The cervical spine has 7 stacked bones called vertebrae. These are typically labelled C1 through to C7. The top of the cervical spine connects to the skull, and the bottom connects to the upper back which is at about shoulder level. From the side, the cervical spine forms a smooth lordotic curve by gently curving toward the front of the body and then to the back of the body. A healthy neck rests in this balanced neutral position and has symmetry. The cervical spine needs great precision of movement, good timing and motor control. It also needs to have good planned and unplanned movement patterns. This is because the cervical spine is always protecting the spinal cord. The spinal cord is a bundle of nerves that extends from the brain and runs through the cervical spine and thoracic spine (upper and middle back) before ending just before the lumbar spine (lower back). Each vertebra has a large hole (vertebral foramen) for the spinal cord to pass through. Together, these vertebrae keep the spinal cord shielded inside a bony tunnel called the spinal canal.
We live in dynamic movement so the neck needs to be strong to hold up our heavy head and also in movement. Often when there is discomfort in the neck it comes from a lack of strength in the abdominals. There is also a link between faulty breathing and a dysfunctional upper quadrant of the body.
The cervical spine is the most mobile region of the spine. Normal neck movement included flexion, extension, rotation and side bending. Flexion: The cervical spine bends directly forward with the chin tilting down. Neck flexion typically occurs when looking downward or while in forward head posture. For example when sitting with poor posture in front of a laptop. Extension: The cervical spine straightens or moves directly backward with the chin tilting up. For example, neck extension is common when performing overhead work. Rotation: The cervical spine and head turn to one side. Neck rotation is particularly useful when trying to look to the side or over the shoulder. An example of this is when reversing the car. Lateral flexion: The cervical spine bends to one side with the ear moving toward the shoulder. An example of this is when you are on a phone call and you are using your ear to keep your phone in place. Some movements can be performed in combination, such as rotating the neck while also flexing it forward.
General guidelines for neck pain include supporting the neck with a pillow, towel or squishy. This will support the cervical lordosis. Emphasis needs to be on activating the upper back extensors which include the middle and lower trapezius and rhomboids and avoiding activation of the anterior muscles. It is also important to avoid inversions as this places pressure on vertebras. Also, any exercise where the springs or load is too heavy for an individual will place an unnecessary load on the neck.
With so many critical nerves, blood vessels, joints in such a relatively small space, and a range of movement, the cervical spine is one of the body’s most complicated regions. Protecting the neck and making the body strong to support movement is critical to our overall health.