Chapter 25. The Cervical Spine

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.

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 in reference to the functions that the head and neck perform on a daily basis. To carry out these various tasks, the head has to be provided with the ability to perform extensive, detailed, and, at times, very quick motions. These motions allow for precise positioning of the eyes and the ability to respond to a host of postural changes that result from stimulation of the vestibular system (see Chap. 3).1 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.2 Neck and upper extremity pain are common in the general population, with surveys finding the 1-year prevalence rate for neck and shoulder pain to be 16–18%.2,3 This frequency is also reflected in the prevalence of neck pain in the outpatient physical therapy setting, which has been found to be between 15% and 34%.3,4 In the younger population, cervical pathology is most commonly due to a ligament sprain or muscle strain, whereas in the older population cervical injuries are more commonly due to cervical spondylosis and/or spinal stenosis. Due to the complexity of this area, sufficient time must be allowed for a comprehensive examination to ensure that all causes of the signs and symptoms are determined.

Bogduk and Mercer5 divide the cervical spine into four anatomical units: the atlas, the axis, the C2–3 junction, and the remaining cervical vertebrae. For the sake of simplicity, these units are described in separate chapters. The atlas, axis, ...