Limited mobility in cervical rotation is a common issue in patients with neck pain, and its origin is not always related to bone or joint structures.
Imagine a patient comes to your clinic with neck pain and difficulty turning their head. Upon evaluating their mobility, you notice restricted cervical rotation but no obvious signs of joint restriction. If the problem isn’t structural, what’s causing it?
In many cases, this lack of mobility stems from altered motor control patterns in the cervical muscles. Some muscles may be overactive, while others are inhibited or not functioning efficiently. This not only reduces range of motion but also creates overload and perpetuates pain.
For physiotherapists and other healthcare professionals, identifying these muscle activation patterns is key to designing effective treatments.
By the way, if you want to learn more about how EMG can help you assess and treat cervical mobility more effectively, click here.
Below, you’ll learn two formulas for evaluating cervical rotation restriction and detecting whether the issue lies in the motor control of the involved muscles.
Expected Synergy in Cervical Rotation
Proper cervical mobility depends on coordinated muscle activation. When this synergy is disrupted, it results in restricted range of motion, often accompanied by pain or discomfort.
In right cervical rotation, the correct synergistic pattern should be:
This pattern means that when turning the head to the right, the left SCM should activate more than the left scalene, and the right splenius should have greater activity than the right SCM.
When this coordination fails, muscular compensations can occur, not only reducing mobility but also increasing the risk of chronic pain or associated injuries.
For example, if the right SCM is excessively active during right rotation, it may indicate a deficit in the left scalene. These imbalances alter normal neck mechanics, restricting movement and contributing to cervical disorders.
To effectively address this problem, it is crucial to identify the altered muscle pattern and correct it using specific exercises or manual therapy techniques.
Here are two formulas for evaluating and understanding the cause of limited cervical mobility, helping you restore normal neck function in your patients.
Formula 1: Agonist Inhibition
One of the most common reasons for restricted cervical rotation is agonist muscle inhibition. If the main muscle responsible for the movement does not activate sufficiently, it cannot generate the necessary force to initiate and sustain rotation, limiting the range of motion.
Example: Right Cervical Rotation
In this case, the left SCM is the primary agonist of the movement. If its activation is insufficient compared to the right SCM, the result will be reduced mobility to the right.
🔹 Left SCM << Right SCM ❌ → Inhibition of the left SCM.
🔹 Consequence: Reduced mobility in right cervical rotation.
This deficit may be compensated for by other muscles, creating unnecessary tension and biomechanical alterations in the neck. However, by working to properly activate the left SCM, right cervical rotation can significantly improve.
🔎 Solution: Apply specific exercises to increase left SCM activation and restore muscular balance in the cervical region.
Formula 2: Excessive Coactivation of the Antagonist
Another common cause of restricted cervical rotation is excessive antagonist activation. In this case, the muscle that should relax to allow movement is overly active, creating unnecessary resistance.
Example: Right Cervical Rotation
During this movement, the right SCM acts as an antagonist, meaning its activation should be minimal to allow smooth rotation. However, if this muscle becomes excessively active, it acts as a brake, preventing normal neck rotation.
🔹 Right SCM overactive ❌ → Opposition to movement.
🔹 Consequence: Reduced mobility in right cervical rotation.
In this scenario, the right SCM actively resists the movement instead of allowing the left SCM to do its job. This dysfunction can create unnecessary tension and overload in the cervical muscles, increasing the risk of pain and discomfort.🔎 Solution: Retrain the muscle pattern to reduce antagonist coactivation and restore balanced muscle activation. This will increase range of motion in cervical rotation and reduce neck stiffness.
Conclusion
Both inhibited agonist muscles and overactive antagonist muscles can significantly restrict cervical rotation.
These muscle imbalances not only limit movement but can also lead to compensations, overload, and persistent discomfort.
If these dysfunctions are not corrected in time, the problem can worsen, leading to chronic pain, postural alterations, and an increased risk of injury. Therefore, it is crucial to identify the exact cause of the restriction through precise evaluation and neuromuscular re-education strategies.
With mDurance surface electromyography (EMG), you can accurately analyze muscle activation in real-time and objectively detect these dysfunctional patterns.
