Assessing Cervical Proprioception in Dizziness and Instability: The Joint Position Error Test
- Ana Souto
- 7 days ago
- 3 min read
Neck afferent information is important for coordinated head, neck, and upper-extremity movements, as well as for maintaining body position and spatial orientation. When distorted, it can heavily contribute to altered cervical sensorimotor control, which can heavily affect balance and stability and lead to symptoms of dizziness and unsteadiness (Peng et al., 2021).
Considering this, evaluation of cervical proprioception may be the missing key to better management of dizzy patients.
The Joint Position Error Test for cervical proprioception evaluation
The Joint Position Error Test evaluates cervical proprioception by assessing the patient’s ability to relocate their head to a neutral position after active head movement, with eyes closed. The patient should be seated 90 cm from the screen, with their back and feet well supported. The test is composed of 4 conditions of cervical movement (left rotation, right rotation, extension, and flexion). Each movement is repeated three times, and the Mean Angle Magnitude Error is calculated.
A positive result in the Joint Position Error test holds significant clinical relevance, indicating an alteration in cervical proprioception. In general, an error greater than 4.5 degrees in head repositioning suggests a deficit in the accuracy of head and neck relocation. A positive JPE test is frequently associated with impairments in balance control and fine motor function. This is particularly evident in several clinical populations:
Whiplash-Associated Disorders | Patients with persistent pain after acceleration–deceleration injuries frequently exhibit increased joint position error, indicating disrupted cervical afferent input. They also demonstrate altered balance responses, supporting the idea that abnormal cervical input can negatively influence postural control. (Treleaven et al., 2006). |
Rheumatoid Arthritis (RA) | Individuals with RA exhibit significantly impaired cervical proprioception, evidenced by higher joint position error values compared with asymptomatic individuals. These proprioceptive deficits are closely linked to poorer postural control, reflected by increases in center-of-pressure–related parameters (Alkhamis et al., 2025). |
Cervicogenic Dizziness (CGD) | Patients with CGD frequently exhibit joint position errors exceeding 4.5 degrees. The proprioceptive deficits are thought to be linked to altered head-neck spatial orientation and postural instability. In addition, JPE test results correlate positively with pain intensity (L’Heureux-Lebeau et al., 2014). |
Older Adults | Older adults over 65 show higher joint position error values, which is strongly associated with poorer balance performance and reduced functional mobility (TUG). Those with greater joint position errors also present more impaired results in the Limits of Stability assessment (Reddy et al., 2023). |
Given its broad clinical implications, the Joint Position Error test assessment is a valuable diagnostic tool that can guide targeted interventions aimed at improving proprioception, motor control, and overall functional stability across diverse patient populations.
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Ana Souto
Meet Ana, a physiotherapist with a master's degree in human physiology and certified by the American Institute of Balance.
Ana currently serves as the clinical specialist at PhysioSensing, a cutting-edge Balance Assessment and training device. Her approach is firmly rooted in the latest scientific findings, ensuring that PhysioSensing users receive the most effective and up-to-date care. In addition to her role in designing tailored programs, Ana plays a pivotal role in guiding new clients through the learning process of using PhysioSensing. She also provides advanced training and support to existing customers seeking to further deepen their clinical practice knowledge and stay on top of the latest scientific advancements.
Alkhamis, B. A., Elrefaey, B. H., Alahmari, K. A., Koura, G. M., Alfaya, F. F., & Reddy, R. S. (2025). Cervical proprioception, postural control, and pain: Unraveling the interconnected challenges in rheumatoid arthritis. Journal of Orthopaedic Surgery and Research, 20(1), 169. https://doi.org/10.1186/s13018-025-05572-y
L’Heureux-Lebeau, B., Godbout, A., Berbiche, D., & Saliba, I. (2014). Evaluation of Paraclinical Tests in the Diagnosis of Cervicogenic Dizziness. Otology & Neurotology, 35(10), 1858–1865. https://doi.org/10.1097/mao.0000000000000506
Peng, B., Yang, L., Li, Y., Liu, T., & Liu, Y. (2021). Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review. Pain and Therapy, 10(1), 143–164. https://doi.org/10.1007/s40122-020-00230-z
Reddy, R. S., Alkhamis, B. A., Kirmani, J. A., Uddin, S., Ahamed, W. M., Ahmad, F., Ahmad, I., & Raizah, A. (2023). Age-Related Decline in Cervical Proprioception and Its Correlation with Functional Mobility and Limits of Stability Assessed Using Computerized Posturography: A Cross-Sectional Study Comparing Older (65+ Years) and Younger Adults. Healthcare, 11(13), 1924. https://doi.org/10.3390/healthcare11131924
Treleaven, J., Jull, G., & LowChoy, N. (2006). The relationship of cervical joint position error to balance and eye movement disturbances in persistent whiplash. Manual Therapy, 11(2), 99–106. https://doi.org/10.1016/j.math.2005.04.003
