Chapter 25: The Cervical Spine

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

1. Describe the anatomy of the vertebrae, ligaments, muscles, and blood and nerve supply that comprise the cervical intervertebral segment.

2. Describe the biomechanics of the cervical spine, including coupled movements, normal and abnormal joint barriers, kinesiology, and reactions to various stresses.

3. Perform a detailed objective examination of the cervical musculoskeletal system, including palpation of the articular and soft tissue structures, specific passive mobility tests, passive articular mobility tests, and stability tests.

4. Perform and interpret the results from combined motion testing.

5. Assess the static and dynamic postures of the cervical spine and implement the appropriate intervention.

6. Apply manual therapy techniques using the correct grade, intensity, direction, and duration.

7. Evaluate intervention effectiveness in order to progress or modify the intervention.

8. Plan an effective home program, including spinal care, and instruct the patient in this program.

9. Help the patient to develop self-reliant intervention strategies.

OVERVIEW

The cervical spine (Fig. 25-1), which consists of 37 joints, permits more motion than any other region of the spine. The majority of the anatomy of the cervical spine can be explained by reference to the functions that the head and neck perform on a daily basis. The head has to be able to perform extensive, detailed, and, at times, very quick motions during everyday tasks. These motions allow for precise positioning of the eyes and the ability to respond to a host of postural changes. In addition to providing this amount of mobility, the cervical spine has to afford some protection to several vital structures, including the spinal cord and the vertebral and carotid arteries. However, with stability being sacrificed for mobility, the cervical spine is rendered more vulnerable to both direct and indirect trauma.¹

Neck and upper extremity pain are common in the general population. Almost everyone experiences neck pain at some point in their life,² and approximately 54% of individuals have experienced neck pain within the last 6 months.³ In the younger population, cervical pathology is most commonly due to a ligament sprain or muscle strain, whereas in the elderly cervical injuries are more commonly due to cervical spondylosis and/or spinal stenosis. Neck pain, which is characterized by episodes of exacerbation and recovery, has a large financial impact on a number of industrial countries.⁴ Neck pain may also coexist with signs and symptoms of distal involvement, including pain radiating down the arms and weakness or numbness in the upper extremity.⁵ Most individuals with cervical dysfunction are labeled as having nonspecific neck pain caused by a neuromuscular or articular dysfunction.⁶