Download Head and Neck ROM Assessments

Head and Neck ­ ROM Assessments
Head and Neck Flexion
Action: Bend the head and neck forward until limited by pain or tightness.
What is normal: The head and neck should bend forward 65­75 degrees from neutral
position. This should almost place the chin on the chest.
What limits it: This tests head and neck flexion together. Flexion is limited primarily by
the posterior cervical muscles. Shortening muscles do not tend to limit flexion. The upper
traps do not normally limit flexion unless there is also a rotational and sidebending
component.
● Semispinalis capitis and cervicis are strongly involved with checkreining flexion of
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the head and neck. They are likely to limit flexion by invoking their referral to the
back of the head and neck along with a band of pain around the head. A pull may be
felt into the upper back.
Suboccipitals are likely to limit flexion of the head at the neck. Their pain tends to
spread laterally around the head, eye and forehead, making the entire head ache. The
head itself has only ten or so degrees of flexion at the first two vertebrae.
Cervical multifidi limit flexion of particular segments of the cervical spine. They may
invoke their referral during flexion, which will be felt as pain near the spine up and
down the neck. To determine which segments may be involved, tap the spinous
processes and evaluate for tenderness.
Longissimus capitis may limit flexion bilaterally. Referred pain will be felt behind
and below the ear.
Longissimus cervicis may feel tight during neck flexion with sensation along the
spine extending into the upper back.
Splenius capitis and cervicis are not likely to strongly limit flexion, because their
function is much more connected to rotation. Referral may be felt at the top of the
head and/or deep in the socket of the eye.
© Copyright 2013, Chuck Duff
Head and Neck Extension
Action: Have the client actively extend the head and neck by looking up without arching
the back.
What is normal: The head and neck should be able to extend 65­75 degrees from neutral
position, which places the face more or less in a horizontal assuming a neutral starting
point. Of this, 10 degrees or so is extension of the head at the neck.
What limits it: Shortening muscles commonly limit extension via painful contraction on
the short. Anterior neck muscles do not generally limit extension.
● Semispinalis capitis and cervicis are likely to limit exension by invoking their
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referral to the back of the head and neck along with a band of pain around the head.
Strong active extension can produce painful contraction of the semispinalis.
Suboccipitals are likely to painfully contract, limiting extension of the head. They are
particularly likely to cause problems if the client routinely carries the head and neck
in hyperextension.
© Copyright 2013, Chuck Duff
Head and Neck Rotation
Action: Have client rotate head toward each shoulder without tilting the head.
What is normal: 77 to 90 degrees is considered normal. This places the client’s nose
more or less in line with the acromion process of the shoulder.
What limits it: Head rotation may be limited by pain either on the side the head is turning
toward, or the opposite side, or both.
Pain During Rotation to the Same Side:
● Levator scapulae primarily limits rotation to the same side, due to painful
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contraction of the muscle. If there is little restriction in rotation, the levators are
unlikely to be involved.
Splenius capitis and cervicis are likely to limit rotation to the same side because of
painful contraction on the short. Referral may be felt at the top of the head and/or
deep in the socket of the eye as well as in the neck (“stiff neck”). When combined
with levator trigger points, the splenii may almost completely block rotation to the
same side.
Suboccipitals have rotational fibers that can limit rotation to the same side via
painful contraction on the short. Pain can be felt deep underneath the occiput or in the
eye.
High trapezius may limit extreme rotation to the same side if its TrPs are very
active due to stretching taut fibers and causing referral into the neck, which is
perceived as a severe “stiff neck”.
Pain During Rotation to the Opposite Side:
● High trapezius limits extreme rotation to the opposite side due to painful shortening
contraction.
● Splenius capitis and cervicis are likely to limit rotation to the same side because of
painful contraction on the short. Referral may be felt at the top of the head and/or
deep in the socket of the eye as well as in the neck (“stiff neck”). When combined
with levator trigger points, the splenii may almost completely block rotation to the
© Copyright 2013, Chuck Duff
same side.
● Levator scapulae may limit rotation to the opposite side if trigger points are
extremely active due to stretching taut fibers.
● Cervical multifidi and rotatores contract upon rotation of particular segments of the
cervical spine to the opposite side. They may invoke their referral, which will be felt
as deep pain near the spine up and down the neck. To determine which segments may
be involved, tap the spinous processes and evaluate for tenderness.
Neck Side Flexion
Action: Have the client move their ear toward their shoulder, keeping the shoulders level
and without turning the head.
What is normal: 40 to 50 degrees, or approximately halfway.
What limits it: Scalenes are primary muscles for side bending as well as stabilization of
the opposite side (checkreining). They are likely to limit side bending on either side of the
neck, although more likely to limit sidebending to the opposite side via stretch.
● Scalenes are likely to limit lateral flexion to the other side by up to 30 degrees. Pain
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will be felt on the opposite side of the neck, as well as possible referral in the
opposite shoulder, arm, hand, pectoral area and back. May also limit sidebending to
the same side due to shortening activation if severe.
Trapezius limits side bending of the neck to the opposite side due to stretch of taut
fibers.
Longissimus capitis limits side bending and may refer below and behind the ear.
© Copyright 2013, Chuck Duff