Effect of Cervical Force Control Training on Force Sense and Steadiness in Chronic Non-Specific Neck Pain

September 9, 2026 updated by: Mohamed Mahmoud Refaey, Cairo University

Chronic non-specific neck pain (CNSNP) is a very common issue among young adults, often linked to poor posture, prolonged screen time, and sedentary habits. This persistent pain can change how the neck muscles work and control movement. The purpose of this study is to investigate whether a specific type of rehabilitation-called "cervical force control training"-can help improve how well people can feel and control their neck muscle strength, and whether this reduces their pain and improves their daily function.

Researchers will invite young adults (18 to 24 years old) who have had neck pain for at least 3 months to participate. Participants will be randomly divided into two groups:

Force Control Training Group: Will receive a new training program that uses a handheld dynamometer with a screen to help them practice holding steady, precise neck muscle contractions with visual feedback.

Conventional Exercise Group: Will receive a standard physical therapy program consisting of neck muscle stretches and shoulder-blade strengthening exercises.

Both groups will perform their exercises 3 times a week for 8 weeks. Researchers will measure participants' neck muscle steadiness, pain levels, and neck disability before the program starts, right after the 8-week program ends, and again at a 3-month follow-up to evaluate the long-lasting effects.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Chronic non-specific neck pain (CNSNP) involves persistent cervical pain without an identifiable structural pathology. Recent evidence suggests that CNSNP is closely associated with sensorimotor control deficits, including impaired proprioception and diminished force steadiness (the neuromuscular ability to produce and sustain precise submaximal force levels with minimal fluctuations). While conventional exercises improve strength and reduce pain, they often neglect the fine-motor precision and sensorimotor integration necessary for optimal neck function.

This randomized controlled trial (RCT) is designed to investigate the effect of cervical force control training compared to conventional neck exercises on force sense, force steadiness, pain intensity, and functional disability in young adults (18-24 years) with CNSNP.

Following baseline assessments for maximum voluntary isometric contraction (MVIC), force sense, and force steadiness (quantified by the coefficient of variation) using a Handheld Dynamometer (HHD), as well as clinical measures (VAS for pain, NDI for disability), eligible participants will be randomized into two groups:

Experimental Group (Force Control Training):

Participants will undergo an 8-week targeted training program (3 sessions/week, 30-40 mins each). The protocol utilizes submaximal isometric contractions with visual feedback via an HHD device paired with an application. The program progresses systematically through three phases: Phase 1 (Calibration & Reference at MVIC), Phase 2 (Acquisition using descending submaximal intensities 25% to 10% MVIC with continuous visual tracking), and Phase 3 (Retention & Transfer involving faded/no feedback and complex dual-tasking, such as auditory monitoring or arithmetic).

Control Group (Conventional Exercise Training):

Participants will undergo an 8-week program (3 sessions/week, 30 mins each) consisting of standard cervical stretching (upper trapezius and levator scapulae) and scapular strengthening/stabilization exercises (e.g., side-lying external rotation, side-lying forward flexion, prone extension, and push-up plus). Resistance will be tailored based on gender and body weight.

Re-evaluations will be conducted immediately post-intervention (at 8 weeks) and at a 3-month follow-up. The study aims to establish whether integrating specific force-control tasks offers superior benefits in restoring sensorimotor function and alleviating symptoms in patients with CNSNP compared to conventional rehabilitation alone.

Study Type

Interventional

Enrollment (Estimated)

32

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Egypt
    • Kafr el-Sheikh Governorate
      • Kafr ash Shaykh, Kafr el-Sheikh Governorate, Egypt
        • Faculty of Physical Therapy
        • Contact:
        • Principal Investigator:
          • Mohamed M Refaey, M.Sc.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Patients diagnosed with Chronic Non-Specific Neck Pain (CNSNP) lasting >= 3 months.
  • Body mass index (BMI) between 18.5 and 29.9 kg/m² (non-obese).
  • Pain intensity >= 30 mm on the Visual Analogue Scale (VAS).
  • Neck disability ranging from mild to moderate (10% to 48%) on the Neck Disability Index (NDI).
  • Able to perform isometric contractions with visual feedback.

Exclusion Criteria:

  • Shoulder/upper limb fractures or replacement (<12 months), or moderate-severe shoulder osteoarthritis (OA).
  • Cervical radiculopathy/myelopathy, peripheral neuropathy, vestibular disorders, or history of stroke/Transient Ischemic Attack (TIA).
  • Upper limb pathology (tendinopathy, capsulitis), thoracic outlet syndrome, or fibromyalgia.
  • Received neck-specific physiotherapy within the last 3 months.
  • Severe osteoporosis, uncontrolled diabetes (HbA1c >9%), or active infection/inflammation.
  • Cervical injections or surgery within the last 6 months.
  • Inability to follow 2-step instructions.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Experimental Group: Force Control Training
Patients in this group will receive an 8-week cervical force control training program (3 sessions/week). The training involves submaximal isometric neck contractions using visual feedback via a Handheld Dynamometer, progressing from simple feedback-assisted holds to complex dual-task exercises.
Behavioral: Cervical Force Control Training
An 8-week program (3 sessions/week, 30-40 mins each) utilizing submaximal isometric neck contractions with visual feedback via a Handheld Dynamometer. The protocol progresses through three phases: initial calibration, acquisition using descending target intensities (25% to 10% MVIC) with continuous visual tracking, and retention/transfer using faded or no feedback combined with dual-tasking (e.g., auditory monitoring or arithmetic).
Active Comparator: Active Comparator: Conventional Exercise Training
Patients in this group will receive an 8-week conventional exercise program (3 sessions/week). The program includes standard cervical stretching (upper trapezius and levator scapulae) and scapular strengthening and stabilization exercises.
Behavioral: Conventional Exercise Training
An 8-week program (3 sessions/week, 30 mins each) consisting of standard cervical stretching for the upper trapezius and levator scapulae muscles, alongside scapular strengthening and stabilization exercises (e.g., side-lying external rotation, side-lying forward flexion, prone extension, and push-up plus). Resistance is tailored based on patient gender and body weight.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Cervical Force Sense
Time Frame: Baseline, 8 weeks (immediately post-intervention), and 3-month follow-up
Assessed using a Handheld Dynamometer (HHD) during force reproduction tasks. It is measured by calculating the absolute error between a target submaximal force and the reproduced force without visual feedback. Lower error values indicate better force sense and proprioception.
Baseline, 8 weeks (immediately post-intervention), and 3-month follow-up
Cervical Force Steadiness
Time Frame: Baseline, 8 weeks (immediately post-intervention), and 3-month follow-up
Evaluated by calculating the Coefficient of Variation (CoV) of force during submaximal isometric cervical contractions using a Handheld Dynamometer (HHD). Lower CoV percentages indicate better force steadiness and neuromuscular control.
Baseline, 8 weeks (immediately post-intervention), and 3-month follow-up

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Neck Functional Disability (Neck Disability Index - NDI)
Time Frame: Baseline, 8 weeks (immediately post-intervention), and 3-month follow-up
A 10-item patient-completed questionnaire assessing how neck pain affects the ability to manage everyday life activities. Total scores range from 0 to 50, which can be expressed as a percentage (0-100%). Higher scores indicate greater patient-rated functional disability.
Baseline, 8 weeks (immediately post-intervention), and 3-month follow-up
Pain Intensity (Visual Analogue Scale - VAS)
Time Frame: Baseline, 8 weeks (immediately post-intervention), and 3-month follow-up
Pain intensity is assessed using a 100-mm horizontal line, anchored by "no pain" at 0 mm and "worst imaginable pain" at 100 mm. Lower scores indicate a lower level of pain.
Baseline, 8 weeks (immediately post-intervention), and 3-month follow-up

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cairo University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

September 1, 2026

Primary Completion (Estimated)

December 1, 2026

Study Completion (Estimated)

December 1, 2026

Study Registration Dates

First Submitted

September 6, 2026

First Submitted That Met QC Criteria

September 6, 2026

First Posted (Actual)

September 10, 2026

Study Record Updates

Last Update Posted (Actual)

September 11, 2026

Last Update Submitted That Met QC Criteria

September 9, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • P.T.REC/012/006579

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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