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

Table 5 Functional patterns of load intolerance and therapeutic exercise principles in chronic neck pain with nociplastic features

Functional expression	Clinical significance	Therapeutic exercise principle
Intolerance to sustained postures	Pain or fatigue emerges before functional demands are met	Progressive increase in duration rather than intensity, with emphasis on performance consistency
Early fatigue in low-intensity activities	High control cost for simple everyday functions	Exercise at submaximal load with emphasis on maintaining quality over time
Deterioration under cognitive or time pressure	Difficulty combining movement control and attention	Integration of cognitive or environmental demands into functional exercises
Variable performance from day to day	Unstable functional tolerance	Progression based on a tolerable performance range rather than a single “good” session
Avoidance or hesitation in daily activities	Participation restriction, independent of strength or range of motion	Task-oriented practice directed at the execution of functional activities
Ref.	Treleaven et al[5], 2024; de Zoete et al[22], 2023; Camerota et al[52], 2024

Functional patterns are illustrative and do not constitute diagnostic criteria. Therapeutic targeting is determined by the overall clinical presentation and the predominant pain mechanism.