Chronic non-specific neck pain (CNSNP) is a widespread musculoskeletal condition leading to pain, disability, and impaired quality of life. Due to its multifactorial nature involving biomechanical, sensorimotor, and psychosocial aspects, various rehabilitation interventions have been recommended. However, there is a lack of direct evidence comparing structured exercise, sensorimotor training, and pain neuroscience education within a comprehensive biopsychosocial framework.
The primary objective of this randomized controlled trial is to evaluate and compare the effectiveness of structured exercise, sensorimotor training, and pain neuroscience education on disability, pain intensity, sensorimotor control, and psychosocial outcomes in individuals with CNSNP.
Participants aged 18-65 with chronic non-specific neck pain will be randomly allocated into three intervention groups:
Structured Exercise Group (SEG): Cervical stabilization, isometric/isotonic exercises, stretching, and range of motion training.
Sensorimotor Training Group (SMTG): Cervical joint position sense retraining, oculomotor exercises, and balance training.
Pain Neuroscience Education Group (PNEG): Online educational sessions focused on pain neurophysiology, central sensitization, and cognitive-behavioral strategies.
Outcomes will be assessed at baseline (T0), completion of 8 weeks of intervention (T1), and 4 weeks post-intervention follow-up (T2, 12th week).
Diagnosis of chronic non-specific neck pain lasting for more than 90 days
Age between 18 and 65 years (inclusive)
History of receiving standard physical therapy in a clinical setting in Turkey, yet experiencing persistent neck pain
Numeric Pain Rating Scale (NPRS) score ≥ 3/10 at rest and during active cervical movement
Neck pain associated with nerve root involvement or radiculopathy
History of prior cervical spine surgery
Physical therapy interventions received within the last 3 months
Severe spinal pathologies (e.g., fracture, tumor, infection, structural instability)
Parallel
Structured Exercise Program
Other interventionParticipants will receive a structured exercise program consisting of 24 supervised sessions over 8 weeks (3 sessions/week, 20-30 mins/session). The program includes active cervical ROM exercises, stretching for neck muscles, progressive isometric/isotonic elastic band exercises monitored via Borg RPE scale, and craniocervical flexion stabilization using a pressure biofeedback unit.
Sensorimotor Training
Other interventionParticipants will receive sensorimotor training consisting of 24 supervised sessions over 8 weeks (3 sessions/week, 20-30 mins/session) following a 3-minute ROM warm-up. The protocol includes joint position sense retraining using laser feedback, oculomotor exercises (smooth pursuit, gaze stability, eye-head coordination), and static/dynamic balance training under varied visual conditions and support surfaces.
Pain Neuroscience Education
Other interventionParticipants will receive online pain neuroscience education delivered in 10 group sessions via Zoom over 8 weeks. In addition to the pain neuroscience education curriculum covering pain neurophysiology, peripheral and central sensitization, neuroplasticity, descending inhibition, and cognitive modification, 1 session will be dedicated to demonstrating home-based neck exercises. Participants will be encouraged to perform these home exercises 3 days a week for 10 minutes per session. While exercise engagement is encouraged as part of the education, no forced compliance or routine exercise reminders will be provided. Patient exercise diaries will be requested at the end of each month throughout the intervention period.
Neck Disability Index
A self-reported questionnaire used to measure neck pain-related functional disability. It consists of 10 items, each scored from 0 to 5, with a total score ranging from 0 to 50. Higher scores indicate greater disability.
Numeric Pain Rating Scale (NPRS)
A 11-point numeric scale used to measure neck pain intensity, ranging from 0 (no pain) to 10 (worst intensity of pain imaginable). Higher scores indicate greater pain intensity.
Cervical Range of Motion (CROM)
Neck flexion, extension, right/left lateral flexion, and right/left rotation will be measured in degrees using the Clinometer smartphone app. Higher values indicate a greater range of motion.
Flexion-Rotation Test (FRT)
Upper cervical spine rotation mobility (C1-C2 segment) will be evaluated in degrees using the Clinometer smartphone application during passive cervical flexion. Higher degrees will represent better upper cervical mobility.
Cervical Joint Position Error (JPE)
Cervical proprioceptive accuracy will be assessed by measuring the re-positioning error degree from active rotation to the neutral head position using a laser pointer attached to a headband at a 90 cm distance. Lower degrees will indicate better proprioceptive accuracy.
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