The Cervical Spine

cervical spine imageThe cervical spine is an important region of the vertebral column in the field of manual medicine.  It receives a great deal of attention by manual medicine practitioners.  It functions as the support of the skull and biomechanically provides mobility for a number of activities of daily living.  A myriad of head, neck, and upper extremity symptoms have been observed when the cervical spine is dysfunctional.  Symptomatic conditions in the area can be categorized as cervicocephalic syndrome, cervical syndrome, and cervicobrachial syndrome.

The cervicocephalic syndrome includes pain and restriction of motion of the upper cervical spine and associated superficial and deep pain in the head.  This syndrome often demonstrates alteration in vision, vertigo, dizziness, and nystagmus.

The cervical syndrome includes painful stiffness of the neck of varying severity from mild to acute spastic torticollis.

The cervicobrachial syndrome couples painful stiffness of the cervical spine with symptoms in the shoulder girdle and upper extremity.  The upper extremity symptoms result from alteration of the functional capacity of the brachial plexus or altered vascular function through the arterial, venous, and lymphatic systems.  Associated dysfunctions of the thoracic inlet, particularly the first and second ribs and in the thoracic spine and rib cage as far as T5 or T6, contribute to the cervicobrachial syndrome.

The cervical spine is subjected to acute injuries such as the flexion-extension “whiplash” injury and chronic repetitive injury from improper posture and abnormal positions of the head and neck.  It is common in our culture to patients with forward head carriage as a component of poor posture.

Forward head posture results in an increase in the upper cervical lordosis and a flattening of the lower cervical spine.  The balance of the head on the neck is altered, resulting in muscle imbalance with resulting tightness of the neck extensors and weakness of the deep neck flexors.

The clinical practitioner must understand the anatomy, physiology, and biomechanics of the region to understand the therapeutic role of manual therapy and avoid potential complications.

The cervical spine is particularly susceptible to degenerative forces arising from repeated movements, prolonged postures, and simply through the process of aging.  The cervical spine is particularly susceptible to degenerative changes because normal day-to-day activities require frequent movement of the head and cervical spine.  The inevitable degeneration process leads to injury, altering the precision of movement that negatively impacts the rate and type of degeneration.

The onset of painful and degenerative conditions of the cervical spine is precipitated by deviations in alignment and movement patterns.  The clinical practitioner must be particularly familiar with the normal anatomy and kinesiology of the cervical spine to form the basis for understanding and recognizing abnormal motion.

Optimal alignment and movement patterns are believed to slow the degenerative process.  Therefore, good posture and optimal movement patterns should be understood and practiced.

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