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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 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.



Neck and upper extremity pain are common in the general population, and almost everyone experiences neck pain at some point in their life. Indeed, neck pain affects about 30–50% of the general population, with the highest incidence affecting middle-aged individuals.1,2 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. Whatever the age, people experiencing neck pain are 2–3 times more likely to report limitations in work, fitness, and social activities, demonstrating its debilitating effects on overall health. 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. The cervical spine is also a region capable of harboring serious pathology given its proximity to vital neural and vascular structures.

This chapter includes information from the 2017 Neck Pain: Clinical Practice Guidelines (CPG) Linked to the International Classification of Functioning, Disability and Health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association (APTA), particularly its upper portions.3


The cervical spine (Fig. 25-1), consisting of 37 joints, permits more motion than any other spine region. The majority of the cervical spine anatomy can be explained by the daily head and neck functions. The head has to perform extensive, detailed, and, at times, very quick motions during everyday tasks. These motions allow for precise positioning of the eyes and 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 forfeited for mobility, the cervical spine is more vulnerable to direct and indirect trauma.


Cervical vertebra.

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