Differential changes in cervical proprioception and motor imagery following structured imagery training in chronic neck pain

Background Chronic neck pain (CNP) is associated with altered sensorimotor function, including impairments in cervical proprioception and changes in body-related perception. While implicit motor imagery (IMI)–based interventions have shown clinical benefits, their effects on cervical proprioceptive performance and motor imagery-related outcomes in individuals with CNP remain unclear. Objective To investigate the effects of lateralization and IMI training on cervical proprioception (CP), neck awareness (NA), IMI performance, pain, disability, kinesiophobia, and range of motion (ROM) in individuals with CNP. Methods In this clinical trial, 34 participants (17 CNP, 17 healthy controls) completed a 4-week structured imagery training (SIT) program combining lateralization and IMI training delivered via telerehabilitation. Primary outcome was cervical joint position error (JPE). Secondary outcomes included IMI performance (left/right judgment task), pain, disability, kinesiophobia, NA, ROM, and cognitive interference (Stroop). Results Following SIT, the CNP group showed statistically significant within-group reductions in pain intensity (Holm-adjusted p = 0.012, d = 0.76), kinesiophobia (Holm-adjusted p = 0.034, d = 0.50), neck-related disability (Holm-adjusted p = 0.034, d = 0.37), and FreNAQ-T scores (Holm-adjusted p = 0.012, d = 0.09). However, baseline-adjusted models revealed no statistically significant between-group post-training differences for extension JPE ( p > 0.05, partial η 2 = 0.009), flexion JPE (where post-training values remained persistently elevated in CNP; partial η 2 = 0.310), and IMI accuracy/reaction times for neck and hand tasks (all Holm-adjusted p = 1.000, partial η 2 ≤ 0.068). Conclusions A 4-week SIT program was associated with short-term improvements in subjective clinical symptoms in individuals with CNP; however, no differential group effects were observed for objective cervical proprioception or motor imagery performance.