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The neck is a complex structure of bones, muscles, nerves, blood vessels, and connective tissues. It is the most flexible part of the spine, allowing for large movements and proper sensory input. The cervical spine, or the bony part of the neck, is composed of seven vertebrae. The primary motions of the cervical spine are flexion, extension, rotation, and side-bending. This article will focus on the muscles responsible for capital flexion, or the bending of the head forward towards the chest.
| Characteristics | Values |
|---|---|
| Definition | Bending the head forward towards the chest |
| Muscles Involved | Sternocleidomastoid (SCM), anterior scalenes (AS), levator scapulae, scalenes, deep cervical flexors, erector spinae, suboccipitals, semispinalis capitus, longus capitus, longus colli |
| Related Movements | Extension, rotation, side-bending, circumduction, lateral flexion |
| Related Conditions | Neck pain, cervical sprain, disc rupture, cervical dystonia, torticollis |
| Related Anatomy | Vertebral bodies, spinal cord, spinal nerves, intervertebral discs, facet joints |
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What You'll Learn
Capital flexion tests
The capital flexion test is a necessary and effective way of managing nuchal weakness or paralysis. The capital extensors are a group of muscles that lie behind the coronal midline and are inserted on the skull. Motion is centred at the atlanto-occipital and atlantoaxial joints.
During the test, the patient is asked to lie prone with their head off the end of the table and arms at their sides. The therapist stands at the side of the patient, next to their head. One hand of the therapist provides resistance over the occiput, while the other hand is placed beneath the overhanging head to support it and prevent injury in case the muscles fail to hold position. The therapist then applies resistance directly opposite to the movement of the head.
The patient then extends their head by tilting their chin upward in a nodding motion (without extending the cervical spine). They may be asked to "look at the wall" or "hold" and "don't let me tilt your head down".
The cranio-cervical flexion test (CCFT) is another test that assesses the neuromuscular control of the deep cervical flexor muscles, including the longus capitis and colli. The CCFT also evaluates the endurance of the deep cervical flexors and their interaction with the superficial flexors. This test is particularly relevant for patients with neck pain, as it can demonstrate altered performance and increased demand on the deep cervical flexors.
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Muscles involved in capital flexion
Capital flexion, or cervical flexion, is the act of bending the head forward towards the chest. This movement is enabled by several muscles in the neck, which can be divided into three main groups: the deep cervical flexors, the deep neck extensors, and the suboccipital muscles.
The deep cervical flexors include the longus colli, longus capitus, rectus capitis anterior, and rectus capitis posterior. These muscles are responsible for flexing the neck and enabling segmental movements. The longus capitis, in particular, plays a crucial role in capital flexion by facilitating head flexion through bilateral contraction.
The deep neck extensors include the semispinalis cervicis and capitis, and the multifidus. These muscles provide support and stability to the cervical spine, which is composed of seven vertebrae. Cervical vertebrae C1 and C2, also known as the atlas and axis, have unique bony structures designed to support and move the skull.
The suboccipital muscles include the rectus capitus posterior major and minor, and the obliquus capitus superior and inferior. This group of muscles is essential for providing proprioception and input to the visual and vestibular systems. They control small head-on-neck movements, and their dysfunction can lead to sensorimotor impairment and altered balance.
Other muscles that contribute to capital flexion include the splenius capitis and cervicis, which enable the extension of the head and neck, as well as ipsilateral lateral flexion and rotation. The rotatores cervicis facilitate the extension of the spine, while the intertransversarii assist in lateral flexion and stabilization.
It is important to note that the direction of a muscle's line of pull determines its action, and the direction of its fibers determines its line of pull. For example, muscles that cross the spinal joints anteriorly are considered flexors, while those that cross posteriorly are extensors.
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Sternocleidomastoid and anterior scalene muscles
The sternocleidomastoid (SCM) muscle is a large, easily recognizable, and palpable muscle in the anterior portion of the neck. It is one of over 20 pairs of muscles acting on the neck and is an important landmark that divides the neck into anterior and posterior triangles. The SCM binds the skull to the sternum and the clavicle, protecting the vertical neurovascular bundle of the neck, branches of the cervical plexus, deep cervical lymph nodes, and soft tissues of the neck from damage. The SCM has dual innervation and multiple functions, including acting as an accessory muscle of inspiration and playing an important role in the posture of the neck and the body. It also acts in concert with the entire muscular group of the cervicofacial region, responding and aiding in various complex physiological movements beyond its principal function as a lateral neck flexor.
The organizational pattern of the SCM can be arranged into five distinct topographical parts, namely the superficial sternomastoid, profound sternomastoid, sterno-occipital, cleidomastoid, and cleido-occipital parts, which are arranged in superficial and deep layers. The SCM can also have inspiratory muscle action by taking a fixed point on the temporal bone and then lifting the sternum and the clavicles.
The scalene muscles, on the other hand, are three paired muscles of the lateral neck, namely the anterior, middle, and posterior scalene muscles. The anterior and middle scalene muscles are particularly important as they provide an anatomical landmark for performing an interscalene block, which is an anesthetic technique used in upper limb surgery to avoid the use of general anaesthetic. The trunks of the brachial plexus are visible emerging between these two muscles, and the subclavian vein and phrenic nerve pass anteriorly to the anterior scalene. The posterior scalene is the smallest and deepest of the scalene muscles, inserting into the second rib.
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Therapist's knowledge of muscles
A therapist's knowledge of muscles is essential for effective treatment, especially when it comes to the complex structure of the neck. The neck is a collection of structures that connect the head to the torso, including bones, muscles, nerves, blood vessels, lymphatics, and other connective tissues. The cervical spine, or bony part of the neck, is the most flexible part of the spine, allowing for large movements and scans of our surroundings. It also facilitates swallowing, aids in inhalation by elevating the rib cage, and acts as a conduit for the brain to communicate with the rest of the body.
Given the importance of the neck, therapists must have a thorough understanding of the muscles and their functions to provide accurate and specific treatments. This includes knowing the attachments and actions of the neck muscles, such as flexion, extension, rotation, and side-bending. For example, during cervical flexion, the head bends forward towards the chest, while in cervical extension, the head bends backward. Therapists use this knowledge to determine the appropriate treatment techniques, such as deep tissue work, and to guide the patient through specific movements.
The direction of a muscle's fibres determines its line of pull, which, in turn, determines its action. Neck muscles that perform flexion, extension, right lateral flexion, or left lateral flexion must have a vertical component to their fibre direction. On the other hand, muscles that perform rotation must have a horizontal component, wrapping partially around the neck. This understanding of muscle fibre direction helps therapists visualize and assess the rotational ability of the neck muscles.
Additionally, therapists should be adept at identifying and isolating specific neck muscles. For instance, the longus capitis muscle can be targeted through bilateral contraction for head flexion or unilateral contraction for ipsilateral head rotation. Similarly, the longus colli muscle is responsible for neck flexion and lateral neck flexion through bilateral contraction and contralateral neck rotation through unilateral contraction. Therapists can use this knowledge to perform precise treatments and guide patients in contracting and engaging specific muscles.
In conclusion, a therapist's knowledge of muscles, their attachments, actions, and fibre directions is crucial for effective treatment, especially in complex areas like the neck. This understanding allows therapists to accurately identify, isolate, and treat specific muscles, ensuring safe and beneficial outcomes for their patients.
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Neck flexor endurance tests
The neck is a complex structure of bones, muscles, nerves, blood vessels, and connective tissues. It connects the head to the torso and supports the skull while allowing for a wide range of movements. The cervical spine, which is the bony part of the neck, is composed of seven vertebrae, with cervical vertebrae C1 and C2 ("atypical" vertebrae) supporting and moving the skull.
Given the importance of the neck, injuries can have significant consequences for our functionality and, in some cases, can even be fatal. Therefore, it is crucial to assess and maintain the health of the neck muscles through various endurance tests. Here are some detailed descriptions of neck flexor endurance tests:
Deep Neck Flexor Endurance Test
This test aims to assess the endurance of the deep cervical flexor muscles and identify any altered muscle control patterns. The subject is positioned on a plinth with their head slightly flexed upward. The examiner places their hand just below the subject's occiput to provide support. The subject then completes the test twice on the first day of testing. The holding time is measured in seconds, and a change of greater than 17 seconds is considered significant. This test is particularly relevant for individuals with postural neck pain.
Craniocervical Flexion Test (CCFT)
The CCFT is a clinical and research tool that has been developed over 15 years to evaluate the function of the deep cervical flexor muscles. It involves five progressive stages of craniocervical flexion, assessing neuromotor control, muscle activation, isometric endurance, and the interaction between deep and superficial cervical flexors. This test is useful for individuals with neck pain, as it can identify impaired neuromotor control and decreased endurance. Therapeutic exercises using craniocervical flexion have shown positive results in clinical trials.
Capital and Cervical Flexion Tests
These tests involve specific positions and movements to assess the neck muscles' strength and endurance. For the capital flexion test, the patient lies prone with their head off the end of the table and arms at their sides. The examiner provides resistance over the occiput with one hand while the other hand is placed beneath the head for support. The patient then attempts to nod their head without lifting it from the table.
For the cervical flexion test, the patient lies supine with their head on the table and arms at their sides. The examiner places their hands under the occiput to support the head. The patient tries to look back at the therapist without lifting their head from the table. These tests are important for managing nuchal weakness or paralysis.
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Frequently asked questions
Capital flexion is the act of bending the head forward towards the chest.
The longus capitis muscle is involved in head flexion. The splenius capitis and splenius cervicis muscles are involved in the extension of the head and neck.
One test for capital flexion involves lying prone with your head over the edge of a bed, supported by a stool. You then tuck your chin (cranio-cervical flexion) and hold your head steady as the stool is removed, maintaining a horizontal head position.
Capital flexion can be improved by stretching the neck flexor muscles. This can be done by extending the neck, i.e. bending the head backward.
