Deep Neck Flexors (Longus Colli, Longus Capitis, Rectus Capitis Anterior and Rectus Capitis Lateralis)

This course describes the anatomy and integrated function of the deep neck flexor muscles (a.k.a deep cervical flexors, and includes the longus colli, longus capitis, rectus capitis anterior, and rectus capitis lateralis). These muscles have origins and insertions on the cervical vertebra and occipital bone of the skull, are located deep on the anterior surface of the cervical spine, or deep to the more superficial cervical extensors of the occipital muscles. Unfortunately, research is not available on fiber type composition; however, based on the composition of the other paraspinal muscles it is likely these muscles are composed of more type I muscle fibers than type II muscle fibers. The deep cervical flexor muscles cross the joints of the cervical spine segmentally, anterior to the axis of rotation. The longus colli and longus capitis contributes to cervical spine flexion, while the longus capitis, rectus capitis anterior, and rectus capitis lateralis contribute to atlantooccipital joint flexion. The ability to contribute to cervical spine flexion, without also acting as extensors of the upper cervical spine and head, makes these muscles uniquely capable of contributing to cervical retraction (chin tuck). This course also describes the role of the deep cervical flexor muscles in cervical spine arthrokinematics, fascial integration, postural dysfunction and altered muscle activity, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the deep cervical flexors for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation, including neck pain, forward head posture, cervicogenic headaches, whiplash syndrome, chronic neck pain, neck flexor weakness and muscle endurance, neck stability, and there is even a study demonstrating that adding chin tucks to address cervical posture may improve outcomes for low back pain. Additionally, future course may include the effect of deep neck flexor weakness and muscle activation on the activity of the sternocleidomastoid or deep cervical extensors, and deep cervical flexor specific techniques including the deep neck flexor endurance test, and deep neck flexor training including muscle activation, strength, and reactive exercises.

Brookbush Institute’s most recommended techniques for the Deep Neck Flexors (see videos below):

• Assessment: Deep Neck Flexor Endurance Test
• Activation: Deep Neck Flexor Isolated Activation (Chin Tucks)
• Reactive Activation: Deep Cervical Flexor Activation with Chest Pass
• Integration: Abdominis Activation with Deep Neck Flexor Activation

Pre-approved credits for:

• Human Movement Specialist (HMS) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Group Exercise Instructors
• Massage Therapists
• Occupational Therapists
• Personal Trainers
• Physical Therapists
• Physical Therapy Assistants
• Physiotherapists
• Yoga Instructors

This Course Includes:

• AI Tutor
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Practice Exam
• Pre-approved Final Exam

Caption: Anterior view of the deep neck flexor complex

1. Phillip Page, Clare Frank, Robert Lardner, Assessment and Treatment of Muscle Imbalance: The Janda Approach © 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner
2. Donald A. Neumann, “Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation – 2nd Edition” © 2012 Mosby, Inc.
3. Leon Chaitow, Muscle Energy Techniques: Third Edition, © Elsevier 2007
4. Tom Myers, Anatomy Trains: Second Edition. © Elsevier Limited 2009
5. Shirley A Sahrmann and Associates, Movement System Impairment Syndromes: of the Extremities, Cervical and Thoracic Spines © 2011 Mosby Inc.
6. David G. Simons, Janet Travell, Lois S. Simons, Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens
7. Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry – Third Edition. © 2003 by F.A. Davis Company
8. Cynthia C. Norkin, Pamela K. Levangie, Joint Structure and Function: A Comprehensive Analysis: Fifth Edition © 2011 F.A. Davis Company
9. Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani, Muscles: Testing and Function with Posture and Pain: Fifth Edition © 2005 Lippincott Williams & Wilkins
10. Karel Lewit. Manipulative Therapy: Musculoskeletal Medicine © 2007 Elsevier
11. Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004
12. David B. Jenkins, Hollinshead’s Functional Anatomy of the Limbs and Back: Eighth Edition © 2002 Saunders
13. John V. Basmajian, Carlo J. De Luca. Muscles Alive: Their Function Revealed by ElectroMyography. 1985

• Anatomy

1. Falla D, Jull G, Dall'Alba P, Rainoldi A, Merletti R. An electromyographic analysis of the deep cervical flexor muscles in performance of craniocervical flexion. Physical Therapy. 2003; 83: 899-906.
2. White, A. A., and M. M. Panjabi. "Kinematics of the spine." Clinical biomechanics of the spine (1990): 85-125.

• Shoulder

1. Lawrence, R.L., Braman, J.P., Staker, J.L., Laprade, R.F., Ludewig, P.M. (2014) Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, Part 2: Glenohumeral joint. Journal of Orthopaedic & Sports Physical Therapy 44(9). 646-B3
2. Lawrence, R. L., Braman, J. P., Laprade, R. F., & Ludewig, P. M. (2014). Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. journal of orthopaedic & sports physical therapy, 44(9), 636-A8.

• Regional Interdependence

1. Helgadottir, H., Kristjansson, E., Einarsson, E., Karduna, A., & Jonsson, H. (2011). Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders. Journal of Electromyography and Kinesiology, 21(6), 947-953.
2. Cools, A.M., Witvrouw, E.E., Declercq, G.A., Danneels, L.A., Cambier, D.C. (2003) Scapular muscle recruitment patterns: Trapezius muscle latency with and without impingement symptoms. The American Journal of Sports Medicine 31(4). 542-549 – ABSTRACT
3. Otoshi, K., Takegami, M., Sekiguchi, M., Onishi, Y., Yamazaki, S., Otani, K., Shishido, H., Shinichi, K., Shinichi, K. (2014). Association between kyphosis and subacromial impingement syndrome: LOHAS study. Journal of Shoulder and Elbow Surgery. 23. e300-e307
4. Wegner, S., Jull, G., O’Leary, S., & Johnston, V. (2010). The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain. Manual therapy, 15(6), 562-566.
5. Moustafa, I. M., & Diab, A. A. (2015). The Effect of Adding Forward Head Posture Corrective Exercises in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Study. Journal of manipulative and physiological therapeutics, 38(3), 167-178.

• Reduced Activity

1. Jull, G.A., Falla, D., Vicenzino, B., Hodges, P.W. (2009). The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Manual Therapy. 14: 696-701.
2. Fall D, Jul G, Hodges P. Patents with Neck Pain Demonstrate Reduced Electromyographic Activity of the Deep Cervical Flexor Muscles During Performance of the Craniocervical Flexion Test

• Intervention

1. Jull GA, Falla DL, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Manual Therapy. 2009; 14: 696–701.
2. Cagnie B, Dickx N, Peeters I, Tuytens J, Achten E, Cambier D, Danneels L. The use of functional MRI to evaluate cervical flexor activity during different cervical flexion exercises. Journal of Applied Physiology. 2008; 104:230-235.
3. Chiu TT, Lam TH, Hedley AJ. A randomized controlled trial on the efficacy of exercise for patients with chronic neck pain. Spine. 2005; 30(1): E1–E7
4. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. An RCT of exercise and manipulative therapy for cervicogenic headache. Spine. 2002; 27: 1835-1843.
5. Falla D, O’Leary S, Fagana A, Jull G. Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Manual Therapy. 2007; 12: 139–143.
6. O’Leary S, Jull G, Kim M, Vincenzino B. Specificity in Retraining Craniocervical Flexor Muscle Performance. Journal of Orthopaedic and Sports Physical Therapy. 2007; 37(1):3-9.
7. Chiu TT, Lam TH, Hedley AJ. A randomized controlled trial on the efficacy of exercise for patients with chronic neck pain. Spine. 2005; 30(1): E1–E7

• Assessment

1. Jull G, O'Leary S, Falla D. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. Journal of Manipulative and Physiological Therapeutics. 2008; 31: 525-33.
2. Edmondston SJ, Wallumrød ME, MacLéid F, Kvamme LS, Joebges S, Brabham GC. Reliability of isometric muscle endurance tests in subjects with postural neck pain. Journal of Manipulative and Physiological Therapeutics. 2008; 31(5): 348-54