Cervical Extension

I. Description of Motion

Cervical extension consists of moving the head in a posterior direction away from the chest, which is required in many functional movements such as looking up toward the ceiling. This motion is achieved by bringing the occiput toward the seventh cervical vertebra. Cervical extension range of motion is from 0 to 60 degrees.

The muscles involved in cervical extension are:

1. Primary Muscles

• Splenius capitus – C3 and C4
• Splenius cervicis – C4 to C7
• Iliocostalis Cervicis - C6, C7, C8
• Longissimus Cervicis - dorsal rami of lower cervical and upper thoracic spinal nerves
• Longissimus Capitis - dorsal rami of lower cervical and upper thoracic spinal nerves
• Spinalis Cervicis - primary rami of cervical spinal nerves
• Spinalis Capitis - primary rami of cervical spinal nerves
• Upper trapezius fibers - C2 and C3

2. Secondary Muscles

• Semispinalis capitis - dorsal rami of cervical spinal nerves
• Semispinalis cervicis - dorsal rami of cervical spinal nerves
• Levator scapulae - C3,C4,C5

II. Mobilizing – Increasing Range of Motion

Stretching the Cervical Extensors

Upper trapezius stretch
• Start in a seated position looking straight ahead
• Use the right hand to hold on to the chair
• Use the left hand to bring your left ear toward your left shoulder
• Apply pressure until you feel a stretch in R neck
Repeat on the opposite side. Hold stretch for 30 seconds and repeat three times.

Suboccipital Stretch
• In a seated or standing position, gently bring head down toward the chest
• Use your fingers to apply more pressure for a stronger stretch at base of the skull
• The stretch should be felt in the back of the neck
Repeat stretch 3 times for 30 seconds each

Neck Extensor Stretch
• Start in seated position looking straight ahead, use a point on the wall to maintain the position
• Use two fingers to press chin into neck, creating a double chin
• Use one hand to keep chin tucked in, while placing other hand behind head and pulling downward gently.
• A stretch should be felt at the base of the neck
• Keeping chin tucked in
Repeat stretch 3 times for 30 seconds each

Indications for Stretching:

Common conditions that require mobilizing or stretching include:

1. Headaches caused by tightness in the muscles of the posterior neck and sub occipital regions¹.
Common characteristics of headaches:

• neck pain and stiffness
• aggravated by sustained neck positions
• may have trigger points in the upper traps, suboccipitals, and levator scapulae

2. Neck Strains

3. Whiplash Injury: patients that have suffered from a whiplash injury may present with muscle imbalance of cervical flexors and extensors, abnormal cervical range of motion, and alteration of postural control/balance. The cervical flexors should be strengthened, while the cervical extensors should be stretched².

4. Forward head posture (slouching in front of a computer) causes the neck extensors to be in a short and tight position³.

III. Strengthening

Isometric neck extension

• Lie on a mat on your stomach
• Place a towel under your forehead in order to align the spine
• Tuck your chin in and lift your head straight up toward the ceiling
• Hold for 5 seconds while looking straight down

Frequency: Repeat exercise 10 times for 2-3 sets

Progression: you can have a partner place their hand on top of your head and provide resistance as you lift your head up.

Cervical Extension with a ball

• Stand about 6 inches away from a wall. Place a small pillow, a ball about 6-8 inches in diameter, or a folded towel between the back of your head and the wall.
• Slightly tuck your chin and gently tilt your head back into the soft object. Push only with mild to moderate intensity, building up tension gradually. Keep your jaw and forehead relaxed.
• Hold for 30 seconds
• Release the tension slowly. Relax your neck muscles completely before you start the next repetition.

Neck Extension in quadruped

• Assume a quadruped position – knees should be under hips and hands should be under the shoulders
• Start with the back in a natural arch
• Push through the shoulder blades to align the spine
• Slowly and gently bring your head up to the level of your shoulders, keeping your chin tucked

Frequency: perform exercise for 10 repetitions for 2-3 sets

Progression: In order to further strengthen the neck extensors, you can lift the neck all the way back, looking up toward the ceiling.

Potential Clinical Syndromes

Whiplash Injury: http://morphopedics.wikidot.com/whiplash

Cervicogenic Headaches: http://morphopedics.wikidot.com/cervicogenic-headache

Forward Head Posture: http://www.sciencedirect.com/science/article/pii/S1356689X09001052

Additional Resources

1. Altered motor control patterns in whiplash and chronic neck pain. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446396/

2. Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study. http://onlinelibrary.wiley.com/doi/10.1111/j.1468-1331.2008.02301.x/full

3. Trigger Points in the suboccipital muscles and forward head posture in tension-type headaches. http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2006.00288.x/full

Footnotes

1. Page P. Cervicogenic headaches: an evidence-led approach to clinical management. Int J Sports Phys Ther. 2011;6(3):254-66

2. Juul-kristensen B, Clausen B, Ris I, et al. Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain: a cross-sectional study. J Rehabil Med. 2013;45(4):376-84.

3. Edmondston SJ, Björnsdóttir G, Pálsson T, Solgard H, Ussing K, Allison G. Endurance and fatigue characteristics of the neck flexor and extensor muscles during isometric tests in patients with postural neck pain. Man Ther. 2011;16:332–338. doi: 10.1016/j.math.2010.12.005