Nociplastic chronic neck pain: From mechanisms to physical therapy clinical practice

Table 4 Indicative rehabilitation emphasis according to the predominant pain mechanism

Intervention	Predominantly nociceptive	Predominantly neuropathic	Predominantly nociplastic
Patient education	Tissue healing timelines; load management relative to tissue tolerance; expected recovery trajectory	Nature of nerve sensitivity; neuroanatomical explanation of symptoms; realistic neural recovery expectations	Dissociation between pain and tissue damage; symptom intensity as altered processing rather than structural harm; reassessment of movement as safe
Graded exposure and load tolerance	Progressive loading matched to tissue healing stages; symptom response proportional to mechanical load	Gradual increase in activity within neural mechanosensitivity thresholds; avoidance of sustained provocative positions	Progression based on predetermined functional criteria rather than symptom intensity; qualitative load modifications (duration, complexity, cognitive demand)
Sensorimotor retraining	Restoration of local motor control and segmental stability relevant to the injured structure	Retraining of movement patterns adapted to neural mechanosensitivity; graded neurodynamic exposure	Improvement of proprioceptive accuracy, head-eye coordination, and postural control; reduction of protective overactivity
Functionally targeted exercise	Task-specific loading replicating demands of daily or occupational activities relative to tissue capacity	Functional reintegration with consideration of nerve sensitivity and fatigue management	Complex functional contexts approximating real-world participation; emphasis on consistency and tolerance under variable conditions
Passive interventions	Pain modulation and facilitation of tissue mobility to support active loading	Neural tissue mobilization; management of local inflammation and mechanosensitivity	Modulation of sensory input and threat context; short-term facilitation of tolerance to active participation
Ref.	Treleaven et al[5], 2024; Kosek et al[7], 2021; Häuser et al[8], 2026; Raja et al[9], 2020; Kosek et al[10], 2016; Smart et al[11], 2010; Treede et al[12], 2008; Colloca et al[13], 2017; Nijs et al[14], 2023; de Zoete et al[22], 2023; Hage et al[34], 2024; Thapa et al[40], 2025; Cook et al[56],2023

The table presents indicative emphases and does not imply mutually exclusive categories. Mixed mechanistic features frequently coexist, and intervention selection is based on clinical reasoning according to the predominant mechanism.