Concussion assessment continues to advance as research clarifies the functional relationship between the head and the cervical spine. Cervical Joint Position Error testing, known as JPE, provides an objective measure of cervical sensorimotor control and is increasingly incorporated into contemporary assessment frameworks. Its value is strongest when used within a broader, multi system approach that includes vestibular, oculomotor, and balance testing.
This integrated perspective is supported by the work of Dr Julia Treleaven and Dr Theo Farley, whose research has shaped current understanding of how cervical afferent dysfunction contributes to post concussive symptoms and injury risk.
The cervical spine as a key sensory structure
The upper cervical spine contains a dense collection of mechanoreceptors that inform the central nervous system about head position and movement. These inputs work alongside visual and vestibular systems to maintain balance, gaze stability, and spatial orientation. When cervical afferent signalling is disrupted, individuals may experience dizziness, unsteadiness, altered visual tracking, or impaired awareness of head position.
JPE testing quantifies one aspect of this sensorimotor function by measuring how accurately a person can relocate their head to a neutral position without visual input.
Summary of current research
1. JPE helps identify cervical contributions to persistent symptoms
Treleaven’s work consistently links higher JPE values with reduced balance performance and dizziness in both whiplash associated disorders and post concussion presentations. When interpreted alongside assessments such as the Smooth Pursuit Neck Torsion Test and balance measures, JPE helps determine whether cervical mechanisms are contributing to ongoing symptoms.
2. JPE provides insight into concussion risk profiles
Farley’s longitudinal studies in elite rugby demonstrate that specific proprioceptive deficits, particularly increased right rotation error, are associated with a higher incidence of concussion across a season. These findings position cervical proprioception as a distinct and modifiable factor that can complement pre season screening and individual risk profiling.
3. JPE highlights residual deficits during recovery
Research also indicates that individuals may report symptom resolution while retaining altered cervical sensorimotor control. Incorporating JPE into return to play processes therefore offers an additional objective marker to support decision making.
Integration into clinical pathways
Many modern concussion pathways now incorporate cervical assessment as standard practice. The University of Kansas Health System, for example, utilises JPE within a multi disciplinary protocol to guide rehabilitation planning. Depending on the identified deficits, patients may be directed towards vestibular rehabilitation, cervical manual therapy, or sensorimotor retraining.
Tools that support accurate and repeatable JPE assessment, such as head mounted laser systems, are now widely adopted in clinical settings. Devices including the HeadX Kross offer a practical method for delivering standardised JPE testing and for integrating cervical sensorimotor retraining into rehabilitation programmes. This supports current evidence based practice, which encourages the use of objective measures within multi system assessment.
Clinical positioning
The existing evidence supports JPE as a useful component of concussion assessment. Although it should not be interpreted in isolation, its inclusion alongside vestibular, oculomotor, and balance evaluations provides a more complete understanding of the head neck system. This contributes to clearer diagnosis, more targeted rehabilitation, and more informed return to play decision making.
Sources and Further Reading
Sensorimotor Integration and Cervical Afferents
Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual Therapy. 2008.
https://pubmed.ncbi.nlm.nih.gov/17702636/
Treleaven J et al. The relationship of cervical joint position error to balance and eye movement disturbances in persistent whiplash. JOSPT. 2006.
https://pubmed.ncbi.nlm.nih.gov/15919229/
Cervicogenic Dizziness and Assessment Clusters
Manual cervical therapy and vestibular migraine: A case series. Headache.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11065132/
Concussion Risk, Proprioception and Longitudinal Evidence
Farley T et al. Poor cervical proprioception as a risk factor for concussion in professional male rugby union players. Br J Sports Med. 2022.
https://pubmed.ncbi.nlm.nih.gov/35526515/
Farley T et al. Cervical spine sensorimotor deficits persist in people post concussion despite minimal symptoms. Frontiers in Neurology / PMC.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11552255/
Strength vs Proprioception as Independent Factors
Farley T et al. Poor isometric neck extension strength as a risk factor for concussion. Br J Sports Med.
https://www.researchgate.net/publication/358813318
Clinical Protocols and Rehabilitation Evidence
University of Kansas Health System. Outpatient Clinical Concussion Comprehensive Protocol. PMCID: PMC9411741.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9411741/
Responsiveness of the Cervical Joint Position Error Test following four weeks of proprioceptive training. BMJ Open Sport and Exercise Medicine / PMC.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11086922/