marked. The patient (blindfolded or closed) performs active neck movement and then returns to the starting position as accurately as possible. The final laser position is measured relative to the starting position (distance or angle). The errors are measured after cervical extension, flexion, lateral flexions, and rotations. Adapted from Treleaven [4] and Revel et al. [67]
Fig. 3
Fig. 3
Craniocervical flexion test. During craniocervical flexion test, the patient is positioned supine in crook lying with the neck in a neutral position (no pillow), making the line of the face horizontal. An uninflated pressure sensor is placed behind the neck so that it is close to the occiput and inflated to a baseline pressure of 20 mmHg, which is sufficient to fill the space between the table surface and the cervical lordotic curve, but does not push the neck into the lordosis. The device provides feedback and guidance to the patient to perform the five test phases required, with an additional 2 mmHg per phase and a maximum of 30 mmHg. The patient is asked to hold each position for 10 s. There is a 10-s break between the two stages. The figure shows the starting position (left) and the end position of craniocervical flexion (right). The craniocervical flexion includes the head nodding "yes" movement to keep it in contact with the supporting surface, and the flexion movement mainly occurs in the upper neck motion segments. Adapted from Jull et al. [104] and Falla et al. [106]

References

    1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15(6):834–848.
    1. Evans G. Identifying and treating the causes of neck pain. Med Clin North Am. 2014;98(3):645–661.
    1. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017;358:j3221.
    1. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther. 2008;13(1):2–11.
    1. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control–Part 2: case studies. Man Ther. 2008;13(3):266–275.
    1. Treleaven J. Dizziness, unsteadiness, visual disturbances, and sensorimotor control in traumatic neck pain. J Orthop Sports Phys Ther. 2017;47(7):492–502.
    1. Michiels S, De Hertogh W, Truijen S, November D, Wuyts F, Van de Heyning P. The assessment of cervical sensory motor control: a systematic review focusing on measuring methods and their clinimetric characteristics. Gait Posture. 2013;38(1):1–7.
    1. McCaskey MA, Schuster-Amft C, Wirth B, Suica Z, de Bruin ED. Effects of proprioceptive exercises on pain and function in chronic neck- and low back pain rehabilitation: a systematic literature review. BMC Musculoskelet Disord. 2014;15:382.
    1. Carragee EJ, Hurwitz EL, Cheng I, et al. Treatment of neck pain: injections and surgical interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976). 2008;33(4 Suppl):S153–S169.
    1. Childs JD, Cleland JA, Elliott JM, et al. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1–A34.
    1. Stanton TR, Leake HB, Chalmers KJ, Moseley GL. Evidence of impaired proprioception in chronic, idiopathic neck pain: systematic review and meta-analysis. Phys Ther. 2016;96(6):876–887.
    1. 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.
    1. 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.
    1. Humphreys BK. Cervical outcome measures: testing for postural stability and balance. J Manipulative Physiol Ther. 2008;31(7):540–546.
    1. Mergner T, Nasios G, Maurer C, Becker W. Visual object localisation in space. Interaction of retinal, eye position, vestibular and neck proprioceptive information. Exp Brain Res. 2001;141(1):33–51.
    1. Richmond FJ, Abrahams VC. What are the proprioceptors of the neck? Prog Brain Res. 1979;50:245–254.
    1. Cooper S, Daniel PM. Muscle spindles in man; their morphology in the lumbricals and the deep muscles of the neck. Brain. 1963;86:563–586.
    1. Kulkarni V, Chandy MJ, Babu KS. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurol India. 2001;49(4):355–359.
    1. Boyd-Clark LC, Briggs CA, Galea MP. Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine. Spine (Phila Pa 1976). 2002;27(7):694–701.
    1. Amonoo-Kuofi HS. The density of muscle spindles in the medial, intermediate and lateral columns of human intrinsic postvertebral muscles. J Anat. 1983;136(Pt 3):509–519.
    1. Amonoo-Kuofi HS. The number and distribution of muscle spindles in human intrinsic postvertebral muscles. J Anat. 1982;135(Pt 3):585–599.
    1. Liu JX, Thornell LE, Pedrosa-Domellöf F. Muscle spindles in the deep muscles of the human neck: a morphological and immunocytochemical study. J Histochem Cytochem. 2003;51(2):175–186.
    1. McLain RF, Pickar JG. Mechanoreceptor endings in human thoracic and lumbar facet joints. Spine (Phila Pa 1976). 1998;23(2):168–173.
    1. McLain RF. Mechanoreceptor endings in human cervical facet joints. Spine. 1994;19(5):495–501.
    1. Yang L, Yang C, Pang X, et al. Mechanoreceptors in diseased cervical intervertebral disc and vertigo. Spine (Phila Pa 1976). 2017;42(8):540–546.
    1. Mendel T, Wink CS, Zimny ML. Neural elements in human cervical intervertebral discs. Spine (Phila Pa 1976). 1992;17(2):132–135.
    1. Tomlinson J, Zwirner J, Ondruschka B, Prietzel T, Hammer N. Innervation of the hip joint capsular complex: a systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty. PLoS One. 2020;15(2):e0229128.
    1. Moraes MR, Cavalcante ML, Leite JA, et al. The characteristics of the mechanoreceptors of the hip with arthrosis. J Orthop Surg Res. 2011;6:58.
    1. Armstrong B, McNair P, Taylor D. Head and neck position sense. Sports Med. 2008;38(2):101–117.
    1. Yang L, Chen J, Yang C, et al. Cervical intervertebral disc degeneration contributes to dizziness: a clinical and immunohistochemical study. World Neurosurg. 2018;119:e686–e693.
    1. Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiol Rev. 2012;92:1651–1697.
    1. Tuthill JC, Azim E. Proprioception. Curr Biol. 2018;28(5):R194–R203.
    1. Riemann BL, Lephart SM. The sensorimotor system, part I: the physiologic basis of functional joint stability. J Athl Train. 2002;37(1):71–79.
    1. Peng B. Cervical vertigo: historical reviews and advances. World Neurosurg. 2018;109:347–350.
    1. Devaraja K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. Eur Arch Otorhinolaryngol. 2018;275(10):2421–2433.
    1. Brandt T, Bronstein AM. Cervical vertigo. J Neurol Neurosurg Psychiatry. 2001;71(1):8–12.
    1. 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.
    1. Graven-Nielsen T, Svensson P, Arendt-Nielsen L. Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function. Electroencephalogr Clin Neurophysiol. 1997;105(2):156–164.
    1. Svensson P, Arendt-Nielsen L, Houe L. Muscle pain modulates mastication: an experimental study in humans. J Orofac Pain. 1998;12(1):7–16.
    1. Farina D, Arendt-Nielsen L, Merletti R, Graven-Nielsen T. Effect of experimental muscle pain on motor unit firing rate and conduction velocity. J Neurophysiol. 2004;91(3):1250–1259.
    1. Sohn MK, Graven-Nielsen T, Arendt-Nielsen L, Svensson P. Inhibition of motor unit firing during experimental muscle pain in humans. Muscle Nerve. 2000;23(8):1219–1226.
    1. Farina D, Arendt-Nielsen L, Graven-Nielsen T. Experimental muscle pain reduces initial motor unit discharge rates during sustained submaximal contractions. J Appl Physiol (1985). 2005;98(3):999–1005.
    1. Le Pera D, Graven-Nielsen T, Valeriani M, et al. Inhibition of motor system excitability at cortical and spinal level by tonic muscle pain. Clin Neurophysiol. 2001;112(9):1633–1641.
    1. Thunberg J, Ljubisavljevic M, Djupsjöbacka M, Johansson H. Effects on the fusimotor-muscle spindle system induced by intramuscular injections of hypertonic saline. Exp Brain Res. 2002;142(3):319–326.
    1. Ciubotariu A, Arendt-Nielsen L, Graven-Nielsen T. The influence of muscle pain and fatigue on the activity of synergistic muscles of the leg. Eur J Appl Physiol. 2004;91(5–6):604–614.
    1. Falla D, Farina D, Graven-Nielsen T. Experimental muscle pain results in reorganization of coordination among trapezius muscle subdivisions during repetitive shoulder flexion. Exp Brain Res. 2007;178(3):385–393.
    1. Lund JP, Donga R, Widmer CG, Stohler CS. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol. 1991;69(5):683–694.
    1. Falla D, Farina D, Dahl MK, Graven-Nielsen T. Muscle pain induces task-dependent changes in cervical agonist/antagonist activity. J Appl Physiol (1985). 2007;102(2):601–609.
    1. 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.
    1. Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine (Phila Pa 1976). 2004;29(19):2108–2114.
    1. Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine (Phila Pa 1976). 2004;29(13):1436–1440.
    1. Blouin JS, Siegmund GP, Carpenter MG, Inglis JT. Neural control of superficial and deep neck muscles in humans. J Neurophysiol. 2007;98(2):920–928.
    1. De Pauw R, Coppieters I, Kregel J, De Meulemeester K, Danneels L, Cagnie B. Does muscle morphology change in chronic neck pain patients? A systematic review. Man Ther. 2016;22:42–49.
    1. Falla D. Unravelling the complexity of muscle impairment in chronic neck pain. Man Ther. 2004;9(3):125–133.
    1. 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;20(1):447.
    1. Thunberg J, Hellström F, Sjölander P, Bergenheim M, Wenngren B, Johansson H. Influences on the fusimotor-muscle spindle system from chemosensitive nerve endings in cervical facet joints in the cat: possible implications for whiplash induced disorders. Pain. 2001;91(1–2):15–22.
    1. Flor H. Cortical reorganisation and chronic pain: implications for rehabilitation. J Rehabil Med. 2003;(41 Suppl):66–72.
    1. Risbud MV, Shapiro IM. Role of cytokines in intervertebral disc degeneration: pain and disc content. Nat Rev Rheumatol. 2014;10(1):44–56.
    1. Miller RE, Miller RJ, Malfait AM. Osteoarthritis joint pain: the cytokine connection. Cytokine. 2014;70(2):185–193.
    1. Holm S, Indhal A, Solomonow M. Sensorimotor control of the spine. J Electromyogr Kinesiol. 2002;12(3):219–234.
    1. Yacovino DA, Hain TC. Clinical characteristics of cervicogenic-related dizziness and vertigo. Semin Neurol. 2013;33(3):244–255.
    1. Karnath HO. Subjective body orientation in neglect and the interactive contribution of neck muscle proprioception and vestibular stimulation. Brain. 1994;117(Pt 5):1001–1012.
    1. Carlsson CA, Pellettieri L. A clinical view of pain physiology. Acta Chir Scand. 1982;148(4):305–313.
    1. Appelberg B, Hulliger M, Johansson H, Sojka P. Actions on gamma-motoneurones elicited by electrical stimulation of group III muscle afferent fibres in the hind limb of the cat. J Physiol. 1983;335:275–292.
    1. Capra NF, Hisley CK, Masri RM. The influence of pain on masseter spindle afferent discharge. Arch Oral Biol. 2007;52(4):387–390.
    1. Johansson H, Sojka P. Pathophysiological mechanisms involved in genesis and spread of muscular tension in occupational muscle pain and in chronic musculoskeletal pain syndromes: a hypothesis. Med Hypotheses. 1991;35(3):196–203.
    1. Revel M, Andre-Deshays C, Minguet M. Cervicocephalic kinesthetic sensibility in patients with cervical pain. Arch Phys Med Rehabil. 1991;72(5):288–291.
    1. 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.
    1. Treleaven J, Takasaki H. High variability of the subjective visual vertical test of vertical perception, in some people with neck pain—should this be a standard measure of cervical proprioception? Man Ther. 2015;20(1):183–188.
    1. Geisinger D, Ferreira E, Suarez A, Suarez H. Head tilt response: a complementary test to the subjective visual vertical. J Vestib Res. 2010;20(5):381–389.
    1. Kristjansson E, Oddsdottir GL. ‘‘The Fly’’: a new clinical assessment and treatment method for deficits of movement control in the cervical spine. Spine (Phila Pa 1976).2010;35(23):E1298–E1305
    1. Tjell C, Rosenhall U. Smooth pursuit neck torsion test: a specific test for cervical dizziness. Am J Otol. 1998;19(1):76–81.
    1. Treleaven J, Jull G, LowChoy N. Smooth pursuit neck torsion test in whiplash-associated disorders: relationship to self-reports of neck pain and disability, dizziness and anxiety. J Rehabil Med. 2005;37(4):219–223.
    1. Woodhouse A, Liljebäck P, Vasseljen O. Reduced head steadiness in whiplash compared with non-traumatic neck pain. J Rehabil Med. 2010;42(1):35–41.
    1. Bagust J. Assessment of verticality perception by a rod-and-frame test: preliminary observations on the use of a computer monitor and video eye glasses. Arch Phys Med Rehabil. 2005;86(5):1062–1064.
    1. Grod JP, Diakow PR. Effect of neck pain on verticality perception: a cohort study. Arch Phys Med Rehabil. 2002;83(3):412–415.
    1. de Zoete RMJ, Osmotherly PG, Rivett DA, Farrell SF, Snodgrass SJ. Sensorimotor control in individuals with idiopathic neck pain and healthy individuals: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2017;98(6):1257–1271.
    1. de Zoete RMJ, Osmotherly PG, Rivett DA, Snodgrass SJ. Seven cervical sensorimotor control tests measure different skills in individuals with chronic idiopathic neck pain. Braz J Phys Ther. 2020;24(1):69–78.
    1. de Vries J, Ischebeck BK, Voogt LP, et al. Joint position sense error in people with neck pain: a systematic review. Man Ther. 2015;20(6):736–744.
    1. Alahmari KA, Reddy RS, Silvian PS, Ahmad I, Kakaraparthi VN, Alam MM. Association of age on cervical joint position error. J Adv Res. 2017;8(3):201–207.
    1. 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;30(6):1265–1271.
    1. Cheng CH, Wang JL, Lin JJ, Wang SF, Lin KH. Position accuracy and electromyographic responses during head reposition in young adults with chronic neck pain. J Electromyogr Kinesiol. 2010;20(5):1014–1020.
    1. Edmondston SJ, Chan HY, Ngai GC, et al. Postural neck pain: an investigation of habitual sitting posture, perception of 'good' posture and cervicothoracic kinaesthesia. Man Ther. 2007;12(4):363–371.
    1. Elsig S, Luomajoki H, Sattelmayer M, Taeymans J, Tal-Akabi A, Hilfiker R. Sensorimotor tests, such as movement control and laterality judgment accuracy, in persons with recurrent neck pain and controls. A case-control study. Man Ther. 2014;19(6):555–561.
    1. Grip H, Sundelin G, Gerdle B, Karlsson JS. Variations in the axis of motion during head repositioning—a comparison of subjects with whiplash-associated disorders or non-specific neck pain and healthy controls. Clin Biomech (Bristol, Avon) 2007;22(8):865–873.
    1. Rix GD, Bagust J. Cervicocephalic kinesthetic sensibility in patients with chronic, nontraumatic cervical spine pain. Arch Phys Med Rehabil. 2001;82(7):911–919.
    1. Kristjansson E, Dall'Alba P, Jull G. A study of five cervicocephalic relocation tests in three different subject groups. Clin Rehabil. 2003;17(7):768–774.
    1. Lee HY, Teng CC, Chai HM, Wang SF. Test-retest reliability of cervicocephalic kinesthetic sensibility in three cardinal planes. Man Ther. 2006;11(1):61–68.
    1. Lee HY, Wang JD, Yao G, Wang SF. Association between cervicocephalic kinesthetic sensibility and frequency of subclinical neck pain. Man Ther. 2008;13(5):419–425.
    1. Palmgren PJ, Andreasson D, Eriksson M, Hägglund A. Cervicocephalic kinesthetic sensibility and postural balance in patients with nontraumatic chronic neck pain—a pilot study. Chiropr Osteopat. 2009;17:6.
    1. Teng CC, Chai H, Lai DM, Wang SF. Cervicocephalic kinesthetic sensibility in young and middle-aged adults with or without a history of mild neck pain. Man Ther. 2007;12(1):22–28.
    1. Woodhouse A, Vasseljen O. Altered motor control patterns in whiplash and chronic neck pain. BMC Musculoskelet Disord. 2008;9:90.
    1. Armstrong BS, McNair PJ, Williams M. Head and neck position sense in whiplash patients and healthy individuals and the effect of the cranio-cervical flexion action. Clin Biomech (Bristol, Avon) 2005;20(7):675–684.
    1. Knapstad MK, Goplen FK, Ask T, Skouen JS, Nordahl SHG. Associations between pressure pain threshold in the neck and postural control in patients with dizziness or neck pain—a cross-sectional study. BMC Musculoskelet Disord. 2019;20(1):528.
    1. Uthaikhup S, Jull G, Sungkarat S, Treleaven J. The influence of neck pain on sensorimotor function in the elderly. Arch Gerontol Geriatr. 2012;55(3):667–672.
    1. Röijezon U, Björklund M, Bergenheim M, Djupsjöbacka M. A novel method for neck coordination exercise–a pilot study on persons with chronic non-specific neck pain. J Neuroeng Rehabil. 2008;5:36.
    1. Beinert K, Taube W. The effect of balance training on cervical sensorimotor function and neck pain. J Mot Behav. 2013;45(3):271–278.
    1. Duray M, Şimşek Ş, Altuğ F, Cavlak U. Effect of proprioceptive training on balance in patients with chronic neck pain. Agri. 2018;30(3):130–137.
    1. Saadat M, Salehi R, Negahban H, Shaterzadeh MJ, Mehravar M, Hessam M. Traditional physical therapy exercises combined with sensorimotor training: the effects on clinical outcomes for chronic neck pain in a double-blind, randomized controlled trial. J Bodyw Mov Ther. 2019;23(4):901–907.
    1. Falla D, Jull G, Russell T, Vicenzino B, Hodges P. Effect of neck exercise on sitting posture in patients with chronic neck pain. Phys Ther. 2007;87(4):408–417.
    1. Blomgren J, Strandell E, Jull G, Vikman I, Röijezon U. Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review. BMC Musculoskelet Disord. 2018;19(1):415.
    1. Jull G, Falla D. Does increased superficial neck flexor activity in the craniocervical flexion test reflect reduced deep flexor activity in people with neck pain? Man Ther. 2016;25:43–47.
    1. Jull GA, Falla D, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009;14(6):696–701.
    1. Jull GA, O'Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipul Physiol Ther. 2008;31(7):525–533.
    1. Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002;27(17):1835–1843.
    1. Falla D, O'Leary S, Farina D, Jull G. The change in deep cervical flexor activity after training is associated with the degree of pain reduction in patients with chronic neck pain. Clin J Pain. 2012;28(7):628–634.
    1. Schomacher J, Falla D. Function and structure of the deep cervical extensor muscles in patients with neck pain. Man Ther. 2013;18(5):360–366.
    1. O'Leary S, Falla D, Elliott JM, Jull G. Muscle dysfunction in cervical spine pain: implications for assessment and management. J Orthop Sports Phys Ther. 2009;39(5):324–333.
    1. Johnston V, Jull G, Souvlis T, Jimmieson NL. Neck movement and muscle activity characteristics in female office workers with neck pain. Spine (Phila Pa 1976). 2008;33(5):555–563.
    1. Fernández-de-las-Peñas C, Albert-Sanchís JC, Buil M, Benitez JC, Alburquerque-Sendín F. Cross-sectional area of cervical multifidus muscle in females with chronic bilateral neck pain compared to controls. J Orthop Sports Phys Ther. 2008;38(4):175–180.
    1. Uhlig Y, Weber BR, Grob D, Müntener M. Fiber composition and fiber transformations in neck muscles of patients with dysfunction of the cervical spine. J Orthop Res. 1995;13(2):240–249.
    1. Cagnie B, Cools A, De Loose V, Cambier D, Danneels L. Differences in isometric neck muscle strength between healthy controls and women with chronic neck pain: the use of a reliable measurement. Arch Phys Med Rehabil. 2007;88(11):1441–1445.
    1. Jordan A, Mehlsen J, Ostergaard K. A comparison of physical characteristics between patients seeking treatment for neck pain and age-matched healthy people. J Manipul Physiol Ther. 1997;20(7):468–475.
    1. Lee H, Nicholson LL, Adams RD. Neck muscle endurance, self-report, and range of motion data from subjects with treated and untreated neck pain. J Manipul Physiol Ther. 2005;28(1):25–32.
    1. Peolsson A, Kjellman G. Neck muscle endurance in nonspecific patients with neck pain and in patients after anterior cervical decompression and fusion. J Manipul Physiol Ther. 2007;30(5):343–350.
    1. Schomacher J, Farina D, Lindstroem R, Falla D. Chronic trauma-induced neck pain impairs the neural control of the deep semispinalis cervicis muscle. Clin Neurophysiol. 2012;123(7):1403–1408.
    1. Lindstrøm R, Schomacher J, Farina D, Rechter L, Falla D. Association between neck muscle coactivation, pain, and strength in women with neck pain. Man Ther. 2011;16(1):80–86.
    1. Elliott JM, O'Leary SP, Cagnie B, Durbridge G, Danneels L, Jull G. Craniocervical orientation affects muscle activation when exercising the cervical extensors in healthy subjects. Arch Phys Med Rehabil. 2010;91(9):1418–1422.
    1. O'Leary S, Cagnie B, Reeve A, Jull G, Elliott JM. Is there altered activity of the extensor muscles in chronic mechanical neck pain? A functional magnetic resonance imaging study. Arch Phys Med Rehabil. 2011;92(6):929–934.
    1. Conley MS, Stone MH, Nimmons M, Dudley GA. Resistance training and human cervical muscle recruitment plasticity. J Appl Physiol (1985). 1997;83(6):2105–2111.
    1. Conley MS, Stone MH, Nimmons M, Dudley GA. Specificity of resistance training responses in neck muscle size and strength. Eur J Appl Physiol Occup Physiol. 1997;75(5):443–448.
    1. Schomacher J, Erlenwein J, Dieterich A, Petzke F, Falla D. Can neck exercises enhance the activation of the semispinalis cervicis relative to the splenius capitis at specific spinal levels? Man Ther. 2015;20(5):694–702.
    1. Schomacher J, Petzke F, Falla D. Localised resistance selectively activates the semispinalis cervicis muscle in patients with neck pain. Man Ther. 2012;17(6):544–548.
    1. Onyewu O, Manchikanti L, Falco FJ, et al. An update of the appraisal of the accuracy and utility of cervical discography in chronic neck pain. Pain Physician. 2012;15(6):E777–E806.
    1. Falco FJ, Datta S, Manchikanti L, et al. An updated review of the diagnostic utility of cervical facet joint injections. Pain Physician. 2012;15(6):E807–E838.
    1. Sremakaew M, Jull G, Treleaven J, Barbero M, Falla D, Uthaikhup S. Effects of local treatment with and without sensorimotor and balance exercise in individuals with neck pain: protocol for a randomized controlled trial. BMC Musculoskelet Disord. 2018;19(1):48.

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