Maximus Gage
The cervical spine, or neck, is composed of seven vertebrae (C1-C7) and surrounded by muscles, nerves, tendons and ligaments. The neck muscles work together with tendons and ligaments to support and move the neck and head. The direction of a muscle's fibres determines its line of pull, which in turn determines the muscle's action. Muscles that perform flexion must have a vertical component to their fibre direction. The flexor group consists of SCM, AS and DNF, while the extensor group consists of levator scapulae, upper trapezius, semispinalis capitus, semispinalis cervicis, and multifidus.
| Characteristics | Values |
|---|---|
| Definition of cervical flexion | Bending the head forward towards the chest |
| Muscles that limit cervical flexion | Sternocleidomastoid (SCM), anterior scalenes (AS), longus capitus, longus colli, levator scapulae, upper trapezius, semispinalis capitus, semispinalis cervicis, multifidus, erector spinae, suboccipital muscles |
| Muscle groups | Superficial muscles, Suprahyoids, Infrahyoids, Muscles forming musculoskeletal columns around vertebra, Intrinsic and extrinsic muscles, Deep cervical flexors |
| Muscles involved with neck pain | Sternocleidomastoid, trapezius, levator scapulae, scalenes, deep cervical flexors, erector spinae, suboccipitals |
| Cervical vertebrae | C1 (atlas) to C7 |
| Cervical nerves | C1 to C8 |
| Cervical spine function | Stabilize and maintain the head in a position that allows our eyes to be parallel to the ground, assist in balance, scan surroundings, adjust to interact with the environment, aid in swallowing, elevate the rib cage during inhalation, protect the spinal cord |
| Ligaments in the cervical spine | Anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, interspinous ligament, nuchal ligament |
| Muscle contracture causing cervical dystonia | Abnormal sternocleidomastoid (SCM) muscle contracture |
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What You'll Learn
Sternocleidomastoid (SCM) muscles
The sternocleidomastoid (SCM) muscle is a two-headed neck muscle that originates from the manubrium of the sternum (sternal head) and the clavicle (clavicular head). These two heads join to form a single muscle belly that attaches to the lateral surface of the mastoid process of the temporal bone and the lateral half of the superior nuchal line of the occipital bone. The SCM is the largest muscle in the front of the neck and is easily visible and palpable. It is a powerful muscle that enables neck flexion, lateral flexion, and head rotation.
The SCM helps to stabilise the neck and protect the neurovascular structures in the neck, such as the vertical neurovascular bundle, branches of the cervical plexus, deep cervical lymph nodes, and soft tissues. It also assists in breathing by lifting the breastbone and collarbone during inhalation. Additionally, the SCM supports the temporomandibular joint (TMJ), allowing the mouth to open and close.
Injuries, tension, sprains, strains, atrophy, and tumours can damage the SCM muscle. Conditions such as sternocleidomastoid syndrome and torticollis can cause neck stiffness, pain, and trigger points within the SCM. Treatment options for SCM issues include hot and cold therapy, stretching, physical therapy, osteopathic manipulation, and surgery in severe cases.
The SCM has a unique organisational pattern, consisting of five distinct topographical parts: the superficial sternomastoid, profound sternomastoid, sterno-occipital, cleidomastoid, and cleido-occipital. These layers lie within a common fascial sheath and traverse in the same direction. This layered arrangement is important to consider during muscle flap harvesting procedures.
In summary, the SCM is a crucial muscle in the neck that enables various head and neck movements, supports stabilisation, and protects vital neurovascular structures. Its health and proper function are essential for maintaining overall neck health and range of motion.
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Anterior scalenes (AS)
The anterior scalene, also known as scalenus anterior or scalenus anticus (in Latin: musculus scalenus anterior), is one of the lateral muscles of the neck. It is part of the scalene muscle group, which consists of three paired muscles: the anterior, middle, and posterior scalene muscles.
The anterior scalene is located deeply in the neck, behind the sternocleidomastoid muscle. It is positioned between the subclavian vein and the subclavian artery. The brachial plexus and subclavian artery pass through the scalene triangle, which is formed by the anterior scalene. The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene, with the vein running horizontally and the nerve running vertically.
The anterior scalene is innervated by the anterior rami of the spinal nerves C4-C6. It receives its blood supply from the ascending cervical branch of the inferior thyroid artery, which is an indirect branch of the subclavian artery.
The anterior scalene functions to elevate the first rib and is involved in neck movements. When contracted unilaterally, it results in ipsilateral lateral flexion of the neck (to the same side) and rotation of the neck to the opposite side. Bilateral contraction of the anterior scalene causes anterior flexion of the neck.
In patients with respiratory distress, the anterior scalene can act as an accessory muscle of respiration, aiding in breathing by increasing the intrathoracic volume. However, hypertrophy or spasm of the anterior scalene can lead to neurological and vascular symptoms in the upper limb, known as thoracic outlet syndrome.
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Deep cervical flexors
Therefore, targeted strengthening of the deep cervical flexors is an important part of restoring stability, improving posture, and reducing pain in individuals with neck-related issues. Specific strengthening exercises can help to alleviate neck pain and associated symptoms by restoring muscle balance, improving joint function, and reducing compression on spinal structures. Exercises such as chin tucks, supine neck flexion, and isometric neck flexion can help activate the deep cervical flexors and improve posture.
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Erector spinae
The erector spinae is a large and superficial muscle that lies just deep to the thoracolumbar fascia. It is one of the core and paraspinal muscles, with its fibres running vertically throughout the lumbar, thoracic, and cervical regions. The erector spinae is divided into three groups, from medial to lateral: spinalis, longissimus, and iliocostalis. These groups are further divided into regional groups, with the spinalis and longissimus muscles divided into three groups each, and the iliocostalis into two.
The spinalis muscles are the most medial erector spinae muscles. They are innervated by the lateral branches of the posterior rami of the cervical, thoracic, and lumbar spinal nerves. The blood supply to the spinalis muscles comes from the vertebral, deep cervical, occipital, intercostal, and lumbar arteries. The function of the spinalis muscles is to extend and laterally flex the cervical and thoracic regions of the spine. The spinalis capitis is an inconstant muscle fibre that runs from the cervical and upper thoracic and inserts into the external occipital protuberance. The spinalis cervicis originates from the spinous process of T2-C6 and inserts into the spinous process of C4-C2.
The longissimus muscles are the central erector spinae muscles and are the thickest and longest. They have identical innervation to the spinalis muscles. The longissimus muscles receive arterial blood from branches of the vertebral, deep cervical, occipital, transverse cervical, intercostal, and sacral arteries. The function of the longissimus muscles is to extend and laterally flex the spine, with the longissimus capitis also helping to rotate the head ipsilaterally. The longissimus thoracis originates from the sacrum, spinous processes of the lumbar vertebrae, and transverse process of the last thoracic vertebra. The longissimus cervicis originates from the transverse processes of T6-T1 and inserts into the transverse processes of C7-C2.
The iliocostalis muscles are the most lateral erector spinae muscles. They are regionally divided into three groups, from superior to inferior: iliocostalis colli, iliocostalis thoracis, and iliocostalis lumborum. The iliocostalis colli muscle originates from the angle of ribs 3 to 6 and inserts into the transverse processes of vertebrae C4-C6. The iliocostalis thoracis originates from the sacrum, erector spinae aponeurosis, and iliac crest.
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Suboccipital muscles
The suboccipital muscles are a group of four muscles located in the posterior region of the neck, underneath the occipital bone. These muscles are the rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis superior, and obliquus capitis inferior. The suboccipital 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 formed by the dorsal ramus of the first cervical nerve (C1).
The suboccipital muscles function primarily as postural muscles, providing support for the head and neck. They also enable neck extension and rotation movements. These movements include extension and rotation to the ipsilateral side by the rectus capitis posterior major, extension and rotation to the ipsilateral side by the rectus capitis posterior minor, rotation to the ipsilateral side by the obliquus capitis inferior, and extension and lateral flexion by the obliquus capitis superior.
The rectus capitis posterior major is the larger of the two rectus capitis muscles. It originates from the spinous process of the C2 vertebra (axis) and inserts into the lateral part of the inferior nuchal line of the occipital bone. The rectus capitis posterior minor is the most medial of the suboccipital muscles and has a connective tissue bridge to the dura mater, which may be implicated in cervicogenic headaches. It originates from the posterior tubercle of the C1 vertebra (posterior arch of the atlas) and attaches to the medial part of the inferior nuchal line of the occipital bone.
The obliquus capitis superior is located laterally in the suboccipital compartment. It originates from the transverse process of C1 and attaches to the occipital bone between the superior and inferior nuchal lines. The obliquus capitis inferior is the most inferiorly positioned of the suboccipital muscles and does not attach to the cranium. It originates from the posterior tubercle of the posterior arch of the axis and inserts into the transverse process of C1.
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Frequently asked questions
The superficial flexor muscles of the cervical spine include the sternocleidomastoid (SCM) and anterior scalenes (AS).
The SCM functions bilaterally to create neck flexion and unilaterally to create ipsilateral lateral flexion and contralateral rotation.
The function of the longus colli and longus capitus muscles is to maintain cervical lordosis and provide segmental control.
The deep cervical flexors are a muscle group consisting of the longus capitus and longus colli muscles, which run down the front of the cervical spine.
The erector spinae is a group of muscles that attach along the back of the spine. In the cervical spine, they play a key role in supporting posture, rotating the neck, and extending the neck backward.
