Use of neck torsion as a specific test of neck related postural instability

Abstract

Background: Disturbed postural stability in neck pain (NP) is likely due to abnormal cervical afferent function. Several potential causes requires specific diagnostic tests. The neck torsion (head still body rotated) manoeuvre stimulates cervical but not vestibular receptors and identified abnormal cervical afferent input as the cause in patients with NP compared to healthy controls. Comparison between vestibular and NP subjects is now needed. Aims:To compare individuals with unilateral vestibular loss (UVL), persistent NP and asymptomatic controls. It was hypothesized that neck torsion will increase postural stability in NP compared to both the asymptomatic and UVL groups.Methods: Twenty UVL, 20 persistent NP and 20 asymptomatic control subjects underwent measurement of postural stability on a computerised force plate with eyes closed in comfortable stance under 5 conditions: neutral head, head rotated 45 degrees (left and right) and neck torsion (left and right) . Root mean square (rms) amplitude of sway was measured in the anterior posterior (AP) and medial lateral (ML) directions. Average torsion and torsion difference (average torsionneutral neck) were calculated.Results: NP subjects had significantly greater (p< 0.05) AP sway with average torsion and torsion difference compared to both control and UVL. There were no significant differences between control and UVL and no between group differences for neutral neck, rotation or rotation difference. Conclusion:The results of the study suggest that the torsion manouever may identify cervical afferent causes of disturbed postural stability. This is important for guiding assessment and management of balance disturbances in patients.

Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain

“…133 These alterations were not seen in either asymptomatic individuals or those with vestibular pathology. 127,133 This suggests that this test may be specific for those with cervical-related balance deficits. Dynamic and Functional Balance Dynamic and functional balance can also be affected.…”

Decreased respiratory-related postural perturbations at the cervical level under cognitive load

“…In addition, changing the orientation of the head during tracking requires a synergy between the most inferior joints and the cervical spine for an individual to maintain balance (Park et al 2012). Permanent adjustments of the cervical curvature during standing are needed to preserve an adequate head-to-pelvis alignment, which is essential for balance (Vital and Senegas 1986;Dubousset 1994;Amabile et al 2018) , as well as to maintain the head position and a horizontal gaze (Hasegawa et al 2017), which are important for the transmission of the appropriate visual, vestibular and neck proprioceptive afferent feedback signals (Bove et al 2009;Williams et al 2017;Malmström et al 2017) . These adjustments of the cervical curvature are anticipated during tasks requiring attention, such as complex visual (Boulanger et al 2017) or motor tasks (Hamaoui and Alamini-Rodrigues 2017) , as evidenced by prefrontal cortex recruitment, which indicates their central nature (Jahn et al 2004;Taube et al 2008;Mihara et al 2008).…”

Exploring technology for clinical applications and analysis of factors associated with postural control in older adults with idiopathic neck pain

“…Accordingly, the effect of neck torsion on postural control has been demonstrated in patients with whiplash injury (Yu et al, 2011) and in idiopathic NP (Williams et al, 2017). Given the above reasons, the JPE neck torsion appears to be a more suitable method for measuring joint position sense in the NP population.…”

“…Experimentally, neck muscle vibration, that is thought to stimulate muscle spindle afferents, resulted in increased postural sway in healthy older adults (Patel et al, 2009). Organically, altered cervical input can be due to several causes including pain (Treleaven, 2011), altered proprioception (Williams et al, 2017), muscle fatigue (Liang et al, 2014) and asymmetry of range of motion (Quek et al, 2013). It is postulated that postural control changes may be a consequence of a mismatch between afferent signals from the altered cervical input and normal information from the vestibular, visual and central nervous systems (Treleaven, 2008).…”

“…Relatedly, previous studies have suggested that the neck torsion test is able to bias afferent input towards the cervical spine by moving the body on a stationary head (Chen & Treleaven, 2013). Accordingly, the effect of neck torsion on postural control has been demonstrated in patients with idiopathic NP (Williams et al, 2017) and in those with whiplash injury (Yu et al, 2011). However, to date no study has investigated the relationship between JPE and postural stability in older adults.…”