Action Observation and Motor Imagery Training in Cervical Disc Herniation

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.

Inclusion Criteria: Adults aged 18 to 65 years. Diagnosis of cervical radiculopathy confirmed by a physician based on clinical examination and magnetic resonance imaging (MRI). History of chronic neck pain lasting at least 3 months. Sufficient active cervical range of motion to participate in the intervention (flexion and extension ≥20°, lateral flexion ≥15°, and rotation ≥30°). Neck pain intensity of ≥3 points on the Visual Analog Scale (VAS) and neck disability of ≥10 points on the Neck Disability Index (NDI) at baseline. Willingness to participate and provision of written informed consent. Exclusion Criteria: Inability to comply with the study protocol or cooperate with study procedures. Cognitive impairment (e.g., dementia or learning disability) that would interfere with understanding or completing the intervention or assessments. History of cervical spine surgery. Acute trauma, fracture, tumor, infection, or other serious pathology involving the cervical spine or shoulder region. Cervical spinal stenosis, cervical myelopathy, advanced cervical spondylosis, or other significant structural degenerative cervical spine disorders. Uncontrolled neurological or systemic disease that could influence study participation or outcomes. Receipt of any treatment targeting the cervical region within the previous 6 months (e.g., physiotherapy, injection therapy, or other invasive interventions). Visual impairment, hearing impairment, or severe vestibular disorders that would prevent participation in the intervention protocol.