Effects of Proprioceptive Training in the Management of Chronic Mechanical Neck Pain.

Neck pain is a very common complaint. In the general population and musculoskeletal practice, it occurs second to low back pain in its frequency. Neck pain has a point prevalence of nearly 13% and lifetime prevalence of nearly 50%. Neck pain and disability are prevalent throughout the industrialized society. It is a common reason for visits in accidents and emergency departments. In Chiropractic treatment, Neck pain is the second most common complaint. It Is the result of fast, mechanical, stressful life, lack of mobility and poor posture. Some injury can also lead to neck pain. Sometimes neck pain lasts for a few days and itself goes away, but when it persists for a long time it results in greater problems. Neck pain is said to be more common in females than in males and in peaks at the middle age. Sedentary lifestyles are contributing to the prevalence of neck pain. Neck pain is one of the most debilitating musculoskeletal problems. Neck problems are a significant source of disability to patients, but they have not been studied in detail as low back pain problems.

Neck pain can be categorized in many ways i.e. Duration(Acute, Sub acute, Chronic), Intensity, Severity, Type(Mechanical, Neuropathic etc.). Among them duration proves to be the best predictor of outcome. Short duration pain have better prognosis than long standing pain. Mechanical Neck Pain is defined as widespread cervical and/or shoulder pain possessing mechanical properties, such as symptoms aggravated by prolonged or abnormal neck posture, neck mobility and/or by palpation of the neck musculature Mechanical pain originates from the spine or by its supporting structures, such as muscles and ligaments. Pain arising from the facet joints eg, arthritis, diskogenic pain, and myofascial pain can be named as Mechanical pain. It is proposed to be associated with several anatomic structures, predominantly facet joints and uncovertebral(Luschka's joints). The risk factors for mechanical neck pain include abnormal posture, stress, substantial lifting and anxiety. Around 15% females and 10% males suffer from Chronic mechanical neck pain at any one time in life. Clinicians find it challenging to prevent a patient from entering into the chronic phase of their condition.

The most mobile part of the vertebral column is the upper cervical spine. And it is at the expense of its mechanical stability. Neuromuscular control to the mobile cervical spine is provided by the highly developed proprioceptive system. Neck pain can lead to disturbed afferent input from the cervical region that may be a possible cause of symptoms such as dizziness, unsteadiness, and visual disturbances. Signs of altered postural stability, cervical proprioception, and head and eye movement control are also said to be the cause of disturbed afferent input.

By an abundance of mechanoreceptors, the proprioceptive system of the cervical spine is very well developed especially from the muscle spindles in the deep segmental upper cervical muscles. Muscle spindle afferent are more important because they are the first ones to operate in proprioception. As compared to the lower cervical spine, the upper cervical spine has an abundance of muscle spindle receptors and greater contributions to reflex activity and connections to the visual and vestibular systems. It concludes that patients with the cause of upper cervical complaints in neck pain have a greater chance for balance and visual disturbances than those with complaints of lower cervical spine.

The ability to maintain body orientation and posture in relation to the surrounding environment is a key process required for normal functions such as coordinated movements. Sensorimotor control of stable upright posture and head and eye movement depends on afferent information from the vestibular, visual and proprioceptive systems, which all together merge in several areas of the Central Nervous System. Proprioception is important for well-adapted sensorimotor control. Proprioception fulfills roles in feedback sensorimotor control and regulation of muscle stiffness, being specifically important for movement acuity, joint stability, coordination, and balance. For head-eye co-ordination and movement control, cervical proprioception is uniquely important. Musculoskeletal disorders due to pain, effusion, trauma, and fatigue alter the normal proprioceptive mechanism.