Joint Movements Of The Cervical Spine

The normal anterior curve of the spine in the cervical region forms a slightly extended position. Cervical spine extension is movement in the direction of increasing the normal forward curve. It may occur by tilting the head back, bringing the occiput toward the seventh cervical vertebra. It also may occur in sitting or standing by slumping into a round-upper-back, forward-head position, bringing the seventh cervical vertebra toward the occiput.

Cervical spine flexion is movement of the spine in a posterior direction, decreasing the normal anterior curve. Movement may continue to the point of straightening the cervical spine (i.e., the end range of normal flexion), and in some instances, movement may progress to the point that the spine curves convexly backward (i.e., a position of mild kyphosis). Gore et al., using cervical radiographs, reported cervical kyphosis as a normal variant in asymptomatic individuals. (1) Harrison et al. used radiographs to look at the stresses produced by different cervical postures, and they found that stresses in the region of cervical kyphosis were 6 to 10 times greater than those in the regions of cervical lordosis. (2)

Movement of the spine in the frontal plane is referred to as lateral flexion. Consistent with the geometry of the cervical facets, lateral flexion occurs primarily between the occiput and CI, and between CI and C2. (3) When observing lateral flexion, it is important to stabilize the thoracic and lumbar spines and to ensure that the observed motion is lateral flexion and not elevation of the shoulder. (4) Cervical rotation occurs in a transverse plane about a vertical axis between C2 and C7 (5). Due to the coronal and oblique orientation of the cervical facet joints, cervical rotation is combined with lateral flexion. (See p. 152 for flexion and extension of the neck and p. 163 for rotation and lateral flexion of the neck.)

It is important to maintain good neck range of motion. We are constantly challenged by the need to turn the head to look sideways or tilt it to look downward to avoid colliding with or tripping over something. Hence, it is advisable to establish and justify a means by which measurements can be taken to determine the range of motion of the neck in relation to established standards.

Various methods have been employed to measure the range of motion of the cervical spine: radiographs, goniometers, electrogoniometers, inclinometers, tape measures, Cervical ROM devices, ultrasound and digital optoelectronic instrumentation, as well as simple estimations of observable motion (6). The broad assortment of instruments, and the lack of uniform procedures that have been in both reliability and descriptive studies, have contributed to the wide range of published norms for active and passive neck range of motion. However, the table below provides examples of three sources that do support each other.

Taking measurements of a large number of people is not the answer because too many variables exist. Dvorak, et al., found "significant differences both between genders and age decades." (7) In addition, variances will exist between necks that are long and slender as opposed to those that are short and stocky.

It is essential that the subject be placed as close to the ideal postural alignment of the upper back and neck as possible before taking range of motion measurements. Starting with a forward head position will limit movement in every plane.

If the upper back is rigid in a position of kyphosis, treatment of the tight neck extensors with massage and gentle stretching may only be palliative but still worthwhile. If the posture of the upper back is habitually faulty but the person is able to assume a normal alignment, efforts should be directed toward maintaining good alignment. Temporary use of a support to help correct faulty posture of the shoulder and upper back may be beneficial.

CERVICAL RANGE OF MOTION: COMPARISON OF "NORMS"

Cervical Movements

Palmer & Eppler 2nd ed. 1SS8 (8)

Clarkson 2nd ed. 2000 (S)

Reese & Bandy (2002) (10)

Flexion

Cervical Go to 45o

Goto 45o

Go to 45o-5Go

Extension

Cervical Go to 45o

Goto 45o

Go to 45o-75o

Lateral Flexion

Go to 45o-60o

Go to 45o

Goto 45o

Rotation

Go to 60o-75o

Goto 6Go

Go to 8Go

ORIGINS AND INSERTIONS

Muscle

Origin

Insertion

Rectus capitis posterior minor

Tubercle on posterior arch of atlas

Medial part of inferior nuchal line of occipital bone

Rectus capitis posterior major

Spinous process of axis

Lateral part of inferior nuchal line of occipital bone

Obliquus capitis superior --------i

Superior surface of transverse process of atlas

Between superior and inferior nuchal lines of occipital bone

Obliquus capitis inferior

Apex of spinous process of axis

Inferoposterior part of transverse process of atlas

Longus capitis*

Anterior tubercles of transverse processes of third through sixth cervical vertebrae

Interior surface of basilar part of occipital bone

Longus colli*

Superior oblique portion: Anterior tubercles of transverse processes of third through fifth cervical vertebrae

Interior oblique portion: Anterior surface of bodies of first two or three thoracic vertebrae.

Vertical portion: Anterior surface of bodies of first three thoracic and last three cervical vertebrae

Tubercle on anterior arch of atlas

Anterior tubercles of transverse processes of fifth and sixth cervical vertebrae

Anterior surface of bodies of second through fourth cervical vertebrae

Rectus capitis anterior*

Root of transverse process; anterior surface of atlas

Interior surface of basilar part of occipital bone

Rectus capitis lateralis*

Superior surface of transverse process of atlas

Inferior surface of jugular process of occipital bone

Platysma"

Fascia covering superior parts of pectoralis major and deltoid

Inferior margin of mandible; skin of lower part of face and corner of mouth

Sternocleidomastoid b

Medial or sternal head: Cranial part of manubrium stemi

Lateral or clavicular head: Medial Vi of clavicle

Lateral surface of mastoid process; lateral V2 of superior nuchal line of occipital bone

Scalenus anterior*

Anterior tubercles of transverse processes of third through sixth cervical vertebrae

Scalene tubercle and cranial crest of first rib

Scalenus medius*

Posterior tubercles of transverse processes of second through seventh cervical vertebrae

First rib, cranial surface between tubercle and subclavian groove

Scalenus posterior*

By two or three tendons from posterior tubercles of transverse processes of last two or three cervical vertebrae

Outer surface of second rib

Trapezius, upper

External occipital protuberance, medial V3 of superior nuchal line, ligamentum nuchae, and spinous process of seventh cervical vertebra

Lateral & of clavicle; acromium process of scapula

''See illustration, page 123.

NECK MUSCLES

ACTIONS AND NERVES

Muscle

Acting Bilaterally

Acting Unilaterally

Rotation Toward

Extension

Flexion

Lateral flexion

Same Side

Opposite Side

Nerves

Rectus capitis posterior minor

X

Suboccipital

Rectus capitis posterior major

X

X

Suboccipital

Obliquus capitis superior

X

X

Suboccipital

Obliquus capitis inferior

X

Suboccipital

Longus capitis

X

X

Cervical, 1, 2, 3

Longus colli

X

X

X

Cervical, 2-7

Rectus capitis anterior

X

X

Cervical, 1, 2

Rectus capitis lateralis

X

Cervical, 1, 2

Platysma

X

Facial

Sternocleidomastoid

X

X

X

X

Accessory & cervical, 1, 2

Scalenus anterior

X

X

X

Cervical, lower

Scalenus medius

X

X

Cervical, lower

Scalenus posterior

X

X

Cervical, 6, 7, 8

Trapezius, upper

X

X

X

Cranial, (1) Cervical, 3, 4

ANTERIOR AND LATERAL NECK MUSCLES

Rectus capitis lat.

Rectus capitis ant.

Longus capitis multiple origin 3-6

Longus colli V multiple origin 1-T4

Scalenus posterior

INSERTION Scalenus médius

Scalenus anterior

Rectus capitis lat.

Rectus capitis ant.

Scalenus posterior

INSERTION Scalenus médius

Scalenus anterior

Scalenus Scalenus médius anterior 2-7 3-6

Longus capitis multiple origin 3-6

Longus colli V multiple origin 1-T4

Scalenus medius Scalenus anterior

Scalenus Scalenus médius anterior 2-7 3-6

Scalenus medius Scalenus anterior

See pages 148 and 149 for the origins, insertions, actions and nerves of these muscles (11).

SUPRAHYOID AND INFRAHYOID MUSCLES

Mylohyoid

Digastric, ant. belly

Digastric, post, belly

Mylohyoid

Digastric, ant. belly

Digastric, post, belly

See Chapter 3, pages 138 and 139, for the origins, insertions, actions, nerves and roles in deglutition of these muscles (11).

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