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The neck or cervical spine is composed of an intricate system of bones, discs, ligaments and muscles that are responsible for stabilizing our head while still allowing for a wide range of flexibility.  The neck is made up of 7 vertebrae labeled C1-7 that are connected to each other via two facet joints, which slide across each other during normal movements.  Between each vertebrae exists an intervertebral disc, which acts as a shock absorber and maintains normal spacing among adjacent vertebrae, which is also important for normal range of motion.  Without normal spacing, more load is placed on the facet joints, thus, preventing normal cervical movement.  Besides joints and discs, 8 pairs of cervical nerve roots (C1-8) that are responsible for providing motor and sensory function to the neck and arms and numerous local and global muscles and ligaments are present.

The neck moves through all 3 planes of motion, which include the sagittal plane (up and down or ”yes” motion), frontal plane (side to side or ear to shoulder motion) and the transverse plane (rotation or “no” motion).  A loss of normal cervical spine range of motion is common especially as people age and is often due to intervertebral disc degeneration and arthritis at the facet joints.  However, the neck is no different than any other region of the body and the old “use it or lose it” principle still applies.  The following images and descriptions will describe normal neck range of motion and can also be used as simple exercises to help improve movement in directions that may be tight.  Keep reading, there’s more

As a physical therapist, a great deal of my time is spent educating people on the importance of proper body alignment, symmetry and posture.  I would be willing to bet that most of us have been told since an early age that correct posture is important, but how many people can actually explain why this is true.

As I have mentioned in previous posts, most humans fall into a few typical movement or postural patterns and it is these patterns that are responsible for the majority of musculoskeletal complaints.  Now take a minute and think about what I am saying…imagine that on average you are awake 16 hours per day and that a large percentage of those hours are spent in a gravity dependent position such as standing or sitting, whether at school or at work.  Both school and work, in most cases, involve prolonged periods in which we are not moving a whole lot and even sitting for extended amounts of time.  I realize this does not count for everyone, but trust me this scenario is true for most.  While you are sitting or standing in place, your postural muscles are active in an effort to fight the effects of gravity and keep you upright.  This is where the problem occurs.  Most of us give in to the effects of gravity and begin to slouch either out of habit, muscle weakness or fatigue.

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Patients suffering from disc degeneration of the cervical spine (neck) often experience pain and radiculopathy or radiating symptoms into the arm.  When disc degeneration occurs,  water is lost from the disc leading to decreased disc height and narrowing of the space (intervertebral foramen) where the nerve root exits.  This narrowing is termed stenosis and can occur centrally at the spinal cord or laterally over the nerve root. 

In situations where physical therapy, medication, injections and surgical procedures designed to remove bone spurs and interfering disc material fail, many patients must undergo a cervical fusion.  Cervical fusions basically involve locking two vertebrae together to prevent further degeneration and restore the space between the vertebrae to it’s normal height.

This image is an x-ray of a cervical fusion.  You can see the space between each vertebrae, which is where the disc is located.  At the fusion level, you can see how the fusion has increased  the intervertebral space.

The problem with fusions is that they obviously prevent motion at the motion segment they are fusing.  This lack of motion at one segment often leads to increased degeneration at the segments above and below the fusion site.

The good news is that the FDA has just approved the BRYAN cervical disc replacement, which basically replaces the patient’s damaged disc with an artificial disc that allows motion. 

By allowing motion, degeneration at adjacent motion segments would be reduced.  Check out this articlefrom MedGadget for more information.

Studies have shown that as much as 70% of the population will experience neck (cervical) pain at some point in their life with 30% of these individuals going on to develop chronic symptoms including pain, headaches, limited range of motion, decreased strength and impaired function with everyday activities. A growing body of evidence is showing that cervical muscle function plays a large role in recovery after injury and in preventing recurrent symptoms.

The cervical spine is supported by a large number of global muscles designed for movement and deeper muscles intended to provide stability between individual vertebrae. When one considers the fact that the neck would collapse under loads of less than 20% of the weight of the head without this intricate muscle system, it becomes evident why optimal neck function is directly related to muscle strength and endurance.