KINESOLOGY OF CERVICAL SPINE

1. KINESOLOGY OF
CERVICAL SPINE
PRESENTED BY :
DR.ASER MOHAMED KAMAL
PHYSICAL THERAPIST

2. 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

3. 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

4.  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

5.  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

6.  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

7. 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

8. 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

9. 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

10. 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

11.  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

12.  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

13. 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

14.  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