Neck Rotation Strengthening - Why?

Neck Rotation Strengthening - Why?

Want to build a stronger neck? Then build stronger neck rotation muscles. There are multiple neck motions besides rotation including flexion, extension, and lateral flexion. If rotation is just one of the neck motions, why do I push strengthening the neck rotators? 


Let’s take a look at the muscles responsible for rotating the neck. In another article where I discuss the Rotator Eccentric exercise on the NecksLevel device, I reported that roughly 60% of the neck’s musculature is responsible for rotation of the head. 60% seems like a disproportionately high percentage when you consider we also need muscles for flexing, extending, and laterally flexing the neck. Now, any orthopedic clinician worth their salt knows that the neck muscles rarely have a single action. So, for example, the sternocleidomastoid, although it is a strong neck rotator, it also functions to flex and laterally flex the neck. My point is, any given neck muscle usually has at least two actions, and quite often one of those actions is rotation of the neck. 


So, if we want to strengthen the neck, we cannot forget about the neck rotators. Historically, clinicians had no reasonable way to strengthen the neck rotators. Why? The correct equipment just didn’t exist. Resistance bands and cable column systems fixated to the head work for strengthening in straight planes via isometric holds, but isometric holds can only take you so far. Physical therapists needed a tool that could target any neck muscle and strengthen through a range of motion. The NecksLevel device was specifically designed with the neck rotators in mind. Now clinicians can easily target and strengthen the neck rotators.

Here are the NecksLevel exercises that highlight the neck rotator strengthening capabilities of the NecksLevel device:

But what neck rotator muscles are we talking about? I’ll take you through all of the neck rotators one by one, and provide some clinical context.

Neck Rotation Muscles

Actions: Contralateral Rotation, Ipsilateral Lateral Flexion, Flexion

Notes: The sternocleidomastoid is often treated as "bad guy" in cervical rehabilitation due to its relationship with the deep neck flexors. After whiplash, and even in non-traumatic neck pain, the Sternocleidomastoid (SCM) will often be overactive relative to the deep neck flexors. Early on in rehabilitation, clinicians will often try to down-regulate the SCM, while training the deep neck flexors. 

Actions: Ipsilateral Rotation, Ipsilateral Lateral Flexion, Extension
Notes: The Splenius Capitis and Cervicis are among the largest and most superficial posterior neck muscle groups. They can be seen just deep to the Upper Trapezius. Their size, in combination with their fiber orientation makes the Splenius muscle group key neck rotation muscles. 
Actions: Contralateral Rotation, Ipsilateral Lateral Flexion, Extension
Notes: The Multifidus runs from the sacrum all the way up to the cervical spine, and due to its direct attachment on each vertebrae, it is thought to help stabilize adjacent vertebrae. The Multifidus is considered an important muscle in low back rehabilitation, but does not get the same level of attention at the cervical spine. 
Actions: Contralateral Rotation, Ipsilateral Lateral Flexion, Extension
Notes: Unlike its relative, the Semispinalis Capitis, the Semispinalis Cervicis rotates the neck due to its oblique fiber orientation running lateral to medial. Notice the actions of the Semispinalis Cervicis are identical to the Multifidus, and the Iliocostalis. 
Actions: Contralateral Rotation, Ipsilateral Lateral Flexion, Extension
Notes: The Iliocostalis is a large muscle group that has lumbar, thoracic, and cervical portions. At the cervical region, the muscle originates laterally on the rib cage and inserts on to C4-C6, thus will not have any bearing on upper cervical spine motion. 
Actions: Scapular Elevation, Scapular Downward Rotation, Neck Ipsilateral Rotation, Ipsilateral Lateral Flexion
Notes: The Levator Scapulae is another "bad guy" in cervical rehabilitation. Its often reported to be a pain generator, and a muscle that limits neck range of motion. Stretches for the Levator Scapulae are frequently selected by depressing the scapula, flexing the neck, and contralaterally laterally flexing and rotating the neck. 
Actions: Scapular Upward Rotation, Elevation, Neck Contralateral Rotation, Ipsilateral Lateral Flexion
Notes: The Upper Trapezius is nearly synonymous with neck pain. Palpation to the region is often painful, and the muscle can limit neck mobility. Similar to the SCM, this muscle can become overactive and a pain source after neck trauma. Clinicians treat this muscle with soft tissue mobilization, and it is rarely a target for strengthening. 
Actions: Cervical Flexion, Ipislateral Rotation, Ipsilateral Lateral Flexion
Notes: The Longus Colli, and Longus Capitis are two of the three deep neck flexors (DNFs). The DNFs are regarded as a key muscle group in neck rehabilitation. Although collectively the DNFs are small in size and relatively low in strength, activating the DNFs with neck flexion exercises, such as chin tucks, is a staple of most neck rehabilitation programs. This muscle group can be directly targeted on the NecksLevel device via loaded Chin Tucksand incorporated into all NecksLevel strengthening exercises by maintaining a chin tuck.
Actions: Ipsilateral Rotation
Notes: One of the four paired Suboccipital muscles, The Obliquus Capitis Inferior is unique in that it is the only muscle on this list that has a single action, and that action is rotation. It is a pure rotator of the Atlanto-Axial (AA) joint, which provides the neck with half of all its rotation range of motion. The Obliquus Capitis Inferior and the AA joint are both clinically relevant, for if the neck cannot turn >45 degrees to one side, the AA joint is normally at fault. 
Actions: Ipsilateral Rotation, Extension
Notes: Another muscle in the Suboccipital muscle group, the Rectus Capitis Posterior Major runs from C2 vertebrae to the occiput. This muscle and the suboccipitals as a whole, can be pain generators, and even cause headaches, known as cervicogenic headaches. On the NecksLevel device, treatment is simple. Just have the user rotate their head left and right, with no resistance. This motion reciprocally contracts, and relaxes the suboccipitals and can significantly reduce tension, while improving rotation range of motion. Here's the video
What's remarkable is that there are only a few neck muscle groups that aren't on this list, and that's because they don't rotate the spine. Here are the remaining muscles that do not rotate the neck:
  • Rectus Capitis Posterior Minor
  • Semispinalis Capitis
  • Scalenes (Anterior, Middle, Posterior) and some anatomists even argue this muscle group to be involved in neck rotation!
  • Longissimus and Spinalis - Cervical region

So, for those of us counting, 12 out of 19 cervical muscles are involved in neck rotation. Thats 63%! I hope I've made my point. If we want to strengthen the neck, we can't forget about the neck rotators. With the NecksLevel device, strengthening the neck rotators is easy, and patients enjoy the exercises. As was mentioned before, the videos Neck Rotator Strengthening, and Neck Rotator Eccentric Strengthening are the perfect place to start strengthening the neck.


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