339: Integration of Visio-Vestibular Exercises with Manual Therapy and Stabilization in Chronic Neck Pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Non-pharmacological treatments, Physiotherapy (e.g. exercise, rehab), Treatment/management

Background and Aims: Chronic neck pain (CNP) involves sensorimotor dysfunction affecting cervical, visual, and vestibular integration. This study aimed to investigate whether adding visio-vestibular exercises (VVE) to manual therapy and stabilization (MtE) improves pressure pain thresholds (PPT), cervical range of motion (ROM), and health-related quality of life (HRQoL) in CNP patients.

Methods: In this randomized controlled trial, 54 adults with chronic neck pain were assigned to MtE (manual therapy and stabilization exercises; age: 44.96±7.61 years; weight: 75.41±11.24 kg; height: 165.00±8.62 cm) or MtE-VVE (the same protocol plus visio-vestibular exercises including gaze stabilization, smooth pursuit, vergence tasks; age: 44.78±8.30 years; weight: 73.30±9.71 kg; height: 167.33±6.94 cm). Both groups received 12 sessions over 6 weeks. PPT was measured with algometer at cervical and distal sites; active cervical range of motion with goniometer; and SF-36 was evaluated at baseline, post-treatment, and 12-week follow-up.

Results: Fifty-four participants completed the study. Compared to MtE, the MtE-VV group showed significantly greater increases in PPT at cervical (C7) and distal (tibialis anterior) sites (p<0.05). Cervical ROM improved more in the MtE-VV group, particularly in lateral flexion and rotation (p<0.01). SF-36 subscales for Vitality, Mental Health, and Bodily Pain also favored MtE-VV at follow-up (p<0.05).

Conclusions: Adding visio-vestibular exercises to conventional manual therapy and stabilization training provides superior and clinically meaningful benefits in reducing pain sensitivity, improving cervical mobility, and enhancing psychological well-being in chronic neck pain. These findings support the integration of sensorimotor strategies into routine neck rehabilitation.

References: Zaidi S, Khan SA, Zaki S, Sundus H, Alam MF, Nuhmani S. Effectiveness of sensorimotor training on pain, cervical joint position sense, range of motion, balance, and disability in chronic neck pain: A systematic review. Heliyon. 2025;11(10).

Sremakaew M, Jull G, Treleaven J, Barbero M, Falla D, Uthaikhup S. Effects of local treatment with and without sensorimotor and balance exercise in individuals with neck pain: protocol for a randomized controlled trial. BMC musculoskeletal disorders. 2018;19:1-12.

Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual therapy. 2008;13(1):2-11.

Presenting Author: FARUK TANIK
Submitting Author: Faruk TANIK

Senior Author: Derya OZER KAYA

IASP 2026 Global Year theme of Neuropathic Pain: No

• Elif Umay ALTAS: MD, PhD - Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bakircay University, Izmir, Tūrkiye
• Derya OZER KAYA: PT, PHD - Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Tūrkiye