KINESOLOGY OF

CERVICAL SPINE

PRESENTED BY : DR.ASER MOHAMED KAMAL PHYSICAL THERAPIST

Biomechanics of Cervical Spine

Made up of two anatomically and functionally

distinct segments.

1. Superior segment/suboccipital segment:-

A -consist of c1 /atlas and c2/axis

B -connected to eachother and occiput with complex

chain of joints.

C -having 3 axes and 3 degrees of freedom.

2. Inferior segment-

A -stretching from inferior surface of axis to the

superior surface of T1.

B -In total there are 7 cervical vertebras-

c1-c2 c3-c6 c7

atypical typical transitional

Structure of a atypical cervical vertebra

1- Atlas /C1-its ring shaped

Transverse diameter greater than AP diameter

Has two lateral faces oval in shape running obliquely

anteriorly and medially

Which bear biconcave superior articulate facet

superiorly and medially meant to articulate with

occipital condyles

Inferior articular facet –facing inferiorly and medially

Convex AP

Corresponds to superior facet of axis

Anterior arch consist of small cartilagenous oval

shaped articular facets for the odontoid process of axis

Posterior arch is initially flattened but becomes thicker posteriorly to form

posterior tubercle on the midline.

Transeverse process

No spinous process

No intervertebral disc

2- The axis /C2-is atypicsl

Superior surface of the body carries

centrally the odomtoid process which acts

as a pivot for atlantoodontoid joint .

Laterally possess 2 articular facets facing

superior and laterally

Facets are convex AP and flat transversely

Posterior arch consist of narrow laminae

The cartilage lined inferior articular

process corresponds to the superior

articular process of c3

The cartilage lined inferior articular

process corresponds to the superior

articular process of c3

Transverse process

The atlanto-axial joint complex

it is a plane synovial joint

comprises of 3 mechanically linked joints

The central joint is the atlanto odontoid

joint

Two lateral joints-atlanto axial joint

Atlanto-odointoid joint

it is synovial trochoid /pivot joint

Jointsurfaces-anterior articular facet of

odontoid and posterior articular facet of the

anterior arch of the atlas

Movements at atlantoaxial and atlanto-odontoid joint

Flexion-point of contact b/w two convex surface moves

forward

interspace of atlanto odontoid joint opens superiorly

Extention- point of contact b/w two convex surface moves

backward

Interspace of atlanto odontoid jointopens inferiorly

Radiological findingas does not shoe opening of interspaces

This is due to transverse ligament and keeps the anterior arch and odontoid

process in close contact

During flxn and extn tha inferior surface of atlas rols and sides over superior

articular surface of axis

Rotation

Left to right rotation-The left

lateral mass of the atlas moves

forward

Right lateral mass recedes in

rotation from left to right and

vice versa from right to left

Movement of atlanto occipital joint Formed b/w superior articular facets of

atlas and the occipital condyles.

It is an enarthodrial kind of joint

Gives 3 degrees of freedom

Axial rotation-about vertical axis

Flexion/extension-about transverse axis

Lateral flexion-about AP axis.

Flexion:The occipital condyles recede on the lateral masses of the

atlas.

The occipital bone moves away from the posterior archof the atlas

Limited by tension developed in the articular capsules and the

ligament

Extension: Occipital condyles slides anteriorly on the lateral

masses of the atlas.

Occipital bone moves neatrer to the posterior arch of the atlas

Posterior arch of the atlas and axis are approximated

Limited by those 3 bony pieces

Flexion/extension-15 degrees

Lateral flexion Movement only occurs b/w c0-c1 and c2-c3 Left lateral flexion-slipping of occipital condyles on right of atlas

Right lateral flexion-vice versa

Ther is asmall range of motionTotal ROM-C0-C3=8 degrees

C0-C1=3 degrees,C2-C3=5 degrees

Rotation When occiput rotates on atlas its rotation is

secondary to rotation of atlas on axis Around vertical axis passing through the centre of odontoid

Causes right anterior displacement of oright occipital condyle

on right lateral mass of the atlas

Lateral atlanto occipoital ligamenr is streched

Thus rotation of occiput to left is associated with –

Linear displacement of 2-3 mm to the left

Lateral flexion to the right

Structure of a typical cervical vertebra

Vertebral body-superior plateau is raised on either sides by 2

buttresses.

which is called as unciform process.

It is concave transversely and convex anteroposteriorly-

resembling a saddle .

Unciform processes guoides the AP movements during flexion

and extension ut limits lateral flexion

Pedicals-connects the vertebral body to the transverse process.

Project posterolaterally.

Lamina-part of the posterior arch

Meets in the midline to form the bifid spinous process

Projects posteromedially and are thin and slightly curved.

Spinous process-short slender and extend horizontally

The tip is bifurcated

Face superiorly and medially

The length of spinous process decreases from c2-c3

C3-c5 remains constant

And undergoes a significant increase at c7.

Vertebral foramen –is large and triangular

Transverse process They are peculiar in orientation

They are hollowed in to a gutter AP and they point AL.

The posteromedial end of the gutter lines the

intervertebral foramen.

The AL end is bifid giving attachment to scalene muscles.

Possess foramen transversarium

Articular processes-they bear superior and inferior articular

facets.

Superior facets face superiorly and medially

Inferior facets face anteriorly and laterally

Movements at the lower cervical vertebral column Extension-ovrlying vertebral body tilts and slides posteriorly

IV space is compressed posteriorly and opened wide anteriorly

Nucleus palposus is driven slightly anteriorly

Anterior fibers of annulus fibrosus is streched

Superiorly articulating facet slides inferiorly posteriorly and tilts

posteriorly

Limited by anterior longitudinal ligament and by the impact of

the posterior arches through ligaments

Flexion-upper vertebral body tilts and slides anteriorly

Intervertebral space is compressed anteriorly and opened wide

posteriorly

Nucleus pulposus is driven posteriorly

Posterior fibres of annulus fiberosus is streched

Limited by the tension developed in the posterior longitudinal

ligament

By the capsular ligament,ligamentum flavum,ligamentum

nuchae,

Combined lateral flexion and rotation-

Does not occur as pure motions

Governed by orientation of articular facets which are oblique inferiorly and

posteriorly

Rotation is always coupeled with lateral flexion

Considering the whole cervical column from C2-T1 extension component is

also added to these movements

Any movement b/C7 and T1 amounts for mixed rotation and lateral flexion of

C7

Where as any movement b/w C6-C7 also adds up extension

component

Thus three composite movement occurs in 3 planes-

Lateral flexion –frontal plane

Extension-sagittal plane

Rotation-transverse plane

RANGE OF MOTION

FROM- WHITE AND PUNJABI

stability

Cervical region bears less weoight and are more mobile

Stability is provided by bony configuration, muscles , ligaments

Ligaments Anterior atlnatoaxial ligament,posterior

atlantoaxial ligament,tectorial

membrane,ligamentum nuchae

Transverse atlantal ligament-21.9 mm in length

Also refered as atlantal cruciform ligament

Holds dense in closed approximation against the

anterior ring of the atlas

Also serves as an articular surface for dense

Prevents anterior displacement of C1 on C2

Alar ligaments-arise from axis on either side of

dens

Approx.1cm in legth

Are taut in flexion

Axial rotation of head and neck tightens both alar ligaments

Prevents distraction of C1 on C2

Apical ligaments-of the dens connects the axis and occioital bone of the skull

JOINT COMBINED FLEXION

EXTENSION

ONE SIDE LAT BENDING

ONE SIDE AXIAL ROTATION

C2-C3 10 10 3

C3-C4 15 11 7

C4-C5 20 11 7

C5-C6 20 8 7

C6-C7 17 7 6

C7-T1 9 4 2

Muscles of cervical vertebrae

*Muscles-flexion of head and neck-

Depends on anterior muscles of the neck

They are:

1. rectus capitis major, rectus capitis minor

2. Longus cervicis which plays an important role in straightening the cervical

column and holding it rigid

3. Scalene anterior posterior and medius

4. Suprahyoid and infrahyoid muscles helps in supporting the cervical column

at rest

5. sternocliedomastoid

Rectus Capitis Posterior Major

Origin: Spinous process of axis (C2)

Insertion: Lateral half of the inferior nuchal line of

the occipital bone

Action: Extension of the head

Innervation: Posterior Primary Ramus of C1

Primary Actions of the Rectus Capitis Posterior Major:

1. Extension of the head on the neck when acting bilaterally

2. Ipsilateral rotation of the cervical spine when acting unilaterally

Rectus Capitis Posterior Minor:

Origin: Posterior tubercle of atlas (C1)

Insertion: Lateral half of the inferior nuchal line of the occipital bone.

Action: Extension of the head

Innervation: Posterior Primary Ramus of C1

Primary Actions Rectus Capitis Posterior Minor:

1. Extension of the head on the neck when acting bilaterally

2. Ipsilateral rotation of the cervical spine when acting

unilaterally

Splenius Cervicis

Origin: Spinous processes and supraspinous

ligaments of T3 to T6

Insertion: Posterior tubercles of transverse processes

of C1 to C3

Action: Extention of the cervical spine,Lateral flexion

of the cervical spine, Rotation of the cervical spine

Innervation: Dorsal primary rami of C5 to C7

Primary Action of the splenius cervicis:

1. Extension of the cervical spine when acting bilaterally

2. Lateral Flexion of the cervical spine when acting

unilaterally

Secondary Action of the splenius cervicis:

1. Assists with ipsilateral rotation of the cervical spine when acting unilaterally

Scalenes

Scalene Muscle Group:

Scalenus Anterior

Origin: Anterior tubercles of

the transverse processes of (C3-C6)

Insertion: Scalene tubercle and cranial

crest of first rib

Action: Flexion of the cervical spine,

Lateral flexion of the cervical spine,

Innervation: Ventral rami of(C3-C8)

Primary Actions of the Scalenus Anterior:

1. Flexion of the cervical spine when acting bilaterally

2. Lateral Flexion of the cervical spine when acting unilaterally

Secondary Actions of the Scalenus Anterior:

1. Assists with contralateral rotation of the cervical spine when acting unilaterally

2. Assists with forced inspiration by elevating first rib

Scalenus Medius

Origin: Posterior tubercles of the transverse processes

of (C2-C7)

Insertion: Cranial surface of the first rib

Action: Flexion of the cervical spine, Lateral flexion of

cervical spine

Innervation: Ventral rami of (C3-C8)

Primary Actions of the Scalenus Medius:

1. Flexion of the cervical spine when acting bilaterally

2. Lateral flexion of the cervical spine when acting unilaterally

Secondary Actions of the Scalenus Medius:

1. Assists with contralateral rotation of the cervical spine

when acting unilaterally

2. Assists with forced inspiration by elevating the first rib

Scalenus Posterior

Origin: By tendons from the posterior

tubercles of the transverse processes of

(C4–C6)

Insertion: Outer surface of 2nd rib

Action: Lateral flexion of the neck

Innervation: Ventral rami of (C3-C8)

Primary Actions of the Scalenus Posterior:

1. Lateral flexion of the cervical spine when acting unilaterally

Secondary Actions of the Scalenus:

1. Assists with contralateral rotation of the cervical spine when acting unilaterally

2. Assists with forced inspiration by elevating the second rib

Sternocleidomastoid

Sternal Head:

Origin: Upper part of the anterior surface of

the manubrium Clavicular Head:

Origin: Superior surface of the medial one third

of clavicle

Insertion: Lateral surface of the mastoid

process of the occipital bone, from its apex to

its superior border, and by a thin aponeurosis to the lateral half of the

superior nuchal line

Action: Bilaterally: flexion of the head and neck, extension of the head and

neck

Unilaterally: rotation of head to opposite side, lateral flexion

Innervation: Accessory nerve: cranial nerve XII and ventral rami of the (C2,

C3)

Primary Actions of the Sternocleidomastiod:

1. Extension of the head and cervical spine when posterior fibers act bilaterally

2. Flexion of the head and cervical spine when anterior fibers act bilaterally

3. Lateral flexion of the head and cervical spine when acting unilaterally

4. Contralateral rotation of the head and cervical spine when acting unilaterally

*Extension of head and neck-

Brought about by posterior neck muscles

They are:

1- splenius cervicis,

2- semispinalis cervicis,

3- leavator scapulae,

4- transverso spinalis,

5- longismus capiis,

6- spenius capitis,

7- trapezius

These muscles helps in maintaining the cervical lordosis

When contract unilaterally they produce extension rotation and lateral

flexion on the same side

Both flexors and extensor group of muscles are responsible to maintain

cervical column rigid in neutral position

Essential in balancing the head and in supporting weights carried on head

Splenius Cervicis

Origin: Spinous processes and supraspinous

ligaments of T3 to T6

Insertion: Posterior tubercles of transverse

processes of C1 to C3

Action: Extention of the cervical spine,Lateral

flexion of the cervical spine, Rotation of the

cervical spine

Innervation: Dorsal primary rami of C5 to C7

Primary Action of the splenius cervicis:

1. Extension of the cervical spine when acting bilaterally

2. Lateral Flexion of the cervical spine when acting unilaterally

Secondary Action of the splenius cervicis:

1. Assists with ipsilateral rotation of the cervical spine when acting unilaterally

Semispinalis Cervicis :

Origin: By fleshy and tendinous fibers to the

transverse processes of (T1 – T6)

Insertion: Spinous processes of C2 to C5, spanning

four to six levels between attachment points

Action: Extension of the cervical spine, lateral

flexion of the cervical spine, rotation of the cervical

spine

Innervation: Dorsal primary rami of (C3-C5)

Primary Actions of the Semispinalis Cervicis:

1. Extension of the cervical spine when acting bilaterally

2. Lateral flexion of the cervical spine when acting unilaterally

3. Contralateral rotation of the cervical spine when acting unilaterally

4. Extension of the thoracic spine when acting bilaterally

5. Contralateral rotation of the trunk when acting unilaterally

Secondary Actions of the Semispinalis Cervicis:

1. Assists with lateral flexion of the thoracic spine when acting unilaterally

Levator Scapulae Origin: Posterior tubercles of the transverse

processes of C1-C4

Insertion: Superior part of the medial border of the

scapula

Action: Elevation of the scapula, downward

rotation of the scapula

Innervation: Anterior primary rami of (C3 and C4),

dorsal scapular nerve (C5)

Primary Actions of the Levator Scapulae:

1. Elevation of the scapula

Secondary Actions of the Levator Scapulae:

1. Downward rotation of the scapula

Transverso spinalis ORIGIN Transverse processes

INSERTION Spinous processes above and occipital bone (only semispinalis capitis

part shown)

NERVE Posterior primary rami

ACTION:

1. One side - Lateral flexion of the cervical and thoracic spine 2. Both Sides - Extension and hyperextension of atlantooccipital joint

and thoracic spine.

Longissimus Capitis Origin: By tendons from the posterior

surfaces of the transverse processes of T1

to T5 and the articular processes of C4 or

C5-7

Insertion: Posterior margin of the mastoid

process of the occipital bone

Action: Extension of the head and cervical

spine

Innervation: Dorsal primary rami of C4 to

T5

Primary Actions Longissimus Capitis:

1. Extension of the head and cervical spine when acting bilaterally

Secondary Actions Longissimus Capitis:

1. Assists with ipsilateral rotation of the cervical spine and head when acting

unilaterally

SPLENIUS CAPITIS

ORIGIN Lower ligament nuchae, spinous processes and

supraspinous ligaments T1-3

INSERTION Lateral occiput between superior and inferior

nuchal lines

ACTION Extends and rotates cervical spine

NERVE Posterior primary rami of C3, 4

Trapezius

Origin:

Upper part: External occipital proturberance,

medial third of the superior nuchal line, the

ligamentum nuchae, and the spinous process

of C7

Medial Part: Spinous processes of T1 to T5.

Lower Part: Spinous processes of T6 to T12

Insertion:

Upper Part: Lateral third of the clavicle and

the medial aspect of the acromion process of

the scapula

Middle Part: Medial edge of the superior surface of the acromion process of

the scapula and the superior edge of the scapular spine.

Lower Part: Tubercles of the apex of the scapular

spine

Action:

Upper Part: Upward rotation of the scapula,

elevation of the scapula

Middle Part: Retraction of the scapula

Lower Part: Upper rotation of the scapula,

depression of the scapula

Innervation: Spinal Accessory Cranial XI , Ventral

Rami C2-C4

Primary Actions of the Upper Trapezius

1. Upward rotation of the scapula

2. Elevation of scapula

Secondary Actions:

1. Assists with elevation of the cervical spine (distal attachment fixed, acting

bilaterally)

2. Assists with lateral flexion of the cervical spine (distal attachment fixed,

acting unilaterally)

3. Assists with contralateral rotation of the head and cervical spine when acting

unilaterally

Primary Actions of the Middle Trapezius

1. Retraction of scapula

Primary Actions of the Lower Trapezius

1. Upward rotation of the scapula

2. Depression of the scapula