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HumanMovementSystem
MovementSystemImpairment
SyndromesoftheCervicalSpine
ShirleySahrmann,PT,PhD,FAPTA
ProfEmeritaPhysicalTherapy
WashingtonUniversitySchoolof
Medicine St.Louis

PhysicalTherapyIdentity
DiagnosismadebyPTsareofthemovement
system
MovementSystemImpairment(MSI)
Syndromes
SubsetofMovementSystemDiagnoses

MovementSystemImpairment
DiagnosesofCervicalSpine

MSISyndromes
Namedforthealignmentand/ormovement
directionthatmostconsistentlycausespain
andisimpaired
Whentheimpairedmovementiscorrected
thesymptomsdecreaseorareeliminated

Extension
Rotation*
Flexion
Rotationextension
Rotationflexion

*mostcommon
component

ManualSkills
Handsonfor
Assessingthecervical
rotation
Wherethemotionis
occurring
Theresistanceofshoulders
andshouldermusculature

Correctionofcervical
muscleeffectsandthe
effectonmobility

Treatment:
Guidepatientincorrect
motion
Alleviatingsymptomswith
correctionofcervical
alignment,
Cervicalmotion
Shouldergirdlemuscular
effects

Manualassistancefor
correctioninseveral
positions

ContributingFactors
Themusculatureoftheshouldergirdleaffects
alignment,movement,stressonthecervicalspine
alignmentoftheshouldergirdleisakeytocervicalpain

Thealignmentofthethoraxaffectsthealignmentof
thecervicalspine
Bothkyphosisandflat

Alterationofintrinsiccervicalmuscleperformance
usuallyrelatedtoheadpositioninrelationtogravity

Compensationsbetweenupperandlowercervical
spinemotion

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CommonImpairments

UpperCervicalRangeofMotion

Intrinsic neckmusclesbecomeweakorlong
compromisefinecontrolofvertebralmotion
Extrinsic musclesbecomedominantaddingto
compressive,rotational,&shearforces
exertedonthecervicalspine

HeadandNeckExtensors

LowerCervicalRangeofMotion

Intrinsicmuscles
semispinaliscapitis
semispinaliscervicis
puresagittalrotation

DeRosa & Porterfield

AttachmentofCervicoscapular Muscles
ExtensionwithTranslation

Head&NeckRotators/extensors

Trapezius

Levator Scapulae

Intrinsicmuscles
semispinaliscervicis
superioroblique
inferioroblique
rectuscapitis
cervicis
AttachedtoC2
DeRosa & Porterfield

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DeRosa & Porterfield

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MovementsoftheUpperExtremities
Cervicalmotioninducedbyshouldermotion

SignsandContributingFactors:Alteredupperandlowercervical
participation;overdevelopedextensors,inadequatedeepneck
flexors

CERVICALEXTENSIONSYNDROME
Cervical extension with shoulder flexion.

ShoulderFlexionwhilecontractingdeepneckflexors
Decreasescervicalextensionandpain

SignsandContributingFactors:Asymmetricalupperandlowercervical
rotation;Impreciserotation;AlteredactionofCervicoscapularmuscles

CERVICALROTATIONSYNDROME

Upward rotation of scapula stretches levator scapulae muscle

cervical vertebrae will rotate to same side if hypermobile

Upper trapezius rotates head & neck to opposite side

Kendall 1993

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Kendall 1993

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Cervical rotation to the right during left shoulder flexion

Tennisinstructor
Right shoulder
flexion

Left shoulder
flexion
Spinous
processes
to left

AsymmetricalRotation

Cervical rotation limited by

trapezius and levator scapulae muscles

Maximum rotation

Shoulders passively elevated

Upperandlowershiftedtoleft

Cervical rotation limited by

upper trapezius & levator scapulae muscles
Maximum rotation

CervicalRotation:Impaired
AffectedbyCervicoScapularMuscles

Rotation with shoulders elevated

Uppercervicalrotationnotlower

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ImpairedFlexion

NeckFlexors
Intrinsicmuscles
Longuscapitis
Longuscolli
Puresagittal
rotation

Forward head with increase

upper thoracic flexion

DeRosa & Porterfield

Flexion lower spine remains

extended

DominantExtrinsic
NeckFlexors

Sternocleidomastoid
MultipleActions

Sternocleidomastoid
Sternal&clavicularhead>Mastoid
significantinfluenceoncervicalspinemotionbut
doesnotdirectly
attachtoCspine

Extendupper
Cspine

Rotation

Function:

bilateral flexion
unilateral rotatetoone
side&laterallyflexto
oppositeside

Flexion
lowerCspine

Mechanical Neck Pain - Porterfield & DeRosa

LengthenIntrinsic
NeckFlexors

Forward
translationwith
anteriorshear
Particularly with
weak intrinsics

Mechanical Neck Pain - Porterfield & DeRosa

DeepNeckFlexorMuscleWeakness

Longuscapitis
TPsC36>Occiput

Longuscolli

TPsC3C5>C1arch
BodiesofT1,2,3>TPsC5,6
BodiesofC57,T13>Bodies
ofC2,3,4
Mechanical Neck Pain Porterfield & DeRosa

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WeakDeepNeckFlexorMuscles
UnabletoMaintainFlexion

ImpairedPositioning Cervical
ExtensionwithRocking

UpperCervicalExtension

ShoulderElevationandKyphosis
ContributingtoCervicalExtension
Initial visit

Upper cervical extension greater than

Lower cervical -

Limited cervical flexion

ImprovedAlignment DecreasedPain
Initial visit

2 weeks later

2 weeks later

Contributing factors: long trunk, short arms,

large breasts with bras straps adding to downward
pull on neck
Poor sitting alignment

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Corrected sitting alignment

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DominantExtrinsic
NeckFlexors
Scaleni:
Anterior TPsC36>1strib
Middle TPsC27>1strib
Posterior TPsC57>1strib

Function:
Flexionwithanteriorshear

SignsandContributingFactors:Flatcervicalandthoracicspine

CERVICALFLEXIONSYNDROME

Depressedchestaffects
cervicalalignment
Mechanical Neck Pain - Porterfield & DeRosa

CervicalFlexionandFlatThoracic
Spine

Cervical Lordosis with thoracic kyphosis

Kendall 1993
ImpairedCorrection

Kendall 1993

AnotherformofFlexionSyndrome:Swayback

SCALENEMUSCLERESTRICTION

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Without arm support

With arm support

Passive elevation of rib cage

ShoulderDepression Cervical
Compression
Initial Visit

Two Months later

Cervicalsurgerytwicestillinconstantpain

ShoulderDepression Cervical
Extension

ImprovedShoulderMotion
DecreasedCompression

Initial Visit

Initial Visit

Two Months Later

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Two Months Later