By Stephen Rabil
Description of Motion:
The cervical spine moves bends forward consisting of movement by the skull of the occipital condyles on the C1 vertebrae and the C1 vertebrae to C7 vertebrae. The cervical spine's range of motion is between 80 to 90 degrees in flexion, 70 degrees in extension, 20 to 45 degrees of lateral flexion, and up to 90 degrees of rotation1. Muscles involved in flexing the cervical spine: Scalenes which Flex & rotate the neck via the Lower cervical nerve;Longus Colli Cervicis Flexes cervical vertebrae via spinal nerves C2 – C7;Longus Capitus Flexes head via spinal nerves C1 – C3;Rectus Capitus Anterior Flexes head via spinal nerves C2, C3. Primarily longus colli cervicis and longus capitus are the major cervical flexors.2.
Mobilizing: Range of Motion Exercises3
Exercise 1- Neck Extensor Stretch
- Start in seated position looking straight ahead using a point on the wall to stare at.
- Create a double chin by pressing chin into neck.
- Use one hand to keep chin tucked in, while placing other hand behind head and pulling downward gently. You should feel a stretch from the middle of your shoulder blades up the back of your neck(neck extensors) which means you are doing the stretch properly.
- It's important to hold this stretch for 30 seconds and make sure to maintain your chin tucked to avoid placing too much stress on the cervical joints.
Repeat at least 2-4 times per set. This exercise should be done at least one set,three times a day to get the full benefit.
Exercise 24
- Lie face down on a firm bed or futon with head unsupported off the edge.
- Keeps arms to the sides.
- Slowly bend the neck forward until a comfortable stretch is felt in the neck and mid back.
- Hold this position for 15-30 seconds and repeat the sequence.
- This should put a stretch on the paraspinal muscles when you flex your neck. If you feel a stretch, but are in pain or uncomfortable there then you are not doing the stretch properly. These muscles can become tight, especially in jobs where sustained extension of the neck is required and cause a range of motion limitation for cervical flexion if they are tight.
** Repeat at least 2-4 times per set. This exercise should be done at least one set,three times a day to get the full benefit.**
Exercise 3 - Levator Scapula Stretch5
- Seated in chair place one arm behind you diagonally holding onto back of the chair.
- Bend head and tilt head to one side.
- Place other hand on the back of the head light pressing the head towards your knee,which will put a stretch at the back of the neck(levator scap muscle) along the side the head is bent away from and should not feel painful.
- Make sure to look towards the knee on the same side the head is bent towards.
Repeat at least 2-4 times per set. This exercise should be done at least one set,three times a day to get the full benefit.
Common Conditions/Indications for stretching neck flexor and extensor muscles**6
- refer to the following source for more information on physical therapy and common conditions for treating the cervical spine:
http://umm.edu/programs/spine/health/guides/rehabilitation-of-cervical-spine
(If you are experiencing any feeling of instability where you are hesitant to move your neck in any direction you should seek immediate medical attention as this could be indicative of a serious problem with your neck.)
- Motor Vehicle Accident or other trauma to the neck where the neck feels tight or stiff with limited movement after the trauma, but not unstable after you have seen the appropriate clinician.
- Cervical disc degenerative disease, cervical stenosis, and cervical spondylosis
- Limited range of motion due to muscles tightness in bending the head forward or backward.
Strengthening Exercises7.
Exercise 1- Chin Tucks
- Lie down on a firm mattress or table, looking up at the ceiling.
- Tuck in your chin as if someone was pulling a string from the top of your head and hold for 10 seconds.
- Start with 5 repetitions and then progressing to sitting in a chair and performing the exercise and try increasing the number of repetitions to 10 .
This will strengthen primarily your deep neck flexors: longus colli cervicis and longus capitis but may also strengthen the superficial neck flexors: rectus capitis anterior and anterior scalenes.
This exercise should be done at least one set,three times a day to get the full benefit.
Exercise 2- Neck Flexion with ball against wall8.
- Stand facing a wall
- Keep Spine neutral
- Put an exercise ball against the wall at head height
- Place your head to stabilize the ball on the wall
- Press your head into the ball going into neck flexion.
This will strengthen both superficial and deep neck flexors as you concentrically control the head going into flexion.
Start with a least 5 times per set and progressively increase the number of repetitions by 5 or 10 as your strength improves. This exercise should be done at least one set, three times a day to get the full benefit.
Exercise 3- Isometric neck flexion
- Start seated in a chair.
- Keep your spine neutral
- Lightly press two fingers against your forehead to push your neck into extension at the same time resist with your neck flexor muscles consisting of longus colli cervicis, scalenes, longus capitis and rectus capitis anterior and hold this position. After 10 second return head to neutral and repeat.
- To progress perform this exercise in standing, increase the hold to 20 seconds and use the palm of your hand instead of just two fingers to increase resistance against your muscles.
This will strengthen both superficial and deep neck flexors to keep the head as you provide light resistance against the forehead.
Start with at least 5 times per set. This exercise should be done at least one set, three times a day to get the full benefit.
Potential Clinical Syndromes or Etiologies9.
- Please refer to the following link to learn more about this: http://morphopedics.wdfiles.com/local--files/week-nine/Cervical%20spine%20pathology%202012.pdf
Additional Resources
http://www.spine-health.com/conditions/neck-pain/neck-exercises-neck-pain
http://www.livestrong.com/article/306397-physical-therapy-exercises-for-cervical-stenosis/
http://www.spineuniverse.com/conditions/degenerative-disc/video-series-exercises-cervical-spine-degenerative