Cervical Deep Neck Flexors

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton  

Introduction[edit | edit source]

Prevertebal neck muscles

The deep neck flexors (or prevertebral cervical muscles) are the equivalent of the core for the neck. Despite their small size they are the most important antagonists of the large cervical spine extensors. They play an enormous role in the connection and stabilization of the cervical column and the skull.

  • The deep neck flexors are located inside the neck located laterally at the upper vertebral column. They prevertebral layer of the cervical fascia, encloses vertebral column, longus colli and longus capitis muscles.[1]
  • Inappropriate load (e.g. sitting for long periods) and abnormal pattern of posture (eg forward head posture) cause a permanent contraction of the cervical spine extensors which cannot be balanced by the deep neck flexors in the long term. Hyperlordosis of the cervical spine follows, often resulting in neck pain/chronic neck pain and or headaches.[1]

Anatomy[edit | edit source]

Cervical fascias

The Deep cervical flexors include:

The Deep cervical flexors muscles:

  • Located anterior to the cervical vertebral column. Constitute a part of the prevertebral or deep layer of the deep cervical fascia of the neck.
  • Principle function is to span the vertebrae, acting with, and antagonizing the deep muscles of the upper back.[2]
  • Play a vital role in supporting the cervical segments and the cervical curve.
  • The longus colli and longus capitis in particular play an important role in cervical stabilization[3].

Physiotherapy[edit | edit source]

Forward head posture

Neck core strength is often overlooked. For prevention of neck pain, injury prevention and improving posture these muscles play a vital role. These small muscles if dysfunctional often are the cause of eg cervicogenic headaches. As with any other part of the body, part of rehabilitation is to re-strengthen the injured area, in this case with craniocervical flexion exercise (CFE). Deep neck flexor training can also help to reduce headaches. This exercise programme is discussed in more detail here.

Chin tuck with flexion

Studies have shown that CFE targeted at retraining the craniocervical flexor muscles are useful for

  1. Improving or restoring the cervical lordosis, and neck-related function disorders
  2. Reducing pain among patients with non-specific CNP
  3. Correct forward head posture in the patients with neck pain.[4][5].

See Muscle Performance in Neck Pain

Activation of the deep neck flexors helps maintain the natural lordosis of the cervical spine. Injury to the cervical region, or extended periods of time at a desk can cause these muscles to become underactive[6].

The exercises below helps re-activate these muscles if done correctly.

1.A 33 sedond video titled "Deep Neck Flexor - Longus Colli Strengthening")


2. The 5 minutes video below is titled Deep Cervical Flexor Isolated Activation (Longus Colli, Longus Capitis & Rectus Capitis).

In summary it describes a chin retraction exercise for neck pain that works on the local stabilising the deep neck flexors.

  1. The exercise starts in standing in front of mirror, to provide feedback to client re neck posture.
  2. Client has arms at 90 degrees flexions holding onto mirror with theraband resistance band looped behind upper neck.
  3. The action is then to retract chin backwards with a chin tuck, against the resistance band, checking all the while for good postural control.
  4. The hardest part of the exercise is the final part, getting chin back to neutral or beyond.
  5. Client performs 12-20 repeats with slow 2-4 counts, 1-3 sets.

References[edit | edit source]

  1. 1.0 1.1 Ken hub Prevertebral muscles Available: https://www.kenhub.com/en/library/anatomy/prevertebral-muscles(accessed 8.2.2022)
  2. McDavid LJ, Khan YS. Anatomy, Head and Neck, Prevertebral Muscles. StatPearls [Internet]. 2021 Aug 11. Available:https://www.ncbi.nlm.nih.gov/books/NBK560569/ (accessed 8.2.2022)
  3. Musculoskeletal Key Cervical spine Available:https://musculoskeletalkey.com/the-cervical-spine-7/ (accessed 8.2.2022)
  4. Chung S, Jeong YG. Effects of the craniocervical flexion and isometric neck exercise compared in patients with chronic neck pain: A randomized controlled trial. Physiotherapy theory and practice. 2018 Dec 2;34(12):916-25.Available:https://www.tandfonline.com/doi/abs/10.1080/09593985.2018.1430876 (accessed 8.2.2022)
  5. Kim JY, Kwag KI. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain. Journal of physical therapy science. 2016;28(1):269-73.Available:https://www.jstage.jst.go.jp/article/jpts/28/1/28_jpts-2015-653/_article (accessed 8.2.2022)
  6. Rowney Chiro Deep Neck Flexor Activation Available: https://www.rowneychiropractic.com.au/deep-neck-flexor-activation.html (accessed 8.2.2022)
  7. OptimumCareProviders. 1.2 Deep Neck Flexor - Longus Colli Strengthening Level 2. Available from: http://www.youtube.com/watch?v=1smVSuQiQx8 [last accessed 09/03/13]