Influence of Neck Pain, Cervical Extensor Muscle Fatigue, and Manual Therapy on Wrist Proprioception

J Manipulative Physiol Ther. 2022 Mar-Apr;45(3):216-226. doi: 10.1016/j.jmpt.2022.06.002. Epub 2022 Jul 26.


Objective: The purpose of this study was to examine the effects of submaximal isometric neck muscle fatigue and manual therapy on wrist joint position sense (JPS) within healthy individuals and individuals with subclinical neck pain (SCNP).

Methods: Twelve healthy participants and 12 participants with SCNP were recruited. Each group completed 2 sessions, with 48 hours between sessions. On day 1, both groups performed 2 wrist JPS tests using a robotic device. The tests were separated by a submaximal isometric fatigue protocol for the cervical extensor muscles (CEM). On day 2, both groups performed a wrist JPS test, followed by a cervical treatment consisting of manual therapy (SCNP) or neck rest (20 minutes, control group) and another wrist JPS test. Joint position sense was measured as the participant's ability to recreate a previously presented wrist angle. Each wrist JPS test included 12 targets, 6 into wrist flexion and 6 into wrist extension. Kinematic data from the robot established absolute, variability, and constant error.

Results: Absolute error significantly decreased (P = .01) from baseline to post-fatigue in the SCNP group (baseline = 4.48 ± 1.58°; post-fatigue = 3.90 ± 1.45°) and increased in the control group (baseline = 3.12 ± 0.98°; post-fatigue = 3.81 ± 0.90°). The single session of manual cervical treatment significantly decreased absolute error in participants with SCNP (P = .004).

Conclusion: This study demonstrated that neck pain or fatigue can lead to altered afferent input to the central nervous system and can affect wrist JPS. Our findings demonstrate that acute wrist proprioception may be improved in individuals with SCNP by a single cervical manual therapy session.

Keywords: Muscle Fatigue; Neck; Neck Pain; Proprioception; Upper Extremity; Wrist.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Muscle Fatigue* / physiology
  • Musculoskeletal Manipulations*
  • Neck Pain / therapy
  • Proprioception / physiology
  • Wrist
  • Wrist Joint