• Konstantin Beinert, Marc Sofsky, and Jörg Trojan.
• Department of Physiotherapy, University of Applied Health Sciences Rhein-Neckar, Mannheim, Germany - konstantin.beinert@hgwr.de.
• Eur J Phys Rehabil Med. 2019 Feb 1; 55 (1): 63-70.

BackgroundSensorimotor tests, like cranio-cervical flexion and cervical joint position sense tests, share a strong cognitive component during their execution. However, cognitive training for those tests has not been investigated so far.AimThe aim of this study was to compare mental and physical exercises for improving the sensorimotor function of the cervical spine.DesignA within-subject design with 16 participants.SettingOutpatient physiotherapy center.PopulationPatients with chronic neck pain.MethodsParticipants were instructed to perform specific active or mental exercises for the deep and superficial neck flexor muscles. The primary outcomes were cranio-cervical flexion test performance, postural sway, cervical joint position sense and pressure pain threshold. A mixed model analysis was used.ResultsThe interventions improved cranio-cervical flexion performance (P<0.001), with no difference between actively or mentally-performed exercises. Postural sway increased after actively (P<0.01) and mentally (P<0.05) performed deep cervical neck flexor exercises, but not after superficial neck flexor exercises. Mentally-performed superficial neck flexor exercises improved cervical joint position sense when compared to mentally-performed deep cervical flexor exercises (P<0.05), and actively performed superficial neck flexor exercises were effective in improving cervical joint position sense acuity compared to mentally-performed deep cervical flexor exercises (P<0.05) for relocation tasks in the transverse plane. The pressure pain threshold at the cervical spine increased after active deep cervical flexor exercises (P<0.05) and after mental superficial neck flexor exercise (P<0.05).ConclusionsMentally-performed deep cervical flexor exercises improved cranio-cervical flexion test performance and pressure pain threshold at the cervical spine, while postural sway increased. Mentally-performed superficial neck flexor exercises improved cervical joint position sense acuity more than mentally-performed deep cervical flexor exercises.Clinical Rehabilitation ImpactMentally-performed exercises are recommended in the early stages of rehabilitation to counteract extensive muscle impairment, and these can be incorporated into daily routine.

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