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.
Adults diagnosed with cervical radiculopathy based on clinical examination (± imaging confirmation).
History of cervical spine surgery or acute cervical trauma.
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
Case-control
Prospective
cevical range of motion device
DeviceCervical proprioception was evaluated using the Cervical Range of Motion (CROM) device by assessing joint position sense (JPS). With the participant seated in an upright position, the CROM device was securely fitted to the head. The patient was instructed to actively move the head from a neutral starting position into a specific direction (flexion, extension, rotation, or lateral flexion), then return to the perceived neutral position with eyes closed. The difference between the starting neutral position and the repositioned angle was recorded as the joint position error (JPE), measured in degrees. Multiple trials were performed for each movement direction, and the mean JPE value was calculated. Higher JPE values indicated poorer cervical proprioceptive accuracy. The CROM device is considered a reliable and valid clinical tool for quantifying cervical proprioception in patients with cervical radiculopathy.
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
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.
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