Dominic Stone
The neck is a complex structure of bones, muscles, nerves, blood vessels, and connective tissues. The neck muscles support the head and enable a range of movements, including flexion, extension, rotation, and side-bending. These movements allow us to scan our surroundings and perform daily functions like swallowing and breathing. Neck muscles can be categorized into anterior, lateral, and posterior groups, with further subdivisions based on depth, location, and function. This includes muscles like the sternocleidomastoid, scalene muscles, and rectus capitis, which play a crucial role in neck flexion and stabilization. Understanding the anatomy of neck muscles is essential for preventing injuries and maintaining overall functionality.
| Characteristics | Values |
|---|---|
| Number of neck muscles | 30 |
| Location | Base of skull and jaw down to shoulder blades and collarbone |
| Function | Support and stabilise head, neck and upper spine; enable movement of head and neck; assist with chewing, swallowing and breathing |
| Categories | Anterior, lateral (prevertebral), and posterior |
| Anterior muscles | Rectus capitis anterior, rectus capitis lateralis, longus capitis, longus colli |
| Lateral muscles | Anterior, middle and posterior scalene |
| Posterior muscles | Suboccipital muscles: rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis superior, obliquus capitis inferior |
| Other muscles | Sternocleidomastoid, platysma, subclavius, mylohyoid, geniohyoid |
| Exercises for neck pain | Craniocervical flexion exercise (CFE), deep cervical flexor isolated activation |
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What You'll Learn
The Sternocleidomastoid muscle
The sternocleidomastoid (SCM) muscle is a large, two-headed muscle in the neck. It is a powerful muscle that allows you to bend your neck and turn or tilt your head. The SCM muscle extends from the mastoid process at the base of the skull to the collarbones (clavicles) and breastbone (sternum). The SCM muscle is the largest muscle in the front of the neck and is located just below the skin.
The SCM muscle has two heads: the clavicular head and the sternal head. The clavicular head is a mix of muscular and fibrous tissue and originates from the medial third of the clavicle. The sternal head arises from the manubrium of the sternum. The two heads come together and ascend diagonally to insert onto the mastoid process of the temporal bone.
The SCM muscle is innervated by the accessory nerve (CN XI) and anterior rami of spinal nerves C2 and C3. Its blood supply is derived from branches of the occipital, posterior auricular, superior thyroid, and suprascapular arteries.
The function of the SCM muscle depends on whether it acts alone or with its counterpart. A unilateral contraction of the SCM muscle flexes the cervical vertebral column to the same side and rotates the head to the opposite side. A bilateral contraction, on the other hand, elevates the head by dorsally extending the upper cervical joints while flexing the lower cervical column, resulting in an overall bending of the neck towards the chest.
Injuries, tension, and strain in the SCM muscle can lead to pain and stiffness. Treatment options include massage, osteopathic manipulation, physical therapy, and surgery in severe cases. Maintaining good posture and managing stress through regular exercise, sleep, yoga, and meditation can also help care for the SCM muscle.
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Anterior, lateral, and posterior muscles
The neck is a complex structure of bones, muscles, nerves, blood vessels, lymphatics, and connective tissues. The neck muscles can be divided into three main categories: anterior (front), lateral (side or prevertebral), and posterior (back). These muscles support and stabilise the head, neck, and the upper part of the spine, enabling movement of the head and neck.
Anterior Muscles
The anterior vertebral muscles are a deep group of muscles located just anterior to the cervical vertebral column. These include the rectus capitis anterior, rectus capitis lateralis, longus capitis, and longus colli. The rectus capitis is a short strap muscle that arises from the anterior surface of the lateral mass of the atlas (C1 vertebra) and inserts on the basilar part of the occipital bone, anterior to the foramen magnum. The function of the rectus capitis anterior is to flex the head at the atlanto-occipital joint and stabilise this joint. The longus colli also helps in flexing the neck.
Lateral Muscles
The lateral neck muscles, also called the lateral vertebral muscles, are a group of muscles that pass obliquely along the lateral sides of the neck. These include the anterior, middle, and posterior scalene muscles, which extend between the transverse processes of the cervical vertebrae and the upper two ribs. The anterior scalene muscle is the most anterior of the scalene muscles. The scalenes act to flex the neck and can also be recruited as accessory muscles of respiration.
Posterior Muscles
The suboccipital muscles are a group of posterior neck muscles that act to rotate the head and extend the neck. These include the rectus capitis posterior major and rectus capitis posterior minor, which attach the inferior nuchal line of the occiput to the C2 and C1 vertebrae, respectively. The suboccipital muscles are all innervated by the suboccipital nerve.
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Deep neck flexors
The neck is a complex structure of bones, muscles, nerves, blood vessels, lymphatics, and other connective tissues. The muscles in your neck are skeletal muscles, meaning they are attached to bones by tendons. These muscles support and stabilise your head, neck and the upper part of your spine. They also help you move your head in different directions and assist with chewing, swallowing and breathing.
Deep neck flexor training can help to reduce headaches and alleviate neck pain by restoring muscle balance, improving joint function, and reducing compression on spinal structures. Exercises such as chin tucks, supine neck flexion, isometric neck flexion, and theraband resistance exercises can help strengthen the deep neck flexors and improve overall neck health.
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Suboccipital muscles
The neck is a complex structure of bones, muscles, nerves, blood vessels, lymphatics, and connective tissues. It is made up of about 30 muscles, which support the head and neck and allow for a wide range of movements.
The suboccipital muscles are a group of four muscles located in the posterior region of the neck, underneath the occipital bone. They are the rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis superior, and obliquus capitis inferior. These muscles are supplied by the vertebral artery and the deep descending branches of the occipital artery. They are all innervated by the suboccipital nerve, which is the posterior ramus of the first cervical nerve (C1).
The suboccipital muscles function as postural muscles, providing support to the head and neck. They also enable neck extension and rotation movements. The rectus capitis posterior major, rectus capitis posterior minor, and obliquus capitis superior muscles produce extension and rotation to the ipsilateral side. The obliquus capitis inferior is the only suboccipital muscle that does not attach to the cranium, and it produces rotation to the ipsilateral side.
The suboccipital triangle is an anatomical landmark formed by three of the four suboccipital muscles: the rectus capitis posterior major, obliquus capitis inferior, and obliquus capitis superior. This triangle contains the vertebral artery and the suboccipital nerve, which are important structures for surgeons operating in the posterior cervical region.
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Craniocervical flexion exercises
The neck is a complex structure of bones, muscles, nerves, blood vessels, and connective tissues. It supports the skull while allowing for a wide range of movements. Neck muscles help with chewing, swallowing, breathing, and moving the head. There are about 30 neck muscles, which can be categorized into anterior, lateral, and posterior muscles.
Craniocervical flexion (CCF) exercises target the deep neck muscles, specifically the longus capitis and longus colli muscles of the upper cervical region. These exercises are particularly effective in retraining the cervical flexors for antigravity function in a sitting position and improving neck muscle performance in patients with mild neck pain.
CCF exercises can be performed with or without equipment. When using equipment, an air-filled pressure sensor can be utilized. During the exercise, the patient concentrates on feeling the back of their head sliding in the sagittal plane while performing a slow and controlled craniocervical flexion movement. It is important to avoid retraction.
CCF exercises can be combined with conventional cervical flexion (CF) exercises to create a combined movement (CCF-CF) that produces the highest overall muscle activation. This combined movement is recommended for general strength training as it engages all muscles maximally.
Low-load cranio-cervical flexion (C-CF) exercises have been found to be more effective than conventional strengthening exercises in reducing neck pain. After a 6-week training program, C-CF training showed improved results in activating the deep cervical flexor muscles (DCF) and reducing the activation of the sternocleidomastoid muscle.
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Frequently asked questions
Neck muscles are skeletal muscles that are attached to bones by tendons. There are about 30 neck muscles, extending from the base of the skull and jaw down to the shoulder blades and collarbone. They can be divided into anterior, lateral, and posterior groups based on their position in the neck.
The neck muscles can be sub-categorized into anterior, lateral (prevertebral), and posterior muscles. Anterior neck muscles are further divided into superficial, suprahyoid, infrahyoid, and scalene muscles. The superficial muscles include the platysma and sternocleidomastoid. The suprahyoid muscles include the digastric, mylohyoid, geniohyoid, and stylohyoid. The infrahyoid muscles include the sternohyoid, sternothyroid, thyrohyoid, and omohyoid. The lateral neck muscles include the anterior, middle, and posterior scalene muscles.
The neck muscles support the head and help with various movements. They also assist with chewing, swallowing, and breathing. The neck muscles also play a vital role in preventing neck pain, improving posture, and protecting the neurovascular structures necessary for sustaining life.
