I. Description of Motion:
Lateral flexion, side flexion, or side bending is the action of moving one’s ear to shoulder. Normal range of motion is 35-40 deg for each side.1
Muscles active during cervical lateral flexion.2(p149)
|Oliquus capitis superior||Suboccipital|
|Longus colli||Cervical 2-7|
|Rectus capitis lateralis||Cervical 1-2|
|Sternocleidomastoid||Accessory & Cervical 1-2|
|Scalenus anterior||Cervical, lower|
|Scalenus medius||Cervical, lower|
|Scalenus posterior||Cervical 6, 7, 8|
|Upper Trapezius||Cranial Nerve XI, Cervical 3-4|
II. Mobilizing – Increasing Range of Motion:
Each stretch should be held for 30-60 seconds, 3x each side, performed 3x a day. Stretches will be felt on lateral neck and slightly to the front or back.
1. Lateral Neck Flexor Stretch:2(p149)
Patient will sit with shoulders back and hold on to the bottom edge of the chair. Keeping the head in a neutral position, tilt the ear toward the shoulder.
2. Scalene Stretch:
Patient will sit on a chair. Holding the chair, patient will place the other hand on opposite shoulder and tilt ear away from hand. Tilting head backwards or forwards will modify it.
3. Upper Trap Stretch:
Patient will hold hand behind back and gently tilt head away with the help of the opposite hand.
III. Indications for Stretching:
Most common conditions/indications that are supported by literature that require mobilizing or stretching.
• Whiplash Injuries4
• Cervical Disc Disease Surgery5
• Post-Concussion Syndrome (PCS)6
• Tinnitus and related conditions7
Each exercise should be performed 10 reps, 3 sets every other day to allow muscles time to recover.
1. Isometric Cervical lateral Flexion:
A. Using their hand, patient will apply resistance to their head and resist the motion, hold 5-10 seconds, perform 10 reps, 3 sets. (i.e. use left hand if trying to work on left side flexion).
B. To progress, patient can use a theraball and bring ear to shoulder, hold contraction for 2-5 seconds, 10 reps, 3 sets.
C. Further progress by using a resistance band and holding the contraction for 2-5 seconds, 10 reps, 3 sets.
(The last exercise demonstrated in the video is concentric lateral flexion with resistance band; to perform as an isometric exercise, patient would hold the contraction instead of moving the head sideways and back).
2. Cervical Lateral Flexion Against Gravity:
Patient lies on the side, resting head onto the arm. Other arm is placed comfortably onto the mat. Head is lifted toward the opposite shoulder. Progress exercise using manual resistance. Each exercise should be performed 10 reps, 3 sets.
3. Resistance Band Cervical Lateral Flexion:
Patient places the resistance band around the temple and holds the band in their hand. Patient will then tilt the ear toward the shoulder, hold for two seconds and come back to neutral. Progress the exercise by increasing the level of resistance of the band.
V. Potential Clinical Syndromes or Etiologies:
• TMD – When the temporomandibular joint is dysfunctional, the body compensates for changes in posture. Structures like muscles in the cervical region and other areas of the body take over for the loss of range of motion and increased tension.3 Physical therapy alone is not the answer to the dysfunction, but strengthening and stretching may provide short-term relief.
• Whiplash Injuries – MVAs often lead to neck dysfunction. Therapeutic exercise and range of motion gains help the patient restore normal day to day function in both acute and chronic cases.4 However, more research is needed to strengthen these conclusions from past studies.4
• Cervical Disc Disease Surgery – Strengthening the cervical spine and increasing range of motion would allow the patient to cope well with pain and improve daily functioning, especially with chronic conditions.5
• Post-Concussion Syndrome (PCS) – Within one year of incident, lasting effects are seen in one-third of the population who suffers concussions.6 These lead to chronic neck issues that may be alleviated by strengthening and improving flexibility.
• Tinnitus and related conditions – Increasing cervical spine range of motion is hypothesized to decrease symptoms of cervicogenic somatic tinnitus, though more research needs to be conducted to prove this thought.7
VI. Additional Web Based Resources:
More information on theraband coloring, level of resistance, and dosage:
Great reference for therapeutic exercises:
VII. References for stretches and strengthening exercises:
Upper Trap Stretch. HEP 2 GO. http://www.hep2go.com/exercise_editor.php?exId=376&userRef=0. Created September 1, 2009. Accessed December 5, 2014.
Isometric Neck Side Bend. http://natural-back-pain-relief.ca/neck-pain-relief-exercises/
Cervical lateral Flexion Isometric. HEP 2 GO. http://www.hep2go.com/exercise_editor.php?exId=12643&userRef=0. Created May 2, 2013. Accessed December 5, 2014.
Elastic Band Cervical Lateral Flexion. http://www.hep2go.com/exercise_editor.php?exId=381&userRef=0. Created September 1, 2009. Accessed December 5, 2014.
Head lift: Neck Side Bend. http://natural-back-pain-relief.ca/neck-pain-relief-exercises/
VIII. References (AMA format)
1. Neumann D. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd ed. Mosby Elsevier; 2009.
2. Kendall F, McCreary E, Provance P, Rodgers M, Romani W. Muscles: Testing and Function, with Posture and Pain. 5th ed. Lippincott Williams & Wilkins; 2005.
3. WalczyNska-Dragon K, Nitecka-Buchta A, Tkacz E, Baron S. Correlation between TMD and Cervical Spine Pain and Mobility: Is the Whole Body Balance TMJ Related? BioMed Res. Int. 2014;2014:e582414. doi:10.1155/2014/582414.
4. Jull GA. Considerations in the Physical Rehabilitation of Patients With Whiplash-Associated Disorders. Spine 2011;36(Supplement 25S):S286-S291. doi:10.1097/BRS.0b013e318238823c.
5. Peolsson A, Öberg B, Wibault J, et al. Outcome of physiotherapy after surgery for cervical disc disease: a prospective randomised multi-centre trial. BMC Musculoskelet. Disord. 2014;15(1):1-15. doi:10.1186/1471-2474-15-34.
6. Steilen D, Hauser R, Woldin B, Sawyer S. Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability. Open Orthop. J. 2014;8:326-345. doi:10.2174/1874325001408010326.
7. Michiels S, Hertogh WD, Truijen S, Heyning PV de. Physical therapy treatment in patients suffering from cervicogenic somatic tinnitus: study protocol for a randomized controlled trial. Trials 2014;15(1):297. doi:10.1186/1745-6215-15-297.