Upper Cervical Spinal Manipulation and Cervical Sensorimotor Control: What a 2026 Trial Found

Research Update: A 2026 exploratory randomized controlled trial examined whether upper cervical spinal manipulation at C1–C2 produces immediate changes in cervical sensorimotor control in people with chronic primary cervical pain. The study found a different pattern of head and neck movement after manipulation compared with sham manipulation, particularly in movement speed and movement time. However, it did not demonstrate a statistically significant between-group difference in movement accuracy.

That distinction matters. The findings are interesting because they suggest that upper cervical spinal manipulation may temporarily alter how a person performs an accuracy-focused head-and-neck movement task. They do not establish that the manipulation improves cervical sensorimotor function, produces better clinical outcomes, or has lasting effects.

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Video overview: This ChiroSecure Research Update examines a 2026 exploratory randomized controlled trial investigating the immediate effects of upper cervical spinal manipulation at C1–C2 on cervical sensorimotor control in individuals with chronic primary cervical pain.

The study used a cervical movement sense (CMS) test to examine movement accuracy, movement time, movement speed, and movement accuracy–time ratio before and immediately after the intervention.

Transcript: A downloadable transcript was not located on the current ChiroSecure page or in the available site search for this video. If a transcript asset exists separately, add it here before publication.

What did the 2026 study investigate?

The study by Minwoo Lee and Yongwoo Lee, published in Chiropractic & Manual Therapies in January 2026, examined the immediate effects of upper cervical spinal manipulation (UCSM) applied at the C1–C2 segment.

The researchers recruited 35 adults with chronic primary cervical pain. Eighteen participants were assigned to the experimental group and received upper cervical spinal manipulation. Seventeen participants were assigned to a sham-manipulation control group.

The study was designed as an exploratory, single-blind, sham-controlled randomized controlled trial with blinded outcome assessment. Participants were recruited in Seoul, Republic of Korea, between May and June 2024.

The trial was retrospectively registered with the Clinical Research Information Service (CRIS) in 2025. The authors reported that the study received institutional review board approval and that participants provided written informed consent.

Read the study abstract on PubMed or read the full open-access article on PubMed Central.

What is cervical sensorimotor control?

Cervical sensorimotor control describes the nervous system’s ability to integrate sensory information and use it to coordinate accurate movement and stability of the head and neck.

The process involves information from several sensory systems, including proprioceptive input from muscles and joints, visual information, and vestibular information. The cervical region therefore contributes to a broader sensorimotor system rather than functioning as an isolated mechanical structure.

Research has found differences in several sensorimotor measures among people with neck pain. A 2024 systematic review and meta-analysis that included 34 studies found poorer joint-position sense, oculomotor function, and wider postural sway in people with neck pain compared with healthy controls. The authors also noted that results varied according to factors such as pain intensity and dizziness.

This broader evidence helps explain why researchers are interested in measuring cervical sensorimotor performance. At the same time, differences on a sensorimotor test do not automatically establish the cause of a patient’s symptoms or demonstrate that a particular intervention will improve clinical outcomes.

Read the 2024 systematic review and meta-analysis of sensorimotor testing in neck pain.

How did the researchers measure cervical movement?

The researchers used a cervical movement sense (CMS) test. Participants wore a headband equipped with a laser pointer and sat approximately one meter from a wall containing a zigzag pattern.

They were instructed to trace the pattern with the laser as accurately as possible while choosing their own movement speed. The researchers recorded the movements with a smartphone camera and analyzed the recordings using a customized video-analysis algorithm.

Four movement directions were tested. Participants completed four trials before the intervention and four trials afterward.

This task is important when interpreting the results because the instructions emphasized accuracy. The researchers did not ask participants simply to move as quickly as possible.

That creates an important interpretive issue: movement speed and movement accuracy can trade off against one another. A participant may slow a movement in an attempt to control the trajectory more precisely.

What did the study find?

The researchers examined four principal CMS variables:

• Movement accuracy (MA): how accurately the participant traced the target.
• Movement time (MT): how long the movement task took.
• Movement speed (MS): the speed of movement during the task.
• Movement accuracy–time ratio (MAT): a combined measure intended to reflect the relationship between accuracy and time.

Measure	Finding after intervention	Interpretation
Movement accuracy	Time × Group interaction was not statistically significant; exact p=0.0504.	The trial did not demonstrate a statistically significant between-group improvement in movement accuracy.
Movement time	Significant Time × Group interaction, p=0.003. The sham group reduced movement time by 13%; the manipulation group showed no statistically significant within-group change.	The groups changed differently, but the manipulation group did not show a statistically significant reduction in movement time.
Movement speed	Significant Time × Group interaction, p=0.001. The manipulation group decreased speed by 11%; the sham group increased speed by 8%.	The clearest immediate difference was a slower movement pattern after UCSM.
Movement accuracy–time ratio	Time × Group interaction was not statistically significant, p=0.055.	The combined measure did not show a statistically significant between-group difference.

The statistical results therefore point to a change in movement strategy or kinematics, rather than clear evidence of improved sensorimotor performance.

Did upper cervical manipulation improve movement accuracy?

Not conclusively.

The manipulation group showed a descriptive increase in movement accuracy of approximately 8%. However, the Time × Group interaction for movement accuracy did not reach statistical significance. The exact p-value was 0.0504.

The distinction between a descriptive trend and a statistically significant between-group effect is important. The researchers themselves characterized the study as exploratory and advised caution when interpreting these findings.

Therefore, it would be inaccurate to summarize the study as demonstrating that upper cervical manipulation improved cervical proprioception or movement accuracy.

Why did movement speed decrease after manipulation?

The authors propose that the answer may relate to the speed–accuracy trade-off.

In motor-control research, accuracy and speed can compete with one another. When a task emphasizes accurate performance, slowing down can be one strategy for controlling movement more precisely.

That possibility is particularly relevant here because participants were instructed to trace the target as accurately as possible at a self-selected speed.

The researchers therefore suggested that the slower movement observed after UCSM could represent a temporary movement pattern that placed greater emphasis on accuracy than speed. They also discussed the possibility that altered proprioceptive input could temporarily change sensorimotor integration.

These explanations remain hypotheses. The study did not directly measure the proposed neurophysiological mechanisms, so the findings cannot establish why the movement pattern changed.

What does the study tell us about C1–C2 manipulation specifically?

The intervention targeted the C1–C2 articulation. The study is therefore relevant to questions about upper cervical manipulation and sensorimotor performance.

However, the findings should not be interpreted as proof that the observed response was uniquely caused by stimulation of C1–C2.

Segmental specificity remains an active area of research. Some experimental evidence suggests that the location of a spinal manipulation can influence certain neurophysiological responses, while other research indicates that the exact target may be less important for some clinical outcomes.

The present study did not compare different cervical segments. Consequently, it cannot determine whether C1–C2 produced a response that would not occur after manipulation elsewhere.

What are the important limitations?

This was a small exploratory study, and its limitations are important when translating the findings into clinical practice.

• Small sample: Only 35 participants completed the study.
• Specific population: Participants were adults with chronic primary cervical pain and unilateral C1 restriction identified by manual palpation.
• Immediate outcomes: The researchers measured performance immediately after the intervention. The study did not establish whether any change persisted.
• Retrospective registration: The trial was registered after recruitment had begun, although the authors reported that the statistical analysis plan had been defined a priori in the approved protocol.
• Blinding: Participant blinding was not formally tested.
• Measurement limitations: The customized video-analysis algorithm had not yet undergone formal evaluation of its reliability and measurement error.
• No imaging: Participant screening relied on clinical assessment rather than imaging, so unrecognized structural or systemic variations could not be completely excluded.
• Exploratory design: The possibility of spurious findings cannot be completely excluded.
• No clinical outcome conclusion: The study measured a laboratory-style sensorimotor task, not long-term pain, disability, quality of life, or functional recovery.

The authors also reported no adverse events following the interventions. That finding supports the feasibility of the experimental protocol, but it should not be interpreted as evidence that cervical manipulation has no risk under all clinical circumstances or for every patient.

What does this mean for chiropractors?

The most useful clinical lesson is not that a single manipulation produces a predictable sensorimotor improvement. Instead, the study adds another piece of evidence showing that spinal manipulation may be associated with short-term changes in movement behavior that are detectable with sensitive kinematic testing.

For clinicians, several points are worth keeping in view:

1. Separate immediate kinematic changes from clinical improvement. A change in movement speed is not the same thing as an improvement in pain, disability, function, or quality of life.
2. Consider the task being measured. Because the CMS test emphasized accuracy, slowing may represent a different movement strategy rather than impaired performance.
3. Use sensorimotor findings as part of clinical reasoning. Sensorimotor tests can provide useful information, but they should be interpreted alongside the patient’s symptoms, examination findings, goals, and functional status.
4. Do not overgeneralize the population. These results came from adults with chronic primary cervical pain and a specific C1 mobility finding.
5. Reassess the individual patient. Research findings describe group-level responses. They do not predict exactly how an individual patient will respond.
6. Recognize the uncertainty. The study authors explicitly call for larger studies and longer follow-up before determining clinical relevance.

ChiroSecure’s broader research coverage also includes evidence concerning spinal manipulative therapy for neck pain and current evidence-based guidelines. Those resources provide useful context because the present study addresses a very specific sensorimotor question rather than the overall effectiveness of chiropractic care for neck pain.

Review evidence-based guidelines for chiropractic treatment of adult neck pain.

Read the ChiroSecure review of spinal manipulative therapy for acute neck pain.

What should researchers study next?

The 2026 trial raises several useful questions.

• Do the observed kinematic changes persist beyond the immediate post-intervention period?
• Would a larger sample produce a clearer effect on movement accuracy?
• Do the same changes occur in other neck-pain populations?
• Does the response differ when other cervical or spinal regions are manipulated?
• How does upper cervical manipulation compare with sensorimotor exercise or other active interventions?
• Do changes in CMS performance translate into meaningful improvements in pain, disability, balance, dizziness, or daily function?
• Can more formally validated measurement systems improve the reliability of cervical movement testing?

These questions are important because a laboratory or clinical movement measure becomes more useful when researchers can establish how changes relate to outcomes that matter to patients.

Frequently Asked Questions

What is upper cervical spinal manipulation?

Upper cervical spinal manipulation refers to spinal manipulation directed toward the upper cervical region. In this study, the intervention targeted the C1–C2 articulation using a high-velocity, low-amplitude technique.

What is the cervical movement sense test?

The cervical movement sense test evaluates head-and-neck movement performance by asking a person to trace a visual target with a head-mounted laser. Researchers can analyze movement accuracy, movement time, movement speed, and related measures.

Did the 2026 study prove that upper cervical manipulation improves proprioception?

No. The study found immediate differences in movement kinematics, particularly movement speed and movement time. It did not establish a statistically significant between-group improvement in movement accuracy, and it did not directly measure proprioceptive mechanisms.

Why might someone move more slowly after manipulation?

The study authors suggest that the slower movement could reflect a speed–accuracy trade-off under instructions that emphasized accuracy. They also proposed possible sensorimotor adaptation to altered sensory input. These explanations remain exploratory rather than proven mechanisms.

Was the study randomized?

Yes. Thirty-five participants were randomly assigned to an upper cervical manipulation group or a sham-manipulation group. The study also used a blinded outcome assessor.

Were adverse events reported?

No adverse events were reported following the interventions in this study. That finding supports the feasibility of the experimental protocol, but it does not establish that cervical manipulation is risk-free in all clinical settings.

Can the results be applied to every patient with neck pain?

No. The study involved a specific population of adults with chronic primary cervical pain and unilateral C1 restriction. Its findings should not automatically be generalized to other patient populations or clinical presentations.

Bottom Line

This 2026 exploratory randomized controlled trial adds useful information to the emerging literature on cervical sensorimotor control and spinal manipulation.

Upper cervical spinal manipulation at C1–C2 was followed by a different pattern of head-and-neck movement during an accuracy-focused cervical movement task. The clearest finding was an 11% reduction in movement speed in the manipulation group, while the sham group showed a 13% reduction in movement time and an 8% increase in movement speed.

However, movement accuracy did not show a statistically significant between-group difference, and the combined movement accuracy–time ratio also did not show a statistically significant interaction.

The findings are therefore best viewed as preliminary evidence of an immediate change in movement strategy or kinematics, not as proof that upper cervical spinal manipulation improves cervical sensorimotor function or produces lasting clinical benefits.

For chiropractors and other clinicians, the study provides a useful reminder that the effects of manual interventions can be examined at several levels—from pain and disability to movement behavior and sensorimotor performance. Future research will need larger samples, validated measurement methods, longer follow-up, and clinically meaningful outcomes to determine how these immediate changes translate into patient care.

Primary Research Reference

Lee M, Lee Y. Immediate effects of upper cervical spinal manipulation on cervical sensorimotor control in individuals with chronic primary cervical pain: an exploratory randomized controlled trial. Chiropractic & Manual Therapies. 2026;34:4. doi:10.1186/s12998-026-00626-2.

Read the full research article | PubMed | PubMed Central

Additional Reading

• Särkilahti N, et al. Sensorimotor tests in patients with neck pain and its associated disorders: a systematic review and meta-analysis. Scientific Reports. 2024;14:12764. Read the systematic review.
• International Association for the Study of Pain. ICD-11 chronic pain classification.
• Evidence-Based Guidelines for the Chiropractic Treatment of Neck Pain in Adults.
• Spinal Manipulative Therapy for Acute Neck Pain: What the Evidence Shows.

Explore More ChiroSecure Research

ChiroSecure continues to publish research updates examining spinal manipulation, neck pain, sensorimotor function, and the evidence relevant to chiropractic practice. Explore the ChiroSecure research and education library for additional evidence summaries.