Neck Stability

A lecture by J. Douglas-Morris for:

BIOS1169 Functional Musculoskeletal Anatomy B

Dates: Week 12 Monday May 24 2010

Week 12 Monday Oct 18 2010

Neck Stability lecture – May 24/Oct 18 2010

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Images in this lecture have been created by J. Douglas-Morris in 2008/9

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
 Neck functions
1. support of head

2. protection of neurovascular structures

spinal cord, roots & nerves + vertebral arteries

3. optimal positioning of special senses

ie. vision, hearing, olfactory, vestibular
Š head still, body moves under stationary head
Š head turns on stationary body

Basic requirement for neck

mobility ++
achieved by high degree of inter-
segmental (inter-vertebral) motion

Æ a very high demand for

dynamic inter-segmental
stability

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
Line of Gravity mastoid
external auditory meatus

(LOG) process anterior to transverse axis

of A-0 joint Æ head flexion
posterior tubercle
of atlas (C1) due to gravity effect
spinous process (sp) C1 dens (odontoid process) of C2
of axis (C2) C2
styloid process
C3
posterior to (transverse) transverse foramen
axis for flexion-extension C4
for vertebral artery
of mid-cervical joints C5 transverse process
Æ neck extension
C6
due to gravity effect
C7 anterior to
T1 (transverse) axis
for flexion-extension
C7 & T1 sps T2 of lowest cervical joints
Æ neck flexion
body of T1 due to gravity effect

JanDM 09
LOG
lateral view of neck

Implications of LOG
If the LOG passes anterior to the (transverse) axis
for flexion-extension, there will be a flexor moment
for the head &/or neck created by gravity which then
needs to be controlled by increased activity in the
head extensors (eg. suboccipital muscles)
…AND in some neck extensors for the low cervical region.
If the LOG passes posterior to the (transverse) axis
for flexion-extension, there will be an extensor
moment for most of the neck created by gravity
which then needs to be controlled by increased
activity in the neck flexors (eg. longus colli) and/or
passive tension in structures located anteriorly (eg.
anterior longitudinal ligament (ALL)).

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
 Neck stability is complex

An interaction between:
‘muscular’ ‘non-muscular’
i) active & passive structures

ii) global & local (segmental) structures

‘span neck’ attach to individual vertebrae

eg. splenius capitis is active and global

eg. ligamentum flavum is passive and
local (segmental)

Achieving/Maintaining ‘Stability’
1. congruency of joints/bony fit PASSIVE
- articular surfaces can be congruent or incongruent in:
Š size

Š shape eg. “flat-topped” vertebral body develops unci

in neck region at ~8-9 years
- bony articular surfaces can appear to be incongruent or
congruent in shape but their congruency is able to be
altered by the relative thickness of their articular cartilage
eg. lateral A-A joint bony surfaces are ~flat-flat
(congruent in shape) but the articular cartilage
of each iaf C1 and saf C2 is thicker centrally
and thinner peripherally Æ convex-convex
joints = incongruency Æ mobility

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
Achieving/Maintaining ‘Stability’
2. orientation of joints PASSIVE
dens

mandible
C1 hyoid bone
C2 opposite C3
C2 spinous process
C3
C34, C45 & C56
zygapophyseal
C4
joints lie more
C6 spinous process C5 oblique in the
C7 spinous C6 coronal plane
process C7 C23 and C67
zygapophyseal
joints are more
vertical in the
Lateral neck X-ray – outline of bones coronal plane

Cervical zygopophyseal joint variations

The size and orientation of the superior and inferior
articular facets of the cervical zygapophyseal joints vary
and, therefore, variably contribute to the degree/range of:

• WB of the head if more oblique in the coronal plane,

they bear more weight
• flexion/extension if more vertical in the coronal plane,
there is less flexion/extension ROM
between individual vertebrae
• “coupling” between planar motions

• shearing and torsion between vertebrae

more vertical = less anterior shear during flexion
The articular facets for the C5 vertebra are more horizontally orientated than
high up or low down in neck Æ ↑ WB ↑ ROM ↑ ant shear/torsion on IV discs

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
 Achieving/Maintaining ‘Stability’
2. capsule & extracapsular ligaments PASSIVE
eg. lax capsules of cervical Z joints Æ mobility ++
ALL and PLL Æ stabilise interbody joints (IV discs)
ligamenta flava Æ stabilise/protect zygapophyseal joints

3. fascial structures eg. ligamentum nuchae

PASSIVE

4. intra-articular inclusions eg. meniscoids

(fibrofatty space fillers) in the lateral atlanto-axial
and cervical zygapophyseal joints
PASSIVE

Passive & local (segmental)

ƒ capsules of zygapophyseal joints
ƒ intervertebral discs
ƒ segmental ligaments (for C2-T1 vertebrae)
• ligamentum flavum
• interspinous and intertransverse ligaments
• PLL*
• deepest parts of ALL*
ƒ “ligaments” for A-O and A-A joints
• anterior atlanto-occipital (O-C1) membrane (cts ALL)
• posterior atlanto-occipital (O-C1) membrane (~ lig.flava)
• alar ligaments*
• apical ligament of dens
• tectorial membrane (cts with PLL)
• transverse ligament of atlas*
• superior and inferior bands of cruciform (cruciate) ligament

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
 Atlanto-occipital & atlanto-axial joints **critical
ligaments
- ligaments & membranes anterior tubercle of atlas
alar ligament** dens synovial cavities
(2) of the A-A joint
transverse anterior atlanto-
ligament of occipital membrane
the atlas** lateral mass of atlas

transverse
09 process
DM
Jan transverse
tectorial foramen for
membrane vertebral artery
saf atlas
non-articular “waist”
posterior atlanto- posterior arch of atlas
occipital membrane
posterior tubercle of atlas
superior view of atlas and dens tip

Ligamentum nuchae raphe provides

a large thick fibrous attachment for:
structure in the midline of • upper trapezius
the posterior neck in • splenius capitis
two parts: • rhomboid minor
• serratus posterior
1. thick flat raphe superior
from C7 sp to
inion (external
occipital protuberance)
2. thin septum (wall) septum separates
composed of fascia left and right side
connecting the raphe muscles
JanDM

to the bifid spinous

processes “not a true ligament”
posterior view of body Mercer SR,
Bogduk N (2003)

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
How do the neck muscles stabilise
the head/neck?
1. Most of the muscles of the neck are in a
position to contribute to neck stability as
they will compress many, if not all, of the
cervical vertebrae when they contract.

2. The muscles of the neck also contribute to

neck stability when they contract
eccentrically as they control the range of
movement (ROM) and speed of
movements opposite to their actions.

3. Many of the muscles of the neck attach to

individual cervical vertebrae so are able
to directly control the position of any one
vertebrae in relation to its neighbouring
vertebra(e) Æ intersegmental stability.

4. The superficial neck muscles ‘span’ from

base of neck to head so are able to
stabilise by correctly orientating the
head in space.

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
5. All neck muscles are able to contribute to
neck stability by isometrically contracting
to produce a co-contraction of agonists
and antagonists which prevents any neck
movement from occurring at all.

6. The deep neck muscles have a high

density of proprioceptors so are able to
contribute to neck stability by feeding
back information about the
instantaneous position, direction of motion
and speed of motion of the neck joints.

Active & local (segmental)

Any muscle that has individual fibres attaching
independently to parts of adjacent cervical vertebrae

Mid and low cervical region

Deep posterior muscles: Deep anterior & lateral
muscles:
ƒ transversospinalis group ƒ levator scapulae
- semispinalis cervicis ƒ longus colli
- multifidus ƒ scalenes
- rotatores - anterior
„ erector spinae group
- middle
- posterior
- iliocostalis cervicis
ƒ intertransversarii
- longissimus cervicis
„ interspinales

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
Deep posterior neck muscles (cts with back muscles)
– mid- & low cervical region

longissimus All deep neck TS

capitis C1 group muscles control
C2 • ipsilateral neck
C3 rotation
longissimus • some neck flexion
C4
cervicis C5 (eccentric)
iliocostalis rotatores
cervicis C6 (cervicis)
C7 multifidus
All neck ES control
• contralateral neck T1 (cervicis)
lateral flexion
T2
• neck flexion concentric
• contralateral neck contraction
rotation Æcompression
(eccentric) of vertebrae
posterior view of deep neck

Deep posterior neck muscles

 mid- & low cervical

C1
C2

C3
C4 concentric
semispinalis cervicis C5 contraction
controls C6 Æcompression
• ipsilateral neck of vertebrae
rotation C7
• some neck flexion T1
• some contralateral
neck lateral flexion T2
(eccentric)
09
D M
Jan

posterior view of deep neck

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
Deep anterior & lateral neck muscles
– mid & low cervical All 3 parts of longus
colli control neck
transverse process extension (eccentric)
of atlas (C1) C1 longus colli
C2
All scalenes control superior oblique part
contralateral neck of longus colli
lateral flexion C3
vertical (middle) part
(eccentric)
C4 of longus colli
middle scalene inferior oblique
C5
anterior scalene C6 part of longus colli
posterior C7
middle scalene
scalene T1
posterior scalene

T2
concentric
contractionÆ
T3
Ja

compression
nD
M

of vertebrae
09

anterior view of deep neck

Intermediate layer of posterior neck muscles

 mid-cervical concentric
contraction
Æcompression
of vertebrae
C1
C2
C3
C4
C5
levator scapulae
C6
splenius cervicis C7
controls
• neck flexion T1
• contralateral T2
neck lateral flexion
09
• contralateral neck DM
Jan
rotation
(eccentric)

posterior view of deep neck

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
Opposing muscles act as ‘guy ropes’ 
mid-cervical region
resultant
vector Æ
compression
of cervical
vertebrae

levator scapulae anterior scalene

controls controls
• contralateral neck • contralateral neck
lateral flexion lateral flexion
• neck flexion • some neck extension
• contralateral neck • ipsilateral neck
rotation rotation
(eccentric) (eccentric)
lateral view of deep neck

Active & local (segmental)

Any muscle that has individual fibres attaching
independently to parts of adjacent cervical vertebrae

Upper cervical region

Deep posterior muscles:
ƒ rectus capitis posterior major
ƒ rectus capitis posterior minor
ƒ superior oblique of head
ƒ inferior oblique of head
ƒ splenius cervicis
Deep anterior & lateral
muscles:
ƒ levator scapulae upper 2 slips
ƒ middle scalene upper 2 slips
ƒ longus colli
superior oblique part
„ rectus capitis anterior
„ rectus capitis lateralis

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
 Deep posterior neck muscles superior oblique
controls
– upper cervical • head flexion
• contralateral head
rectus capitis lateral flexion
posterior major • ipsilateral head
rectus capitis C1 rotation
C2 (eccentric)
posterior minor
C3 inferior oblique
both control
C4 controls
• head flexion
C5 • atlas (C1) flexion
• contralateral head C6
rotation • contralateral C1
C7
(eccentric) lateral flexion
upper 2 slips
• contralateral head
T1
splenius cervicis rotation
T2 (eccentric)
controls
• neck flexion M
09 levator scapulae
Ja nD upper 2 slips
• contralateral neck
lateral flexion concentric contraction
• contralateral neck rotation Æcompression of atlas
(eccentric) posterior view of deep neck
and axis

Deep anterior & lateral neck muscles

– upper cervical rectus capitis
anterior
• controls head
mastoid process extension (eccentric)
styloid process
C1
transverse process rectus capitis
C2
of atlas (C1) lateralis
• controls contralateral
longus capitis C3 head lateral flexion
• controls head & high (eccentric)
C4
neck extension superior oblique part
(eccentric) C5
of longus colli
C6
middle scalene upper 2 slips
upper 2 slips C7 • controls neck
• controls contra- T1
extension (eccentric)
lateral neck lateral
flexion (eccentric) T2 concentric
contraction
T3
Ja

Æcompression
nD
M

of atlas & axis

09

anterior view of deep neck

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
 Active & global
Any muscle that spans between the head and lower cervical
vertebrae or the thoracic cage has the leverage to produce
head/neck motion but also to de-stabilise cervical vertebrae

Upper cervical region

Posterior muscles: Anterior & lateral muscles:
ƒ upper trapezius ƒ sternocleidomastoid
ƒ splenius capitis ƒ longissimus capitis
ƒ semispinalis capitis

Active & global

Any muscle that spans between the head and lower cervical
vertebrae or the thoracic cage has the leverage to produce
head/neck motion but also to de-stabilise cervical vertebrae

Mid- & lower cervical region

Posterior muscles: Anterior & lateral muscles:
ƒ upper trapezius ƒ sternocleidomastoid
ƒ splenius capitis
ƒ semispinalis capitis
ƒ levator scapulae
lower cervical only
ƒ spinalis capitis
ƒ spinalis cervicis

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
Ligaments and muscles attaching to C5

JanDM 0
9
Passive structures Active structures
local global
anterior • • •
• • •
lateral • • •
• •
•
posterior • • •
• • •
• • •
• • •
• • •
• •

Rotation of the head and neck to the LEFT is

PRODUCED or ACCELERATED by concentric
contraction of…
LEFT splenius capitis and cervicis
LEFT levator scapulae
LEFT rectus capitis posterior major and minor
LEFT inferior oblique of head

RIGHT sternocleidomastoid**
RIGHT upper trapezius
RIGHT semispinalis cervicis
RIGHT multifidus
RIGHT anterior scalene
RIGHT superior oblique of head

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine
Rotation of the head and neck to the LEFT is
therefore CONTROLLED or DECELERATED by
eccentric contraction of…
RIGHT splenius capitis and cervicis
RIGHT levator scapulae
RIGHT rectus capitis posterior major and minor
RIGHT inferior oblique of head

LEFT sternocleidomastoid**
LEFT upper trapezius
LEFT semispinalis cervicis
LEFT multifidus
LEFT anterior scalene
LEFT superior oblique of head

©The University of Sydney 2010

Prepared by J.Douglas-Morris
Discipline of Biomedical Science, School of
Medical Sciences, Faculty of Medicine