It is well documented that people with neck pain display reduced strength, endurance, poorer steadiness of contraction, and limited range of active cervical motion. In addition, evidence suggests that neck pain may alter the task-related modulation of neck muscle activity so that motor control of the cervical spine is solved by alternative, presumably less efficient, combinations of muscle synergistic activities. For example, the activity of the deep seminspinalis cervicis muscle is reduced and less defined in patients with neck pain during multidirectional isometric tasks and is associated with increased activation of the superficial extensor, the splenius capitis.

A reorganization of neck muscle activity may have short term benefits as it allows motor output to be maintained during sub-maximal tasks. However in the long term, pain-induced altered neural control may dispose some muscles to overload and, and as a consequence, injury and other muscles to reduced activity with consequent atrophy of specific fiber types. Moreover, impaired neuromuscular control of the cervical spine may predispose spinal structures to mechanical strain and perpetuate chronic symptoms.

A progressive understanding of the alterations of neuromuscular control of the cervical spine in the presence of neck pain has directed rehabilitation programs to include more specific exercise regimes as a component of a multimodal intervention. In particular novel motor-skill training which is associated with rapid changes in cortical excitability and cortical re-organization is considered relevant for treating patients with pain.