NASM CES Chapter 16: Corrective Strategies for the Cervical Spine

If you have not yet signed up for the NASM CES certification, receive a big discount here.

Get your copy of the NASM CES exam cheat sheet. It helps immensely for studying for the exam.

My PTP students report cutting their NASM CES study time and effort in half with Trainer Academy. 

Benefit from the Exam Pass Guarantee and Retake Fee Guarantee. Plus, take advantage of my current discount code PTPOCTOBER for 50% off the MVP Program (Ends October 14th, 2024).

Try it out for free here to see if it’s right for you, or read my detailed review for further insights.

Chapter Goals:

• Know the basic functional anatomy of the cervical spine.
• Find the mechanisms for common injuries to the cervical spine.
• Describe the influences of alterations of the cervical spine movements and the kinetic chain. 
• Find the right strategies for systematic assessment of the cervical spine.
• Be able to choose the right strategies for corrective exercise in the cervical spine. 

Introduction

According to a survey, neck pain is the third most common form of pain for the American population and also one of the four main disability causes in the entire world. About 2/3 of the population will experience some form of this pain throughout their life.

It can be mild or even severe and interfere with our normal life, like sitting, turning, and sleeping.

It can be acute pain or chronic.

It is also known that women are three times more likely to experience this problem than men.

When someone is under stress, the pain in their neck chances will increase by 150%. 

Review of the Cervical Spine Functional Anatomy

The cervical spine has a lot of influence on the rest of the kinetic chain. Numerous bones, joints, and muscles are involved in the cervical spine. This section is for those. 

Bones and Joints

The cervical spine starts at the base of the skull and it has seven different vertebrae in it.

These are C1 to C7. the C1 is known as the atlas. Anterior to the cervical spine is our hyoid bone, and it does not articulate with any other bones and instead is suspended with muscles.

Muscles 

The cervical spine is a small region, but many muscles are responsible for proper functioning.

The deep neck flexors, lower traps, and the serratus anterior comprise the upper oblique subsystem, the pecs, upper traps, and the levator scapulae. 

The key muscles that we have to know that are associated with the cervical spine are the levator scapulae, rhomboids, trapezius, sternocleidomastoid, pec minor, scalenes, cervical extensors, and deep cervical flexors. 

One of the more common muscle problems comes from upper crossed syndrome being present in the body. 

Altered Cervical Spine Posture and Movement

People will take on many different head and neck positions while doing activities.

Exclusive PTP CPT Offers
Gold Standard Cert	Most Popular Cert	Best Study Materials
A Good Option	A Good Option	Best CPT for you?

Forward head posture is one of the most common posture impairments we see.

It is very common for workers who work at a desk, people who use smartphones, and kids who play video games for long periods. 

Static Malalignments

Forward head posture will be when the head and neck both protrude forward and force the lower cervical spine to flex and the upper cervical spine to extend so that the head can be kept upright in the right form somewhat.

This condition will cause a lot of stress to the cervical vertebrae, lengthen the anterior muscles of the neck, and shorten the posterior muscles of the neck.

These compensations will have much influence elsewhere in the body, especially the shoulders right below. 

Causes of Forward Head Posture

Kids and adolescents that have poor posture for long times from playing video games for extended time periods will bring these poor alignments with them into adulthood.

Spinal remodeling can be an effect of this long time poor posture.

It increases the risks we have of degenerative conditions occurring. 

When people use computers, primarily for a desk jobs, we see this chance of forward head posture increase.

This is also seen to cause more headaches and neck pain.

Smartphones are another factor that plays a role in the occurrence of forward head posture.

We see people looking down at their phones for long periods, accentuating the poor posture of the head. 

Abnormal Movement Patterns

When we see the forward head posture in the static assessment, it is reasonable to consider that there will be imbalances in the myofascial system.

Muscles will be found to be overactive and underactive and we can usually guess these.

The advanced stages of forward head posture will have compression of the upper cervical spine, which will end up seriously affecting the ability to rotate C1 around C2. 

Dynamic Malalignment 

With our movements, the neck, head, shoulder girdle, and thoracic spine all work as independent body parts. When forward head posture is present, the excessive strain may be put on regions below the head.

Range of motion decreases will result from the forward head posture in the cervical and the upper thoracic spine.

These issues will be more common in adolescents and adults participating in using computers for long periods and online gaming or smartphones. 

Cervical Spine Dysfunction and the Regional Interdependence Model

Dysfunction of the spine, like all checkpoints we look into, will have some effects that resonate in the other parts of the body. There will be issues above and below the cervical spine. 

Hyoid Bone Positioning

This is a floating bone, meaning that it has no attachment to another bone, but instead, it is suspended by muscles.

It is a link between the cervical spine and the head and has a big role in chewing, swallowing, speaking, and proper breathing.

Exclusive PTP CPT Offers
Gold Standard Cert	Most Popular Cert	Best Study Materials
A Good Option	A Good Option	Best CPT for you?

Forward head posture increases the tension in the muscles relating to the hyoid bone and may lead to jaw pain and poor swallowing of food. 

Influence Above the Cervical Spine

The load bearing on the muscles and joints in the upper cervical spine is affected by forward head posture.

If it is sustained constantly, it may lead to overactivity and shortening of the extensors ad suboccipital muscles.

Pain thresholds and predisposition for myofascial trigger points are linked with forward head posture. 

TMJ is a hinge joint of the jaw and can be negatively influenced by these problems of forward head posture. 

Influence Below the Cervical Spine

Many people with a forward head posture will also have rounding of their shoulders, showing a clear link between cervical spine dysfunction affecting the proximal and inferior thoracic spine and shoulder region. 

The scapulohumeral rhythm is affected and this can lead to scapular dyskinesis.

This is when the scapula cannot move normally during humeral elevation and is associated with shoulder pain and impingement. 

Forward head posture is also likely to affect our respiratory system.

Normal breathing is initiated by contracting the primary muscles of respiration of the diaphragm and the external intercostals. 

Assessment Results for the Cervical Spine

Like the other body regions, the cervical spine can and will be assessed using static posture assessments, dynamic and transitional assessments of movement, and range of motion or mobility assessments.

Look at the table in this part of section two of the chapter to see the various results we may receive from going through these different assessments. 

Static Posture

The postural dysfunctions highlighted for this region are the upper cross and the layered cross syndrome, including a forward head posture and rounded shoulders.

Both of these are what you look for, primarily in the static posture observations. 

Transitional Movement Assessment

Like how we see some people’s feet turn out in an overhead squat, some muscle imbalances of the neck only show up when we put the body under non-static testing.

The overhead squat and the pushing and pulling loaded assessments will be the most useful for us here. 

Overhead Squat Assessment

In the overhead squat, the cervical spine may extend too much into the forward head posture.

This is usually due to overactive extensors that cause the deep neck flexors to get underactive and lengthen. 

Loaded Movement Assessment

Overactivity in the sternocleidomastoid, upper traps, and/or the scalenes may cause forward head posture, but those muscles can also impact the dynamic posture in the shoulder.

So, these muscles’ poor function will directly affect two regions. 

Dynamic Movement Assessments

These are similar to the biomechanics in a loaded pushing movement, so the Davies test will be the primary one to highlight cervical spine dysfunctions. 

Mobility Assessments

When clients show static or dynamic posture problems in their neck and shoulder checkpoints, the professional should be doing mobility assessments in the cervical spine. 

Corrective Strategies for the Cervical Spine

Forward Head Posture Program:

Inhibiting the use of SMR on the sternocleidomastoid muscles, levator scapulae, upper trapezius, and cervical extensors will be used in this phase. We will also pay attention to and use the acute training variables that were established for this phase of corrective exercise in the associated chapter. 

Lengthening the sternocleidomastoid, levator scapulae, upper traps, and scalenes with the use of static stretching is the second part of the process. We will also pay attention to and use the acute training variables that were established for this phase of corrective exercise in the associated chapter. 

Activation with isolated strengthening will be used third, which has us isolated strengthening the muscles of the deep cervical flexors, rhomboids, and the mid and low traps. We will also pay attention to and use the acute training variables that were established for this phase of corrective exercise in the associated chapter. 

Integration is the final stage. Here we use integrated dynamic movement with the deep cervical flexors, rhomboids, and mid and lower traps. We will also pay attention to and use the acute training variables that were established for this phase of corrective exercise in the associated chapter. 

Make sure to go through the steps and pictures associated with the program. 

Common Issues Associated with the Cervical Spine

Local injuries to the cervical spine:

• Pain and stiffness in the area
• Text neck
• Elevation of the hyoid bone
• Dysfunction of the traps
• Dysfunction of the levator scapulae
• Dysfunction in the cervical joint
• Cervical strains of the muscles
• Dysfunction of the deep flexors
• Lesions of the cervical discs

Injuries that are above the cervical spine:

• Cervicogenic headaches
• Dizziness and lightheadedness
• Symptoms relating to TMJ

Injuries below the cervical spine:

• Pain and weakness of the upper extremity
• Impingement of the AC
• Dysfunction of breathing, the scapula, and thoracic spine
• Thoracic outlet syndrome
• Anterior pelvic tilt and lower back pain
• Dysfunction of the sacroiliac joint

Muscle Strain

The cervical spine is exposed often and especially so when doing sports and athletics.

There is a risk of collision during contact sports.

The most common injury of the neck will be a muscle strain, which happens when a tendon or muscle is overstretched or overworked, disrupting or tearing the muscle tissues.

We also know this as a pulled muscle. The result is pain, swelling, spasms, and weakness. 

Stenosis of the Cervical Spine

Spinal stenosis is seen in older people more often. Some middle aged people will be predisposed to it, and they will have it occur sooner than old age.

There is a reduction in disc height and thickening and reduced flexibility of the spine’s ligaments. 

Degenerative Disc Disease

The intervertebral discs will make up one fourth of the height of a healthy spine.

During the natural aging process, the spinal discs’ height will e less able to hold fluids, which will show up in the form of lost height and reductions in shock absorption.

At advanced ages, we see the discs dry out and become thinner.