Understanding the Connection Between Cervical Proprioception, Postural Control, and Pain in Rheumatoid Arthritis
- Julian Simpson
- Jun 9
- 4 min read
Understanding the Connection Between Cervical Proprioception, Postural Control, and Pain in Rheumatoid Arthritis
What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a long-term, systemic autoimmune condition that significantly impacts the body, particularly marked by continuous inflammation of the synovial joints. This persistent inflammation leads to progressive joint damage, resulting in severe pain, physical disability, and a diminished quality of life for those affected.
It affects approximately 1% of the global population, making it a prevalent condition that can emerge at any age, although it is most commonly diagnosed in middle-aged individuals. The onset of Rheumatoid arthritis (RA) can vary widely among individuals, with some experiencing sudden symptoms while others may notice a gradual development over time.
The inflammatory process in Rheumatoid arthritis (RA) primarily targets the synovium, which is the connective tissue lining the joints. This results in a condition known as synovitis, characterised by swelling and discomfort in the affected areas. Over time, the ongoing inflammation can lead to the erosion of cartilage and bone, fundamentally altering the structure of the joints and impairing their function.
This ongoing inflammation can eventually cause deformities, particularly evident in the small joints of the hands and feet, where the effects of RA can be most pronounced. Additionally, larger joints, such as the knees and shoulders, as well as the cervical spine, may also be affected as the disease progresses. This can lead to significant mobility issues and challenges in performing daily activities, further exacerbating the impact of the disease on the individual's life.
Postural control involves maintaining the body’s centre of mass within its base of support, both during static positions and dynamic movements. Effective postural control is crucial for overall stability and balance, particularly in individuals with Rheumatoid arthritis (RA) who may struggle with joint stability due to pain and inflammation.
Poor postural control increases the risk of falls and associated injuries, which are common and potentially serious complications for individuals with Rheumatoid arthritis (RA) . This risk is further heightened by the fact that many patients may already have compromised mobility due to joint pain and stiffness, making them more vulnerable to accidents.
Proprioception refers to the sense of position, movement, and force of the cervical spine, encompassing joint position sense, force sense, and kinesthesia. These elements are critical for maintaining head and neck alignment and facilitating coordinated movements. In individuals with RA, proprioceptive feedback may be disrupted, leading to difficulties in balance and coordination.
Chronic pain in Rheumatoid arthritis (RA) is not solely a result of ongoing inflammation; it also involves central sensitization mechanisms that amplify pain perception. This heightened sensitivity can interfere with proprioceptive processing and motor control, further exacerbating balance issues and increasing the likelihood of falls.
Research released in 2025 indicated that significant impairments in RA patients’ cervical proprioception and postural control are evidenced by greater errors in cervical flexion, extension, and rotation, as well as higher centre-of-pressure measures. These findings underscore the importance of addressing proprioceptive deficits in this patient population.
Why does this happen in Rheumatoid arthritis (RA) patients?
Inflammation and joint degeneration commonly seen in RA can impair mechanoreceptors within the cervical spine. This impairment leads to diminished proprioceptive feedback, which is crucial for maintaining balance and coordination. As a result, patients may experience increased difficulty in controlling their movements, contributing to instability and a higher risk of falls.
Additionally, chronic pain and discomfort, which are prevalent in Rheumatoid arthritis (RA) , can disrupt postural control mechanisms. This disruption can lead to increased center-of-pressure length, sway area, and velocity, all of which are indicators of poor balance and stability. The combination of these factors significantly impacts the overall well-being and functional abilities of individuals living with RA.
What Can Chiropractors Do to Improve Posture and Help with Rheumatoid Arthritis?
First, we need to examine the muscle and spinal hygiene of the patient. This involves assessing the overall condition of the muscles surrounding the spine and identifying any areas of tension or weakness that may contribute to poor posture.
Next, we utilise state-of-the-art technology to assess the posture of the patient. This may include advanced imaging techniques or computerized postural analysis to accurately gauge alignment and identify specific areas that require intervention.
Finally, we can work on the spinal joints to improve joint proprioception and initiate the process of regenerating poor spinal hygiene. This may involve targeted adjustments, therapeutic exercises, and education on proper body mechanics to enhance overall function and reduce pain.
For more information about how we can help YOU with your pain and improve your underlying dysfunction so the problem doesn’t come back .
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Reference
Alkhamis BA, Elrefaey BH, Alahmari KA, Koura GM, Alfaya FF, Reddy RS. Cervical proprioception, postural control, and pain: unraveling the interconnected challenges in rheumatoid arthritis. J Orthop Surg Res. 2025 Feb 15;20(1):169. doi: 10.1186/s13018-025-05572-y. PMID: 39955601; PMCID: PMC11829552.
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