Comparison of cranio-cervical flexion training versus cervical proprioception training in patients with chronic neck pain: A randomized controlled clinical trial

J Rehabil Med. 2016 Jan;48(1):48-55. doi: 10.2340/16501977-2034.


Objective: To compare the effects of cranio-cervical flexion vs cervical proprioception training on neuromuscular control, pressure pain sensitivity and perceived pain and disability in patients with chronic neck pain.

Methods: Twenty-eight volunteers with chronic non-specific neck pain were randomly assigned to 1 of 2 interventions and undertook 6 physiotherapist-supervised sessions over a period of 2 months. Both groups performed daily home exercise. Performance on the cranio-cervical flexion test, pressure pain thresholds and reported levels of pain and disability were measured before and immediately after the first treatment session, 1 month after starting treatment and 2 months after starting treatment (at completion of the intervention).

Results: At 2 months, both groups improved their performance on the cranio-cervical flexion test (p < 0.05), but this did not differ between groups (p > 0.05). Both groups showed a reduction in their pain at rest and disability at 2 months, but this was also not different between groups (p > 0.05). Pressure pain sensitivity did not change for either group.

Conclusion: Both specific cranio-cervical flexion training and proprioception training had a comparable effect on performance on the cranio-cervical flexion test, a test of the neuromuscular control of the deep cervical flexors. These results indicate that proprioception training may have positive effects on the function of the deep cervical flexors.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Chronic Pain / physiopathology
  • Chronic Pain / rehabilitation*
  • Disability Evaluation
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neck Muscles / physiopathology
  • Neck Pain / physiopathology
  • Neck Pain / rehabilitation*
  • Pain Threshold / physiology
  • Proprioception / physiology*
  • Visual Analog Scale