The Numerical Pain Rating Scale (NPRS) is a unidimensional measure of pain intensity that serves as a segmented numerical version of the visual analog scale (VAS). It consists of an 11-point scale where the respondent selects a whole number from 0 to 10 that best reflects the intensity of their pain, with 0 representing "no pain" and 10 representing the "worst imaginable pain" .

The NPRS has demonstrated high construct and criterion validity for assessing pain severity in patients with chronic musculoskeletal disorders. It is considered a valid tool for differentiating pain characteristics between individuals with chronic neck pain and healthy controls. The research suggests that the NPRS is often more responsive to clinical changes and easier for patients to comprehend than the traditional VAS .This scale is characterized by excellent test-retest reliability (ICC: 0.95),

Neck disability index (NDI) is self-reported assessment includes ten items: pain severity, personal care, lifting, work, headaches, concentration, sleeping, driving, reading, and recreation. Higher scores imply a greater level of disability. Arabic version of the NDI was used to assess Arabic patients with neck pain, as the Arabic version of the NDI is reliable and valid

A digital inclinometer is a handheld electronic device used to objectively measure the degrees of spinal curvature by detecting inclination relative to the force of gravity.In cervical spine assessment, it is used to quantify movements including flexion, extension, lateral flexion, and rotation.The digital inclinometer is recognized as a highly valid and reliable instrument for measuring cervical range of motion (CROM). Recent studies have reported excellent intra-rater and inter-rater reliability (ICC > 0.85), particularly for cervical rotation and lateral flexion. It is often preferred over traditional goniometry because it provides precise, objective, and quantitative data that is less susceptible to manual measurement error.

The TSK-11 is a shortened, 11-item version of the original Tampa Scale, designed to assess kinesiophobia. Defined as an irrational and debilitating fear of physical movement resulting from a feeling of vulnerability to painful injury or re-injury . The Arabic version was developed to provide a linguistically and culturally adapted tool for assessing fear-avoidance beliefs in Arabic-speaking populations. The Arabic version of the TSK-11 has been cross- culturally validated and demonstrates strong psychometric properties. It exhibits high internal consistency, with Cronbach's alpha values typically ranging from 0.86 to 0.90, and excellent test-retest reliability. It shows significant concurrent validity, as scores are strongly correlated with pain intensity (NPRS) and functional disability measures like the Neck Disability Index.

An overhead LASER pointer will be used to assess cervical proprioception by performing the Cervical Joint Position Error (JPE) test. The Joint Position Sense Error (JPSE) is considered one of the essential measures to clinically assess cervical proprioception. The test has good (ICC: 0.77-0.78)

Patient positioning: Seated or standing, with spine in neutral or slight flexion.

• Therapist hand placement: Thumb or fingers on the targeted cervical vertebra (e.g., C2-C7 or upper thoracic T1-T4).
• Direction of glide: Anterior and upward glide along the plane of the facet joint, synchronized with the patient's active movement (e.g., rotation, extension)
• Repetitions: 10 repetitions per session, each held for 10 seconds, with rest intervals.
• Session structure: SNAG mobilizations performed first, followed by conventional exercises.
• Cervical spine: Targeted for joint position sense, pain, and dizziness.

Technique variations:

• Minor adjustments in force direction to optimize symptom reduction.

Based on the American Physical Therapy Association (APTA) Clinical Practice Guidelines for Neck Pain with Mobility Deficits, participants in the conventional therapy group received a multimodal treatment program consisting of mobility exercises, strengthening and endurance training, stretching exercises, and patient education

• Cervical and thoracic mobility exercises.
• Strengthening and endurance exercises for the deep cervical flexors, cervical extensors, and scapulothoracic muscles.
• Stretching exercises for the upper trapezius, levator scapulae, pectoral, and cervical muscles.
• Patient education regarding posture, ergonomics, activity modification, and self-management strategies.

Sequencing:

• SNAG mobilizations performed at session start, followed by active exercises and stretching

Manual therapy timing:

• SNAG component adds ~10 minutes to a 20-minute exercise session

The Arabic NDI is validated and used widely in neck pain research.

• The patient completes 10 items, each scored 0-5.

• Total scores range from 0-50 (or converted to %).

• Disability categories:

  • 0-4: No disability
  • 5-14: Mild
  • 15-24: Moderate
  • 25-34: Severe Procedure

• Provide the patient with the questionnaire.

• Explain each item when needed (common in Arabic versions).

• Sum the scores and classify disability.

Multiple studies describe standardized inclinometer protocols

Devices show good validity compared with 3D motion capture

1. Patient is usually seated upright with feet on the floor.
2. Place the inclinometer on the vertex of the head aligned with T1 or other fixed reference, depending on the device.
3. Measure flexion, extension, lateral flexion, and rotation.
4. Perform 3 trials per direction and use the mean.

Kinesiophobia was assessed using the Arabic version of the Tampa Scale of Kinesiophobia (TSK-AV-11), which is a valid and reliable tool

for evaluating fear of movement in Arabic-speaking patients. It consists of 11 items scored on a 4-point Likert scale, with higher scores indicating greater fear of movement Brief and validated for chronic pain including neck pain Contains 11 items, each scored 1 (strongly disagree) to 5 (strongly agree). Procedure

1. Provide the questionnaire.
2. Ensure the patient answers all 11 items.
3. Sum all item scores (minimum 11, maximum 55).
4. Higher scores = higher kinesiophobia

Setup

• Attach a laser pointer to the patient's forehead or headband

• Place a target on the wall at a distance of 90 cm.

• Align the laser to the center of the target at the neutral head position. Testing procedure

  1. Patient sits upright, eyes closed (no visual feedback allowed)

  2. Patient moves head:

     1. Rotation right
     2. Rotation left
     3. Flexion
     4. Extension

  3. Patient returns to what they believe is the original neutral position.

  4. Record the deviation in degrees from the center of the target.

  5. Repeat 3-5 trials per direction; average the error