Train the brain! Immediate sensorimotor effects of mentally-performed flexor exercises in patients with neck pain A pilot study

BACKGROUND: Sensorimotor 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. AIM: The aim of this study was to compare mental and physical exercises for improving the sensorimotor function of the cervical spine. DESIGN: A within-subject design with 16 participants. SETTING: Outpatient physiotherapy center. POPULATION: Patients with chronic neck pain. METHODS: Participants 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. RESULTS: The 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). CONCLUSIONS: Mentally-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 IMPACT: Mentally-performed exercises are recommended in the early stages of rehabilitation to counteract extensive muscle impairment, and these can be incorporated into daily routine.