Sensory Motor Control and Muscle Energy Technique for Chronic Mechanical Neck

Participants allocated to Group A will receive Muscle Energy Technique (MET) using the Post-Isometric Relaxation (PIR) method targeting the cervical musculature. The intervention will be administered by a licensed physiotherapist and will include treatment of the upper trapezius, levator scapulae, sternocleidomastoid, deep neck flexors, deep neck extensors, and scalene muscles.

For each muscle, the therapist will position the muscle at its initial resistance barrier and instruct the participant to perform a gentle isometric contraction (approximately 20-30% of maximal effort) against therapist resistance for 5-10 seconds, followed by complete relaxation. The therapist will then move the muscle to the new barrier and maintain the stretch for 10-15 seconds. This sequence will be repeated 3-5 times for each muscle group.

The treatment protocol includes:

Upper Trapezius: Side-bending of the cervical spine away from the affected side following isometric contraction.

Levator Scapulae:

articipants in the experimental group will receive a combination of Muscle Energy Technique (MET) and Sensory Motor Control (SMC) Training. Treatment sessions will be conducted under the supervision of a physiotherapist. MET will be applied to the shortened cervical muscles, including the upper trapezius and levator scapulae, using post-isometric relaxation techniques to reduce muscle tightness, improve cervical mobility, and decrease pain.

Following MET, participants will perform a structured SMC training program aimed at improving cervical proprioception, eye-head coordination, gaze stability, movement control, balance, and postural awareness. The SMC program will include the following exercises:

Smooth Horizontal and Vertical Tracking: A card measuring approximately 10-15 cm × 7-10 cm will be placed 2 meters from the participant. In Level 1, participants move their eyes while keeping the head stationary; in Level 2, they move the head while maintaining visual fixation on the targe

The Numeric Pain Rating Scale (NPRS) will be used to assess the intensity of neck pain experienced by participants. The NPRS is a valid, reliable, and widely used self-reported measure of pain intensity. Participants will be asked to rate their current neck pain on an 11-point scale ranging from 0 to 10, where 0 indicates "no pain" and 10 indicates "the worst pain imaginable."

Participants will select the number that best represents their average pain intensity over the preceding 24 hours. NPRS scores will be recorded at baseline and after completion of the intervention period. A reduction in NPRS score will indicate improvement in pain symptoms. The scale has demonstrated excellent reliability and responsiveness in individuals with musculoskeletal disorders, including chronic mechanical neck pain.

Scoring:

0 = No pain 1-3 = Mild pain 4-6 = Moderate pain 7-10 = Severe pain

Interpretation:

Lower scores indicate lower pain intensity, while higher scores indicate greater pain intensi

The Neck Disability Index (NDI) will be used to assess self-reported disability and functional limitations associated with chronic mechanical neck pain. The NDI is one of the most widely used, valid, and reliable questionnaires for evaluating neck-related disability in both clinical practice and research.

The questionnaire consists of 10 items that assess the impact of neck pain on daily activities, including pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item is scored on a 6-point scale (0-5), with higher scores indicating greater disability. The total score ranges from 0 to 50 points and can also be expressed as a percentage by multiplying the total score by two.

Participants will complete the NDI at baseline and after the intervention period. Changes in NDI scores will be used to determine the effectiveness of the treatment in improving functional status and reducing disability related to neck pain.

Scori

Cervical Joint Position Error (JPE) testing will be used to assess cervical proprioception and sensorimotor control in participants with chronic mechanical neck pain. The test evaluates the individual's ability to accurately reposition the head to a neutral starting position after active cervical movement, reflecting the integrity of cervical joint position sense.

Participants will be seated comfortably with a laser pointer attached to a headband, facing a target placed approximately 90 cm away at eye level. The participant will first establish a neutral head position, which will be marked on the target. With eyes closed, the participant will actively move the head into flexion, extension, right rotation, and left rotation, and then attempt to return to the original neutral position.

The distance between the original target point and the repositioned point will be measured and converted into degrees of error, representing the joi

A digital inclinometer will be used to assess cervical range of motion (ROM) in participants with chronic mechanical neck pain. The inclinometer is a valid, reliable, and objective tool for measuring cervical spine movements and detecting changes following therapeutic interventions.

Cervical ROM will be assessed in the following directions:

Flexion Extension Right lateral flexion Left lateral flexion Right rotation Left rotation

During assessment, participants will be seated comfortably in an upright position with their feet supported on the floor. The inclinometer will be positioned according to standardized measurement procedures, and participants will be instructed to move their head actively to the maximum pain-free range in each direction. Three measurements will be recorded for each movement, and the average value will be used for analysis.

Assessments will be performed at baseline and after completion of the intervention period. ROM values will be recorded in degrees (°). A

The Tampa Scale of Kinesiophobia is a self-reported questionnaire used to assess fear of movement and re-injury associated with pain. It measures the extent to which individuals believe that physical activity may cause further injury or increase pain. The scale consists of 17 items, each scored on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). Total scores range from 17 to 68, with higher scores indicating greater fear of movement and avoidance behaviors.

In clinical trials involving chronic mechanical neck pain, the TSK is used to evaluate changes in pain-related fear and movement avoidance following therapeutic interventions. It is a reliable and valid tool for assessing psychological factors that may contribute to pain persistence, disability, and reduced participation in daily activities. A reduction in TSK scores after treatment indicates improved confidence in movement and decreased fear of pain-related activities