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

Integrated functional anatomy of the longus colli, longus capitis, rectus capitis anterior and rectus capitis lateralis (deep neck flexors). Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common exercises, foam rolling, and stretches for the deep neck flexors. 

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

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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):

Deep Neck Flexor Isolated Activation (Chin Tucks)

Deep Cervical Flexor Activation with Chest Pass

Abdominis Activation with Deep Neck Flexor Activation

The deep neck flexors which include the longus colli and longus capitis

 Course Description: Deep Neck Flexor

 "that extends considerably from end to end," Old English lang "long," from Proto-Germanic *langgaz (cognates: Old Frisian and Old Saxon lang, Old High German and German lang, Old Norse langr, Middle Dutch lanc, Dutch lang, Gothic laggs "long"). (

 early 13c., "of or pertaining to the head," from Old French capital, from Latin capitalis "of the head," hence "capital, chief, first," from caput (genitive capitis) "head" (see 

 word-forming element usually meaning "with, together," from Latin com, archaic form of classical Latin cum "together, together with, in combination," from PIE *kom- "beside, near, by, with" (compare Old English ge-, German ge-). (

 - 1640s, from French linéaire, from Latin linearis "belonging to a line," from linea "string, line" (see 

 c.1400, from Old French rectifier, literally “to make straight” (14c.), from Late Latin rectificare “make right,” from Latin rectus “straight” (see 

 (adj.1)) + root of facere “to make” (see 

 1610s, Latin, literally "former," comparative of ante "before" (see 

 - early 15c., from Middle French latéral and directly from Latin lateralis "belonging to the side," from latus (genitive lateris) "side" (see oblate (n.)). As a noun, from 1630s, "a side part." As a type of pass to the side in U.S. football, it is attested from 1934. Related: Laterally. (

Why is there not a brevis capitis or brevis colli?

You may have noticed that the commonly used adjective "longus" was the first word rather than last word in these muscles. In Latin and Greek languages, the adjective comes after the subject - for example, 

 is a "tibia muscle" on the posterior side. Apply the same logic to these muscles and you find that "longus" is the name of the muscle and not an adjective in this case, and "capitis" (of the head) and "colli" (co-linear) are the adjectives.

Anterior view of the deep neck flexor complex

Anterior Cervical Spine in Cadaveric Dissection - By Anatomist90 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19544659

Attachment of the longus colli muscle of the neck

The attachment of the longus capitis muscle

The attachment and location of the rectus capitis anterior

Posterior view of the rectus capitis lateralis muscle

Image of the rectus capitis lateralis muscle

Attachments & Innervation: Deep Neck Flexors

Note the longus colli and longus capitis lay deep to the fascia on the anterior side of the cervical vertebrae

Where are the Deep Neck Flexors Located?

Attachment of the deep neck flexors on the cervcial spine and skull

Palpating the Deep Neck Flexors

Introduction to the Deep Neck Flexors

Atlantooccipital joint: Flexion and may contribute to lateral tilt of the occiput on C1

Note: These muscles are given significant attention in rehabilitation and corrective exercise programs due to their unique ability to contribute to flexion of the upper cervical spine, and reduce cervical lordosis (cervical retraction).

Cadaver dissection illustrating the longus colli and longus capitis

Cadaver Dissection - Lateral View of Deep Tissues of the Neck. Note the location of the longus colli and longus capitis - By Anatomist90 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19461789

Forward head position (cervical protraction) demonstrated in Justin Bieber

Integrated Function

Arthrokinematics

Deep Neck Flexor Actions

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature's “motherboard.” A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Image of the fascial system of the body connecting muscles

Anterior Tubercles of the Transverse Processes of C3 - C6:

 The anterior tubercles of the transverse process of C3 - C6 are shared by tendinous attachments of the longus colli, longus capitis, and anterior scalenes. These muscles share the ability to flex the lower and middle cervical spine. While the longus colli and capitis contribute to segmental flexion and a reduction in the cervical lordosis, the anterior scalenes pull the center of the cervical spine toward their attachment on the first rib increasing the cervical lordosis. The contribution of the longus colli and longus capitis to lateral flexion seems unlikely, but the potential for lateral stabilization seems reasonable. This would provide an additional reason why these muscles may be linked. Or, perhaps the anterior scalenes are as much a part of the "intrinsic stabilization subsystem" of the neck as they are the "global movers" of the spine - a role not unlike the 

Deep front line with the deep cervical flexors illustrated

Anterior Longitudinal Ligament and the Prevertebral Fascia:

 The longus colli is the only muscle with a direct attachment to the anterior longitudinal ligament; however, the longus capitis, rectus capitis anterior and rectus capitis lateralis are all enveloped by the prevertebral fascia which emanates laterally from the anterior longitudinal ligament and extends to the base of the occiput. These muscles may exist in a "quasi-deep anterior compartment" as the prevertebral fascia may attach to the anterior tubercles of the transverse process between the longus capitis and the more lateral anterior scalenes (illustrations and texts are not consistent with this detail). The unique ability of these muscles makes it easy to see a functional connection, but more consideration should be given to fascial continuity.

Forward head and hyperkyphosis in a seated position

https://pbs.twimg.com/profile_images/2915161838/353bf1c2eccae9f4e9a1da940d33ee7b_400x400.jpeg

Fascial Integration

The deep neck flexors (longus colli, longus capitis, rectus capitis anterior, and rectus capitis lateralis) have been noted as long and under-active by several clinicians (1, 4, 5, 10, 23, 24). Further, their unique ability to flex the upper cervical spine, reduce the cervical lordosis and resist anterior translation of the cervical vertebrae (cervical retraction) has inspired cervical retraction exercises as a staple of rehabilitation programs for cervical pain and dysfunction (1, 4, 5, 10, 24 - 31).

 (Forward Head Translation/Cervical Protraction) – Several studies and texts have noted a decrease in the activity of the deep neck flexors in those with cervical pain and dysfunction. The most commonly noted impairment relative to the cervical spine is the adoption of a static posture that includes forward head translation or cervical protraction (lower cervical flexion, upper cervical extension, and an increased lordotic curve) (5). This posture would result in a relative increase in the length of the deep neck flexors. Further, increased activity and a decrease in length have been noted in larger global muscles of the neck, including the SCM, 

, and scalenes. This may imply changes in the activity of the deep neck flexors are partially the result of altered reciprocal inhibition, and/or synergistic dominance. Further, many clinicians have noted facet joint dysfunction and stiffness are commonly associated with neck pain, which could also contribute to a decrease in deep neck flexor activity via arthrokinematic inhibition.

In short, cervical pain, an increase in length, altered reciprocal inhibition, synergistic dominance, and arthrokinematic inhibition have been implicated as reasons for a reduction in deep neck flexor activity. Resolution and normalization of deep neck flexor activity are dependent on not only activation of deep neck flexors, but release of all over-active structures, mobilization of stiff facets, optimization of cervical arthrokinematics, and postural re-education.

 The deep neck flexors may have an indirect relationship with 

 present with excessive anterior tipping and downward rotation of the scapula (16). Although the deep neck flexors do not act on the scapula, cervical pain has been correlated with a decrease in 

 activity (17), which may result in scapular dyskinesis and 

. Further, a forward head position may increase the thoracic lordosis and alter length/tension relationships of the 

 muscles, which may also affect scapular motion. An increased thoracic kyphosis, as well as altered trapezius activity, have been correlated with shoulder pain (19 - 21)

Lumbo Pelvic Hip Complex Dysfunction (LPHCD) and Sacroiliac Joint Dysfunction (SIJD)

: Although the deep neck flexors of the cervical spine do not play a significant role in 

, their function is similar to those muscles of the 

. Further, in a very interesting study, those with lumbar radiculopathy had better outcomes 6 months post-injury when interventions for improving cervical posture were added to their rehabilitation program (22).

 The deep neck flexors play no significant role.

, the deep neck flexors have the propensity to become 

. This may imply these muscles should be the focus of 

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

. Optimal intervention would also include release and lengthening of over-active/short muscles of the cervical spine, cervical and upper thoracic mobilization, and postural re-education. Manual release and mobilization techniques are often beneficial for those with cervical dysfunction (28), but should only be performed by licensed professionals (PT, ATC, DC, OT, DO).

X-Ray of the cervical spine in flexion and in extension

X-ray of the Cervical Spine in Flexion and Extension - By Cervical_Xray_Extension.jpg: StillwaterisingCervical_Xray_Extension_view.jpg: Stillwaterisingderivative work: F. Lamiot (talk) - Cervical_Xray_Extension.jpgCervical_Xray_Extension_view.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=12017769

Trigger point and hyper-tonicity of cervical and supra-scapula muscles

Shoulder and Scapulothoracic pain due to Movement Impairment/Scapular Dyskinesis

Signs of Altered Length/Tension and Tone:

Forward Head Translation: Long/Under-active

 (32, 33) - Inability to maintain an optimal position for 30 seconds: Long/Under-active

Although the longus colli and longus capitis may be palpated, it is likely this would only be used to assess function during activation exercise and not as a means of releasing trigger points or reducing hypertonicity. The longus colli, longus capitis, rectus capitis anterior, and rectus capitis lateralis do not appear in Travell and Simmons (6). Based on the research, hypothesized behavior in postural dysfunction, the sensitive structures in close proximity to these muscles, and the difficulty in palpating these muscles should not be surprising. These are commonly under-active muscles, unlikely to develop trigger points, and I could find no reported cases of deep neck flexor trigger point release relieving a patient's symptoms.

Postural Dysfunction & Deep Neck Flexors

Standing Isolated Activation of Deep Cervical Flexors

Stabilization Progressions for Deep Cervical Flexors

Deep Cervical Flexor Activation Progressions for Stabilization 2

Deep Cervical Flexor Activation Progressions for Range of Motion (ROM)

Cobra with Cervical Retraction

Deep Cervical Flexor Explosive Chest Pass

Exercises and Techniques for the Deep Neck Flexors

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

Movement System Impairment Syndromes: of the Extremities, Cervical and Thoracic Spines

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

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Manipulative Therapy: Musculoskeletal Medicine

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

John V. Basmajian, Carlo J. De Luca. Muscles Alive: Their Function Revealed by ElectroMyography. 1985

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.

White, A. A., and M. M. Panjabi. "Kinematics of the spine." 

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

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

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

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. 

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. 

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.

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

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.

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

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.

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.

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

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.

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.

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.

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.

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

Bibliography

Questions, comments, and criticisms are welcome and encouraged

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

Related Courses:

Course Description: Deep Neck Flexor

Introduction to the Deep Neck Flexors
3 Sub Sections

Deep Neck Flexor Actions
2 Sub Sections

Fascial Integration

Postural Dysfunction & Deep Neck Flexors

Exercises and Techniques for the Deep Neck Flexors
6 Sub Sections

Bibliography

Related Courses:

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Guest

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

Related Courses:

Course Description: Deep Neck Flexor

Introduction to the Deep Neck Flexors3 Sub Sections

Deep Neck Flexor Actions2 Sub Sections

Fascial Integration

Postural Dysfunction & Deep Neck Flexors

Exercises and Techniques for the Deep Neck Flexors6 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the Deep Neck Flexors
3 Sub Sections

Deep Neck Flexor Actions
2 Sub Sections

Exercises and Techniques for the Deep Neck Flexors
6 Sub Sections