The Anatomy of the Neck. Part One: The Cervical Vertebrae

In the reading I do about physical therapy, it is assumed that I will know anatomy quite well . When I put my hands on a body, it is not just what is immediately beneath my hands, but also the connections via nerves, muscles and skeleton that I touch.

Most of our clients have some idea of the difference between head, torso, and feet, but after that, they are lost. So if you as a therapist can give them information about the body which is relevant to their condition, you will feel more confident about addressing their problems and help them to trust your knowledge and judgement.

My next statement will no doubt bring howls of anger from some of you, but my overall experience across Europe has been that too many physical therapists have only a marginally better knowledge of the body than their clients!

You do not have to be a specialised anatomist, but no matter what treatment protocol you use, you must know what is under your hands and how it connects to the rest of the body.

A good example of this is the area of the neck. For therapists, necks are often an area of extreme caution and trepidation. This can create tension when working on them and this can transfer to the client. Another good reason to be familiar with the anatomy that is under your hands.

In this, the first in a series of posts focussing on the neck, I hope to familiarise you with this part of the body. Neck problems are some of the most common problems that new clients will present with and you want to feel as confident as possible in dealing with this delicate and problematic area.

This first post focusses on the cervical vertebrae. Unique in structure and articulation in the spine, these are  fascinating bones, beautifully designed to give strength and flexibility.

If you cut off the feet at the ankle and the head at C1 and place them on a set of scales they will weigh approximately the same. This is the weight that the neck is responsible for supporting. The structure of the neck is strong and extremely flexible. This has advantages, it also means it can be easily damaged and slow to repair. Pain here affects the whole posture and creates wide ranging emotional states.

So how does it work?

There are seven cervical vertebra, they are very different from the other vertebra in the axial skeleton.

What do cervical vertebra, have that others do not?

• Their superior services project upwards at the sides.
• Their inferior side surfaces are slightly chamfered
• They have a hole medial to the transverse process, called a foramen transversarium through which pass the vertebral blood vessels and nerves.
• The inter-vertebral discs do not completely cover the disc body, but have a synovial joint at the lateral vertebral edge. This allows a greater range of movement and is called an uncolateral joint.

Like every other vertebrae, they each have a slightly different job to do, hence their structure is relative to their function.

Holding the whole spine together, attached to the front and rear of the vertebral bodies are strong ligaments which, depending on where you start from, run front and rear of the sacral area and finish in the head, where they basically join at the Foramen Magnum. See any deep meridian coincidences here?

Specialist Cervical Vertebrae:-

Atlas C1:  This is basically a ring of bone with the transverse processes modified and shrunk. The occiput of the skull has two projections at its posterior base, which sit in indentations in C1 allowing a nodding movement.

Axis C2:  Similarly, a ring of bone, which has a modification at the anterior superior surface. This is a bit like a smooth tooth projecting upwards. This “Dens” as it is called, sits inside the Atlas and articulates at its front edge allowing rotational movement.

The top of the Dens has strong ligaments which hold it stable. These ligaments spread out to the mastoid processes and to the Foramen Magnum. The Foramen Magnum is the hole in the base of the skull through which passes the spinal-cord.

C3, C4, C5: The movements of rotation, flexion, extension and sideways rotation within these bones are complicated and as far as physical therapy is concerned they can be seen as one unit.

Upper body and shoulder pain, are very often associated with disharmony is in this area.

C6 when extending the head this bone has the greatest range of movement.

With the client in prone, forehead on the back of the hands, find C7 and gently palpate the area above the spinous process of vertebra. Ask the client to slowly raise their head from their hands and you will feel soft area above C7 increase as C6 slides forward.

C7: this bone articulates with T1 which is fixed by T2 and the first rib. C7, T1 and the first rib are major anchor points for neck muscles and distortions here are often created by postural incorrectness from work or lifestyle positions.

So that’s a brief run-down on the bones, there is so much more that you could learn but that is up to you.

To recap, no matter what system of body realignment or contact or energetic work that you do, the more you know about the anatomy, the better your client will respond to treatment.

Next up are ligaments, nerves and blood vessels in the neck. Let me know if you found this useful.