Cervical Spine Range of Motion

The Cervical Spine Range of Motions correspond to motions of the head, although the range of head movement bears little relation to the cervical ROM and that the total range is the sum of both the head and the neck ROMs.

Cervical spine range of motion for flexion is 45º-80°, for extension is 50°-70°, for lateral flexion 20°-45° of and for Side Rotation is 80°, as we will see later.

The cervical spine boasts a remarkable range of motion due to its intricate design of joints and muscles. This mechanical system is composed of multiple degrees of freedom, with at least 20 pairs of muscles capable of performing similar actions. The surrounding neck musculature plays a crucial role in providing 80% of the cervical spine’s mechanical stability, while the osseoligamentous system contributes 20%. The ligaments mainly stabilize the spine in end-of-range postures, whereas muscles provide dynamic support during activities around neutral- and mid-range postures.

The zygapophyseal joints, which allow for flexion and extension, have a sagittal range of 50-80 degrees in each direction. Arthrokinematic motions of these joints are limited to an inferior, medial glide during extension and a superior, lateral glide during flexion. When it comes to segmental side bending and rotation coupled with ipsilateral side bending, there is extension of the ipsilateral joint and flexion of the contralateral joint.

Many of the neck muscles have multiple functions or can change their function depending on the initial position of each vertebral joint and the degree to which the joints are free to move in each of the planes of motion. This allows for a variety of combinations of kinematic and muscle actions to achieve voluntary motor tasks in the head and neck. Despite the cervical range of motion, most functional daily tasks are performed in and around mid-range postures. As a result, the muscles controlling the cervical spine are subject to constant external and internal forces.

If you’re looking to improve your cervical spine ROM, it’s essential to incorporate exercises that target the neck muscles and joints in mid-range postures. Regular physical activity can also help to maintain flexibility and reduce the risk of injury.

See Also: Shoulder Range of Motion

Cervical Spine Range of Motion Types

Cervical Spine motions include Flexion, Extension, Side Bending and Rotation.

Cervical Flexion

Cervical spine range of motion during flexion occurs in three sequential phases, with the lower cervical spine (C4-7) contributing first followed by the upper cervical spine (C1-C4) and then again by the lower cervical spine.

At the segmental level, flexion involves an anterior tilt of the superior vertebra, a glide of the zygapophyseal joints, and a translation slide of the superior vertebra on the IVD, resulting in compression and distraction of the cervical disk. The uncovertebral joint may experience an anterior spin during flexion, and impairments in this joint can be detected in all cervical positions.

The extensor muscles and posterior ligaments restrict anterior osteokinematic motion, while the joint capsule restrains superoanterior arthrokinematic motion, and the disk and nuchal ligament restrict translation.

This understanding of cervical spine range of motion is important for those seeking to manage or prevent issues related to neck pain and dysfunction.

Normal Cervical ROM flexion is approximately 45º-80°.

See Also: Spine Examination

Cervical Extension

Cervical spine extension involves a complex series of movements, including a posterior osteokinematic sagittal rock, an inferoposterior glide, and an approximation of the superior facets of the zygapophyseal joints. Additionally, a posterior translation of the vertebra on the disk occurs, while the uncovertebral joint undergoes a posterior arthrokinematic spin. However, the anterior prevertebral muscles and the ALL limit the osteokinematic motion of extension. On the other hand, the zygapophyseal joint capsule restricts the arthrokinematic motion. Finally, the posterior translation is restrained by the intervertebral disc (IVD).

Understanding the mechanisms involved in cervical spine extension and the factors that limit the range of motion is essential to managing related conditions. If you are experiencing limited cervical spine extension, consult with a healthcare professional to determine the underlying cause and receive appropriate treatment.

Rotation below the C5-6 level results in forward flexion, whereas rotation above the C4-5 level results in extension. As a result, when cervical spine rotation occurs, the anterior edge of the vertebral bodies below the C5 to C6 segments bears the greatest degree of weight, while the posterior edge above the C4 to C5 segments does so (this is believed to be a factor in the development of spondylosis in these areas).

The C5 to C6 segment exhibits the most cervical motion, with the C4 to C5 and C6 to C7 segments coming in a close second. Significant flexion takes place at C5 to C6, while extension occurs around C6 to C7. A coupled translation of 2 to 3.5 mm occurs with flexion and extension. In the midcervical segments, side bending averages about 10 degrees on each side and decreases in the caudal segments.

Normal Cervical ROM extension is approximately 50°-70°.

Side Bending

Side bending or lateral flexion involves a movement pattern where the vertebrae on one side bend towards each other. During this motion, the superior facet on the opposite side glides forward and upward, while the facet on the same side moves downward and backward. There is also a sliding motion of the vertebra on the disc towards the opposite side and an inward and downward glide of the uncovertebral joint on the same side, and an outward and upward glide of the uncovertebral joint on the opposite side.

These combined movements result in a curved translation of the spine. The scalene muscles and intertransverse ligaments limit this movement pattern. The joint capsule restricts the motion of the uncovertebral and zygapophyseal joints, and the intervertebral disc limits the translation. If side bending is restricted, but translation is not affected, it may be due to soft tissue shortening, whereas if both side bending and translation are limited, it likely indicates a problem with the joint complex.

Normal Cervical ROM Side Bending is 20° to 45° of lateral flexion,

Rotation

Rotation primarily refers to the movement of the vertebrae around a vertical axis, which is typically accompanied by bending towards the same side. It is believed that translation occurs in the opposite direction of the side bending (i.e., towards the opposite side), leading to the same arthrokinematic motions of the uncovertebral and zygapophyseal joints as observed during side bending.

Normal Cervical ROM Side Rotation is 80°, while the neck’s total angle of rotation is 160°.

References

1. Sukari AAA, Singh S, Bohari MH, Idris Z, Ghani ARI, Abdullah JM. Examining the Range of Motion of the Cervical Spine: Utilising Different Bedside Instruments. Malays J Med Sci. 2021 Apr;28(2):100-105. doi: 10.21315/mjms2021.28.2.9. Epub 2021 Apr 21. PMID: 33958964; PMCID: PMC8075604.
2. Swartz EE, Floyd RT, Cendoma M. Cervical spine functional anatomy and the biomechanics of injury due to compressive loading. J Athl Train. 2005 Jul-Sep;40(3):155-61. PMID: 16284634; PMCID: PMC1250253.
3. Van Mameren H, Drukker J, Sanches H, et al: Cervical spine motions in the sagittal plane. I: Ranges of motion of actually performed movements, an x-ray cine study. Eur J Morphol 28:47–68, 1990.