Action Observation and Motor Imagery Training in Cervical Disc Herniation

Summary

Cervical disc herniation is a common degenerative spinal disorder associated with chronic neck pain, impaired cervical function, reduced motor control, and decreased quality of life. Although conventional physiotherapy is widely used, innovative rehabilitation strategies that enhance motor learning may improve treatment outcomes. This randomized controlled trial aims to investigate the clinical effectiveness of Action Observation (AO) and Motor Imagery (MI) training as an adjunct to conventional physiotherapy in individuals with cervical disc herniation and chronic neck pain.

Thirty-six participants diagnosed with cervical disc herniation will be randomly assigned to one of two groups. The control group will receive conventional physiotherapy combined with sham observation consisting of neutral nature videos, while the experimental group will receive conventional physiotherapy plus AO and MI training. The intervention period will last six weeks. Clinical outcomes will be assessed before and after the intervention. Primary and secondary outcome measures will include pain intensity, pressure pain threshold, neck disability, kinesiophobia, cervical motor control and endurance, and cervical proprioception using validated assessment tools.

The findings of this study are expected to provide evidence regarding the effectiveness of AO and MI training as complementary rehabilitation approaches for individuals with cervical disc herniation and to support the integration of motor learning-based interventions into clinical physiotherapy practice.

Conditions

• Cervical Disc Herniation
• Chronic Pain
• Kinesiophobia
• Cervical Pain

Interventions

OTHER

Conventional Physiotherapy

Participants in both study groups will receive an individualized conventional physiotherapy program three times per week for six weeks. The program will include electrotherapy (conventional transcutaneous electrical nerve stimulation or vacuum interferential current applied on alternating sessions), superficial heat therapy, soft tissue mobilization, and a supervised therapeutic exercise program. The exercise program will consist of deep cervical flexor activation exercises, cervical range-of-motion exercises, scapular stabilization exercises, postural correction exercises, and stretching exercises targeting the upper trapezius, levator scapulae, and pectoral muscles. All treatment sessions will be delivered individually by the same physiotherapist, and exercise intensity will be adjusted according to each participant's tolerance and clinical status.

OTHER

Action Observation and Motor Imagery Training

Participants in the experimental group will receive approximately 20 minutes of Action Observation (AO) and Motor Imagery (MI) training in addition to conventional physiotherapy during each treatment session, three times per week for six weeks. During the AO component, participants will observe standardized videos demonstrating correct execution of cervical and scapular movements, including cervical flexion, extension, lateral flexion, rotation, and scapular retraction. Immediately afterward, participants will perform MI under physiotherapist supervision by mentally rehearsing the same movements using both visual imagery (imagining observing themselves performing the movement) and kinesthetic imagery (imagining the sensory experience of performing the movement). All sessions will be delivered individually following a standardized intervention protocol.

OTHER

Sham Observation

Participants in the control group will receive approximately 20 minutes of sham observation in addition to conventional physiotherapy during each treatment session, three times per week for six weeks. Instead of Action Observation and Motor Imagery training, participants will watch neutral nature videos without any human movement or motor-related content. The sham intervention is designed to match the experimental intervention in duration, therapist supervision, and attention while avoiding activation of motor learning processes.

Sponsors & Collaborators

• Halic University

  collaborator OTHER

• İrem Çetinkaya

  lead OTHER

Principal Investigators

• İrem Çetinkaya, PhD · Marmara University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-08-25

Primary Completion

2026-11-01

Completion

2026-12-01