Sex-Based Differences in Cervical Joint Position Sense in Patients With Chronic Mechanical Neck Pain

Neck pain is a common condition and one of the leading causes of disability worldwide, with mean estimates of 7.6% point prevalence (range, 5.9-38.7%), 37% annual prevalence (range, 16.7-75%), and 48.5% lifetime prevalence(range, 14.2-71%).

Although neck pain can be attributed to traumatic (such as whiplash associated) disorders, metabolic, neoplastic, inflammatory, or infectious diseases, most neck pain has no discernable cause and is considered to be idiopathic.

Chronic mechanical neck pain (CMNP) is a prevalent musculoskeletal condition, particularly among working-age adults, with a higher prevalence observed in females compared to males. The condition is commonly associated with impairments in cervical proprioception, pain, and functional disability. Cervical joint position sense (JPS) is a crucial component of sensorimotor control and has been found to be impaired in individuals with chronic neck pain.

The clinical practice guidelines for chronic idiopathic neck pain do not support percutaneous or open surgical treatment and recommend conservative treatment. However, as conservative treatment usually fails to maintain long-term efficacy, clinical studies begin to pay attention to the evaluation and management of proprioceptive dysfunction in patients with idiopathic neck pain.

Sex differences in pain perception and musculoskeletal disorders have been well-documented in the literature. A previous study revealed that the repositioning accuracy of the knee joint was significantly lower in female participants than in males and Sex-based difference in the accuracy of knee joint proprioception may imply that knee proprioceptive sensitivity might potentially contribute to the high incidence of knee injury in females compared with males. Another study showed that shoulder position sense, as part of the neuromuscular control system, differs between men and women. the findings showed a significant difference in constant position sense error between men and women and a significantly higher variability in the performance of men compared to women.

However, limited studies have directly compared cervical proprioception between males and females in the context of chronic mechanical neck pain. Understanding these differences is essential for optimizing rehabilitation strategies and personalizing interventions.

This study aims to investigate whether there are sex-based differences in cervical proprioception, pain intensity, and neck disability in patients with chronic mechanical neck pain. The findings may contribute to better individualized care plans and inform future clinical guidelines.

Inclusion criteria

• Patients with a primary complaint of chronic neck pain (assessed by VAS )for more than 3 months .
• patients with age range from 18 to 45 years old.
• patients with body mass index less than 30 kg/m2

Exclusion criteria

• previous spine surgery
• pregnancy.
• Diabetic patients
• Hypertensive patients
• Patients were excluded if neck pain was associated with cervical radiculopathy, whiplash injuries or severe headaches -cervical spine fracture - vertebrobasilar insufficiency.
• red flags suggesting of cancer, infection, vascular insufficiency
• Rheumatologic condition as mild systemic lupus erythematosus, poly-articular osteoarthritis, rheumatoid arthritis and advanced cervical spine degenerative diseases.
• patients received any form of cervical treatments within past 6 months