Chronic Neck Pain and Text Neck: Cervical Spine Rehabilitation in Virtual Reality Reduces Pain by 0.94 Points Out of 10 from the Very First Sessions
Chronic neck pain affects between 16.7% and 75% of the global population and represents one of the leading reasons for consultation in musculoskeletal physiotherapy.
Neck pain is a common musculoskeletal disorder, with a worldwide prevalence ranging from 16.7% to 75.1%. Screen-related postural disorders — "text neck" — worsen this picture by establishing chronic cervical flexion and a proprioceptive deficit. A first meta-analysis of 6 randomised controlled trials, totalling 243 participants, establishes that virtual reality (VR) significantly reduces pain intensity in chronic neck pain, with a mean effect of -0.94 points on a 0-to-10 pain scale.
The challenge of chronic neck pain linked to screens
Common chronic neck pain is not simply a "stiff neck." It is a complex picture, combining persistent pain, loss of mobility, proprioceptive deficit and, often, a behavioural component related to digital habits.
The increasing use of mobile devices has led to a rise in forward head posture, commonly referred to as "text neck." This posture, maintained for hours in front of a screen, generates repeated mechanical stress on the cervical spine, well beyond what the anatomical structures can absorb without consequence.
Chronic pain frequently involves the cervical spine, leading to acute and prolonged painful episodes, accompanied by muscle tension in the suboccipital muscles, trapezius and levator scapulae.
What your patients describe — a stiff neck in the morning, tension headaches at the end of the day, the inability to look over their shoulder without pain — reflects a deep sensorimotor dysfunction, not merely a muscle contracture. Proprioception may be impaired in people with neck pain; the cervical joint position sense test, which measures joint position error (JPE), is the most widely used test to assess this proprioception.
Your standard tools — mobilisations, strengthening, stretching — remain essential. The question is: how do you combine them with a clinical tool that precisely targets this sensorimotor deficit, while maintaining patient engagement over time?
💡 Discover what KineQuantum can change in your practice.
Text Neck and screens: understanding the clinical picture to treat it more effectively
Chronic flexion posture: an invisible mechanical overload
When your patient spends six to eight hours a day with their head tilted towards a screen, the cervical structures absorb a load far greater than normal. The load applied to the cervical spine increases considerably with the angle of head flexion, compared to the 4 to 5 kg supported in an upright position.
Text neck, or forward head posture, is associated with increased sympathetic activity and decreased parasympathetic modulation, as evidenced by heart rate variability indices. In other words, screen posture does not only stress the muscles: it also disrupts the patient's autonomic nervous system regulation.
The three deficits to target as a priority
When faced with chronic neck pain against a background of digital postural disorders, three functional dimensions deserve particular attention:
1. Altered cervical proprioception. Several studies have shown that cervical proprioception may be impaired in people with neck pain, regardless of its aetiology. The patient no longer correctly perceives the position of their head in space, which perpetuates postural compensations.
2. Disrupted oculomotor control. The relationship between cervicocephalic kinaesthetic sensitivity measured during dynamic head movements and the control of eye movements is documented in patients with neck pain. The cervico-oculomotor link, often overlooked in conventional rehabilitation, is nonetheless central to active repositioning.
3. Impoverished cervical kinematics. Data show greater improvement in movement velocity in groups benefiting from cervical kinematic training with VR. Speed, accuracy and range of motion constitute the triad to be restored for a return to function.
What the research says about cervical spine rehabilitation in VR
Evidence accumulating since 2024
This first large-scale meta-analysis to evaluate and synthesise the effects of VR on patients with chronic neck pain brought together six randomised controlled trials of fair to good methodological quality, including a total of 243 participants.
For neck pain, immersive VR reduced pain intensity (SMD: -0.48; 95% CI: -0.75 to -0.21; p = 0.0004) in the short term. This result is clinically significant: a reduction of nearly one point out of ten translates concretely into better activity tolerance, improved sleep and reduced kinesiophobia (fear of movement).
Positive effects in favour of VR were found in the short term for patient satisfaction and cervical range of motion (SMD − 0.42; 95% CI -0.65, -0.19).
The decisive contribution of combining VR with conventional rehabilitation
In a randomised controlled trial involving 64 participants with chronic neck pain, divided between a VR + conventional rehabilitation group (10 sessions over 4 weeks) and a conventional rehabilitation-only group, the results support the effectiveness of combining VR + conventional rehabilitation for relieving pain, improving kinematic function and reducing disability.
The integration of VR into conventional rehabilitation demonstrates significant improvements in pain, disability and kinematic function in patients with chronic neck pain, maintained both at post-intervention and at 3-month follow-up.
Although muscle activation was not directly assessed, VR appears to promote the function and coordination of cervical muscles, thereby reducing stress on cervical segments and relieving cervical pain and disability.
An effect maintained beyond the sessions
Combining VR with cervical mobility exercises and strengthening produced superior and lasting improvements compared to exercises alone. Significant benefits were observed on disease impact, central sensitisation, cervical disability and kinesiophobia, with effects maintained at 1 month only in the VR group.
Parameter assessed | Results observed in favour of VR |
|---|---|
Pain (VAS — Visual Analogue Scale) | Mean reduction of -0.94/10 |
Cervical range of motion (ROM) | Significant improvement in the short term |
Cervical kinematics (speed) | Greater gain vs. rehabilitation alone |
Disability (NDI — Neck Disability Index) | Reduction maintained at 3 months |
Kinesiophobia | Effects at 1 month in the VR group only |
Patient satisfaction | In favour of VR vs. control |
Building a relevant clinical protocol for your neck pain patients
Identifying the suitable patient profile
Not all of your chronic neck pain patients will benefit equally from VR. Here are the profiles that gain the most from this approach:
Common chronic neck pain (pain evolving for more than 3 months)
Text neck presentation with documented forward head posture
Objectively identified cervical proprioceptive deficit (JPE test)
Patient working on screen for more than 5 hours per day
Moderate kinesiophobia limiting engagement with conventional exercises
Patient expressing fatigue with conventional protocols
⚠️ Key point: VR is not indicated as a first-line treatment for recent acute neck pain, cervical radiculopathy with active neurological signs, or in cases of contraindication to visual immersion (photosensitive epilepsy, acute unstabilised vertigo). Reserve this tool for stabilised chronic or subacute stages, as a complement to the initial assessment.
Proposing a structured protocol
1. Cervical assessment in VR: Before scheduling the first exercise, carry out an objective cervical kinematic assessment. VR enables measurement of range of motion in the six directions of movement, speed of displacement and repositioning error (JPE). The VR assessment records movement angles in the six directions — flexion, extension, right and left lateral tilts, right and left rotations. These data constitute your baseline and your progression indicators.
2. Active proprioceptive training: The core of the protocol. The patient guides a cursor, an avatar or a virtual object through movements of their head. The joint position sense test assesses the ability to perceive the position of the neck and head. With a darkened VR screen — simulating visual occlusion — the task consists of finding a neutral head position, performing a movement, then repositioning as accurately as possible. In therapeutic mode, this principle is applied through active and progressive exercises.
3. Integrated oculomotor work: VR naturally allows the integration of moving visual targets that simultaneously engage the oculomotor system and cervical control. This is where the major clinical added value lies compared to table-based rehabilitation: the cervico-ocular coupling is trained in a functional and motivating context.
4. Progression by difficulty: Start with limited ranges of motion and nearby targets, then progressively increase the required speed, range of motion and task complexity. Gamification sustains effort and allows the physiotherapist to objectively monitor progression from session to session.
5. Complementary postural rehabilitation: Both approaches — postural biofeedback and muscular biofeedback — have shown a significant reduction in pain and cervical disability scores. Both have demonstrated their effectiveness in producing a significant reduction in neck pain and a comparable modification of cervical flexion posture. VR fits within this logic of augmented biofeedback.
Protocol parameter | Recommended value |
|---|---|
Protocol duration | 4 to 6 weeks |
Number of sessions | 10 to 12 sessions |
Frequency | 2 to 3 sessions per week |
Duration per VR session | 20 to 30 minutes |
Supervision | Systematic (physiotherapist present) |
Intermediate assessment | Session 5–6 (VR kinematic assessment) |
Final assessment | Session 10–12 + 1-month follow-up |
💡 Key takeaway: VR does not replace your clinical expertise — it amplifies it. The VR protocol must always be integrated into a comprehensive management plan including therapeutic education, ergonomic work (screen posture, workstation adjustment) and, if necessary, deep cervical flexor exercises. It is the combination that produces the best long-term results.
How KineQuantum turns this science into concrete results
From research to your daily practice.
1. An objective cervical assessment from the very first session — KineQuantum automatically records ranges of motion in the six planes of movement, speed and repositioning error. You have a numerical report, usable for follow-up, writing clinical notes and communicating with referring physicians. Visit the physiotherapy assessments in VR page to find out more.
2. Dedicated cervical spine rehabilitation exercises, progressive and configurable — KineQuantum's cervical VR rehabilitation modules allow you to adjust the working range of motion, target speed, exercise duration and difficulty level, session by session. Progression is documented automatically.
3. Oculomotor and proprioceptive training within the same environment — The immersive scenes naturally couple visual targets and head control, without requiring additional equipment. The VR technology for physios is designed to integrate seamlessly into your treatment room.
4. A tool usable independently and in the practice — Whether you prefer the KineQuantum Liberté tool for maximum mobility or the KineQuantum Classique tool with its additional sensors, each configuration adapts to your practice organisation.
5. Longitudinal monitoring that highlights your work — Each session feeds into a patient dashboard. You can show your patient, in graphs and figures, the evolution of their cervical kinematics and pain. This is a powerful lever for therapeutic adherence, particularly in discouraged chronic patients.
Cervical VR rehabilitation: a practice that positions you as an expert therapist
Screen-related chronic neck pain is a pathology of the digital everyday. It is commonplace in how it develops, but complex in its lasting management.
Research confirms it: moderate evidence supports VR as a beneficial non-pharmacological approach for improving pain intensity in neck pain, with advantages for multimodal interventions, patients with chronic neck pain, and VR performed in clinical or research settings.
By integrating VR into your cervical spine rehabilitation protocol, you are not changing your profession. You are adding a clinical tool that quantifies what you observe, engages your patients where exercises alone struggle to maintain motivation, and produces objective follow-up data.
Your patients suffering from text neck, postural neck pain or chronic proprioceptive disorders deserve care that matches the complexity of their symptoms. You now have the scientific evidence and clinical tools to offer it to them.
Also explore how KineQuantum can support you with other conditions: lower back pain in VR, balance rehabilitation or chronic pain management through relaxation in VR.
Frequently asked questions about cervical spine rehabilitation in VR
Is cervical spine rehabilitation in VR effective for chronic neck pain?
The data support the effectiveness of combining VR + conventional rehabilitation for relieving pain, improving kinematic function and reducing disability in patients with chronic neck pain. The available evidence, drawn from several meta-analyses published in 2024–2025, indicates a significant short-term effect on pain and an improvement in cervical ranges of motion. VR is all the more effective when integrated into a multimodal protocol supervised by a physiotherapist.
Can VR treat text neck and screen-related postural neck pain?
The aim is to evaluate the effectiveness of VR-based exercises for reducing cervical pain and improving cervical proprioception in subjects with forward head posture. This posture affects proprioceptive feedback from the cervical muscles and leads to postural control deficits as well as neck pain. VR is particularly well suited to this presentation because it simultaneously targets proprioception, oculomotor control and active cervical kinematics.
How many VR sessions are needed to see results for chronic neck pain?
The available studies use protocols of 10 to 12 sessions over 4 to 6 weeks, at a rate of 2 to 3 sessions per week. Significant improvements in pain, disability and kinematic function are observed post-intervention and maintained at 3-month follow-up. The first subjective benefits (pain, perceived mobility) may appear as early as the 3rd or 4th session in combined protocols.
Is VR suitable for all neck pain patients, including older adults and office workers?
A single-blind randomised clinical trial was conducted on 56 participants divided into three groups: VR + cervical mobility exercises, cervical mobility exercises alone, and a control group. Participants included a varied profile of adults with chronic neck pain. VR is generally well tolerated; absolute contraindications are limited (photosensitive epilepsy, uncontrolled acute vertigo). For screen workers, it is of particular interest due to the direct link between digital postural disorder and the sensorimotor deficit targeted by the tool.
Does KineQuantum offer specific modules for cervical VR rehabilitation?
Yes. KineQuantum includes modules dedicated to cervical spine rehabilitation in VR, comprising active repositioning exercises, cervical kinematics and oculomotor control. These modules are configurable by the physiotherapist and generate follow-up data at each session. They are distinct from the vestibular protocols dedicated to benign paroxysmal positional vertigo (BPPV) and inner ear conditions.
💡 Would you like to integrate cervical spine rehabilitation in VR into your practice or centre?
📚 References
[1] Hao J, He Z, Chen Z, Remis A. (2024). Virtual reality training versus conventional rehabilitation for chronic neck pain: A systematic review and meta-analysis. PM&R, 16(10), 1143–1153. Voir l'article →
[2] Guo Q, Zhang L, Han LL, et al. (2024). Effects of Virtual Reality Therapy Combined With Conventional Rehabilitation on Pain, Kinematic Function, and Disability in Patients With Chronic Neck Pain: Randomized Controlled Trial. JMIR Serious Games, 12, e42829. Voir l'article →
[3] Brea-Gómez B, Laguna-González A, Pérez-Gisbert L, Valenza MC, Torres-Sánchez I. (2024). VR based rehabilitation in adults with chronic neck pain: a systematic review and meta-analysis of randomized clinical trials. Virtual Reality, 28, 86. Voir l'article →
[4] Cetin H, Aydogdu S, Onal B, Dulger E, Bilgin S, et al. (2025). Immersive virtual reality versus cervical mobilization: The effects on joint position sense and pain for chronic neck pain — a randomized controlled trial. Brazilian Journal of Physical Therapy, 29(5), 101228. Voir l'article →
[5] Lo HHM et al. (2024). Immersive and nonimmersive VR-assisted active training in chronic musculoskeletal pain: Systematic review and meta-analysis. JMIR Rehabilitation and Assistive Technologies. Voir l'article →
[6] AlDahas A, et al. (2024). Measurement properties of cervical joint position error in people with and without neck pain: a systematic review and narrative synthesis. BMC Musculoskeletal Disorders. Voir l'article →
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