4.3. Proprioception
ocular movements, disability reduction, CNNP, pain, microtrauma, GNE, chronic neck pain, neck pain, Proprioceptive deficits
CONTRACTION
Aside from pain and disability reduction, we observed proprioception improvement in both training programs. These findings emphasize the findings by Mahto and Malla [Proprioceptive deficits observed in CNNP patients can impair the eccentric activity of neck muscles, which in turn leads to reduced neck stability and excessive strain and microtrauma to the neck structures. Muscle contraction, in contrast, can modify the activity of Golgi tendon organs, their adaptation to stretch, and α-γ coactivation. All these result in better sensorimotor control, movement patterns, and proprioceptive acuity after exercise [Despite all the benefits of muscle spindle retraining on proprioception acuity, we observed more variation in JRE improvement in the SNE group. This finding may be interpreted as lesser stability in JRE improvement after SNE training. Three of the patients in the SNE group even showed increased JRE after the training, which was unexpected. The reason for this finding could be the number and type of proprioceptors which are upskilled in each training program. Eye-head coordination exercises such as the exercises in our SNE groups can improve proprioceptive acuity by stimulating the muscle spindles; in deep neck muscles, the spindles have several connections to the vestibular and visual systems. On the other hand, ROM exercises such as those in the GNE group can stimulate Golgi tendon organs and muscle spindles as well as joint mechanoreceptors. Therefore, it seems that the GNE program retrained more proprioceptors and caused a more stable improvement in the proprioception acuity compared to the SNE program. Some researchers believe that CNNP patients have a variety of sensorimotor impairments and a single mode of exercise cannot address all of them [Furthermore, there are various methods for quantifying proprioception. Within the scope of this investigation, JRE was utilized to indirectly evaluate the precision of joint repositioning. Given the role of joint receptors in furnishing this kind of sensory input, it is conceivable that incorporation of the exercises involving joint motions (GNE) could have had more consistency in diminishing the JRE.The intrinsic muscles of the eye and neck are enriched with muscle spindles, underscoring the significance of accurate ocular movements and the ongoing necessity for precise head positioning. As a result, the SNE program targeting both the intrinsic eye and neck muscles contributed to an enhancement of proprioception as well.Our findings could align with the suggested approach for addressing chronic neck pain, as outlined in the clinical practice guidelines for neck pain. These guidelines advocate for the use of diverse and combined exercise regimens instead of relying on a solitary exercise. A mixed exercise program for the cervical and scapulothoracic regions may encompass neuromuscular exercises (such as coordination, proprioception, and postural training), stretching, strength training, endurance exercises, aerobic conditioning, as well as elements that engage cognitive and emotional aspects [