The Neck - Base of skull

I wanted to write about the muscles of the neck this month and the common complaints that I see in the clinic. I will break down the neck into four parts 

1.   The upper rear neck, base of skull to C2 

2.   The lower rear neck C3-C7 

3.   The front 

4.   The sides 

The upper rear neck 

The main problems are loss of range of motion, dizziness, tension headaches, travelling pain (numbness and tingling) and fatigue.  

The main muscles are deep and superficial. 

Deep muscles are: 

·    Intertransverse muscles, these help side bending, stabilisation and proprioceptors (helps brain monitor neck position) of the head. The main issues with these muscles are wryneck, spasms or strains creating neck stiffness, also if injured can create more movement between the vertebrae creating chronic neck pain, whiplash results in reduced range of motion and pain. 

·    Interspinalis help extension (tilting head back), primarily they also stabilize and are proprioceptors. When injured or weakened (also poor posture) it creates strain on the vertebrae and pain, creates tension headaches and cervicogenics headaches (one-sided, non-throbbing pain radiating from the back of the neck/head to the front). If whiplash has occurred then fatty infiltration or atrophy can affect the muscles. 

·    Transversospinalis, there are three muscles here that control extension, flexion and rotation of head while giving stability. When injured and/or poor posture, it leads to chronic pain, headaches, and stiffness. 

·    Rectus capitis posterior minor/major - these are felt at the base of occiput and connect to C1, C2. These muscles are very important, especially the minor as it connects to the alantoccipital membrane (when constantly tight creates chronic tension headaches), they help in extension and rotation of the head. The main issues we see are atrophy and reduced stability (usually from whiplash), neck pain, vertigo, chronic tension, hypertrophy, these can also be effected by forward head postition (desk work, tablet/phone use) 

·    Obliquus capitis superior/inferior - located next to and below the rectus capitis muscles. These guys help stabilize the head during movement, posture support, extension, flexion, rotation, and side bending. When injured or have a dysfunction, they create cervicogenic headaches, vertigo, dystonia (involuntary jerky twisted head movements), reduced mobility (usually from forward head posture) and vascular concerns (due to the proximity to the vertebral artery) 

Superficial muscles are: 

·    Trapezius upper descending fibres - These help elevate the scapula and help shoulders stay level when weight is being carried by hand. They are connected to the ridges on the back of the skull and insert on the rear of C1-C6 vertebrae. The upper trapezius has many issues that can occur prone to knots, tenderness, headaches, reduced mobility, increases shoulder impingement and heavy head feeling, these are caused by poor posture, stress/anxiety, repetition of movement and weakness in surrounding muscles.  

·    Levator scapulae - They connect to transverse processes of C1-C4 and insert at the top midline of the scapula. These help to elevate and retract (move toward the spine) the scapula. It also helps with depression of shoulder when carrying bags. This muscle creates a deep aching pain, stiffness in turning of head, tension headaches, shoulder pain at the top of blade, and stiffness. Usually these issues arise from poor posture (forward head and rounded shoulders), stress, overuse (think carrying bags on shoulders) sleeping with arm in awkward position. 

Most important is what we can do to help these muscles. 

You can come in and I can do muscle release by massage, myotherapy (a little deeper therapy) and Acupuncture. At home you can follow the below suggestions 

The modern day problem is poor posture, so reduce screen time set your desk up ergonomically and reduce phone usage.  

For superfiscial muscles of the trapezius chin tucks, ear to shoulder stretches and strengthening to help with underlying weakness use barbell shrugs. 

Levator scapulae can be helped with trigger points, heat therapy and gentle stretching. To stretch you can sit tall and turn your head 45 degrees away from the tight side (looking toward your armpit). Gently pull your head down toward that armpit with the corresponding hand, holding for 20–60 seconds 

For the deep muscles craniocervical elexion Exercises (CFE) to do this you lie on your back with knees bent and head in a neutral position (use a small towel roll under the neck if needed). Perform a slow, gentle chin tuck (nodding motion) as if saying "yes". Common protocols include 10-second holds, repeated 10 times per set, for 2-3 sets. 

Isometric neck extensions - Place your hands behind your head and gently press backward while resisting with your hands (no movement should occur). 

Quadruped  retraction/extension -  Get on hands and knees. Tuck the chin, then gently lift the head to align with the spine.  

Supine Head Extensions (Edge of Bed) - Lie on your back with your head over the edge of the bed. Slowly allow your head to lower, then lift it back to neutral. 

Chin Tucks, this is the foundation for strengthening deep neck muscles and correcting forward head posture - Sit or stand upright. Draw your chin straight back as if creating a "double chin." Hold for 5–10 seconds. Repeat 10-20 times. 

Occiput to bed – When lying on the bed on your back with knees bent press head back into the matress hold for 10 seconds, release for 10 seconds repeat 10 times. 

Eye coordination – sit facing a target on wall, close eye move head to the right, then move back to start point, open eyes, see if you end looking at the target. 

Isometric Suboccipital Press - Lie on your back with a rolled-up towel under the base of your skull. Gently press the back of your head into the towel/floor while maintaining a slight chin tuck. 

Head Rotation in 4-Point Kneeling - In a four-point kneeling position, slowly rotate your head to one side while maintaining a gentle chin tuck. Ensure the head stays level with the body