Cervical proprioception and its role in balance disorders: Implications for rehabilitation: A systematic review

Postural stability depends on the integration of visual, vestibular, and somatosensory inputs, with cervical proprioception providing critical information about head and neck position. Disruption of cervical afferent input, commonly observed in chronic neck pain, whiplash-associated disorders, and cervicogenic dizziness, may contribute to dizziness, postural instability, and balance impairment. This systematic review with narrative synthesis examined the role of cervical proprioceptive dysfunction in balance disorders and evaluated the effectiveness of physiotherapy-based rehabilitation. A literature search of PubMed/MEDLINE, Scopus, Web of Science, and physiotherapy evidence database (PEDro) identified studies published between January 2015 and July 2025. Forty-one studies, including randomized controlled trials, observational studies, and systematic reviews, were included. Across studies, individuals with neck-related disorders consistently demonstrated impaired cervical proprioception, most commonly assessed using joint position error, alongside increased postural sway and reduced static and dynamic balance compared with healthy controls. Rehabilitation approaches emphasizing cervical sensorimotor training, vestibular–cervical integration, and multimodal exercise programs were associated with improvements in proprioceptive accuracy, balance, and dizziness-related outcomes. Manual therapy demonstrated greater benefit when combined with active exercise-based rehabilitation rather than when applied alone. Technology-assisted interventions showed short-term benefits, although the evidence remains limited. These findings support targeted assessment and rehabilitation of cervical sensorimotor function as a key component in the management of neck-related dizziness and balance impairment.