Muscle Performance in Neck Pain

Original Editor - Tarina van der Stockt

Top Contributors - Tarina van der Stockt, Manisha Shrestha, Kim Jackson, Admin, Simisola Ajeyalemi, Vidya Acharya, Lucinda hampton, Jess Bell, Tony Lowe and Robin Tacchetti

Deep and Superficial Cervical Muscle Groups

In the presence of neck pain and injury there is evident changes in muscle function in terms of motor control, strength, endurance, and patterns of activation. 2 The muscles affected will be listed below:

Deep cervical flexion muscles

• Longus capitis https://www.physio-pedia.com/Longus_Capitis
• Longus colli (longus cervicis) https://www.physio-pedia.com/Longus_Colli - 3 portions, superior oblique, inferior oblique, vertical
• Rectus Capitis Anterior https://www.physio-pedia.com/Rectus_Capitis_Anterior
• Rectus Capitis Lateralis https://www.physio-pedia.com/Rectus_Capitis_Lateralis

Superficial cervical muscles

• Sternocleidomastoid https://www.physio-pedia.com/Sternocleidomastoid
• Anterior scalene https://www.physio-pedia.com/Anterior_Scalene

Cervical Extensors

• Levator scapulae https://www.physio-pedia.com/Levator_Scapulae and upper trapezius https://www.physio-pedia.com/Trapezius - “muscles of the shoulder girdle and yet form a superficial layer over the cervical extensor group”. 1
• Splenius Capitis https://www.physio-pedia.com/Splenius_Capitis and Splenius Cervicis https://www.physio-pedia.com/Splenius_Cervicis
• Semispinalis capitis (third layer) https://www.physio-pedia.com/Semispinalis_Capitis#cite_note-Rez-1
• Semispinalis Cervicis

Craniocervical extensors

• Rectus capitis posterior major (Greater Posterior Rectus Capitis) https://www.physio-pedia.com/Rectus_Capitis_Posterior_Major
• Rectus capitis posterior minor https://www.physio-pedia.com/Rectus_Capitis_Posterior_Minor
• Obliquus capitis superior https://www.physio-pedia.com/Obliquus_Capitis_Superior
• https://www.physio-pedia.com/Obliquus_Capitis_Inferior

Muscle function in the presence of pain

• Reduced activity of the the deep cervical flexor muscles goes hand in hand with an increase in activity and neuromuscular inefficiency of the superficial muscles even under low load and even with non-functional tasks 2 3 4 This change in activation can be seen in functional as well as cognitive tasks and is not dependent on the cause or the duration of neck pain. 2 4
• Patients with neck pain also struggle to relax the superficial neck flexor muscles even after an activity has ceased. 4
• These changes in muscle function occur soon after the pain started and does not automatically return to normal once the pain clears up. 4
• Changes in function in the deep cervical muscles has an influence in function as it affects the support and control of the cervical spine and could lead to overload on specific segments 42
• Research have shown that both the cervical flexors and extensors loose strength and endurance in the presence of neck pain 5 4, and that co-activation of these muscle start to happen especially with functional tasks. 2
• Superficial cervical muscles will fatigue quicker 4
• Endurance is reduced in the cervical muscles for both maximal and low contractions 2
• The feed forward activation is lost - this influences the timing of activation and can be seen when the patient is doing rapid arm movements. 2 When a patient without neck pain rapidly lifts his/her arm the cervical muscles will activate within 50ms of deltoid activation, in patients with neck pain there is a significant deficit for both the superficial and deep neck flexors which can result to increase strain on the cervical spine. 4
• Muscle atrophy occurs in the cervical muscles of patients with neck pain 2
• Fatty infiltration have been identified in the deep flexor and extensor muscles of people with chronic whiplash associated disorder, but not in chronic insidious-onset of neck pain 2

Assessment

• Cranio-cervical flexion test (CCFT) - Motor control assessment of the longus capitis and colli activation and isometric endurance, while observing their interaction with sternocleidomastoid and anterior scalene muscles.

https://www.physio-pedia.com/Cranio%E2%80%90cervical_Flexion_Test Youtube video: The Student Physical Therapist. Craniocervical Flexion Test Published on May 20, 2017 [Accessed 6 June 2018] Available from: https://www.youtube.com/watch?v=oC8zZ72BRQs

• Neck Flexor Endurance Test | Deep Neck Flexors
  • With patient in prone on elbows (puppy position) and the cranio-cervical region in neutral -test cervical extension of the deeper cervical group. Rotation can also be assessed in this position. 2

• Neck extensor tests
  • Physiotutors CEET | Cervical Extensors Endurance Test Published on Sep 15, 2017 [Accessed 6 June 2018] Available from: https://www.youtube.com/watch?v=qUZ5QzuoQs

References

 

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