Sleep Posture, Cervical Mechanics, and Sensorimotor Control: Identifying a Tissue-Specific Mechanobiological Gap in...

Non-specific neck pain (NSNP) remains a leading cause of disability worldwide, yet prevailing etiologic models incompletely account for time-dependent mechanical exposures during sleep. Existing frameworks emphasize structural and psychosocial factors, central sensitization, and altered sensorimotor control, while sleep disturbance is primarily considered through systemic or central mechanisms. This paper integrates sleep physiology, cervical biomechanics, and tissue-specific mechanobiology to identify an underrecognized gap: the biomechanical environment of the cervical spine during sleep. Sleep represents the longest continuous period of spinal loading, characterized by reduced neuromuscular stabilization, prolonged postural exposure, and time-dependent viscoelastic tissue behavior. We propose that recurrent nocturnal exposure to sustained non-neutral cervical alignment may influence afferent signaling and contribute to altered sensorimotor control in susceptible individuals. This framework generates testable hypotheses and supports inclusion of sleep-related mechanical exposure within contemporary models of NSNP.