The purpose of this review is to provide an updated overview of structural and functional changes of cervical neuromuscular system associated with Insidious Onset Mechanical Neck Pain [IOMPT]. Methods: MEDLINE and SCOPUS databases were searched. Observational studies published after 01-01-2003 in English or Italian languages were included. The following search string was used: "neck pain" AND (muscle OR "motor control" OR behaviour OR function OR endurance OR "isometric contraction") NOT

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... lopathy OR surgery OR "specific neck pain"). Results: 15 papers concerning changes in structure of neck neuromuscular system, 19 on changes in pattern of neuromuscular activation, and 16 on deficit in neuromuscular function associated to IOMNP were selected. From this review emerges that pain, whether it be artificially produced or due to IOMNP, provokes an alteration of the cervical region function and a number of anomalies in the behavior of the neuro-muscular system. IOMNP is associated with structural alterations affecting the cervical region at different levels (metabolic, histological, and even macroscopic). Changes in cervical neuromuscular system structure concern altered histology and metabolism, cross sectional area thickness, muscle fatty infiltration, trigger points generation, and alterations of muscular activation pattern. Changes in neuromuscular function concern reduced maximal voluntary contraction, alteration on proprioception, coordination and on complex functions. Conclusion: The relationships between IONMP and changes in the intrinsic properties, behavior, and function of neck muscles have now acquired evidence. There is a widespread consensus about the fact that these alterations contribute to the onset, maintenance, and recurrence of neck pain. Citation: Mario DM, Carla V, Paolo P, Antonio R (2015) Structural and Functional Changes of Cervical Neuromuscular System Associated with Insidious Onset Mechanical Neck Pain: A literature Review. Int J Phys Ther Rehab 1: 103. doi: http://dx. Results After deleting doubles items, the search yielded 1441 results. 1201 articles were excluded by reading titles, 174 by reading abstracts and 16 by reading full texts. Finally, this review included 15 papers concerning changes in structure of neck neuromuscular system, 19 on changes in pattern of neuromuscular activation, and 16 dealing with deficit in neuromuscular function associated to IOMNP (Figure 1 ). Results were organized and presented by different topics. Changes in cervical neuromuscular system structure (histology and metabolism, cross sectional area and ratio of size, muscle fatty infiltration, trigger points generation, and changes in muscular activation pattern) and