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patients with neck pain often have impaired proprioception of the neck and reduced rom , for 
 which proprioception training and rom training are usually prescribed in rehabilitation 
 protocols .
more and more researchers and clinicians are interested in the assessment1 and treatment of strength2 , endurance , range of motion and 
 proprioception3 of the cervical spine . 

cervical rom has been used to evaluate the severity of impairment or disability of patients 
 as it is related to cervical disorders and injuries .
it has also been used as part of the 
 clinical criteria for classification of disease as well as the evaluation of the efficacy of 
 a rehabilitation program4 . the joint position error ( jpe )
test is considered the primary measure of neck 
 proprioception and has been widely used as an outcome measure for patients with chronic neck 
 pain5 .
abnormal jpe has been detected in 
 patients with neck pain using either tests of ability to relocate the neutral head posture 
 after an active movement or to actively relocate a position within a movement plane6 .
neuromuscular joint facilitation ( njf ) is a new therapeutic exercise based on kinesiology , 
 and it integrates with the facilitation element of proprioceptive neuromuscular facilitation 
 ( pnf ) with the joint composition movement , aiming to improve the movement of the joint 
 through passive exercise , active exercise and resistance exercise .
the njf technique uses the same motion pattern as pnf , 
 but njf changes the resistance part .
the purpose of this study was to examine the immediate effects of njf training and njf 
 distal resistance training on cervical rom and position sense .
ten healthy people with an average age of ( 35.014.5 ) years , and an average height of 
 ( 172.214.0 ) cm , an average body weight of ( 76.030.0 )  kg were recruited for this study .
the 
 characteristics of the subjects are shown in table 
 1table 1.subject characteristics ( n = 10)age ( yrs ) 35.014.5height ( cm ) 172.1514weight ( kg ) 76.030.0values are mean  sd . all the subjects were able to independently perform activities of daily 
 living .
they all agreed to participate in the study , after the researchers had given them a 
 verbal explanation of the study method and aims .
this study was approved by the research 
 ethics committee of the international university of health and welfare .
the subjects were divided into three groups : 10 in the control group , 10 in the njf distal 
 resistance training group , and 10 in the njf training group .
a miniature wireless motion 
 recorder was used to record the maximum cervical rom and jpe before and after the 
 interventions .
two miniature wireless motion recorders ( mvp - rf8-gc , microston corperation , 
 japan ) were used in this study to measure the angle change of the neck .
one was placed on 
 the middle of the forehead , and the other one was placed on the manubrium sterni .
the tests 
 and performance were based on similar tests used in previous studies which investigated the 
 neck proprioception8 .
subjects were 
 comfortably positioned by sitting with their feet flat on the ground with their head in the 
 neutral resting position .
subjects were familiarized with the tasks by performing a few practices in each test 
 direction : extension , left rotation , and right rotation . for the formal tests ,
subjects were 
 blindfolded , and their neutral head position was automatically set to zero by the sensor . in 
 the three testing directions , the neck and head moved to the end of their range and returned 
 as accurately as possible to the starting position .
three trials were performed of left and 
 right neck rotation , and extension . before each trial , subjects were allowed to remove the 
 blindfold , open their eyes and face a big mirror to relearn the neutral position .
then , they 
 were blinded again , and the head was repositioned back to the starting position the subjects 
 by themselves . prior to each new direction , the subject was able to recenter his starting 
 position with the help of the mirror before being blindfolded again .
neutral position , the positions of maximum rotation ( and 
 extension ) , and the end position after the return to the  neutral position .
the differences 
 in angle between the starting and the maximum range positions were calculated to deduce the 
 rom of each movement at each sensor site .
the differences in angle between the starting and 
 the end range position were calculated to deduce the neck joint position error of each 
 movement at each sensor site .
jpe and rom were calculated as the average data for the three 
 trials in each direction ( extension , right rotation , and left rotation ) .
it is considered that left and right lateral flexion allows the trunk 
 muscle to affect the neck movement .
it interferes too much with the proprioceptive sense of 
 the neck , so it was not used in the present study .
the focus of the present study was 
 proprioception sense . in the cervical region ,
most of proprioceptors are distributed in the 
 deep flexion muscle groups of the neck9 . 

test of neck position sense after the neck extension then back to the neutral position , 
 involving neck flexion muscle group s activation , would be more persuasive for neck position 
 ability in the present study .
the interventions for control group was two minutes rest , for njf distal resistant 
 training group was njf distal resistance training and for the njf group was njf neck flexion 
 pattern training .
two - way repeated measures anova was used to compare joint position error between before and 
 after the intervention .
the two factors were group and intervention . if a significant 
 interaction among groups was found , the two - way repeated measures anova with the bonferroni 
 was performed to investigate the differences between before and after intervention .
no difference in rom was observed among the three groups ( table 2table 2.comparison of rom before and after intervention ( )beforeafterextension njf 63.4212.4467.2015.31njf - d 64.5311.3062.8815.04control 67.5712.2563.8513.23 left rotationnjf 74.9413.8377.2915.81njf - d 71.2514.6272.9215.30control 72.4514.9271.1013.88right rotation njf 74.2517.1372.6114.09njf - d 72.9812.5475.2115.01control 76.3612.5274.3915.36values are mean  sd . comparison with before intervention : * : p<0.05 ; 
 * * : p<0.01 .
njf : neuromuscular joint facilitation group , njf - d : njf distal 
 resistance group , control : control group , rom : range of motion ) .
two - way anova showed that there were significant interactions of jpe from 
 extension to the starting 
neutral position among the groups ( p<0.05 ) , indicating that 
 the changes were different among the groups . a significant pre- to post - intervention 
 decrease in jpe from extension to the starting 
no other significant differences were observed among the three groups 
 ( table 3table 3.comparison of jpe before and after intervention ( )beforeafterextension njf 10.164.26.464.37njf - d 5.954.043.402.79control 2.651.143.051.65left rotationnjf 3.012.013.651.42njf - d
njf : neuromuscular joint facilitation group , njf - d : njf 
 distal resistance group , control : control group , jpe : joint position error ) .
values are mean  sd . comparison with before intervention : * : p<0.05 ; 
 * * : p<0.01 .
njf : neuromuscular joint facilitation group , njf - d : njf distal 
 resistance group , control : control group , rom : range of motion values are mean  standard deviation
. comparison with before intervention : * : 
 p<0.05 ; * * : p<0.01 .
njf : neuromuscular joint facilitation group , njf - d : njf 
 distal resistance group , control : control group , jpe : joint position error
in the current study , no difference was found in the neck range of motion of the different 
 study groups .
this finding may be due to the subjects being healthy individuals without any 
 neck problems , who do not have any abnormal limited range motion of the cervical joint . 

cervical spine studies have suggested that warm - up exercises which simulate the actual 
 testing procedure can increase the compliance of neck soft tissues and minimize the process 
 of creep related to repetitive measurements10 , 11 . before the test and the intervention , 
 therefore , subjects were allowed to practice the task and perform movements in each 
 direction , to warm up the neck muscle to avoid tight muscles .
therefore , it is reasonable to 
 assume that healthy people would have the similar normal cervical joint range of motion at 
 both pre and post intervention .
if a method improves the proprioceptive function of the neck , the positioning ability of the 
 neck should show more acuity .
the result of this study indicate that njf training provides 
 proprioceptive acuity that is superior to njf distal resistance training .
this is because , 
 in njf , proximal resistance is exerted , promoting the contraction of the neck multifidus 
 thereby activating more proprioceptors .
there was a pre- to post - intervention decrease in 
 jpe of extension , possibly due to the patterns of njf training , with focus much more on the 
 directions of extension and flexion of the neck , and less on the left and right rotation . 
 according to the results of our study ,
it is evident that njf training can promote the 
 proprioceptive function of the neck .
njf is suitable for neck dysfunction rehabilitation 
 training and neck proprioceptive function disorder rehabilitation training .
. nevertheless , further investigations are 
 necessary to find out the best approaches for improving proprioceptive function , and to 
 investigate the different effects of different training programs after long - term 
 interventions for healthy people and neck disorder patients .
this result suggests that the better way to 
 improve proprioceptive acuity is an intervention together with proximal resistance training , 
 such as njf training .
[ purpose ] the purpose of this study was to evaluate whether neuromuscular joint 
 facilitation ( njf ) training is superior to njf distal resistance training at improving the 
 rom and proprioceptive acuity of the neck . 
 [ subjects ] 10 healthy subjects ( 8 males , 2 
 females ) participated in this study . [ methods ] 
 the participants were allocated to three 
 groups : 10 in the control group , 10 in the njf distal resistance training group , and 10 in 
 the njf training group . 
 a miniature wireless motion recorder was used to record the 
 maximum cervical range of motion and joint position error ( jpe ) before and after the 
 interventions . 
 the three interventions were tested on different days . 
 [ results ] no 
 difference of rom was observed among the three groups . 
 a significant pre- to 
 post - intervention decrease in jpe in extension was identified in the njf group . 
 no other 
 significant differences were observed among the three groups . [ conclusion ] 
 the njf 
 training conferred remarkable benefits on the cervical jpe of healthy people . 
 this result 
 suggests that the best way to improve proprioceptive acuity is intervention together with 
 proximal resistance training , such as njf training .