The deep neck flexors are primarily made up of the longus coli and longus capitus muscles. They play a pivotal role in cervical spine conditions, and are often overlooked as a source of locomotor system dysfunction. Fiber orientation would suggest these muscles have specific actions, including lateral flexion and flexion of the cervical spine.4 However, these muscles appear to play the role of a local stabilizer, allowing for proper movement, rather than creating it, through a slight flattening of the cervical curve. This does not straighten the curve; it only acts to open the posterior facet slightly.3 In turn, this allows the large global and more superficial muscles of the cervical spine, scapulae and thoracic spine (with cervical or cranial attachments), to move the cervical spine without facet joint compromise.
In whiplash-associated disorders, chronic neck pain, and cervicogenic headache, there is a faulty overactivation of the superficial sternocleidomastoid (SCM) muscles during neck flexion.1,3 This should signal to the examiner that there is dysfunction in the cervical stabilization system.2,3 Mechanically, this makes sense; however, it lacks an explanation for the moderately high rate of success chiropractic physicians and other manipulative therapists have had in treating these conditions without addressing the deep neck flexors.
Recently, Sterling, et al.,5 investigated the effects of cervical spine mobilization on the deep neck flexors. They found decreased EMG activity in the superficial SCM muscle, and an increase in deep neck flexor activity. They stated, "For optimal management of patients with chronic mid-to-lower cervical spine pain, application of SMT, prior to retraining of deep neck flexor muscles, would be the most beneficial approach."
As the discipline of chiropractic advances its understanding of locomotor system dysfunction, we continue to realize that it is often not what we practice that changes, as much as our understanding of what is being practiced. Adding deep neck flexor stability exercises to your treatment protocol following the adjustment is highly effective, and does not require significant extra time.
Authors' note: A practical approach to cervical spine stabilization, and a more comprehensive review of cervical spine biomechanics and muscle interactions, can be found in an excellent text by Murphy.4
References
Joel D. Johnston, DC
Oxford, Ohio
Mark A. King, DC
Cincinnati, Ohio
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
