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The cervical extensor muscles are a group of muscles that form a sleeve around the vertebral column, enabling control of posture and segmental movements. There are four layers of cervical extensor muscles, ranging from the most superficial to the deepest layers. The first layer consists of the levator scapulae and upper trapezius muscles, which are typically considered shoulder girdle muscles but also form a superficial layer over the cervical extensor group. The second layer includes the splenius capitus and cervicis, which function as extensors and produce rotation. The semispinalis capitus, primarily a cervical extensor, is part of the third layer. The deepest layer, or the fourth layer, consists of the semispinalis cervicis and multifidus, collectively known as the transversospinalis group. These deep cervical extensors play a crucial role in controlling segmental movements of the cervical spine, and their weakness can lead to complex compensatory activation patterns, contributing to chronic neck pain.
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What You'll Learn
- The deep cervical extensors are the semispinalis cervicis and multifidus
- The Head/Neck Extension Test can be used to assess cervical extensor muscle balance
- Weakness in the deep cervical extensors can lead to complex compensatory muscle activation patterns
- Exercises can help restore activation of the deep cervical extensors
- The cervical extensors are organised into four layers
The deep cervical extensors are the semispinalis cervicis and multifidus
The cervical extensor muscles are a group of muscles that form a sleeve around the vertebral column, enabling control of posture and segmental movements. These muscles can be described in layers, from the most superficial to the deepest.
The semispinalis cervicis and multifidus muscles work in synergy with the deep flexors of the cervical spine to control vertebral movements. They are innervated by the medial branches of the posterior rami of spinal nerves and receive arterial supply from the occipital, deep cervical, and vertebral arteries. The nerve supply to the multifidus muscle, in particular, is derived from the corresponding cervical, thoracic, and lumbar regions.
Research has shown that the deep cervical extensors lose strength and endurance in the presence of neck pain. This can lead to reduced activation of these muscles and altered activation patterns. Specific cervical extensor exercises have been found to be effective in pain relief, disability improvement, and muscle strength enhancement.
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The Head/Neck Extension Test can be used to assess cervical extensor muscle balance
The Head/Neck Extension Test is a useful way to assess cervical extensor muscle balance. The cervical extensor muscles are a group of muscles that form a sleeve around the vertebral column, enabling control of posture and segmental movements. They include the deep cervical flexors, deep neck extensors, and suboccipital muscles.
The test is performed with the patient lying prone, with their head and neck past the edge of the table, and the cervico-thoracic junction stabilized. The patient is asked to lift their head off the examination table, and the pattern of muscle contraction is assessed as the head lifts. Normally, the Levator Scapula and Upper Trapezius muscles should remain relaxed, and palpation of these muscles during the movement confirms this. If these muscles are active, it indicates an undesirable compensatory pattern where the scapulo-cervical muscles dominate the cervical extensors.
In addition to active range, the strength of the cervical extensors can be tested. With the head and neck extended off the table, the examiner gently presses the patient's head into flexion. The patient should be able to resist this pressure without additional muscle activity of the scapulo-thoracic muscles.
Failure of any portion of the Head/Neck Extension Test indicates cervical extensor dysfunction. A positive finding for weakness of the deep neck extensors is observed when the 'chin length' increases with neck extension, indicating dominance of the superficial extensors of the neck. This can lead to hyper-extension of the upper cervical spine and excessive flexion and anterior shear of the lower cervical spine.
The Head/Neck Extension Test is a valuable tool for assessing cervical extensor muscle balance and identifying potential dysfunction. It helps guide treatment approaches for patients experiencing neck pain and related disorders.
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Weakness in the deep cervical extensors can lead to complex compensatory muscle activation patterns
The cervical spine is composed of three main groups of muscles that form a sleeve around the vertebral column and enable control of posture and segmental movements. The deep cervical flexors, the deep neck extensors, and the suboccipital muscles. The deep neck extensors include the semispinalis cervicis and multifidus, which are collectively known as the transversospinalis group and referred to as the deep cervical extensors (DNE or DCNE).
The Head/Neck Extension Test can be used to assess cervical extensor muscle balance and identify dysfunction. A positive finding for weakness in the deep neck extensors is an increase in "chin length" during neck extension, indicating dominance of the superficial extensors. This can lead to hyper-extension of the upper cervical spine and excessive flexion of the lower cervical spine.
To address weakness in the deep cervical extensors, specific exercises can be prescribed to improve neck strength and stability. These exercises may include low-load and high-load movements to induce neurophysiological and morphological adaptations, respectively. By targeting the deep cervical extensors, individuals can improve neck health, reduce pain, and decrease the potential for injury.
Overall, weakness in the deep cervical extensors can lead to complex compensatory muscle activation patterns, impacting the overall health and function of the cervical spine and neck. Addressing this weakness through targeted exercises can help improve strength, stability, and overall neck health.
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Exercises can help restore activation of the deep cervical extensors
The cervical extensor muscles are a group of muscles that form a sleeve around the vertebral column, enabling control of posture and segmental movements. They can be described or conceptualized in layers, with four layers of cervical extensor muscles. The deep cervical extensors are the semispinalis cervicis and multifidus, which are collectively known as the transversospinalis group.
Research has shown that the cervical extensors lose strength and endurance in the presence of neck pain, and that co-activation ceases, especially with functional tasks. Structural changes such as higher concentrations of fat within the muscle, variable cross-sectional area, and higher proportions of type II fibres have been observed in the deep cervical extensors of patients with neck pain compared to healthy individuals. These findings suggest that the behaviour of the deep extensors may be altered in patients with neck pain, with reduced activation of the deep cervical extensors and less defined activation patterns.
Therefore, exercises can help restore activation of the deep cervical extensors. For example, in a quadruped position, the neck extensors must contract to hold the head and neck in proper alignment against gravity. From this position, the chin is tucked towards the neck, and then the head is gently extended back towards the ceiling. Shoulder motions can be added to progress the exercise, and light weights can be used to further increase the demand on the neck musculature.
Another exercise to target the deep cervical extensors involves sitting upright on a chair with hands folded and placed slightly below the occiput. This is an isometric training exercise.
Overall, exercises can help restore activation of the deep cervical extensors, which is important for the rehabilitation of patients with neck pain and the management of segmental dysfunction.
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The cervical extensors are organised into four layers
The cervical spine, or neck, consists of the first seven vertebrae in the spine, from C1 to C7. These vertebrae are surrounded by muscles, nerves, tendons, and ligaments. The cervical extensors are a group of muscles that enable the neck to extend backward, tilt the head upward, and rotate the head from side to side. These muscles are organised into four layers, from most superficial to deep:
Layer 1 consists of the levator scapulae and upper trapezius muscles. These muscles are primarily considered part of the shoulder girdle but form a superficial layer over the cervical extensor group. The upper trapezius is innervated by a spinal root of the accessory nerve, while the levator scapulae are innervated by the dorsal scapula nerve.
Layer 2 includes the splenius capitus and cervicis muscles, which act bilaterally as extensors and ipsilaterally to produce rotation. These muscles are innervated by the dorsal rami of the middle cervical spinal nerves.
Layer 3 comprises the semispinalis capitus muscle, which is a cervical extensor and contributes to lateral flexion. The semispinalis capitus is innervated by dorsal rami of spinal nerves.
Layer 4, the deepest layer, contains the semispinalis cervicis and multifidus muscles, collectively known as the transversospinalis group. These muscles are referred to as the deep cervical extensors (DNE or DCNE). They provide posterior support for cervical lordosis and help prevent a forward head position. The semispinalis cervicis acts as a cervical extender, while the multifidus serves as a segmental stabiliser. These muscles are innervated by dorsal rami of cervical spinal nerves.
The deep cervical extensors play a crucial role in maintaining the function and stability of the cervical spine. Research has shown that these muscles lose strength and endurance in the presence of neck pain, leading to altered behaviour and reduced activation patterns. Specific exercises targeting the cervical extensors have been found to be effective in pain relief, disability improvement, and muscle strength enhancement.
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Frequently asked questions
The cervical extensor muscles are found in the neck and are responsible for posture and movement of the head and neck.
There are four layers of cervical extensor muscles:
- Layer 1: Levator scapulae and upper trapezius.
- Layer 2: Splenius capitus and cervicis.
- Layer 3: Semispinalis capitus.
- Layer 4: Semispinalis cervicis and multifidus, also known as the transversospinalis group.
One exercise for the cervical extensor muscles is the quadruped neck retraction/extension exercise. In this exercise, the neck extensors contract to hold the head and neck in alignment against gravity. The chin is then tucked towards the neck, and the head is gently extended back towards the ceiling.
