Cervical Proprioception After Concussion: Why We Assess the Neck
Following a concussion or head and neck injury, symptoms such as headache, dizziness, balance problems and difficulty with head movement can occur. These symptoms may be related to the concussion itself, a cervical (neck) injury, or a combination of factors.
One area we assess at Neuro Junction is cervical proprioception - the neck’s ability to sense its position and movement.
What is cervical proprioception?
The neck contains muscles and joints that provide the brain with important information about the position and movement of the head and neck. This information works together with the visual and vestibular (balance) systems to help control posture, balance and coordinated head and eye movements.
Following a head or neck injury, this information may not be as accurate. This can potentially contribute to symptoms such as dizziness, imbalance, headaches or difficulty with head movement—even when significant neck pain is not present.
Interestingly, research in rugby players has also found a relationship between poorer cervical proprioception and concussion incidence. In simple terms, players who had greater errors when repositioning their heads, particularly when turning to the right, were more likely to experience a concussion. The study found that for every 10% increase in right-rotation repositioning error, concussion incidence increased by approximately 5%.
This finding shows why cervical proprioception may be an important factor to assess, although it does not mean that poor proprioception causes concussion.
How do we assess cervical proprioception?
At Neuro Junction, cervical proprioception can be assessed a number of ways. One test we may use is the Cervical Joint Position Sense (JPS) test, also known as cervical joint-reposition error test.
During the assessment, a person moves their head and then attempts to return it to a neutral starting position with their eyes closed. We measure how accurately they are able to reposition their head.
If the head consistently returns to a position that differs from the starting position, this is known as a joint position sense error. Increased repositioning errors may indicate reduced accuracy of cervical position sense and provide useful information about possible cervical involvement following a head or neck injury.
Why is this important after concussion?
Concussion symptoms can overlap with symptoms associated with cervical injury. For example, headache, dizziness and balance difficulties may have contributions from the brain, vestibular system, visual system, cervical spine, or several of these systems together.
Cervical JPS testing is therefore one part of a broader assessment. It can help our physiotherapists determine whether the cervical system may be contributing to ongoing symptoms and whether cervical rehabilitation should be included as part of an individualised concussion management program.
How can physiotherapy help?
If cervical involvement is identified, rehabilitation may include:
Targeted neck muscle exercises
Cervical repositioning and proprioceptive exercises
Controlled head and neck movements
Balance and postural control activities
Integration of cervical, visual and vestibular systems
Gradual progression towards everyday activities, work, learning and sport
At Neuro Junction, our neurological and vestibular physiotherapists assess these systems together rather than looking at concussion symptoms in isolation. This helps us identify potential contributing factors and develop a rehabilitation program that is tailored to the individual.
Reference
Cheever K, Kawata K, Tierney R, Galgon A. Cervical Injury Assessments for Concussion Evaluation: A Review. Journal of Athletic Training. 2016;51(12):1037–1044.
Farley, T., Barry, E., Bester, K., Barbero, A., Thoroughgood, J., De Medici, A., Sylvester, R., & Wilson, M. G. (2022). Poor cervical proprioception as a risk factor for concussion in professional male rugby union players. Physical Therapy in Sport, 55, 211–217. https://doi.org/10.1016/j.ptsp.2022.03.010