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.
• 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.
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
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